Professional Documents
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CP 1
CP 1
DEMOGRAPHIC DATA
Chief Complaints - My Patient’s Mother Complaints That Baby Refused To Feed And Cry And
Bluish Discolouration Of The Body
PERSONAL HISTORY
Bowel & Bladder Pattern - Regular.Urine Frequency Is 4-6 Times Per Day.
FAMILY HISTORY
My Patient’s Family Has No Specific Hereditary Diseases Like Hypertension, Diabetes Mellitus, Cancer
Etc. There Is No Family History Of Communicable Diseases Like Tuberculosis, Aids Etc.
Electricity - Available
PRENATAL HISTORY
Mother Had No Other Diseases During Pregnancy.She Was Not Taking Any Type Of Drugs Except Folic
Acid And Iron Tablets During Pregnancy Period.
NATAL HISTORY
Initiation Of Breast Feeding - Baby Had First Breast Feeding Within 1 Hour.
Baby Of Deepa Admitted Due To Breathing Diffficulty And Baby Refused To Cry And Feeding.
NUTRITIONAL HISTORY
My Patient Takes Breast Feeding 5-6 Times Per Day In Small Duration.
IMMUNIZATION HISTORY
AGE VACCINE TAKEN
DAY 1 SINGLE DOSE OF BCG.
PHYSICAL EXAMINATION
ANTHROPOMETRIC MEASUREMENT
HEIGHT - 50cm
WEIGHT - 2.5kg
GENERAL APPEARANCE
Complexion - Fair
HEAD
Hair - Black
Scalp - Soft
Fontenelle – Anterior And Posterior Fontenels Remains Open With Normal Shape
FACE
Eye
Conjunctiva - Pinkish
OphthalmiaNeonatorum - Absent
EAR
Pinna – Curved
MOUTH
Lips - Moist
Tongue – Pinkish
NECK
CHEST
ABDOMEN
Inspection - No Distension
BACK
EXTREMITIES
Polydactaly - Absent
Syndactaly - Absent
Nail - Developed
GENITALS:
VITAL SIGNS
Temperature – 99f
REFLEXES
(1) ROOTING:-
Stimulation: - Touching Or Stroking The Cheek Near The Corner Of The Mouth.
Response: - Head Turns In Direction Of Stimulation So That The Neonate Can Find Food. When The Breast
Touches The Cheek, Neonate Turns Toward The Nipple.
Diappearence: - 6th Week Of Life When The Source Of Food Can Be Seen. Disappears 3-4 Months When
Awake When Asleep 7-8 Months.
(2) SUCKING:-
Stimulation: - Touching The Lips With The Nipple Of The Breast Or Bottle Or Other Object.
Disappearrence: - Begins To Diminish At 6 Months Disappears Soon After Birth It Not Stimulates. If A
Neonate Cannot Take Oral Feedings A Pacifier May Be Need To Maintain The Reflex.
(3) SWALLOWING:-
(4) GANGING:-
Stimulation: - When More Is Taken Into The Mouth That Can Be Successfully Swallowed.
(6) EXTRUSION:-
(7) BLINKING :-
Stimulation: - Exposure Of Eyes To Bright Light From A Flash Light Or Sudden Movement At Object To
Ward Eye.
Stimulation: - Turn The Newborn’s Head Slowly To The Right Or Left Side.
Stimulation: - Touching The Sole At The Foot At The Base Of The Toes.
Disappearance :- 8 To 9 Months In Preparation For Walking May Continue To Be Present During Sleep.
Stimulation :- Hold Neonate In A Vertical Position With The Feet Touching A Flat, Firm Surface.
Disappearance :- 3-4 Weeks. The Neonate Soon The Reefer Can Bear Some Weight On The Legs Without
Stepping.
(12) BABINSKI :-
Stimulation :- Stroking The Lateral Aspect Of The Sole Of The Foot With A Relatively Sharp Object From
The Heal Up To Ward The Little Toe And Across The Foot To The Big Toe.
Response :- Fans The Toes (+Ve Babinski Sign). The Adult Normally Flexes The Toes. The Newborns
Response Is Due To An Immature Level Of Nervous System Development.
Stimulation :- Turing The Head Quickly To One Side While The Infant Is Supine.
