OB preemie NANDA help

[ACNP 2B S1S2RRR]

Hi, I am probably being a goober, but can you guys give me some ideas for possible NANDAS for a premature infant born at 31 weeks gestation, weighing three pounds 10 ounces without a gag reflex? Mother smoked marijuana and cigs until delivery and had no prenatal care, and pt Dx'd with IUGR and SGA.

Thanks, all help is appreciated!!

[pharmgirl]

The child is going to have issues first of all with the lack of gag reflex. If she/he has no gag reflux, what kind of risk is this going to put her if she has issues swallowing? aspiration? How is her breathing? at 31 weeks are her lungs developed? So if her lungs are not fully developed what is the risk? What about the drugs? Will the nicotine and the marijuana have an effect on the baby? how?

there's a start for ya

[ACNP 2B S1S2RRR]

Thank you, I am working on that now. Yeah, I was being a goober

So far, these are the NANDAS that I have found suitable for my pt. I know that in several instances I have "risk for" NDX as well as the actual NDx. I know that I need to decide which one is correct, but I really wanted to make sure that I was prioritizing my NANDAs right since this is my first newborn careplan. I'll go back later and make adjustments as deemed necessary.

I must pick 5 of these NANDAs (the most significant) for my preemie, and I think that I am going to choose five pertaining specifically to this pt rather than to newborns in general because several of these NANDAs would be used on all newborns.

Would I put the NANDAs pertaining to drug abuse by the mother at the top since this has contributed to the IUGR, SGA, and PROM medical complications?

Contamination (exposure to cig and tobacco smoke in utero... does this NANDA address environmental exposure only?)

ineffective protection

failure to thrive (I've never used this one, but I heard my OB teacher use it in lecture. She just mentioned this NDx and did not explain how to use it, so I don't even know if this fits for this pt but it sounds like it should. Shouldn't this be the first NDx in order of priority?)

risk for impaired skin integrity

risk for injury

risk for falls

risk of infection

Risk for contamination (exposure to cig and tobacco smoke)

Ineffective Airway Clearance

impaired oral mucosa

impaired swallowing

Risk for Aspiration

risk for suffocation

Impaired Gas Exchange

ineffective breathing pattern

impaired spontaneous ventilation

Risk for SIDS

ineffective renal, hepatic, peripheral, and cardiopulmonary tissue perfusion (aeb hyperbilirubinemia, jaundice, abnormal CBC values with abnormal values placed here,

delayed growth and development (IUGR, SGA, exposure to THC and radicals in-utero, insufficient nutrient intake, deficient levels of GH secondary to premature birth AEB pt's length and weight below expected values---with actual values)

hypothermia

impaired thermoregulation (low body fat content secondary to premature status and insufficient intake, absence of body hair secondary to premature birth)

risk for disproportionate growth

Risk for delayed development

ineffective infant feeding pattern

Nutritional deficit: less than body requirements

deficient fluid volume

risk for unstable blood glucose

Total incontinence

total self-care deficit

disorganized infant behavior

impaired verbal communication

relocation stress syndrome

impaired social interaction

interrupted family processes

impaired attachment

Deficient Diversional Activity (at hospital and at home r/t prioritized healthcare and lack of downtime with infant...at home r/t parent negligence, presence of eight other children, mother unable to meet leisure demands of infant, absence of stimulation from mother while under the influence of marijuana)--- the healthcare worker cannot be blamed for this issue. This is a consequence of not having enough staff on the unit and inability of hospitals to hire more staff due to funding issues, but this is a NDx that is indicated in newborns, right?

stress overload

fatigue

I hope that I prioritized these right, but this is my first newborn careplan and my first preemie careplan. I've probably made several errors in the prioritizing errors, though. Thank you to all who took the time to assist me in this task!!! God Bless!

[pharmgirl]

OB is sooo not my thing either. Give me a good code! lol.....As far as prioritizing the dx, we were taught to always (kid, gero, alien, whatever) think ABC first and then move to Maslow's. Hope that helps you prioritize

[ACNP 2B S1S2RRR]

Thanks for the assistance! I think I've got it now. Yeah, that makes sense... ABC's before Maslow. Don't think they taught us that way, but maybe I just missed something. That clears up a lot of issues I've been having with prioritizing, though. Thanks!

[mhan]

Hi, I am a new member and a student as well. I don't think that you need to think ABC and than move to Maslov, because the bottom of pyramid is ABC. It just helps to prioritize your physiological needs.

[NicuGal, MSN, RN]

With Preemies, their lung issues are always top of the list, it is hard to say with the little info you give.

Most likely has RDS, lack of gag...could be just prematurity, the kid could be younger than 31 weeks if mom didn't have prenatal care. Could be something neuro like a bleed from in utero too.

Nutrition usually is second...but the thing with the lack of body hair...preemies are usually kind of hairy since all preemies have lanugo in utero lol Lack of hair doesn't have anything to do with temp instability, it is lack of fat lol They hypoglycemia is good..SGA kids have a higher incidence of having glucose instability.

What about sepsis? A mom without prenatal care has a higher chance of having a baby with sepsis.