Un|vers|ty of Nueva Caceres

College of nurslng
ClLy of naga
CASL kLSLN1A1ICN
Area neonaLal lnLenslve Care unlL
kLSLN1CkS
San !uan kevln Sem 1 Sanarez !an karla L
1aday !ohn aul A 1oledano lrancla C
vlllanueva uomlnlc C
CASL kLSLN1A1ICN
IN1kCDUC1ICN IN1kCDUC1ICN
A1ILN1 nLAL1n nIS1Ck A1ILN1 nLAL1n nIS1Ck
nSICAL ASSLSSMLN1 nSICAL ASSLSSMLN1
ANA1CM AND nSICLCG ANA1CM AND nSICLCG
A1nCnSICLCG A1nCnSICLCG
CCUkSL IN 1nL WAkD CCUkSL IN 1nL WAkD
IN1kCDUC1ICN
Ak1 no 1
ACkC8Cunu Cl 1PL S1uu?
W LasL !uly 182011 our 73 group was asslgned aL NICU
(Neonata| Intens|ve Care Un|t)
W Among Lhe paLlenLs LhaL we have handled aby boy
L2 ecomes Lhe focus of our case sLudy
W ay oy L2 was orn on u|y 9 2011 343S weeks
ACG dellvered Lhrough CS and a producL of mu|t|p|e
pregnancy
W Pe has b||atera| pneumon|a
and manlfesL oLher compll
caLlons of premaLurlLy
1he sLudy alms Lo achleve Lhese followlng
crlLerla
W 1o provlde lndlvlduallzed care Lo Lhe paLlenL
ensurlng concealed ldenLlLy ln Lhe case sLudy
process
W 1o acqulre eLLer undersLandlng regardlng
premaLurlLy and lLs compllcaLlons
W 1o effecLlvely dlscuss wlLh Lhe moLher and
slgnlflcanL oLhers or relaLlves of Lhe paLlenL Lhe
proper way ln handllng premaLure ales
CLC1IVLS
uLllnl1lCn Cl 1L8MS
CheyneStokes resp|rat|on characLerlzed y
deeper fasLer reaLhlng followed y a
gradual decrease LhaL resulLs ln a
Lemporary sLop ln reaLhlng
Lthy|ened|am|ne ls Lhe organlc compound
wlLh Lhe formula C
2
P
4
(nP
2
)
2
Gramnegat|ve bacter|a are acLerla LhaL do
noL reLaln crysLal vloleL dye ln Lhe Cram
sLalnlng proLocol
Lx (Nelssetlo qooottboeoe)
Grampos|t|ve bacter|a are Lhose LhaL are sLalned dark lue or vloleL y
Cram sLalnlng MosL paLhogens ln humans are CramposlLlve organlsms
Lx Stepococcos ooJ 5opbylococcos
Mean corpuscu|ar vo|ume (MCV) ls a measure of Lhe average red lood cell
volume normal value 82 98 fl
Mean corpuscu|ar hemog|ob|n (MCn) ls Lhe average mass of hemogloln per
red lood cell ln a sample of lood normal value 28 33 pg
Mean corpuscu|ar hemog|ob|n concentrat|on (MCnC) ls a measure of Lhe
concenLraLlon of hemogloln ln a glven volume of packed red lood cells
normal value 33 36 g/L
Mononuc|eos|s ls a condlLlon where
Lhere ls an unusual prollferaLlon of
lymphocyLes ln Lhe lood due Lo an
lnfecLlon wlLh Lhe LpsLeln
arr vlrus (Lv)
uLllnl1lCn Cl 1L8MS
Super|nfect|on ls Lhe process y whlch a cell LhaL has prevlously een
lnfecLed y one vlrus geLs colnfecLed wlLh a dlfferenL sLraln of Lhe vlrus or
anoLher vlrus aL a laLer polnL ln Llme vlral superlnfecLlons of serlous
condlLlons can lead Lo reslsLanL sLralns of Lhe vlrus whlch may prompL a
change of LreaLmenL lor example an lndlvldual superlnfecLed wlLh Lwo
separaLe sLralns of Lhe Plv vlrus may conLracL a sLraln LhaL ls reslsLanL Lo
anLlreLrovlral LreaLmenL
Umo|]L (m|cromo|e per L|ter) of LoLal lllruln level ls converLed Lo mg/L y
mulLlplylng lL Lo 003848
SA (Str|ct Asp|rat|on recaut|on) ls Lhe general Lerm LhaL lndlcaLes checklng
placemenL of CC1 efore feedlng feedlng ay y gravlLy and holdlng
head uprlghL whlle feedlng
1racheobronch|a| tree ls Lhe sLrucLure from Lhe Lrachea ronchl and
ronchloles LhaL forms Lhe alrways LhaL supply alr Lo Lhe lungs
uLllnl1lCn Cl 1L8MS
SCCL Anu LlMl1A1lCn
1he case sLudy on paLlenL ay
oy L2 whlch Lackled aouL
premaLurlLy of Lhe paLlenL focuses on
pneumonla as lLs manlfesLed
compllcaLlon lnformaLlon's are Laken
from Lhe charL of Lhe ay and Lhe
moLher as well as from Lhe lnLervlew
conducLed wlLh Lhe moLher aLlenL
and slgnlflcanL oLhers noL named Lo
provlde confldenLlallLy and prlvacy of
Lhe paLlenL lnlLlals and flrsL names are
Lhe only ldenLlfylng way ln Lhe case
sLudy
aLlenL PealLh PlsLory
