CASE-PRESENTATION-Bronchopulmonary Dysplasia

A Case Study on
Bronchopulmonary Dysplasia (BDP)
In Partial Fulfillment of the Requirements in

RT 312 - CLINICAL EDUCATION I
PEDIATRIC INTENSIVE RESPIRATORY

CARE ROTATION
Submitted to:
GUIA LAUREN L. TARRANZA, RTRP
Clinical Instructor
Submitted by:
ABDULLAH, ASLANIE
CANUDAY, GIANE CHRISTINE
GALLARDO, ZAIRA
LARCEÑA, JESSA NEIL
MANSA, LOUIE
PACE, MARY ESTHER MAY
PARCON, KARL KRYSKYR MYLEE
BSRT4A - Group 1
Date Submitted:
SEPTEMBER 06, 2022
TABLE OF CONTENTS
I. COVER PAGE ……………………………………………………………………… i

II. TABLE OF CONTENTS…………………………………………………………….1
III. INTRODUCTION…………………………………………………………………….5
IV. OBJECTIVES………………………………………………………………………..7
a. General Objectives…………………………………………………………..……...7
b. Specific Objectives……………………………………………………..…………...7
V. DEFINITION OF DIAGNOSIS…………………………………………………..…8
VI. PERSONAL DATA……………………………………………………………...…10
a. Biographic Data………………………………………………………………...….10
b. Clinical Data………………………………………………………………………..11
VII. PATIENT HISTORY……………………………………………………………....12
a. Past Medical History………………………………………………………………12
b. Present Health History……………………………………………………………12
c. Genogram………………………………………………………………………….13
d. Narrative……………………………………………………………………………14
VIII. ASSESSMENT…………………….………………………………………………15
a. Physical……………………………………………………………………………..15
Vital Signs…………………………………………………………………………..15
Pediatric Glasgow Coma Scale…………………………………………………..16
APGAR Scoring System…………………………………………………………..16
Silverman Scoring System………………………………………………..………17
Head………………………………………………………………………………...17
Eyes…………………………………………………………………………………17
Ears………………………………………………………………………………….18
Nose…………………………………………………………………………………18
Mouth………………………………………………………………………………..18
Neck…………………………………………………………………………………19
Thorax and Lungs………………………………………………………………….19
Abdomen……………………………………………………………………………19
Upper Extremities………………………………………………………………….20
Lower Extremities………………………………………………………………… 20
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b. Developmental Task………………………………………………………………21
Erik Erikson’s Stages of Psychosocial Development……………………………...21
Robert Havighurst’s Developmental Task…………………………………………..21
IX. ANATOMY AND PHYSIOLOGY…………………………………………………24
a. The Fetal Lung Development…………………………………………………….24
Embryonic Period……………………………………………………………...24
Pseudoglandular Period………………………………………………………25
Canalicular Period……………………………………………………………..25
Terminal Sac Period…………………………………………………………..25
b. Placenta…………………………………………………………………………….26
c. Fetal Circulation……………………………………………………………………28
d. Fetal Lung Fluids…………………………………………………………………..29
e. The Pulmonary Vascular System………………………………………………..30
Arteries………………………………………………………………………….30
Arterioles………………………………………………………………………..31
Capillaries……………………………………………………………………….31
Venules and Veins…………………………………………………………………….32
f. The Lymphatic System……………………………………………………………33
g. The Respiratory System…………………………………………………………. 33
Lower Airway………………………………………………………………………….. 34
Trachea…………………………………………………………………………34
Bronchi and Subdivisions……………………………………………………..34
Lungs……………………………………………………………………………35
Alveoli…………………………………………………………………………...35
X. PATHOPHYSIOLOGY…………………………………………………………....36
a. Predisposing Factors……………………………………………………………...36
b. Precipitating Factors………………………………………………………………36
c. Diagram……………………………………………………………………………..38
d. Narrative…………………………………………………………………………….40
XI. DIAGNOSTICS………………………………………………………………….....42
a. Chest X-ray…………………………………………………………………………42
b. Arterial Blood Gas…………………………………………………………………42
c. High-Resolution Computed Tomography……………………………………….43
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d. Complete Blood Count…………………………………………………………….44
e. Mechanical Ventilator Setup……………………………………………………...46
XII. DRUG STUDY……………………………………………………………………..48
a. Albuterol…………………………………………………………………………….48
b. Furosemide…………………………………………………………………………52
c. Dexamethasone……………………………………………………………………56
d. Palivizumab………………………………………………………………………...59
XIII. RESPIRATORY CARE PLAN 1……………………………………..………….. 62
a. Subjective…………………………………………………………………………..62
b. Objective……………………………………………………………………………62
c. Analysis……………………………………………………………………………..69
d. Planning…………………………………………………………………………….69
e. Interventions………………………………………………………………………..70
f. Evaluation…………………………………………………………………………..72
g. Recommendations…………………………………………………………………72
XIV. RESPIARATORY CARE PLAN 2………………………………………………..74
a. Subjective…………………………………………………………………………..74
b. Objective……………………………………………………………………………74
c. Analysis……………………………………………………………………………..81
d. Planning…………………………………………………………………………….82
e. Interventions………………………………………………………………………..82
f. Evaluation…………………………………………………………………………..84
XV. RESPIRATORY CARE PLAN 3……………………………………………….....86
a. Subjective…………………………………………………………………………..86
b. Objective……………………………………………………………………………86
c. Analysis……………………………………………………………………………..94
d. Planning…………………………………………………………………………….94
e. Interventions………………………………………………………………………..95
f. Evaluation…………………………………………………………………………..96
XVI. PULMONARY REHABILITATION……………………………………………….99
XVII. PATIENT PROGNOSIS…………………………………………………………104
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XVIII. REFERENCES…………………………………………………………………...107
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INTRODUCTION
Pediatric Intensive Respiratory Care (PIRC) specializes in the care of children who
are critically ill or in an unstable condition as a result of a serious accident, illness, or other
acute and chronic life-threatening illness. These are patients whose conditions may
suddenly change and necessarily involve immediate medical attention. Ventilator
management, diagnostic blood sampling, bronchoscopy, oxygen therapy, and all aspects
of hemodynamic monitoring are among the procedures performed by respiratory
therapists.
The most common adverse outcome of very preterm delivery is bronchopulmonary

