General Aspects: Nursing Care of the High-Risk Infant and Family

  1. General overview: The birth of a physiologically compromised neonate is psychologically stressful for both infant and family and physiologically stressful for the neonate. Effective, goal-directed nursing care is directed toward:
    1. Minimizing physiological and psychological stress.
    2. Facilitating/supporting successful coping or adaptation.
    3. Encouraging parental attachment/separation/ grieving, as appropriate.
  2. Assessment-directed toward determining neonate’s present and projected status:
    1. Determine neonate’s current physical status.
    2. Identify specific status and diagnosis-related problems and needs.
    3. Describe family psychological status, strengths, and coping mechanisms/skills.
    4. Determine medical/surgical/nursing approach to problems-and prognosis.
  3. Analysis/nursing diagnosis:
    1. Parental anxiety/fear related to physiological compromise of neonate.
    2. Self-esteem disturbance related to feelings of guilt or anger.
    3. Ineffective individual coping related to severe psychological stress.
    4. Knowledge deficit related to diagnosis, treatment, prognosis of infant.
    5. High risk for altered parenting related to concern about infant.
  4. Nursing care plan/implementation:
    1. Goal: preoperative and postoperative care.
      1. Maintain/improve physiological stability.
        1. Temperature stabilization-keep warm.
        2. Oxygenation:
          1. Position.
          2. Administer oxygen, as ordered or necessary.
        3. Nutrition/hydration:
          1. Administer/monitor IV fluids.
          2. Oral fluids, as ordered.
          3. Feed, as status permits.
      2. Assist with diagnostic testing.
    2. Goal: emotional support of parents.
      1. Encourage exploring and ventilating feelings.
      2. Involve parents in decision-making process.
    3. Goal: health teaching.
      1. Determine knowledge/understanding of problem.
      2. Explain/simplify/clarify, as needed, physician’s discussions with parents.
      3. Describe/explain/discuss neonate’s present status and any auxiliary equipment; teach CPR to family.
      4. Refer, as needed, to hospital/community resources.
    4. Goal: promote bonding. Encourage parental participation in care of the neonate.
  5. Evaluation/outcome criteria:
    1. Parents verbalize understanding of relevant information; make informed decisions regarding infant care.
    2. Parents demonstrate comfort and increasing participation in care of neonate.
    3. Infant maintains/increases adequacy of adaptation to extrauterine life.
    4. If relevant, parents demonstrate progress in grieving process.