Stageportfolio
Neonatologie
Medium Care
Naam:
Studentennummer:
Inleverdatum:
Studiegroepscode:
Naam cursus:
Naam docent:
Aantal woorden klinisch redeneren: 3833
Aantal woorden onderzoekend vermogen: 4124
,Inhoudsopgave
Evaluatieformulier (CANMEDS)................................................................................................................................3
Klinisch redeneren........................................................................................................................................................4
Stap 1: Probleemoriëntatie/klinisch beeld..................................................................................................................4
Situation.................................................................................................................................................................4
Background............................................................................................................................................................4
Assessment............................................................................................................................................................6
Recommendation...................................................................................................................................................6
Psychosociaal........................................................................................................................................................6
De veranderde situatie...........................................................................................................................................7
Ernst van de situatie...............................................................................................................................................7
Screeningsinstrumenten & resultaten....................................................................................................................7
Diagnoses, differentiaaldiagnoses en hypothetische diagnoses............................................................................8
Stap 2: Probleemanalyse..............................................................................................................................................8
Disfunctionele orgaansystemen.................................................................................................................................8
Respiratoir systeem (breathing).............................................................................................................................8
Cardiovasculair systeem (circulation)...................................................................................................................8
Bloed (circulation).................................................................................................................................................9
Digestief systeem (circulation & exposure)..........................................................................................................9
Thermoregulatie systeem (exposure)....................................................................................................................9
Afweersysteem (exposure)..................................................................................................................................10
Psychische stoornissen en (psycho)sociale problematiek........................................................................................10
Resultaten van de screeningsinstrumenten..............................................................................................................10
Stap 3: Aanvullend onderzoek en diagnose..............................................................................................................11
Laboratoriumonderzoek...........................................................................................................................................11
Lichamelijk onderzoek.............................................................................................................................................11
Beeldvorming...........................................................................................................................................................11
Aanvullends anamnese.............................................................................................................................................11
Edinburgh Postnatal (Postpartum) Depression Scale (EPDS).............................................................................11
Verpleegkundige diagnoses.....................................................................................................................................12
Stap 4: Klinisch beleid................................................................................................................................................13
Stap 5: Het klinisch verloop van hyperbilirubine door prematuriteit...................................................................15
Korte termijn............................................................................................................................................................15
De behandeling....................................................................................................................................................15
Lange termijn...........................................................................................................................................................16
De gevlogen.........................................................................................................................................................16
Nodige zorg.........................................................................................................................................................16
Stap 6: Evaluatie.........................................................................................................................................................17
Onderzoekend vermogen............................................................................................................................................19
Samenvatting (CAT).................................................................................................................................................19
Probleemanalyse (inleiding)................................................................................................................................21
2
, Doelstelling..........................................................................................................................................................21
Onderzoeksvraag.................................................................................................................................................21
De interventie......................................................................................................................................................22
De voor- en nadelen van de interventie in de praktijk.........................................................................................23
2. Methode................................................................................................................................................................23
Keuze voor databanken & zoekstrategie.............................................................................................................23
3. Resultaten.............................................................................................................................................................25
Artikel 1: Beginning to see the light: lessons learned from the development of the circadian system for
optimizing light conditions in the neonatal intensive care unit (Hazelhoff et al., 2021)....................................25
Artikel 2: Emerge and influences of circadian rhythmicity in infants (Rivkees, 2004)......................................25
Artikel 3: Timing for the Introduction of Cycled Light for Extremely Preterm Infants: A Randomized
Controlled Trial (Brandon et al., 2017)...............................................................................................................26
Artikel 4: Very preterm infants show earlier emergence of 24-hour sleep-wake rhythms compared to term
infants (Guyer et al., 2015)..................................................................................................................................26
4. Discussie..............................................................................................................................................................27
De sterke aspecten...............................................................................................................................................28
De zwakke aspecten............................................................................................................................................28
Implicaties voor de praktijk.................................................................................................................................28
5. Conclusie..............................................................................................................................................................29
6. Advies...................................................................................................................................................................29
Literatuurlijst..............................................................................................................................................................30
Bijlagen........................................................................................................................................................................34
Bijlage 1: Neonatal comfort scale laag complex (NCS)..........................................................................................34
Bijlage 2: Huid observatie: Neonatal Skin Condition Score (NSCS)......................................................................35
Bijlage 3: Beoordelingslijst wetenschappelijke onderzoekspublicaties artikel 1:...................................................36
Bijlage 4: Beoordelingslijst wetenschappelijke onderzoekspublicaties artikel 2:...................................................39
Bijlage 5: Beoordelingslijst wetenschappelijke onderzoekspublicaties artikel 3:...................................................42
Bijlage 6: Beoordelingslijst wetenschappelijke onderzoekspublicaties artikel 4:...................................................46
Bijlage 7: Feedbackformulier klinisch redeneren...................................................................................................49
Bijlage 8: Feedbackformulier 1, onderzoekend vermogen......................................................................................49
Bijlage 9: Feedbackformulier 2, onderzoekend vermogen......................................................................................49
Evaluatieformulier (CANMEDS)
3
, Klinisch redeneren
Stap 1: Probleemoriëntatie/klinisch beeld
De probleemoriëntatie en het klinische beeld worden aan de hand van de SBAR-methode (situation,
background, assessment, recommendation) uitgewerkt vormgegeven (Bakker, 2017).