dysplasia (BPD), which affects up to 75% of infants born before 28 weeks of gestation
worldwide (Greenough, 2022). The incidence of new BPD varies widely between
countries, regions, and local healthcare institutions. Many factors affect BPD rates
including delivery room resuscitation practices for ELBW infants, invasive and
noninvasive mechanical ventilation strategies, early versus rescue surfactant use, criteria
for weaning and extubation, and acceptable pulse oximetry ranges. Geographical
characteristics can also come into play because the incidence of new BPD is much
greater at high altitudes than at sea levels (Balest, 2021).
Many prenatal conditions might have an impact on the development of the infant’s
respiratory system. In the Philippines, the preterm birth rate is 3.0%. Incidence of low birth
weight (LBW) was 11.9% in 2020. Increased use of prenatal care, essential newborn
care, and kangaroo mother care has reduced adverse birth outcomes and neonatal
mortality rate. Regardless of the fact that there is no significant difference in low-birth
weight (LBW) incidence between urban and rural areas, there are still regional disparities.
Prenatal diseases such as bronchopulmonary dysplasia are caused by developmental
anomalies of the heart, lungs, or airways, while others are caused by prematurity, issues
during labor and delivery, and consequences from treating the underlying disorders
(Balest, 2021). According to Lintao et al. (2022), Metro Manila had the lowest LBW rate
(9.0%), while two southern Philippine regions had the highest rate, with Davao at 20.0%
and Zamboanga at 21.0%. It has been reported that parent smokers were more likely to
have LBW newborns (21.0%) than nonsmokers (14.0%). Most babies who have BPD get
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better in time, but they may need chronic respiratory support for months or even years.
They may continue to have lung problems throughout childhood and even into adulthood
(Kacmarek et al., 2019).
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OBJECTIVES
General Objectives
Within the two-week Pediatric Intensive Respiratory Care (PIRC) rotation, the
respiratory therapy student interns will demonstrate the medical theories, principles, and
concepts that will be incorporated into the actual clinical setting to improve the patient's
condition by collecting all the patient's data, as well as analyzing the pathophysiology of
the patient's condition, in order to come up with a comprehensive respiratory case study.
Specific Objectives
The respiratory therapy interns intended to specifically:
a.) Define the diagnosis of bronchopulmonary dysplasia (BDP);
b.) provide the personal data and medical data of the patient;
c.) present the history of the patient, specifically past health history, present health
history, and genogram;
d.) examine the patient through cephalocaudal assessment;
e.) define the anatomy and physiology affected by bronchopulmonary dysplasia;
f.) create a diagram on the pathophysiology of bronchopulmonary dysplasia (BPD),
including the predisposing and precipitating factors;
g.) identify the diagnostic tests used for the bronchopulmonary dysplasia (BPD)
patient;
g.) enumerate the medications administered to bronchopulmonary dysplasia
(BDP)
h.) formulate three respiratory care plans for the patient following the SOAPIER
method;
i.) create a pulmonary rehabilitation plan for the patient using METHODS protocol;
and
j.) assess the patient’s prognosis.
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DEFINITION OF DIAGNOSIS
Preterm infants (i.e., 1000 g or less and/or 10 weeks premature) are at risk of
developing a common chronic pulmonary condition called bronchopulmonary dysplasia .
BPD is a complex condition marked by lung injury or inflammation caused by oxygen
and/or positive pressure. BPD may lead to lung development problems, pulmonary
emphysema, and pulmonary hypertension. Historically, BPD has been commonly defined
by the requirement for supplemental oxygen at 28 days in infants born below 32 weeks
gestation. Furthermore, chest x-ray initially shows diffuse haziness due to accumulation
of exudative fluid; appearance then becomes multicystic or sponge-like, with alternating
areas of emphysema, pulmonary scarring, and atelectasis. Alveolar epithelium may
slough, and macrophages, neutrophils, and inflammatory mediators may be found in the
tracheal aspirate (Balest, 2021).
Bronchopulmonary dysplasia symptoms can be the same as those caused by RDS

