Question

Client Profile

Baby Martin was born via a normal spontaneous vaginal delivery (NSVD) at 36 weeks gestation. The mother arrived at the emergency room dilated to 9 centimeters and 100 % effaced. The mother also reports ruptured membranes for the past 22 hours. The fetal heart rate upon admittance to the emergency room is 170 bpm. The mother delivered in the emergency room 30 minutes after being examined. This is her seventh pregnancy, and she did not have prenatal care.

Case Study

Martin was admitted to the observation nursery from the emergency room where he was born. He weighed 5 pounds and was 19 inches long. His APGAR scores were 6 at one minute, and 8 at five minutes. Points were initially taken off for tone, reflexes, and color. His initial glucose was 35 and vital signs were heart rate 150, respirations 76, and temperature 97.2. The nurse noted some nasal flaring, grunting, and coarse breath sounds. He was given 1 ounce of D5W orally; oxygen therapy, and his skin and pharynx were cultured. The orders also included that he be placed on a warmer with skin probe for temperature monitoring.

At two hours the baby's glucose was 40, the nasal flaring continued, respiratory rate was 100 with continued coarse breath sounds. He exhibited acrocyanosis, and his temperature was 96.8. The baby was treated for transient tachypnea of the newborn with oxygen therapy and a warm environment.

At four hours the nurse noted that the baby was lethargic and difficult to arouse. He appeared pale with circumoral cyanosis, nasal flaring, and grunting with sternal retractions. The nurse notified the doctor, an IV was started, and the baby was transferred to the neonatal intensive care unit at a hospital in the next town.

At six hours the mother called the NICU to check on his progress and was told that he had subsequently developed jaundice and was on a ventilator.

Questions

1.This baby is initially being screened for infection and treated for transient tachypnea of the newborn. What data supports this diagnosis? (explain)

2.List the progressive signs of respiratory distress exhibited by this infant after birth.(explain)

3.List the risk factors that existed for infection.

Answer 1

1. When 7TH GRAVIDA the mother has admitted to the hospital with history ruptured of membranes over the 22 hours, on examination, her cervix is 100 effaced and 9 centimeters dilated. Then she delivered baby martin with 30 minutes of admission. Baby had apgar score 6 at one minute and 8 at 5 minutes and had hypoglycemia, tachyponea, tachycardia, nasal flaring, grunting, coarse breath sounds on observation. Baby was treated with glucose D5 on ounce orally, oxygen therapy. Baby skin and pharynx was cultured for any organism.

                 Then after two hours, baby developed further hypoglycemia, continuing tachycardia, tachypnea, coarse breath sounds, and acrocynosis. At four hours, the baby becomes lethargic, pale in appearance along with circumoral cyanosis. On observation, baby shows of nasal flaring, grunting and sternal retractions

At six hours baby developed jaundice

Initially the physician diagnosed it as infection because the mother has history of rupture of membrane for the past 22 hours. When the rupture of membrane crossed the 6 hours, there is a chance of infection from vato fetus due to chorioamnionitis as a result of normal bacteria in the vagi may go into uterus and causes infection. When mother was admitted, rapid heartbeat of baby was found. Within 6 hours of rupture of membrane, antibiotic need to be administered if progress of labour is delayed. Baby showed signs of infections, when infections occur, it cause low level of sugar, low temperature, pallor, breathing difficulties, jaundice, lethargy.

2. After birth baby showed apgar 6 at one minute after birth followed by 8 apgar at 5 minute after birth. Baby developed hypoglycemia because his blood glucose was 35 and vital signs showed tachycardia because his heart rate 150 and tachypnoea because his respiratory rate was 76 and subnormal temperature. Baby has  nasal flaring because of difficulty in breathing, grunting sound can be heard when baby exhales, coarse breath sound is low pitched sound can be assessed in lung examination . these are signs of respiratory distress syndrome

         At two hours, baby continues to have hypoglycemia, tachycardia, tachyponea, coarse breath sounds, acrocynosis (bluish discoloration of mouth and extremities.

   At four hours, lethargic is sluggish in appearance, pallor is due low blood circulation to body and central cyanosis is generalized bluish discoloration of skin in the body, nasal flaring, grunting with sternal retractions as a result of  breathing diffuculty and baby uses muscles for breathing.

at 6 hours of birth, baby developed jaundice

3.

A. the membrane that has ruptured for the past 22 hours this is the reason nbacteria can enter the uterus causes infection mainly E.coli

B. she has never under gone prenatal check up. if she has undergoes, she has consulted earlier in the hospital for better treatment

C. the baby delivered after 22 hours of rupture of membranes. prolonged may cause increase the chance of infection and fetal distress