Core Curriculum for Neonatal Intensive Care Nursing

Front Cover
Contents
Front Matter
	Core Curriculum for Neonatal Intensive Care Nursing
Copyright
Dedication
Contributors
Reviewers
Preface
Table of Contents
PART ONE Antepartum, Intrapartum, and Transition to Extrauterine Life
	1 Uncomplicated antepartum, intrapartum, and postpartum care
		Terminology
		Normal maternal physiologic changes by systems
		Antepartum care
			Assessment of gestational age
			Genetic screening
			Antepartum visits
			Antepartum fetal surveillance
			Laboratory assessments for documenting fetal lung maturity (Greenberg and Druzin, 2017)
			Maternal infections
		Normal labor and birth
		Puerperium: The “fourth trimester”
		References
	2 Antepartumintrapartum complications
		Anatomy and physiology (Baschat and Seravalli, 2017; Burton et al., 2017; London et al., 2017)
		Conditions related to the antepartum period
			Preeclampsia and eclampsia (ACOG, 2013; Sibai, 2017; Webster and Waugh, 2017)
			Diabetes in pregnancy (ACOG, 2018; Landon et al., 2017; Soh et al., 2017)
		Conditions related to the intrapartum period
			Preterm labor (Hezelgrave and Shennan, 2017)
			Abruptio placentae (Francois and Foley, 2017; Davidson et al., 2016)
			Placenta previa (Davidson et al., 2016; Francois and Foley, 2017; Navti and Konje, 2017)
			Umbilical cord prolapse (Davidson et al., 2016; Steer and Chandraharan, 2017)
			Shoulder dystocia (Crofts and Draycott, 2017; Lanni et al., 2017)
			Breech presentation (Cluver and Hofmeyr, 2017; Lanni et al., 2017)
		Obstetric analgesia and anesthesia (Davidson et al., 2016; Hawkins and Bucklin, 2017; Nutter, 2019; Tsen, 2017)
			Obstetric analgesia
			Inhaled analgesia (Nutter, 2019; Tsen, 2017)
			Obstetric anesthesia (general, neuraxial, regional) (Davidson et al., 2016; Hawkins and Bucklin, 2017; Nutter, 2019; Tsen, 2017)
			Cesarean delivery (Berghella et al., 2017; Robson and Bergholt, 2017)
		References
	3 Perinatal substance abuse
		Overview
		Risk factors associated with substance use disorder in women
		Pregnancy outcomes for substance use disorder associated with common drugs of abuse
		Fetal and neonatal outcomes for common drugs of prenatal substance dependence
		Childhood outcomes for common drugs of prenatal substance dependence
		Breast milk and drugs
		Preconception counseling and screening
		Treatment approaches for pregnant women
		Barriers to treatment
		Comorbidities associated with substance use disorders
		Screening methods to identify potential substance users
		Neonatal abstinence syndrome
		Clinical signs of neonatal abstinence syndrome
		Clinical signs associated with some drugs
		Assessment of neonatal abstinence syndrome
		Onset of signs of neonatal abstinence syndrome
		Differential diagnosis
		Nonpharmacologic treatment of neonatal abstinence syndrome
		Pharmacologic treatment of neonatal abstinence syndrome (Raffaeli et al., 2017)
		Drugs used to treat neonatal abstinence syndrome
		Standardization of pharmacologic management
		Environment to care for infants with neonatal abstinence syndrome
		Discharge and follow-up
		The future (Hamdan, 2017)
		References
	4 Adaptation to extrauterine life
		Anatomy and physiology
			Characteristics of placental–fetal circulation
			Fetal lung characteristics
			Fetal metabolism and hematology
			Labor
			Delayed cord clamping
			Cardiopulmonary adaptation at birth
		Routine care considerations during transition (Gardner and Hernandez, 2016; Taylor et al., 2018; Walker, 2018)
		Recognition of the sick newborn infant
			Review of perinatal history (Rezaee et al., 2013)
			Physical assessment (refer to chapter 7)
			Diagnostic tools (Bradshaw and Tanaka, 2016)
			Common problems and clinical presentation
			Acute hypovolemic shock
			Initial stabilization of the sick newborn infant
		Parent teaching
			Before delivery
