ASSESSMENT O > pinkish oral mucosa With OGT Prolonged NPO(3days) On EBM of 2cc every 4 hours Normoactive bowel

owel sounds (+) swallowing reflex Poor suck noted Actual weight is 1.27kg Premature baby With chest indrawing With intercostal retractions With O2 at 0.5-1 LPM via nasal cannula With D5IMB + Calcium, Amino Acid via infusion pump. A Imbalanced Nutrition: Less than body requirements

EXPLANATION OF GOALS AND THE PROBLEM OBJECTIVES Nutrition Goal: problems can The patient will arise with a be able to preterm infant obtain because the adequate infants body is nutrition. attempting to continue to LTO: maintain the After 72 hours rapid growth of of nursing intrauterine interventions, growth. the patient will Digestion and be able to gain absorption of weight of 20-30 nutrients in a grams per day preterm infants after stomach and stabilization. intestine may be immature. STO: Nutrition After 8 hours of problems are nursing further interventions, compounded by the patient will a preterm not manifest infants high metabolic immature rate such as reflexes, which increased make swallowing temperature, and sucking increased RR, difficult, with PR. this OGT was placed, and then

NURSING INTERVENTIONS Monitor Intake and Output

RATIONALE Strict intake and output provides information about fluid volume deficit and fluid volume excess. Daily weights indicate growth. Increased metabolism requires increase calories and decrease those available for growth.

EVALUATION LTO: Objective unmet, because patient did not gain weight of 20-30 grams per day. STO: Objective met, because patient did not manifest signs and symptoms of high metabolic rate.

Weigh infant daily without diapers Decrease metabolic needs of infant: maintain neutral thermal environment, support oxygenation, decrease stimulation. Assess infants suck, swallow, and gag reflex.

Auscultate bowel sounds.

The infant needs a coordinated suck and swallow reflex, and an effective gag reflex in order to begin oral feeding. Bowel sounds

related to additional nutrients needed for maintenance of rapid growth, possible sucking difficulty and small stomach

the patients abdomen becomes bloated then they stop the feeding and the patient was on NPO for 3 days. Increased activity that occurs from ineffective sucking may increase the metabolic rate and oxygen requirements even more. In addition the preterm infants stomach capacity is small, possibly limiting adequate intake. Reference: Maternal and child health nursing, 6th edition by Adele Pillitteri.

Monitor for respiratory distress and fatigue with feeding. Hooked to D5IMB via infusion pump.

Administer OG feedings.

Educated mother on expression of breastmilk.

indicate peristalsis. Monitoring provides information about infants tolerance of feeding. To provide parenteral nutrition that is needed for preterm infants and those who cant tolerate oral feeding. Orogastric feeding provides adequate calories. To provide nutrition to the baby and to ensure milk supply for when the infant is able to breastfeed.