IDENTIFICATION DATA:

Baby of –Smuti parida

Registration no: 190941085

Father’s name: SALIL PARIDA

Bed no:05

Name of the ward: NICU

Chronological age: 2 days

Developmental age:Neonate

Sex:male child.

Religion: Hindu.

Address: vill- balugaon

Po:- chilika

Dist: khordha

Date of admission: 9/7/19

Diagnosis: Respiratory distress syndrome

CHIEF COMPLAIN:

 born by LSCS cried after positive pressure ventilation for 30 sec

 restlessness soon after birth
 dyspnoea since 1 hour after birth
 fever since 2 days

HISTORY OF PRESENT ILLNESS:

Present medical history:

Baby was born one month before having birth weight 1.39kg,single,preterm,34
week,SGA,born in LSCS cried after positive pressure ventilation for 30sec.

Present surgical history:

Nothing significant
HISTORY OF PAST ILLNESS:

Past medical history: Nothing significant.

Past surgical history: Nothing significant.

BIRTH HISTORY:
 ANTENATAL HISTORY:
At the time of pregnancy mother was 33 years. The baby is first order child of the
mother. Mother attended all antenatal visits. She has been immunized by doses of inj.
TT. Mother has not taken any another vaccination. Mother has taken the require diet
like protein, carbohydrate, fat as per doctor’s order. She had taken iron folic acid
tablet during pregnancy. Mother had not taken any other drug without doctor’s
prescription. Mother had no history of exposure to radiation. The mother had attended
2 times ultrasonography during antenatal period & the ultrasound report showed
normal activity & position of the baby. Mother had history of hypothyroidism and
PIH she was taking tab labetalol(100)mg & tab calciguard retard 40mgduring
pregnancy.
 NATAL HISTORY:
Mother delivered a term baby in hospital by LSCS delivery. The history of no sever
oligohydramnios no meconium stained amniotic fluid. Birth weight is 1.39kg & baby
is not cried immediately after birth. Positive pressure ventilation has given for 30 sec.
 POST NATAL HISTORY:
Baby has not cried immediately after birth. Breast feeding start after birth.

DIETARY HISTORY:
Present history:

Pre operative time IV fluid- 120 ml/ kg/day. 10% dextrose.

Post operative after 15 days- baby get feeding 20 ml/ 2hours.

IMMUNIZATION HISTORY:
AGE NAME OF VACCINE TAKEN REMARKS
VACCINE
At birth BCG, OPV ‘0’ dose Yes Any complication is
not present at that
time.

DEVELOPMENTAL MILESTONE:
BOOK PICTURE PATIENT’S PICTURE
 PHYSICAL & BIOLOGICAL PHYSICAL & BIOLOGICAL
Weight: 2.5-3.5kg Weight: 1.39 kg
Height:48-50 cm Height:44cm
Head circumference: 35-37 cm. Head circumference: 30cm.
Chest circumference:32-35cm Chest circumference: 28cm
MUAC:11-12cm MUAC:10cm
VITAL SINGS: VITAL SINGS:
Pulse – 110-160beats/ minute. Pulse – 152beats/ minute.
Respiration- 35-45 breaths/ minute. Respiration- 64breaths/ minute.
Blood pressure – 80/50-90/60 mm of Hg. Blood pressure – 90/58 mm of Hg.
REFLEX REFLEX
Well-developed sucking, rooting, Sucking, rooting, swallowing reflexes are not
swallowing, extortion reflexes. well-developed.
Well-developed motor reflex &tonic neck
reflexes. Baby is very sick not understand properly.

DENTITION:baby have no natal teeth.

PERSONAL HISTORY:

Hygiene: sponge baby daily with warm water & changed the baby clothes every day
morning.

Elimination: baby passing urine frequently & baby passing stool every day 4-5times.

Sleep & rest: baby sleeps 18-20 hours every day.

FAMILY HISTORY:
Family chart:

NAME AGE/ RELATI EDUCATION OCUPATION HEALTH

SEX ON
SmrutiParida 25 yrs./F Mother Matriculation House wife Good
Salil Parida 28 yrs/M Father Graduation Business Good
Baby 2daysM Self RDS

Family tree:

- female

- male

-diseased
GENERAL EXAMINATION:

General appearance: baby is lethargic.

