Neonatal intensive care nursing / edited by Glenys Boxwell.

Format:

Book

Contributor:

Boxwell, Glenys, 1957-

Language:

English

Subjects (All):

Neonatal intensive care.

Newborn infants--Diseases--Nursing.

Newborn infants.

Intensive care nursing.

Intensive Care, Neonatal--methods.

Neonatal Nursing--methods.

Infant, Newborn, Diseases--nursing.

Infant, Premature, Diseases--nursing.

Newborn infants--Diseases.

Medical Subjects:

Intensive Care, Neonatal--methods.

Neonatal Nursing--methods.

Infant, Newborn, Diseases--nursing.

Infant, Premature, Diseases--nursing.

Physical Description:

xxix, 455 pages : illustrations ; 25 cm

Place of Publication:

London ; New York : Routledge, 2000.

Summary:

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Contents:

1 Advanced neonatal nursing practice / Fiona Allan 1

Factors influencing the development of the neonatal nurse role 2

The developmental history of the Advanced Neonatal Nurse Practitioner role 4

Legal aspects of advanced neonatal nursing practice 5

Potential areas in neonatal care for advancing neonatal nursing practice 6

Evidence-based neonatal care 7

2 Developmentally focused nursing care / Tilly Reid, Yvonne Freer 14

Theories on developmentally focused care 15

Behavioural assessment 19

Sleep-wake states 21

Behaviour 24

The NICU environment 24

Noise hazard 26

Light hazard 26

Handling 28

Contingent care 28

Postural support 30

Equipment 32

Prone position 32

Supine position 33

Side-lying position 34

Developmental models of care 34

3 Resuscitation of the newborn / Glenys Boxwell 43

Asphyxia 44

Anticipation 46

ABC(D and E) of resuscitation 47

Airway 48

Breathing 48

Circulation 50

Drugs 51

Meconium stained liquor 56

Evaluation of resuscitation 57

4 Management of thermal stability / Pauline Fellows 64

Embryology 65

Mechanisms of heat gain 66

Vasoconstriction 66

Thermal receptors 66

Non-shivering thermogenesis 67

Thermoneutrality 69

Mechanisms of heat loss 70

Conduction 70

Convection 70

Radiation 70

Evaporation 71

Heat exchanged through the respiratory tract 71

Surface area 71

Immature skin 71

Transepidermal water loss (TEWL) 72

Respiratory water loss 73

Thermal instability 73

Hypothermia 73

Cold stress 74

Neonatal cold injury 74

Re-warming in severe hypothermia 75

Hyperthermia 76

Management of thermal stability at delivery 76

The healthy infant 76

Delivery by cesarean section 77

The asphyxiated infant 77

Meconium stained liquor 77

The low birth weight infant 77

Management of thermal stability in the NICU 79

Radiant warmers 79

Incubators 80

Radiant warmers vs incubators 81

Humidity 81

Skin 83

Heated water-filled mattresses 83

Thermal status during transport 84

Temperature measurement 85

Continuous monitoring 85

Intermittent temperature recordings 86

Localised hypothermia following birth asphyxia 86

5 Management of respiratory disorders / Joan Cameron, Julie Haines 96

The development of the respiratory system 97

Respiration in the neonate 100

Respiratory distress syndrome (RDS) 101

Pneumonia 103

Meconium aspiration syndrome (MAS) 104

Pneumothorax 106

Pulmonary haemorrhage 107

Acid base balance 108

Respiratory support 113

Continuous positive airway pressure (CPAP) 113

Positive-pressure ventilation 114

High frequency ventilation (HFV) 119

High frequency jet ventilation (HFJV) 119

High frequency flow interrpution (HFFI) 119

High frequency oscillation (HFO) 120

Negative extrathoracic pressure 121

Extracorporeal membrane oxygenation (ECMO) 121

Nitric oxide (NO) 122

Liquid ventilation 123

6 Cardiovascular management / Margaret Howat 129

Cardiac embryology 130

Development of the heart 130

Formation of the four chambers of the heart 132

The endocardial cushions 132

The atria 132

The ventricles 132

Formation of the aortic and pulmonary trunks 133

The fetal circulation 133

Transition from fetal to neonatal circulation 136

Cardiac function 137

The cardiac cycle 137

Blood pressure 137

Regulation of blood pressure 138

The management of blood pressure 138

Congenital heart defects 139

Patent ductus arteriosus 140

Transposition of the great arteries 141

Hypoplastic left heart syndrome 142

Coarctation of the aorta 143

