Documente Academic
Documente Profesional
Documente Cultură
Nursing Assessment
and Management,
2nd Edition
Lyn E. Vargo, PhD, NNP, RNC
Carol Wiltgen Trotter, PhD,
NNP, RNC
Slides prepared by Margaret Comerford Freda, EdD, RN, CHES, FAAN
March of
Dimes
Objective
Healthy
People
Objective
infant
Nurses need to understand general
principles of delivery-room management,
resuscitation and thermoregulation for
premature infants.
Certification
by the Management
Neonatal Resuscitation
Delivery-Room
Program (NRP) of the American Heart
Association (AHA) and the American Academy
of Pediatrics (AAP) is essential for all nurses
who work with premature infants.
Delivery-Room
Risks
Tendency to haveManagement
difficulty with transition
Delivery-Room Management
Precautions
not required.
Preterm infants may require endotracheal
intubation and surfactant administration
soon after birth.
Delivery-Room Management
Precautions (Continued)
Administer medication slowly as
RDS
Incidence 10% for all premature infants
Incidence 50% for 26 week to 28 weeks
Risk factors:
Low gestational age
Male
Born to diabetic mothers
Born after an asphyxial insult before birth
Born after maternal-fetal hemorrhage
Multiple gestation
2006, March of Dimes
RDS
(Continued)
NIH Recommendations
for
Use
of pregnant
Antenatal
Steroids
Give
to all
women
24 to 34
weeks gestation who are at risk for
preterm delivery within 7 days:
2 doses of 12 mg of betamethasone IM 24
hours apart OR
4 doses of 6 mg of dexamethasone IM 12 hours
apart
(Continued)
Thermoregulation
RDS
Treatment
RDS Treatment
(Continued)
barotrauma or volutrauma.
Treat underlying cardiovascular infectious
environment.
2006, March of Dimes
Surfactant Therapy
Surfactant coats the inside of the alveoli.
Surfactant Therapy
(Continued)
outcomes.
(Continued)
HFV
Allows the use of small tidal volumes (smaller than
anatomic dead space) and high frequencies.
Rates of 150 to 3,000 breaths per minute can be
used depending on the type of HFV.
HFV limits large tidal volumes and wide ventilator
pressure swings associated with volutrauma/
barotrauma caused by traditional mechanical
ventilation.
Oscillation
2006, March of Dimes
(Continued)
(Continued)
balance.
Monitor blood glucose levels.
Reduce environmental stressors.
Provide parental support.
2006, March of Dimes
BPD
A significant problem for premature
infants
Uncommon after 32 weeks gestation
A secondary disease that develops in
neonates treated with positive pressure
ventilation and oxygen for primary lung
problems such as RDS
7,500 new cases every year in the United
States
10% die by 1 year of age
requirement
Hypercapnia, tachypnea with increased work
of breathing
Episodic bronchospasm with wheezing
In severe cases, CHF with cor pulmonale
Abnormal postures of neck and upper trunk
BPD Treatment
Therapy is preventive and supportive.
Preventive measures begin prenatally with
AAP/CPS Summary/Recommendations on
Postnatal Steroids
Systemic administration of dexamethasone
AAP/CPS Summary/Recommendations on
Postnatal Steroids (Continued)
Use of inhaled corticosteroids to prevent CLD
AAP/CPS Summary/Recommendations on
Postnatal Steroids (Continued)
Outside the context of a randomized
controlled trial, the use of postnatal
corticosteroids should be limited to
exceptional clinical circumstances (an infant
on maximal ventilatory support). Parents
should be fully informed about the shortand long-term risks and agree to treatment.
slowly.
Recognize that stressful situations can
minimize hypoxemia-inducing events.
Use sucrose with nonnutritive sucking
before painful procedures to decrease
pain.
