Presentation on theme: "Screening and Teaching for Discharge"— Presentation transcript:
1Screening and Teaching for Discharge Patsy J. Hammonds, RN, C, MS, CNA
2Objectives Provide recent birth and admission statistics Identify admission criterion for Level I, II, and III nurseriesEvaluate the knowledge level of the parents and their educational needsEvaluate the needs of the infant prior to and following discharge.Identify screening measures necessary for appropriate dischargeProvide information on SIDS to increase the parents awareness of how to be proactive in the care of their infantProvide information on infant care and safety issues that are relevant to the care of an infant being discharge from the hospitalIdentify home care needs and red flags
3General Birth and Admission Statistics for 2006-2007 14.3 million infants born in the US148,403 infants born in GA21,007 Preterm infants born in GA14,209 LBW infants <2500gms in GA2,682 VLBW infants <1500gms in GAThe data above was obtained from the Georgia Department of Human Resources, Division of Public Health
4Statistics Continued10-12% of all infants (preterm and term) are admitted to Level II or Level III NurseriesAverage LOS <1500grams: 2-4 months; LOS >1500 grams: daysNeonatal survival for weeks gestation is 11-76%27% of infants <1000gms at birth who have normal Head Ultrasounds at discharge have severe to moderate CP or other severe neurodevelopmental challenges.Kelly M. Journal of Pediatric Health Care “The Medically Complex Premature Infant in Primary Care” November/ December (2006) 20 (6)
5Need for Admission into a Level I, Newborn Nursery >34 weeks, healthyAbsence of prenatal careBirth traumaMurmurHyperbilirubinemiaInfant of a Diabetic Mother (IDDM)Infection risk factors (GBS, PROM, elevated temperature…(etc.)Substance abuseTemperature control issuesWeight loss >8%Need for further non-oxygen observation (TTN, transition)
6Need for Admission into a Level II Intermediate Care Nursery RDS (minimal-moderate O2 need)Spontaneous pnuemothoraxTTNFeeding 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)InfectionNarcotic withdrawalIV therapy for glucose managementPerinatal challenges during birth (asphyxia, etc.)Monitoring (arrhythmias, etc.)
7Need for Admission into a Level III NICU Nursery Respiratory distress or respiratory failurePrematurity (<1250 grams or <30 weeks gestationCardiac deficitDiaphragmatic herniaHematologic issues (DIC, hemolytic disorders, etc)Neurologic deficits (seizure activity, depressed skull fracture, etc)Congenital anomalies requiring supportive or diagnostic careAbdominal wall defects (i.e. gastroschisis, omphalocele)Neurologic defects (i.e. hydrocephalous, myelomeningocele)Post operative monitoring
8WHEN SHOULD YOU START DISCHARGE PLANNING??? Discharge planning should start the day of delivery.Waiting until the day of discharge is too late!!!
9Remember to plan ahead. Keep families informed Remember to plan ahead! Keep families informed. Educate them as you help them to prepare for their transition home.
10Using a team approach is the best way to plan. ParentsPhysiciansNursesPatient Care CoordinatorLactationRespiratory TherapySpeech-LanguagePhysical/Occupational TherapyNutritionPharmacists
11ParentsMost important members of the discharge team, they are the one’s that are taking the infant homeMust learn to care for the infantMust be prepared with the necessary items at home to care for the infantMust be versed on special needs that the infant may have
12Physicians and Nurses Provide the level of care that the infant needs Observe the infant’s and parents status day to day.Interact with the family unit dailyBring in other team members as needed and have periodic meetings as necessary throughout the stay, keeping the family informed as the infant makes progress, with the ultimate goal being discharge.
13Patient Care Coordination checks on many things… Limited financial resources/no insuranceDocumented substance abuse during pregnancy/positive drug screenDocumented signs/symptoms of abuse/neglect/domestic violenceTerminal stages of illnessNew diagnosis of CancerHistory of postpartum depressionNo prenatal care/limited prenatal careAdoption/surrogate birthTeen pregnancyHIV/AIDSPatient unable to care for self or infantExtended length of stays for either vaginal or cesarean births
14If 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.