			At delivery
			During transition
			Postpartum period (early discharge)
			Transfer to level II, III, or IV setting
		References
	5 Neonatal delivery room resuscitation
		Definitions
		Anatomy and physiology
		Risk factors
		Anticipation of and preparation for resuscitation
		Equipment for neonatal resuscitation
		Apgar scoring system
		Decision-making process
			Initial steps of resuscitation
		Postresuscitation care
		Complications of resuscitation
		The premature neonate
		Special situations
		Resuscitation outside the hospital or beyond the immediate neonatal period
		Ethics
		References
PART 2 Cornerstones of Clinical Practice
	6 Thermoregulation
		Introduction
		Physiology of thermoregulation
		Management of the thermal environment
		Summary
		References
	7 Physical assessment
		Perinatal history (see chapters 1, 2, 3, and 4)
		Gestational age instruments
		Classification of growth and maturity
		Physical examination
		References
	8 Fluid and electrolyte management
		Fluid balance
			Physiologic and assessment considerations
		Disorders of fluid balance
			Fluid depletion
			Fluid excess
		Electrolyte balance and disorders
			Sodium
			Potassium
			Calcium
			Magnesium
		Acid–base balance and disorders
			Acid–base physiology
			Disorders of acid–base balance
		References
	9 Glucose management
		Glucose homeostasis
		Hypoglycemia
		Infant of diabetic mother
		Hyperglycemia
		Transient or permanent neonatal diabetes
		References
	10 Nutritional management
		Anatomy and physiology of the premature infant’s GI tract
		Nutritional requirements
		Parenteral nutrition (Denne, 2018; AAP Committee on Nutrition, 2014)
		Enteral feedings: Human milk and commercial formulas for term, special-needs, and premature infants
		Enteral feeding methods
		Nursing interventions to facilitate tolerance of enteral feedings
		Nutritional assessment and standards for adequate growth
		References
	11 Developmental support
		Threats to development
		Early experience
		What is developmental care?
		Operationalizing developmental care
		Developmentally supportive environment
		Developmental care practices
		Parent support and involvement (Papile and Spruill-Turnage, 2017; Pineda et al., 2018)
		Teamwork and continuity of care (Spruill and Heaton, 2015)
		References
	12 Pharmacology
		Principles of pharmacology
			Terminology
		Pharmacodynamics
		Pharmacokinetics
		Medication categories
			Antimicrobial agents
			Cardiovascular agents
			Central nervous system medications
			Diuretics
			Immunizations
		Nursing implications for medication administration in the neonate
		References
	13 Laboratory testing in the nicu
		Laboratory testing in the NICU
		Laboratory specimen collection best practices
			Laboratory test collection methods in the NICU (see also chapter 15)
		Laboratory test interpretation principles
		Principles of test utilization
		Laboratory interpretation—decision tree
		Laboratory testing—iatrogenic sequelae and preventive strategies
		Decision questions to ask before obtaining a laboratory test
		References
	14 Radiologic evaluation
		Basic concepts
		Terminology
		X-ray views commonly used in the newborn infant (fig. 14.1)
		Risks associated with radiographic examination in the neonate
		Approach to interpreting an x-ray
		Respiratory system
		Pulmonary parenchymal disease
		Pulmonary air leaks
		Miscellaneous causes of respiratory distress
		Thoracic surgical problems
		Cardiovascular system
		Gastrointestinal system
		Skeletal system
		Indwelling lines and tubes
		Diagnostic imaging
		References
	15 Common invasive procedures
		Airway procedures
			Endotracheal tube suctioning: Fundamental procedure
			Oral endotracheal intubation: Advanced practice procedure
			Thoracentesis: Advanced practice procedure
		Circulatory access procedures
			Peripheral intravenous line placement: Fundamental procedure
