Nursing care for a newborn with Lamellar Ichthyosis: a case study in a neonatal unit

Moraes, Etiene Leticia Leone de; Freire, Márcia Helena de Souza; Rocha, Franciele; Secco, Izabela Linha; Costa, Taine; Afonso, Regiane Queiroz

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Professional Experience Report • Rev. esc. enferm. USP 53 • 2019 • https://doi.org/10.1590/S1980-220X2018031603519 copy

Nursing care for a newborn with Lamellar Ichthyosis: a case study in a neonatal unit

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To present the nursing care of a newborn with Lamellar Ichthyosis admitted to the neonatal intensive care unit of a public children's hospital in a municipality in the state of Paraná, Brazil.

Method:

A qualitative intralocal study implementing the Case Study methodology, in which a real case was explored in a delimited system with data collection from multiple sources of information during 66 days of hospitalization in 2016.

Results:

The nursing care present in the protocol was based on: maintaining skin integrity through hydration and continuous lubrication with emollients, temperature control, nutrition and prevention of secondary infections.

Conclusion:

Through the case study, it is affirmed that implementation of the Nursing Process, especially the care plan, was essential for the multidisciplinary success of the treatment. There was improvement in the skin and mucous membranes, as well as prevention of infections, culminating in favorable survival conditions and the autonomy of parents for home care.

DESCRIPTORS
Ichthyosis, Lamellar; Congenital Abnormalities; Infant, Newborn; Intensive Care Units, Neonatal; Neonatal Nursing

Nursing Diagnosis	Nursing Prescription
1 – Ineffective infant feeding pattern due to eclabium etiology and skin dryness around the mouth and mucosal lesions.	1 – Administer the gravitational diet. 2 – Maintain elevated decubitus at 30°. 3 – Check the gastric tube positioning before diet administration. 4 – Weigh the newborn daily. 5 – Moisturize lips with Vaseline before administering the oral diet.
2 – Risk of unstable glycemia due to etiology of insufficient gavage diet volume or due to emesis episodes.	6 – Check activity and reactivity of the newborn. 7 – Report capillary glycemia less than 45 mg/dl or greater than 145 mg/dl.
3 – Risk of unbalanced fluid volume due to sepsis etiology and skin lesions.	8 – Monitor skin turgor. 9 – Evaluate mucosal hydration and communicate any changes to the nurse.
4 – Sleep deprivation due to the etiology of irritability and pain.	10 – Keep the environment quiet and dim during the whole period. 11 – Perform restricted and grouped handling.
5 – Ineffective respiratory pattern due the etiology of pain, dyspnea, abnormal respiratory pattern (frequency, rhythm and depth).	12 – Attention to episodes of dyspnea, apnea, nasal fluttering. 13 – Check vital signs every 4 hours.
6 – Risk of paternity or maternity impaired by the etiology of prolonged parental separation and illness.	14 – Encourage the mother and father to care for the newborn. 15 – Maternal/paternal care/holding; kangaroo position. 16 – Permit the parents to stay in the unit indefinitely.
7 – Risk of stress in the caregiver role by the etiology of the illness' severity of the care recipient, health instability of the care recipient.	17 – Maintain active listening. 18 – Ask for psychological support for the parents whenever necessary. 19 – Promote appropriate religious support to the interest and beliefs of the mother and father. 20 – Promote socialization of the companion (mother and/or father) with other companions; encourage short-term exits from the in-hospital environment, taking advantage of open spaces to talk.
8 – Disorganized behavior of the infant due to the etiology in their difficulty to calm down, restlessness and pain. 9 – Acute pain from the etiology of pain evidenced by applying the standardized Checklist of Non-verbal Pain Indicators (CNPI), observation of expressive behavior (shaking, crying) and facial expression of pain.	21 – Promote non-pharmacological measures during painful procedures, such as: rolling over, restraint, non-nutritive suction associated with glucose 25%, skin-to-skin contact for venous punctures, arterial puncture, calcaneal puncture, orogastric tube, upper airway aspiration. 22 – Maintain the newborn properly positioned, nestled in its incubator. 23 – Promote skin-to-skin contact. 24 – Meticulously conduct the pain scale and communicate when a score is equal to or greater than two in order to medicate according to medical prescription.
10 – Injury by impaired primary defense mechanism, such as skin ruptures.	25 – Bath with sterile water and oatmeal daily. 26 – Apply warm compresses with chamomile tea all over the body, every 12 hours. 27 – Moisturize the skin with liquid vaseline every 2 hours.
11 – Risk of infection due to the central venous catheter etiology, desquamated lesions throughout the body extension, oroenteral tube.	28 – Maintain central venous catheter permeability, use aseptic technique to perform flush and medication administration. 29 – Change extensors and stopcocks every 72 hours and diet equipment every 24 hours.
12 – Risk of corneal injury due to ectropion etiology. 13 – Risk of ocular dryness due to vitamin A deficiency.	30 – Sanitize eyes with saline solution. 31 – Apply lubricating eye drops every 4 hours. 32 – Administer Acitretin according to medical prescription.

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Etiene Leticia Leone de Moraes, Rua Delfim Moreira, 451 – Apto 04, Alto das Oliveiras, CEP 84265-360 – Telêmaco Borba, PR, Brazil etieneleticia@hotmail.com