Admission and Care of the Neonate to the Special Care Nursery/ Neonatal Intensive Care Unit
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. Infant of Diabetic Mother.Sepsis. Severe Asphyxia.< 37 weeks gestation Medical problem. Jaundice Surgical problem. Congenital Diaphragmatic Hernia Post respiratory Arrest Cardio respiratory monitoring
.Abdominal wall defect.
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
.A brief history is given by doctor/mother -The resusitaire/ incubator is heated.
A physical assessment is done
.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 .
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. CXR. Full-LP. Partial.Bld. studies. CXR.Studies. 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
. Urine. Bld.
The Needs of the Neonate
Oxygenation Circulation Thermoregulation Nutrition/fluids Elimination Sensory/Comfort Hygiene/skin care Mobility Emotional/communication Educational
colour -Administer sedatives as ordered (NICU) -Apply non-invasive monitor.Management of the Neonate in SCN/ICU
Oxygenation Ensure ETT is properly secured -Assess rate. respiratory status. movements. 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
-Monitor ABG results -Ensure ETT is properly secured
pulses. haematological status. signs of constriction/oedema
-Skin perfusion. apex beat. blood pressure.
4hrly -Apply heat conserving/losing measures eg. incubator Decrease heat loss with positioning ie. Do temp. radiant warmer. swaddling -Pre-warm linen. if temp. scales.5-37 C in term infants).97. flexion -Use warm water on skin -Delay or defer bathing (admission).5 C in preterm infants). Prone. skin (36-36.Thermoregulation
-Monitor peripheral/central/environmental temperature -Maintain stability of temperature-axillary (36. is .2F do not bathe
for infants with hypoglycaemic episodes do more often
. feeding plan. tolerance of enteric feeds. information on lactation and expression.Nutrition/fluids
-Monitor fluid balance biochemical status. feeding performance. hypothermia) and external (ie noise stressors) -Do glucose checks Q4hrly. feeding readiness. -Administer fluids and or calories orally or intravenously as ordered Decrease energy expenditure by decreasing internal (hypoxia.
. bilirubin status. consistency. stool chart. urine tests -Observe and document frequency of stools.
respond quickly to alarms. direct light. graspings. Dim light as soon as possible cover incubator with blanket or cover -Auditory.Sensory/comfort
-Assess tolerance of handling -Ensure rest periods between procedure/handling -Handle gently and minimally. support and maintain in flexion -Visual ± shield from bright.talk quietly.minimize painful stimuli. pacifiers
. relieve pain with pharmacologic management Provide comfort measures eg. advise parents to talk softly keep ill neonates away from crying babies -Pain.
IV sites. Do eye/mouth care. note reaction to handling
. wound care. postural changes. groin care. skin protection -Use barrier creams as indicated Mobility -Do position changes.Hygiene/skin care
-Assess skin integrity -Observe pressure areas. dressings.
-Ascertain religious beliefs and practices. with whom the baby will go home.Emotional/Communication
-The goals of care should be family-centred. parent support groups. but it is the family of whatever construct. social support and responsibilities. -Inform parent(s) of visiting/residential arrangements. ethnic or cultural beliefs and practices. access arrangements. Provide for communication between parent/s and primary care team communication
. It is the patient we treat.
access to self-help groups and specialist centres. follow-up arrangements.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.
Ali.P. Gardner L. Routledge Merestein B. S (1998) Handbook of Neonatal Intensive Care St. Z. G.Missouri: Mosby
. Louis. (2001) Neonatal Intensive Care Nursing London.. (1998) Medical Care of the Newborn Trinidad and Tobago: C. G.