Ak1 no 2
lCC8APlC uA1A
Name ay oy L2
Sex Male
Age neworn
C|t|zensh|p llllplno
Date of |rth !uly 9 2011
(Anthropometr|c Measurement)
nead C|rcumference
28cm
Chest C|rcumference
24 cm
Abdom|na| C|rcumference
22cm
Length 39 3 cm
We|ght 13 kg / 1307g/214 ls
1|me of |rth 824 pm
Manner of De||very
Cesarean SecLlon
keason for adm|ss|on
remaLurlLy
A||erg|es no known allergles
PealLh Concern upon Admlsslon
Way oy L 2 was orn premature|y 343S weeks of gestat|on
Lhrough cesarean method
WPe had a Lwln slsLer ay Clrl L 1 dellvered earller aL around 8 20
ln Lhe afLernoon (raterna| tw|ns)
WLung |mmatur|ty presenL
WoLh neworn were dlagnosed Lo have suffered from pneumonla
ay oy L 2 has b||atera| pneumon|a
Wuurlng lmmedlaLe neworn care (+) grunLlng (+) chesL reLracLlon
and (+) resplraLory dlsLress was noLlced from Lhe paLlenL
WCxygen supporL vla face mask aL 7 8 LM
WrescrlpLlon wlLh Amplclllln 63mg lv q 12 CenLamlcln 7mg lv Cu
Amlnophylllne 7mg lv Lhen 3mg q 12 aLlenL ay oy L2 ls under
nC supplemenLed wlLh dexLrose glucose of u10 W 91ml aL 3 4
ugLLs/mln
lamlly PlsLory of lllness
W1he moLher ls 24 y]o
WPousewlfe and someLlmes works for laundry
WMoLher ls pasL alcohol user and a smoker
WShe gave lrLh Lo flrsL ay aL an age of 18 y/o
WPer flrsL chlld dled d/L an accldenL aL 2 years old
WaLlenL's faLher ls a consLrucLlon worker (annual lncome of
hp6000)
WPe was also an a|coho| user smoker and has hlsLory ln
Laklng |||ega| drugs uL he sLaLed LhaL when he already had
famlly he mlnlmlzed Lhe addlcLlon such chemlcals
WoLh Lhe couple has asthma hypertens|on and Lhe faLher
has allergy Lo sea foods
MensLrual and CsLeLrlc PlsLory
W 1he moLher sLaLed LhaL she always aLLends Lo her
prenaLal checkup aL Lhe |co| Med|ca| Center CDC
and also aLLends some healLh Leachlng program aouL
pregnancy
W Per osLeLrlc hlsLory ls Cravlda 2 ara 3 1erm 1
reLerm 2 AorLlon 2 and Llvlng 3
W She mensLruaLed lasL November 20 2010 and her
expecLed daLe of dellvery (Luu) ls on August 27 2011
W uurlng her pregnancy she complalned Lo have suffered
from cramps dlzzlness and headache and vomlLlng no
vlslle varlcoslLles and no hemorrholds
W 1he presenL lllness of Lhe moLher ased on her
laoraLory flndlngs ls hypertens|on wlLh elevaLed
LuL serum cholesLerol and Lrlglycerlde She also
suffered from anem|a shown y her low 8C counL
low hemaLocrlL and hemogloln resulL from her CC
Laken durlng pregnancy 1he moLher has also (+)
asthma and () allerglc reacLlon Lo any sLlmull Per
lood pressure ranges from 140/80 mmPg 130/90
mmPg
W Nutr|v|ve ls Lhe only medlcaLlon Laken dally per
capsule y Lhe moLher durlng her 3
rd
LrlmesLer of
pregnancy as ordered
MensLrual and CsLeLrlc PlsLory
nSICAL ASSLSSMLN1
Ak1 no 3
nead clrcumference of 28cm sofL ulglng fonLanels
Sk|n Mlnlmal vernlx caseosa (+) hemaLoma 1hln
and smooLh shlny skln wlLh vlslle velns under Lhe skln
covered y lanugo
ody at D|str|but|on Less ody faL welghL 214 ls
Lyes plnk con[uncLlva anlcLerlc sclera
Lars () ear dlscharge symmeLrlcal wlLh sofL flexlle
ear carLllage
Nose WlLh nasal flarlng paLenL alrway symmeLrlcal
Mouth () ClefL llp and palaLe
Neck supple molllLy
C|av|c|es () lracLure symmeLrlcal
1horax (+) chesL reLracLlons (+) slgns of resplraLory
dlsLress symmeLrlcal ChesL Clrcumference of
24cm
neart 8aLe 140 eaLs per mlnuLe lrregular rhyLhm
Lungs (+) grunLlng raLe of resplraLlon 37 reaLhs per
mlnuLe wlLh cheyne sLokes resplraLlon
Abdomen Adomlnal clrcumference of 22cm gloular
shape
Umb|||cus 2A1v
Lxtrem|t|es ody LengLh 393 cm weak muscle Lone
symmeLrlcal normal dorxlflexlon no cyanosls
Gen|ta| Small scroLum smooLh wlLhouL rldges and
undescended LesLlcles
Anus aLenL anus
