35
RESEARCH ARTICLE
A cohort study conducted to study the Low plasma folate concentrations in pregnancy are associated with preterm birth. 34,480 low-risk singleton pregnancies enrolled in a study of aneuploidy risk, preconceptional folate supplementation was prospectively recorded in the first trimester of pregnancy. Comparing to no supplementation, preconceptional folate supplementation for 1 y or longer was associated with a 70% decrease in the risk of spontaneous preterm delivery between 20 and 28 wk versus 4 spontaneous preterm births, respectively; HR 0.22, 95% confidence interval and a 50% decrease in the risk of spontaneous preterm delivery between 28 and 32 wk versus 12 preterm birth, respectively. However, the risk of spontaneous preterm birth decreased with the duration of preconceptional folate supplementation and was the lowest in women who used folate supplementation for 1 y or longer. The study concluded that Preconceptional folate supplementation is associated with a 50%–70% reduction in the incidence of early spontaneous preterm birth. The risk of early spontaneous preterm birth is inversely proportional to the duration of preconceptional folate supplementation. Preconceptional folate supplementation was specifically related to early spontaneous preterm birth and not associated with other complications of pregnancy.
CONCLUSION:
B/O Kavya was admitted to MSRMH (NICU) immediately after birth, due pre maturity. Baby is under observation and treated with all medical measures and nursing care provided, which promote baby to recover from illness and presently baby is taking feed normally with palada and breathing pattern is normal.
36 BIBLIOGRAPHY :
1. Ghai OP, Vinod KP, Arvind B. Ghai Essential Peadrics.7th edn. CBS Publishers. New Delhi:2009:Pg:295.
2. Wong DL,Whaley &wong.nursing care of infants and children.6th edn.Mosby.1999.Pg. 841.
3. Dutta DC. Text book of Obsterics. 6th ed. New central book agency: Kolkata;2004.p.458-62
4. CIMS (Current Index of medical specialities). Apr- Jul 2009. India.
5. Ruth VB, Linda KB. Myles text book for midwives. 12th ed. Churchill livingstone; New york :1999.p.432-35.
6. CIMS
7. Annamma J. A comprehensive textbook of midwifery. 2nd ed.Jaypee brothers; new delhi: 2009.p.473-77.
8. Radek B, Fergal D. Malone,Flint T. Porter,David A. Nyberg, Preconceptional Folate Supplementation and the Risk of Spontaneous Preterm Birth: A Cohort Study. http://www.nlm.nih.gobv/medlineplus/ency/article/001563.htm
37 ASSESS MENT NURSIN G DIAGN OSIS OBJEC TIVES
NURSING INTERVENTIONS IMPLEMENTATION EVALUATI
ON On observatio n child is having dyspnea, substernal retraction on breathing and saturation is not is not maintainin g and presence hurried breathing. Impaired breathing pattern related to atelactasi s secondar y to surfactant deficienc y. The child will be breath normally and saturation will maintain at normal level.
Assess respirations; note quality, rate, pattern, depth, flaring of nostrils, dyspnoea, use of accessory muscles. Auscultate lungs for presence of
decreased or absent breath sounds. Administer humidified oxygen as per
order.
Assess changes in vital signs and temperature
Do suctioning if necessary
Monitor arterial blood gases (ABGs). Maintain normal body temperature of
baby.
Change position of baby 2 hourly. Provide comfort to the baby
Give chest physiotherapy if required
Assessed respirations; note quality, rate, pattern, depth, flaring of nostrils, dyspnoea, use of accessory muscles. Auscultated lungs for presence of
decreased or absent breath sounds. . Administered humidified oxygen at 4
litre /hr
Assessed changes in vital signs continuously with the help of pulse oxymeter
Monitored arterial blood gases (ABGs) as per order.
Maintained normal body temperature of baby by placing the baby under radiant warmer and maintaining temperature between 36.5- 37.5 C Position of baby changed 2 hourly. Provided comfort to the baby by
meeting the basic needs such as feeding, hygienic needs and love and affection. Baby is maintaining normal saturation And free dyspnoea.
38 On observatio n Looks hypotherm ic, extremitie s are cool. Ineffectiv e thermore gulation related immature of thermore gulation centre, less subcutan eous fat. Child will be able to maintain normal body temperat ure.