since RDS is a common base condition in those infants who later develop BPD. If babies,
including those with RDS, continue needing oxygen therapy past their original due dates,
it’s an early indication of BPD. This neonatal disorder is typically suspected when a
ventilated infant is unable to wean from oxygen therapy, mechanical ventilation, or both.
Infants typically develop worsening hypoxemia, hypercapnia, and increasing oxygen
requirements. Additionally, when an infant cannot be weaned within the expected time,
possible underlying disorders, including patent ductus arteriosus and nursery-acquired
pneumonia, should be sought (Balest, 2021). Symptoms include bluish skin tone, quick
breathing, grunting sounds, nostrils flaring, shortness of breath, coughing, and pulling
between and below the ribs when breathing.
BPD is classified into three severity levels (mild, moderate, and severe) depending
on the need for respiratory assistance at 36 weeks postmenstrual age (Kacmarek et al.,
2019). BPD is diagnosed by the need for oxygen (>0.28) for at least 28 days, with
respiratory support needed at a specified evaluation time, determined by the degree of
prematurity. At >28 days but evaluate <56 days postnatal age or discharge to home
(whichever comes first). In mild cases, no supplemental oxygen requirement at time of
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evaluation. At moderate BPD, the need for FIO2 ≤ 0.30 and/or PPV or NCPAP at the time
of evaluation. At severe, there is a need for ≥ 0.30 FIO2 and/or PPV or NCPAP at the
time of evaluation (Kacmarek et al., 2019).
There are multiple risk factors for the development of BPD. These are not,
however, causative factors, and not one factor is considered a definitive link to BPD. The
risk factors include gestational age of 28 weeks or less, birth weight 1,000 g or less,
hypothermia at admission to the neonatal intensive care unit (NICU), hypotension at
admission, RDS, the need for more than 2 hours of MV in preterm infants of greater than
26 wG, hypercarbia (PaCO2 >50 mm Hg) during the first 6 days of life in extremely
premature extremely low birth weight (ELBW) infants, the need for exogenous surfactant
therapy, higher fluid therapy, nosocomial infection, more than two packed red blood cell
transfusions, chorioamnionitis, which can increase the risk of BPD even in the absence
of RDS, and preeclampsia (Kacmarek et al., 2019).
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PERSONAL DATA
Biographic Data
Name : Patient A.S.G
Gender : Male
Age : 28 days old
Height : 32.6 cm
Weight : 1.65 lbs (0.75 kg)
BMI : 7.06
Birth date : August 2, 2022 (4:35 PM)
Birth delivery : Premature delivery (25 weeks gestation)
Place of Birth : Davao City
Nationality : Filipino
Religion : Roman Catholic
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Clinical Data
Date of Admission : August 30, 2022
Time of Admission : 5:00 PM
Manner of Admission : Inpatient
Hospital : Southern Philippines Medical Center
Ward : NICU-1
Attending Physician : Dr. M.J. Buenvenida
Chief Complaint : Bluish discoloration around the lips; tachypnea
Admitting Diagnosis : Severe Bronchopulmonary Dysplasia
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PATIENT HISTORY
This section will comprehensively discuss the aspects of obtaining a patient's
history, such as past and present health histories, a genogram to identify familial
relationships and medical history, and a narrative summarizing the diagram.
Past Medical History

Patient ASG is a Filipino born on August 2, 2022 at 4:35 PM in Davao City and is
a first-born child. The patient was delivered preterm via natural spontaneous vaginal
delivery (NSVD), weighing 1.65 lbs (0.75 kg) and measuring up to 32.6 centimeters. In
the first week, the patient had progressive respiratory distress where oxygen
supplementation via mechanical ventilation was later administered. Until the 4th week,
the patient was still intubated for a total of 28 days on oxygen support.
Present Health History