Source MaLernal and Chlld PealLh nurslng
y Adele llllLLerl
Ak1 no 4
nLk1LNSICN nLk1LNSICN
AS1nMA AS1nMA
ANLMIA ANLMIA
kLMA1UkI1 kLMA1UkI1
kLSIkA1Ck
kCLLMS
kLSIkA1Ck
kCLLMS
LUNG
IMMA1UkI1
LUNG
IMMA1UkI1
NLUMCNIA NLUMCNIA
MUL1ILL
kLGNANC
MUL1ILL
kLGNANC
8LCnAnC? Anu AS1PMA
W AsLhma ls a chronlc lnflammaLory dlsease of Lhe alrways
W CharacLerlzed y lncreased responslveness of Lhe
tracheobronch|a| Lree Lo mulLlple sLlmull
W lL ls Lhe mosL common chronlc condlLlon ln pregnancy
W May e preclplLaLed y tobacco
a|coho||c and other chem|ca| use
efore pregnancy
W leLus depends on Lhe alr LhaL Lhe
pregnanL moLher reaLh for lLs oxygen
W uurlng asLhma aLLack Lhe feLus may
not get enough oxygen
W 1hls can puL Lhe feLus ln greaL danger
8LCnAnC? Anu P?L81LnSlCn
W regnancy ls Lhe carrylng of one or more offspr|ng known as
a feLus or emryo lnslde Lhe wom of a female
W Mlddle parL of pregnancy |s |ow
W 1here are Lwo Lypes of hyperLenslon
1 Chron|c hypertens|on
2 regnancy|nduced
hypertens|on elevaLed
edema wlLh or wlLhouL proLeln ln
your urlne causes decreased
lood flow Lo Lhe placenLa whlch
resulLs ln less nuLrlenLs and
oxygen reachlng your ay
8LCnAnC? Anu AnLMlA
W Anemla few 8C's or a
lowered alllLy of 8C's Lo carry
oxygen or |ron
W Womans lood volume
lncrease y S0
W 1hls causes Lhe concenLraLlon
of 8C's ln Lhe ody Lo ecome
d||uted
W 1he feLus ls dependenL on Lhe moLhers lood and anemla
can cause poor feta| growth preterm b|rth and |ow
b|rthwe|ght
nLCnA1AL L8lCu
W SLage of developmenL from lrLh Lo Lhe flrsL 28 days of ||fe
W Spark of physlologlcal and even psychologlcal changes
W CrlLlcal sLage ln Lhe neworn
W 2]3 of a|| deaths LhaL occur durlng Lhe flrsL year of llfe occur ln
Lhls perlod
1L8M lnlAn1
W orn ln Lhe lnLerval from Lhe 37
th
compleLed
week Lo Lhe 42
nd
compleLed week of
gesLaLlon
W 2S9 days Lo 293 days
W WelghL of 2S00g (S|bs 8 oz) aL lrLh
1L8M lnlAn1S
kLSIkA1Ck SS1LM
W Alveoll caplllarles form
eLween Lhe 24
th
and 28
th
weeks
W llrsL reaLh requlres a
Lremendous amounL of 40 to 70
cm n
2
C
W SponLaneous resplraLory pracLlce
eglns ln 3 months conLlnue
LhroughouL lnLrauLerlne llfe
W Speclflc lung fluld wlLh low surface Lenslon and low vlscoslLy
forms ln alveoll
W Surfactant phospollpld decreases alveolar surface Lenslon
on explraLlon LechlLln and Sphlngomyelln (21)
1L8M lnlAn1S
kLSIkA1Ck SS1LM
W All n have some fluld ln lungs from
lnLrauLerlne llfe and aouL 1]3 of Lhls ls
forced ouL of Lhe lungs y Lhe pressure
of vaglnal lrLh
W Cnce Lhe alveoll has een lnflaLed wlLh
Lhe flrsL reaLh reaLhlng ecomes
much easler for a ay (6 to 8 cm n
2
C
pressure)
W CS b|rth does noL have much lung
fluld expelled aL lrLh as one orn vaglnally and so may have
more dlfflculLy esLallshlng effecLlve resplraLlons
8L1L8M
lnlAn1
WLlveorn lnfanL orn efore
Lhe end of week 37 ACG
WWelghL of less Lhan 2S00g (S|bs
8 oz) aL lrLh
GLNLkAL CnAkAC1LkIS1ICS C kL1LkM INAN1
Gestat|ona| Age 37 weeks
Congen|ta| Ma|format|on ossllllLy
u|monary rob|ems 8esplraLory ulsLress Syndrome
Apnea Lp|sodes very SLrong ossllllLy
We|ght Ga|n |n Nursery Slow
8L1L8M lnlAn1S
kLSIkA1Ck SS1LM
W Lung growLh occurs y alveolar mulLlpllcaLlon unLll 6 to 8
years
W Alrways remaln narrow whlch resulLs ln a h|gh |nc|dence
of alrway dlsease
W venLllaLlon almosL enLlrely d|aphragmat|c
W er|od|c resp|rat|on presenL
W neonaLes are ollgaLory nose breathers may e a prolem
lf Lhe nose locked
W Lung SurfacLanL does noL form ln adequaLe amounLs
W CS lrLh may lead ln addlLlonal resplraLory compllcaLlons
ecause of reta|ned f|u|d ln Lhe lungs
Ak1 no S
A1nCnSICLCG
lLA1L8AL nLuMCnlA
W Some preLerm lnfanLs parLlcularly Lhose wlLh resplraLory
dlseases may e vulnerale Lo laLer resplraLory prolems