Body built: lean & thin.

Nourishment: not well nourishment

Level of consciousness: baby is conscious.

Vital signs:
TPR& BP Normal value Patient value Remarks
Temperature 97 F 96.7 Vitals signs are
Pulse 120-160 beat/min 140 beat/min normal.
Respiration 30-50 breath/min 35 breaths/ min
Blood pressure 90/60 mm of hg 90/58 mm of Hg

REFLEXES:

Rooting, swallowing, sucking reflexes are present & other reflex are not present.

ANTHROPOMETRIC MEASUREMENT:

PARAMETER NORMAL VALUE PATIENT VALUE REMARKS

Weight 2.5-3.9 kg 1.39kg Baby’s biological
Height 48 cm 44cm growth is inadequate
head circumference 35cm 30cm
Chest 33cm 28cm
circumference
MUAC 12cm 10cm

HEAD TO TOE EXAMINATION:

HEAD:

 Shape of skull: shape of skull is round shape.

 Fontanel: anterior & posterior fontanels are not closed, wide gap is present between
two sutures.
 Hair colure & texture: black, silky & smooth hair.
 Presence of infection: no infection presence.
 Dandruff: dandruff is not present.
 Lice: lice are not present.
 Throat: there is no abnormalities.
  Neck: there is no abnormalities.

FACE:

 Face is round shape.

 Oedema is not present.
 Lesion is not present in face.

EAR:

 Both ears are symmetrical & size is same.

 Discharge or any lesion is not present.

EYES:

 Position: both eyes are symmetrical.

 Redness: redness is not present.
 Discharge: no discharge.
 Sclera: there is no abnormalities.
 Other: nothing significant.

NOSE:

 Patency: two nostrils are patent.

 Nasolabial fold:nothing significant.
 Flaring: not present.
 Discharge: not present.

CHEST:

 Both sites are symmetrical, bilateral equal. Incision wound is present.

 Nodules are not present.
 S1 & S2 heart sound are present. No abnormal heart sound.

ABDOMEN:

 Round shape.
 No enlargement.
 Bowel sounds are present.

BACK & SPINE:

  Back is clean.
 Lesion is not present.
 Spinal deviation is not present.

GENITALIA:

both the testes are descended. Rugae present. There is no anorectal malformation.

SKIN:

 Skin is not intact.

 Surgical wound is present.
 Small wound in left hand is present.

INVESTIGATION:

BLOOD TEST:

PARAMETER PATIENT VALUE

Complete blood count:
WBC 8.23 (10^ 3/UL)
RBC 4.77(10^ 6/UL)
HGB 17.3 mg/dl
PLT 88 (10^ 3/UL)
NEUTROPHYLE 82.4%
LYMPHOCYTE 13.3%
MONOCYTE 2.8%
EOSONOPHYLE 1.3%
BASOPHYLE 0.2%
BIOCHEMISTRY:
NA+ 135 MEQ/L
K+ 3.0 MEQ/L
CHLORIDE 100 MEQ/L
MICROBIOLOGY:

CPR- .2-5mg/lit CPR- 2.74mg/lit elevated

Titration = > 0.6 mg/ dl Titration = 0.6 mg/ dl normal

HHH-nonreactive HHH-nonreactive normal

Bilirubin direct-0-0.4mg/dl Bilirubin direct-0.75mg/dl normal

Bilirubin total-0.3-1.0mg/dl Bilirubin total-12.52mg/dl normal

TSH-1.7-9.1mu/l TSH-6.12mu/l normal

MEDICATION:

NAME OF THE DRUGS DOSE ROUTE

Inj.piptaz 140mg IV
Inj. Amikacin 22mg IV
Inj Meropenum 55mg IV
Inj.Aminoven 2gm/kg/hour IV
 MEDICATION
NAME COMPOSITION INDICATION DOSE & ACTION SIDE FEECTS CONTRAIN NURSING
& GROUP ROUTE DICATION RESPOSIBILITY
Inj.piptaz Composition:  UTI Parenteral Tazobactum inhibits  Diarrhoea  Clostr ASSESS:
Each vial contains  Pneumonia route. beta lactamase and  Rash idium 1. Condition of the
4gm piperacillin as  Gynaecologi 100mg/kg prevents the  Itching diffici patient.
sodium salt cal infection /dose. destruction of  Fever le 2. ECG for decrease QT
&0.5gm  Intraabdomi piperacillin.  Nausea infecti & T wave inversion.
tazobactum. nal infection Therefore  Vomiting on 3. Maintain strict I/O
 Skin tazobactum is given  Bleed CHAR.
 Pain at
infection with piperacillin to ing 4. Cardiac status or
the
 Bacterial enhance the activity disord hemodynamic
injection
infection of piperacillin is er monitoring.
site
 neutropenia. eradicating bacterial  Kidne Administration:
infections. y 5.Maintain 10 rights.
Piperacillin kills diseas 6.IV Bolus over 10 mins.
bacteria by inhibiting e
the synthesis of  Allerg
bacterial cells. ies of
penici
llin

NAME COMPOSITIO INDICATION DOSE & ACTION SIDE FEECTS CONTRAIN NURSING
N ROUTE DICATION RESPOSIBILITY
& GROUP
Inj Composition:  Prevention Loading Action needed for to  Nausea History of ASSESS:
amikacin Amikacin & treatment dose 10 treat variety of  Vomiting hypersensitiv  Condition of the
sulphate  Respiratory mg/kg,then bacterial infection  stomach ity to patient.
Mrethylparaben, tract 7.5mg/kg / upset amikacin.  Monitor the patient
propylparaben infection 12hours  loss of vital signs.
, appetite  Maintain strict I/O
chart.
 Checking patients
patients spo2
 Administration:
 Maintain 10 rights.
 Maintain hygiene

NAME COMPOSITIO INDICATION DOSE & ACTION SIDE CONTRAINDIC NURSING

N ROUTE FEECTS ATION RESPOSIBILITY
 & GROUP
Inj. Composition: For parental 16-20 ml  For parental Nausea Hypersensitivity. ASSESS:
Meropene Aminoven 10 nutrition per kg nutrition of infants ,vomiting 1. Check
m consists body (preterm and term monitor
glycinealanine , weight babies) 2. Blood report.
L arginine, Health talk:
L crystenine,L 1. That long term
valine, N acetyl therapy may be
needed to clear
infection.
2. That medication
may be taken..
3. To notify
prescribed of
nausea, vomiting,
diarrhoea,
anorexia, dark
urine
INTRODUCTION:
Acute lung disease of the new-born caused by pulmonary surfactant deficiency tends to
occur in neonates younger than 32 weeks of gestational age.Outcome of RDS has improved
with the increased use of antenatal steroids and early postnatal surfactant therapy.

Definition:
 Hyaline membrane disease (HM) is a disease manifesting within 6 hrs of birth being related
to deficiency of surfactant in the alveoli, leading to acute respiratory distress with fatal
termination if not treated promptly

incidence:
• Premature infants

• Inversely related to gestational age and birth weight

• 60-80% of <28 weeks

• 15-30% of 32-36 weeks

• rarely >37 weeks

ETIOLOGY:

According to the book According to the patient

 Deficiency of surfactant Exact cause is unknown

 Weak and excessively complaint

 Acidosis

 Hypothermia

 Asphyxiated newborn

 Infant with diabetic mother

PATHOPHYSIOLOGY
Prematurity

Decrease surfactant

Increase alveoli surface tension

Hypoxemia → atelectasis

Acidosis → co2 retention

Pulmonary vasoconstriction &hypo profusion

Capillary damage

Plasma leak fibrinogen

↓
fibrin(hyaline membrane)

CLINICAL MANIFESTATION:
ACCORDING TO BOOK ACCORDING TO PATIENT
 Peripheral edema increases My patient has-

 Muscle tone decreases

 Cyanosis increases    Present

 Body temperature drops  

 Present
 Bradycardia  
 Present
 Diminished breath sounds

 Hypotension  

 Edema of the hands and feet ∀ .