Congestive heart failure 144

Nursing management 145

Clinical assessment 145

Physical examination 145

Evaluation of the pulses, peripheral perfusion and blood pressure 146

Palpation of the chest wall and the liver 147

Auscultation 147

Care plan 147

Family support 148

7 Brain injury in the premature infant / Victoria Cullens 152

Introduction: the vulnerability of the premature infant brain 153

Subependymal germinal matrix 153

Periventricular vascular anatomic factors 153

Alterations to cerebral blood flow 154

Hypoxic-ischaemic reperfusion injury 154

Risk factors for brain injury 154

Periventricular-intraventricular haemorrhage (PIVH) 156

Clinical features 156

Parenchymal haemorrhagic infarction 157

Periventricular leukomalacia (PVL) 157

Management 158

Prevention of brain injury in the premature infant 158

Pharmacological interventions 159

Acute management 159

Post-haemorrhagic ventricular dilatation 159

Nursing management 160

The outcome of brain injury in the premature infant 160

Periventricular-intraventricular haemorrhage 160

Parenchymal haemorrhagic infarction 161

Periventricular leukomalacia 161

8 Haematological problems / Jackie Dent 164

Jaundice in the newborn 165

Physiology of bilirubin production 165

Bilirubin metabolism and excretion 165

Predisposing factors to physiological jaundice in the newborn 167

Other causes of jaundice 167

Rhesus incompatibility 167

ABO incompatibility 169

G6PD deficiency 169

Breast feeding 170

Management of jaundice 170

Investigation of jaundice 171

Phenobarbitone 172

Intravenous albumin 172

Metalloporphyrins 172

Phototherapy 173

Exchange transfusion 175

Kernicterus (bilirubin encephalopathy) 177

Haemorrhagic disease of the newborn/vitamin K deficient bleeding 177

Disseminated intravascular coagulation (DIC) 180

Signs of DIC 180

Management 181

Anaemia 181

Top-up transfusions 183

Iron supplementation 184

Recombinant erythropoietin 184

9 Pain and comfort in neonatal intensive care / Pamela East 188

Theory of pain 190

Infant response to pain and distress 191

Chemical responses 192

Behavioural response 192

Physiological response 194

Assessment of pain in a non-verbal client group 194

Pain assessment tools 195

Potential consequences of untreated pain 198

Relief strategies 199

Non-pharmacological measures 199

Pharmacological measures 201

10 Fluid and electrolyte balance / Dee Beresford, Glenys Boxwell 211

Embryological development 212

Physiology of urine production 212

Sodium balance 213

Hyponatraemia 214

Hypernatraemia 215

Potassium balance 215

Hypokalaemia 216

Hyperkalaemia 216

Chloride balance 216

Calcium and phosphate balance 217

Water management 217

Fluid requirements 218

Monitoring fluid balance 218

Glucose homeostasis 220

Renal handling of glucose 220

Hypoglycaemia 221

Hyperglycaemia 223

Acute renal failure 224

Investigations 224

Management 225

Dialysis 226

Peritoneal dialysis 226

Continuous haemofiltration 228

11 Nutritional management of the infant in the NICU / Kaye Spence 234

The gastrointestinal system 236

Outcomes of nutrition 238

Growth 239

Assessment 240

Feeding the NICU infant 241

Requirements 242

Parenteral nutrition 243

Enteral nutrition 244

Methods 245

Specific problems in the NICU 248

Family support 249

12 Neonatal infection / Glenys Boxwell 259

Acquisition of antenatal infection 260

Acquisition of intrapartum infection 262

Late onset and nosocomial infection 263

The susceptible host 264

Signs of neonatal sepsis 268

Respiratory signs 268

Thermal signs 269

Cardiovascular signs 269

Skin signs 269

Abdominal signs 270

Neurological signs 270

Investigations 270

Surface swabs and site cultures 270

Haematological tests 272

Cerebrospinal fluid 273

Urine 273

Management of the infected newborn 274

General supportive therapy 274

Antimicrobial therapy 276

Adjunctive therapies 279

13 Diagnostic and therapeutic procedures / Elizabeth Harling 285

Gastric tube placement 286

Naso/orogastric

tube 286

Transpyloric tube 287

Endotracheal tube placement 289

Chest drain placement 291

Blood sampling 294

Capillary blood sampling 294

Venous blood sampling 296

Arterial blood sampling 297