such as ouLs of pneumon|a
lLA1L8AL nLuMCnlA
W neumonla ls Lhe lnfecLlon and
lnflammaLlon of a|veo|| resulLlng
from reLalned flulds ln Lhe lungs
W n who are orn more Lhan 24
afLer rupture of the amn|ot|c
membranes and w|th amn|ot|c f|u|d
asp|rat|on or mecon|um
W Can e d/L m|croorgan|sms |rr|tants
or unknown causes wlLh lnfecLlous
causes elng Lhe mosL common
W osslle causaLlve agenL of neumonla
a VIkUS resplraLory syncyLlal vlrus (8Sv) Perpes slmplex vlrus
b AC1LkIA 5tepococcos oqolocloe (normal flora of Cl may
spread Lo Lhe vaglna ln 1030 of women)
c UNGI lsoplosmo copsoloom
d IDLCA1nIC nonlnfecLlous
lLA1L8AL nLuMCnlA
W lrom Lhe declduas Lhe paLhogen
may reach Lhe space eLween
Lhe amnlon and chorlon Lhe
amnloLlc fluld and flnally Lhe
feLus Lherey causlng lnfecLlon
CCUkSL IN 1nL WAkD
Ak1 no 6
AuMlSSlCn AuMlSSlCn
Adm|ss|on u|y 9 2011
C (+) grunLlng
(+) chesL reLracLlon
V|ta| s|gns taken dur|ng
Immed|ate N Care
1 373 degree celclus
88 37 pm
8 172pm
W 18 q 1
W conLrapLlon u10 w
91cc [ 34
ugLLs/mln
W Cxygen vla
facemask [ 7 8
W nC
D|agnost|cs
WPgL q' 8
WCC wlLh AC
WChesL xray AL
LAC8A1C8? ux llnulnCS LAC8A1C8? ux llnulnCS
CCMLL1L LCCD
CCUN1
kesu|t Un|t Norma| kange
WC
798 109/ L 48 108
kC
332 1012/ L 47 61lc
nemog|ob|n
1229 g/L 120 180
nematocr|t
03994 037 034
MVC
1203 fl 82 98
MCn
3703 pg 28 33
MCnC
3077 g/L 33 36
nemog|uco 1est 80 mg/dl aL !uly 9 2011 12pm
Comp|ete |ood Count resulL recelved on !uly 102011
WLlevaLed MCV MCn and low MCnC ls lndlcaLlve of MacrocyLlc
Anemla
|ate|et Count kesu|t Un|t Norma| kange
Neutroph||
413 40 70
Lymphocyte
366 19 48
Los|noph||
12 2 8
Monocyte
199 3 9
asoph||
08 0 3
LAC8A1C8? ux llnulnCS LAC8A1C8? ux llnulnCS
Chest k ray A LA1 resulL recelved on !uly 13 2011
|nd|ngs neumonla llaLeral
WLlevaLed MonocyLe ls lndlcaLlve of a chronlc lnfecLlon
MLulCA1lCn MLulCA1lCn
Med Dosage Ind|cat|on
Contra|n
d|cat|on
S|de Lffects
Amplclllln
1rlhydraLe
(Amplcln)
63 mg lv q
12 hrs
8esplraLory Cl1 Cu1 skln
and sofL Llssue lnfecLlons
caused y suscepLlle
gram () and gram (+)
organlsms
Pypersen
slLlvlLy Lo
penlclllln
lnfecLlous
mononuc
leosls
PypersenslLlvlLy reaLlons
anaphylaxls Cl
dlsLurances hemlc and
lymphaLlc sysLem
dlsorders laryngeal
sLrldor fever sore
mouLh or Longue
superlnfecLlon
CenLamlcln
SulfaLe
(CenLamlcln)
7mg lv Cu 1reaLmenL of lnfecLlons due
Lo suscepLlle organlsms
u1l resp LracL lnfecLlons
menlnglLls perlLonlLls
lnfecLed surglcal wounds
severe sofL Llssue lnfecLlons
Pypersen
slLlvlLy
vesLlular and audlLory
damage nephroLoxlclLy
anLlloLlc assoclaLed
collLls nausea vomlLlng
rash
MLulCA1lCn MLulCA1lCn
Med Dosage Ind|cat|on
Contra|n
d|cat|on
S|de Lffects
Amlno
phylllne
7mg lv
now Lhen
3mg q 12
hrs
ManagemenL of
asLhma and CCu
8elleve apnea ln
neonaLes hearL
fallure osLrucLlve
Ml
hypersenslL
lvlLy Lo
eLhylenedl
amlne
nausea vomlLlng
adomlnal paln
dlarrhea CL8u
lnsomla headache
anxleLy resLlessness
dlzzlness Lremor and
palplLaLlon
SLCCnu 1Pl8u uA? SLCCnu 1Pl8u uA?
2
nd
day |n hosp|ta| u|y 10 2011
Wlace lnslde lncuaLor
Wu10W x 8' 33cc [ 4 ugLLs/mln
WCxygen y face mask [ 7 8 Lpm
WSLlll on nC
3
rd
day |n hosp|ta| u|y 11 2011
WCC1 l8 feed aL 2cc of LM q 3'
wlLh SA
WCxygen y nasal low [ 1 2 L/mln
Wu10 lM 34cc x 8' 4 3 ugLLs/mln
WulagnosLlc requesL
Wna k Ca deLermlnaLlon
ngt resu|t
8am 120 mg/dl
4pm 100 mg/dl
V]S taken at 8am
1 368
88 48pm
8 133 pm
LAC8A1C8? ux llnulnCS LAC8A1C8? ux llnulnCS
Laboratory resu|ts
*PgL q 8hrs
10am 80 mg/dl
4pm 100 mg/dl
12 pm 60 mg/dl
8esulL 8ef lnLerval unlL
Ca
203 212 232 mmol/L
k
47 33 31 mmol/L
na
138 136 143 mmol/L
|ood Chem|stry na k Ca deLermlnaLlon
Wuepressed level of Ca ls lndlcaLlve oh hypocalcemla
lCu81P uA? lCu81P uA?