15Lactation Preterm baby Infants with a dysfunctional suck Multiple gestationBaby in NICU or Intermediate NurseryH/O breast reduction/augmentationFlat or inverted nipplesBaby weight loss greater than 10%Patient’s requestLactation will see all families, including bottle feeding infants to help with feeding difficulties
16Respiratory TherapyCollaborate with the physician and the nursing staff to treat infants with any breathing problemsParticipate with the group as the infant and the family is prepared for discharge
17Speech and Language Therapy Baby with poor coordination with feeds (i.e. suck, swallow, breath and initiation)Baby with any oral motor abnormalityBaby greater than 34 weeks with feeding problems
18Physical/Occupational Therapy Baby with hypersensitivity and/or compromised neurological statusBaby with poor tone or abnormal resistance to movement and greater than 34 weeks
19Pharmacists Reviewing discharge medications Helping secure special medications for the preterm infant being discharged home
20Discharge Packet, Information and Teaching Newborn metabolic screening*Hearing screening*Eye exams*Hepatitis B vaccine*Car seat test*Synagis*Safety*Feeding and elimination*Baby care*Red Flags*
21Discharge Packet, Information and Teaching Home phototherapyCPR instructionLactation instruction and supportDischarge summaryBabies Can’t Wait or other developmental assistance programsHome health arrangements if necessary (O2, feeding, equipment, apnea monitor, phototherapy, etc.)Follow-up with Pediatrician, and Specialist visits as needed.
22Georgia Newborn Screening Program Effective January 1, 2007The Georgia Newborn Screening Panel has expanded its screening tool from tests.There will be a $40.00 fee for specimens.Georgia Newborn Screening website for updates:Georgia Department of Human Resources, Division of Public Health, Newborn Screening Program
23Why do we do Newborn Screening? Newborn screening can identify potentially fatal diseases or ones that may cause extensive brain damage within the first few days of life.All are treatable with diet and/or medications and it is important to get treatment early.It is a test required by Georgia Law.
24Newborn Screening as of January 1, 2007 PhenylketonuriaCongenital HypothyroidismMaple Syrup Urine DiseaseGalactocemiaTyrosinemiaHomocustinuriaCongenital Adrenal HypoplasiaBiotinidase DeficiencyMedium Chain Acyl-CoA Dehydrogenase Deficiency (MCADD)Sickle Cell Anemia (3 types)Isovaleric acidemiaGlutaric acidemia type I3OH-3-CH3 glutaric aciduriaMultiple carboxylase deficiencyMethylmalonic acidemias (2 types)3 Methylcrotonyl-CoA carboxylase deficiency (3MCC)Propionic acidemiaBeta- ketothiolase deficiencyVery long-chain acyl-CoA dehyrogenase deficiency (VLCAD)Long-chain L-3-OH acyl CoA dehydrogenase deficiency (LCHAD)Trifunctional protein deficiencyCarnitine uptake defectCitrulinemiaArgininosuccinic acidemiaCystic fibrosis
27Newborn Hearing Screening Can be done within a few hours after birth (results can be affected by debris and fluid in the ear canals)Allows for early treatment if hearing loss is foundEarly treatment can improve the baby’s language and brain developmentMay be delayed if currently on or recently on antibiotic therapyHearing screening and follow-up are tracked by the State just like the Metabolic Screening
30Infant Eye Exams Eye exams when applicable: Infant birth weight less than 1300 grams (gestational age < 30 weeks)Perform initial eye exam at 4-6 weeks of ageContinue Q1-2 week follow-up until satisfactory developmentInfant birth weight less than 1800 grams (gestational age <36 weeks) and received Supplemental OxygenPerform initial eye exam at 5-7 weeks of ageInfants with prolonged Supplemental Oxygen exposure see above guidelines
31Hepatitis B VaccineAll 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.
32ImmunizationsAmerican Academy of Pediatrics 2008 Guidelines.
33Infant Car Seat Safety98 % of infants under the age of 1 year are restrained when riding in vehicles80% of child restraint devices are used incorrectlyMotor vehicle accidents remain the leading cause of death in children under 4 years of ageInfants should be in rear facing car seats that are secured in the back seat until 1 year of age AND 20 pounds
343-M’s of Infant Car Seat Safety Measurement Mounting Mobility**According to the AAP, infants <2500 grams or <37 weeksgestation at birth should be tested.
37Definition of Sudden Infant Death Syndrome (SIDS) 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--postmortem examinationSIDS is a diagnosis of Exclusion
38What We Know The cause(s) of SIDS remains unknown SIDS cannot be predicted or preventedNo one is to blame for a SIDS deathNot parentsNot caregiversNot emergency personnel or other health care providers
39What HappensBaby is usually healthy or may have had sniffles or a coldBaby is put down for a nap or nightFound dead minutes to hours laterNo sign of struggle or distressSIDS can happen in any family
40Facts about SIDSThe leading cause of death in infants between one month and one year of age in the U.S.Happens in about one of every 1000 live birthsHappens most often between two and four months of ageHappens most often in the winterIncidences of SIDS doubles in the African American population and triples in the Native American population
41SIDS is NOT Caused By: Suffocation Vomiting or choking Child abuse Disease or illnessImmunizations
42Maternal Risk Factors Young--- less than 19 years of age Tobacco use doubles the risk of SIDSSubstance use is associated with increased riskLimited or late prenatal careShort intervals between pregnancies
43Infant Risk Factors for SIDS Male genderInfant ageLow birth-weightMultiple birthsPremature birthBabies can die of SIDS without having risk factors!
