Premature Infant Care: Joshua's Case

This assignment delves into the case of Joshua, a premature infant requiring specialized care. It highlights the challenges faced by parents and emphasizes the crucial role of neonatal nurses in providing accurate information, frequent updates, and establishing collaborative relationships. The document underscores the importance of immediate action by nurses during delivery and adherence to specific procedures for managing premature infants.

The Infant Requiring Assisted
Ventilation

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
Question 1........................................................................................................................................1
Five priorities of nursing management.......................................................................................1
Question 2........................................................................................................................................3
Three potential long or short term complications of using CPAP and strategies to reduce risk.3
Question 3........................................................................................................................................4
Four potential long term problems that Joshua and his family due to Joshua's preterm birth....4
Question 4........................................................................................................................................5
Strategies to enhance development of collaborative and equal relationship between Kathy and
neonatal nurses caring for Joshua...............................................................................................5
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................7

INTRODUCTION
Nursing management can be determined as the performance related to the function of
leadership for decision making and governance within the organization. Further, it includes all
functions for management like organizing, staffing, controlling, directing and planning. There
are different types of departments that are handled by nurses. Present report is based on case of
Joshua who was born within 29 weeks gestation and it was witnessed that he was sufferin g from
respiratory distress. This report covers priorities of nursing management with respect to neonatal
nursery. Further, it covers short and long term complications of using CPAP (Continuous
positive airway pressure). Lastly, it also includes long term problems which Joshua and his
family will experience due to Joshua's preterm birth.
Question 1
Five priorities of nursing management
There are different set of priorities that has to be followed by nurses for patient. Further,
Immediate care has to be provided to the new born baby as well. In this context, below given are
the five priorities which are required to be followed:
Immediate steps for respiratory distress: As per the findings, it can be stated that out of
10, 2 of the babies suffer this type of issue. Further, it is also known as Neonatal respiratory
distress syndrome (RDS) that is commonly faced by the premature babies (Cools, Offringa and
Askie, 2015). This is generally caused when their lungs are not fully developed. As per the
responsibility of nurses, it is important for nurses to make sure that babies are given artificial
surfactant as it is helpful for the baby to get oxygen. Further, warm and moist oxygen should be
provided and they should be kept under incubator so that the body and the lungs can be
developed and the baby can inhale the oxygen.
Health assessment: It is essential to conduct health assessment. In this context, it includes
test like blood pressure, pulse rate, etc. For the baby, it is necessary for the nurse to ensure that
all the muscle tone are correct. Further, the pulse rate should be checked. Moreover, colour of
skin, respiration, etc. should be considered by nurses of the new born babies. This can be
determined as basic function that needs to be considered by a nurse. If any issues in relation with
the identified area are determined then these immediate steps should be taken so that proper care
can be provided to the new born baby. More specifically, there are scores which are provided by
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the nurses for each baby that is born (Kirpalani, Millar and Roberts, 2013). It is given out of 10
and if it is 7 or more then it is considered to be normal. However, in cases if the score is give in
between 4 to 6, then this shows that baby should be given resuscitation measures and proper
monitoring is required. In addition to this, if the score is below 3, then immediate life saving
techniques and resuscitation should be given to save the life of child.
Physical examination: It is essential to conduct proper physical examination to check the
signs that show any type of issues that identify in the new born baby. At the time, baby is born,
there are immediate steps taken in order to make sure that there is not serious issues that are
faced by the child. This is generally witnessed in the nursery or in the delivery room but these
actions depends upon the policies and procedures which are followed in the firm (Overman, Liu
and Moore, 2013). There are different types of procedures that are followed and it includes
measuring the heart rate, respiratory rate and temperature. Further, it includes measuring the
length, head circumference and weight. It helps in determining that whether the growth is normal
or not. Special care is provided to babies who are born underweight or are very large and are
overweight. Once the temperature of the baby is stabilized, then they are given first bath. In
addition to this, footprints are taken for the medical record.
Placing all the tools and equipments: During delivery time, there are different types of
complications that are caused and for each of them it is important to consider all things and
accordingly adequate steps are taken with the help of which complications can be reduced.
Further, at this time, the equipments and tools should be ready in case of emergency.
CPAP: At the time when the child is kept at CPAP, it is important for the nurses to that
proper observation should be done so that all the changes that take place in child have been taken
into consideration (Sharma, Clark and Keszler, 2015). It is essential to ensure that the proper
pressure is maintained in CPAP to recover the baby quickly. Further, it is essential to time to
time report the doctors so that proper meditations can be provided by them.
