Neonatal nurse spevialist , arba minch , university , labour, neonatal health

1. By ADDISU URMALE
ID. PRMHS/087/14
SEMINAR PRESENTATION
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2. ARBAMINCH GENERAL HOSPITAL
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3. 1. Neonatal history taking
A. Maternal profile: Meseret Adimasu is a 23years old para I mother who
come from Eligo kebele. She has no occupation and work as housewife in her
home. Educational status she was grade 12+1. Her blood group is A+. She
has no history of known chronic maternal illnesses (like diabetes,
hypertension, TB, renal diseases, asthma, etc), but have history of sexually
transmitted diseases HIV positive status, which detected during here ANC
visit while she was linked to ART clinic but not adhere to HAART drug
properly. Otherwise she has no sign and symptoms like vaginal discharge,
genital ulcers, or investigations like VDRL, Hepatitis B virus positive status.
HISTORY AND PHYSICAL EXAMINATION OF THE
NEWBORN
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4. B. Current pregnancy:
Meseret remember her LNMP and it was on 25-29/10/14 E.C making a
gestational age of 38weeks + 2day on (18-7-15E.C )and EDD was(will)
29/7/15e.c. She had a total of 4ANC follow up at Arbaminch General
Hospital where she was given a red tablet to be taken 1tab/day. She didn’t face
problems like bleeding, hypertension, diabetes, thyroid diseases, eclampsia,
acute or chronic infection during pregnancy.
Cont….
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5. C. Previous pregnancy:
No history of abortion, fetal death, early neonatal death, premature birth,
history of early neonatal jaundice, history of birth defect.
Cont..
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6. D. Drug history:
Meseret was/is using HAART from last 8months. Otherwise no history of
alcohol ingestion, cigarette smoking and any other medications during
pregnancy.
Cont..
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7. E. Family history:
Her husband is a car driver and have unknown HIV status. Otherwise there is
no family history of inherited diseases like diabetes mellitus, hypertension,
bronchial asthma, thyroid disease and others.
Cont..
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8. F. Labor and delivery:
Place of delivery was Arba Minch General Hospital. Onset of Labor
spontaneous viginal delivery on 18/7/15 at 8o’clock local time. Time of ROM
intrapatium making APGAR score of 1 and 2 at first and five minute
respectively because of prolonged second stage of labor. She received
unknown intrapartium IV medication(most probably zidovudine). The baby
didn’t cry immediately after delivery and born with birth weight of 3,700g.
Cont..
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9. G Presenting compliant:
Referred from Oby-Gyn side.
Cont..
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10. GA = acute sick looking
Vital signs
RR = 42bpm
PR = 140bpm
Temp. = 36.2c
Spo2 = 92% on oxygen
Anthropometric measurement
Wt. = 3660g(date 19-7-2015e.c)
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2. PHYSICAL EXAMINATION

11. Color = Acrocyanotic
HEENT:
Head: Diamond shaped anterior fontanel, no bleeding under skin,
Eye: No eye discharge, eye close and open symmetry and spontaneously
while cry, Pink conjunctiva, no icterus, and the pupule react to light
Ear : In line with eye, pinna well formed
Nose and Throat: No nasal discharge, well formed nasal septum, Nasal
prong inserted through nostrils, orogastric tube was inserted through
mouth
Mammary gland: no discharge from breasts and enlargement of limb nodes
Cont.…
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12. Respiratory system: RR= 42bpm, mild intercostal retraction, Dwones score
of 4, there is acrocyanosis,
Cardiovascular: HR= 140bpm, mild murmur
Abdomen: no distention, no organ enlargement, no bleeding and discharge
from umbilicus, abdomen move with respiration.
External genitalia: uncircumcised male neonate well formed external
gentalia. Urine and Meconium passed.
Musculoskeletal: no limb defects like club foot, syndactly, polydactyl,
symmetry and movement of extremities, birth injuries, no protrusion
depersion on spinal area, no edema.
Cont..
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13. Skin examination: no rash, pink skin, bluish discoloration around extremities
No birth marks, no meconium around skin.
Neurological examination: 2 episode of ABM characterized by extension
and flexion of extremities, no unrolling of eyes and drooling of saliva.
primitive reflex
Moro reflex symmetry
Rooting reflex, absent
Grasp reflex both arm and plantar present but week
Sucking reflex, present but not sustain.
Cont..
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14. WBC = 5.9
LYM% = 45.5
MID% = 33.3
GRAN% = 21.2
LYM# = 2.6
MID# = 1.9
GRAN# = 1.4
RBC = 4.23
HGB = 14.1
HCT = 39.2
MCV = 92.7
MCH = 33.3
MCHC = 35.9
RDW_CV = 16.1
RDW _SD = 59.6
PLT = 30
MPV = 14.6
PDW = 7.2
PCT = 0.04
P_LCR = 52.8
P_LCC = 15
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HEMATOLOGY ANALYSIS REPORT

