Screening and Teaching for Discharge . Patsy J. Hammonds, RN, C, MS, CNA. Objectives. Provide recent birth and admission statistics Identify admission criterion for Level I, II, and III nurseries Evaluate the knowledge level of the parents and their educational needs
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Patsy J. Hammonds, RN, C, MS, CNA
The data above was obtained from the Georgia Department of Human Resources, Division of Public Health http://health.state.ga.us
Kelly M. Journal of Pediatric Health Care “The Medically Complex Premature Infant in Primary Care” November/ December (2006) 20 (6)367-373
Absence of prenatal care
Infant of a Diabetic Mother (IDDM)
Infection risk factors (GBS, PROM, elevated temperature…(etc.)
Temperature control issues
Weight loss >8%
Need for further non-oxygen observation (TTN, transition)Need for Admission into a Level I, Newborn Nursery
Feeding issues (cleft’s, etc.)
Apnea of prematurity
<34 weeks gestation or <2250 grams**(This is changing in some instances as insurance companies are refusing to pay for the low birth weight infants in the Intermediate Nurseries)
IV therapy for glucose management
Perinatal challenges during birth (asphyxia, etc.)
Monitoring (arrhythmias, etc.)Need for Admission into a Level II Intermediate Care Nursery
Prematurity (<1250 grams or <30 weeks gestation
Hematologic issues (DIC, hemolytic disorders, etc)
Neurologic deficits (seizure activity, depressed skull fracture, etc)
Congenital anomalies requiring supportive or diagnostic care
Abdominal wall defects (i.e. gastroschisis, omphalocele)
Neurologic defects (i.e. hydrocephalous, myelomeningocele)
Post operative monitoringNeed for Admission into a Level III NICU Nursery
Discharge planning should start the day of delivery.
Waiting until the day of discharge is too late!!!
Documented substance abuse during pregnancy/positive drug screen
Documented signs/symptoms of abuse/neglect/domestic violence
Terminal stages of illness
New diagnosis of Cancer
History of postpartum depression
No prenatal care/limited prenatal care
Patient unable to care for self or infant
Extended length of stays for either vaginal or cesarean birthsPatient Care Coordinationchecks on many things…
If the infant requires home nursing or home care equipment, be sure to keep in close contact with your facility’s discharge planner or case manager.
It may take several days to weeks for approval and arrangement of home care and equipment.
Newborn metabolic screening* be sure to keep in close contact with your facility’s discharge planner or case manager.
Hepatitis B vaccine*
Car seat test*
Feeding and elimination*
Red Flags*Discharge Packet, Information and Teaching
Home phototherapy be sure to keep in close contact with your facility’s discharge planner or case manager.
Lactation instruction and support
Babies Can’t Wait or other developmental assistance programs
Home health arrangements if necessary (O2, feeding, equipment, apnea monitor, phototherapy, etc.)
Follow-up with Pediatrician, and Specialist visits as needed.Discharge Packet, Information and Teaching
Georgia Department of Human Resources, Division of Public Health, Newborn Screening Program http://health.state.ga.us/programs/nsmscd/
Phenylketonuria be sure to keep in close contact with your facility’s discharge planner or case manager.
Maple Syrup Urine Disease
Congenital Adrenal Hypoplasia
Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCADD)
Sickle Cell Anemia (3 types)
Glutaric acidemia type I
3OH-3-CH3 glutaric aciduria
Multiple carboxylase deficiency
Methylmalonic acidemias (2 types)
3 Methylcrotonyl-CoA carboxylase deficiency (3MCC)
Beta- ketothiolase deficiency
Very long-chain acyl-CoA dehyrogenase deficiency (VLCAD)
Long-chain L-3-OH acyl CoA dehydrogenase deficiency (LCHAD)
Trifunctional protein deficiency
Carnitine uptake defect
Cystic fibrosisNewborn Screening as of January 1, 2007
Eye exams when applicable:
All infants should get their first Hepatitis B vaccine prior to discharge from the hospital and should complete the series by 6-18 months of age.
American Academy of Pediatrics 2008 Guidelines.
Measurement Mounting Mobility
**According to the AAP, infants <2500 grams or <37 weeks
gestation at birth should be tested.
The sudden and unexpected death of an apparently healthy infant usually under one year of age which remains unexplained after a:
--complete medical history
--death scene investigation
SIDS is a diagnosis of Exclusion
SIDS can happen in any family
Babies can die of SIDS without having risk factors!
**Synagis is not a vaccine or an immunization.