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Continuing Care

Continuing Care. Mary P. Martinasek, RRT Director of Clinical Education Hillsborough Community College. Homeostatic Thermoregulation. Defined as the maintenance of equality between: Heat dissipation and heat production Core body temp of 37 degrees C. Heat Production.

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Continuing Care

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  1. Continuing Care Mary P. Martinasek, RRT Director of Clinical Education Hillsborough Community College

  2. Homeostatic Thermoregulation • Defined as the maintenance of equality between: • Heat dissipation and heat production • Core body temp of 37 degrees C

  3. Heat Production • Adult - can be produced by metabolic and physical activity (shivering) • Infant - has diminished shivering response and relies on metabolism of brown fat for heat production. • The breakdown of brown fat is called nonshivering thermogenesis

  4. Methods of Heat Loss • Radiant • Conductive • Convective (ambu bag air blowing on pt.) • Evaporative

  5. Goal of Thermoregulation • Maintain an environmental temperature such that the neonate’s core body temperature is maintained between 36.5 and 37.5 degrees C

  6. Thermoregulation • Incubator • Controlled environment (less convective heat loss) • Barrier to excessive handling • Quieter environment • Radiant Warmer (open bed) • Easier patient access (critical care) • Easier to attach probes and electrodes

  7. Fluid and Electrolyte Balance • Distribution of Body Water • 80% of total body weight of term infant • Decreases with aging • Distribution of Solutes • Fluid Deficit • Anterior fontanelles • Electrolyte Balance

  8. Extracellular Major Sodium Chloride Minor Potassium Calcium Magnesium Bicarbonate Protein Intracellular Major Potassium Magnesium Phosphate Minor Sodium Bicarbonate Distribution of Solutes

  9. Insensible Water Loss • IWL - water lost by evaporation from the skin and respiratory tract • Factors that increase insensible water loss • Premie • Respiratory distress • High environmental temperature • High body temperature • Break in skin • Radiant warmer • Phototherapy • Increased activity

  10. Neonatal Jaundice • Physiologic vs. Pathologic • Physiologic is common (25-50% of all newborns) • Pathologic • Caused by RH or ABO incompatibility • Bacterial or viral infections • Hemorrhaging in fetal body • IDM • Breast fed infants • Determined to be pathologic by certain criteria

  11. Exchange Transfusion • Used in an attempt to rid the neonatal body of factors causing hemolysis • Replaces about 87% of patient’s blood volume • Corrects severe anemia • Treats hemolytic disease by removing antibody-coated RBC • Removes excessive amounts of unconjugated bilirubin

  12. Necrotizing Enterocolitis (NEC) • Idiopathic disorder characterized by ischemia and necrosis of the intestine • Etiological Factors include: • Mucosal wall injury • Bacterial invasion into the damaged intestinal wall • Formula in the intestine

  13. Clinical Signs and Treatment • Guaiac-positive stools (presence of blood) • Poorly tolerated feedings • Abdominal distension • Bile residuals • Signs of sepsis (lethargy and increased O2 requirements) • Tx= avoid factors that lead to presence

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