			Peripherally inserted central catheter and midline catheter: Advanced practice procedure
			Removal of peripherally inserted central catheter: Fundamental procedure
			Umbilical vessel catheterization: Advanced practice procedure
			Umbilical artery catheterization
			Umbilical vein catheterization
			Peripheral artery catheterization: Advanced practice procedure
		Blood sampling procedures
			Choice of method for blood sampling
			Capillary blood sampling: Fundamental procedure
			Venipuncture (phlebotomy): Fundamental procedure
			Radial artery puncture: Advanced practice procedure
		Miscellaneous procedures
			Bladder catheterization: Fundamental procedure
			Male catheterization
			Female catheterization
			Lumbar puncture: Advanced practice procedure
		Simulation
		References
	16 Pain assessment and management
		Definition of pain
		Neonatal intensive care unit procedures that cause pain
		Postoperative pain
		Physiology of acute pain in preterm neonates
		Standards of practice
		Pain assessment
		Pain assessment instruments
		Echelle douleur inconfort nouveau-né, neonatal pain and discomfort scale (EDIN) (Debillon et al., 2001) (fig. 16.3)
		Nursing care of the infant in pain
		Pain management at end of life
		Parents’ role in pain assessment and management
		References
	17 Families in crisis
		Grief
			Interventions for facilitating crisis resolution
			Interventions for facilitating grief resolution
			Interventions for parents experiencing a perinatal loss
		References
	18 Patient safety
		Domain one—culture
		Structured effective methods of communication
		Domain two—learning system
		Core value of the framework: Parent/family engagement
		References
	19 Discharge planning and transition to home
		Introduction
		General principles
		Health care trends
		Individualized discharge criteria for the infant and family
		Parenting in the nicu and after discharge
		Discharge preparation and process for all NICU infants
		Additional considerations for discharge of infants with complex medical needs (table 19.1)
		Family and infant care postdischarge (box 19.9)
		References
	20 Genetics: From bench to bedside
		Basic genetics
			Terminology
			Dominance and recessiveness
			Autosomal disorders
			X-linked disorders
			Mitochondrial disorders
		Chromosomal defects
			Abnormal number
			Abnormal structure
		Prenatal diagnosis
			Indications and advantages of prenatal diagnosis
			Prenatal tests
				Triple and quad screen tests
			Ultrasonography
			Amniocentesis (“amnio”)
			Chorionic villus sampling
			Percutaneous umbilical blood sampling
		Postnatal testing
		Human genome project
		Genetic counseling
		Newborn care
			Diagnosis
			History
			Examination and care
			Examples of specific disorders (for more specific disorders, see chapter 35)
				Vater association
			Vacterl association
			Common trisomies
				Trisomy 21 (Down syndrome) (table 20.2)
			Trisomy 18
			Trisomy 13
		References
	21 Intrafacility and interfacility neonatal transport
		Historical aspects
		Philosophy of neonatal transport
		Intrafacility neonatal transport (AAP, 2007, 2016; Demmons and James, 2008; National Association of Neonatal Nurses, 2010a)
		Interfacility neonatal transport
			Types of transports (AAP, 2007, 2016)
			Selection of transport vehicles
			Transport personnel
		Transport equipment (Gershanik, 2006; Orlando et al., 2007)
		Neonatal transport process (AAP, 2007, 2016; NANN, 2010a)
		Documentation
		Safety (AAP, 2016; Camts, 2018; Levick, 2010)
		Disaster preparation (AAP, 2016; Gershanik, 2006; Orlando et al., 2007)
		Air transport considerations
		Legal and ethical considerations
		Quality management (CAMTS, 2018; NANN, 2010a, GAMUT, 2019)
		References
	22 Care of the extremely low birth weight infant
		Overview
		Epidemiology (Centers for disease control and prevention [CDC], 2017; March of Dimes, 2018)
