Nursing care plan Of The newborn

Nursing Care Plan of the newborn

Cues/Evidence O !ECTI"E D#T#$ Dx: NSVD with thick meconium stain Presence of thick (dark) meconium during suctioning (in nose and mouth) Use of mechanical suctioning Slight flaring ala nasi during the P. A of new orn Snee!ing noted during initial care ""# $% c&m New orn has faint cries Nursing Diagnosis Objective Intervention Rationale Evaluation At the end of our care( the new orn achie)ed effecti)e reathing &attern as e)idenced *+ ""# 23 c&m fast and shallow /laring of the ala nasi not o ser)ed an*more nose and mouth were free of mucus secretions good cr* was initiated

Ineffective breathing pattern r/t aspiration of %econiu% during birth

'ithin our care( the new orn will ha)e an effecti)e reathing &attern as e)idenced *+ A sence of res&irator* distress such as flaring of the ala nasi( c*anosis( d*s&nea and a normal reath sound "" should e within normal range (%, -$,c&m) A sence of

Assess and re&ort further sings of res&irator* distress

/urther signs and s*m&toms could lead to com&lications which ma* result to chronic h*&oxia and acidosis( increasing the risk of .NS damage 0his hel&s remo)e accumulated fluid( facilitates res&irator* effort and hel&s &re)ent further as&iration 1nitiall*( a strong cr* increases al)eolar &ressure of ox*gen and &roduces the necessar* chemical changes to con)ert fetal to

.lear the new orns airwa* * suctioning the mouth using a ul s*ringe

Note the &itch and intensit* of the cr* of the new orn

mucus secretions in the nose and mouth 1nitiation of good cr* O !ECTI"E D#T#$ Dx: NSVD with thick meconium staining Presence of thick (dark) meconium during suctioning (in nose and mouth) Vital signs: 0em&.# %$.37. 8"# 492 &m ""# $%c&m ;anifest no signs of infection like fe)er and chills Ris& for infection r/t i%%ature i%%une s'ste% 'ithin our care( the new orn will+ Vital signs within normal range 0# %: o . P"# 49, 4$, &m ""# %, -$, c&m ;onitor )ital signs

neonatal circulation( so that the heart rate increase to 4526 43,uterus

Determine an* a normal changes( raise in tem&erature ma* indicate infection Allows recognition of a normal findings and allow &rom&t inter)ention if com&lication occurs 8and washing is the single est wa* to a)oid s&reading &athogen <lo)es reduce the

At the end of our care( the new orn+ Vital signs remained within normal range 0em&.# %57. 8"# 4%= &m ""# 23c&m New orn is free of signs and s*m&toms of infection such as fe)er and fatigue ;other had full* understood the im&ortance of reastfeeding in relation to

washing hands efore and after &ro)iding care

wearing glo)es to maintain ase&sis when &ro)iding direct care and when in contact

with lood or od* secretions ;onitor '>. count a o)e 44(,,,?mm%

&ossi ilit* of transmitting disease

strengthening the immunit*

@ncourage mother to egin reastfeeding earl* if indicated

1ndicates increased &roduction of leukoc*tes * one marrow( usuall* in res&onse to the &resence of acterial &athogens .olostrum and reast milk contain high amounts of immunoglo ulin A( which &ro)ides &assi)e immunit* and hel&s reduce infection 1nstill o&hthalmic dro&s or ointment to &ro)ide

1nstilling e*e ointment (gentamicin ointment)

&ro&halaxis against o&thalmia menatorum