Absent bowel sounds

 Decreased urine out put

 Expiratory grunting

 Inspiratory nasal flaring

DIAGNOSTIC EVALUATION:
ACCORDING TO BOOK ACCORDING TO PATIENT
BLOOD TEST Investigation:
CBC
Cord blood grouping
ABG
TSH
Serum ca All investigations have done
RBS
BT CT
Chest x ray
 Ground glass change Normal study
  Air Broncho gram
 White lung
USG abdomen

MANAGEMENT:

According to Book Picture According to patient picture

1. Supportive treatments Patient has taken all type of

2. Oxygen therapy management.
3. Mechanical ventilation
4. Surfactant replacement therapy

1. Supportive treatment
 Body temperature
 Scheduled “touch times” to avoid
hypothermia and minimize oxygen
consumption
 Placed the radiant warmer to
maintained core temperature
between 37 ± 0.5 °C

 Nutritional support
 For the 1st 24 hr, 10%DW should be
infused through a peripheral vein at a
rate of 65–75 mL/kg/day
 For VLBW and ELBW, TPN should be
added
 Day 2-3, Na 3-4 mEq/kg/day and K 2-
3 mEq/kg/day should be added (TV
not more than 90 ml/kg/day)
 Excessive fluids (>140 cc/kg/day)
contribute to the development of
PDA and BPD On day 1, if good
clinical, step feed by started at 0.5-1
ml/kg x 8 feeds drip in 1-2 hr with
TPN (TV 80-100)
.2. Oxygen therapy
 Warm humidified oxygen should be
provided at a concentration initially
sufficient to keep PaO2 50-80 mmHg,
pH 7.25-7.45, PaCO2 40-50 mmHg
and SpO2 90–95%
 to maintain normal tissue
 oxygenation while minimizing the risk
of oxygen toxicity
 O2 box is not recommended for
newborn with VLBW and ELBW
because of high concentration of O2
may increase risk of ROP
 . Oxygen therapy
 If the PaO2 cannot be maintained
above 50 mmHg at inspired oxygen
concentrations of 60% or greater,
applying CPAP at a pressure of 5–10
cmH2O by nasal prongs
 CPAP prevents collapse of surfactant-
deficient alveoli, improves FRC, and
improves ventilation-perfusion
matching
 The amount of CPAP required usually
decreases abruptly at about 72 hr of
age, and infants can be weaned from
CPAP shortly thereafter.

.3. Mechanical ventilation

 Continue positive airway pressure

(CPAP) is being use with 4-8 cm·H2O
To make Functional residual capacity
(FRC) for the lung to prevent
atelectasis Usually started with 5
cm·H2O and increased by 1 cm·H2O
in subsequent with increase oxygen
by 10%  Routes of administration 
Nasal prongs  Nasopharyngeal tube
 . Mechanical ventilation
 Indication for ventilator
 Apnea with no improvement 
Cyanosis or PaO2 ≤ 40 mmHg (when
using CPAP and high oxygen
oncentration)

 4.Surfactant replacement therapy

 Surfactant replacement therapy can
reduce mortality and incidence of
Chronic pulmonary disease
 There are 2 types of surfactant : 1.
Natural surfactant extract 
Bovine(Survanta), Porcine(Curosurf),
 Surfacten, Alveofact and Calf
(Infasurf) 2. Synthetic surfactant 
Exosurf and ALEC (Artificial Lung
Expanding Compound)
 . Surfactant replacement therapy
 Natural surfactants appear to be
superior, perhaps because of their
 surfactant-associated protein content
 Natural surfactants have a more
rapid onset and are associated with a
lower risk of pneumothorax and
improved survival
 . Surfactant replacement therapy 
The 2 main indications
 Prophylactic treatment  Being use
for infant delivered during 23-29 wk
of gestation and birth weight 600-
1250 g  Results :  Improve dyspnea
in first 48-72 hr of life (Decrease O2
requirement, ventilation improved) 
Decreased incidence of
pneumothorax and BPD  Not affect
the incidence of IVH and PDA 
Decrease mortality
 Surfactant replacement therapy 
The 2 main indications :
 Therapeutic or Rescue treatment 
Initiated as soon as possible in the
1st 24 hr of life  Repeated dosing is
given via the endotracheal tube every
6–12 hr for a total of 2 to 4 doses,
depending on the preparation 
Results :  Clinical improved
(Decrease O2 requirement) 
Decreased incidence of
pneumothorax  Not affect the
incidence of BPD, IVH and PDA 
Decrease mortality There is no
significantly difference between
single dose and multiple dose of
surfactant replacement therapy .

