A premature baby (preemie) is one born before 37 weeks of gestation. These infants require specialized nursing care to address their unique needs and prevent complications. This nursing diagnosis focuses on identifying and managing the complex challenges premature infants face while supporting their growth and development.
Causes (Related to)
Premature births can occur due to various maternal and fetal factors:
Maternal Factors:
- Multiple pregnancies
- Preeclampsia or eclampsia
- Chronic health conditions (diabetes, hypertension)
- Infections during pregnancy
- Previous preterm births
- Substance abuse
- Poor prenatal care
- Advanced maternal age
Fetal Factors:
- Congenital abnormalities
- Chromosomal disorders
- Intrauterine growth restriction
- Placental problems
- Fetal distress
Signs and Symptoms (As evidenced by)
Subjective: (Parent reports)
- Feeding difficulties
- Irregular sleep patterns
- Irritability
- Temperature instability
- Frequent crying
- Weak sucking reflex
Objective: (Nurse assesses)
- Low birth weight (<2500g)
- Small size for gestational age
- Thin, translucent skin
- Visible veins
- Underdeveloped lungs
- Poor muscle tone
- Irregular breathing patterns
- Immature reflexes
- Limited body fat
Expected Outcomes
Successful management of a premature infant includes:
- Maintaining stable vital signs
- Achieving appropriate weight gain
- Demonstrating improved feeding abilities
- Maintaining adequate temperature regulation
- Showing developmental progress
- Preventing complications
- Transitioning successfully to home care
Nursing Assessment
Monitor Vital Signs
- Temperature stability
- Heart rate and patterns
- Respiratory rate and effort
- Blood pressure
- Oxygen saturation
Assess Growth and Development
- Daily weight measurements
- Head circumference
- Length
- Developmental milestones
- Muscle tone
- Reflexes
Evaluate Feeding Status
- Sucking reflex
- Swallowing coordination
- Feeding tolerance
- Weight gain pattern
- Hydration status
Monitor for Complications
- Respiratory distress
- Infections
- Jaundice
- Thermoregulation issues
- Neurological status
Assess Family Coping
- Parental stress level
- Knowledge of care requirements
- Support system
- Resources available
Nursing Care Plans
Nursing Care Plan 1: Ineffective Thermoregulation
Nursing Diagnosis Statement:
Ineffective Thermoregulation related to immature thermal control mechanisms as evidenced by temperature instability and cold stress.
Related Factors:
- Immature nervous system
- Limited subcutaneous fat
- High surface area to mass ratio
- Immature skin barrier
Nursing Interventions and Rationales:
- Maintain a neutral thermal environment
Rationale: Prevents heat loss and promotes temperature stability - Monitor axillary temperature q2-4h
Rationale: Enables early detection of temperature changes - Use appropriate warming devices
Rationale: Supports temperature regulation
Desired Outcomes:
- The infant will maintain a temperature between 36.5-37.5°C
- The infant will show no signs of cold stress
- The infant will demonstrate stable vital signs
Nursing Care Plan 2: Risk for Impaired Gas Exchange
Nursing Diagnosis Statement:
Risk for Impaired Gas Exchange related to immature lung development as evidenced by irregular breathing patterns and decreased oxygen saturation.
Related Factors:
- Underdeveloped lungs
- Surfactant deficiency
- Immature respiratory muscles
- Increased work of breathing
Nursing Interventions and Rationales:
- Monitor respiratory status continuously
Rationale: Enables early detection of respiratory compromise - Position for optimal breathing
Rationale: Promotes lung expansion and prevents atelectasis - Administer oxygen as prescribed
Rationale: Maintains adequate oxygenation
Desired Outcomes:
- The infant will maintain oxygen saturation >90%
- The infant will demonstrate improved breathing patterns
- The infant will show no signs of respiratory distress
Nursing Care Plan 3: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to the immature immune system as evidenced by increased susceptibility to pathogens.
Related Factors:
- Underdeveloped immune system
- Invasive procedures
- Extended hospitalization
- Immature skin barrier
- Limited maternal antibodies
Nursing Interventions and Rationales:
- Implement strict hand hygiene
Rationale: Prevents transmission of pathogens - Monitor for signs of infection
Rationale: Enables early detection and treatment - Maintain sterile technique during procedures
Rationale: Reduces risk of infection
Desired Outcomes:
- The infant will remain free from infection
- The infant will maintain stable vital signs
- The infant will show no signs of sepsis
Nursing Care Plan 4: Imbalanced Nutrition
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than body requirements related to immature feeding reflexes as evidenced by poor weight gain and feeding difficulties.
Related Factors:
- Immature sucking reflex
- Poor coordination of suck-swallow reflex
- Increased metabolic demands
- Limited energy reserves
Nursing Interventions and Rationales:
- Monitor feeding tolerance
Rationale: Ensures adequate nutrition without complications - Track daily weights
Rationale: Measures growth and nutrition status - Implement appropriate feeding method
Rationale: Promotes safe and effective nutrition delivery
Desired Outcomes:
- The infant will demonstrate appropriate weight gain
- The infant will show improved feeding skills
- The infant will maintain adequate hydration
Nursing Care Plan 5: Interrupted Family Processes
Nursing Diagnosis Statement:
Interrupted Family Processes related to premature birth and hospitalization as evidenced by parental anxiety and altered family dynamics.
Related Factors:
- Separation from infant
- Complex medical needs
- Financial stress
- Uncertainty about outcomes
- Changed parental role expectations
Nursing Interventions and Rationales:
- Promote parent-infant bonding
Rationale: Strengthens attachment and parental confidence - Provide education and support
Rationale: Increases parental competence and reduces anxiety - Facilitate kangaroo care
Rationale: Promotes bonding and infant stability
Desired Outcomes:
- Parents will demonstrate confidence in infant care
- The family will report decreased anxiety
- Parents will actively participate in care decisions
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
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- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Moroney K. Family reflections: premature baby. Pediatr Res. 2021 Feb;89(3):705-706. doi: 10.1038/s41390-020-01296-3. Epub 2020 Dec 8. PMID: 33293680.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
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