		Mortality and morbidity (Eichenwald, 2018; Revenis, 2016; Stoll et al., 2015)
		Perinatal management (American academy of pediatrics [AAP] and American college of obstetricians and gynecologists [ACOG], 2017)
		Perinatal consultation (Cummings and Committee on Fetus and Newborn, 2015)
		Antenatal steroids
		Timing of umbilical cord clamping after birth (ACOG, 2017; AAP, 2017; AAP and American heart association [AHA], 2016)
		Delivery room care specific to ELBW infants
		Thermoregulation (see chapter 6) (AAP and ACOG, 2017; Eichenwald, 2018)
		Ventilatory practices in the delivery room (AAP and AHA, 2016)
		Admission to the neonatal intensive care unit
		Vascular access (see chapter 15)
		Skin care (see chapter 36)
		Assisted ventilation (see chapter 26)
		Nutritional management (Dell, 2019; Poindexter and Martin, 2019) (see chapters 8 and 10)
		Management and prevention of infection (Esper, 2019) (see chapter 32)
		Neurosensory complications (Papageorgiou et al., 2016)
		Developmental interventions (Eichenwald, 2018) (see chapter 11)
		End-of-life care (AAP and ACOG, 2017)
		Future directions
		References
	23 Care of the late preterm infant
		Gestational age assessment (see chapter 7) (Holditch-Davis et al., 2017; Trotter, 2019)
		Respiratory (see chapters 24 and 25) (Holditch-Davis et al., 2017; Mohan and Jain, 2018; Williams and Pugh, 2018)
		Thermoregulation issues (see chapter 6) (Holditch-Davis et al., 2017; Mohan and Jain, 2018; Williams and Pugh, 2018)
		Hypoglycemia (see chapter 9) (Blackburn, 2018; Holditch-Davis et al., 2017; Mohan and Jain, 2018; Williams and Pugh, 2018)
		Sepsis (see chapter 32) (Blackburn, 2018; Holditch-Davis et al., 2017; Mohan and Jain, 2018)
		Hyperbilirubinemia (see chapter 29) (Blackburn, 2018; Holditch-Davis et al., 2017; Mohan and Jain, 2018; Williams and Pugh, 2018)
		Feeding difficulties (see chapter 10) (Evans et al., 2019; Holditch-Davis et al., 2017; Mohan and Jain, 2018; Williams and Pugh, 2018)
		Neurologic development (see chapter 34) (Mohan and Jain, 2018; Williams and Pugh, 2018; Woythaler, 2019)
		Parent education and support (see chapters 17 and 19) (Holditz-Davis et al., 2017; Williams and Pugh, 2018)
		Discharge criteria (Mohan and Jain, 2018; Williams and Pugh, 2018)
		Long-term outcome (Woythaler, 2019)
		References
PART 3 Pathophysiology: Management and Treatment of Common Disorders
	24 Respiratory distress
		Lung development
		Physiology of respiration
		Respiratory disorders
			Respiratory distress syndrome
			Pneumonia
			Retained lung fluid syndromes—transient tachypnea of the newborn
			Persistent pulmonary hypertension of the newborn
			Meconium aspiration syndrome
			Bronchopulmonary dysplasia
		Pulmonary air leaks (pneumomediastinum, pneumothorax, pneumopericardium, pulmonary interstitial emphysema)
		Pulmonary hypoplasia
		Pulmonary hemorrhage
		Other causes of respiratory distress
		References
	25 Apnea
		Definitions of apnea (table 25.1)
		Types of apnea
		Pathogenesis of apnea in the premature infant
		Causes of apnea (table 25.2)
		Evaluation for apnea
		Management techniques
		Home monitoring
		References
	26 Assisted ventilation
		Physiology
		Treatment modalities
			Types of assisted ventilation
			Ventilator modes
		Nursing care of the patient requiring respiratory support or conventional mechanical ventilation
		High-frequency ventilation
		Nursing care during therapy
		Medications used during ventilation therapy
		Weaning from conventional ventilation
			Nursing care during the weaning process
		Interpretation of blood gas values
		References
	27 Extracorporeal membrane oxygenation
		ECMO: A historical perspective
		Common neonatal ECMO pathophysiology
		Criteria for use of ECMO
		ECMO perfusion techniques
		Circuit components and additional devices
		Physiology of extracorporeal circulation