Complication
According to book picture According to the patient
 Bronchopulmonary dysplasia (BPD) Not present

lung injury Not present

NURSING DIAGNOSIS:

1. Increase the body temperature related to disease process as evidenced by temp-

99.4ᵒf.
2. Altered nutrition less than body requirement related to pain of surgery area.
3. Ineffective airway clearance related to inflammation, increased secretion.
4. Risk for infection related to presence of cannula in right hand.
5. Interrupted family processes related to child’s illness, hospitalization, & medical or
therapeutic regimen.
 ASSESSMENT DIAGNOSIS GOAL INTERVENTION RATIONALE EVALUATION

SUBJECTIVE
DATA:-  -Vital sign has checked & All activities are The body restlessness
Patient’s mother tell The baby crying To maintain recorded properly. the will be reduce of the
that child is feeling & baby also normal  -Proper positioning has Help to reduce the child.
dryand, crying restless. respiratory maintained. body ache of the
Objective data:- pattern.  Supplementary oxygen child.
Restless. concentration every hour has
Breathless ness. recorded
 Suction has done.
 ABG has monitored
 .
 ASSESSMENT DIAGNOSIS GOAL INTERVENTION RATIONALE EVALUATION

SUBJECTIVE Alteration in
DATA:- thermoregulation Reduce  Assess the body temperature
child has rising related to immaturity the body temperature. All activities are the Temperature is reduced after
temperature. as evidenced by body temperature. reducing the body giving sponge & medicine.
 Shows the mother how to give temperature of the Temperature is 98.4ᵒf.
Objective data:- temperature was 99
sponging of the body of the child.
The child body degreef.
patient.
temperature is
99degreef.
 Proper positioning has given to
the child.

 Well ventilated & odour free

environment has provided.
 Intake output chart has
maintained
 ASSESSMENT DIAGNOSIS GOAL INTERVENTION RATIONALE EVALUATION

To maintain  -Assess the reason of the not

SUBJECTIVE Altered nutrition less normal taking food. All activities are the
DATA:- than body nutritional help to maintain The nutritional status will be
Patient is not requirement related to status.  -Intravenous fluid has given, nutritional status of improve of the child.
taking food orally disease condition.. RL is given, that is properly child.
for his disease calculated & maintain the time
condition. order
Objective Data:-  &drop etc.
The patient has
not taken  -Health education has given to
anything orally the parent about to give breast
feeding to the patient in small
amount & frequently as
advised by doctors order

 Adequate caloric intake and

output chart has maintained.
 ASSESSMENT DIAGNOSIS GOAL INTERVENTION RATIONALE EVALUATION

SUBJECTIVE Return from  -Position child for maximal

DATA:- normal ventilator efficiency & airway
baby has problem Ineffective airway breathing patency. All activities are After 2 hr child become take
in breathing for clearance related to pattern. return the normal normal breath, prevent
secretions. inflammation,  -Humidified o2 has provided. breathing pattern of obstruction from secretion.
OBJECTIVE increased secretion. baby.
DATA:-  -CPT as need has provided
Difficulty has.
vocalizing.  Bronchodilator.
Ineffective cough.
Restlessness,  Medication has administered
Crying.
 -Administer antibacterial
medication.

- The position of the

baby for facilitate the
drainage has changed.

 -Monitoring vital signs has

monitered
  -

ASSESSMENT NURSING GOAL INTERVENTION RATIONAL EVALUATION

DIAGNOSIS

SUBJECTIVE Baby will free  aseptic procedure has All activities are relief
DATA:- \Risk for infection from infection. maintained. from infection. child will be free from
Baby’s mother related to presence of  -Implement & practice infection.
telling baby’s cannula in right hand. standard precautions.
right hand  -Implement contact &
become airborne precaution as needs.
swelling. family to practice hand washing has
OBJECTIVE encouraged.
DATA:-
Redness in  Antibacterial medication has
cannula site. administered.
Swelling  vital signs has monitored.
HEALTH EDUCATION:
 Advice to give carefully feeding to the baby.
 Advice to use catori & spoon for feeding after discharge from hospital.
 educate mother should do burping of the baby& sit upright position for some time to avoid choking.
 Advise to practice kangaroo Moher care.

