Preterm Infant

Born at 37 weeks of gestation or less.

1. Disorders affecting nutrition
1. Pathophysiology-underdeveloped feeding abilities, small stomach capacity, immature enzyme system, fat intolerance.
2. Etiology-immature body systems associated with preterm birth.
3. Assessment:
1. Weak suck, swallow, gag reflexes-tendency to aspiration.
2. Signs of malabsorption and fat intolerance (abdominal distention, diarrhea, weight loss, or failure to gain weight).
3. Signs of vitamin E deficiency (edema, anemia).
4. Analysis/nursing diagnosis:
1. Altered nutrition, less than body requirements, related to poor feeding reflexes, reduced stomach capacity, inability to absorb needed nutrients.
2. Impaired gas exchange related to aspiration.
5. Nursing care plan/implementation: Goal: maintain/increase nutrition.
1. Frequent, small feedings-to avoid exceeding stomach capacity, facilitate digestion.
2. Frequent “burping” during feeding-to avoid regurgitation/aspiration.
3. Supplement vitamin E (alpha-tocopherol) intake, as ordered, in formula-fed infants (Note: intake adequate in breastfed babies.) Vitamin E actions:
1. Antioxidant.
2. Maintains structure and function of smooth, skeletal, and cardiac muscle.
3. Maintains structure and function of vascular tissue, liver, and RBC integrity.
4. Coenzyme in tissue respiration.
5. Treatment for malnutrition with macrocytic anemia.
Encourage parent/family participation.
6. Evaluation/outcome criteria:
1. Feeds well without regurgitation/aspiration.
2. Maintains/gains weight.
3. No evidence of malabsorption, vitamin deficiency.
2. Disorders affecting nutrition/elimination: necrotizing enterocolitis (NEC)
1. Pathophysiology-intestinal thrombosis, infarction, autodigestion of mucosal lining, and necrotic lesions; incidence increased in preterm.
2. Etiology-intestinal ischemia, due to blood shunt to brain and heart in response to:
1. Fetal distress.
2. Fetal/neonatal asphyxia.
3. Neonatal shock.
4. After birth, may result from:
1. Low cardiac output.
2. Infusion of hyperosmolar solutions.
5. Complicated by action of enteric bacteria on damaged intestine.
3. Assessment-early identification is vital.
1. Abdominal distention or erythema, or both.
2. Poor feeding, vomiting.
3. Blood in stool.
4. Systemic signs associated with sepsis that may need temporary colostomy or ileostomy:
1. Lethargy or irritability.
2. Hypothermia.
3. Labored respirations or apnea.
4. Cardiovascular collapse.
5. Medical diagnosis:
1. Increased gastric residual.
2. X-ray shows ileus, air in bowel wall.
4. Analysis/nursing diagnosis:
1. Altered nutrition, less than body requirements, related to inability to tolerate oral feedings and gastrointestinal dysfunction secondary to ischemia, thrombosis, or necrosis.
2. Constipation related to paralytic ileus with stasis; diarrhea related to water loss.
3. High risk for injury related to infection, thrombosis, metabolic alterations (acidosis, osmotic diuresis, dehydration, hyperglycemia) due to parenteral nutrition.
4. Altered parenting related to physiological compromise and prolonged hospitalization.
5. Impaired skin integrity when colostomy is necessary.
5. Nursing care plan/implementation:
1. Goal: supportive care.
1. Rest GI tract: no oral intake-to achieve gastric decompression.
2. IV fluids, as ordered-to maintain hydration.
2. Goal: prevent infection. Administer antibiotics, as ordered.
3. Goal: prevent trauma to skin surrounding stoma.
6. Evaluation/outcome criteria:
1. Tolerates oral feedings.
2. Demonstrates weight gain.
3. Normal stool pattern.
4. Parents are accepting and knowledgeable about care of infant.