S/S: malabsorption, diarrhea, and failure to thrive Tx: during surgery every effort is made to preserve as much bowel as possible; mainstay treatment is nutritional support; TPN primary source of nutrition; enteral nutrition started as soon as possible to allow intestines to adapt to food Nurse manages infant’s TPN and enteral feedings Strict aseptic technique during TPN feedings through central line
33 Nurse carefully assesses and documents infant’s tolerance to enteral feedings and notes any signs of dehydration, electrolyte imbalances and nutritional deficits Nonnutritive sucking provided as well Caring for the SGA/LGA infant – 2 o SGA o Therapeutic management is focused on prevention with good prenatal care to identify and treat problems early o When growth restriction cannot be prevented, ultrasound exam may permit early discovery of the condition o Serial nonstress tests and biophysical profiles may help determine if the infant should be delivered early and preparation can be made for the expected complications at birth o Problems during and after birth are treated as they occur o They may include asphyxia, meconium aspiration, hypoglycemia, and polycythemia o SGA infants have a greater surface area and higher metabolic rate than infants who are appropriate for gestational age o This increases their risk for temperature instability o Care must be adapted to the specific problems of the infant o When signs of growth restriction are present, the nurse must observe for complications that commonly accompany it o The general appearance and measurements give an indication of the type of growth restriction that has occurred o Nurse should assess for hypoglycemia o Caloric needs are greater than normal infant, making early and more frequent feedings important o Temperature and respiratory support are additional concerns o Observation for jaundice is important in infants with polycythemia o LGA o Therapeutic management based on identification of increased size during pregnancy by measurements of fundal height and ultrasound exam o Delivery problems may lead to use of vacuum extraction, forceps, or c- section o Birth injuries and complications are treated as they arise o The nurse assists in difficult delivery and c-section resulting from dystocia when the infant if LGA o After birth the infant is carefully assessed for injuries or other complications such as hypoglycemia or polycythemia o Nursing care is geared to the problem presented Gavage feedings – 1 o Usually started before oral feedings for preterm infants
34 o A small, soft catheter is inserted through the nose or mouth every 2-3 hours for intermittent (bolus) feedings o An indwelling catheter may also be used to provide for intermittent or continuous feedings o Inserting the catheter at each feeding may be more traumatic than leaving it in place o Frequent oral placement may cause vomiting or increase infant aversion to oral stimuli, which may lead to difficulty with oral feedings later o
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- Fall '15