4
th
day |n hosp|ta| u|y 12 2011
v/S [ 8am
1 37 88 62pm 8 163pm
Cxygen supporL vla face mask 3 6 L/mln
u10 lM 38cc q 8 hrs 4 3 ugLLs/mln
CC1 feedlng 2cc q 3 hrs
D|agnost|c request
lood culLure and senslLlvlLy LesL
PgL q 8hrs
MLulCA1lCn MLulCA1lCn
Med Dosage Ind|cat|on
Contra|n
d|cat|on
S|de Lffects
lpera
clllln na
(vlgocld)
63 mg lv
q 12'
Surglcal
lnfecLlons
prophylaxls
PlsLory of allerglc
reacLlons Lo
penlcllllns
cephalosporlns and
lacLamase
lnhllLors
nausea lndlgesLlon
vomlLlng dlarrhea or
consLlpaLlon rash
lLchy or red skln
urLlcarla sleeplng
dlfflculLy headache or
dlzzlness
superlnfecLlon
Med|cat|on
ulsconLlnue CenLamlcln and Amplclllln
shlfL Lo lperaclllln 63mg lv q 12 hrs
Amlkacln 20 mg lv q 24 hrs
MLulCA1lCn MLulCA1lCn
Med Dosage Ind|cat|on
Contra|n
d|cat|on
S|de Lffects
Amlkacln
SulfaLe
(Amlkln)
20mg lv
q 12'
ShorL Lerm
LreaLmenL of serlous
lnfecLlons due Lo
suscepLlle gram ()
sLralns lncludlng
seudomonas sp May
e of use ln LreaLmenL
of known or suspecLed
sLaphylococcal dlsease
Pypersen
slLlvlLy Lo
amlnogly
cosldes
CLoLoxlclLy and
nephroLoxlclLy rarely
rash fever
paresLhesla arLhralgla
anemla and
hypoLenslon
LAC8A1C8? ux llnulnCS LAC8A1C8? ux llnulnCS
Laboratory kesu|ts
*PgL resulL
8am 80 mg/dL
4pm 120 mg/dL
12 mn 100 mg/dL
* |ood cu|ture and sens|t|v|ty test
llndlngs no growLh afLer 24 hrs lncuaLlon
lll1P uA? lll1P uA?
S
th
day |n hosp|ta| u|y 13 2011
v/S Laken [ 8am
1 367 88 47 8 148
Change ln color !aundlce
CC1 q 3 hrs wlLh SA [ 2cc
SLlll on C2 supporL 3 6 Lpm
Med|cat|on
ConLlnue lperaclllln and Amlkacln
LAC8A1C8? ux llnulnCS LAC8A1C8? ux llnulnCS
Laboratory and D|agnost|c request
8equesL for 11 1 2
PgL q 8hrs
PgL resulL
* 12 pm 80 mg/dL
* 8pm 80 mg/dL
W12 mn 100mg/dL
1IL resu|t s||ght|y hemo|yze spec|men
Component 1ested kesu|t keference Interva|
1oLal lllruln Level (1lL) 173 umol/L 017
WSllghLly elevaLed 1lL ls lndlcaLlve of sllghLly hemolyzed 8C
Slx1P Anu SLvLn1P uA? Slx1P Anu SLvLn1P uA?
6
th
day |n hosp|ta| u|y 14 2011
v/S [ 8am 1 37 88 46 8 142
u10 lM 41cc x 8hrs [ 3 6 ugLLs/mln
laced under phoLoLherapy aL nlCu level 2
ConLlnue Cxygen Lherapy
lncreased CC1 feedlng Lo 4cc q 3 hrs wlLh SA
Med|cat|on ConLlnue lv Meds
7th day |n hosp|ta| u|y 1S 2011
v/S [ 8am 1 372 88 33 8 143
8equesL for 111 2 ConLlnue Cxygen supporL
ConLlnue lv meds
CC1 feedlng 4cc q 3hrs wlLh SA
LAC8A1C8? ux llnulnCS LAC8A1C8? ux llnulnCS
Laboratory and D|agnost|c resu|ts
ngt resu|t (6
th
Day)
8am 120 mg/dL
4pm 120 mg/dL
12mn 80mg/dL
ngt resu|t (7
th
Day)
8am 40 mg/dL
12mn 60 mg/dL
Component 1ested kesu|t keference Interva|
1oLal lllruln Level (1lL) 149 umol/L 017
Con[ugaLed lllruln (ulL) CuanLlLy noL sufflclenL
LlCP1 1C LLLvLn1P uA? LlCP1 1C LLLvLn1P uA?
Date
V|ta| S|gns taken at 8 am
1emperaLure (C)
8esplraLory 8aLe
(pm)
Cardlac 8aLe
(pm)
!uly 16 37 30 146
!uly 17 371 30 148
!uly 18 37 31 147
!uly 20 372 33 130
LlCP1 1C LLLvLn1P uA? LlCP1 1C LLLvLn1P uA?
