Special Nursing Care for Neonates PDF

Special Nursing Care Neonates  Reading Reference: McCurnin’s Clinical Textbook for VT and Nurses, 10th Edition Ch 21: Neonatal Care of Puppies, Kittens, (and foals) Emergency & Critical Care for Small Animals 4th ed. Battaglia & Steele Ch : 10:...

Special Nursing Care Neonates  Reading Reference: McCurnin’s Clinical Textbook for VT and Nurses, 10th Edition Ch 21: Neonatal Care of Puppies, Kittens, (and foals) Emergency & Critical Care for Small Animals 4th ed. Battaglia & Steele Ch : 10: Supporting the Critically, page 129 (paragraph: posture & positioning) Life stages of Dogs and Cats Stage Cat Dog Pediatric Birth to 6 months Birth to 6 months Neonate First 4 weeks First 4 weeks Juvenile 6 months to15 months 6 months to 15 months Adult 15 months to 12 years 15 months to 7-12 years (breed dependent) Senior 12 years + 7-12 years + Geriatric Late senior years (16 years +) Late senior years (11-16 years +) EMERGENCY C-SECTION SMALL ANIMAL Patient likely compromised Fetal HR slows with hypoxia Fetal HR < 180 signals of fetal distress Fetal HR < 160 signals emergency intervention Problems seen with these cases: Hypovolemia - mama Hypocalcemia - mama Hypoglycemia – pup/kitten +/- mama **Stabilization of the patient (mama & offspring) Time is very important  Clear oropharynx NEONATE CARE @ Birth! Suction Swing technique (not to hard & support body & neck Ensure breathing & MM colour! Stimulate if needed Supply oxygen PRN Clamp, cut & tie off umbilicus Body massage with dry towel Drugs: Reverse opioids or any other drug used for premedication 1 drop (25G needle) of reversal or emergency drug sublingually Give emergency drugs if needed Heat and O2 support/ consider dextrose  PE of neonate Need: Warm, clean blanket Pediatric stethoscope (2 cm bell) Digital Thermometer (low to 34C) Need to know: Skin turgor ≠ hydration, use oral mm Body covered in hair except ventral abd Ventral abdomen: normal = pink to dark pink, bluish = cyanosis, dark red = sepsis PE: What to look for? Symmetry, normal conformation Open fontanels, cleft palate, nasal anatomy Bulging behind closed eyelids Umbilical hernia Discharge from umbilicus Urine from umbilicus (persistent urachus)  Pups Kittens Shape “mildly pudgy” “long and lean” Common Concerns of the Neonate! 1.Hypothermi a 2.Dehydration 3.Hypoglycem ia Neonates: What’s normal? Week One Sleep 80% of time Nurse every 2 - 4 hrs Body temp 34.8C – 38.3C Not able to maintain body temperature need to be tucked up with Mom Happy babies are quiet babies  Week One At birth: brain not completely developed Motor skills: crawling, sucking, distress vocalization Respond to: odour, touch, pain Mom stimulates voiding HR: 200 – 220 beats per minute RR: 16 -35 breaths per minute Umbilical cord: dries day 1, falls off day 2  Week 1: Who’s who? Sexing kittens challenging! Examine anogenital distance: Female ~ 7.6 mm Male ~ 12. 9 Testicles not descended at birth (hard to palpate) *Pups: testicles descend ~ 6 weeks Week 2 Still cannot maintain body temperature unaided Temperature closer to adult level More active, crawling Body weight goals: Kittens: double weight every 7 – 10 days Pups: double weight every 10 - 12 days Eyes begin to open 7 – 12 days Ear canals open 14 – 16 days Common Concerns: Hypothermia Why? Little to no SubQ fat Treatment: High surface area-to-body- Controlled, monitored ambient weight-ratio- leads to RAPID warmth evaporative heat loss Heating pads, lamps, Brown Fat metabolism incubators, warm water Non shivering thermogenesis gloves Homeotherms at 6 weeks of age Raise temperature approx. 