Situation
Het desbetreffende kindje (Man) is geboren op 25-02-2022 om 9:07. Het geboortegewicht is 2375 gram.
Reden van opname is prematuriteit en verdenking op infectie door langdurig gebroken vliezen. Op 26-
02-22 zag het kindje icterisch, waarbij er de volgende dag een hyperbilirubinemie is geconstateerd (zie
veranderende situatie).
Background
Het kindje is geboren met een zwangerschapsduur van 32+2 (preterm premature rupture of
membranes: PPROM 30+6) is het eerste kindje van ouders ter wereld ingekomen met een volle bos
donkere hoofdhaartjes en lanugobeharing. Het kindje was spontaan geboren met een goede start en
gewicht. Moeder is geboren in 1991, dit was haar eerste zwangerschap (gravida 1 para 0) en is
bloedgroep A+ resus C+.
De background wordt uitgewerkt door het gebruik van de AMPLE-methode (allergieën, medicijnen, past,
laatste maaltijd, e: context) (Bakker, 2017).
Allergieën
Geen allergieën/onbekend.
4
Neonatologie
Medium Care
Naam:
Studentennummer:
Inleverdatum:
Studiegroepscode:
Naam cursus:
Naam docent:
Aantal woorden klinisch redeneren: 3833
Aantal woorden onderzoekend vermogen: 4124
,Inhoudsopgave
Evaluatieformulier (CANMEDS)................................................................................................................................3
Klinisch redeneren........................................................................................................................................................4
Stap 1: Probleemoriëntatie/klinisch beeld..................................................................................................................4
Situation.................................................................................................................................................................4
Background............................................................................................................................................................4
Assessment............................................................................................................................................................6
Recommendation...................................................................................................................................................6
Psychosociaal........................................................................................................................................................6
De veranderde situatie...........................................................................................................................................7
Ernst van de situatie...............................................................................................................................................7
Screeningsinstrumenten & resultaten....................................................................................................................7
Diagnoses, differentiaaldiagnoses en hypothetische diagnoses............................................................................8
Stap 2: Probleemanalyse..............................................................................................................................................8
Disfunctionele orgaansystemen.................................................................................................................................8
Respiratoir systeem (breathing).............................................................................................................................8
Cardiovasculair systeem (circulation)...................................................................................................................8
Bloed (circulation).................................................................................................................................................9
Digestief systeem (circulation & exposure)..........................................................................................................9
Thermoregulatie systeem (exposure)....................................................................................................................9
Afweersysteem (exposure)..................................................................................................................................10
Psychische stoornissen en (psycho)sociale problematiek........................................................................................10
Resultaten van de screeningsinstrumenten..............................................................................................................10
Stap 3: Aanvullend onderzoek en diagnose..............................................................................................................11
Laboratoriumonderzoek...........................................................................................................................................11
Lichamelijk onderzoek.............................................................................................................................................11
Beeldvorming...........................................................................................................................................................11
Aanvullends anamnese.............................................................................................................................................11
Edinburgh Postnatal (Postpartum) Depression Scale (EPDS).............................................................................11
Verpleegkundige diagnoses.....................................................................................................................................12
Stap 4: Klinisch beleid................................................................................................................................................13
Stap 5: Het klinisch verloop van hyperbilirubine door prematuriteit...................................................................15
Korte termijn............................................................................................................................................................15
De behandeling....................................................................................................................................................15
Lange termijn...........................................................................................................................................................16
De gevlogen.........................................................................................................................................................16
