E. A.-Q., age 4 w, Hx Neonatal Lupus, Admitted 4/10/21: worsening rash, very fussy and refusing t...

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E. A.-Q., age 4 w, Hx Neonatal Lupus, Admitted 4/10/21: worsening rash, very fussy and refusing to take bottles, Wt 3.61 kg, Mother at bedside continuously by Mind Map: E. A.-Q., age 4 w, Hx Neonatal Lupus, Admitted 4/10/21: worsening rash, very fussy and refusing to take bottles, Wt 3.61 kg, Mother at bedside continuously

1. Basic care/comfort

1.1. family- centered care, Cluster care, meeting mother's needs

1.1.1. clustering care (especially labs) can help increase infants comfort and lower mothers anxiety

2. Pharmacological/ parenteral tx

2.1. methylprednisolone, simethicone, albuterol, furosemide, sodium polystyrone, immune globune (human)

2.1.1. steroid for anti-inflammatory, reduction of gas for comfort, helps to decrease potassium levels, allows potassium to removed with BM, antibodies to support immune system

3. Psychosocial integrity

3.1. Establishing interpreter - mother speaks Spanish only, monitoring for neglect, mother makes eye contact with baby,

3.1.1. Maintain communication and understanding of plan of care, optimal growth and development to increase mother and baby's comfort

4. Management of care

4.1. SBAR - contact phys for multiple labs, orders, cluster care, RN - pull meds, supplies, increase immune globulin q

4.1.1. Maintaining appropriate plan of care with all disciplines to increase rate of success and goal of discharge

5. Safety & Infection Control

5.1. Bed to the lowest level, wheels are locked, fall precautions for mother, monitor IV q1, educating parent infection control measures, hand hygiene, isolation- signage, educate baby back to sleep

5.1.1. Prevention of injury, infection and SIDS

6. Health promotion & maintenance

6.1. Maintain hydration and caloric intake - mixture of formula, breastmilk and pedialyte 2 oz q2-3, hand hygiene, immunizations up to date, educating parent infection control measures, educate baby back to sleep

6.1.1. Maintain optimal growth and development to reduce risk of injury, infection and SIDS

7. Physiological adaptations

7.1. 1. Immune System: recent dx of neonatal lupus, frequent monitoring of multiple labs

7.1.1. Risk of complications of neonatal lupus include heart block, low platelets, anemia, neutropenia, hepastsplenomegaly, cholestatic hepatitis

7.2. 2. Cardiac: thrombocytopenia, PLT 15, generalized petechiae rash, hyperkalemia, K 6.6, S1-S2, no murmur

7.2.1. Risk for bleeding, dysrithmias, VTach and VFib

7.3. 3. Digestive: Electrolyte imbalance, Cl 111, Creat 0.19, Bil 0.8, AST 102, anemia

7.3.1. Monitor for dehydration, kidney and liver complications

8. Reduction of Risk

8.1. hand hygiene, monitor changes/trends in vs, focused assessments - cardiac, digestive, immune,

8.1.1. Prevention of infection and injury from kidney, liver and neo-natal lupus complications