Mind map
Pre-mature Birth
Mind map: Premature birth nursing care plan
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Pre-mature Birth
2. Impaired nutrition related to esophageal reflux as evidenced by baby spitting up food.
- Assessment Evidence: Patient drank approx. 60 ml of formula and spit up and saturate a burp cloth within an hour of finishing.
- Intervention: Nurse will incline patient's bed.
- Intervention: Nurse will administer patient's prescription for Prevacid.
- Intervention: Nurse will burp patient after feedings.
- Outcome: Patient continued to spit up throughout shift.
- Intervention: Nurse will burp patient after feedings.
- Intervention: Nurse will administer patient's prescription for Prevacid.
3. Constipation related to dehydration as evidenced by lack of bowel movement.
- Assessment Evidence: Patient passes gas regularly but has not had a bowel movement in the last 24 hrs.
- Intervention: Nurse will feed infant 2ml of prescribed prune juice twice a shift.
- Intervention: Nurse will change the patient's formula to one that aids with constipation per doctor's order.
- Outcome: Patient did not have a bowel movement.
- Intervention: Nurse will change the patient's formula to one that aids with constipation per doctor's order.
1. Impaired gas exchange related to underdeveloped lungs as evidenced by tachypnea and low oxygen saturation.
- Assessment Evidence: Patient's respiratory rate frequently escalated to 75-88/min throughout the day. Patient also had 1 liter of 30% oxygen via nasal cannula throughout the day.
- Intervention: Nurse will ensure infant resuscitation equipment is nearby in case of respiratory emergency.
- Intervention: Nurse will increase oxygen concentration and volume to 1.5 liters and 35%.
- Intervention: Nurse will keep monitor on patient's foot for 24/7 observation.
- Outcome: Patient remained stable throughout shift but still experienced de-sats and tachypnea.
- Intervention: Nurse will keep monitor on patient's foot for 24/7 observation.
- Intervention: Nurse will increase oxygen concentration and volume to 1.5 liters and 35%.
4. Interrupted family process related to baby being in the NICU as evidenced by infrequent family visits.
- Assessment Evidence: the patient had no visitors in the last 24 hrs.
- Intervention: Nurse will call parents to see if they would like to visit.
- Intervention: Nurse will ask parents if they would like to meet with a social worker.
- Outcome: Family did not come to visit during shift.
- Intervention: Nurse will ask parents if they would like to meet with a social worker.