1C Leads to: per hour !!!!!!!!!! No more ileus, impaired immune function, bradycardia, death Early Clinical signs: Temperature Cool to the touch Restlessness, crying Red mucous membranes  Remember!!!! Hypothermic neonates prone to: Hypoglycemia Hypoxemia Poor GI function Room Goals: Ambient temp 29 – 32 C Can control body temp Humidity 55 – 65 % by 6 wks. Common Concerns: Dehydration Why? Treatment: Increased body water Fluid therapy - ml/kg/hr Increased water turnover Use warmed fluids Immature renal system (36.7C) Not fully developed yet! IV, IO, SQ, IP Clinical Signs: Dry mucous membranes (5-7% dehydrated) Common Concerns: Hypoglycemia Why? seizures etc.. Little glycogen store in liver Treatment: Poor gluconeogenesis in liver 2.5- 5% dextrose in 0.9% NaCl If otherwise healthy can maintain IV Dextrose bolus diluted & SLOW sugars for 24 hours IV or IO ****Not SubQ! Failure to suckle 24 – 36 hours If hydrated & normal temperature depletes liver stores can apply concentrated dextrose to mm SIGNS: Monitor: Crying, tremors, increased appetite, lethargy, coma, stupor, Blood glucose levels At risk of hyperglycemia  It’s up to you...... Orphan care Needs: Keep warm Feeding Hygiene & elimination COLOSTRUM Keeping them warm Nesting box Line with smooth material Warming alternatives: Circulating warm H2O blanket Rice or hot H2O bags Heat lamps *Neonates should be able to move away from heat*  Warming up!!!! Warm slowly Controlled, monitored ambient warmth Excellent: Warm inspired air: incubator Best: Bair hugger – forced circulating warm air Good: warm water gloves, heat lamp etc… Good: Warm IV or IO fluids Raise temperature approx. 1 C per hour  Monitor Temp! Normal neonate: 35.5 – 36.5 C at birth 34.8 – 38.3 C first week Keep ambient temperature thermometer near babies 29 – 32 C If Hypothermic (< 34.5C): *shallow breathing, bradycardia, ileus DO NOT FEED Impaired GI Function - Ileus Untreated can lead to coma & death  Nutrition Correct dehydration and hypothermia first Assessment of dehydration: Oral mucous membranes dry and pale Correct with warm IV or IO fluids  EXTRA- Feeding: what we need to do Bottle, syringe Weight Gain Allow to suckle, ensure Kittens: gain 70–100g weekly swallowing Double weight q 7-10days 1 drop every 1-2 seconds Diet Commercial milk replacer OG Tube Esbilac, KMR Weigh daily: food scale, baby Homemade Milk replacer: scale McCurnin Table 21-2 (pg 797) Puppy: Gain 1 g for every 4 or 5 meals per day 2-5g milk intake Small amounts frequently Double weight every Mix new formula every feeding 10-12 days Monitor hydration EXTRA: Feeding: How much? Age Puppies Kittens Fluids for Both kcal/100g/day kcal/100g/day ml/100g/day Week1 13-15 < 38 at birth 18 28 thereafter Week 2 15-20 28 13-22 Week 3 20 27 13-22 Week 4 > 20 25 13-22 Hygiene and elimination Stimulate voiding after each feeding with gentle rubbing of the area Until ~ 3 wks. of age Sponge bath once or twice a day Baby Basics Quiz Baby Basics Quiz During the first week a) 40 of life, normal kittens b) 60 and puppies will c) 80 sleep what % of d) 95 time? Baby Basics Quiz During the first week a) 40 of life, normal kittens b) 60 and puppies will c) 80 sleep what % of d) 95 time? Baby Basics Quiz The normal heart a) 80-110 bpm rate for week one b) 140-160 bpm puppies and kittens c) 160-180 bpm can be expected to d) 200-220 bpm be: Baby Basics Quiz The normal heart a) 80-110 bpm rate for week one b) 140-160 bpm puppies and kittens c) 160-180 bpm can be expected to d) 200-220 bpm be: Baby Basics Quiz The umbilical cord a) One usually falls off on b) Two c) Three what day after d) Four birth? Baby Basics Quiz The umbilical cord a) One usually falls off on b) Two c) Three what day after d) Four birth? Baby Basics Quiz Eyes begin to open a) 4-7 on which days? b) 7-12 c) 12-15 d) 12-21 Baby Basics Quiz Eyes begin to open a) 4-7 on which days? b) 7-12 c) 12-15 d) 12-21