Response :- Arm An Leg On The Side The Head Is Turned Toward Extend. Arm And Leg On The Opposite
Side Flex. Both Hands May Make Fists.
Disappearance :- 18-20 Weeks. Tonic Neck Reflex Is Replaced With Symmetric Positioning Of Both Sides
Of The Body.
Stimulation :- Startling The Infant With A Loud Voice Or Apparent Loss At Support Due To A Change In
Equilibrium. The Neonate Is Hold In A Supine Position Above The Table Or Be. The Nurse Supports The
Upper Back And Head With The Other. The Newborn’s Head Is Suddenly Allowed To Drop Backward An
Inch Or So.
Response :- Generalized Muscular Activity Symmetric Abduction And Extension Of The Arms And Legs
With Fanning Of The Fingers. The Thumb And Index Finger On Each Hand From A C Shape. The
Extremities Then Flex And Adduct The Baby May Cry.
INVESTIGATION
MEDICATIONS
S.NO NAME OF DRUG DOSE ROUTE TIME ACTION SIDE EFFECT NURSING
RESPONSIBILIT
Y
1 INJ.SODIUM 2Meq IV STAT SYSTEMIC ANTACID - -ASSESS
BICARBONATE .ORALLY NEUTRALIZES IRRITABILITY RESPIRATORY
GASTRIC ACID,WHICH -HEADACHE AND PULSE
FORMS -CONFUSION RATE AND
WATER,NACL,CO2.INCREASE -WEAKNESS RHYTHM
S BI CARBONATE REVERSES - -ASSESS FLUID
ACIDISIS. CONVULSION AND
S ELECTROLYTE
BALANCE
2 INJ.EPINEPHRIN 0.1mg/kg IV STAT CALCIUM CHANNEL - -ASSESS VITAL
E BLOCKERS.ASYMPTOMATIC TACHYCARDI SIGNS
ADRENERGIC AGONIST A ESPECIALLY
THAT STIMULATE ALPHA - HEARTRATE
ADRENERGIC RECEPTORS PALPITATION AND BP.
CAUSING -HEADACHE
VASOCONSTRUCTION -DIZZINESS
-
DIAPHORESIS
3 IV.DEXTROSE 5% 6ml IV STAT ELECTROLYTE NEEDED FOR -HEADACHE -MONITOR
ADEQUATE BLOOD -BRAIN PULSE AND BP
CLOTTING,PREVENTION OF DAMAGE -MONITOR FOR
HAEMORRHAGES - ANY
HAEMOGLOBI BLEEDING
NURIA
-
HYPERBILIRU
BINEMIA
DISEASE CONDITION
INTRODUCTION
A Condition Where A Newborn Infant Fails To Start Breathing On Its Own In The Minutes Following
Birth.Perinatal Asphyxia Or Neonatal Asphyxia Is The Medical Condition Resulting From Deprivation Of
Oxygen To A Newborn Infant That Lasts Long Enough During The Birth Process To Cause Physical Harm,
Usually To The Brain. Hypoxic Damage Can Occur To Most Of The Infant's Organs (Heart, Lungs, Liver,
Gut, Kidneys).
DEFINITION
According To D C Dutta, Birth Asphyxia Is Clinically Defined As Failure To Initiate And Maintain
Spontaneous Respiration Following Birth.
CAUSES
The Following List Shows Some Of The Possible Medical Causes Of Asphyxia Neonatorum .
