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1. IMPAIRED GAS EXCHANGE related to inadequate surfactant levels; as evidenced by grunting, flaring, substernal and intercostal retractions, CO2 50 and pH 7.31 per CBG and CXR with ground glass appearance suggestive of hyaline membrane disease.2. INEFFECTIVE THERMOREGULATION related to prematurity and low birth weight; as evidenced by poor flexion and lack of subcutaneous fat stores needed for non shivering thermogenesis. 3. ALTERED NUTRITION: LESS THAN BODY REQUIREMENTS related to respiratory distress; as evidenced by confinement under oxyhood, oral gastric tube to drainage, respiratory rate greater than 60 per minute, and NPO status. 1. IMPAIRED GAS EXCHANGE related to inadequate surfactant levels; as evidenced by grunting, flaring, substernal and intercostal retractions, CO2 50 and pH 7.31 per CBG and CXR with ground glass appearance suggestive of hyaline membrane disease. 2. INEFFECTIVE THERMOREGULATION related to prematurity and low birth weight; as evidenced by poor flexion and lack of subcutaneous fat stores needed for non shivering thermogenesis. 3. ALTERED NUTRITION: LESS THAN BODY REQUIREMENTS related to respiratory distress; as evidenced by confinement under oxyhood, oral gastric tube to drainage, respiratory rate greater than 60 per minute, and NPO status.

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15y ago
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14y ago

Risk for Infection R/T break in skin integrity at umbilical cord site Ineffective Thermoregulation R/T immature compensation for changes in environmental temperature.

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11y ago

Ineffective nutrition and temp. regulation .

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Q: What nursing diagnosis for post term infant?
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