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Nursing Care Plan for Premature Babies


Newborn infants with gestational age 37 weeks or less at birth is called premature babies. Although small, premature infants in size according to pregnancy, but the development of intra-uterine rudimentary, can cause complications during the post-natal. Newborns whose weight was 2500 grams, or less with a gestational age of more than 37 weeks is called small for gestational age, is different from the premature, although 75 % of neonates whose weight was below 2500 grams born prematurely.

Clinical problems occur more often in premature infants than in full-term infants. Prematurity caused immaturity system development and function, restricting the infant's ability to cope with the problem of disease.

A common problem among others ; respiratory distress syndrome (RDS), necrotizing enterocolitis, hyperbilirubinemia, hypoglycemia, thermoregulation, patent ductus arteriosus (PDA), pulmonary edema, intraventricular hemorrhage. Another additional stressor in infant and parents include hospitalization for illness in infants. Parental responses and coping mechanisms they can cause interference in the relationship between them. Necessary planning and adequate measures for these problems.


Etiology and Precipitating Factors :

Problems in the mother during pregnancy :
  • Diseases / disorders such as hypertension, toxemia, placenta previa, placental abruption, cervical incompetence, multiple fetuses, malnutrition and diabetes mellitus.
  • Low socioeconomic level and inadequate prenatal care.
  • Preterm labor, or induced abortion.
  • Abuse consumption in the mother, such as ; drugs, alcohol, smoking and caffeine.


Assessment
1. History of pregnancy.
2. Status of the newborn.
3. Physical examination head to toe, including : cardiovascular, gastrointestinal, integument, musculoskeletal, neurologic, pulmonary, renal, reproduction.
4. Supporting data
  • X-ray of the chest and other organs to determine the presence of abnormalities.
  • Ultrasonography to detect abnormalities of organs.
  • Stick glucose to determine glucose levels decrease.
  • Serum calcium levels, decreased levels means there is hypocalcemia.
  • Bilirubin levels, to identify improvement (due to premature are more sensitive to hyperbilirubinemia)
  • Electrolyte levels, blood gas analysis, blood type, blood culture, urinalysis, fecal analysis, and so forth.


Nursing Diagnosis

1. Risk for respiratory distress related to immaturity of the lungs, with decreased production surfactan that cause hypoxemia and acidosis.

2. Risk for hypothermia or hyperthermia related to prematurity or changes in ambient temperature.

3. Imbalanced nutrition less than body requirements related to inadequate glycogen reserves, iron, and calcium and loss of glycogen stores due to the high rate of metabolism, inadequate intake of calories, and lose calories.

4. Fluid and Electrolyte imbalances related to immaturity, radiation environment, the effect fototherapy or loss through the skin or lungs.

5. Risk for infection related to immunologic immaturity of the baby and the possibility of infection from mothers or medic / nurse.

6. Risk for impaired skin integrity related to immaturity and fragile skin.

7. Impaired sensory perception : visual, auditory, kinesthetic, gustatory, tactile and olfactory related to less stimulation or excessive in the intensive care environment.

8. Knowledge Deficit (family) about treatment of the sick infant at home.

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