Need assistance NICU Assignment Please read the

Need assistance NICU Assignment Please read the case study below and answer the associated questions. This is an individual assignment. Birth History: JZ was born 7 months ago at 25w 2d to a G4P3 mother via c/s for breech presentation after PROM and preterm labor. JZ weighed 840g at birth and had apgars of 5, 6, & 7 at 1, 5, & 10 minutes, respectively. The pregnancy was complicated by mom being HSV + with active lesions during delivery, GBS +. She is A+ blood type. Delivery/Respiratory: JZ was placed on a ventilator after birth and remained intubated for 3 weeks; she was extubated to CPAP for another 3 weeks, then hi-flow NC on and off with NC for 4 weeks, and had weaned to NC then RA—except that she was intubated for 2 days following her surgery and was on NC for 2 days. Medical History: JZ initially tolerated trophic feeds but then became septic with HSV meningitis. She was treated with Acyclovir (IV) for 21 days and has been on prophylactic PO ACV since. Feeds were resumed and but she did not attain full feeds. Two weeks ago, she was noted to not be tolerating feeds. An x-ray and an upper GI were completed—the Upper GI revealing Non-Obstructive Malrotation without volvulus. A surgical repair with Ladd’s procedure was performed 12 days ago; an ostomy was also placed during surgery. JZ was vented (as mentioned) for 2 days, and extubated to a NC for 2 days, she is now on RA. A 14Fr G-tube is in place and she is on increasing feeds and has a Hickman central line with TPN & lipids infusing. 2 days ago, JZ was febrile and a complete septic workup was completed—but all cultures have been negative. She is at risk for withdrawal from narcotics due to surgery and intubation. Current Status: JZ is a 7-months-old, she weighs 5.78kg. She is on RA. She has a #14FR G-tube in her RUQ. She is receiving PurAmino 20Kcal/oz at 18ml/hr. She has a patent ostomy. She also has a Broviac CL in place at her R chest with TPN infusing at 36.7ml/hr and Lipids at 1.5ml/hr. Social History: JZ’s mother visits every day for an hour, but she has 3 other children at home and lives 1.5 hours away. The mother is attentive and affectionate but has verbalized concern for how she will manage JZ’s health problems—both physically and financially. JZ’s father left the family shortly after JZ was born. When you receive bedside report, you note: There is a moderate amount of spit-up in the crib and JZ is crying loudly, flailing in the crib. Her linens are scattered all over the crib. Her TPN bag is near empty. The nurse does not review the current rates of TPN and Lipids and does not show you the rates on the pump. There is a dirty diaper in her crib. The trash is full and nearly overflowing. You note there is a pediatric sized ambu bag hanging on the wall, and an intact, clean suction set up. What concerns you from the above information? What will require action? What action will you do first? During your focused assessment, you note: VS: BP 95/57, HR 156, RR 50, T 37.1C, 93% on room air Labs: negative septic work-up, POCT glucose: 88. Intake: 794 ml Output: 399ml JZ has a soft, flat fontanel. Her eyes are alert but she is gazing frantically as she cries. She is pink and has pink, moist mucous membranes. Her nasal passages are clear. She has spit out her pacifier and will not suck on it at this time. Her heart rate is regular with no murmur. Her cap refill is <2 sec. She has clear breath sounds and no signs of increased work of breathing. Her abdomen is full and she has a large amount of output in her ostomy—more than 20ml/kg/shift. Her Broviac site is WNL, dressing is intact. The area around her ostomy is reddened and healing. There is formula leaking from her g-tube site and a small amount of pus is noted. JZ has the following medications on her EMR: Acyclovir 92mg every 8 hours Clonidine 4mcg/kg/day every 6 hours Famotidine 0.5mg/kg/day every 12 hours Fat emul-soy-MCT fish oil: 1g/kg/day once daiy Morphine 0.05mg/kg every 12 hours Pediatric MV 1ml once daily Below, note the exact dose for Clonidine, Famotidine, and Morphine based on JZ's current weight of 5.78kg and show the math on how you determined each dose: Clonidine: Famotidine: Morphine: What are the 3 most concerning assessment findings based on the focused assessment? Why did you select the three findings from 4? What could be going on? What will first require action from your focused assessment? Are there any intervention you want to avoid? What are the critical safety issues and how would you address them? What specific items would you teach the patient's family? SCIENCE HEALTH SCIENCE NURSING COMMUNITY NR443

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