May be related to:
Immaturity of respitatuvar center, limited muscular development, decreased energy/fatigue
Possibly evidenced by:
periods of apnea, nasal flaring, use of accessory muscles, cyanosis, tachycardia
RISK FOR INEFFECTIVE BREATHING PATTERN
Maintain periodic breathing pattern (apneic periods last 5 - 10 sec, followed by short periods of rapid ventilation),with mucous membranes pink, and heart rate 110 - 160/respiratoryrate 24 - 60.
Assess respiratory rate and breathing pattern. Note presence of apnea and changes in heart rate, muscle tone, and skin color associated with procedures or care. Institute continuous respiratory and cardiac monitoring.
Helps in distinguishing normal cyclic periodic breathing pattern from true apneic spells, which are particularly common prior to 30 weeks gestation as we observe Baby T who is 27 gestation weeks, is tend to present apnea attacks.
Maintain optimal body temperature because even slight increase or decrease in environmental temperature can lead to apnea.
Provide prompt tactile stimulation (e.g., rub infant’s back) if apnea occurs. Note presence of cyanosis, bradycardia, or hypotonia. Encourage parental contact.
Goal Met: Baby T has not shown any apnea attacks.