Nicu Rotation Paper

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The primary diagnosis of my patient is prematurity, she was born at 36 weeks and is considered a late preterm infant. Late preterm infants are at an increased risk for early death and long- term health problems when compared with infants who are born full term (Alden, 2012, p. 780). Late preterm are also at greater risk for complications such as respiratory distress and are more likely to be hospitalized longer and require intensive care. In addition, preterm infants are at risk because their organ systems are immature and they lack adequate reserves for bodily nutrients (Alden, 2012, p. 896).

One of the signs and symptoms of a late premature baby includes respiratory distress or apnea due to immaturity of the lungs. The early signs of respiratory distress are flaring of the nares, infants color change from pink to circumoral cyanosis, shallow breathing and expiratory grunt. The cardiovascular system is also affected some of the signs and symptoms are slow capillary refill, hypotension and continued respiratory distress despite supplying of oxygen. Also, late premature infants are at risk for temperature instability some of the signs and symptoms of temperature instability are apnea, tachycardia, weak or absent cry, warm to touch, flushed/red skin, poor feeding, sweating, hypoglycemia and shivering (Alden, 2012, p. 896).

My patients was exhibiting some respiratory distress symptoms, such as flaring of the nares and tachypnea. She was also exhibiting a sign of hypoglycemia, which is a sign of hypothermia. This was more likely due to the minimal or no fat stores of a preterm infant, which then results in the infant burning more calories and glucose in order to conserve heat, as a result the infant becomes hypoglycemic due to the low level of glucose in the bloodstream. My patient was also showing signs of physiological jaundice, it is common among preterm babies due to an immature liver and inability to conjugate bilirubin. In preterm infants, jaundice is first evident after the 48 hours and disappears by the ninth or tenth day. Physiological jaundice usually resolves without treatment (Alden, 2012, p. 538).

One of the most important assessments that should be performed on a premature infant is a physical shift assessment. This assessment includes assessment of the skin, abdomen, consciousness and pulse rhythm. A feeding assessment should also be performed this assessment includes observing suck, swallow and gag reflexes, the infant's ability to take and digest nutrients, intake and output and weight changes. Interventions for my patient include taking axillary temperature every 4 hours to monitor temperature, maintaining infant in an isolette, administering NGT feedings, advance volume and concentration of formula, documenting daily weight, periodically assess readiness to oral feed and allow mother to provide breast milk for feedings (Alden, 2012,p. 900).

The orders by the doctor in the chart were a bilirubin level daily due to the risk of developing jaundice, which is most likely due to an immature liver and the inability to conjugate and excrete bilirubin (Alden, 2012, p. 923). A CBC was also in the doctor's orders, it is an order to detect an infection, bleeding or anemia it's usually a standard protocol for premature infants. An order for a hypoglycemia protocol, if blood sugar is unstable start DOW @ 80cc/kg/day, this order is more likely due to the my client being a premature and inability to maintain body temperature (heat loss), decreased glycogen stores and having less body fat (Alden, 2012, p. 922) . There was also and order for breastfeeding as soon as infant can tolerate oral feedings or the mother can pump her breast milk, it is essential for bonding in fact breast milk provides essential nutrients to the infant.

My client only weighed 2.0 kg at birth which is considered low birth weight. Heather Owens, OB ( personal communication, October 3, 2012) stated that a preterm infant...
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