Introduction to Nursing Management
Nursing management can be determined as the performance related to the function of leadership of decision making and governance within the organization that is employing nurses. Further, it included all the functions for management like organizing, staffing, controlling, directing and planning. There are different type of department that are handled by nurses. Present report is based on a case of Joshua who was born within 29 weeks gestation and it was found that he has respiratory distress. This report covers priorities of nursing management admission to neonatal nursery. Further, it covers short and long term complications of using CPAP (Continuous positive airway pressure). Lastly, it also includes long term problems that Joshua and his family will experience due to Joshua's preterm birth.
Five priorities of nursing management
There are different set of priorities that has to be followed by nurses towards the patient. There are many immediate care that has to be provided to new born baby as well. In this context, below given are the five priorities that has to be followed:
Delivering proper care: There are different type of requirements that a patient and their child need. It is important to make sure that all type of services are being delivered to them. In this context, it is the main priority that all the information that is provided by patient is not being disclosed to anyone (Cools, Offringa and Askie, 2015). It is essential that all the basic requirement are satisfied so that delivery can be conducted properly. During delivery time, there are different type of complications that can be caused and for each of the issues or problems, it is important to consider that all things are considered and adequate steps are taken with the help of which complications can be reduced. Further, there should be equipments and tools ready in case of emergency.
Health assessment: It is essential to conduct health assessment. In this context, it includes test like blood pressure, pulse rate, etc. For the baby, it is necessary for the nurse to make sure that all the muscle tone are correct. Further, pulse rate should be checked. Moreover, colour of skin, respiration, etc. should be considered. These are the basic function that needs to be considered by a nurse. When there are issues in relation with any of the determined areas are identified, then immediate steps should be taken so that proper care can be provided. More specifically, there is score that is given by nurses for each of the baby that is born (Kirpalani, Millar and Roberts, 2013). It is given out of 10 and if it is 7 of more than that, then it is considered to be normal. However, in cases if the score is give is between 4 to 6, then this shows that baby should be given resuscitation measures and proper monitoring. In addition to this, if the score is below 3, then immediate life saving techniques and resuscitation should be given.
Physical examination: It is essential to conduct proper physical examination in order to check the signs that there is any type of issues that is identified in the new born baby. At the time, baby is born, there are immediate steps taken in order to make sure that there is not serious issues that are faced by the child. This generally take place within nursery or delivery room but it depends upon the policies that are followed in hospital (Overman, Liu and Moore, 2013). There are different type of procedures that are followed and it includes measurement of heart rate, respiratory rate and temperature. Further, it includes measurement of length, head circumference and weight. It enables to determine whether the growth is normal or not. Special care is provided to babies who are born underweight or are very large and are overweight. Once the temperature of the baby is stabilized, then they are given with first bath. In addition to this, footprints are taken for medical record.
Care to new born: All the babies are observed and those who have normal weight and stabilized body temperature are given bath immediately. On the other hand, child who are born premature are given special care and are kept under observation and care is provided according to their requirement.
Monitoring and observation: At the time when child is kept at CPAP, it is important that proper observation should be made so that all the changes that taken place in child should be observed (Sharma, Clark and Keszler, 2015). It is essential to make sure that there is proper pressure maintained in CPAP so that baby will be able to recover quickly.
In accordance with the case, it can be started that Joshua was a premature baby and weighted 1200 grams. He had issues in relation with respiration and so he was given CPAP. With this respect, it is important to consider that the steps taken by nurses at that point of time were right as the child needed oxygen. In this context, positive pressure ventilation was given so that with time the child will be able to overcome the problem of respiration after proper observation.
