Jennifer Troutman

4832 NURSING CARE OF CHILDREN

NICU CASE STUDY

Choose any premature infant in the NICU. Review the infant’s medical record and answer the
following:
Infant’s initials: A.A. Sex: Male
Medical Dx: Premature Birth Date: 9/20/2017
Gestational age at birth: 24 weeks, 5 days Today’s age: 48 days old
Birth weight: 1lb. 9oz. (0.86kg) Today’s weight: 3lbs. 8oz. (1.59kg)
Apgar’s scores:(1min. 5min.) unable to find Vital signs: bp 71/35 hr 145 o2 86-99%
Type of bed: Isolette
Temperature control: Yes, set to 35.9 degrees Celsius
Oxygen: Yes, o2 percentage was set at 55-65% on the high frequency ventilator
Nutrition: (amount/type/route/frequency) 29ml, breast milk, via NG, q4 hour. Duration of
feed however is 3 hours.
Medications: (name, dose, route, action, recommended dose, side effects, and reason for
use)
 Caffeine 17mg IV. It stimulates the respiratory center in the medulla, increases sensitivity to
carbon dioxide, increases skeletal muscle tone, enhances diaphragmatic contractility,
increases minute ventilation, increases metabolic rate, and increases oxygen consumption.
also stimulates the central nervous and cardiovascular systems, enhances catecholamine.
secretion, has a diuretic effect, and alters glucose homeostasis. The recommended dose for a
premature infant less than 34 weeks gestation is 5mg/kg/day. So that would be 7.95kg/day.
Tachycardia, metabolic acidosis, and hyperglycemia have been reported. The reason for use
is apnea of prematurity and intermittent hypoxemia for this infant.
 Cephapime 80mg IV. Recommended dose is 50mg/kg. So that would be would be a safe
range for the patient. Cephapime is an antibiotic used to treat bacterial infections. Some side
effects of this drug includes headache and diarrhea. This antibiotic is used for a UTI and an
infection in the trach.
 Jennifer Troutman

 Morphine .17mg IV. Recommended dose it 0.05-0.2 mg/kg/dose. So that would be

0.0795mg-0.318mg/dose, therefore the dose is a safe range. Morphine is used as an analgesia
for neonates, as well as for Neonatal Abstinence Syndrome and treatment of opiate
withdrawal. But for this neonate, morphine is used as an analgesic. Some side effects of this
drug is respiratory depression, dependence, increased ICP, drowsiness, N/V, and
constipation.
 Versed .17mg IV. Recommended dose is 0.05-0.15mg/kg/dose. For this infant, the safe range
would be 0.0795-0.239mg, so he is within the safe range. Uses for this drug include sedation
during mechanical ventilation/ procedures, and for treatment of refractory seizures. For this
patient, Versed is used for sedation during mechanical ventilation. Some side effects include
respiratory depression, respiratory arrest, hiccoughs, CNS depression, myoclonic jerks,
hypotension, and bradycardia.
 Lasix 1.7mg IV. Recommended dose for neonates is 1-2mg/kg. The safe range for this
neonate 1.59-3.18mg, so the patient is within the safe range. This drug is used for edema and
resistance hypertension, and for this patient Lasix is used for edema. Some side effects
include hyperuricemia and hypokalemia.
 Sodium chloride 7 mEq IV. The recommended fluid maintenance for this infant is
100ml/kg/24hr – the calculations equals 6.625ml/hr, therefore the patient is getting the
recommended fluid maintenance. Sodium chloride is used for fluid loss and to restore sodium
chloride balance, as well as to treat patients who are unable to take fluids by mouth. For this
neonate, it’s little bit of a combination of all of those.
Treatments: (include rationale for each treatment)
 During rounds today, they changed the frequency of the versed from being routine to PRN
when the patient is agitated. Versed is not a pain reliever, so if the infant is agitated then they
need to be assessed for pain. Although the patient is on the vent, they do not need to be
sedated 24/7
 They also ordered lab work to see how the electrolytes and CBC is doing. This information
will be used to see if an infection is developing or if the patient is dehydrated or may have a
fluid overload. Continuously monitoring the lab for on this neonate is vital.
 They sent a urine test during midnight shift to see if there is a UTI. If so, they will treat with
an antibiotic.
 Jennifer Troutman

 They also decided that they were going to keep the neonate on an antibiotic prophylactically.
This is obviously to prevent any infection from developing. This antibiotic may or may not
prevent the UTI. The patient just got over an infection from the trach, so they want to prevent
more infections from coming.
Define prematurity. Identify 3 major risks of the premature infant. Discuss the role of the
nurse in the NICU. Reflect on your clinical experience in the NICU.
 A premature birth is a birth that takes place more than three weeks before the baby is due.
Premature birth gives the baby less time to develop in the womb.
 3 major risk factors for the premature infant:
o Delay in physical development
o Neurological disorders, like vertebral palsy, that affect the brain, spinal cord and nerves
throughout the body
o Bronchopulmonary dysplasia (BPD) which is a chronic lung disease that causes the lungs
to grow abnormally or to be inflamed.
 This infant was a one-on-one, so the role of the NICU nurse for this infant was to
continuously monitor patient during her whole shift. Administer the correct medications with
the right dosages, look at lab work for abnormalities, monitor the infants’ saturations
constantly because he was up and down during the whole shift. Suction the infant as needed,
change and measure the diapers when changed, take vital signs, give emotional support to
family, and work as a team with every healthcare professional that cares for the infant.
 Overall, I thought that the NICU was amazing. I have never seen a baby so small in my entire
life and I thought it was amazing how far medicine has come to help save these premature
babies. I hope to one day be able to care for these babies to be a part in getting them healthy
and sending them home.