Postpartale 2
Inhoudsopgave
LES 1: NEONATOLOGIE - WELKOM OP NEONATOLOGIE ..................................................................14
WELKOM OP NEONAAT – OLOGIE .......................................................................................................... 14
Indeling – verschil N* & NICU ....................................................................................................... 15
Transfer naar perinataal centrum ................................................................................................. 15
Opnamecriteria .......................................................................................................................... 15
Aangeboren afwijkingen .............................................................................................................. 16
Hyperbilirubinemie ..................................................................................................................... 16
Ontslagcriteria............................................................................................................................ 18
PREMATURE PASGEBORENE ................................................................................................................... 18
Premature PG - Vroeggeboorte .................................................................................................... 18
Incidentie ................................................................................................................................... 19
Beïnvloedende factoren .............................................................................................................. 19
Anticiperen op vroeggeboorte ...................................................................................................... 19
Lichaamskenmerken voreggeboorte ............................................................................................ 19
Medische gevolgen – premature PG ............................................................................................. 21
Klinische problemen – premature PG ........................................................................................... 22
Premature PG – Anemie .............................................................................................................. 23
Premature PG - retinopathie (ROP) ............................................................................................... 23
Premature PG – hersenproblemen ............................................................................................... 23
Premature PG – Follow-upprogramma ......................................................................................... 24
DYSMATURE PASGEBORENE ................................................................................................................... 24
Dysmature PG – dysmaturiteit ..................................................................................................... 24
Dysmature PG – incidentie .......................................................................................................... 24
Dysmature PG – oorzaken ........................................................................................................... 25
Dysmature PG – ZS diabetes ........................................................................................................ 25
Dysmature PG – klinische problemen ........................................................................................... 26
LEVENSVATBAARHEID ........................................................................................................................... 26
Definitie ..................................................................................................................................... 26
Levensvatbaarheid – etisch dilemma ........................................................................................... 26
Levensvatbaarheid – beïnvloedende factoren ............................................................................... 27
Levensvatbaarheid – morbiditeit en mortaliteit ............................................................................. 27
Levensvatbaarheid - Belgisch beleid !!!!!!!! ................................................................................... 27
INFECTIEPREVENTIE ............................................................................................................................. 28
Infectiepreventie – neonatale sterfte ............................................................................................ 28
Infectiepreventie – infectietekens ................................................................................................ 28
Infectiepreventie – maatregelen ................................................................................................... 29
Infectiepreventie – isolatiemaatregelen !!!!!! ................................................................................. 29
LES 2: NEONATOLOGIE - OPVANG VAN DE NEONAAT .....................................................................30
EERSTE INDRUK .................................................................................................................................. 30
Eerste indruk – apgartest ............................................................................................................. 30
Eerste indruk – apgarscore interpretatie ....................................................................................... 30
1
, Eerste indruk – reflexen ............................................................................................................... 30
ALGEMENE OBSERVATIE ........................................................................................................................ 31
Algemene observatie – gedrag & activiteit ..................................................................................... 31
Algemene observatie – huid ......................................................................................................... 31
Algemene observatie – spijsvertering ........................................................................................... 33
Algemene observatie – abdomen ................................................................................................. 33
Algemene observatie – urine & stoelgang !!!!!!!!!!!! ........................................................................ 34
VITALE PARAMETERS ............................................................................................................................. 34
VP – temperatuur ........................................................................................................................ 34
VP – warmte-instellingen ............................................................................................................. 35
VP – ademhaling !!!!!!!!!!! ............................................................................................................. 35
VP – zuurstofsaturatie ................................................................................................................. 35
VP – hartslag............................................................................................................................... 36
VP – bloeddruk ........................................................................................................................... 36
VP – bloeddrukmeting ................................................................................................................. 36
MONITORING ..................................................................................................................................... 36
Monitoring – plaatsing elektroden ................................................................................................ 36
Voedingsbeleid ........................................................................................................................... 37
Voedingsbeleid – uitdagingen ...................................................................................................... 37
Voedingsbeleid – voedingsschema .............................................................................................. 38
Voedingsbeleid – welke voeding? ................................................................................................. 38
Voedingsbeleid – donormelk........................................................................................................ 38
Voedingsbeleid – BMF ................................................................................................................. 38
Voedingsbeleid – kunstvoeding .................................................................................................... 39
Voedingsbeleid – EFS .................................................................................................................. 39
ADEMHALINGSONDERSTEUNING ............................................................................................................. 39
AHondersteuning – medicatie ...................................................................................................... 40
AHondersteuning – zuurstoftoediening ......................................................................................... 40
AHondersteuning – toedieningssysteem....................................................................................... 41