Three potential long or short term complications of using CPAP and strategies to reduce risk
CAPA (Continuous positive airway pressure) is a type of positive airway pressure ventilator. This is helpful to apply mild air pressure continuously so that person gets proper oxygen. There are different type of long term complications that are faced by the use of CPAP. In this context, below given are three long term complications:
Bloody nose: This is one of the long term complication that is faced due to CPAP during preterm birth. Further, there is no fixed time in which a person's nose can bleed. In this, there is not pain felt but excess loss of blood causes blood lose and haemoglobin rate within body decreases (Greenough, Murthy and Sundaresan, 2016). There are cases in which it becomes difficult to stop bleeding and it causes serious health issues for the person. Further, it is difficult to find out that main reason due to which this type of issue is caused. When CPAP is given, then mouth and nose is covered with mask and when the pressure of oxygen is not properly stabilized as per requirement, then it affects nose and this causes a reason for nose bleeding.
Breathing problems: Lungs gets affected when CPAP is given. The respiratory system also gets negatively affects. There are cases in which patients are not able to perform physical exercise and when such activities are performing, then it becomes difficult to breath and this result in unconsciousness. To perform any type of role, it requires proper concentration and when body fails to breath in enough oxygen, then it creates issues so as to complete the work effectively. It is essential to inhale enough oxygen so that body functioning can be operated efficiently. It is important to make oxygen reach all part of the body. However, there are cases in which due to use CPAP during preterm birth increases the rate of issues related to breathing.
Stomach problem: Due to CPAP machine, there are cases in which it causes stomach pain and bloating. This type of issue arises as the air pressure that is set on the machine make it pump high pressure of air into the mask (Szyld, Aguilar and Musante, 2014). This is caused when nurses do not take proper care to adjust with sleep specialist. Stomach problems creates issue for digestion when anything that is consumed causes pain and it also creates issue for taking food inside.
There are different strategies that are implemented in order to make sure that the rate of negative impact is reduced that is caused because of CPAP. In this context, during the situation of preterm birth, it is important that there is proper monitoring done of the baby. There are cases in which serious issues can cause child if the pressure is more compared with the required one (Cools, Offringa and Askie, 2015). In order words, it requires real time monitoring and it enables to reduce the risk of lung damage. Further, protective strategy is used by nurses in order to make sure that the rate of lung damages caused by CPAP can be reduced. When a child like Joshua is placed in CPAP, then it is important that there is proper monitoring so that in case of any emergency situation or problems can be reduced.
Four potential long term problems that Joshua and his family due to Joshua's preterm birth
There are different type of problems that can be faced by Joshua and his family due to Joshua's preterm birth. In this context, below given are four of the potential long term problems:
Intellectual and developmental disabilities: With age there are certain growth that occurs to a child. In this context, it includes physical and mental development. However, when child like Joshua who had premature birth have difficulties in physical development (Kirpalani, Millar and Roberts, 2013). Further, there are issues in relation with learning thing which normally same age children can perform. Moreover, it becomes difficult to have proper communication with other. It is important to have proper interaction with for the family of Joshua but it becomes difficult for them to understand or also difficult for Joshua to make them understand regrading the thing that he wants to convey. Further, children with premature birth prefer to be alone and do not get easily adjusted with others. Further, the basic things that a child can perform of the same age of Joshua but he can find it difficult for the same. Further, there are also conditions in which the growth of any one of the body part can get affected.
Autism: This is a type of behavioural disorder. In this, child gets affected with behavioural, social and speech. This has negative impact over brain, spinal cord and nerves. It becomes difficult for the child to perform basic activities and in having proper communication with others (Overman, Liu and Moore, 2013). There are conditions in which parents also does not have proper information about it and they fail to make sure that proper care is being provided to them. This is a type of disease that does not have proper cure. However, the only thing that can be done is to reduce the negative impact by therapies and medications. It becomes difficult to have a social life as in autism and to make other understand and express.
Lung problem: One of the disease that is caused when lungs gets affected is Asthma. It is a type of condition that affects the airways and increases breathing problems. Breathing problems affects social life and it is important to have continuous meditation so that the rate of issues can be solved. Further, there is another type of lung related issues that is caused among premature babies that is Bronchopulmonary dysplasia (BPD). There are chances that Joshua can get affected with this type of disease (Sharma, Clark and Keszler, 2015). As per this lung disease, it causes lungs to grow abnormally or to be inflamed. With time this type of issue get reduced but the chances of getting asthma is high and their symptoms remains throughout their life.
