NN 600

TOPIC 1:

NURSING CARE OF THE HIGH RISK NEW BORN

DR ROSE M LAISSER
SESSION OUTLINE
• IDENTIFICATION OF HIGH RISK NEW BORN
• CLASSIFICATION
• INTENSIVE CARE FACILITIES

• NURSING CARE OF HIGH RISK NEW BORN

IDENTIFICATION OF HIGH RISK
NEONATE

• High risk neonate is a newborn , regardless of gestational

age or birth weight.
• One has greatest chance of morbidity or mortality because
of conditions superimposed on normal course of events of
birth processes or adjustment to extra uterine life .
• Period – between 23days of gestation to 28 days after
delivery
CLASSIFICATION.. 1

• Low Birth Weight (LBW) (Less than 2500)

• Extremely Low Birth Weight (ELBW) ((less than 1g)
• Very Low Birth Weight (less than 1.5g)
• Appropriate for gestational age (AGA)- Weight falls between 10th and
90% on intrauterine growth curves
• Small for date (SGA)
• Intra Uterine Growth retardation ((IUGR)
• Large for gestational age (LGA)
CLASSIFICATION 2

• Prematurity
• Full term
• Postmaturity
CLASSIFICATION 3…
• Live Birth

• Neonatal Death (Occurs first 27 days of life)

• Perinatal Mortality ( total number of fetal and early neonatal death

per 1000 live births)

• Postnatal Death- (28 days to 1 year)

INTENSIVE CARE FACILITIES
• Neonatal Intensive care Facilities (NICUs) is a major medical facility

• Important facility to care for seriously ill infants

• Monitoring of cardiorespiratory is at NICUs

• Methods for assisted ventilations and methods for controlled heating

need adequate skills
 ORGANISATION OF SERVICES
• Neonatal ICUs provides three levels of services

• Level I facility- Normal Maternal and new born care

• Level 2- Equipped to manage majority of maternal and

neonatal complications

• Level 3- has capacity to provide care for more complex

neonatal complications
NURSING CARE OF HIGH RISK
NEWBORNS
• ASSESSMENT ( see guidelines for assessment)- Systematic assessment
to be followed) ?? Done in semester 1???
• Respiratory assessment
• Cardiovascular assessment
• Gastrointestinal assessment
• Genitourinary assessment
• Neurologic- Musculoskeletal assessment
• Temperature
• Skin assessment
NURSING CARE ..(2)
• MONITORING PHYSICAL DATA

• Neonates are placed on controlled thermal environment

• Monitored for respiratory activity, heart rate and temperature

• Alarm are commonly used – BUT important to check APICAL bits during assessments

• Urine checks –using 100% cotton balls provides accurate results for specific gravity,
pH and protein

• Blood examinations are necessary for sick neonates.

• Normal rages are for different birth weights

BLOOD PRESSURE RANGES IN
DIFFERENT WEIGHT GROUPS
Birth weight in gm Systolic Diastolic

501-750 50-62 26-36

751-1000 48-59 23-36

1001-1250 49-61 26-35

1251-1500 46-56 23-33

1501-1750 46-58 23-33

1751-2000 48-61 24-35

NURSING DIAGNOSES
• There are several problems accompanying high risk
neonates –the nurse is alert of conditions and
complications
• The following are examples of nursing diagnoses
• Ineffective breathing pattern related to pulmonary
and neuromuscular immaturity, decreased energy
and fatigue
• Ineffective thermoregulation related to immature
temperature control and decreased subcutaneous
body fat
NURSING DIAGNOSES..2
• Risk for infection related to deficient immunological
conditions
• Imbalanced nutrition less than body requirement risk)
related to inability to ingest nutrients because of
immaturity and illness
• Risk for fluid volume deficit or excess related to immature
physiologic characteristics of preterm and /or illness
• Risk for impaired skin integrity related to immature skin
structure, immobility, decreased nutritional state ,
invasive procedures
NURSING DIAGNOSES ..3
• Risk for injury from variable cerebral blood loss, systemic
hypertension or hypotension and decreased cellular nutrients
(glucose and oxygen) related to immature central nervous system and
physiologic stress response
•ß
• Pain related to procedures, diagnosis , treatment , handling

• Delayed growth and development related to preterm birth, unnatural

NICU environment, separation from parents
PLANNING
• The plan depends largely on the nursing diagnoses. The basic goals of
care include
• Neonate will inhibit adequate oxygenation
• Neonate will maintain stable body temperature
• Neonate will exhibit no evidence of nosocomial infection
• Neonate will receive adequate hydration
• Neonate will maintain skin integrity
• Neonate will maintain normal intracranial pressure and no evidence of
intraventricular hemorrhage
• Neonate will experience no pain or a reduction of pain
ACTIVITY 1

• For each of the planning goal select the appropriate nursing diagnoses
and describe its intervention /or nursing implementation

• Submit your work on Wednesday 12.30 pm

EXERCISE 1: THERMOREGULATION
• A 24 day old preterm baby with 1.5 gm is in an incubator who has a
consistent loss of 30 to 50 gm over the last 2 days following adequate
weight gain gavage feeding. The environment temperature in the
incubator is steadily increased by 5 degrees Celcious. T=36.4 to 36.5.
Tthere is heavy traffic and the incubator is near the door way.

• Q. what is the possible explanation for the neonates increased

environmental control and appropriate interventions?

• Response submission next session

Any Comment?