2006, March of Dimes
(Continued)
Kangaroo Care
Improvement in gas exchange and
Apnea of Prematurity
50% of NICU infants
Periods of cessation of respiration for
Apnea Treatment
Cardiac and respiratory monitoring until no
Apnea Treatment
(Continued)
PDA
The most common cardiac complication
in premature infants
Incidence inversely related to
gestational age
Occurs in 45% of infants with a
birthweight <1,750 g
Occurs in 80% of infants with a
birthweight <1,200 g
2006, March of Dimes
PDA
2006, March of Dimes
PDA Treatment
Treatment is controversial.
Medical management with fluid restriction
indomethacin.
Assess infant after indomethacin for ductal
ROP
A significant cause of blindness in children
develop ROP.
ROP (Continued)
47% of infants weighing 1,000 g to 1,500 g
ROP Treatment
ROP progresses at different rates in
different infants.
The goal of treatment for ROP is
prevention of blindness.
Surgical therapiesLaser photocoagulation
and cryotherapy
Late Onset
7 days to 3
months
Late, Late
Onset
>3 months
Intrapartum
complications
Often present
Usually absent
Varies
Transmission
Vertical; organisms
often acquired from
mothers genital tract
Vertical or via
postnatal
environment
Usually postnatal
environment
Clinical
manifestations
Fulminant course,
multisystem
involvement,
pneumonia
Insidious, focal
infection, meningitis
common
Insidious
Case-fatality
rate
5 percent to 20 percent
5 percent
Low
(skin abrasions)
Invasive procedures in the nursery (umbilical
Phagocytic cells
Humoral immunity
Meningitis
Severely debilitating illness in VLBW infants
Caused by the same pathogens that cause
sepsis
Incidence of culture-proven meningitis: 1.8%
Occurs in neonates with lower mean birthweights and gestational ages
Residual major neurologic abnormalities and
subnormal scores on MDI on the Bayley Scales
of Infant Development
2006, March of Dimes
Meningitis
(Continued)
Pneumatocele
Pneumonia
Developed:
In utero through transplacental transfer of
organisms and aspiration of pathogens from
amniotic fluid of mothers with chorioamnionitis
During/After delivery through aspiration of
infected materials
Postdelivery through inhalation of particles from
individuals or equipment; through contaminated
endotracheal tubes; through hematogenous
spread from pathogens in the bloodstream
NEC
The most common neonatal intestinal
emergency
Characterized by intestinal ischemia, most
often involving the terminal ileum
Pathogenesis is uncertain.
Three major factors: bowel wall ischemia;
bacterial invasion of the bowel wall; enteral
feedings
2006, March of Dimes
Pathogenesis of NEC
NEC Treatment
Goals:
Stabilize the neonate.
Treat the infection.
Rest the intestinal tract.
Discontinue feedings.
Initiate IV access for fluids and antibiotics.
NG tube to decompress GI tract
standards
Improved accuracy of the diagnosis of
bacteremia
Reduced line and line connection (hub)
bacterial contamination
line placement
Decreased
Number of skin punctures
Duration of IV lipid infusion
Duration of central venous line use
IVH/PVH
50% will die.
Occurs in 25% to 30% of all VLBW infants
IVH/PVH
(Continued)
ventricular dilation.
Severe (Grade IV) is an IVH with parenchymal
hemorrhage.
2006, March of Dimes
infusions.
for procedures.
Provide parental support.
continuous).
Avoid early lumbar puncture (72 hours old).
Use optimal positioning.
parents
Discussion with parents after discharge
Kangaroo care
Nurse home visitation
March of Dimes
Prematurity Campaign
Multi-year, multimillion-dollar campaign to
help families have healthier babies by:
Funding research to find causes of premature
birth
Educating women about risk reduction
Providing support to families
March of Dimes
Prematurity Campaign
(Continued)
March of Dimes
NICU Family Supportsm
Provides emotional and informational
March of Dimes
Share Your Story
Online community for families with a child
in the NICU
Users share NICU experiences, participate
in online discussions and meet other NICU
families.
More than 10,000 registered members
marchofdimes.com/share