AHondersteuning – low flow systeem ........................................................................................... 41
AHondersteuning – high flow systeem .......................................................................................... 41
INVASIEVE BEADEMING ......................................................................................................................... 42
LES 3: NEONATOLOGIE – OPVANG VAN DE OUDERS .......................................................................43
OPNAME OP DE NEONATOLOGIE .............................................................................................................. 43
Ingrijpende gebeurtenissen ......................................................................................................... 43
Grote verwerkingsopdracht ......................................................................................................... 43
Gevoelens van ouders................................................................................................................. 43
Trauma....................................................................................................................................... 44
Verlies ........................................................................................................................................ 44
Anticipatorisch verlies................................................................................................................. 44
Machteloosheid, jaloezie en woede ............................................................................................. 44
TAKEN VAN DE VERPLEEGKUNDIGE ........................................................................................................... 44
Opvang ...................................................................................................................................... 44
Aandachtspunten ....................................................................................................................... 45
Bij overlijden ............................................................................................................................... 45
2
, Postpartale 2
VERGEET DE BRUSJES NIET! .................................................................................................................... 46
Impact op het hele gezin ............................................................................................................. 46
Speelkoger ................................................................................................................................. 46
LES 4: ONTWIKKELINGSGERICHTE ZORG ......................................................................................47
DOELSTELLIGEN ................................................................................................................................. 47
VERSCHILLENDE PIJLERS ....................................................................................................................... 47
Handleiding lichaamstaal interpreteren ....................................................................................... 47
Fysiologische signalen ................................................................................................................ 48
Motorische signalen.................................................................................................................... 48
Slaap – waakpatroon ................................................................................................................... 49
Zelforganisatie ............................................................................................................................ 49
Gedragsobservatie – oefeningen .................................................................................................. 50
ONTWIKKELING ONDERSTEUNENDE INTERVENTIES ...................................................................................... 50
Doel ........................................................................................................................................... 50
Omgevingsgeluid ........................................................................................................................ 50
Positieve auditieve stimulatie ...................................................................................................... 51
Licht .......................................................................................................................................... 51
Tastzin ....................................................................................................................................... 51
Positieve tactiele stimulatie ......................................................................................................... 51
Vestibulaire systeem ................................................................................................................... 52
Reukzin ...................................................................................................................................... 52
Smaakzin ................................................................................................................................... 52
Conclusie................................................................................................................................... 52
Positionering .............................................................................................................................. 53
Handelingen ............................................................................................................................... 53
Sociale omgeving........................................................................................................................ 53
LES 5: SPECIFIEKE ZORGEN NEONATOLOGIE ................................................................................54
LUCHTWEGASPIRATIE ........................................................................................................................... 54
Luchtwegenaspiratie - Fysiologie pasgeborene............................................................................. 54
Luchtwegenaspiratie - Verschillende methoden ........................................................................... 54
Luchtwegenaspiratie - Mogelijke complicaties.............................................................................. 54
Luchtwegaspiratie bij geboorte .................................................................................................... 54
Luchtwegaspiratie - bronchiaal toilet ........................................................................................... 55
Luchtwegaspiratie – sputumkweek .............................................................................................. 55
MEDICATIE ........................................................................................................................................ 55
Toedieningsvormen ..................................................................................................................... 55
Toediningsvormen – inspuitingen ................................................................................................. 55
Toedieningsvormen: IV medicatie ................................................................................................ 56
Farmacokinetiek......................................................................................................................... 56
Metabolisme .............................................................................................................................. 57
Eliminatie ................................................................................................................................... 57
Geneesmiddelengebruik ............................................................................................................. 57
Antibiotica .................................................................................................................................. 57
Respiratoir syncytieel virus (RSV) preventie .................................................................................. 57
3
, Orofaryngeale candidose (spruw) ................................................................................................ 58
Vitaminen................................................................................................................................... 58
MAAGSPOELING ................................................................................................................................. 58
WONDZORG ...................................................................................................................................... 58
Wondzorg van postoperatieve wonde ........................................................................................... 59
Stomazorg .................................................................................................................................. 60
Navelzorg ................................................................................................................................... 60
Navelzorg – complicaties ............................................................................................................ 60