After 28 days of long-term mechanical ventilation and supplemental oxygen, the
patient has shown signs of cyanosis, hypoxemia, hypercapnia, tachypnea, and
retractions. Upon checking, the patient was hooked into a pulse oximeter with a SpO2
measuring 92%. Nasal flaring and evident use of accessory muscles were also observed.
Upon assessment, the patient's Glasgow Coma Scale was 3, indicative of
unresponsiveness. Additionally, the patient's overall APGAR score was 3 (severely
depressed), and Silverman Scoring System was 8 indicating an impending respiratory
failure. Patient ASG is under medication of Albuterol, Furosemide, Dexamethasone, and
Palivizumab as per the doctor’s order. Furthermore, increased airway resistance,
decreased static lung compliance, and bronchospasm was also noted.
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Genogram
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Narrative
Patient ASG has no siblings and is the first grandchild of the family. He was
diagnosed with bronchopulmonary dysplasia at 28 days old. S1 (M) is currently 38 years
old with history of smoking. She used to be a heavy smoker from 2010 to 2021. On the
maternal side, the patient’s grandfather died at the age of 89 due to Emphysema. The
grandfather was noted to be a heavy smoker with 20 pack years. On the other hand, the
grandmother died at 85 due to old age. She has a history of birth defects in her second
child (S2). S2 (M) is also a heavy smoker up to the present date.
On the paternal side, the patient’s grandfather died at the age of 88 due to lung
cancer. While the grandmother died at the age of 91 without any known disease. S1 (P)
was also a healthy individual with no history of major diseases. However, S2 (P) who is
currently 35 years old, occasionally smokes up to the present day with noted food
allergies.
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ASSESSMENT
Physical
General Survey
Patient Baby A.S.G was born prematurely in Southern Philippines Medical Center
on August 2, 2022 at 4:35 PM. The patient was given ventilatory support due to the
difficulty in breathing as premature babies are often not able to breathe well enough on
their own. The patient showed a persistent need for a high level of respiratory support
even after days of ventilation, which led to suspicion of Bronchopulmonary Dysplasia, and
was later diagnosed on August 30, 2022. Further physical assessment was done
thereafter.
Vital Signs
Date and Time: August 30, 2022 (5:00 PM)
Vital Sign Results Normal Values
Blood pressure 65/40 mmHg 39/16 mmHg – 59/36 mmHg
Heart Rate 180 bpm 120 – 160 bpm
Respiratory Rate 75 cpm 30 – 60 cpm
Temperature 35.0°C 35.5 °C – 36.5°C (Axillary)
Oxygen Saturation 92% 90 – 95% (Preterm Neonates)
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Pediatric Glasgow Coma Scale
Response Point Scale
Eye Response 1 No response
Verbal Response 1 No response
Motor Response 1 No response
GCS Score 3 Unresponsive
APGAR Scoring System
Assessed Sign Score Scale
Activity (Muscle Tone) 0 Absent
Pulse 2 >100 beats/min
Grimace (Reflex Irritability) 0 Flaccid
Appearance (Skin Color) 0 Blue, Pale
Respiration 1 Irregular
APGAR Score 3 Severely Depressed
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Silverman Scoring System
Sign Score Scale
Upper Chest Retraction 2 See-saw
Lower Chest Retraction 2 Marked
Xiphoid retraction 1 Just visible
Chin Movement 2 Lips apart
Expiratory Grunt 1 Audible with Stethoscope
Silverman Score 8 Impending Respiratory Failure
Level of Consciousness
As of 5:00 PM, the patient is unresponsive. The eye, verbal, and motor
responses are all absent.
Head
Upon inspection, the shape of the infant’s head appears to be microcephalic, with
no noted deformities and lesions. The amount of hair looks normal, greyish in color, and
evenly distributed over the scalp.
Upon palpation, the hair is fine and somehow oily. No palpable mass, lumps, or
tenderness noted.
Eyes
Upon inspection, the patient’s eyebrows have evenly distributed hair, have intact
skin, and are symmetrically aligned. Both brows have equal movement. The conjunctiva
appears to be dry, capillaries are sometimes evident, and the sclera appears to be
17
anicteric. The eyeballs are sunken. The cornea is transparent, shiny, and smooth. Details
of the iris are visible. The iris is black, flat and round.
Upon assessing the pupils for light reaction, pupils are noted to be equally round
and immediately reactive to light accommodation. Both eyes have a pupillary diameter of
2mm.
Ears
Upon inspection the patient’s external canal is dry, has presence of hair follicles,
and no pus or blood noted. Normal voice tones are audible to patients. Sound is heard
on both or localized at the center of the head.
Upon palpation, the ear is without any tenderness, lump, or mass. The pinna
recoils after being folded.
Nose
Upon inspection, the nasal septum is located midline. Nasal flaring is noted due to
the use of accessory muscles in breathing. No lesions observed. A nasogastric tube is
attached to the right nostril.
Upon palpation, there was no tenderness noted. No bone and cartilage deviation
are observed.
Mouth
Upon inspection, the lips were bluish and dry. The blue coloring is caused by an
evident low amount of oxygen in the blood. Gums are in excellent health. A 6.0 cm long
uncuffed endotracheal tube with a 2.5 mm internal diameter is attached to the mouth.
Upon palpation, there was no inflammation and swelling noted. No gum bleeding
is indicated. The tongue is thick and lumpy white. The surface is rough and no lesions are
noted.
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Neck
Upon inspection, the trachea is located midline. Bruises and lesions were not
noted. Use of accessory muscles specifically the sternocleidomastoid and supraclavicular
muscles was evident. No lumps were noted. Jugular vein is not distended. A CV line on
the right side of the neck is present.
Upon palpation, there were no lymph nodes and signs of bulging masses.
Thorax and Lungs
Upon inspection, no deformity of the chest is seen. The spine is straight and in a
vertical position. No deformities and lesions noted. A single ECG lead is present on the
left side of the chest.
Upon palpation, the patient's chest is warm to the touch. Chest rise is noted to be
fast and irregular due to abnormal breathing patterns.
Upon percussion, there is a presence of dullness.
Upon auscultation, crackles and occasional expiratory wheezing were noted.

