Newborn careplan-Nanda Diagnosis Elimination

[rhoangel123]

Hello,

I am a nursing student. I am stuck on a care plan. I have a newborn with a preliminary diagnosis of Transient Tachypnea of the Newborn. I am stuck on a NANDA diagnosis for elimination. This infant was 0-2 hours old when I was observing it. I am supposed to pick NANDA diagnosis for an infant who voided but has not yet has a stool. What would be an accptable NANDA diagnosis for elimination? I have been trying to figue this one out for a few days now.

Thank You

[Coffee Nurse, BSN, RN]

Do you have to choose an elimination-related diagnosis? For a kid with TTN who's not even three hours old, lack of stool would not even be on my list of concerns.

[rhoangel123]

Yes, we have a long assessment form which we are required to fill out, a section for each system. Elimination along with everything else requires a NANDA diagnosis. It can be wellness, risk for or actual problem such as constipation. After we come up with a NANDA for each system, we then choose the top two concerns and careplan those. I was thinking of choosing impaired gas exchange and possibly ineffective thermoregulation for my top two. The other systems are really stumping me.

[Coffee Nurse, BSN, RN]

Maybe Risk for Dysfunctional Gastrointestinal Motility, i.e. necrotizing enterocolitis? Was the baby a preemie? Had they started feeding?

[rhoangel123]

The infant was 38 wks gestation, Repeat C-Section, forceps and vac assist dilivery. The Dr couldn't get infant out right away and amniotic sac was still over infants head. Infant swallowed fluid just before birth. It took a lot of suctioning to get airway cleared. Weighed 6 pounds 16 oz. Would not turn pink for a while. Apgars were 7 at 1 min and 9 at 5 mins. Required radiant warmer with Servo. My thought was, is it ever a problem with constipation due to stress right after birth? I am trying to figure if I should anticipate a problem or could do a risk for or wellness diagnosis. What do statistics show about an infant with transient tachypnea and ailementary or other systems besides respiratory and circulatory?

[rhoangel123]

By the way the infant was 2 hours old when I left the floor, had voided and was just starting to breastfeed.

[Coffee Nurse, BSN, RN]

I was thinking about the fact that they might delay feedings secondary to the tachypnea and concerns about aspiration, but evidently that wasn't the case. I can't think of any connection between stress and elimination problems, either; if there had been a prolonged hypoxic episode after birth, the kidneys might have taken a hit, but Apgars of 7 and 9 don't suggest that. I think a wellness diagnosis might be in order.

[gatherswool]

Hmm....I'm a PNP, so my NANDA knowledge isn't too fresh, but I do work in a well nursery. A term baby with a difficult delivery and subsequent TTN will usually have the following issues:

amnio-filled lungs

immediate inability to feed due to tachypnea

subsequent breastfeeding difficulties secondary to mom/baby separation

feeding difficulties due to aggressive suctioning (oral defensiveness)

The latter two could result in delayed stooling (not constipation). I have yet to see constipation in the normal newborn population; at least not in-hospital. If a baby gets formula instead of breastmilk s/he might eventually develop constipation, but any delay in stooling in the first few days of life is either related to inadequate intake, to narcotics for NAS, or to a more serious condition like an obstruction or Hirschsprung's. Birth stress doesn't cause constipation; if anything babies mec when distressed.

Would it be cheating to list incontinence; total?

(I'm only partly kidding; those diapers DO have to be changed!)

Good luck, and I hope you enjoyed your newbie!