LES 1: ONTWIKKELINGSPSYCHOLOGIE & HECHTING (M.M.)..........................................................61
INTRODUCTIE ..................................................................................................................................... 61
DEEL 1 – ONTWIKKELINGSPSYCHOLOGIE – COGNITIEVE ONTWIKKELING ............................................................ 61
Kernbegrippen ............................................................................................................................ 61
Theorieën van cognitieve ontwikkeling ......................................................................................... 62
DEEL 2: SOCIO-EMOTIONELE ONTWIKKELING, PERSOONLIJKHEIDSONTWIKKELING & HECHTING .............................. 68
Ontwikkeling van emotionele expressie ........................................................................................ 68
Social referencing ....................................................................................................................... 70
Ontwikkeling van het ‘ik’ .............................................................................................................. 71
Theory of mind & empathie .......................................................................................................... 71
Hechtingstheorieën .................................................................................................................... 74
Belang van een veilige hechting ................................................................................................... 80
Persoonlijkheidsontwikkeling ...................................................................................................... 82
LES 2: ROUW (M.M.) .....................................................................................................................83
INLEIDING ......................................................................................................................................... 83
WAT IS PERINATAAL VERLIES? ................................................................................................................. 83
Definitie ..................................................................................................................................... 83
Soorten perinataal verlies............................................................................................................ 84
Kenmerken perinataal verlies ...................................................................................................... 85
ROUWMODELLEN................................................................................................................................ 86
Definitie ..................................................................................................................................... 86
Rouwmodellen – Fasenmodel Kübler – Ross ................................................................................. 86
Rouwmodellen – Takenmodel worden .......................................................................................... 87
Rouwmodellen – Duale procesmodel van Stroebe & Schut ........................................................... 87
Rouwmodellen – Integratief model (Johan Maes) .......................................................................... 88
Digerentiaaldiagnosen ................................................................................................................ 88
IMPACT OP OUDERS EN OMGEVING .......................................................................................................... 90
Fasen van een perinatale verlieservaring ...................................................................................... 90
Impact op de omgeving ............................................................................................................... 91
Rol van de vroedkundige ............................................................................................................. 95
ROUWBEGELEIDING............................................................................................................................. 95
LES 1 INTRODUCTIE IN DE NEONATOLOGIE (DR. VERMANING) .......................................................96
WAT IS NEONATOLOGIE? ....................................................................................................................... 96
Neonatologie .............................................................................................................................. 96
Indeling op basis van zwangerschapsduur.................................................................................... 96
4
Inhoudsopgave
LES 1: NEONATOLOGIE - WELKOM OP NEONATOLOGIE ..................................................................14
WELKOM OP NEONAAT – OLOGIE .......................................................................................................... 14
Indeling – verschil N* & NICU ....................................................................................................... 15
Transfer naar perinataal centrum ................................................................................................. 15
Opnamecriteria .......................................................................................................................... 15
Aangeboren afwijkingen .............................................................................................................. 16
Hyperbilirubinemie ..................................................................................................................... 16
Ontslagcriteria............................................................................................................................ 18
PREMATURE PASGEBORENE ................................................................................................................... 18
Premature PG - Vroeggeboorte .................................................................................................... 18
Incidentie ................................................................................................................................... 19
Beïnvloedende factoren .............................................................................................................. 19
Anticiperen op vroeggeboorte ...................................................................................................... 19
Lichaamskenmerken voreggeboorte ............................................................................................ 19
Medische gevolgen – premature PG ............................................................................................. 21
Klinische problemen – premature PG ........................................................................................... 22
Premature PG – Anemie .............................................................................................................. 23
Premature PG - retinopathie (ROP) ............................................................................................... 23
Premature PG – hersenproblemen ............................................................................................... 23
Premature PG – Follow-upprogramma ......................................................................................... 24
DYSMATURE PASGEBORENE ................................................................................................................... 24
Dysmature PG – dysmaturiteit ..................................................................................................... 24
Dysmature PG – incidentie .......................................................................................................... 24
Dysmature PG – oorzaken ........................................................................................................... 25
Dysmature PG – ZS diabetes ........................................................................................................ 25
Dysmature PG – klinische problemen ........................................................................................... 26
LEVENSVATBAARHEID ........................................................................................................................... 26
Definitie ..................................................................................................................................... 26
Levensvatbaarheid – etisch dilemma ........................................................................................... 26
Levensvatbaarheid – beïnvloedende factoren ............................................................................... 27
Levensvatbaarheid – morbiditeit en mortaliteit ............................................................................. 27
Levensvatbaarheid - Belgisch beleid !!!!!!!! ................................................................................... 27
INFECTIEPREVENTIE ............................................................................................................................. 28
Infectiepreventie – neonatale sterfte ............................................................................................ 28
Infectiepreventie – infectietekens ................................................................................................ 28
