Discussion: Neonatal intensive care unit (NICU)
Drew is admitted to the neonatal intensive care unit (NICU) immediately after delivery. The admitting diagnosis is a neural tube defect. Drew was full term at birth, with a birth weight of 3.2kg (50th percentile) and length of 19.8 cm (50th percentile). Drew’s mother is a 37 year old with a history of three miscarriages. Drew is her first child. The pregnancy was a “surprise,” and the mother was not aware she was pregnant until 12 weeks post-conception. She was financially unable to receive consistent prenatal care and has had no prenatal screening. Upon admission to the NICU a complete evaluation of the defect is performed. Spina bifida cystica is visible at birth. When the defect is accompanied by a Chiari II malformation, resulting hydrocephalus is expected and signs of increasing ICP are assessed. The neonatologist will perform a complete examination of Drew to evaluate the lesion (sac on back), nerve involvement, and degree of motor and sensory function.
1. The following are the physical examination findings. Identify what these findings indicate:
1. The defect is located at the level of the lumbar spine (L1).
2. The sac is intact, without CSF leakage.
3. The cranial sutures are expanded.
4. The anterior fontanel is bulging.
5. The head circumference is 37.5cm.
6. The lower extremities are atrophied.
7. Muscle tone of the lower extremities is poor (limp and flaccid)
8. The bladder is full and tense.
2. Drew is scheduled for surgical closure of the sac the following day. The NICU staff begins preoperative care measures for prevention of the infection. The focus of the preoperative care for the neonate or the child with myelomeningocele is on maintaining integrity of the sac to prevent CSF loss and infection (meningitis).
The following care interventions are instituted. Provide a rationale for each intervention.
a. Position the neonate on the abdomen.
b. If the child is prone, place a cloth roll under the hips.
c. h. Intermittent urinary catherization is performed.
d. There is assessment for signs and symptoms of meningitis.
3. Explain the additional preoperative care considerations for Drew:
a. Nothing by mouth (NPO)
b. Fluids at two-thirds maintenance rate.
c. Latex precautions
d. Neurologic assessment every 2 hours.
4. Could the defect have been detected before delivery (prenatal diagnosis)?
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.
You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.Read more
Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.Read more
Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.Read more
Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.Read more
By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.Read more