Comforting the Neonate and the Comfort Care Theory

Running head: COMFORTING THE NEONATE AND THE COMFORT CARE THEORY

Comforting the neonate; application of the comfort care theory

Lindsey Braswell

Union University, Jackson, Tennessee

Comforting the neonate; application of the comfort care theory

The case study of interest is about a baby that will be referred to as Caitlin. Caitlin was an ex-twenty-three weaker born to a primigravida forty-year-old mother. Caitlin was born via cesearan section, intubated immediately and brought to the Neonatal Intensive Care Unit. Caitlin was only given a 10 percent chance of survival at birth due to her extremely low gestational age and birth weight. Upon admission, Caitlin was given porcine surfactant, Survanta, along with multiple umbilical lines. Caitlin was also placed in a humidified isolette which was covered with a dark blanket to create as much of a pseudouterine environment as possible. Within twenty-four hours of life, Caitlin was already over the "honeymoon" phase experienced by most preterm babies. Caitlin's sodium level had climbed to an amazing 180 mg/dL and her glucose was over 400 mg/dL. All of Caitlin's intravenous fluid therapy had to be changed over to minimal glucose and nonexistent sodium concentrations. Caitlin was also started on an insulin drip to aid in reduction of her glucose. Just as Caitlin's glucose was becoming controlled, her potassium began to climb and reached an outstanding 8.3 mg/dL. This began a series of glucose and insulin boluses that stopped counting at 22 total. Aside from the hemodynamic rollercoaster Caitlin was on, her respiratory status was less than optimal. Due to her chronic lung disease and poor kidney function from her extreme prematurity, Caitlin was always in a state of mixed acidosis. She was started on a low dose sodium bicarbonate drip which complicated her already high sodium and exacerbated her chronic carbon dioxide retention. The bicarbonate drip had to be discontinued due to the side effects and the metabolic acidosis became just "where Caitlin lived."

On day fourteen of life, another huge setback was acquired for Caitlin. Upon receiving an ultrasound of her head, Caitlin was discovered to have a grade IV intraventricular hemorrhage, which is the worst possible. This just compounded the already growing list of problems