Preterm Newborn Nursing Care Plan & Management

Description

• A preterm newborn is one born before 37 weeks’ gestation.

Etiology

1. The etiology of preterm labor is poorly understood.
2. Possible factors include the following:
   1. Multiple gestation
   2. Maternal history of preterm delivery
   3. Hydramnios
   4. Uterine anomalies
   5. More than one second trimester abortion
   6. Incompetent cervix
   7. Infection
   8. Uterine structural anomalies
   9. Premature rupture of membranes
   10. Maternal substance abuse (especially cocaine).
   11. Maternal age less than 18 years , poor nutrition, and lack of prenatal care

Pathophysiology

• Preterm newborns exhibit anatomic and physiologic immaturity in all body systems; this immaturity hinders the adaptations to extrauterine life that the newborn must make.

Assessment Findings

1. Associated findings. Altered parenting as evidenced by:

• Decreased or absent parental visits
• Parental resistance or refusal to participate in newborn care
• Denial of severity of newborn illness
• Resistance or refusal to touch newborn
• Persistent verbalization of guilt

2. Clinical manifestations. There is a higher risk for the following manifestations with a younger gestational         age.

• Respiratory manifestations include tachypnea, grunting, nasal flaring, retractions, cyanosis, decreased oxygen saturation, decreased oxygen levels, and abnormal arterial blood gas (ABG) values.
• Cardiovascular manifestations include poor tissue perfusion, hypotension, and patent ductus arteriosus.
• Gastrointestinal manifestations include feeding intolerance, gastric reflux, vomiting, and gastric residuals.
• Altered fluid status may be manifested by fluid excess or fluid deficit.
  • Fluid excess is manifested by edema and congestive heart failure.
  • Fluid deficit is manifested by tachycardia, poor skin turgor, decreased urine output, abnormal electrolyte levels, and decreased blood pressure.
• Iatrogenic anemia secondary to blood sampling may be present. It is exhibited by tachycardia, pallor, decreased blood pressure, increasing oxygen requirements, and apnea.
• Infection may occur.
• Hypoglycemia or hyperglycemia may be present.
• Ineffective temperature control may be observed, and is exhibited by an inability to maintain core body temperature.
• Neuromuscular system manifestations include decreased suck and swallow reflex, hypotonia, and altered state transition.
• Hyperbilirubinemia is characterized by rapid destruction of red blood cells, jaundice, and lethargy. Kernicterus is the deposition of unconjugated bilirubin in the brain cells and is associated with mental retardation.

Nursing Management

1. Provide respiratory support (see Drug Chart)

2. Perform the following assessments.

• Assess heart sounds for presence of murmurs.
• Assess pulse and perfusion.
• Monitor blood pressure, heart rate, and pulse pressures.

3. Provide adequate fluids and electrolytes and nutrition.

4. Maintain a neutral thermal environment.

5. Prevent infection.

6. Assess for readiness for selected interventions.

• Provide stimulation when appropriate to infant state and readiness.
• Encourage flexion in the supine position by using blanket rolls.
• Provide the newborn with body boundaries through swaddling or using blanket rolls against the newborn’s body and feet.

7. Promote parent-newborn attachment.

8. Initiate phototherapy as required.

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A Sample NCP for Late Preterm Infants