Assess infant’s body temperature. Place the child under radiant warmer
and maintain temperature between 36.5 – 37.5 C
Mummify the baby to reduce heat loss.
Avoid touching baby with cold hands to avoid hypothermia to baby.
Monitor the temperature of the warmer and adjust if needed
Warm both hands before touching the baby to avoid hypothermia to baby.
Assessed infant’s body temperature. Placed the child under radiant warmer
and maintain temperature between 36.5 – 37.5 C
Mummified the baby with a warm blanket to reduce heat loss. Avoided touching baby with cold
hands to avoid hypothermia to baby. Monitored the temperature of the
warmer and adjust temperature to 36.7 C
Hands are warmed and disinfected with germiclean before touching the baby. Baby maintain normal body temperature under radiant warmer.
39 On observatio n child looks fatigue, restless And low body weight is 2.2 kg. Imbalanc ed nutritiona l status less than body requirem ent related NPO status, inability to take breast milk. The child will be able maintain normal nutritiona l status
- Assess the nutritional status of the child by nutritional assessment. - Monitor child weight daily
- Administer fluids, electrolytes and nutrients as per order.
- Provide comfort to the baby by meeting the daily needs.
- Give expressed breast milk or prepared lactose feed to baby through NG tube or with the help of palada.
- Encourage mother to give exclusive breast feeding every 2 hourly or on demand of the baby.
- Monitor intake output chart.
- Encourage diversional therapies while providing food to the child.
- Assess the nutritional status of the child by nutritional assessment. - Monitor child weight daily
- Administer fluids, electrolytes and nutrients as per order.
- Provide comfort to the baby by meeting the daily needs.
- Give expressed breast milk or prepared lactose feed to baby through NG tube or with the help of palada.
- Encourage mother to give exclusive breast feeding every 2 hourly or on demand of the baby.
- Monitor intake output chart.
- Encourage diversional therapies while providing food to the child.
Baby increased weight from 2.2 kg to 2.8 kg. Baby taking palada feedscomfort ably.
40 Mother express her feeling that she is having fear about her child illness. Anxiety to parents related to child health condition Mother will be able to cope up with present condition
Assess parent’s level of anxiety and determine how parents copes with anxiety.
Acknowledge awareness of patient’s anxiety. Acknowledgment of the patient’s feelings validates the feelings and communicates acceptance of those feelings.
Reassure patient that he or she is safe. Stay with patient if this appears necessary.
Maintain a calm manner while interacting with patient.
Establish a working relationship with the patient through continuity of care. Use simple language and Encourage
parents to talk about anxious feelings. Avoid false reassurances.
Assessed parent’s level of anxiety and determine how parents cope with anxiety.
Acknowledged awareness of patient’s anxiety. Acknowledgment of the patient’s feelings validates the feelings and communicates acceptance of those feelings.
Explained about child health status, cause for illness and outcome of health status.
Involved parents in child care.
Allowed child to see baby every day.
Used simple language
Encouraged parents to seek assistance from the health care provider when anxious feelings comes
Mother verbalizes that she is free from fear and she is able to cope with current situation.
41 On observatio n baby is taken out from the incubator on and off. Risk for infection related to immature immune system. Baby will be free from infection.
Assess conditions risk for development of infections
Monitor vital signs hourly to know the signs of infections (fever)
Keep baby environment clean, hygienic.
Follow aseptic measures while performing any procedures ( hand washing, wearing gloves)
Wash hands thoroughly with
antiseptics before and after touching each baby.
Use clean and sterile instruments for baby care.
Improve baby’s immune system by providing high calorie feeds to the baby.
Do routine blood investigation ( CRP level, ESR, WBC count, blood culture etc.)
Clean all tubings, IV canula site with antiseptic solution every day.
Assessed conditions risk for development of infections
Monitored vital signs hourly to know the signs of infections (fever)
Kept baby environment hygienically .
Aseptic measures used during each nursing procedures
Hands are washed thoroughly with antiseptics before and after touching each baby.
Used clean and sterile instruments for baby care.
Administered fluids, electrolytes intravenously.
Expressed milk given through palada every 2 hourly.
Routine blood investigation done.
All tubings, IV canula site are cleaned with antiseptic solution every day.
Baby is free from infection as evidenced by normal vital signs.