Hypoglycemia Disease Assignment
13 Pages4843 Words388 Views
Added on 2019-12-03
Hypoglycemia Disease Assignment
Added on 2019-12-03
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How postnatal midwives couldprevent hypoglycaemia relatedto hypothermia in newborns
INTRODUCTION Proper and organized neonatal care is critical to preventing several complex issues in newborn babies. Hypoglycaemia, related to hypothermia, is the most common metabolic problem innewborns. However, considering its long term consequences, it is a serious concern to preventthis condition in the infants. Hypothermia is the state of having a body temperature which isabnormally low. The likelihood of developing hypothermia is more in newborns because theyhave a larger surface area as compared to body weight (What are the symptoms of hypothermiain infants and children?, 2015). This makes them lose body heat at a faster rate. Neonatalhypoglycaemia is defined as the condition in which blood glucose level is lower than the normal(Hypoglycaemia in the Newborn, 2015). In order to keep the body warm, the neonates utilizeglucose stores of the body which lads to hypoglycaemia. Postnatal midwives play a crucial rolein providing care and support to the newborns and their family. The present essay criticallyanalyses the aspect of hypothermia related hypoglycaemia in newborns within the environmentof neonatal practice. It will explore the ways in which postnatal midwives can preventhypothermia related hypoglycaemia in newborns within the neonatal special and transition careunit. Good practice with regard to prevention of hypothermia related hypoglycaemia will beanalysed. Further, a thorough literature search has been conducted so as to explore and discussissues surrounding this area of neonatal practice. On the basis of analysis, one improvement orchange in practice will be recommended in the essay. Lastly, method used for auditing theproposed changed will be described. As per the NMC code of professional conduct, the nurses and midwives should respectpeople's confidentiality (The code, 2008). Therefore in order to maintain confidentiality, theactual name of the baby and the family has not been disclosed. In this regard, all the names havebeen changed. This essay is based on a personal experience which took place in a neonatalintensive care unit. With the objective of obtaining a good learning outcome and andimplementing it in future, Gibbs Model of reflection has been followed for this essay. Accordingto Jayatilleke (2012) reflective practices help nurse make sense of their work and analyse it. Itcontributes to learning and professional development of a person (Jayatilleke, 2012). As per theviews of Fleming (2007) reflection leads to self awareness and enhances personal development(Fleming, 2007). Gibbs reflective cycle is capable of encouraging a clear description of the2
situation. The present essay is based on a situation in which Miley gave birth to a baby, Jack,who was bought up to the unit by an SHO. Jack was suffering from low blood sugar andvomiting. On assessing the temperature of the baby, it was found that it was below limitsdefined. Jack was nearly eight hours after birth and had no cloths. He was only wrapped in twotowels. The midwives on post natal ward did not ensure that the baby was warm enough. Thisled to hypothermia and hypoglycaemia. For these reasons, Jack had to be admitted to the unit fordextrose infusion. He was also kept nil by mouth due to history of vomiting. According to NHS choices, babies are more likely to develop hypothermia because theability of their body to regulate temperature is not fully developed (Hypothermia, 2015).Waldron and Mackinnon (2007) assert that in the management of neonates, thermoregulation ismore important. Hypothermia at birth is a world wide problem. It can also occur when theneonates are being transferred to neonatal units during routine care. If immediately afterdelivery, appropriate action is not taken the core and skin temperatures of a newborn candecrease at the rate of 0.1 and 0.3 degree Celsius per minute respectively. According to theWorld Health Organization, mild hypothermia is defined as a core body temperature of 36- 36.4degree Celsius while moderate hypothermia as 35.9- 32 degree Celsius. A core body temperatureof less than 32 degree Celsius is defined as severe hypothermia. Knobel, Wimmer and Holbert,(2005) also explain that the physical characteristics of the newborns and environment of thedelivery room. In typical situations, a wet newborn who has a high ratio of surface area tovolume, moves from a warm aqueous environment to delivery room which is comparativelycooler and dry (Knobel, Wimmer and Holbert, 2005). Soll (2008) agrees that one of the keyphysiologic challenges that newborn infant faces after delivery is maintaining a neutral thermalenvironment. By paying attention to the management of neutral thermal environment of anewborn, clinical outcome can be improved. While in utero, there is heat production by the fetus.This leads to half a degree higher fetal temperature as compared to the maternal temperature.After birth, the environment to which newborn is exposed is much different (Soll, 2008). Knobel and Davis (2007) study revealed that the newborns may lose heat by our basicmechanisms of conduction, radiation, evaporation and conduction. Heat loss through radiationinvolves the temperature of those surfaces which surround the baby but are not in direct contact.Heat energy is emitted by the newborn in the form of infrared electromagnetic waves (Knobel3
and Davis, 2007). As per the views of Guyton and Hall (2006) for an infant that is older than 28weeks gestational age, heat loss through radiation is the most important source of heat transfer.Through connection, heat can be lost when it is carried away from the body through air currents.Similarly, evaporation also leads to loss of heat from the infant's body (Guyton and Hall, 2006).Knobel, Wimmer and Holbet (2005) assert that if the newborn is not attended adequately, it mayresult in hypothermia and cold stress. Hypothermia, in turn is responsible for a variety ofphysiologic stresses (Knobel, Wimmer and Holbet, 2005). The infant experiences increasedoxygen consumption, metabolic acidocis, decreased cardiac output, hypoglycaemia andincreased peripheral vascular disease. According to Page- Goertz (2007), concern abouthypoglycaemia in newborn is a common issues however it may adversely affect subsequentneurologic development. Cold stress or hypothermia is considered to be risk factor forhypoglycaemia in newborns. More energy is used by a colds baby who is more prone tobecoming stressed and hypoglycaemic (Page- Goertz, 2007). This is because, cold stress leads toan increase in the metabolic demands of infants at the time when there is only marginalavailability of glucose.Klossner (2006) also agrees that in response to heat loss and low glycogen stores, anewborn typically experiences hypoglycaemia (Klossner, 2006). Study by Burdan, Botiu andTeodorescu (2009) considered neonatal hypoglycaemia as one of the most common problemsexperienced in neonatal intensive care units. But it is of serious concern was prolongedhypoglycaemia results in brain damage and mental retardation (Burdan, Botiu and Teodorescu,2009). Study by Laptook and Jackson explores unique challenges that are posed by late preterminfants for doctors and nurses taking care of them. There can be lack of attention regardingimportant components which depict successful transition after birth. According to authors, coldstress and hypoglycaemia are two important problems which can be seen in infants (Laptook andJackson, 2006). These problems require immediate attention. Therefore, it is important to carryout surveillance of physiological variables to ensure that these problems do not affect thesuccessful adaptation of infant during early hours after birth.It order to prevent hypothermia related hypoglycaemia, it is important for the midwivesto create a neutral thermal environment in the birthing area. In addition to this, there is also needto reduce the risk of cold stress in the new born which can be done by towel drying and4
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