Special Considerations - Neonate Nursing PDF

Nursing 2 -- Lecture 13 **Life Stages of Cats** A table with a dog and a dog Description automatically generated **Emergency C- Section Small Animal** Patient likely compromised - Fetal HR slows with hypoxia - Fetal HR less than 180bpm signals fetal distress - Fetal HR less than 160bom...

Nursing 2 -- Lecture 13 **Life Stages of Cats** A table with a dog and a dog Description automatically generated **Emergency C- Section Small Animal** Patient likely compromised - Fetal HR slows with hypoxia - Fetal HR less than 180bpm signals fetal distress - Fetal HR less than 160bom signals emergency intervention Problems with these cases - Hypovolemia -- mama - Hypocalcemia -- mama - Hypoglycemia -- pup/kitten +/- mama Stabilization of the patient (mama & offspring) time is very important Clear Oropharynx - Suction - Swing technique (not hard & support body & neck) Ensure Breathing & MM Color - 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 - 1gtt (25g needle) of reversal or emergency drug sublingually - Give emergency drugs if needed Heat & 02 support / consider dextrose **PE of Neonate** Need: - Warm, clean blanket - Pediatric stethoscope - Digital thermometer 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 - Discharge from umbilicus - Urine from umbilicus (persistent urachus) - Puppies should be "Mildly pudgy" - Kittens should be "long & lean" **Common Concerns of the Neonate** - Hypothermia - Dehydration - Hypoglycemia **Neonates, Normal** Week One - Sleep 80% of the time - Nurse every 2-4 hrs - Body temp 34.8c-38.3c - Not able to maintain body temp -- need to be tucked up with mom - Happy babies are quiet - At birth brain is not fully developed - Motor skills -- crawling, suckling, distress vocalization - Respond to: odor, touch, pain - Mom stimulates voiding - HR: 200bpm -- 220bpm - RR 6-35 bpm - Umbilical cord dries at day one and falls off day 3 Week One Gender Determination Examine anogenital distance Female 7.6mm Male 12.9mm - Testicles not descended at birth (hard to palpate) - Testicles descend at 6 weeks (puppies) Week Two - Still cannot maintain body temp unaided - Crawling, more active - Body weight: Kittens: double every 7-10days Puppies double every 10-12 days - Eyes begin to open 7-12 days - Ears open 14-16 days Common Concerns: Hypothermia Why - Little to no sub q fat - High surface area to body weight ratio leads to rapid evaporative heat loss Brown fat metabolism - Non shivering thermogenesis - Homeotherms at 6 weeks Leads to: - Ileus, impaired immune function, bradycardia, death Early Clinical Signs - Temp, restlessness - Cool to touch, red mm Hypothermic neonates prone to hypoglycemia, hypoxemia, poor GI function Room temp goal (ambient) 29-32c Humidity 55-65% Common Concerns: Dehydration Why? - Increased body water - Increased water turnover - Immature renal system Clinical Signs - Dry mucous membranes (5-7% dehydrated) Treatment: - Fluid therapy -- ml/kg/hr - Use warmed fluids (36.7) - IV, IO, SQ, IP Comon Concerns: Hypoglycemia Why? - Little glycogen store in liver - Poor gluconeogenesis in liver - If otherwise healthy can maintain sugars for 24 hours - Failure to sucks 24-36 hours depletes liver stores Signs: - crying, tremors, increases appetite, lethargy, coma, stupor, seizures Treatment: - 2.5-5% dextrose in 0.9% NaCl - IV dextrose bolus diluted & slow IV or IO -- Not SubQ - If hydrated & normal temp can apply concentrated dextrose to mm Monitor: - blood glucose levels - At risk of hyperglycemia **Thermoregulation** Keeping them warm Nesting Box - Line with smooth material Warming Alternatives: - Circulating warm H20 Blanket - Rice or hot H20 bags - Heat lamps Neonates should be able to move away from heat Warm slowly, controlled, monitored ambient warmth Excellent -- warm inspired air: incubator Best: Bair hugger Good: warm water gloves, heat lamps, warm IV or IO fluids Aim to raise temp approx. 1c per hour **Monitor Temp** Normal: 35.5-36.5c at birth 34.8-38.3 c first week Keep ambient temp thermometer near babies, 29-32c If Hypothermic: - Do not feed, raise temp - Untreated can lead to coma and death **Nutrition** - Correct dehydration and hypothermia first - Assessment of dehydration -- oral mm dry and pale - Correct with warm IV or IO fluids Bottle, Syringe feeding -- allow to suckle, ensure swallowing - 1gtt every 1-2 sec OG Tube - Weigh daily: food scale, baby scale - Puppy gain 1g for every 2-5g milk intake - Double weight every 10-12 days Weight Gain: - Kittens gain 70-100g weekly - Double weight q7-10 days Diet: - Commercial milk replacer - Homemade milk replacer - 4 or 5 meals per day Small amounts frequently - Mix new formular every feeding - Monitor hydration **Elimination** - Stimulate voiding after each feeding with gentle rubbing of the area - Until 3 weeks of age - Sponge bath once or twice a day