In accordance with the case, it can be started that Joshua was a premature baby and
weighted 1200 grams. He had issues in relation with the respiration and so he was given CPAP.
With this respect, it is important to consider that the steps taken by the nurses at that point of
time were right as the child needed oxygen. In this context, positive pressure ventilation was
given so that with time the child can overcome the problem of respiration after the proper
observation.
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Question 2
Three potential long or short term complications of using CPAP and strategies to reduce risk
CAPA (Continuous positive airway pressure) is a type of positive airway pressure
ventilator. This is helpful in applying mild air pressure continuously so that the person gets
proper oxygen. There are different types of long term complications which are faced by using
CPAP. In this context, below given are three long term complications:
Bloody nose: This is one of the long term complications that are faced due to CPAP
during the preterm birth. Further, there is no fixed time in which a person's nose can bleed. In
this, no pain is felt and excess loss of blood causes reduction in blood and haemoglobin rate
within body decreases (Greenough, Murthy and Sundaresan, 2016). There are cases in which it
becomes difficult to stop bleeding which can cause serious health issue to the person. Further, it
is difficult to identify the main reason due to which this type of problem can occur in the person.
When CPAP is given, then mouth and nose is covered with mask and when the pressure of
oxygen is not properly stabilized as per requirement then it can cause bleeding of nose.
Breathing problems: Lungs are affected when CPAP is given. The respiratory system is
also negatively affected. There are cases in which patients are not able to perform physical
exercise and when such activities are being performed, then it becomes difficult to breathe and
this results in unconsciousness. To perform any type of role, it is required that proper
concentration is there and when body fails to take breath in enough oxygen, then it creates issues
so as to complete the work in effective manner. It is essential to inhale enough oxygen so that the
body can function effectively. It is important that oxygen should reach all parts of the body.
However, there are cases in which by using CPAP is preterm birth increases the rate of issues
related to breathing.
Stomach problem: the problems related to stomach pain as well as bloating are caused
due to using CPAP. . This type of issue arises because the air pressure that is set on the machine
makes it pump highly pressurized air into mask (Szyld, Aguilar and Musante, 2014). This is
caused when nurses do not take proper care to adjust with the sleep specialist. Stomach problems
create issue in digestion. When anything that is consumed causes pain, then it also creates issue
for taking the food inside.
There are different strategies that are implemented to reduce the negative impact which is
caused because of CPAP. In this context, during the situation of preterm birth, it is important that
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for the baby proper monitoring is done. There are cases in which serious issues can cause
problem to child if the pressure is more than the required one (Cools, Offringa and Askie, 2015).
In order words, it requires real time monitoring and it enables to reduce risk of lung damage.
Further, protective strategy is used by the nurses to ensure that the rate of lung damages caused
by CPAP can be reduced. When a child like Joshua is placed in CPAP, then it is important that
proper monitoring should be conducted in the emergency situation to reduce the occurrence of
problem.
Question 3
Four potential long term problems that Joshua and his family due to Joshua's preterm birth
There are different types of problems that can be faced by Joshua and his family due to
Joshua's preterm birth. In this context, below given are four potential long term problems:
Intellectual and developmental disabilities: With age, there is a certain growth that
occurs in a child. In this context, it includes physical as well as mental development. However,
when child like Joshua who had premature birth have difficulties in physical development and it
also affects their growth (Kirpalani, Millar and Roberts, 2013). Further, there are issues in
relation with learning thing which normally same age children face. Moreover, it becomes
difficult to properly communicate with other. It is important to properly interact with the family
of Joshua but it becomes difficult for them to understand and also difficult for Joshua to make
them understand regarding the thing that he wants to convey. Further, children with premature
birth prefer to be alone and do not get easily adjusted with others. Further, the basic things that a
child can perform of the same age of Joshua but he can find it difficult to perform similar
activities. Further, there are also conditions in which growth of one of the body part get
affected.
Autism: This is a type of behavioural disorder. In this, child gets affected with behaviour,
social and speech. This has negative impact on brain, spinal cord and nerves. It becomes difficult
for the child to perform basic activities and in order to have proper communication with others
(Overman, Liu and Moore, 2013). There are conditions in which parents does not have proper
information about it and they fail to make sure that proper care is provided to them. This is a type
of disease which does not have proper cure. However, the only thing that can be done is to
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reduce negative impact by therapies and medications. It becomes difficult to maintain a social
life in autism and to make other understand and express.