SUMMARY:
The baby has admitted in SUM hospital on 15.02.19. I am received the baby 18.02.19 after surgery. I applied all type of necessary care
according to the baby’s need.After providing all nursing care patient condition has improved.

CONCLUSION:
Through the case study, i learned about the disease process in details, the how the body system get affected by the disease pathology, what are
the clinical feature, how to manage such type of patient. I learned nursing care plan using the nursing theory. During my positing all the staff of
the ward are very much co-operative with me.

REFERENCES:
 Basvanthapa “Text book of child health nursing” 1st edition, New Delhi.
jaypee brother’s medical publisher (p) LTD,

 Beevi Assuma “the text book of pediatric nursing” 1st edition, ELSEVIR A division of reed, Elsevier India private limited.

 Dutta parul “pediatric nursing” 2nd edition. New dhlhi. Jaypee brother’s medical publishers (p) LTD, 2009

 Sharma Rample, Essenntial of pediatric Nursing, 1st edition, New Delhi, Jaypee brother’s medical publisher (p) LTD, 2013
 CASE STUDY
ON
Respiratory distress syndrom

SUBMITTED TO: SUBMITTED BY:

ASSOC SUGUMAR S pranati jena
Hod Child health nursing M.Sc Nursing, 1st year
SNC, BBSR. SNC, BBSR.

Submitted on: 18.7.19

 THEORY APPLICATION

(FAYE GLENN ABDELLAH)

INTRODUCTION:

As a profession nursing should identify its own unique body of knowledge which is essential to nursing practice. To identify this knowledge,
nurse must develop and recognize concept and theories which are specific to nursing.

“Theory is defined as a system or ideas that is proposed to explain a given phenomenon or event.”

It provides professional autonomy by guiding the nursing practice, education and research function.

BIO GRAPHY OF FAYE GLEN ABDELLAH

Abdellah was born in New York city. In 1942 she received diploma in nursing from Fitkin Memorial Hospital, School of nursing.

She received B.S, M.A and Ed.D from Teacher’s college at Columbia University and She completed her doctoral work in 1955.

The nursing theory devloped by Faye Abdellah etal emphasized upon delivering nursing care for the whole person to meet the physical,
emotional,Intellectual, social and spiritual needs of the client and family.

21 NURSING PROBLEM

A. Basic to all patient :-

1. To maintain good hygiene and physical comfort.
2. To promote optimal activity, exercise, rest and sleep.
3. To promote safety through prevention of accident, injury or other trauma and through the prevention of the spread of infection.
4. To maintain good body mechanics and prevent and correct deformities.

B.Sustenal care needs:-

5. To facilitate the maintenance of a supply of oxygen to all body cells.

6. To facilitate the maintenance of nutrition to all body cells.

7. To facilitate the maintenance of elimination.

8. To facilitate the maintenance of fluid and electrolyte balance.

9. To recognize the physiological response of the body to disease conditions- physiological and compensatory.

10. To facilitate the maintenance of regulatory mechanisms and functions.

11. To facilitate the maintenance of sensory function.

C. Remedial care needs :-

12. To identify and accept positive and negative expressions and feelings.

13. To identify and accept interrelatedness of emotions and organic illness.

14. To facilitate progress towards achievement of personal spiritual goal.

15. To promote the development of productive interpersonal relationship.

16. To facilitate progress towards achievement of personal spiritual goal.

17. To create and maintain a therapeutic environment.

18. to facilitate awareness of self as an individual with varying emotional , physical and developmental needs.

D. Restorative care needs:-

19. To accept the optimum possible goal in the light of limitation, physical, emotional.

20. To use community resources as an aid in resolving problems arising from illness.

21. To understand the role of social problems as influencing factors in the cause of illness.

From this theory all complain applied on my client. Once the person gets disease then all disturbance get & cannot get proper nutrition, rest sleep
etc. There for this theory is applicable to my patient care.

NURSING DIAGNOSIS:

 Increase the body temperatureRelated to disease process as evidenced by temp- 99.4.

 Altered nutrition less than body requirement related to pain of surgery area..

 Ineffective airway clearance related to inflammation, increased secretion

 Risk for infection related to presence of cannula in right hand

 Interrupted family processes related to child’s illness, hospitalization, & medical or therapeutic regimen