The Sick Infant: Provision of Developmentally Appropriate Care - Essay Example

Enhancing Practice in Neonatal Nursing - The Sick Infant: Provision of Developmentally Appropriate Care. Introduction Neonatal care for preterm infants has improved since the 1960’s as the mortality rate among preterm infants with low gestation age and birth weights survive (22–23 weeks gestation with a birthweight of < 500 g) (Monterosso et al 2005,p.109). The nursing practitioner specializing in neonates is faced with the challenge of providing optimal care as well as understanding the nuances of preterm infants in expressing their pain, hunger and other physical discrepancy that threaten their young lives. The nurses together with the parents of the neonates work to improve the conditions of the child. However, due to the lack of appropriate medical knowledge of the parents, the nurses take on the surrogate duty of providing care for the ill child. Although technology has effectively extended the necessary intervention to preterm, ill neonates, there are still gaps in determining whether the technology-driven interventions are effective in addressing developmental needs. Monterosso et al (2005) attributed this gap to the lack of appropriate guidelines to follow when to provide or withhold these interventions (p.109). Moreover, the results of the interventions remain uncertain when it comes to quality of life after treatment. Previously, the neonatal care decisions were exclusively and confidentially determined between the parents and the attending physicians of the sick infant. In recent years, society demanded that more care should be taken when making decisions so that they are rooted in “public autonomy, justice and societal good” (Monterosso et al 2005, p.109). Preterm neonates experienced extreme pressures and stressors that could range from “adverse birth conditions to frequent interventions in preterm infants or circumcision in full-term infants” (Traut 2004,p.235). The preterm infants communicate quite differently from full term infants. Traut (2004) observed that some behavioural cues from preterm infants were subtler compared to full term babies (p.235). To many nursing practitioners, motor activity indicated distress among preterm neonates. The degree of motor activity also reflected the “maturation and neurodevelopment” level of the preterm infant. Nurses have the primary role in determining the source of stressors and the assessment and management of pain in the ill neonates. The key indicators like heart rate, breathing, sleep/wake rates can aid nurses to make sound decisions. Traut (2004) however, noted that although some nurses may make decisions about pain management, the lack of a pain management plan hindered the effective delivery of care (p.235). Aside from interventions aimed at extending or improving developmental processes of the preterm infant, nursing care also involves providing appropriate strategies for nutrition. Nutrition is considered an optimal development thrust for neonates. Preterm and full term infants have varied nutrition needs. They vary based on “on gestational age, metabolic state, and physiological complications that may arise during the neonatal period” (Gregory 2005, p.98). In particular focus for this study is the application of nutrition interventions for preterm infants. Aside from direct medical intervention provided for the neonates, the nurses also had a direct role in providing support for the parents of the unwell child. Mok and Leung (2006) wrote that the stressful situation of preterm births also affects the mothers of the children. Mothers or parents should be provided with support to reassure them that everything is being done to improve the situation. Mothers gained more confidence if there were open communication between the parents and the nursing team. Nurses were in the best position to “promote positive parent–infant interaction throughout the course of hospitalisation” (p.727). Pre-Term Infant Profile The preterm infant, female, was born at 25 weeks gestation and weighed only 600 grams at birth. The infant is currently in the Neonatal Intensive Care Unit of the hospital. The gestation was terminated preterm because the mother suffered from pregnancy-induced hypertension and the infant’s condition while in the womb was rapidly deteriorating. The low birth weight was attributed to the inability of the mother to provide appropriate sustenance. The child had underdeveloped lungs at birth and her breathing had to be artificially aided. At three days after birth, the child showed signs of improvement but the attending physicians still required continuous observation until the child responds to the intervention. Some behavioural cues were observed in the child. The child had interrupted sleep/wake patterns. The child was also observed breathing rapidly and very shallowly at times. Until conditions improved, the child will remain in the incubator until further examinations by the physician. Other than the foregoing observations, the preterm infant had suffered no other physiological defects. The nurse on duty is tasked to observe every minute behavioural and motor activities to determine the source of distress of the infant. The physician also proposed non-narcotic intervention to alleviate the perceived discomfort in the infant. Finally, as an extension of the nursing care delivery, the nurse on duty must keep constant communication with the mother who was recovering from the emergency C-section performed. Preterm Neonatal Nursing Care Intervention Strategies Proposed Strategies The developmental care approach is proposed as the main nursing care strategy for the female pretermer. Developmental care approach was selected because it had promising outcomes for preterm infants. Millette, Richard and Martel (2005) noted that under the developmental care approach, positive outcomes were observed in “weight, number of mechanical ventilation days, length of hospitalization, incidence of intracranial haemorrhage and an improvement in neonatal neurobehavioural organization” (p.95). Aside from physiological issues, developmental care approach proved beneficial to the preterm infants’ long-term cognitive and behavioural development (p.95). Three approaches were utilized to improve the conditions of the patient. First, the nurse must have a competent knowledge about the condition and utilizes the most appropriate intervention tools. The nurse should also be aware of the correct positioning of the child to improve circulation. The nurse on duty utilized approved positioning aids like rolled blankets to promote “flexion of all limbs” (Millette, Richard and Martel 2005,p.96). Finally, the nurse must make every effort to reduce environmental noise that would provide external stressors to the infant. With every intervention, the nurse must document the results of their actions to facilitate future discussions and studies with the nursing team and physician in charge. This would also provide information whether the intervention used was appropriate or not. The child, though under serious observation has improved remarkably after 72 hours. The main thrust of the nursing care strategy was to sustain the favourable conditions. Unless adverse conditions developed within the time frame allotted for the nurse on duty, the physician must also be constantly updated on the conditions of the child. Pain Management and Intervention Plan The physician discouraged narcotic pain management strategy forty-eight hours after birth. The attending specialist also noted that the child is calmed when an attendant touches or sooths the extremities of the child (hands, feet). No further pain management strategy was recommended unless the nurse attendant would observe continuous distress in the infant. The nurse on duty is advised to notify the medical staff immediately when irregular heart and breathing rates are observed. Nutritive and Non-Nutritive Interventions Nutritive intake especially in preterm babies is an important factor in promoting better health indicators. Like full term babies, preterm infants also require minimum consumption of nutrition and liquids to create balance and prevent adverse physical effects. The water intake requirements vary between preterm and full term babies. For low birth weight like the subject patient, the required water intake should be 80-140 ml/kg/day (Gregory 2004, p.99). Similar issues regarding water balance must also be addressed in preterm infants with Very-low-birth-weight (VLBW) infants ( Read More