		Care of the infant requiring ECMO
		Post-ECMO care
		Parental support
		Follow-up and outcome
		References
	28 Cardiovascular disorders
		Cardiovascular embryology and anatomy
			Cardiac development
			Great vessel development
			Circulatory development
			Cardiovascular physiology
		Congenital heart defects
			Occurrence
		Risk assessment and approach to diagnosis of cardiac disease
			Sex preferences associated with cardiac lesions
			History (Swanson and Erickson, 2016)
			Clinical presentation
			Diagnostic adjuncts
		Defects with increased pulmonary blood flow (table 28.6)
			Patent ductus arteriosus
			Ventricular septal defect
			Atrial septal defect (Swanson and Erikson, 2016)
			Endocardial cushion defect (canal)
		Obstructive defects with pulmonary venous congestion (see table 28.6)
			Coarctation of the aorta
			Critical aortic stenosis
		Obstructive defects with decreased pulmonary blood flow (see table 28.6)
			Tetralogy of fallot
			Pulmonary stenosis
			Pulmonary atresia
			Tricuspid atresia
		Mixed defects
			Transposition of the great vessels
			Truncus arteriosus
			Total anomalous pulmonary venous return
			Hypoplastic left heart syndrome
		Congestive heart failure
			Etiology
			Clinical manifestations
			Management of congestive heart failure
		Postoperative cardiac management
			Noninvasive monitoring
			Invasive monitoring
			Hemodynamic management
		Postoperative disturbances
			Heart failure
				Etiology
				Recognition of low cardiac output
				Management of low cardiac output
				Bleeding
				Pulmonary hypertension/pulmonary vasospasm (see chapter 24)
				Maintenance of fluid and electrolyte balance (see chapter 8)
			Shock
				Etiology
				Clinical indicators
				Management of shock
			Pain control and sedation (see chapter 16)
			Developmental care (see chapter 11)
			Long-term outcomes
			Congenital heart disease and pregnancy
			Parental support and education (see chapter 17)
				General information.
		References
	29 Gastrointestinal disorders
		Gastrointestinal embryonic development
		Functions of the gastrointestinal tract
		Assessment of the gastrointestinal system
		Abdominal wall defects (O’Connell et al., 2016; Raymond et al., 2018)
		Obstructions of the gastrointestinal tract
		Necrotizing enterocolitis (Fidanza and Sables-Baus, 2019; Hagen and Skelley, 2019; Kim and Claud, 2019; Yanowitz et al., 2019)
		Short-bowel syndrome (Chandra and Kesavan, 2018; Mayer and Kerner, 2017; Norsa et al., 2019)
		Biliary atresia (Bezerra et al., 2018; Siddiqui and Ahmad, 2019; Wehrman et al., 2019)
		Cholestasis (Ananth, 2018; Moreira-Silva et al., 2019; Pandita et al., 2018)
		Gastroesophageal reflux (Gulati and Jadcherla, 2019; Janek et al., 2019)
		Multisystem disorders with gastrointestinal involvement (Achour et al., 2018)
			Congenital diaphragmatic hernia (Aydin et al., 2019; Basurto et al., 2018)
		References
	30 Endocrine disorders
		The endocrine system
		Pituitary gland disorders
		Thyroid gland disorders
			The thyroid gland
			Hypothyroidism (Kim et al., 2018; Wassner, 2017; Wassner and Brown, 2018)
			Hyperthyroidism (Kim et al., 2018; Léger, 2017)
		Adrenal gland disorders
			The adrenal gland
			Adrenal disorders in the neonate
			Congenital adrenal hyperplasia (Fechner, 2018; Mccann-Crosby and Sutton, 2015; Shnorhavorian and Fechner, 2018; Stokowski, 2014; Witchel, 2017)
		Sexual development
		Disorders of sexual development (Mccann-Crosby and Sutton, 2015; Mcnamara et al., 2017; Shnorhavorian and Fechner, 2018; Stokowski, 2014)
			46,XX DSD
			46,XY DSD
			Androgen insensitivity syndrome (AIS)
			Testosterone biosynthetic defects
			5-α-reductase-2 deficiency
			Gonadal dysgenesis
			Ovotesticular DSD
			General principles of management of DSDs
		Pancreas
			Disorders of the pancreas
				Infant of a diabetic mother (see chapter 9).
