NUR322: Nursing - Care of The Neonate - Essay Writing Assessment Answers

Care of the Neonate

Sometimes, the 40 weeks it takes to form a full grown baby may seem like forever but given the fact that the design of a human body is sophisticated, sometimes that time is not even enough to allow the full growth of all the functional units. Newborn babies face a lot of risks in their initial days in the world. Sometimes not all the organs have the capacity to perform their tasks at birth (Rennie & Roberton, 2012). Neonatal hyperbilirubinemia is one of the most common conditions that newborns develop 2-4 days after birth as a result of ineffective liver functioning (small production of glucuronic acid transferase) which may lead to jaundice. According to Kenner & Lott (2014), Jaundice is a yellow pigment in the blood that effects when there is more destruction of red blood cells and irregularities in the excretion of a chemical known as bilirubin. The inconsistent bilirubin levels owe to the fact that newborns have a deficiency in the hepatocyte binding protein, an inefficient glucuronosyl transferase, and problems with enterohepatic circulation which lead to elevated levels of in conjugated bilirubin.

The insoluble bilirubin arises when the liver does not produce enough glucuronic acid which makes bilirubin soluble enough for secretion and also detoxifies it. The excess of it may deposit on the skin and mucous membranes giving the skin or eyes a yellowish colour which is pale due to reduced red blood cells (Hockenberry, Wilson & Wong, 2013). Statistics have proven that up to 50-80% of newborn babied develop Jaundice which may subside as the liver adapts to its function or may elevate tremendously posing a significant risk since it may lead to hemolysis, chronic encephalopathy, cerebral palsy or even death (Hockenberry, Wilson & Wong, 2013).

Emma has neonatal hyperbilirubinemia which is an onset for the development of physiological Jaundice which was evidenced by the vital signs of the face and trunk (Chowdhury, Kisat & Tullus, 2015), reduced feeding and oversleeping which are the primary symptoms of Neonatal Jaundice. Since the visual diagnosis may be biased the serum analysis was carried out and the measure seen to be 350 micro/ml which is evidence of high bilirubin levels. This assessment will help to identify the actual potential risks of the baby and the family and the techniques to be used to provide the proper care for the child and family.

In this, I will apply the UVA professional practice model which will provide a framework and guidance for practice and ethical performances. The design emphasizes on relationship based nursing whereby the nurse is empathetic and understands the needs of the patients and family, the hospital staff and personal needs or her role in the treatment process. It will be appropriate since the patient is an infant and the parents may need moral support to avoid an emotional breakdown. Also, there will be frequent communication with doctors on progress reports and inquiries, and the model will ensure effective relationships.

Poor feeding and jaundice

Poor food response refers to a situation whereby an infant has little interest in nutrition and thus not able to take in the necessary nutrients to enhance body functions. Emma is only a few days old, and this is when she needs breast milk the most. Emma is receiving phototherapy for treatment, the primary purpose of exposing her skin to the light is because light degrades insoluble bilirubin into a less complex form that is soluble thus easily dissolves in bile where there is ready excretion from the body. For this to happen there is the need for energy for the metabolism and also water to aid in the circulation of these components. The fact that she is not getting enough nutrients and water is risky since the phototherapy only degrades the bilirubin but does not excrete it if the conjugated bilirubin is absorbed back into the bloodstream, then it may lead to liver problems and may also find its way into the brain causing kernicterus. There is a need to find a plan to increase the nutrient intake of the baby (Nakagawa et al. 2015).

One of the strategies I may try is to use a breast pump to extract milk from the mother and pour it into sterilized bottles so as to change the mode of feeding. Pumping will help not only the baby but also the mother will experience relief from milk build up, reduce chances of breast abscess and enhance the milk supply of the mother. If not then I can have the doctor recommend a good formulae supplement for Emma. The mother, on the other hand, should eat healthy food and plenty of fluids so that whatever small amount of milk the baby takes, it may have a huge effect. I will ensure that I frequently update the mother on the child's progress and assure her that she is going to be okay. Hope will achieve stress management to both the parents and thus ensure steady milk supply. It will also be my priority to check for any signs of pathological jaundice as opposed to the physiological to avoid complications of wrong diagnosis facts. Again it is important that I make a regular assessment of the effectiveness of the treatment method so as to establish if the bilirubin levels are reducing or escalating. If it's not effective, then I will recommend an exchange transfer for treatment.

