Prepared by:

Jasmine G. Macuha
BSU SN 2018 Prepared to:
Mrs. Maria Christina E. Bay, RN, MAN
Clinical Instructor
OBJECTIVE
The case study is the most flexible of all research designs, allowing the researcher to
retain the holistic characteristics of real-life events while investigating empirical events.
In general, a case study is an empirical inquiry which:
 investigates a contemporary phenomenon within its real-life context
 the boundaries between phenomenon and context are not clearly evident
Goals and Objectives:
 To apply nursing process to a patient/family under the students care.
 Able to positively influence clinical practice by actively engaging students in the process
of learning about a specific disease process
 To review the literature supporting the use of case studies as an effective teaching
strategy that facilitates learning, improves critical thinking, and enhances decision-
making.
 To reinforce the understanding of the rules guiding image presentation.
 To help users identify various temptations and pressures that make misconduct more
likely, and to reflect on ways to avoid those temptations.
 To design a process to seek solutions through observation and analytical reasoning.
Significance of Case Study:
 A case study gives an interesting overview of the existing problem or a
success story.
 It attracts the attention of the lay person who will be able to understand the
problem or success in the format of a story.
 It gives a strong evidence for the problem you are trying to make someone
understand or a success you want to publicize.
 The use of the case study can thus facilitate the development of critical-
thinking and problem-solving skills necessary to positively affect the quality of
care delivered to the patient
 The case study method expands on previously learned material to make the
nurse more effective at the bedside
 Meconium aspiration syndrome (MAS) is the

aspiration of stained amniotic fluid, which can

occur before, during, or immediately after birth.

Meconium is the first intestinal discharge from

newborns, a viscous, dark-green substance composed

of intestinal epithelial cells, lanugo, mucus, and

intestinal secretions
Factors that promote the passage of meconium in utero include
the following:
•Placental insufficiency
•Maternal hypertension
•Preeclampsia
•Oligohydramnios
•Maternal drug abuse, especially of tobacco and cocaine
•Maternal infection/ chorioamnionitis
•Fetal hypoxia
Name: Patient AC Age: 5days old
Birthday: November 8, 2017
Address: United Better Living San Pedro Laguna
Admitting Diagnosis:
Newborn Full Term 39wks by pediatric aging delivered via CS
Section Secondary to Pre Eclampsia to a 36 year old G3 P3 BW 3935
gms LGA and for Apgar Score 2,7,8 Meconium Stained Amniotic Fluid
Final Diagnosis: Neonatal Pneumonia
Neonatal Sepsis
Attending Physician: Jaymee Christine M. Abarquez, MD

Source of Information: Patient's Chart

 Patient AC who were born at Batangas Medical Center via CS section
around 12:31 on the afternoon this 8th day November 2017 with the admitting
diagnosis of Newborn Full Term 39wks by pediatric aging delivered via CS
Section Secondary to Pre Eclampsia to a 36 year old G3 P3 Birthweight 3935
grams LGA and for Apgar Score 2,7,8 Meconium Stained Amniotic Fluid. The
doctor ordered to have umbilical catheterization on the same day of her
delivery.
I received the patient asleep on bed with heplock last November 13, 2017
and the patient has been discharged the next day November 14, 2017. On her
chart the doctor ordered “May Go Home per request” last November 12, 2017
but the billing were not settled.
It quickly summarize the health of newborn children
This test was given : 1min after birth
5mins after birth

Normal Range 7-10 out of 10

Name: Patient AC
Baby Girl
Date of Birth: Nov. 8, 2017
Address: San Pedro Laguna

Newborn Record Admission

Physical Examination
Name: Patient AC
Baby Girl
Date of Birth: Nov. 13, 2017
Address: San Pedro Laguna

HEAD TO TOE ASSESSMENT

Respiratory System provides oxygen to the body’s cells
while removing carbon dioxide
Nose and Nasal Cavity
It forms the main external opening for the respiratory system and are the
first section of the body’s airway—the respiratory tract through which air
moves.

Mouth
Also known as the oral cavity, is the secondary external opening for the
respiratory tract. Most normal breathing takes place through the nasal cavity,
but the oral cavity can be used to supplement or replace the nasal cavity’s
functions when needed.

