Documenti di Didattica
Documenti di Professioni
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ON
SUBMITTED To
MRS.V.JAYANTHI,M.SC.(N)
LECTURER,
SUBMITTED BY
S.PALANIAMMAL,
OBSTETRICS AND
GYNAECOLOGICALNURSING ,
COLLEGE OF NURSING
COLLEGE OF NURSING,
CHENNAI-03.
CHENNAI-03
SIGNATURE OF FACULTY
NICU plays a critical role in reducing infant mortality rate (IMR) in poor urban
populations
Even in a metro city like Bangalore only some private hospitals have NICU and are
expensive
An NICU at a nominal cost will benefit many and save the babies.
To improve babies chances of survival and minimise the morbidity associated with
being born either premature or term and sick. It is a high cost, low throughput service
in which clinical expertise is a key determinant of the quality of the outcomes for the
baby.
To provide a family-centred approach to care, defined as involving families in the
care of their own children, and helping parents understand their babys needs.
To improve quality of care by working in partnership with other provider units and
service commissioners within Operational Delivery Networks (ODNs) as part of the
broader Maternity and Childrens Strategic Network. This will ensure integration
across the whole maternity and childrens pathway of care.
The service will deliver the aim to improve both life expectancy and quality of life for
newborn babies by:
Ensuring neonatal outcomes are in line with the type of unit where babies are cared for.
Ensuring neonatal outcomes across an ODN are in line with other ODNs across England
& Wales.
Delivering care in a family-centred way that seeks to minimise the physical and
psychological impact of neonatal care on the baby and their family, for example by
improving psychological outcomes and breastfeeding rates.
Providing an environment where parents are enabled to make informed decisions about
treatment and become involved in the care of their baby / babies, thereby minimising the
psychological trauma of premature or sick term babies.
provide services to women with uncomplicated pregnancies and newborn infants without
complications
undertake appropriate management, including consultation with, or transfer to a higher
level of care (if required)
undertake immediate management of unanticipated complications arising in a newborn
baby.
Level 2:Larger hospitals that, while providing for all Level 1 services, also:
provide services for the diagnosis and management of selected at-risk pregnancies and
neonatal conditions (excluding intensive care)
participate as a local hub in the network established to provide consultative services and
perinatal education.
Level 3
Large tertiary maternity and childrens hospitals that provide neonatal intensive care as
well as a broad range of sub-specialty consultative and paramedical services.
They may also provide Level 1 and Level 2 neonatal care.
PRINCIPLES OF SAFE AND STABLE TRANSPORT TO NICU :neonatal transport:-Ideally all infant from high risk preganancies should be delivered in
maternity units attached to a level III NICU. Some babies may be born prematurely or term
babies may become sick after birth and hence need to be transferred
In-utero transfer:-If problem is known or arises in early labour, the preganant women is
transferred before delivery to a high risk prenatal center.
Ex-utero transfer:-Inter hospital transport of the baby is considered if the medical resources or
personnel needed for high risk baby are not available at the hospital
CRITERIA FOR ADMISSION OR TRANSPORT TO NICU:
Centralized O2 supply, suction facilities, incubators/open care system, vital signs and
transcutaneous ventilators and infusion pumps.
Physical facilities
Temperature of the unit-The temperature inside the unit should be maintained at 28o
29oC while the humidity must be above 50%
Shifting facilities
Physical Set up (Size)-The NICU can be in a single area or it can be in multiple
rooms with a capacity of 2-4 infants each.
Bed Strength of NICU-30 Intensive care beds would be reapured for our country.
ASPECTS OF NICU:Two main important aspects in NICU -Physical Set up, Administrative set up
PHYSICAL SET UP -SPACE BETWEEN THE PATIENT:
Resuscitation set - 6
OPEN care system
- 4
Incubators
- 2
Infusion pumps - 12
Positive pressure ventilators - 6
O2 Hoods, O2 Analyzers - 6
Heart rate apnea monitors without scope-6
Phototherapy Unit-6
Electronic Weighing Scale-12
Pulse Oxymetres -6
Trans cutaneous PO2 and PCO2 monitors 2-3.
Non invasive B.P. monitors -1-2.
Invasive B.P. monitors 1-2
ECG Monitor without Defibrillator-1
Intracranial Pressure Monitor -1.
Layout map for a single corridor special neonatal intensive care unit for 24 infants
NEONATAL CONDITIONS MANAGED ACCORDING TO LEVEL OF CARE:Three levels of care are described.
Variations in services may be warranted based on the needs of individual patients, resources and
limitations unique to the hospital or type of practice. When present, variations in service
provision require documentation.