8th to 11th day |n hosp|ta| u|y 16 19 2011
ConLlnue phoLoLherapy
ConLlnue lv meds
CC1 feedlng aL same raLe and lncreased y 6cc
q3 y !uly 18 2011
Cxygen Lherapy dlsconLlnued
8equesLed 11 2 3 on !uly 172011
ConLlnue PgL q8hrs monlLorlng
PgL monlLorlng dlsconLlnued on !uly 19 2011
LAC8A1C8? ux llnulnCS LAC8A1C8? ux llnulnCS
u|y 17 2011
Component 1ested kesu|t keference Interva|
1oLal lllruln Level (1lL) 134 umol/L 017
Con[ugaLed lllruln (ulL) 1 umol/L 0 3
u|y 19 2011
Component 1ested kesu|t keference Interva|
1oLal lllruln Level (1lL) 12 6 umol/L 017
Con[ugaLed lllruln (ulL) 3 umol/L 0 3
lndlrecL lllruln (llL) 1231 umol/L 340 1370
LAC8A1C8? ux llnulnCS LAC8A1C8? ux llnulnCS
nG1 kesu|ts
Date 8am 4pm 12mn
u|y 16 2011 100mg/dL 80mg/dL 60mg/dL
u|y 17 2011 40mg/dL 120mg/dL
u|y 18 2011 60mg/dL 80mg/dL 100mg/dL
u|y 19 2011 80mg/dL ulsconLlnued
1WLLl1P Anu 1Pl81LLn1P uA? 1WLLl1P Anu 1Pl81LLn1P uA?
12
th
day |n hosp|ta| u|y 20 2011
v/S Laken aL 8 am
1 368 degree celclus
88 43 pm
8 142 pm
1ransfer Lo MlA
lvl change Lo heplock
CC1 feedlng lncreased Lo 10cc q 3hrs wlLh SA
ConLlnue lv meds
ConLlnue phoLoLherapy
1WLLl1P Anu 1Pl81LLn1P uA? 1WLLl1P Anu 1Pl81LLn1P uA?
13
th
day |n hosp|ta| u|y 21 2011
v/S [ 8am 1 37 88 33 8 148
CC1 feedlng lncreased Lo 13 cc q 3hrs wlLh SA
ConLlnue phoLoLherapy
ConLlnue lv meds
Component 1ested kesu|t keference Interva|
1oLal lllruln Level (1lL) 132 umol/L 0 17
Con[ugaLed lllruln (ulL) 3 umol/L 0 3
lCu81LLn1P 1C SLvLn1LLn1P uA? lCu81LLn1P 1C SLvLn1LLn1P uA?
14
th
1S
th
day |n hosp|ta| u|y 2223 2011
u|y 22 v/S [ 8am 1 372 88 36 8 130
u|y 23 v/S [ 8am 1 368 88 33 8 132
ConLlnue phoLoLherapy
CC1 13cc q 3hrs
Med|cat|on
ConLlnue lv meds
Peraclene (dlencozlde)
Ind|cat|on remaLure ales low lrLh welghL
reLarded growLh poor appeLlLe ln lnfanL chlldren
and adulL
lCu81LLn1P 1C SLvLn1LLn1P uA? lCu81LLn1P 1C SLvLn1LLn1P uA?
16
th
day |n hosp|ta| u|y 24 2011
u|y 24 v/S [ 8am 1 37 88 30 8 148
CC1 feedlng lncreased Lo 17cc q 3 hrs
SLlll on phoLoLherapy
Med|cat|ons
ConLlnue lv meds
Peraclene (dlencozlde)
MulLlvlLamlns
vCC ( vlrgln coconuL oll)
Carosyrup
Ind|cat|ons of ora| meds lor low lrLh welghL
premaLure ales
lCu81LLn1P 1C SLvLn1LLn1P uA? lCu81LLn1P 1C SLvLn1LLn1P uA?
17
th
day |n hosp|ta| u|y 2S 2011
u|y 2S v/S [ 8am 368 37 88 48 8 130
ulsconLlnue phoLoLherapy
ConLlnue lv and Cral meds
CC1 feedlng aL 17 cc q 3hrs
nu8SlnC CA8L LAn nu8SlnC CA8L LAn
NC ocus NC ocus
reath|ng attern
k|sk for Asp|rat|on
Nutr|t|on
nu8SlnC CA8L LAn
CCUS reath|ng attern
ASSLSSMLN1
CLC1IVL
W 3433 weeks ACC
W (+) slgn of resplraLory dlsLress
W (+) chesL reLracLlon
W (+) CrunLlng
W lncreased monocyLe counL
W V]S taken dur|ng performance of |mmed|ate newborn care
W 1 373 C
W 8 172 pm
W 8837 pm
ulACnCSlS
lneffecLlve reaLhlng paLLern
relaLed
Lo
lung lmmaLurlLy
lnlL8LnCL
W Lung lmmaLurlLy ln preLerm neonaLes ls developmenLally deflclenL
ln a maLerlal called surfacLanL SurfacLanL ls a complex sysLem of
llplds proLelns and glycoproLelns whlch are produced ln speclallzed
lung cells called 1ype ll cells or 1ype ll pneumocyLes ulpalmlLoyl
phosphaLldyl chollne (uC) ls Lhe maln componenL of Lhe
pulmonary surfacLanL lL spreads ln Lhe lung Llssuealr lnLerface
prevenLlng alveolar collapse durlng explraLlon and allowlng Lhe
alveoll Lo open easlly aL Lhe nexL lnsplraLlon lnadequaLe producLlon
of pulmonary surfacLanL ls seen lf laor occurs efore 3436 weeks
of pregnancy 1he alveoll wlll collapse durlng explraLlon and each
lnsplraLlon wlll requlre conslderale efforL 1hls slLuaLlon rapldly
leads Lo faLlgue decreased resplraLory efforL hypoxla cyanosls
acldosls and evenLually deaLh lf unLreaLed
LAnnlnC LAnnlnC
WlLhln hosplLallzaLlon hours paLlenL wlll exhllL
lessen effecL of lung lmmaLurlLy and mlnlmlzed
resplraLory dlsLress as evldenced y