Nodige zorg.........................................................................................................................................................16
Stap 6: Evaluatie.........................................................................................................................................................17
Onderzoekend vermogen............................................................................................................................................19
Samenvatting (CAT).................................................................................................................................................19
Probleemanalyse (inleiding)................................................................................................................................21
2
, Doelstelling..........................................................................................................................................................21
Onderzoeksvraag.................................................................................................................................................21
De interventie......................................................................................................................................................22
De voor- en nadelen van de interventie in de praktijk.........................................................................................23
2. Methode................................................................................................................................................................23
Keuze voor databanken & zoekstrategie.............................................................................................................23
3. Resultaten.............................................................................................................................................................25
Artikel 1: Beginning to see the light: lessons learned from the development of the circadian system for
optimizing light conditions in the neonatal intensive care unit (Hazelhoff et al., 2021)....................................25
Artikel 2: Emerge and influences of circadian rhythmicity in infants (Rivkees, 2004)......................................25
Artikel 3: Timing for the Introduction of Cycled Light for Extremely Preterm Infants: A Randomized
Controlled Trial (Brandon et al., 2017)...............................................................................................................26
Artikel 4: Very preterm infants show earlier emergence of 24-hour sleep-wake rhythms compared to term
infants (Guyer et al., 2015)..................................................................................................................................26
4. Discussie..............................................................................................................................................................27
De sterke aspecten...............................................................................................................................................28
De zwakke aspecten............................................................................................................................................28
Implicaties voor de praktijk.................................................................................................................................28
5. Conclusie..............................................................................................................................................................29
6. Advies...................................................................................................................................................................29
Literatuurlijst..............................................................................................................................................................30
Bijlagen........................................................................................................................................................................34
Bijlage 1: Neonatal comfort scale laag complex (NCS)..........................................................................................34
Bijlage 2: Huid observatie: Neonatal Skin Condition Score (NSCS)......................................................................35
Bijlage 3: Beoordelingslijst wetenschappelijke onderzoekspublicaties artikel 1:...................................................36
Bijlage 4: Beoordelingslijst wetenschappelijke onderzoekspublicaties artikel 2:...................................................39
Bijlage 5: Beoordelingslijst wetenschappelijke onderzoekspublicaties artikel 3:...................................................42
Bijlage 6: Beoordelingslijst wetenschappelijke onderzoekspublicaties artikel 4:...................................................46
Bijlage 7: Feedbackformulier klinisch redeneren...................................................................................................49
Bijlage 8: Feedbackformulier 1, onderzoekend vermogen......................................................................................49
Bijlage 9: Feedbackformulier 2, onderzoekend vermogen......................................................................................49
Evaluatieformulier (CANMEDS)
3
, Klinisch redeneren
Stap 1: Probleemoriëntatie/klinisch beeld
De probleemoriëntatie en het klinische beeld worden aan de hand van de SBAR-methode (situation,
background, assessment, recommendation) uitgewerkt vormgegeven (Bakker, 2017).
Situation
Het desbetreffende kindje (Man) is geboren op 25-02-2022 om 9:07. Het geboortegewicht is 2375 gram.
Reden van opname is prematuriteit en verdenking op infectie door langdurig gebroken vliezen. Op 26-
02-22 zag het kindje icterisch, waarbij er de volgende dag een hyperbilirubinemie is geconstateerd (zie
veranderende situatie).
Background
Het kindje is geboren met een zwangerschapsduur van 32+2 (preterm premature rupture of
membranes: PPROM 30+6) is het eerste kindje van ouders ter wereld ingekomen met een volle bos
donkere hoofdhaartjes en lanugobeharing. Het kindje was spontaan geboren met een goede start en
gewicht. Moeder is geboren in 1991, dit was haar eerste zwangerschap (gravida 1 para 0) en is
bloedgroep A+ resus C+.
De background wordt uitgewerkt door het gebruik van de AMPLE-methode (allergieën, medicijnen, past,
laatste maaltijd, e: context) (Bakker, 2017).
Allergieën
Geen allergieën/onbekend.
4