				Neonatal diabetes mellitus (NDM) (see chapter 9).
				Congenital hyperinsulinism (Arnoux et al.,2011; Devaskar and Garg, 2018).
				Cystic fibrosis
		References
	31 Hematologic disorders
		Development of blood cells
		Coagulation
		Anemia
		Hemorrhagic disease of the newborn
		Disseminated intravascular coagulation
		Thrombocytopenia
		Polycythemia
		Inherited bleeding disorders
		Transfusion therapies
		Evaluation by complete blood cell count
		References
	32 Infectious diseases in the neonate
		Transmission of infectious organisms in the neonate
		Risk factors
			Identification of predisposing risk factors for neonatal infection
		Diagnosis and treatment
			Recognition of clinical manifestations of neonatal infection
			Hematologic evaluation
			Additional diagnostic evaluation
			Systemic inflammatory response syndrome (SIRS)
			Therapy
			Treatment of septic shock
			Treatment goals and prevention strategies
		Neonatal septicemia
			Common focal sites and pathogens
		Infection with specific pathogens
			Group B streptococcus
			Fungal infection: Candidiasis
			Torches clap infections
		Infection control
		References
	33 Renal and genitourinary disorders
		Overview
		Fetal development of the kidney
		Development of the bladder and urethra (Vogt and Springel, 2020)
		Renal function
		Renal anatomy
		Regulation of postnatal renal hemodynamics (Solhaug and Jose, 2017)
		Clinical evaluation of renal and urinary tract disease
			Prenatal diagnosis of renal disorders (Bates and Schwaderer, 2018; Gimpel et al., 2018)
			Postnatal evaluation of renal and urinary tract disease (Bates and Schwaderer, 2018)
		Laboratory evaluation of renal function (table 33.1)
		Radiographic evaluation (Gimpel et al., 2018; Vogt and Springel, 2020)
		Acute kidney injury (table 33.2)
			Evaluation of acute kidney injury (Vogt and Springel, 2020)
			Medical management of acute kidney injury (Vogt and Springel, 2020)
		Renal tubular acidosis
		Developmental renal abnormalities
		Disorders of the genitalia
		References
	34 Neurologic disorders
		Anatomy of the neurologic system (Blackburn, 2018; Moore et al., 2012; Volpe, 2018)
		Physiology of the neurologic system (Blackburn, 2018; Mclean et al., 2012; Volpe, 2018; Yager, 2012)
		Neurologic assessment (Blackburn, 2018; Rennie and Huertas-Ceballos, 2015; Volpe, 2018)
		Neural tube defects (NTDs)
			Anencephaly (Ditzenberger and Blackburn, 2014; Volpe, 2018)
			Encephalocele
			Spina bifida
		Neurologic disorders
		Intracranial hemorrhages
		Seizures (Piña-garza and James, 2013; Porsors et al., 2016; Scher, 2012, 2013)
		Hypoxic–ischemic encephalopathy (Laptook, 2012; Mcadams and Traudt, 2018; Porsors et al., 2016; Scher 2013)
		Periventricular leukomalacia (Back and Miller, 2018; Neil and Inder, 2018; Scher, 2013)
		Meningitis (see chapter 32)
		References
	35 Congenital anomalies
		Specific disorders
			Abnormalities of chromosomes
				Trisomy 21 (Down syndrome)
			Trisomy 18 (Edwards syndrome)
			Trisomy 13 (Patau syndrome)
				22q11.2 deletion syndrome.
