The purpose of this assignment is to encourage critical analysis and reflection on practice. It is important to remember that nurses in a neonatal intensive care unit (NICU) work as a member of a collaborative team and therefore this should be reflected in your response to this scenario. This assignment consists of a scenario for your consideration. Respond to the related questions and utilise the peer reviewed literature (research based and contemporary texts) to inform and support your responses.
When undertaking this assignment it is important that you:
• Answer all questions following the scenario (in bold print)
• Present information in an essay format, in a clear and concise manner.
• Identify the principles of family centred care relevant to this scenario and demonstrate consideration of the impact of the family
• Identify, critically review and discuss the neonatal intensive care nurse’s role in the provision of collaborative care
You are a registered nurse/midwife working in a neonatal intensive care unit (NICU). You have been allocated the admission of a 26 week infant and requested to be present for the imminent delivery.
Anne, is a 32 year old gravida 4, para 3 woman, who presented with spontaneous premature rupture of membranes (PROM) 2 days previously with no prior complications in the pregnancy. Her husband Tony is currently caring for the other children aged 5, 3 and 2 who were all delivered at term.
Two doses of Betamethasone have been administered to Anne and intravenous antibiotics were commenced due to the increased risk of infection for mother and infant due to PROM and history of Group B Streptococcus positive on vaginal swab in Anne’s previous pregnancy. Anne commenced contracting 48hours after admission and progressed to a spontaneous vaginal delivery.
Following birth the baby was immediately placed on the resuscitation cot and wrapped in plastic wrap for assessment and stabilisation, and a saturation probe placed on her right hand.
Zoe, Anne’s baby showed signs of respiratory distress including an expiratory grunt at birth however by 1 1⁄2 minutes of age she became apnoeic with a heart rate on auscultation of 80bpm. Her initial treatment of CPAP via the face mask and Neopuff changed to positive pressure ventilation via the face mask and Neopuff. This mode of resuscitation was effective and her heart rate 60 seconds later was 136bpm with spontaneous respirations.
The Apgar score was 5 at 1 minute and 9 at 5 minutes.
Zoe remained on CPAP via the face mask and was transferred to NICU for ongoing care. On departure from Delivery suite the cot was brought beside Anne for her to touch Zoe and an explanation of her condition was provided as well as reassurance that staff would contact her husband, Tony with the news.
On admission to NICU Zoe was electively intubated and given surfactant 200mg/kg via the endotracheal tube. She was then extubated and commenced on Hudson Prong CPAP at 6cm water with the oxygen level being titrated to maintain her saturation levels between 88-96, targeting 90-94%.
Zoe weighed 840g (50th centile) and her head circumference was 24cm (50th centile)
After considering the anatomical and physiological changes that occur during transition to extra uterine life; identify and discuss problems that may occur in the transition period and relate these to Zoe’s resuscitation at birth.
Discuss your priorities during the admission and stabilisation process for Zoe and provide a rationale for actions you identify.
In this discussion consider the following
• Priorities of care for a 26 week infant
• Observations, laboratory testing and imaging
• Treatment strategies for Zoe
Identify and discuss the clinical and social issues of a premature birth for Zoe and her parents and provide rationale for the importance of identifying these issues and the value of family centred care.