44Multifactorial SIDS Theory Infant’s Physiologic ResponsesSIDSDevelopmentEnvironment
46Development—Age Vulnerability 2-4 months %4-6 months %Respiratory system is unstable in all infantsMay take less of an environmental stress to trigger SIDS at this age
47Environmental Factors Sleep positionsSmokingBeddingSwaddlingSeasonMinor Respiratory SymptomsDrug usePovertyLimited prenatal care
48Ten Ways to Reduce the Risk of SIDS Always place a baby on his or her BACK TO SLEEP even for naps.Never allow smoking around a baby.Place a baby on a firm, flat surface to sleep.Remove all soft things such as loose bedding, pillows, and stuffed toys from the sleep area.Never place a baby on a sofa, waterbed, soft chair, pillow or bean bag.Take special precautions when a baby is in bed with you. (Infant should sleep alone, no co-bedding)Make sure a baby doesn’t get too hot.Keep baby’s face and head uncovered during sleep.Share this information with everyone who cares for the babyConsider using a pacifier at nap and bedtime once breastfeeding has been well established.
49SmokingRespiratory infections are frequent infants who are exposed to smoke from cigarettes.Smoking is one factor associated with Sudden Infant Death SyndromeParents who smoke should be encouraged to quit, otherwise to smoke only outside the home as smoke is absorbed by the infant even when the smoking occurs in another room in the house.Advise the parents not to smoke in the car or closed spaces around the infant.
50Synagis Synagis is given to the infant to protect them from RSV. Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and pneumonia among infants and children under 1 year of age.During their first RSV infection, between 25% and 40% of infants and young children have signs or symptoms of bronchiolitis or pnuemonia.The majority of children hospitalized for RSV infection are under 6 months of age.Indications: Siblings school age or in day care, smokers in the home, congenital heart disease, or less than 35 weeks.**Synagis is not a vaccine or an immunization.
51Baby Care Discuss circumcision with the OB or Pediatrician. Do not clean the umbilical stump with alcohol or soap and water.Fold the diaper down below the umbilical stump to allow for drying.It is not necessary for daily baths.The infant should not be submerged in a bath tub until the umbilical stump and/or the circumcision is completely healed.Be sure to wash hands before and after diaper changes.Check and change diapers prior to and after feedings.
52Feeding and Elimination 6-8 wet diapers per day1-3 stools per day (more if breast feeding)Wash your hands before and after each feedingDiscuss with your Pediatrician or Lactation Consultant regarding a breast feeding planDO NOT BOTTLE PROPDo not microwave breast milk or formulaDo not give infant waterDo not dilute ready to feed formula, and always prepare the concentrated formula, and powdered formula according to directionsDo not give infant honey or sugar
53RED FLAGS- When to Call or See the Pediatrician Labored or difficulty with breathingBleeding from orificesChanges in skin color (yellowing of skin or bluish/gray tingeExcessive vomitingRefusal to feed several times in a rowExcessive lethargy or weaknessSigns of pain (excessive crying or screaming)Fever greater than or equal to degreesIrritated eyes with drainage
54SafetyProtect infant from infection by limiting exposure to crowds, sick individuals, or toddlers for the first month.Dress the infant appropriately for the temperature, do not overdress.Avoid direct sun exposure (>15 minutes).Stress the importance of car seat restraint.Reinforce that seats must be used properly.Encourage parents to examine toys and small objects for loose parts that could obstruct airways as well as rattles that contain small objects that could choke the baby if the rattle breaks.
55SafetyIf pacifier is needed, encourage a one-piece pacifier that cannot come apart and cause chokingNever tape or tie the pacifier to the infantAdvise parents to remove items from a baby’s reach that can be harmful and put all medication/toxic substances out of reach of childrenCheck the crib to be sure that the slats are no greater than 23/8 inches apartThe mattress should be firm, pillows, bumper pads, wedgies, and stuffed animals should not be used in the cribAdjust the hot water supply to the faucets to the lowest tolerable setting (approximately 120 degrees)