Primary Nursing Diagnosis

Grief related to the loss of an infant through SIDS

OUTCOMES. Coping; Grief resolution; Psychosocial adjustment: Life change; Self-esteem; Mood equilibrium

INTERVENTIONS. Counseling; Family support; Active listening; Coping enhancement; Crisis intervention; Emotional support; Family support; Grief work facilitation: Perinatal death

H PLANNING AND IMPLEMENTATION Collaborative

Following an ALTE or with infants at risk for SIDS, a number of preventive measures can occur. Positioning is one measure that appears to aid in the prevention of SIDS. Encourage all parents to place infants on their backs to sleep until at least 6 months of age. Because of publicity on the link between sleep position and SIDS, the use of a prone sleeping position for infants has decreased in the United States from 70% to 24%. At the same time, the Centers for Disease Control and Prevention have reported that the SIDS rate has fallen by 38% in the United States.

Encourage parents to use a firm mattress for their infants. Explain that they should not use soft bedding or have stuffed animals in the bed with the infant, and infants should not sleep on a waterbed or with parents. Parents should avoid overheating the infant's room (temperature should be in the range of 68°F to 72°F). Recommend that mothers avoid alcohol and drug use during pregnancy and breastfeeding; explain that parents should not allow passive inhalation of cigarette smoke by the infant.

Home monitoring may be recommended for infants with ALTEs or for siblings of infants who have died from SIDS. However, the rate of SIDS in succeeding children is very low (<2%). Because monitoring cannot prevent the occurrence of SIDS, some controversy exists about home monitoring for succeeding infants. Monitors exist to measure heart rate, heart rate variability, and respiratory rate. Apnea monitors, however, may not detect complete airway obstruction as infants continue to make respiratory efforts even when the airway is obstructed. There is little information available to determine whether home monitoring is necessary, and the decision is generally made by the physician or nurse practitioner and the parents. If monitoring is initiated, the abilities of members of the household to handle and interpret monitors become important so that true and false alarms may be handled appropriately. In addition, parents should receive appropriate training in cardiopulmonary resuscitation and proper use of monitoring equipment.

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