THE NEONATE AT 24 TO 48 HOURS FOLLOWING EARLY DISCHARGE

THE NEONATE AT 24 TO 48 HOURS FOLLOWING EARLY DISCHARGE -...

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THE NEONATE AT 24 TO 48 HOURS FOLLOWING  EARLY DISCHARGE This plan of care focuses on the infant who is discharged within 30 hr of birth. It is intended to be used in  conjunction with the CP: The Neonate at Two Hours to Two Days of Age. Although early discharge may be  detrimental to a few infants, newborn health appears to hinge more on the parent(s) level of knowledge and support at  home. The home assessment at 24–48 hr following discharge involves evaluation of the newborn’s ability to adapt  positively to extrauterine life. NEONATAL ASSESSMENT DATA BASE To meet the stringent criteria for early discharge, the newborn must be a normal, healthy infant as determined by  thorough physical examination: Gestational age, 38–42 wk; birth weight, 2500–4000 g; vital signs and temperature  stable; Apgar score greater than 7 at 1 and 5 min; normal elimination pattern; and successful feeding. DIAGNOSTIC STUDIES Hct:  40%–61% Coombs’ Test:  Negative Screening tests, including PKU and thyroid tests, dependent on individual risk factors and agency policy NURSING PRIORITIES 1. Support transition of newborn to extrauterine life. 2. Promote positive parent-infant interaction. 3. Provide support and information regarding home care of infant. NURSING DIAGNOSIS: NUTRITION: altered, less than body requirements May Be Related To: Inability to ingest adequate nutrients (because of fatigue, excessive  oropharyngeal secretions) Possibly Evidenced By: Weight loss, decreased urine output, dry mucous membranes, poor  skin turgor, sunken fontanels DESIRED OUTCOMES/EVALUATION  Be adequately hydrated with normal urine output. CRITERIA—NEONATE WILL: Display weight loss less than 10% of birth weight. ACTIONS/INTERVENTIONS RATIONALE Independent Weigh newborn. Compare weight with birth weight  Nutrient needs are based on body weight. Weight  and discharge weight. gains or losses indicate adequacy of intake. Neonates  need 100–120 kcal/kg (54 cal/lb) each day. Only  breast milk or formula should be given. Feedings  should be provided approximately every 3 hr (6–8  times a day) or on demand. Average fluid  requirements are 5 oz/kg per 24 hr.
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Determine condition of fontanels, skin turgor,  Depressed fontanels, poor skin turgor, and dry  amount of mucus production. Observe newborn  mucous membranes suggest dehydration.  for jitteriness or lethargy. Jitteriness may indicate hypoglycemia.
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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THE NEONATE AT 24 TO 48 HOURS FOLLOWING EARLY DISCHARGE -...

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