REFLECTION PAPERIn this essay I will reflect upon an incident I had

REFLECTION PAPERIn this essay, I will reflect upon an incident I had experienced when I was on a long day shift and was assigned in the Special Care Babies Unit of our Neonatal Department. To fully explain the situation and analyse it, I will be using the Gibbs cycle of reflection (Gibbs, 1998) to help signpost my answers and to help the readers to read this essay with ease.DESCRIPTIONA baby was assigned under my care for the whole 12-hour shift. The baby was transferred to SCBU from HDU, and she was still on an incubator with an air temperature of 29 degrees, self-ventilating on room air, and with nasogastric tube in place. It was handed over that the baby can be transferred to a cot since the baby had stable vital signs over the night. Upon my assessment, the temperature was 37 degrees so at around 10:00, I transferred the baby to an open cot, placed her clothes on. Continuous monitoring was done and the baby still maintained vital signs within the normal limits. At around 12:00, the parents came to visit the baby. Dad cuddled the baby for some time. The Dad left because he had to go back to the post-natal ward to be with the mother. The baby was due for a nappy change a 13:00 so I took the observations again. The baby was having cold extremities and body temperature taken in axilla was 36.3 degrees, so I checked the temperature on the other axilla but still the reading was 36.3 degrees. I did the nappy change and wrapped the baby snuggly with blanket. After an hour, I checked the baby’s temperature and it was 36.5 degrees.Because it was still on borderline, and the baby was still having cold extremities, I turned on the heated mattress at 33 degrees. I also updated the room leader about the baby having hypothermia and informed her that I am going to put the baby on a heated mattress. An hour after turning on the heated mattress, the temperature was still 36.5 degrees. With that, I just kept the heated mattress on and swaddled the baby to make her feel warm.Prior to the next feeding at 19:00, I rechecked the baby’s temperature and it was already 36.7 degrees. I did a blood gas and did the nappy change using warm sterile water then snuggly wrapped the baby with blanket thereafter. After getting the blood gas result, the glucose level was 2.4mmol/L. I informed the Nurse Coordinator and the Registrar, and he ordered to just feed the baby and then recheck the blood sugar after 30 minutes post feed. So, I fed the baby and she was able to take 70ml of milk by bottle. After 30 minutes, I rechecked the blood sugar and it was already 4.5mmol/L.Because of the nursing intervention done, the baby was able to maintain normal vital signs and temperature was stable.FEELINGSIt was handed over that the baby can be transferred to an open cot right away because the temperature was stable overnight. Before transferring the baby to the cot, I was confident that the baby is normothermic since the body temperature was 37 degrees and the Dad cuddled the baby so baby was well thermoregulated. While the Dad was cuddling the baby, I have noticed that there were moments that the blanket placed over the baby was being removed exposing the baby. However, knowing that the Dad was doing cuddles with the baby, I was assured that the baby will not experience hypothermia. But when I found out that the baby had low temperature, I felt a bit worried because I knew that I could have done something to prevent that from happening. I informed my room leader and according to her I just had to continue checking the baby’s body temperature. Now, I am aware that even if the babies under my care are being held and cuddled by the parents, I still have to monitor their temperature and make sure they are not experiencing a cold stress. EVALUATIONThrough this experience, it enabled me to gain an insight that I should still be more vigilant in observing the babies under my care. It made me realize that babies are very susceptible to heat loss that can be caused by conduction, convection, evaporation, and radiation. With that in mind, it also reminded me that there are ways to prevent these heat losses and it will guide me on what nursing interventions can be done to the babies who are at risk of and who are experiencing hypothermia.Though the baby, experienced hypothermia, measures were done to manage it thus returning her body temperature within the normal limits. After what happened, I was more cautious about ways to keep the baby thermoregulated. So, when the mom came to cuddle the baby, I encouraged the mom to do Kangaroo Care or do skin-to-skin contact which she was happy to do so. The mom was elated to see her baby up close for the first time following the caesarean section procedure. In a way, I felt that I had a contribution in developing their mother and baby bonding which greatly helped the mom and the baby psychologically. ANALYSISThermoregulation is defined by Ellis, J. (2005) as the ability to balance heat loss and heat production through normal thermoregulatory mechanisms in order to maintain body temperature within a normothermic range. Thermoregulation is controlled by the hypothalamus and thermal stimuli providing information to the hypothalamus are derived from the body’s skin and deep thermal receptors and from thermal receptors in the pre – optic area of the hypothalamus. It is in the hypothalamus that sensory information describing thermal status throughout the body is processed and compared against the temperature set point. Body heat-and therefore body temperature-is modified by alterations in metabolism, motor tone and activity, vasomotor activity, and sweating to produce either heat gain or loss. Neonates are prone to temperature maintenance problems.A Neutral Thermic Environment (NTE) is the environment, specifically the environmental temperature, in which the infant is able to maintain a normal temperature with a minimal metabolic rate and therefore minimal oxygen consumption. A Normothermic temperature ranges from 36.5°C – 37.5°C. Temperature control or thermoregulation in the neonate is a critical physiological function that is strongly influenced by physical immaturity, extent of illness and environmental factors. Thermal management requires identifying mechanisms for heat loss and/or gain including conduction, convection, radiation, and evaporation. Conduction is heat transfer from the infant to an object while convection is heat transfer by a moving air which is affected by air temperature and air velocity. Radiation, on the other hand, is the transfer of radiant energy between body surface and surrounding surfaces not in contact with the infant. And lastly, evaporation is the loss of heat due to latent heat of evaporation. According to Smith, Alcock and Usher (2013), poor thermoregulation in neonates should be well understood and recognised to appropriately manage heat or cold stress. McCall et al (2010) stated that hypoglycaemia, respiratory distress, hypoxia, metabolic acidosis, necrotizing enterocolitis, and failure to gain weight can be a result in response to cold stress. Hackman (2001) also added that as the babies try to keep their bodies warm, the rate of metabolism increases risk for hypoglycaemia because glucose is being utilised for heat production.So, to prevent cold stress, some ways can be done to ensure that babies maintain their temperature within normal limits. Firstly, it is a must to warm all surfaces which are in direct contact with infant. Skin to skin contact or Kangaroo care with the parents should be encouraged. Infants should be kept out of drafts and should be placed over with a blanket snuggly, or can clothe the infant. A hat can be used to cover the infant’s head helps to reduce heat loss since the head is the largest part of the infant’s anatomy and is a large source of heat loss. Adding layers of clothing may also help to insulate the baby such as vests, socks, and gloves. Do not allow the infant to remain in wet diapers, and use warm water when doing nappy cares. Infants should also be nursed in a pre-warmed double walled isolette and make sure to humidify the crib if infant weighs

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