Decreased air movements are also heard. Prolonged expiration at 1:3 was recorded. Air
trapping and presence of secretions were evident.
Abdomen
Upon inspection, there are no scars and lumps noted. The abdomen is distended.
Upon palpation, enlarged and tender liver were not noted. Bowel sounds are
tympanic and normoactive in all four quadrants upon auscultation.
Upon percussion, the abdomen is tympanic in all areas of the abdomen.
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Upper Extremities
Upon inspection, there are no skin rashes observed. Signs of cyanosis are seen
on patients' hands and nails. On the right hand, a pulse oximeter is attached with a
reading of 92% Sp02. Capillary refill test is 4 seconds.
Upon palpation, no tenderness and deformity were present.
Lower Extremities
Upon inspection, the legs are thin in shape and signs of cyanosis are evident in
the nail beds. No scars and bruises were noted.
Upon palpation, no tenderness and edema were noted.
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Developmental Task
Erik Erikson’s Stages of Psychosocial Development
(Infancy from birth to 18 months)
CRISIS OUTCOME RATIONALE
Trust Positive If a child successfully develops trust, the child will feel safe and
secure in the world.
Mistrust Negative Mistrust or the failure to develop trust will result in fear and a
belief that the world is inconsistent and unpredictable.
Robert Havighurst’s Developmental Task
TASK MET/UNMET RATIONALE
Achieving UNMET At this stage, babies can

autonomy crawl, sit without support, reach out with both
hands, and crawl around the house but given the
circumstances of the patient who is a premature
infant, this milestone is far off reach.
Establishing UNMET At this stage, children begin to define themselves

identity and
others by physical attributes, such as hair
color or eye color. However, the patient is still a
premature infant therefore she is not yet able to
complete this task.
Developing UNMET At this stage, the person develops an integrated

emotional stability and balanced way of perceiving
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the problems of life, usually prominent during
middle adulthood. However, the patient is still a
premature infant therefore she is not yet able to
complete this task.
Establishing a UNMET At this stage, the person obtains an occupation

career to keep up with the living standards of society.
However, the patient is still a premature infant
therefore she is not yet able to complete this
task.
Finding intimacy UNMET At this stage, the person obtains a partner and
learns to cohabitate with them. However, the
patient is still a premature infant therefore she is
not yet able to complete this task.
Becoming part of a MET At this stage, the person simply joins a group of
group or people living in the same place or having a
community particular characteristic in common. Despite
being a premature baby, the patient becomes a
part of a group, be it as a residence or a family
member through processed papers.
Establishing a UNMET At this stage, the person starts managing a home

residence and and starting a family. However, the patient is still
learning how to a premature infant therefore she is not yet able
manage a to complete this task.
household
Becoming a parent UNMET At this stage, the person assists teenage children
and rearing child to become responsible and happy adults.
However, the patient is still a premature infant
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therefore she is not yet able to complete this
task.
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ANATOMY AND PHYSIOLOGY
The Fetal Lung Development

