Ineffective Thermoregulation related to Asphyxia Neonatorum

Nursing Care Plan for Asphyxia Neonatorum

Neonatal asphyxia is a condition in newborns who fail to breathe spontaneously and regularly soon after birth.

Signs and Symptoms

1. Hypoxia.
2. Respiration rate of more than 60 x / min or less than 30 x / min.
3. Gasping breath until respiratory arrest may occur.
4. Bradycardia.
5. The reduced muscle tone.
6. Cyanotic skin color / pale.

Diagnostic examination

1. Blood Gas Analysis.
2. Blood electrolytes.
3. Blood sugar.
4. Baby grams (chest X-ray).
5. Ultrasound (head).

Nursing Diagnosis : 

Ineffective thermoregulation related to temperature regulation system is not inadequate.

Nursing Outcomes :

Thermoregulation: neonate

Indicators:
Normal body temperature

Assessment scale:
1. Extremely compromised.
2. Substantially compromised.
3. Moderately compromised.
4. Mildly compromised.
5. Not compromised.

Nursing Interventions

Temperature regulation

• Place the baby in a warm temperature environments.
• Monitor axillary temperature in infants unstable.
• Monitor signs of hypothermia: fatigue, weakness, discoloration, skin.
• Avoid situations that may cause the baby to lose heat, such as exposure to cold air, window or shower.

Rationale :

• Maintaining the temperature of the baby's body.
• Monitor the baby's body temperature.
• Avoiding heat loss through conduction.

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