Peripheral vein cannulation 298

Peripheral artery cannulation 300

Peripheral venous longline 301

Umbilical vessel catheterisation 303

Umbilical vein catheterisation (UVC) 303

Umbilical artery catheterisation (UAC) 305

Lumbar puncture 307

Urine sample collection 309

Suprapubic aspiration 309

14 Neonatal anaesthesia / Beverley Guard, Liam Brennan 316

Preoperative assessment 317

Problems of prematurity affecting anaesthesia 317

Associated congenital/chromosomal abnormalities 318

Familial anaesthetic problems 320

Preoperative investigations and preparation 320

Investigations 320

Preparation 321

Premedication 321

Transfer to the operating theatre 322

The operating theatre environment 322

Intraoperative management 322

Induction of anaesthesia 322

Airway management 323

Maintenance of anaesthesia 324

Emergence from anaesthesia and extubation 324

Analgesia 325

Opioids 325

Paracetamol 326

Non-steroidal anti-inflammatory drugs 326

Local anaesthesia 326

Fluid therapy 329

Maintenance fluid 329

Replacement of fluid lost by evaporation/sequestration 329

Replacement of blood loss 330

Anaesthetic equipment 330

Airway equipment 330

Breathing systems 332

Ventilators 334

Equipment for maintenance of body temperature 334

Equipment for intravenous fluid administration 335

Anaesthetic monitoring 335

Cardiovascular monitoring 335

Respiratory monitoring 336

Temperature monitoring 337

Postoperative care 337

Postoperative apnoeas 337

Post-extubation stridor 338

Respiratory insufficiency 338

Assessing the need for postoperative ventilation 339

15 Surgical aspects of neonatal intensive care nursing / Stevie Boyd 343

General principles of management 344

Thermoregulation 345

Respiratory function 345

Gastric decompression 345

Fluid and electrolyte balance 345

Pharmacological support 347

Transportation 347

Postoperative considerations 347

Most commonly encountered congenital disorders 347

Oesophageal atresia (OA) and tracheo-oesophageal fistula (TOF) 347

Mechanical intestinal obstruction 352

Congenital diaphragmatic hernia (CDH) 358

Abdominal wall defects 362

Most commonly encountered acquired disorders 366

Necrotising enterocolitis (NEC) 366

Spontaneous bowel perforation 368

Miscellaneous disorders 369

Cystic hygroma 369

Teratoma 370

Ovarian cyst 370

Testicular torsion 371

Biliary atresia 371

16 Neonatal transport / Stevie Boyd 377

The transport team 378

Transport vehicles 380

Hazards of transportation 380

Equipment required for transporting a sick neonate 382

At the referral unit 383

At the referring unit 384

The parents 385

The return journey 385

Back at the referral unit 386

Legalities involved with transporting a sick neonate 386

17 Family support / Cath Henson 389

Family support

a definition 390

Family-centred care 390

The components of family support 391

The caregiver group 391

The recipient group

the infants and their families 392

The neonatal environment 393

Strategies for providing family support in the neonatal setting 394

Supporting the family in the antenatal period 394

Supporting the family during the admission period 394

Being aware of the profound effects of separation 396

Supporting the family during the discharge preparation period 397

Supporting the family of the dying infant 398

Basic principles of family support 399

Working in partnership with parents 399

Facilitating parents' attachment with their infant 403

Planning programmes of family support 404

18 Ethics and neonatal nursing / Helen McBean 412

Ethical theories: an overview 413

Utilitarianism or consequentialism 413

Deontological or Kantian theory 414

Virtue-based theory 414

Rights-based theory 414

Ethical principles 415

Respect for autonomy 415

Non-maleficence 416

Beneficence 417

Justice 417

Fetal rights 419

Respecting maternal autonomy: the giving of informed consent 420

Should fetal rights exist? 421

Ethics in practice 423

19 Medication in the newborn / Catherine Hall 430

Pharmacokinetics 431

Therapeutic drug monitoring (TDM) 436

Unlicensed medicines 437

Drug administration 438

Appendix Normal values in the neonate 443.

Notes:

Includes bibliographical references and index.

ISBN:

0415203392

OCLC:

42772951