Hypothermia and Treatment Strategy

Another potential risk is that the baby is likely to be exposed to chances of contracting chronic hypothermia which refers to a rapid reduction in temperatures of a newborn (Hayashi, Bullock, Dietrich, Maekawa & Tamura, 2004). The phototherapy may be the most appropriate method to treat neonatal jaundice, but it is necessary to consider the risks of using the machine. During the process, a baby is stripped naked, and because a baby has a higher surface area to volume ratio unlike adults, thus she may lose a lot of heat which may lead to hypothermia. Emma is likely to suffer from radiant heat loss which results from bare skin exposure to the environment which may have cooler temperatures (Hayashi, Bullock, Dietrich, Maekawa & Tamura, 2004). To avoid these adverse effects, I will ensure that the environmental temperatures of the phototherapy room are neutral thermal regulated; this can be achieved by having a 200-watt bulb in the room and an air conditioner. After some time in phototherapy, I will take Emma from the machine and place her in a radiant warmer or an incubator so as to regain any heat loss. Also, to Jump start the growth inhibited by the loss of heat. From time to time, there should be a skin to skin contact with the mother for the exchange of heat (Hayashi, Bullock, Dietrich, Maekawa & Tamura, 2004).

Parental stress due to unplanned hospitalization

Emma is the first born child of Lily and Edward; it must be hard for them to imagine that the life of their daughter is at risk. It's not easy for anyone to come to terms with that. If Edward stresses too much, then this may also affect Lily who will reduce her milk production. To reduce the stress levels, I will give the two constant hope and guidance and assurance that Emma is going to be okay. To reinstate faith, I will give them case studies of babies that survived Jaundice that was even more elevated, probably SBR greater than 400 yet they survived and got well (Kahveci et al. 2013). Stress from a financial aspect will be dealt with by providing possible insurance options or telling them that money is inanimate and not as important as their child (Ezeaka et al. 2014).

Impaired mother-infant bonding

Emma needs to spend a lot of time in the phototherapy process, and so this reduces the amount of time she can spend in her mother's arms. More over if the mode of feeding is to change to the bottle feeding, then contact will reduce even further. Scientifically it is proven that an infant bond creates a trusting relationship between a mother and her child and acts as a basis for a healthy lifetime relationship (Suwanski, 2014).It is not fair if the mother and father feel devastated by the fact that they cannot bond with their baby and so I will make it happen to reduce the chances of overstressing. Here I will ensure that there is some time for the parents to hold the baby and spent time with her. I will educate them on the fact that an infant bond is not always necessarily impacted in the early days of life, but as the baby grows, this means that they will have a lot of time to bond after the treatment is over.

Conclusion

Neonates are the most delicate people in existence yet so innocent. It is therefore heart breaking to see a new born fall sick and cause immense emotional torture to the parents. Emma is suffering from Jaundice and this has reduced her interest in feeding which may further complications of the disease. The only available and most recommended form of treatment is the phototherapy. However the process may put her at risk of contracting hypothermia at her age since her bare skin is being exposed to the environment. The reduced feeding and treatment has reduced the amount of time available for infant bonding and the parents are worried that this bond won’t be established. However using the UVA model for the nursing process will provide a good working framework for me to treat the child as if she were my own and ensure she receives 100% quality care (Lundbye, 2012). I also understand my roles as a counsellor to the parents, to provide hope and support at these hard and trying times. This support is especially relevant to the mother who needs to stay strong to maintain a good supply of breast milk. The model is based on relationships and so I will also maintain good relations with the doctors so as to enhance communication. Good communication will enable the doctor to heed to my call if there are changing signs in the treatment of Emma.