Infectiepreventie – maatregelen ................................................................................................... 29
Infectiepreventie – isolatiemaatregelen !!!!!! ................................................................................. 29
LES 2: NEONATOLOGIE - OPVANG VAN DE NEONAAT .....................................................................30
EERSTE INDRUK .................................................................................................................................. 30
Eerste indruk – apgartest ............................................................................................................. 30
Eerste indruk – apgarscore interpretatie ....................................................................................... 30
1
, Eerste indruk – reflexen ............................................................................................................... 30
ALGEMENE OBSERVATIE ........................................................................................................................ 31
Algemene observatie – gedrag & activiteit ..................................................................................... 31
Algemene observatie – huid ......................................................................................................... 31
Algemene observatie – spijsvertering ........................................................................................... 33
Algemene observatie – abdomen ................................................................................................. 33
Algemene observatie – urine & stoelgang !!!!!!!!!!!! ........................................................................ 34
VITALE PARAMETERS ............................................................................................................................. 34
VP – temperatuur ........................................................................................................................ 34
VP – warmte-instellingen ............................................................................................................. 35
VP – ademhaling !!!!!!!!!!! ............................................................................................................. 35
VP – zuurstofsaturatie ................................................................................................................. 35
VP – hartslag............................................................................................................................... 36
VP – bloeddruk ........................................................................................................................... 36
VP – bloeddrukmeting ................................................................................................................. 36
MONITORING ..................................................................................................................................... 36
Monitoring – plaatsing elektroden ................................................................................................ 36
Voedingsbeleid ........................................................................................................................... 37
Voedingsbeleid – uitdagingen ...................................................................................................... 37
Voedingsbeleid – voedingsschema .............................................................................................. 38
Voedingsbeleid – welke voeding? ................................................................................................. 38
Voedingsbeleid – donormelk........................................................................................................ 38
Voedingsbeleid – BMF ................................................................................................................. 38
Voedingsbeleid – kunstvoeding .................................................................................................... 39
Voedingsbeleid – EFS .................................................................................................................. 39
ADEMHALINGSONDERSTEUNING ............................................................................................................. 39
AHondersteuning – medicatie ...................................................................................................... 40
AHondersteuning – zuurstoftoediening ......................................................................................... 40
AHondersteuning – toedieningssysteem....................................................................................... 41
AHondersteuning – low flow systeem ........................................................................................... 41
AHondersteuning – high flow systeem .......................................................................................... 41
INVASIEVE BEADEMING ......................................................................................................................... 42
LES 3: NEONATOLOGIE – OPVANG VAN DE OUDERS .......................................................................43
OPNAME OP DE NEONATOLOGIE .............................................................................................................. 43
Ingrijpende gebeurtenissen ......................................................................................................... 43
Grote verwerkingsopdracht ......................................................................................................... 43
Gevoelens van ouders................................................................................................................. 43
Trauma....................................................................................................................................... 44
Verlies ........................................................................................................................................ 44
Anticipatorisch verlies................................................................................................................. 44
Machteloosheid, jaloezie en woede ............................................................................................. 44
TAKEN VAN DE VERPLEEGKUNDIGE ........................................................................................................... 44
Opvang ...................................................................................................................................... 44
Aandachtspunten ....................................................................................................................... 45
Bij overlijden ............................................................................................................................... 45
2
, Postpartale 2
VERGEET DE BRUSJES NIET! .................................................................................................................... 46
Impact op het hele gezin ............................................................................................................. 46
Speelkoger ................................................................................................................................. 46
LES 4: ONTWIKKELINGSGERICHTE ZORG ......................................................................................47
DOELSTELLIGEN ................................................................................................................................. 47
VERSCHILLENDE PIJLERS ....................................................................................................................... 47
Handleiding lichaamstaal interpreteren ....................................................................................... 47
Fysiologische signalen ................................................................................................................ 48
Motorische signalen.................................................................................................................... 48
Slaap – waakpatroon ................................................................................................................... 49
Zelforganisatie ............................................................................................................................ 49
Gedragsobservatie – oefeningen .................................................................................................. 50
ONTWIKKELING ONDERSTEUNENDE INTERVENTIES ...................................................................................... 50
Doel ........................................................................................................................................... 50
Omgevingsgeluid ........................................................................................................................ 50
Positieve auditieve stimulatie ...................................................................................................... 51
Licht .......................................................................................................................................... 51
Tastzin ....................................................................................................................................... 51
