A case of

MECONIUM ASPIRATION SYNDROME

NEONATAL INTENSIVE CARE UNIT

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER

To be presented by:

BSN III-GROUP D2

ALL ABOUT THE CASE:

The group chose this case because we find it so unique and it was so interesting rather than the other cases that we’ve encountered at NICU. We would like also to encourage pregnant mothers the importance of having weekly or monthly Prenatal Checkups before giving birth or delivery of the baby. For them to know if there’s any problem or any risk factors of the baby inside the womb.

BACKGROUND OF THE CASE

Meconium Aspiration Syndrome Syndrome occurs when a baby breathes in

amniotic fluid containing meconium (the baby’s first stools).

It is also a serious condition in which a newborn breathes a mixtures of meconium and amniotic fluid into the lungs around the time of delivery.

Meconium is passed into the amniotic fluid in about 5 to 15 percent of births

BACKGROUND OF THE CASE

Meconium Is the first intestinal discharge from

newborn. viscous, dark-green substance

composed of intestinal epithelial cells, lanugo, mucus, and intestinal secretions.

sterile and does not contain bacteria, the primary factor that differentiates it from stool.

BACKGROUND OF THE CASE

Signs and Symptoms Cyanosis Breathing Problems

Difficulty in breathing No breathing Rapid breathing

Limpness in infant at birth. Intercostal retractions Auscultated rales and bronchi Yellow green staining of fingernails, umbilical cord, and skin may

be observed.

BACKGROUND OF THE CASE

Causes : Placental insufficiency Maternal Hypertension Pre-Eclampsia Oligohydramnios Maternal Drug abuse Maternal Infection/ chorioamnionitis Fetal hypoxia

PERSONAL DATA: Name of the baby: B. boy Valyena Gender : Male Mother’s Name : Mrs. Dina Valyena

(not her real name) Civil Status : Single Age : 17 years old

Age upon delivery : 39 weeks of gestation

Date of delivery : October 16, 2010 Time of delivery : 9:15 am Type of delivery : Caesarian Section 2

degree oligohydamnios (18 hours PROM)

Weight : 2,100 grams Height : Pediatrician : Dra. Navarro

PAST MEDICAL HISTORY(OF THE MOTHER)

She has asthma 3 years ago

And no other history of illnesses

GENERAL APPEARANCE (OF THE BABY)

Bluish color (cyanosis) Small for Gestational Age Limpness of the infant Chest irregular expansion Presence of Meconium Stain

PHYSICAL ASSESSMENT

Parts to be assessed

Observation Measurement Normal findings

Interpretation

I. Gross general appearance 1.1 Height 1.2 Weight 1.3 Posture/ Gait 1.4 Skin Color 

Pinkish

2,100 grams 2,500 g- 4,200g not normal

COURSE IN THE WARD

Doctor’s Order Nursing responsibility

Rationale

Maintain Oxygen and ET tube

-place the patient in a comfortable position.-Check for any unnecessary dysfunction of the equipments.-Check for any secretions.

-To be able to patent the passage of the o2.-To avoid

Continue Positive Airway Pressure

Continue IV meds and IV FLUIDS

- Administer right me

LABORATORY RESULTS

Category Results Normal Range

• Hemoglobin 17.9 g/dl

• RBC count 5.97

• WBC Count 5.7

• Hematocrit 54.2%

• Platelet count 60

ANATOMY AND PHYSIOLOGY

RESPIRATORY SYSTEM Nostrils/Nasal Cavities  Epiglottis Pharynx  Sinuses  Larynx  Trachea Lungs   Bronchioles  Alveoli  Bronchi

PATHOPHYSIOLOGY

DRUG STUDY

Generic name

Indications Action Contrain-dications

Adverse effects

Nsg. Considerations

Ampicillin Brand Name;AmpicinCelidam

Treatment of respiratory tract and soft tissue infections.Bacterial meningitis caused by susceptible microorganisms

Interferes with cell wall synthesis of susceptible organisms, preventing bacterial multiplications.

Hypersensitivity to penicillin. Oral form not used to treat severe pneumonia, emphysema. 

•Thrombophlebitis at injection site•dizziness•fatigue•skin rashes•Itchy eyes•convulsions•seizures•neurolocity•Neuromuscular irribility•erythematic. 

1. Obtain patient history of infection2. Obtain C and S before drug therapy3. Assess history of previous sensitivity reaction to penicillin.4. Assess for allergic/hypersensivity, chills, fever, joint pain, pruritus and rash.5. Monitor renal function and urine output.

Generic Name

Indications Action Contraindications

Adverse Effects

Nsg. Considerations

Dopamine 

Brand Name:DocardHospira

dopamine HCI

Immediate precursor of epinephrine in the body exogenous administration produces direct stimulation of beta-1 receptors and variable. These action results in increased myocardial contraction and cardiac output. 

Should not be used in patient with phaechromocytoma or hyperthyroidism nor in the presence of uncorrected tachyarrhythmia or ventricular fibrillation

Correction for hemodynamic imbalances present in shock after myocardial infarction, trauma end toxic, septemia renal failure or imbalances in conditions of chronic refractory cardiac decompenecation

Ectopic beats;tachycardia,angina pain,papitation,hypotension,Vasoconstriction, headache, anxiety, dilated pupils. 

1.Obtain history of patient underlying disease condition before therapy2. Monitor vital sign and ECG3.Monitor urine output, necrosis.4. Monitor blood pressure.

Generic Name

Indication Action Contraindication

Adverse Effects

Nsg. Considerations

Gentamicin Brand Name; AdelaninGaramycinTopigen 

Interferes with protien synthesis in bacterial cell by binding to ribosomal sub unit causing misreading of genetic code;inaccurate pepticle sequence forms in protein chain causing bacterial death. 

Short-term treatment of serious infections caused by susceptible strains of microorganism espicially gram-negative bacteria;

Hypersensitivity to gentamicin.CI; injury and ulceration of the cornea; viral infection(Herpes simplex,vaccinia)or mycosis eye tuberculosis;glaucoma. 

Headache,dizziness,encephalopathy;lethargy, convulsion,muscle weakness

-Assess patient for previous sensitivity reaction.-Monitor Electrolytes; potassium, sodium, chloride, magnesium monthly. If patient is on long term therapy.

Generic Name

Indications Action Contraindications

Adverse Effects Nsg. Considerations

Piperacillin Tazobactam

Sodium 

Brand Name:Zosyn

Treatment of patients with moderate to severe infections caused by piperacillin-resistant such as: Community-acquired pneumonia (moderate severity only) caused by piperacillin-resistant, β‑lactamase producing strains of Haemophilias influenza.

A combination of piperacillin sodium and tazobactam sodium, a beta lactamase inhibitor.

Hypersensitivity to penicillin’s , cephalosporin’s, or beta-lactamase inhibitors. 

Diarrhea, Constipation, nausea and vomiting, dyspepsia, headache, rash, rhinitis, dyspnea, abnormal pain.

Generic Name

Indications Action Contraindications

Adverse Effect

Nsg.Consideration

NURSING CARE PLAN