Fallot's Tetralogy
Shoulder Dystocia
Spina Bifida
Dystocia
Hydrocephalus
Osteomalacia
Uterine Rupture
Primary Dysfunctional Labour
Maternal Short Stature
Uterine Atony
Foetal Malposition
Umbilical Cord Prolapse
Premature Labour& Delivery
Post-Maturity
Placental Insufficiency
Anencephaly
Gestational Diabetes
Cystic Hygroma
Breech Presentation
Fibromyoma, Uterine
Epidural Anaesthesia
Cephalopelvic Disproportion
Multiple Pregnancy
Oligohydramnios
Neural Tube Defects
Polyhydramnios
Vasa Praevia
Placenta Praevia
Grand Multiparity
Patent DuctusArteriosus
PATHOPHYSIOLOGY
When Oxygenation Of The Mother Is Impaired As A Result Of Maternal Diseases, A Previously Normal
Baby Suffers Recurrent Episodes Of Asphyxia Neonetorum Due Toreduction Of Oxygen Supply To The
Fetus Leading To Hypoxia. When This Hypoxia Persists There Is Presence Of Glycolsis Resulting In A
Metabolic Acidosis Detection Of Glucose Reserve Lead, To Brandy Cardiac Causing Anal Sphincture
Relaxation Hence Passing Meconium Stool Liquor. Hypoxia Lead To Gasping And Aspiration Of
Meconium Stained Liquor To The Lungs. In The Uterus The Fetus Lungs Are Filled With Fluid Following
Delivery When The Baby Breaths, Or Gasps Air Is Drawn Into The Lungs And The Liquid Disappear Into
The Periphery Of The Respiratory Tree /System And It Is Cleared By The Pulmonary Circulation, Failure
To Complete The Process Satisfactory Leads To Tachypnoea As The Lungs Expand And Fill With Gas,
Pulmonary Blood Flow Increase Pressure In The Left Atrium Closing The Oval. As Oxygen Pass Through
DuctusArteriosus A Contraction Occurs And Close Arteriosus, If This Does Not Happen Oxygenated Blood
Mixes With Deoxygenated Blood, Baby Remains Cyanosed Although Can Probably Respond To Prompt
Resuscitation.
The List Of Signs And Symptoms Mentioned In Various Sources For Asphyxia Neonatorum Includes The 6
Symptoms Listed Below:
Cyanosis
Bradycardia
Poor Response To Stimulation
Hypotonia
Hypoxia
Metabolic Acidosis
DIAGNOSTIC EVALUATION
Classically, The Evaluation Of Cardio-Pulmonary Status In The Newborn Has Been Assessed By Apgar
Scoring At 1 And 5 Minutes After Birth. Diagnosis Can Be Objectively Assessed Using The Apgar Score—
A Recording Of The Physical Health Of A Newborn Infant, Determined After Examination Of The
Adequacy Of Respiration, Heart Action, Muscle Tone, Skin Color, And Reflexes. Normally, The Apgar
Score Is Of 7 To 10. Infants With A Score Between 4 And 6 Have Moderate Depression Of Their Vital
Signs While Infants With A Score Of 0 To 3 Have Severely Depressed Vital Signs And Are At Great Risk
Of Dying Unless Actively Resuscitated.
MANAGEMENT
The Treatment For Asphyxia Neonatorum Is Resuscitation Of The Newborn. All Medical Delivery Rooms
Have Adequate Resuscitation Equipment Should An Infant Not Breathe Well At Delivery. Between 1970
And 2000, Neonatal Resuscitation Has Evolved From Disparate Teaching Methods To Organized Programs.
The Most Widely Used Procedure Is The Neonatal ResucitationProgram.If Stimulation Fails To Initiate
Regular Respiration In The Newborn, The Attending Physician Attempts Resuscitation. He May Decide
First To Gently Suction The Oropharynx—The Area Of The Throat At The Back Of The Mouth, With A
Soft Catheter. When Stimulation And A Clear Airway Do Not Result In Adequate Respiration, The
Physician May Give 100 Percent Oxygen Via A Face Mask. If The Infant Is Still Not Breathing, Some Form
Of Artificial Ventilation Is Then Required. The Usual Method Is To Use Mask Ventilation With A
Resuscitator. The Mask Is Applied Tightly To The Infant's Face. If This Procedure Fails, The Infant Can Be
Intubated With A Endotracheal Tube To Which The Resuscitator Can Then Be Connected. The More Severe
The Fetal Asphyxia, The Longer It Will Take Before The Infant Starts To Breathe Spontaneously. If The
Infant Does Not Breathe Despite Adequate Ventilation, Or If The Heart Rate Remains Below 80 Beats Per
Minute, The Physician Can Give An External Cardiac Massage Using Two Fingers To Depress The Lower
Sternum At Approximately 100 Times A Minute While Continuing With Respiratory Assistance.
Adrenaline May Also Be Administered To Increase Cardiac Output. Once The Infant Starts Breathing, He
Or She Is Transferred To A Nursery For Observation And Further Assessment. Temperature, Pulse And
Respiratory Rate, Color, And Activity Are Recorded, And Blood Glucose Levels Checked For At Least
Four Hours.