W resplraLlons
wlLhln
accepLale
range
W asence or mlnlmlzed manlfesLaLlons of slgns
andsympLoms of resplraLory dlsLress such as
cyanosls and dlfflculLy ln reaLhlng
ln1L8vLn1lCnS Anu 8A1lCnALLS
IN1LkVLN1ICNS kA1ICNALLS
MonlLor vlLal slgns parLlcularly 88 and C8
rhyLhm and raLe
Assess for slgns and sympLoms of
resplraLory dlsLress
Cserve mlnlmal handllng of Lhe paLlenL
erform all procedures of LreaLmenL
asepLlcally
MonlLor effecLlveness of anLlmlcrolal
Lherapy
1o monlLor Lhe progress of Lhe dlsease
and Lhe need for lmmedlaLe lnLervenLlon
lrequenL assessmenL provldes
lnformaLlon aouL any lmprovemenL or
deLerloraLlon ln paLlenL's condlLlon
8educes llkellhood of exposure Lo oLher
lnfecLlous paLhogens
1o mlnlmlze Lhe rlsk for nosocomlal
lnfecLlon and furLher conLamlnaLlon
slgns of lmprovemenL ln condlLlon should
occur wlLhln 2448hrs
IN1LkVLN1ICNS kA1ICNALL
Cserve for any slgns of adverse
reacLlons Lo medlcaLlons Laken
lnLravenously such as hypersenslLlvlLy and
Cl prolems
AdmlnlsLer anLlmlcrolals as prescrled
8egulaLe level of oxygen supporL
accordlngly as ordered
1o assess paLlenL's reacLlon Lo
medlcaLlon and Lo lmmedlaLely reporL Lo
physlclan any manlfesLaLlon of adverse
reacLlon
Lo ensure effecLlveness of LreaLmenL
reglmen Lhese drugs are used Lo comaL
mosL of Lhe mlcrolal lnfecLlons
1o susLaln llfe of Lhe paLlenL and avold
LoxlclLy
ln1L8vLn1lCnS Anu 8A1lCnALLS
LvALuA1lCn
Coals meL aLlenL exhllLs a normal and
effecLlve resplraLory paLLern as evldenced y
W 8esplraLlons wlLhln normal range 88 31 pm
afLer 3hrs of LreaLmenL
W () Lachycardla 8 140 pm afLer 3hrs of
LreaLmenL
W asence of chesL reLracLlon nasal flarlng
W plnklsh appearance of skln
CCUSNU1kI1ICN
ASSLSSMLN1
W Cb[ect|ve
W 3433 weeks ACC (age of gesLaLlon)
W poor muscle Lone
W poor suck
W WelghL(1307g)214ls
W V]S taken as fo||ows
W
W 1373 C
W 8172
W 8837 pm
nu8SlnC CA8L LAn
nu8SlnC ulACnCSlS
A|tered nutr|t|on |ess than body
requ|rements r]t |mmature
swa||ow|ng and suck|ng ref|ex
lnlL8LnCL
W Sucklng and swallowlng reflex can e seen ln ales aL
aouL 1213 weeks of gesLaLlon oor sucklng reflex
usually happens ln premaLure lnfanLs Lemporarlly and
usually susldes wlLh growLh and developmenL
remaLure lnfanL may e unale Lo Lake feedlngs
normally and may requlre asslsLance wlLh oLh
resplraLlons and feedlngs ecause of poor sucklng
reflex lnfanL ls supplemenLed y parenLeral feedlng
and su[ecLed Lo nC for hls flrsL few days of llfe and
CC1 mlghL e lnserLed wlLh gradual lncrease ln volume
of LM whlch also suppresses Lhe nuLrlLlonal needs of
premaLure lnfanL 1hese lnfanLs may have a weak suck
reflex faLlgue and Lend Lo asplraLe
LAnnlnC
W AfLer 8 hours of nurslng lnLervenLlon paLlenL
wlll show manlfesLaLlons of conLenLmenL and
saLlsfacLlon ln food elng fed Lo hlm Lo meeL
hls meLaollc needs
W 1he paLlenL wlll galn welghL afLer a week of
lnLervenLlon
ln1L8vLn1lCnS Anu 8A1lCnALLS
IN1LkVLN1ICN kA1ICNALLS
MonlLor vlLal slgn of Lhe ay
8ecord Lhe welghL of Lhe paLlenL every
week aL Lhe same Llme and Lhe same
cloLhlng
Assess Lhe ay's urlne and sLool
frequency conslsLency color and odor
MonlLor and rcord glucose level of Lhe
ay Lhrough hemoglucose LesL
1o assess any danger durlng feedlng of
Lhe ay
1o evaluaLe ay's welghL changes LhaL
wlll deLermlne hls need for furLher
nuLrlLlonal relaLed lnLervenLlons
1o deLermlne lf Lhe ay had alance
lnLake and ouLpuL and lf feedlng ls well
LoleraLed y Lhe ay
1o lmmedlaLely provlde lnLervenLlon for
any anormal glucose level relaLed Lo
nuLrlLlonal lmalance
IN1LkVLN1ICNS kA1ICNALLS
SLrlcLly fed Lhe paLlenL every 3 hours
Lhrough CC1
erform feedlng of LM Lhrough CC1
wlLh SA (SLrlcL asplraLlon precauLlon)
and leLLlng Lhe ay urp afLer feedlng
Clve enough amounL of LM as
prescrled y Lhe physlclan
