Question

ANSWER 5-7

1. John is a 10-week-old male who was born at 28 weeks gestation and weighed 0.8 kg (1 pounds, 12.2 ounces) at birth. His Neonatal ICU stay was essentially uneventful. John has an older sister, Jane, who just started preschool. Last week Jane was ill with a respiratory infection, and now John is starting to seem ill as well. He initially became ill with a runny nose, sneezing, coughing, and wheezing, and he has not been breastfeeding well. He has since been admitted to the pediatric floor with worsening respiratory symptoms that include consistent tachypnea, moderate retractions, circumoral cyanosis, and periods of apnea. Based on John’s medical history and clinical manifestations, the nurse suspects that his most likely medical diagnosis is: 2. How is this illness diagnosed? 3. John now weighs 6 pounds. The provider orders D10 1/2 NS maintenance fluids. Using the “4-2-1 Rule,” what is the correct hourly infusion rate? 4. As John’s nurse, what are some interventions that you would expect may be included in his plan of care? 5. What type of isolation do you expect that John will be placed in? What personal protective equipment (PPE) should be used when entering his room? 6. What medication therapy do you expect John to receive if his illness becomes very severe (i.e. he requires intubation)? Who should not handle this medication? 7. What product is given to certain infants in the NICU prior to discharge to prevent contraction of this illness? What are the criteria that makes an infant eligible to receive this product?

Answer 1

1-) john , 10 weaks old male , born at 28 weaks of gestation, with weigh 0.8 kg thats indicate extremely very low birth weight. Such neonates are at high risk of intrauterine growth retardation child.

His old sister Jane which is preschoolers that means her age in between 5-8years old.

Jane is suffering from respiration infection, which is communicable that also transmit to her youger brother John ,as John already has a weak immunity due to the very low birth weight and are more prone to infection .so , he gets the infection very rapidly., As showing the symptoms of infection such as initially runny nose, sneezing, coughing, and wheezing, and he has not been breastfeeding well. So, He has been admitted to the pediatric floor with worsening respiratory symptoms that include consistent tachypnea, moderate retractions, circumoral cyanosis, and periods of apnea. to beconsistent tachypnea,

John symptoms indicates to the respiratory distress syndrome.

2-)Infant respiratory distress syndrome (RDS) is a lung condition causing breathing problems in newborn premature infants. Another name for this condition is hyaline membrane disease (HMD).As we know that more premature the birth, the less able your baby's lungs are to function well.

In the lungs, the exchange of oxygen and carbon dioxide takes place in the alveoli (small air sacs). Between the 24th and 26th weeks of pregnancy, the lungs begin to produce a substance called surfactant. Surfactant helps to keep the alveoli from collapsing once they are inflated.

.Physical Examination

• breath sounds on auscultation (e.g crackling)
• Heart auscultation
• Cyanosis
• Test Results
• Arterial blood gases
• Chest x-ray
• Blood Tests
• Sputum Culture
• CT Scan
• Heart Failure Examination
• Test X-ray and blood test are done to help the doctor make the diagnosis.

3-) by using the " 4-2-1 " rule

Weigh<10 kg= 4ml/kg/hrs

So, John weigh = 6pounds that is to be approx 2kgThen infusion rate would be = 2×4ml/hr =8ml/hr

4-) As nurse of john , I planned for the intervention of John care as likely to be supportive care and focuses onReducing shunt fraction,Increasing oxygen deliveryDecreasing oxygen consumption,Avoiding further injury.

• Patients are mechanically ventilated, guarded against fluid overload with diuretics, and given nutritional support until evidence of improvement is observed.

• The mode in which a patient is ventilated has an effect on lung recovery. Evidence suggests that some ventilatory strategies can exacerbate alveolar damage and perpetuate lung injury in the context of ARDS.

Possible Interventions for ARDS

• Suctioning (Open / Closed)
• Ventilator Hyperinflation (VHI)
• Positioning (see below).
• Ventilator Hyperinflation (VHI)

Due to the high levels of PEEP that are required to maintain lung recruitment for an ARDS patient, using the ventilator to deliver the hyperinflation is ideal. Also, VHI allows the constant monitoring and monitoring of airway pressures allowing the delivery to be titrated accordingly.

Prone Positioning

Placing the ARDS patient into prone will result in a significant increase in PaO2 for approximately 70% of the patients. By placing the patient into prone, there is an improvement in the recruitment of the dorsal aspect of the lung resulting in a more evenly distributed perfusion and improving V/Q ,Swimmer's position' in prone. Ideal for regulating breathingEvidence has shown that prone positioning is beneficial particularly those who are severely hypoxaemic/severe ARDS, with reductions in ICU mortality without increased airway complications

5-)Droplet precautions prevent large droplet transmission of respiratory infection. . Place patients in single rooms, or group together those with the same etiological diagnosis. If an etiological diagnosis is not possible, group patients with similar clinical diagnosis and based on epidemiological risk factors, with a spatial separation. When providing care in close contact with a patient with respiratory symptoms (e.g. coughing or sneezing), Limit patient movement within the institution and ensure that patients wear medical masks when outside their rooms.

Apply contact precautions Contact precautions prevent direct or indirect transmission from contact with contaminated surfaces or equipment (i.e. contact with contaminated oxygen tubing/interfaces).

Use PPE (medical mask, eye protection, gloves and gown) when entering room and remove PPE when leaving and practise hand hygiene after PPE removal. If possible, use either disposable or dedicated equipment (e.g. stethoscopes, blood pressure cuffs, pulse oximeters, and thermometers). If equipment needs to be shared among patients, clean and disinfect between each patient use. Ensure that health care workers refrain from touching their eyes, nose, and mouth with potentially contaminated gloved or ungloved hands. Avoid contaminating environmental surfaces that are not directly related to patient care (e.g. door handles and light switches). Avoid medically unnecessary movement of patients or transport. Perform hand hygiene.

Apply airborne precautions when performing an aerosol-generating procedure Ensure that health care workers performing aerosol-generating procedures (e.g. open suctioning of respiratory tract, intubation, bronchoscopy, cardiopulmonary resuscitation) use the appropriate PPE, including gloves, long-sleeved gowns, eye protection, and fit-tested particulate respirators (N95 or equivalent, or higher level of protection).

6-) As the john having extremely very low birth rate,

Monitor the john condition is very important, he needs to be hospitalised.

Intravenous infusion for maintaining acid - base balance and nutritional status of baby.

7.5% soda bicarb should be administered to the baby in dose of 3.8 meq / kg in 24 hour or dose of soda bicarb may be calculated by john body pH

• . Ventilator support

CPAP should be started if arterial oxygen saturation remains below 50 mmhHg

• Oxygen via hood

After weaning the John from the ventilator , oxygen should be administered via hood to maintain paO2 between 50-80 mmHg or a saturation of 90- 95%

• Surfactant therpy

It is effective in both the prevention and management of respiratory distress. Surfactant administered intratracheally via Et tube in a dose of 100 mg / kg body weight.

• Antibiotic

It would be routinely administered to treat any pulmonary infection. And administration of vitamin E , treatment of respiratory distress syndrome, requires administration of high concentration oxygen which may lead to the development of bronchopulmonary dysplasia and retrolental fibroplasia vitanin E being biologic antioxidant , inhibition the peroxidation of membrane lipids therby reducing chances of retrolental fibroplasia and bronchopulmonary dysplasia.

7-) prior to the discharge , the dexamethasone or betamethasone which helps in maturation of infant lungs and the surfactant of alveoli.