Level 1:- Uncomplicated- gestation 37 weeks or greater, birthweight 2,500 grams or greater
The majority of preterm infants born at 35 or 36 weeks gestation are suff ciently mature
to maintain their body temperature and feed normally enabling observation to occur in
the birthing unit and/or postnatal ward. birthweight 2,000 grams or greater, including
growing preterm and convalescing infants.
Infants requiring incubator care for,short-term transition problems , mild complications:
oxygen requirement (not exceeding 40 per cent), apnoea monitoring, blood glucose
monitoring, short-term intravenous therapy, phototherapy, gavage feeding.
Level 3 high dependency: Uncomplicated -gestation 32 weeks or greater, birth weight 1,300
grams or greater.
Note: The more immature the infant, the greater the complexity of care required and the higher
the risk for assisted ventilation.
PARENTING PROCESS;
Parenting is a process that begins in pregnancy and flowers when parental responsibilities
begins.
The degree of ease and satisfaction with which people make the transition to parenthood
depends mostly on how successfully they have defined and accepted their relationship with each
other.
By using this frame work health providers can help the parents and their significant others gain
the necessary information or experience to bring them to a full awareness of the anticipated
behavior patterns sensations and goals involved in the complementary role s of mother and
father.
This approach assist the parents to be in moving to role mastery of parenthood. The
impending role must be atleast partly rehearsed ,modeled and clarified through a process of
communication with significant others. In so doing the role expectations become clearer and the
partners begin to put themselves into the role of parents .as this is done ,there is a better fit
to the impending role ,with increased confidence leading to role mastery.
Lifespan cycles and role transition inpregnancy;
Family researchers have outlined four broad stages in a role cycle that have implications for
pregnancy and parenthood.
Anticipatory stage;
Formal or informal training for the role. Socializes the incumbent to-be; may take place years
before; no role modeling for the pregnant role.
Couples in the anticipatory stage experience many intense feelings ,challenges and
responsibilities. If used correctly this can be an opportune time to test skills in preparing to
accept integrate the new family member into the system.
Honey moon stage;
Immediately follow the assumption of the role ;exploration and adjustment to the fit of the
role to the incumbent ;reality testing.
The honeymoon stage refers to the postpartum period during which an attachment between the
parents and infant is achieved through prolonged contact and intimacy(Rossi 1968).
It is an intense period when the mother and their new family member and their relationships to
the infant ,who, in turn ,is working out a complicated communication system with the parents so
that his or her survival is assured. The couples personal relationship is no less important ,but
most of their energies at this time are focused on developing the new relationship with the infant.
Plateau stage;
Role is fully exercised; validation of role adequacy.
Disengagement stage or termination stage;
Immediately proceeds and includes role termination ;sometimes tangible (pregnancy); sometimes
less distinct (parenthood)
Laboring for relevance;
In a study using grounded theory, Jordan (1990) used the term laboring for relevance to describe
the essence of the experience of expectant and new fatherhood . This concept encompasses
intrapersonal and interpersonal aspects. The man labors to incorporate the parental role into his
self identity as a salient and integrated component of his personhood and to be seen as relevant to
child bearing and child rearing by others.
Laboring for relevance is the three-part process that consists of the following;
Parent infant fit including satisfaction with sex of infant compatibility of infant state
with parents and compatibility of temperament of all parties.
Attachment process;
Positive reciprocal feedback; it includes verbal non verbal an social real or perceived responses
of infant to parent and parent to parent, which make the interactions mutually satisfying.
Claiming behavior; leading to identification of the newborns as theirs and identify with him or
her gradually expands the new borns identity; seeing infants as like them in some respects and
different from them in others.
Mutuality in interaction; the newborn has and develops a repertoire of behaviors that calls forth
corresponding behaviors in the parents, particularly the mother ;these behaviors initiate and
maintain contacts with their parents. Signaling behaviors (crying,cooing,smiling) executing
behaviors(rooting,suckling,grasping) are crucial in bringing the parents near and maintaining
contact.
CONCLUSION;
We have discussed about the organization of neonatal intensive care unit, transportation, levels
of services, administration and parenting process.
BIBLIOGRAPHY:
Adelle Pillitery (2006) Maternal and Child Health Nursing, 2nd edition, Lippincott and
Williams Publishers.
D.C. Dutta (2004), Text book of Obstetrics, 6th edition, Published by New central Book
Agency (P) Ltd.,
V. Ruth Bennet (2005) Myles Text Book for Midwives, 12th edition, Published by English
Language Book Society
Lowdermilk, Maternity and Womens Health Care 9th edition, Mosby, Missouri.
Susan A.Orshan Maternity, Newborn & womens Health Nursing First Edition, 2008.
Lippincott & Williams Publication.
Danfortis Obstetrics & Gynecology 9th Edition. Lippincott & Williams Publication.
Reeder .Martin koniak-griffin Maternity Nursing 19th edition. Wolters kluwer and
lippincot Williams publications ,Philadelphia.