新生兒加護病房中的發展性照護

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貌附邰
9 years ago
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1 Ultimate goal : Facilitate and promote infants growth and development *Altering environmental and caregiving stressors that interfere with physiological stability How to Achieve the Goals? Promoting individual neurobehavioral organization and maturation by: *Identifying and facili-tating stable behaviors *Reducing stressful behaviors Conserving energy Teaching parents to interpret infant behaviors Promoting parent-infant interaction and caregiving Establishing biorhythmic balance and physiologic homeostasis Providing a sensitive, responsive NICU environment (Marilyn & Laurie, 2003) NICU,

2 (Becker, Grunwald, Moorman, & Stuhr, 1993; Becker, Grunwald, & Brazy, 1999; Starr & Hoye, 1998) * NICU * NICU * NICU (Blackburn, 1998),, (Blackburn, 1998; Brandon, Holditch-Davis, & Beylea, 1999) (Becker, 1999) (Facilitation) (Positional Support) (Pacing) (Becker, Grunwald, & Brazy, 1999) (Becker et al., 1999) (Corff et al., 1999) (Neu & Brown, 1997) *

3 * (Becker, Grunwald, & Brazy, 1999) (Fearon et al., 1997 ; Neu & Brown, 1997; Taquino & Blackburn, 1994) Insulin, Glucagon, Adrenalcortical hormone (Positional Support) 2-3,,,,,,, Sucking, :,,,,,, : ( ) (Pacing)

4 ,,, ( State Modulating),, :,,, (Minimal Handling),,, :, (Als, 1999) : (Handling) : *:,, :,

5 ,, Sensitive handling: based on infant state and cues Minimal handling (Shaker, 1999) * * * * * *

6 oxygen saturation *Hct Work Work

7 > 60 /min *(Drooling) (Gulping)

8 *Desaturation *Bradycardia *Apnea *Suppression of the breathing *Compromise airway protection *Gulping requires rapid and successive swallows *Increase the likelihood of mistiming. *Stimulate the phary-ngeal stretch receptors, result vagal mediated apnea. * Apnea, bradycardia Cough and choking Cough and choking Cough and choking Facilitate the infant self-regulation

9 (Imposed break) *Imposed break *Imposed break Imposed break Imposed break Imposed break

10 (Bolus size) Bolus size Bolus size (Flow rate) *High-flow bolus control.. hypercarbia and acidosis apnea or bradycardia High-flow *Mathew apneas and bradycardia high-flow nipple. (Flow rate) *Meier Parents learn to recognize infant s cues and modify their own behavior to help infant self-regulate Parent behavior become contingent on infant behaviors

11 This interactive fit is critical for developing parent confidence and competence in feeding their baby Nurses describe stress behaviors explain in simple term Nr explain contingent interventions she is using, parents learn how they can intervene to help baby feed successfully and safely. Parents would no longer be feeding babies blindfolded or waiting for their baby to choke and turn blue Confidence comes from having information necessary to assess the infant during feeding When parents begin to feed baby, Nr is there to help them recognize infant cues, provide anticipatory guidance, reinforce appropriate and timely interventions Conclusion When caregivers support preterm infants by modifying care according to his behaviors, the infant have better outcomes. Caregivng practice and routines have a strong influence on development of successful feeding skills Use of individualized, DSC approach to feeding can optimize intake, prevent fatigue, and ensure safety, and promote earlier disch-arge

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