		Sex chromosome abnormalities
			Turner’s syndrome
			Klinefelter’s syndrome
		Non-chromosomal abnormalities
			Malformation disorders
				Osteogenesis imperfecta.
				Achondroplasia
			Specific neural tube defects
				Developmental dysplasia of the hip (DDH).
			Talipes equinovarus (clubfoot)
			Polydactyly
		Deformation abnormalities
			Amniotic band syndrome
			Talipes calcaneovalgus
		Congenital metabolic problems
			Inborn errors of metabolism
		Disorders of metabolism
			Errors of amino acid metabolism
				Phenylketonuria
			Maple syrup urine disease
			Errors of carbohydrate metabolism
				Galactosemia.
			Errors of fatty acid oxidation
				Medium-chain acyl-coenzyme a dehydrogenase deficiency
		References
	36 Neonatal dermatology
		Anatomy and physiology of the skin
		Care of the newborn infant’s skin
		Assessment of the newborn infant’s skin
		Common skin lesions
		References
	37 Ophthalmologic and auditory disorders
		Anatomy of the eye (fig. 37.1)
			Protective structures
			The eyeball
			Extraocular muscles
		Patient assessment
			History
			Examination (de Alba Campomanes and Binenbaum, 2017; Johnson, 2016)
		Pathologic conditions and management
			Birth trauma
			Conjunctivitis
				Etiology
					Neisseria gonorrhoeae
					Chlamydia trachomatis
			Nasolacrimal duct obstruction
			Cataracts
			Retinoblastoma (de Alba Campomanes and Binenbaum, 2017)
			Congenital infections
			Congenital rubella syndrome
			Cytomegalovirus
			Toxoplasmosis (Peyron et al., 2016)
			Retinopathy of prematurity
		Anatomy of the ear (fig. 37.3)
			External ear
			Middle ear
			Inner ear
		Innervation
		Patient assessment
			History
			Examination
			Hearing loss
			Hearing screening
		References
PART 4 Professional Practice
	38 Foundations of neonatal research
		Research and generation of nursing knowledge
		Research process and components of a research study
		Quantitative research
		Qualitative research
		Areas of exploration in neonatal nursing
		Nurses as consumers of research
		Ethics in research and nurses as advocates
		References
	39 Ethical issues
		Examining ethical issues in the NICU
		Principles of biomedical ethics
			Beneficence
			Nonmaleficence
			Respect for autonomy
			Justice
			Utilization of the principle approach in the NICU
		Other approaches to ethical issues
			Ethical theories
			Kantianism
			Utilitarianism
			Liberal individualism
		Case analysis model
			Medical indications
			Patient preferences
			Quality of life
			Contextual features
		The nurse’s role in ethical issues
			Adequate communication with parents
			Supporting the NICU team
		Assessing ethical advisories from maternal child organizations
		Consulting the hospital ethics committee
		Summary
		References
	40 Legal issues
		Nursing process
		Standard of care
			State and federal regulations
			Institutional policies, procedures, and protocols
			Testimony from expert witnesses
			Standards of professional organizations
			Current professional literature
			Further issues: Practice guidelines and ethical standards
		Malpractice
		Liability
		Advanced practice
		Documentation (Yankowsky, 2017)
		Informed consent
		Professional liability insurance
		References
APPENDIX A Newborn metric conversion tables
Index
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