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Admission and Care of the Neonate to the

Admission and Care of the Neonate to the

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Published by: Diana Parsons Mcintyre on Jan 20, 2011
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Admission and Care of the Neonate to the Special Care Nursery/ Neonatal Intensive Care Unit

OBJECTIVES ‡ ‡ ‡ ‡ Identify reasons for admission to the SCN/NICU Explain the process of admission Identify the needs of the Neonate Discuss the management of the neonate admitted to the SCN/NICU .

Reasons for Admission ‡ Prematurity.Sepsis. Severe Asphyxia.< 37 weeks gestation ‡ Medical problem. Infant of Diabetic Mother. Congenital Diaphragmatic Hernia ‡ Post respiratory Arrest ‡ Cardio respiratory monitoring . Jaundice ‡ Surgical problem.Abdominal wall defect.

A brief history is given by doctor/mother ‡ -The resusitaire/ incubator is heated.Admission Process ‡ . or a cot is prepared ‡ -Suction apparatus is checked and put in place ‡ -Oxygen apparatus is checked and a headbox /Cpap apparatus/ventilator put in place ‡ -A scale for baseline weight .

Admission Process Cont¶d ‡ -An assessment is done to determine the need for suctioning and supplemental oxygen( if not intubated) ‡ -The infant is weighed ‡ -Vital signs are done ‡ -A baseline glucose check is done ‡ .A physical assessment is done .

studies. Bld. CXR.Bld. Urine. Partial.Admission Process Cont¶d ‡ -The doctor is assisted with the IV preparation/umbilical catheterization/ if required ‡ -Assistance with a full/partial Sepsis screen is given if required. LP ‡ The infant is placed in a cot/incubator/resuscitaire and attached to the ventilator ‡ -The doctors orders are noted and implemented ‡ -Delay or defer bathing ‡ -Documentation is done .Studies. Full-LP. CXR.

The Needs of the Neonate ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Oxygenation Circulation Thermoregulation Nutrition/fluids Elimination Sensory/Comfort Hygiene/skin care Mobility Emotional/communication Educational .

Management of the Neonate in SCN/ICU ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Oxygenation Ensure ETT is properly secured -Assess rate. colour -Administer sedatives as ordered (NICU) -Apply non-invasive monitor. titrate FiO2 to maintain Sats 92-94% (NICU) -Handle gently minimally -Position prone to maximize oxygenation -Delay or defer bathing (admission) -Suction when necessary -Ascultate lung field -Take specimen for trapped sputum . respiratory status. movements.

‡ -Monitor ABG results ‡ -Ensure ETT is properly secured .

apex beat. ‡ haematological status.Circulation ‡ -Skin perfusion. blood pressure. signs of constriction/oedema . pulses.

5 C in preterm infants). radiant warmer. swaddling ‡ -Pre-warm linen.Thermoregulation ‡ -Monitor peripheral/central/environmental temperature ‡ -Maintain stability of temperature-axillary (36. Do temp. if temp. flexion ‡ -Use warm water on skin ‡ -Delay or defer bathing (admission).2F do not bathe .5-37 C in term infants). Prone. skin (36-36. incubator ‡ Decrease heat loss with positioning ie.97. is . 4hrly ‡ -Apply heat conserving/losing measures eg. scales.

hypothermia) and external (ie noise stressors) ‡ -Do glucose checks Q4hrly. tolerance of enteric feeds. information on lactation and expression. ‡ -Administer fluids and or calories orally or intravenously as ordered ‡ Decrease energy expenditure by decreasing internal (hypoxia. feeding performance. feeding readiness. for infants with hypoglycaemic episodes do more often . feeding plan.Nutrition/fluids ‡ -Monitor fluid balance biochemical status.

consistency. urine tests ‡ -Observe and document frequency of stools. stool chart. . bilirubin status.Elimination ‡ -Output assessment.

talk quietly. advise parents to talk softly ‡ keep ill neonates away from crying babies ‡ -Pain. relieve pain with pharmacologic management ‡ Provide comfort measures eg. pacifiers . support and maintain in flexion ‡ -Visual ± shield from bright. Dim light as soon as possible ‡ cover incubator with blanket or cover ‡ -Auditory. respond quickly to alarms. direct light.Sensory/comfort ‡ -Assess tolerance of handling ‡ -Ensure rest periods between procedure/handling ‡ -Handle gently and minimally.minimize painful stimuli. graspings.

skin protection ‡ -Use barrier creams as indicated Mobility ‡ -Do position changes.Hygiene/skin care ‡ -Assess skin integrity ‡ -Observe pressure areas. postural changes. wound care. note reaction to handling . IV sites. ‡ groin care. dressings. Do eye/mouth care.

‡ -Ascertain religious beliefs and practices. with whom the baby will go home. parent support groups. ethnic or cultural beliefs and practices. but it is the family of whatever construct.Emotional/Communication ‡ -The goals of care should be family-centred. social support and responsibilities. ‡ -Inform parent(s) of visiting/residential arrangements. access arrangements. It is the patient we treat. ‡ Provide for communication between parent/s and primary care team communication .

. follow-up arrangements. access to self-help groups and specialist centres.Educational ‡ -Assess parent/s knowledge re-disease process/illness ‡ -Identify areas in which information is needed ‡ -Initiate a teaching programme/or refer ‡ -Provide supporting material ‡ -Arrange interview schedule ‡ -Give information re-discharge.

Reference ‡ Ali. Z.Missouri: Mosby L/M 2005 . S (1998) Handbook of Neonatal Intensive Care St. Gardner L. G.P. Routledge ‡ Merestein B. Louis.. (1998) Medical Care of the Newborn Trinidad and Tobago: C.P. G. (2001) Neonatal Intensive Care Nursing London.P ‡ Boxwell.

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