Positieve tactiele stimulatie ......................................................................................................... 51
Vestibulaire systeem ................................................................................................................... 52
Reukzin ...................................................................................................................................... 52
Smaakzin ................................................................................................................................... 52
Conclusie................................................................................................................................... 52
Positionering .............................................................................................................................. 53
Handelingen ............................................................................................................................... 53
Sociale omgeving........................................................................................................................ 53
LES 5: SPECIFIEKE ZORGEN NEONATOLOGIE ................................................................................54
LUCHTWEGASPIRATIE ........................................................................................................................... 54
Luchtwegenaspiratie - Fysiologie pasgeborene............................................................................. 54
Luchtwegenaspiratie - Verschillende methoden ........................................................................... 54
Luchtwegenaspiratie - Mogelijke complicaties.............................................................................. 54
Luchtwegaspiratie bij geboorte .................................................................................................... 54
Luchtwegaspiratie - bronchiaal toilet ........................................................................................... 55
Luchtwegaspiratie – sputumkweek .............................................................................................. 55
MEDICATIE ........................................................................................................................................ 55
Toedieningsvormen ..................................................................................................................... 55
Toediningsvormen – inspuitingen ................................................................................................. 55
Toedieningsvormen: IV medicatie ................................................................................................ 56
Farmacokinetiek......................................................................................................................... 56
Metabolisme .............................................................................................................................. 57
Eliminatie ................................................................................................................................... 57
Geneesmiddelengebruik ............................................................................................................. 57
Antibiotica .................................................................................................................................. 57
Respiratoir syncytieel virus (RSV) preventie .................................................................................. 57
3
, Orofaryngeale candidose (spruw) ................................................................................................ 58
Vitaminen................................................................................................................................... 58
MAAGSPOELING ................................................................................................................................. 58
WONDZORG ...................................................................................................................................... 58
Wondzorg van postoperatieve wonde ........................................................................................... 59
Stomazorg .................................................................................................................................. 60
Navelzorg ................................................................................................................................... 60
Navelzorg – complicaties ............................................................................................................ 60
LES 1: ONTWIKKELINGSPSYCHOLOGIE & HECHTING (M.M.)..........................................................61
INTRODUCTIE ..................................................................................................................................... 61
DEEL 1 – ONTWIKKELINGSPSYCHOLOGIE – COGNITIEVE ONTWIKKELING ............................................................ 61
Kernbegrippen ............................................................................................................................ 61
Theorieën van cognitieve ontwikkeling ......................................................................................... 62
DEEL 2: SOCIO-EMOTIONELE ONTWIKKELING, PERSOONLIJKHEIDSONTWIKKELING & HECHTING .............................. 68
Ontwikkeling van emotionele expressie ........................................................................................ 68
Social referencing ....................................................................................................................... 70
Ontwikkeling van het ‘ik’ .............................................................................................................. 71
Theory of mind & empathie .......................................................................................................... 71
Hechtingstheorieën .................................................................................................................... 74
Belang van een veilige hechting ................................................................................................... 80
Persoonlijkheidsontwikkeling ...................................................................................................... 82
LES 2: ROUW (M.M.) .....................................................................................................................83
INLEIDING ......................................................................................................................................... 83
WAT IS PERINATAAL VERLIES? ................................................................................................................. 83
Definitie ..................................................................................................................................... 83
Soorten perinataal verlies............................................................................................................ 84
Kenmerken perinataal verlies ...................................................................................................... 85
ROUWMODELLEN................................................................................................................................ 86
Definitie ..................................................................................................................................... 86
Rouwmodellen – Fasenmodel Kübler – Ross ................................................................................. 86
Rouwmodellen – Takenmodel worden .......................................................................................... 87
Rouwmodellen – Duale procesmodel van Stroebe & Schut ........................................................... 87
Rouwmodellen – Integratief model (Johan Maes) .......................................................................... 88
Digerentiaaldiagnosen ................................................................................................................ 88
IMPACT OP OUDERS EN OMGEVING .......................................................................................................... 90
Fasen van een perinatale verlieservaring ...................................................................................... 90
Impact op de omgeving ............................................................................................................... 91
Rol van de vroedkundige ............................................................................................................. 95
ROUWBEGELEIDING............................................................................................................................. 95
LES 1 INTRODUCTIE IN DE NEONATOLOGIE (DR. VERMANING) .......................................................96
WAT IS NEONATOLOGIE? ....................................................................................................................... 96
Neonatologie .............................................................................................................................. 96
Indeling op basis van zwangerschapsduur.................................................................................... 96
4