During the fetal lung development, the process is divided into four (4) periods:
embryonic, pseudoglandular, canalicular, and terminal sac.
EMBRYONIC PERIOD
The development during the first five (5) weeks after fertilization falls under the
embryonic period. The first appearance of the lungs is said to be on the 24th day of
embryonic life wherein the lungs appear as a small bud, arising from the esophagus. The
appearance of the said small bud branches into the right and left lung buds during the
28th day of gestation. The beginning of primitive lobar bronchi development marks
between the 30th and 32nd day, in which there are two (2) bronchi on the left lung bud
and three (3) bronchi on the right lung bud. This is where we can differentiate bronchial
smooth muscle from connective tissue and cartilaginous plates.
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PSEUDOGLANDULAR PERIOD
After the 5th week, the presence of all segments and subsegmental bronchi are
efficiently visible. By the 16th week, the results of further branching of the subsegmental
bronchi are detectable. Ciliated columnar epithelial cells and a primitive basement
membrane appear in the conducting airways by the 10th week as well as the appearance
of goblet cells in the trachea and large bronchi. A sudden burst of bronchial branching
occurs between the 10th and 14th weeks. With the estimates of 75 percent, the
conducting airways are noted to form during this period.
Cartilage starts to appear in the lobar bronchi at 11 weeks of gestation, and the
cartilaginous airway formation continues to form until 24 weeks of gestation. The
appearance of bronchial mucous glands starts by the 12th week, and it is noted that
immature smooth-muscle cells are also present in the pulmonary arteries. It is observed
that there is a formation of new bronchial glands until the 25th and 26th week of gestation
as the tracheobronchial tree develops. 20 generations of bronchial airways have formed
by the end of the 16th week.
CANALICULAR PERIOD
The changes that occur between the 17th week and 24th week of gestation are
during the canalicular period. The terminal bronchioles are proliferating and the
appearance of primitive respiratory bronchioles becomes evident. The lung lobes become
easily distinguishable and the lung mass becomes highly vascularized. It is observed that
the lymphatic vessels begin to appear at the 20th week of gestation.
TERMINAL SAC PERIOD
The acinus (respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli)
develops along with the components that first emerged during the canalicular stage. At
this point, the type I and type II alveolar cells are visible, and pulmonary surfactant starts
25
to develop. There is an unclear definition of the air-blood interface between the alveoli
and the pulmonary capillaries, despite the fact that pulmonary capillaries start to develop
during the 24th week. During the 26th and 28th weeks of gestation, the air-blood interface
and the amount of pulmonary surfactant start to be adequate to support life. The
respiratory acini are fully established by the 34th week and in the final weeks of gestation,
the conducting airways’ smooth muscle fibers start to emerge. After birth, these muscles
continue to develop.
Placenta
At the time of implantation, the placenta begins to develop. After conception, the
fertilized egg moves down the uterine tube, wherein implantation in the uterus wall begins.
The placenta delivers maternal oxygen and nutrients to the fetus and transports waste
products out of the fetal circulation. The placenta consists of 15 to 20 cotyledons, which
are composed of fetal vessels, chorionic villi, and intervillous spaces. The interface
between maternal and fetal circulation is supplied by these cotyledons.
The two umbilical arteries carry deoxygenated blood from the fetus to the placenta.
The said two umbilical arteries are wrapped around the umbilical vein. The normal PO2
in the umbilical cord is 20 torr and the PCO2 is 50 torr.
The umbilical arteries divide once inside the placenta and deliver blood to each
cotyledon. The umbilical arteries move into the cotyledon to branch into the fetal vessels
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which loop around the internal portion of the fingerlike projections of the chorionic villi.
The intervillous space surrounds the chorionic villi externally.
Maternal blood enters the intervillous space through the spiral arterioles from the
uterine arteries. These spiral arterioles continue to spurt oxygenated blood and nutrients
around the chorionic villi. There is a decrease in maternal PCO2 due to alveolar
hyperventilation that is present as the growing infant restricts the diaphragmatic excursion
of the mother.
Oxygen and nutrients in the maternal blood move through the tissues of the
chorionic villi once they are in the intervillous space, and then enter the fetal blood. There
is a transfer of oxygen from the maternal to fetal blood because of (1) maternal-fetal PO2
gradient, (2) higher hemoglobin concentration in the fetal blood compared with the
maternal blood, and (3) greater affinity of fetal hemoglobin (Hb F) for oxygen that with
adult hemoglobin (Hb A). Carbon dioxide and other waste products move out of the fetal
blood and enter the maternal blood while maternal oxygen and nutrients move into the
fetal blood.
Fetal blood that is oxygenated, flows out of the chorionic villi through the fetal
vessels, then returns to the fetus by the umbilical vein. The following are believed to be
the causes of the large discrepancy between the maternal and fetal PO2 and PCO2:
• The placenta is an actively metabolizing organ.
• The permeability of the placenta varies from region to region with respect to
respiratory gases.
• There are fetal and maternal vascular shunts. The arteriovenous pressure gradient
causes the fetal waste products in the maternal circulation to exit the intervillous
gap. The spiral arteries have a pressure of around 75 mm Hg, while the venous
orifices next to them have a pressure of about 8 mm Hg.
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Fetal Circulation
The one that carries oxygenated blood and nutrients from the placenta to the fetus
is the umbilical vein. The umbilical vein enters the fetus’ navel and goes up anteriorly to
the liver. One-half of the blood launches into the liver and the remaining blood flows via
the ductus venosus and then enters the inferior vena cava. Through this, it can result in
oxygenated fetal blood mixing with deoxygenated blood from the lower parts of the fetal
body. After that, the freshly combined fetal blood ascends to the inferior vena cava and
enters the right atrium, wherein deoxygenated blood mixes with the newly mixed fetal
blood again from the superior vena cava. The foramen ovale allows the majority of the
blood to pass directly from the right atrium into the left atrium. The fetal blood and a tiny
amount of deoxygenated blood from the pulmonary veins mix once more in the left atrium.
The blood is subsequently pushed largely to the heart and brain after entering the left
ventricle.
The remaining blood in the right atrium is pushed into the pulmonary artery by the
right ventricle. The ductus arteriosus allows the majority of the blood to leave the
pulmonary artery and travel directly to the aorta without passing through the lungs.
28
About 15 percent of the blood passes through the lungs and then returns to the left
atrium via the pulmonary veins. The PaO2 in the descending aorta is about 20 torr. The
external and internal ilia are formed by the branching of the common iliac arteries. The
blood present in the internal iliac branch enters the umbilical arteries and flows back to
the placenta again, to get oxygen and to drop off waste products.
Once the lungs, renal, digestive, and liver functions are well-developed after birth,
the special structures of the fetal circulation are no longer essential. The following are the
changes in the special structures that occurred after birth:
• The placenta is expelled by the mother
• The umbilical arteries atrophy changes to lateral umbilical ligaments
• The umbilical vein becomes ligamentum teres, a round ligament of the
liver.
• The ductus venosus becomes ligamentum venosum, a fibrous cord in the
liver.
• The flap on the foramen ovale usually closes, due to increased left atrium
blood pressure and becomes the fossa ovalis, a depression in the
interatrial septum.
• The ductus arteriosus atrophies become the ligamentum arteriosum.
Fetal Lung Fluids
According to estimates, the functional residual capacity of a newborn is roughly