1o provlde nuLrlLlonal supporL Lo Lhe
ay's need and Lo avold sklp ln feedlng
Lhe ay
1o prevenL asplraLlon of ay LhaL mlghL
add dlscomforL durlng feedlng and Lo
ensure feedlng ls well LoleraLed y Lhe
ay
1o sufflclenLly supply nuLrlenLs of
expressed reasL mllk for Lhe ay's
growLh and developmenL
ln1L8vLn1lCnS Anu 8A1lCnALLS
IN1LkVLN1ICNS kA1ICNALLS
LducaLe moLher regardlng nuLrlLlon of
Lhe ay and lmporLance of proper
reasLfeedlng
AdmlnlsLer mulLlvlLamlns and oLher
medlcaLlons for nuLrlLlonal
supplemenLaLlon of Lhe paLlenL as
prescrled
1o gulde moLher ln provldlng good
nuLrlLlon for ay ln cooperaLlon wlLh
healLh care provlders
1o ensure paLlenL's welghL galn and
enough supplemenLaLlon of needed
nuLrlenLs
ln1L8vLn1lCnS Anu 8A1lCnALLS
LvALuA1lCn
Coals are meL paLlenL fed successfully Lhrough CC1 and
appears saLlsfled afLer feedlng shown y hls followlng
ehavlors afLer feedlng
Pad sLop crylng afLer feedlng
ecomes relax and fell asleep afLer a few mlnuLes
feedlng well LoleraLed wlLhouL any slgn of asplraLlon
AfLer 1 week Lhe ay galned 210g wlLh a LoLal welghL galn of
1317g/132kg(33ls)
nu8SlnC CA8L LAn
lCCuS 8lSk lC8 ASl8A1lCn
ASSLSSMLn1
C[ecLlves
W wlLh orogasLrlc lnLuaLlon depressed LCC 88
of 48 pm vlsuallzaLlon of reLracLlons
nu8SlnC ulACnCSlS
8lsk for asplraLlon r/L orogasLrlc
lnLuaLlon and lmmaLure
physlology
lnlL8LnCL
W resence of orogasLrlc lnLuaLlon places pL aL rlsk for
mlsplacemenL d/L anaLomlcal poslLlon of Lhe
esophagus and Lrachea ln addlLlon Lo Lhe depressed
LCC of Lhe pL whlch ln Lurn conLrluLe Lo a depressed
gag reflex 1he preLerm lnfanL also has pneumonla
whlch ls manlfesLed y rapld lrregular forceful
reaLhlng whlch lncreases chances of LM asplraLlon
lneffecLlve sucklng reflex ls also presenL d/L dlmlnlshed
sLlmulaLlon Sucklng allows for Lhe normal course of
swallowlng whlch ls a naLural defense agalnsL
asplraLlon lmmaLure smooLh muscle Llssue of Lhe
preLerm lncreases rlsk for regurglLaLlon of gasLrlc
conLenLs whlch may compromlse furLher asplraLlon
LAnnlnC
W AfLer 8 shlfL Lhe paLlenL should e ale Lo
W Lxperlence no asplraLlon as evldenced y
nolseless resplraLlon clear reaLh sounds
W 1oleraLe feedlng
ln1L8vLn1lCnS Anu 8A1lCnALLS
MonlLor resplraLory raLe depLh and
efforL
Check placemenL of CC1 y
ausculLaLlng ln[ecLed alr efore
lnLermlLLenL feedlngs
leedlng pL c gravlLy
Cserve sLrlcL asplraLlon precauLlons
durlng enLeral feedlngs such
as keeplng Lhe head of Lhe pL elevaLed
aL 30 Lo 43 degrees durlng feedlng
oslLlon paLlenL ln prone poslLlon
rovlde regular oral care
W 1o lmmedlaLely deLecL and prevenL
furLher asplraLlon and Lo lnlLlaLe
LreaLmenL LhaL can e llfesavlng
W1o deLermlne lf CC1 ls sLlll ln Lhe
sLomach ecause a mlsplaced CC1 may
resulL ln asplraLlon of LM
W1o allow conLrol of LM admlnlsLraLlon
W1o reduce rlsk of regurglLaLlon or gasLrlc
reflux
W1o asslsL ln gasLrlc decompresslon and
posLural dralnage of posslle regurglLaLed
gasLrlc conLenLs whlch may lead Lo
asplraLlon
W1o promoLe hyglenlc pracLlces and ald ln
oral sLlmulaLlon
LvALuA1lCn
W Coal parLlally meL
W ManlfesL no slgns of asplraLlon
W leedlng well LoleraLed
W 88 33 pm
W uecreased resplraLory efforL
nLAL1n 1LACnING
1 Nutr|t|on
a) reastfeed|ng (23 hrs)
W roper Lechnlques
W roper poslLlonlng
W roper hyglene
2 hototherapy
W Lxpose ay ln sunllghL 1020mlns
3 revenLlng lnfecLlon
W SLerlllze maLerlals used for feedlng (3043mlns under
olllng waLer)
W use dlsLllled waLer for Lhe ay
W e cauLlous Lo mllk and foods glven Lo Lhe ay
W 1each moLher ln performlng full aLh and cord care
Lo Lhe ay Change solled dlaper
W AdmlnlsLer Lhe home medlcaLlons prescrled y Lhe
docLor
W lmmunlzaLlon of Lhe ay musL also e remlnded
1PAnk ?Cu lC8 LlS1LnlnC!
W San !uan kevln Sem 1 Sanarez !an karla L
W 1aday !ohn aul A 1oledano lrancla C
W vlllanueva uomlnlc C