Ecmo Is A Technique Similar To A Heart-Lung Bypass Machine, Which Assists The Infant's Heart And
Lung Functions With Use Of An External Pump And Oxygenator.
ALTERNATIVE TREATMENT
If An Inadequate Supply Of Oxygen From The Placenta Is Detected During Labor, The Infant Is At High
Risk For Asphyxia, And An Emergency Delivery May Be Attempted Either Using Forceps Or By Cesarean
Section.
NURSING MANAGEMENT
NURSING DIAGNOSIS
Infective Breathing Pattern Related To Low Intake Of Oxygen Evidence By Cyanosis Difficult In
Breathing And Weak Cry At Birth Altered
Hypothermia Related To Immature Heat Regulation Centre Evidenced By Temperature 36.5
Knowledge Deficit Related To Baby Care After Hospitalization Evidenced By Parents Verbalizing
Indicating Lack Of Knowledge On Care Of Sick New Born Baby At Home .
Risk Of Infections Related To Invasive Procedures And Immaturity Of Baby System
Potential For Impaired Skin Integrity Related To Improper Feeding
THEORY APPLICATION
Kathryn.E.Bernad
a. Credentials And Background Of Theorist:-
Born On April 16, 1938
1956-Prenursing Prof. At Nebrasaka University And Graduated With A Bachelor Of
Science In Nsg In 1960
Headnurse Position And Became Assistant Instructor In Pead, Nsg
1961-Master Degree In Boston University
Also Worked As Private Duty Nurse
b. Theoretical Source:-
Her Cites Were Florence Nightingale,Virgina,MarthaRogers,Direct Influence On Her
Research And Theory Devt.Bernads Credits Florence And Blake For Beliefs And Values
Making Up The Foundation Of Current Nsg.Practice.
BERNARD MODEL
Caregiver-parent characteristics. Infant characteristics
Infant’s Responsiveness To The Caregiver:- Infant Must Send Cues So That Parent Can
Modify His/Her .The Infant Must Also Read Cues So That She/He Can Modify His/Her
In Turn.
Parent’s Ability To Alleviate The Infant’s Distress:- Some Cues Sent By The
Infant,Signal That Assistace From Parent Is Needed.
Parent Social And Emotional Growth Fostering Activities:- The Ability To Initiate
Socl&Emot Growth Fostering Activities Depend Upon More Global Parent Adaptation.
Environment:- The Environment Represent The Environment Of Both Child And Mother.
Characteristics Of Environment Includes,
-Aspect Of The Physical Environment Of The Family
-The Father Involvement &The Degree Of Parent Neutrality In Regard To Child
Reasoning.
D. MAJOR ASSUMPTIONS:-
Nursing: Defined As Process By The Patient Is Assisted In Maintenance & Promotion Of His Independence
Person:She Describes Person/Human Being.She Speaks Of The Ability To Take In Auditory & Visual &
Tactile Stimuli.
Health: She Doesn’t Define Health But Describes Family As A Basic Unit Of Health Care.
Environment: Includes All Experiences Encountered By The Child,People,Object,Place,Sounds,Visual&
Tactile Sensation.
BERNARD APPLICATION
PROGRESS NOTES
Temp-100f,Pulse-160beats/Min,Resp-60breaths/Min
Temp-99f,Pulse-130beats/Min,Resp-50breaths/Min
Temp-98f,Pulse-130beats/Min,Resp-40breaths/Min
HEALTH EDUCATION
• Mother Was Reminded Of The Previous Day Health Education And She Could Remember
• Importance Of Keeping Baby Warm And Dry, To Prevent Skin Excoriation And Cold
• Exclusive Breast Feeding On Demand For 6 Months Before Introduction Of Complementary Feeds.
• Follow Up Immunization For The Baby According To Keeping Schedule As Instructed As The Baby `Had
Already Received The Birth Polio And Bcg In The Ward.
• To Bring Back Baby For Follow Up In Pediatric Outpatient Clinic After 2 Weeks.
• To Take Well Nutritious Diet (Family) To Promote Health And It Will Assist Her Get Enough Milk For
Baby.