Risk for Fluid Volume Deficit related to Low Birth Weight

Nursing Care Plan for Low Birth Weight

Nursing Diagnosis : Risk for Fluid Volume Deficit age and extreme weight, excessive fluid loss (thin skin), less fat layer, immature kidney / failure to concentrate urine.

Goal: liquid fulfilled

Expected outcomes:

• Free of signs of dehydration.
• Shows the weight gain of 20-30 grams / day.

Interventions :

Independent:

• Compare the input and output of urine, every shift and balance each periodic cumulative 24 hours.
• Monitor the specific gravity of each finished urinating or every 2-4 hours to inspire urine from diapers when the baby can not stand the reservoir bag urine.
• Evaluation of skin turgor, mucous membranes, and the state of the anterior fontanelle.
• Monitor blood pressure, pulse, and mean arterial pressure (TAR).

Collaboration:

• Monitor laboratory examination in accordance with the indications; Ht.
• Give parenteral infusion.
• Give a blood transfusion.

Rationale :

• Output should be 1-3 ml / kg / h, while the need for fluid therapy is approximately 80-100 ml / kg / day on the first day, increased to 120-140 ml / kg / day on the third day postpartum. Blood sampling for tests lead to decreased levels of hemoglobin / hematocrit.
• Although renal immaturity and inconvenience to concentrate urine, usually resulting in a low specific gravity in preterm infants (range normal1,006-1,013). Low levels indicates excessive fluid volume and content of greater than 1.013 indicates the inability of fluid intake and dehydration.
• Loss or minimal fluid shifts can quickly lead to dehydration, visible by poor skin turgor, dry mucous membranes, and sunken fontanelle.
• Losing 25% of blood volume resulting in shock, with TAR 25 mmHg indicates hypotension.
• Dehydration increases hematocrit levels 45-53% above normal serum potassium.
• Hypoglycemia can occur due to loss through diarrhea or vomiting nasogastric tube.
• The replacement of body fluids increase the volume of blood, helps restore vasoconstriction due to hypoxia, acidosis, and right-to-left shunt through the PDA, and has helped in reducing complications necrotizing enterocolitis, and bronchopulmonary dysplasia.
• It may be necessary to maintain the levels of hematocrit / hemoglobin optimal and replace blood loss.

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Ineffective Breathing Pattern related to Low Birth Weight

Nursing Care Plan for Low Birth Weight

Nursing Diagnosis :  Ineffective Breathing Pattern

According Manuaba (2002) since 1961 WHO replace the term premature with low birth weight (LBW) as they realized that not all babies born weighing less than 2500 grams at birth is not premature baby, then according Pantiawati (2009), LBW is a baby with birth weight less than 2500 grams. Meanwhile, according Proverawati (2010) LBW is babies born weighing less than 2500 grams regardless of pregnancy, in line with the opinions Prawiroharjo (2011) LBW is newborn birth weight less than 2500 (up to 2499 grams).

According Proverawati (2010), Clinical / LBW Infants characteristics:

• Weight less than 2500 grams.
• Length of less than 45 cm.
• Chest circumference less than 30 cm.
• Head circumference less than 33 cm.
• Thin subcutaneous fat tissue or less.
• Gestational age less than 37 weeks.
• Larger heads.
• Transparent thin skin, lanugo hair a lot, less fat.
• Cartilage earlobe, rudimentary growth.
• Weak hypotonic muscle is a muscle that is no active movement of the arms and elbows.
• Irregular breathing can occur apnea.
• Extremities: abduction of the thigh, the knee / leg flexion-straight, heel shiny, smooth soles.
• Head is not able to erect, yet nerve function or ineffective and weak tears.
• Breathing 40-50 times / min and pulse 100-140 beats / min.

Nursing Diagnosis for Low Birth Weight : Ineffective breathing pattern related to the immaturity of the respiratory center, the limitations of muscle growth or decline in muscle weakness and metabolic imbalance.

Goal: Patterns breath back effectively.

Expected outcomes:
Neonates will maintain periodic breathing patterns.
Pink mucous membranes.

Nursing Interventions :

Independent:
Assess the frequency and pattern of breathing, note the presence of apnea and cardiac frequency changes.
Suction the airway as needed.
Place the baby in the abdomen or supine position with a rolled diaper under the shoulder to produce hyperextension.
Review the history of the mother to drugs that would aggravate respiratory depression in infants.

Collaboration:
Monitor laboratory tests as indicated.
Give oxygen as indicated.
Give medications as indicated.

Rationale :

Help in distinguishing normal breathing rotation period of true apnea attacks, especially common in the 30th week of gestation.
Eliminate mucus that clogs the airways.
This position facilitates breathing and decrease episodes of apnea, especially if found any hypoxia, metabolic acidosis or hypercapnia.
Magnesium sulfate and narcotics suppress the respiratory center and CNS activity.
Hypoxia, metabolic acidosis, hypercapnia, hypoglycemia, hypocalcemia and sepsis aggravate apnea attacks.
Improvement of oxygen and carbon dioxide levels can improve respiratory function.

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