equivalent to the amount of liquid that partially inflates the lungs during delivery. The fluid
is originally from the alveolar cells during fetal development. The following are the
mechanisms of the removal of birth fluid from the lungs during the first 24 hours of life:
• As the baby passes through the birth canal, around one-third of the fluid is forced
out of the lungs.
• The pulmonary capillaries absorbed about one-third of the fluid.
• About one-third of the fluid is removed by the lymphatic system.
29
The Pulmonary Vascular System
This specific system delivers blood to and from the lungs for the process of gas
exchange. It also supplies nutritional substances to structures distal to terminal
bronchioles.
ARTERIES
The one that pumps deoxygenated blood into the pulmonary artery is the right
ventricle. The pulmonary artery divides into the right and left branches, which then
penetrate their respective lung through the hilum. The hilum is a part of the lung that
serves as the entrance for the main stem bronchi, vessels, and nerves. There are three
layers of tissue in the walls of pulmonary arteries. Tunica intima is considered to be the
inner layer and is composed of endothelium and a thin layer of connective and elastic
tissue. The middle layer is tunica media, which consists of elastic connective tissue in
large arteries, and for the medium to small-sized arteries, it consists of smooth muscle.
The said middle layer is noted to be the thickest among the three layers. Lastly, tunica
adventitia is the outermost layer that is composed of connective tissue and has small
vessels to nourish all three layers. With the help of these layers, arteries are suitable for
30
carrying blood; especially under high pressures in the systemic system, which make these
arteries become stiff.
ARTERIOLES
The endothelial layer comprises the walls of the pulmonary arterioles, which is an
elastic layer and a layer of smooth-muscle fibers. The pulmonary arterioles provide
nutrients to the respiratory bronchioles, alveolar ducts, and alveoli. These arterioles
impart a big help in the regulation of the blood, with the support of their smooth-muscle
fibers. These arterioles are called the resistance vessels.
CAPILLARIES
These capillaries are composed of an endothelial layer, a single layer of squamous

epithelial cells and are an important extension of the inner lining of the larger vessels. The
endothelium of the said pulmonary capillary has a selective permeability to other
substances, namely, water, electrolytes, and sugars. In terms of measurements, the walls
of capillaries are less than 10 μm in thickness, and the external diameter of each vessel
is 10 μm. This is where the gas exchange happens.
Aside from having an important role in the exchanging of gas, pulmonary
capillaries also have a role in the production and destruction of active substances. These
pulmonary capillaries can destroy serotonin, norepinephrine, and some prostaglandins.
They also produce and synthesize some prostaglandins.
31
VENULES AND VEINS
From the pulmonary capillaries, the blood enters the pulmonary venules which are
tiny veins continuous with capillaries. After entering the venules, it empties into the veins
that carry blood back to the heart. These veins also have three layers of tissue in their
walls, similar to the arteries.
The difference between arteries and veins is both their middle layer. The middle
layer of the veins is undeveloped. With this, veins have thinner walls compared to arteries
and contain less smooth muscle and elastic tissue.
For the veins, there are only two layers that lack a layer that is comparable to the tunica
adventitia of the arteries. These veins have the ability to collect large amounts of blood
with only minimal changes in pressure. With this, veins are called capacitance vessels
and they take a more direct route out of the lungs. Veins in the lungs combine into two
large veins and exit through the lung hilum. The four primary veins then empty into the
left atrium of the heart.
32
The Lymphatic System
Lymphatic vessels can be found around the lungs. The removal of extra fluid and
protein molecules that leak from the pulmonary capillaries is the primary duty of the
lymphatic vessels. The lymphatic veins emerge from the interstitium, a loose region deep
within the lungs. To reach the lung's hilum, the vessels travel over the bronchial airways,
pulmonary arteries, and veins. One-way valves are located in the lymphatic channels that
direct fluid toward the hilum. The Autonomic Nervous System regulates the larger
lymphatic channels that are enclosed by smooth-muscle bands, which always produce
peristaltic movements. Lymphatic fluid is moved toward the hilum by both smooth-muscle
contractions and the typical, cyclic pressure changes created in the thoracic cavity. The
end line of the vessel, which is located just inside and outside of the lung parenchyma, is
located in the pulmonary and bronchopulmonary lymph nodes.
The Respiratory System