Lung problem: One of the disease which is caused when lungs gets affected is Asthma. It
is a type of condition that impacts the airways and increases breathing problems. Breathing
problems affects the social life and it is important to continuously meditate so that the rate of
issues can be solved. Further, there is another type of lung related issues which is caused among
premature babies that is Bronchopulmonary dysplasia (BPD). There are chances that Joshua can
get affected with this type of disease (Sharma, Clark and Keszler, 2015). As per this lung
disease, it causes lungs to grow abnormally or to be inflamed. With time this type of issue gets
reduced but the chances of getting asthma are high and their symptoms remains throughout their
life.
Heath problems: Joshua is at high risk due to health related problems. In this context, it
includes intestinal problems that are generally caused to premature babies which are also known
as necrotizing enterocolitis. This is a type of disease that affects intestine of babies. Intestine is
body function that helps in breaking down of food. Majority of child who are premature faces the
intestine problem but for most of them stays for life long. Further, it also causes different types
of infections like meningitis as this is the type of infection which is caused in brain. Further, it
includes pneumonia which is a type of infection caused in lungs. Moreover, premature babies
also face problem of vision (Greenough, Murthy and Sundaresan, 2016). In this context, it
induces diseases like retinopathy of prematurity. In addition to this, it also causes dental problem
and hearing loss.
Question 4
Strategies to enhance development of collaborative and equal relationship between Kathy and
neonatal nurses caring for Joshua
In order to create equal and collaborative relationship with Kathy and neonatal nurses, it
is important to make sure that the below given strategies are followed:
Effective communication: To create strong relationship it is essential to have proper
interaction. This enables to develop trust and confidence over the services that are being
delivered by the nurses. With this respect, there is a type of stress which is developed in Kathy as
they are well informed about the issues that Joshua can face as it is premature baby. When there
is strong relationship then the issues which are faced by patients are freely discussed. There are
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different types of complications that are witnessed at the time of delivery (Szyld, Aguilar and
Musante, 2014). However, the stress and issues that are faced by patient can be resolved at the
high extent. On the other hand, when patient provide adequate information about the issues that
they face, then it becomes helpful enough for the nurses to provide them with services.
Patient education: There are conditions in which patient does not have enough
information about steps which was taken by them towards their child or any other problem. As
per the given case, strong relationship can be developed among Kathy and nurses by providing
adequate information to Kathy related with the issues that Joshua has to face. Further, it also
includes different steps that should be taken by the parents to provide proper care to Joshua and
this information should be provided by nurses (Overman, Liu and Moore, 2013). Neonatal nurses
have experience and they know better about the health conditions that are generally faced by
premature babies. With this aspect, information provided by these nurses is effective enough for
patients to provide proper care and support to their child.
Delivering frequent information: As per the case, Joshua was under CPAP and it is
important to frequently observe so that the pressure of oxygen provided can be controlled as per
the requirement. All the information and changes should be conveyed to patient that is Kathy as
it will be helpful enough to develop collaborative relationship with the nurse.
CONCLUSION
As per the findings, it can be stated that proper information should be provided to the
parents related with health issues which are faced by the patient. Further, it is important to have
effective communication so that strong relationship can be developed among the nurses and the
patients. This way trust and confidence is developed. Moreover, nurses have to take immediate
actions at the time of delivery, type of issues that can occur is not fixed. Further, there are
certain steps and procedures that have to be followed by the nurses which should be kept in
mind.
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REFERENCES
Cools, F., Offringa, M. and Askie, L. M., 2015. Elective high frequency oscillatory ventilation
versus conventional ventilation for acute pulmonary dysfunction in preterm infants. The
Cochrane Library.
Greenough, A., Murthy, V. and Sundaresan, A., 2016. Synchronized mechanical ventilation for
respiratory support in newborn infants. Cochrane Database of Systematic Reviews. (8).
Kirpalani, H., Millar, D. and Roberts, R. S., 2013. A trial comparing noninvasive ventilation
strategies in preterm infants. New England Journal of Medicine. 369(7). pp.611-620.
Overman, A. E., Liu, M. and Moore, B. M., 2013. Tracheostomy for infants requiring prolonged
mechanical ventilation: 10 years’ experience. Pediatrics. 131(5). pp.e1491-e1496.
Sharma, S., Clark, S. and Keszler, M., 2015. Tidal volume requirement in mechanically
ventilated infants with meconium aspiration syndrome. American journal of perinatology.
32(10). pp.916-919.
Szyld, E., Aguilar, A. and Musante, G. A., 2014. Comparison of devices for newborn ventilation
in the delivery room. The Journal of pediatrics. 165(2). pp.234-239.
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