Pharynx
 Also known as the throat,
 A muscular funnel that extends from the posterior end of the nasal cavity
to the superior end of the esophagus and larynx.
 3 Regions of Pharynx:
 nasopharynx,
 oropharynx, and
 laryngopharynx.
>>Inhaled air from the nasal cavity passes into the
nasopharynx and descends through the oropharynx,
located in the posterior of the oral cavity.
>>Air inhaled through the oral cavity enters the pharynx
at the oropharynx. The inhaled air then descends into
the laryngopharynx, where it is diverted into the opening
of the larynx by the epiglottis.

Epiglottis is a flap of elastic cartilage that acts as a

switch between the trachea and the esophagus.
  Larynx
- Also known as the voice box
- A short section of the airway that connects the laryngopharynx and
the trachea.
 Trachea
- Also known as windpipe, is a 5-inch long tube made of C-shaped
hyaline cartilage rings lined with pseudostratified ciliated columnar
epithelium.
- to provide a clear airway for air to enter and exit the lungs.
 Bronchi and Bronchioles
• These millions of tiny terminal bronchioles conduct air to the alveoli of the lungs.
• The main function of the bronchi and bronchioles is to carry air from the trachea
into the lungs. Smooth muscle tissue in their walls helps to regulate airflow into the
lungs.
 Lungs
- The lungs are a pair of large, spongy organs found in the thorax lateral to the heart
and superior to the diaphragm.
 Muscles of Respiration
- The principal muscle of respiration in the human body is the diaphragm, a thin sheet
of skeletal muscle that forms the floor of the thorax. Relaxation of the diaphragm
allows air to flow back out the lungs during exhalation.
PATHOPHYSIOLOGY
 In utero meconium passage results from neural stimulation of a maturing
gastrointestinal (GI) tract, usually due to fetal hypoxic stress. As the fetus approaches
term, the GI tract matures, and vagal stimulation from head or spinal cord compression
may cause peristalsis and relaxation of the rectal sphincter, leading to meconium
passage.
The effects of meconium in amniotic fluid are well documented. Meconium directly
alters the amniotic fluid, reducing antibacterial activity and subsequently increasing the
risk of perinatal bacterial infection. In addition, meconium is irritating to fetal skin, thus
increasing the incidence of erythema toxicum. However, the most severe complication
of meconium passage in utero is perinatal aspiration of stained amniotic fluid (before,
during, or immediately after birth)—example, meconium aspiration syndrome (MAS).
Aspiration of meconium-stained amniotic fluid may occur if the fetus is in distress,
leading to a gasping breathing pattern. This aspiration induces hypoxia via four major
pulmonary effects: airway obstruction, surfactant dysfunction, chemical pneumonitis,
and pulmonary hypertension.
 Classificatio Adverse Nursing Monitoring
Name n Action
Reaction Responsibilities Parameters

Generic Penicillin It is used to • Convulsiv Prior to Monitor seizures

Name: antibiotic treat a wide e seizures administration when giving high
ampicilli variety of with skin test is to doses
n bacterial higher be done to Monitor Input and
sodium infections. doses determine Output and pattern
It works by • Dizziness signs and ( Dysuria, Urinary
Brand stopping • Fatigue symptoms of retention,
Name: the growth • Confusion hypersensitivit Hematuria)
Ampisan of bacteria • Paresthes y Monitor renal
unnecessar ia Do not miss a function
y or • Diarrhea, dose unless Monitor hepatic
overuse of • Nausea ordered by the function
any and physician Monitor
antibiotic Vomiting IT should be hematologic
• Rash taken on an function
empty periodically.
stomach Obsrve for signs
Take 1 hour and symptoms of
before or 2 anaphylaxis during
hours after the 1st dose
meal
 Classificatio Adverse Nursing Monitoring
Name n Action
Reaction Responsibilities Parameters

Generic Aminogly It • Ototoxicity •Perform culture Monitor

Name: cosides interferes • Electrolyte and sensitivity renal
gentamicin antibiotic with the disturbances and renal function
bacterial Hypomagnese function prior to Monitor
Brand protein mia first dose and hepatic
Name: synthesis Hypocalcemia periodically function
Garamycin by binding Hypokalemia during therapy Monitor
30S and • Nausea and •Determine hematologic
50S Vomiting creatinine function
ribosomal • Neurotoxicity clearance and
subunits -confusion serum drug
resulting -mental concentrations at
in a depression frequent intervals
defective • pruritus (newborn or infant
bacterial patient have renal
membran immaturity.
e
 The doctor ordered “May go home per request” to the
patient.