15. Assessment
NURSING CARE PLAN
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Subjective data Objective date
Not cried Temp. = 36.2c
Spo2 = 92% on oxygen
Intercostal retraction
Week sucking reflex
Blue extremities
2episode of abnormal body
movement

16. Nursing
diagnosis
Expected
outcome
Interventions Rational Implementation Evaluation
Ineffective
breathing pattern
related to disease
status AEB
pulseoxymery
measurement of
92%on oxygen
Patient will be
able to maintain
oxygen saturation
of normal limits
within 3hours.
Provide oxygen,
Observe and
evaluate the
patient’s
condition through
PNA chart
Monitor vital sign
This will reduce
oxygen demand
and aid in gas
exchange.
Signs and
symptoms will
assessed and
addressed
4L of INO2
For the CPAP 6-
oxygen and 4 –
air
After he was
unable to sustain
breathing she
admitted to NICU
and put on 4Lof
INo2 put unable
to sustain
saturation so we
shifted to CPAP
Failed to suck
related to disease
process as
evidenced by
weak sucking
reflex
Achieves
adequate nutrition
within 6hours.
Encourage skin-
to-skin contact
immediately after
delivery
Skin-to-skin
holding promotes
early
breastfeeding
initiation,
Orogastric tube
inserted
Mantenice fluid
90ml/kg(2/3
Calcium gluconate
10%200mg/kg
1ml=100mg
Ongoing
Con..
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17. Nursing diagnosis Expected outcome Interventions Rational Implementation Evaluation
Risk for infection
related to HIV
exposure
The patient will
remain free of
symptoms of infection
and demonstrate
appropriate behaviors
that reduce the risk of
infection
 Antibiotics
 HIV prophylaxis
 Wash your hands
and use aseptic
technique
 Teach the patient,
family, ways of
HIV/AIDS
transmission
 PMCT
Hand washing and
using aseptic
technique reduces the
likelihood of
transmitting pathogens
to the patient that can
cause infection.
Ampicillin 100mg/kg
BID
Ceftriaxone 500mg/kg
BID
Neverapine 15mg
daily PO within 1hr.
Ziduvidine 15mg PO,
BID within 1hr.
mixed with milk and
administered via
orogastric tube
Maintain a relationship
with the HIV
treatment team.
Ongoing (Monitor
viral load and CD4
count)
Risk of unstable
glycaemia RT
Inadequate glucose for
cellular brain function
Patient will be able to
maintain glucose
levels within normal
limits
Monitor the patient’s
blood glucose level
Manage the
underlying condition.
This is an easy and
quick way to identify
or rule out
hypoglycemia.
Interprate the result
and follow closely
Ongoing
Risk of aspiration RT
tube feeding
Patient will be free
from aspiration
syndrome
Check placement of
orogastric tube
Aspiration can lead to
pneumonia, GERD,
respiratory infections.
Auscultate before and
after
No aspiration yet
Risk for
developmental delay
RT to seizure, brain
injure
Patient will have
normal development
pattern
Keep airway
management
Manage the
underlying condition
analyze patients’
behavior and
challenges with
present developmental
stages.
Ongoing
Con..
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18. Time RR PR Temp. SPO2
2:30 60 165 36.2 83%on oxygen
6:00 53 173 36.4 87% on oxygen
1:30 48 197 36.8 94% on oxygen
3:40 70 110 38.2 88%onoxygen
4:30 63 152 38.3 96%on CPAP
11:30 60 156 38.2 97%on CPAP
2:30 61 140 37.6 95%on CPAP
PROGNOSIS
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19. THANK YOU !!!
ONGOING
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