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Neonatal Case Study: Nursing Challenges

Baby CA was born prematurely at 34-35 weeks to a suspected drug user. At birth she had low APGAR scores and signs of prematurity. After being admitted for respiratory distress syndrome and a possible PDA, she developed jaundice and grunting while breathing. She was discharged at 3 weeks but presented at 6 months with signs of heart failure like crackles and edema. She was started on medications and scheduled for an echo, indicating a congenital heart defect.

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Stephanie Reyes
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241 views2 pages

Neonatal Case Study: Nursing Challenges

Baby CA was born prematurely at 34-35 weeks to a suspected drug user. At birth she had low APGAR scores and signs of prematurity. After being admitted for respiratory distress syndrome and a possible PDA, she developed jaundice and grunting while breathing. She was discharged at 3 weeks but presented at 6 months with signs of heart failure like crackles and edema. She was started on medications and scheduled for an echo, indicating a congenital heart defect.

Uploaded by

Stephanie Reyes
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd

CASE SCENARIO PART I Baby CA ,34-35 weeks old, was delivered today via NSD from a 17 y/o suspected

drug user. At birth, her APGAR score was 6 and 7. Her birth weight is aroud 1,450 grams. Here anthropometrical findings are as follows: HC=33, CC=31, AC=31, VS as follows: HR=160, RR=71 with occasional apnea, Temp=36.7. Ballards-Dubowitz score=36. 1. List at least 5 possible nursing problems the infant may have at the moment. 2. Based on CAs ballards-dubowitz score, what would be her age? a. Give at least 4 neuromuscular and 4 physical traits of immature infants based on this scale. b. With regards to here anthropometrical findings, give at least 5 nursing problems. 3. Since her mother is a suspected drug user, give examples of promoting bonding between the infant and the mother. PART 2 24 hours after birth, you noted that her sclerae was jaundiced. At this point also, a audible grunt when she breathes was also seen. Continuing your assessment, there was also a faint murmur. On referral to the doctor, and after certain discussion with the family, CA was admitted in the critical care units for neonates. On admission, her initial impression was RDS, possible PDA. Mostly, her system review seemed normal although the order for her is bottle feeding with SAP, IV indomethacin, and CPAP at 90% O2. She was also scheduled for 2D echo and cardiac catheterization. 1. Would you consider CAs jaundice normal? Please explain you answer. 2. Briefly discuss the pathophysiology of RDS. Since she is on CPAP, enumerate and explain at least 5 nursing interventions to help promote oxygenation. 3. When she is started on bottle feeding, you noted that she had poor suck. Explain at least 3 nursing rationale that will help you in this problem. Give at least 5 nursing interventions that would promote nutrition. PART 3 After 3 weeks, CA was finally sent home. On her 6th month, she was brought by her mother to the health clinic for follow-up. At this time, her weight was around 2kgs. Her vital signs on her visit were as follows: HR=150, RR=70, Temp=37.8. Her mother also informs you that she has been having difficulty feeding. After further checks, you see that she has coarse crackles on both lung base, the presence of neck vein distention, mild clubbing and the presence of a machinery like murmur. Recommending admission, she was started on antibiotics, digoxin, and furosemide. She is also scheduled for 2D-echo later in the afternoon. 1. At this point, she seems to have a congenital heart disease. What signs in the case might indicate the presence of such. 2. Would her condition be cyanotic or acyanotic? Discuss your answer. 3. Give at least a brief analysis of her pathophysiology. From here, using the nursing process, give at least 10 problems that may arise.

4. The mother tells you later that although her heart was treated, it did not work. What would be the likely outcome of this condition? Based on her current management, what would be your nursing responsibilities?

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