CHILD HEALTH NURSING

CASE SCENARIO

Programme : BSCN, III Year

Topic : Birth Asphyxia
B/O Reeta, a preterm boy baby is born at 28 weeks of gestation via normal vaginal
delivery with meconium stained amniotic fluid. At birth he didn’t cry and APGAR score was
3 and 6 at 1 and 5 mts. He was immediately shifted to baby care area and resuscitation
initiated with bag and mask. Oral suctioning done and Gastric lavage performed after
inserting NG tube. Birth weight is 2kg.
ON EXAMINATION:
 Very weak breathing
 Bluish skin color
 Bradycardia: 100/mt
 RR : 60/mt
 Hypoxia : Spo2 86%
 Hypercarbia : Paco2 65%
 Poor muscle tone
 Weak reflexes
 Respiratory acidosis: ABG reveals- PH 7.2, Hco3 20, Po2 65mmHg, Pco2 55mmHg
 Blood profile: Hb 18gm%, Platelets 1,50,000cumm, PT 21sec , APTT 30sec,
 Meconium stained amniotic fluid present
 Seizures
 Lethargy
 Hypotension: 56/36 mmHg
MANAGEMENT AND TREATMENT:
1. Treatment of respiratory distress
2. Pulmonary hypertension
3. Coagulopathy
4. Myocardial dysfunction.
 Respiratory distress and pulmonary hypertension are treated with intubation,
surfactant, oxygen and inhaled nitric oxide
 Coagulopathy is treated with the prudent use of blood products to maintain oxygen-
carrying capacity and coagulation.
 Myocardial dysfunction may result in a need for vasopressors.
 Renal dysfunction may result in oliguria or anuria; therefore, use of crystalloid fluid
 and blood products
REQUIREMENTS:
 Kardex
 Nurses Notes
 Medicine cards if administered
 Investigation chart
 Feeding chart
 Nursing process according to NANDA: Wellness and illness diagnosis
 Immunization schedule
 Growth and Development:
 Reflexes
 Head to foot examination
 Theories of development
 Play therapy and play materials
HEALTH EDUCATION:
 Newborn care
 Rooming in
 Kangaroo mother care
 Importance of breast feeding/ NG tube feeding
 Prevention of infection
 Prevention of injuries
 Prevention of complications
 Immunization
COMPLICATIONS:

 Disability
 Encephalopathy
 Developmental delay
 Cerebral palsy
 Microcephaly
 Seizures
 Blindness
 Deafness
 Cognition problems
 Lethargy
 Stupor
 Coma
 Death
KARDEX
S. No Medication Dos Rout Freq Time Nursing Interventions
e e
1. Inj.Phenobarbitone 5mg IV BD 9-9  Observe the newborn that
has been successfully
resuscitated for the
2. Inj. Lorazepam 1mg IV BD 10-10 following constellation of
signs.
 Absence of spontaneous
respirations
 Seizure activity in the first
12 hours after birth
 Decreased or increased
urine output (which may
indicate acute tubular
necrosis or syndrome of
inappropriate antidiuretic
hormone)
 Metabolic alterations (e.g.,
hypoglycemia and
hypocalcemia)
 Increased intracranial
pressure marked by
decreased or absent
reflexes or hypertension.
 Decrease noxious
environmental stimuli.
 Monitor the infant’s level
of responsiveness, activity,
muscle tone, and posture.
 Assess vital parameters
that include temperature,
HR, RR, BP and Spo2.
 Administer prescribed
medications, which may
include anticonvulsants
such as phenobarbital and
vasopressors as prescribed.
 Provide respiratory
support on ventilator or
oxygen source as ordered.
 Monitor for complications.
 Measure and record intake
and output to evaluate
renal function.
 Check every voiding for
blood, protein, and
specific gravity, which
suggests renal injury.
 Check every stool for
blood, suggesting
necrotizing enterocolitis
that interfere with
digestion and possibly
 causes paralytic ileus,
perforation, and
peritonitis.
 Take serial blood glucose
determinations to detect
hypoglycemia, and
monitor serum
electrolytes, as ordered.
 Administer and maintain
intravenous fluids to
maintain hydration and
fluid and electrolyte
balance.
 Provide education and
emotional support to the
parents.
 Assess for Blood sugar,
RFT, that include blood
urea, serum creatinine,
LFT, coagulation profile,
PT and PTT, ABG, Spo2,
serum electrolytes, MRI,
CT, EEG.
 Maintain Cardiac output
and cerebral perfusion.
 Maintain Spo2 and
monitor pulse oximetry.
 Treat and prevent
hypoglycaemia.
 Administer IV Fluid: 10%
Dextrose 60 ml/kg/day.
 Treat Hypotension with
Dobutamine,and
Dopamine as per order.
 Administer
anticonvulsants such as
phenobarbitone. Loading
Dose: 20 mg/kg slowly
and Maintenance
Dose:5mg/kg/day,
Phenytoin as a second line
drug Lorazepam 0.05-0.1
mg/kg/dose IV for
seizures.
 Provide cerebro protective
interventions that include
therapeutic hypothermia
cool therapy, Free Radical
 Scavengers, Antagonists
of excitotoxic amino acids
and Calcium Channel
Blockers.
 Administer blood or blood
products as per order.
 Heath educate the parents
regarding baby care,
handwashing technique,
rooming in and Kangaroo
mother care.
 Provide emotional and
psychological support to
the parents.
 Provide spiritual support.
Name : B/O Reeta Age : 1 day
Classification: Newborn
Diagnosis:Neonate with IP NO: 2345
birth asphyxia

Religion: Hindu Dr. Priya

TPR, HR, RR, Spo2 Q2H Diet: NPO

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