Heath problems: Joshua is at high risk to have health related problems. In this context, it includes intestinal problems this is generally caused to premature babies who are also known as necrotizing enterocolitis. This is a type of disease that affects intestine of babies. Intestine is body function that help to break down food. Majority of child who are premature overcome the problems of intestine but for most of them it stays for life long. Further, it also causes different type of infections like meningitis that is a type of infection which caused in brain. Further, it includes pneumonia a type of infection which is caused in lungs. Moreover, premature babies also face problem of vision (Greenough, Murthy and Sundaresan, 2016). In this context, it induces diseases like retinopathy of prematurity. In addition to this, it also causes dental problem and hearing loss.
Strategies to enhance development of collaborative and equal relationship between Kathy and neonatal nurses caring for Joshua
In order to create equal and collaborative relationship with Kathy and neonatal nurses, it important to make sure the below given strategies:
Effective communication: So as to create strong relationship it is essential to have proper interaction. This enables to develop trust and confidence over the services that is being delivered by nurses. With this respect, there is a type of stress that is developed in Kathy as they are well informed about the issues that Joshua can face as it is premature baby. When there is strong relationship, then the issues that are faced by patient are freely discussed. There are different type of complications that are faced at the time of delivery (Szyld, Aguilar and Musante, 2014). However, the stress and issues that are faced by patient can be resolved at high extent. On the other hand, when patient provide adequate information about the issues that are faced by them, then it becomes helpful enough for the nurses to provide them with services.
Patient education: There are conditions in which patient does not have enough information about the steps that has to be taken by them towards their child or any other problem. As per the given case, strong relationship can be developed among Kathy and nurses by proving adequate information to Kathy related with the issues that are faced by Joshua. Further, it also includes different steps that should be taken by parents in order to provide proper care to Joshua and this information should be provided by nurses (Overman, Liu and Moore, 2013). Neonatal nurses has experience and they know better about the health condition that are generally faced by premature babies. With this respect, information provided by these nurses are effective enough for patients to provide proper care and support to their child.
Delivering frequent information: As per the case, Joshua was under CPAP and it is important to have frequent observation so that the pressure of oxygen provided can be controlled as per requirement. All the information and changes should be conveyed to patient that is Kathy as it will be helpful enough to develop collaborative relationship with nurse.
As per the findings, it can be stated that proper information should be provided to parents related with the health issues that are being faced. Further, it is important to have effective communication so that there is strong relationship developed among nurses and patient. This way trust and confidence is developed. Moreover, nurses has to take immediate actions at the time of delivery as what type of issue can take place is not fixed. Further, there are certain steps and procedures that has to be followed by nurses and all those should be considered. When the temperature is stabilized, then new born baby should be given bath.
- Cools, F., Offringa, M. and Askie, L. M., 2015. Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants. The Cochrane Library.
- Greenough, A., Murthy, V. and Sundaresan, A., 2016. Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database of Systematic Reviews. (8).
- Kirpalani, H., Millar, D. and Roberts, R. S., 2013. A trial comparing noninvasive ventilation strategies in preterm infants. New England Journal of Medicine. 369(7). pp.611-620.
- Overman, A. E., Liu, M. and Moore, B. M., 2013. Tracheostomy for infants requiring prolonged mechanical ventilation: 10 years’ experience. Pediatrics. 131(5). pp.e1491-e1496.
- Sharma, S., Clark, S. and Keszler, M., 2015. Tidal volume requirement in mechanically ventilated infants with meconium aspiration syndrome. American journal of perinatology. 32(10). pp.916-919.
- Szyld, E., Aguilar, A. and Musante, G. A., 2014. Comparison of devices for newborn ventilation in the delivery room. The Journal of pediatrics. 165(2). pp.234-239.