Help with Newborn Nursing Diagnoses

mindlor · Mar 14, 2012

Assessment is the first part of the nursing process.

Without a database generated from an assessment your only choice is going to be a fictional account.....

cndn_grl08 · Mar 14, 2012

Well an assessment was done after delivery, which I was not a part of. And like I said, other than the two things I mentioned, everything else seems to be normal. There is nothing in the chart regarding abnormal assessments or concerns at all. This is what is making it hard for me to come up with anything. I have done the "impaired thermoregulation" and "effective feeding" and what not that can be used with pretty much any newborn, but I feel like there should be at least one that relates to THIS babe specifically.

mindlor · Mar 14, 2012

was the passing of meconium normal?

Are you allowed a "risk for" diagnosis?

cndn_grl08 · Mar 14, 2012

Definitely allowed risk for diagnoses. The passing of the meconium was during delivery, which is abnormal. It is usually passed within 24 hours of birth.

mindlor · Mar 14, 2012

Do a little checking on google of some connditions that may be indicated by early passage of meconium....

CF comes to mind for some reason but dont hold me to it.....

If it is CF, then of course you need to take that medical diagnosis, translate it to nursing talk, then target interventions mainly at respiratory and digestive systems possibly?

Also little ones are usually always at risk for violence for many reasons.....so dont be afraid to go down the psychosocial trail. In fact, I am betting that if you come up with a good psychosocial one your teacher would be happy.

mindlor · Mar 14, 2012

The beauty of risk for is they of course have no as evidenced by portion which gets you off the hook for assessment data

EricJRN, MSN, RN · Mar 15, 2012

I agree with mindlor that it's hard to know exactly how to proceed when they're asking you to use the ADPIE process out of sequence. Even still, we can probably come up with some possibilities. I'm not a nursing diagnosis guru and I don't have a reference manual on me, but I help you with some of what we look for.

Mindlor is right that there is a link between CF and meconium - it just has the opposite effect. CF kiddos commonly present with meconium ileus - where mec is not passed at all within the first couple of days - rather than meconium-stained amniotic fluid. Meconium staining may stem from a fetal hypoxic event or vagal issue, but it sounds like your baby is unlikely to have been significantly affected by hypoxia.

Think about some of the precautions that providers and parents routinely take with newborns. Your baby will likely have a hat and blankets and even after discharge the parents will avoid taking the baby out in cold weather, so that may suggest a risk diagnosis to you.

There's some association between meconium staining and perinatal sepsis. Read up a little bit on the amniotic fluid changes that occur when it is stained with meconium. I'm not sure how you'd phrase that in your care plan, but it might get your thinking started. (That same risk diagnosis really exists for any neonate.)

Although it won't be your priority, are there any procedures or tests that a newborn might go through that could cause discomfort?

It's tempting to go down the path of blood loss, but the kid is probably not hypovolemic if he's chilling in mother-baby and feeding well.

Sometimes the respiratory signs and symptoms of meconium aspiration syndrome don't present immediately, but if it's been a few hours and the kid is fine, you're probably not too worried about MAS.