Hypoglycaemia Care Plan

Question 1

Problems and potential problems

Answer 1

Problem:
Hypoglycaemia

Potential problems:
- hypoxia
- hypercapnia
- hypothermia
- poor feeding
- lethargy
- repeated painful procedures
- seizures
- long term neourological, developmental delays

Question 2

Goals of care

Answer 2

• Maintain BGL >2.6
• Maintain temp within 36.5 and 37.5
• To establish a feeding regione which supplements nutritionally but promotes maternal wish to BF
• reduce pain associated with repeated painful procedures
• maintain pre ductal O2 saturations
• assess for any neurological deterioration

Question 3

Intervention and rationale

Answer 3

Feeding
- If infant is old enough to breastfeed, strict 3 hourly breastfeeding regime, express after, and then top up with EBM or formula post
- If infant is not ready for suck feeds, supporting mum to express and enteral feeding, topping up with formula
- If infant is NBM, IV dextrose and TPN commencing at 60ml/kg/day via IV
- ensures baby is being supplemented with enough circulating glucose

Frequent BGLs
- pre feed BGL to assess whether BGL is being maintained or if infant needs further intervention

Nurse in a preheated incubator
- to support maintaining a NTE which prevents cold stress and associated increased energy usage required to maintain temperature but may deplete stores

Swaddle
- keeps infant warm reducing cold stress by minimising heat loss through convection and evaporation

Skin to skin if appropriate of other conditions
- reduces heat loss through conduction
- supports mother infant bonding snd establishment of BF which is vital in maintaining BGL

Dry baby thoroughly and remove wet wraps
- avoids heat loss through evaporation - prevents cold stress

Referral of mother to LC/support lactogenesis II
- more successful establishment of lactogenesis II allows for infant to be fed with larger volumes of breast milk and all its benefits
- NEC
- antibodies

Assess for cardinal signs of respiratory distress

Pain managment
- minimises pain through releasing endogenous opioids like dopamine to support comfort

Question 4

Evaluation

Answer 4

• reassessment of BGL
• frequent temp check with cares or more frequently if necessary
• assess for S+S of worsening hypoglycaemia or respiratory distress
• maintenance of O2 sats or desaturations