The nose, throat, larynx, trachea, bronchi, and their smaller branches, as well as
the lungs, which house the alveoli, are among the respiratory system's organs. The
respiratory system's only externally visible component is the nose. Most of the respiratory
system's organs aid in air distribution, but the actual gas exchange is only carried out by
the tiny, grape-shaped alveoli and the alveolar ducts.
33
BPD harms both the existing and developing alveoli in the lungs. The tiniest blood
arteries that surround the alveoli may also be impacted, complicating the flow of blood
through the lungs.
Lower Airway
Trachea
It is commonly called the windpipe and is the main airway to the lungs. It divides
into the right and left bronchi at the level of the fifth thoracic vertebra, channeling air to
the right or left lung.
Bronchi and Subdivisions
Bronchi are the large tubes that connect to your trachea (windpipe) and direct the
air to the right and left lungs. Bronchi is the plural form of bronchus. The left bronchus
carries air to the left lung. The right bronchus carries air to the right lung. Your bronchi
34
are an essential part of your respiratory system. As you breathe and the lungs expand,
the bronchi distribute the air within the lung.
Lungs
The lungs are two air-filled, spongy organs that are situated on either side of the
chest (thorax). Inhaled air is carried into the lungs by the trachea (windpipe) through the
bronchi, which are tubular branches of the trachea. The bronchi subsequently split into
bronchioles, which are ultimately tiny branches.
Alveoli
Tiny air sacs at the end of the bronchioles (tiny branches of air tubes in the lungs).
The alveoli are where the lungs and the blood exchange oxygen and carbon dioxide
during the process of breathing in and breathing out. Oxygen breathed in from the air
passes through the alveoli and into the blood and travels to the tissues throughout the
body. Carbon dioxide travels in the blood from the body's tissues and passes through the
alveoli to be breathed out.
35
PATHOPHYSIOLOGY
Predisposing Factors
Factors Present/Absent Rationale
Young Present Prematurity can cause a newborn's lungs not to

Gestational develop normally while the baby is growing in the
Age womb. Babies who are premature have fragile lungs
that can be easily irritated or inflamed after birth thus
susceptible to BPD.
Sex Present Male neonates are at higher rates in developing

bronchopulmonary dysplasia as the lung function in
males both in the neonatal period and at 1 year of age
was noted to be worse when compared with females.
White blood cell infiltration is also significantly
increased in hyperoxia-exposed male neonates
causing immediate lung injury.
Precipitating Factors
Factors Present/Absent Rationale
Prolonged Present The lungs of a premature baby are not yet fully
Ventilator- developed and oxygen is induced so that the infant
Induced can breathe more easily, yet this can cause multiple
Injury problems such as BPD because giving oxygen under
pressure such as through a mechanical ventilator can
sometimes hurt the air sacs in the lungs and can scar
them, thus BPD.
36
O2 Toxicity Present Premature infants who receive extra oxygen are
more likely to develop a chronic lung condition
marked by dysregulated inflammation and altered
protease and growth factor expression. Fibrosis,
asymmetric aeration, and respiratory insufficiency
may result from this. Additionally, oxygen causes
abnormal physiological reactions that can harm
premature infants. An early response to oxygen in the
retina, for instance, is vasoconstriction, which can
result in neovascularization, vaso obliteration, and
retinal traction.
Maternal Present Smoking during pregnancy can cause tissue damage

Smoking in the unborn baby, particularly in the lung and brain.
Nicotine appears to be the responsible component of
tobacco smoke that affects lung development, and
some of the effects of maternal smoking on lung
development.
37
Diagram
38
39
Narrative
Bronchopulmonary dysplasia is a chronic respiratory disease that most frequently
occurs in low-weight or premature infants who have obtained supplemental oxygen or
have spent prolonged periods of time on a breathing machine such as infants who have
acute respiratory distress syndrome. BPD can also happen in older babies with abnormal
lung development, some babies with antenatal infections, and some babies with placental
abnormalities.
Most often, this disorder appears after a premature baby has been given extra
oxygen or has used a breathing apparatus. When a baby is born too soon, his lungs have
not fully developed, necessitating the need for oxygen. The patient is born premature and
requires mechanical ventilation due the difficulty of breathing. Oxygen-dependent
supplementation can lead to immense pressure on underdeveloped lungs, thus,
Bronchopulmonary Dysplasia.
Bronchopulmonary dysplasia starts with the presence of alveolar hyaline

membranes in the lung tissue with also patches of atelectasis and lymphatic dilation can
be also seen in the tissue, this abnormality will lead to surfactant deficiency that will result
in an alveolar surface deficiency. After 4-10 days after the premature birth of the patient,
atelectasis is more extensive and metaplasia of the lung tissue cells which is the
transformation of cells from one form and another, bronchial necrosis and alveolar
hyperinflation. This will also lead to the increase of pro-inflammatory cytokines which
promotes inflation. After this process alveolar hyperinflation occurs with the destruction
of bronchioles and necrosis and fibrosis to the lungs of the baby that leads to bronchiolitis.
With this lung destruction of bronchial airways, alveoli and pulmonary capillaries occurring
this will also lead to impaired pulmonary gas exchange and the thickening of the intima
of pulmonary arterioles and pulmonary hypertension.
Patients with bronchopulmonary dysplasia exhibit rapid and shortness of breath,

periods of apnea, wheezing, cyanosis, retractions and nasal flaring The patient presents
as cyanotic with nasal flaring, distended abdomen, and bowel sounds are also present,
40
the tell-tale signs of bronchopulmonary dysplasia. The patient can be diagnosed with the
help of a chest X-ray, CBC, ABG, and High-Resolution Computed Tomography.
Bronchopulmonary dysplasia can be mild, moderate and severe, and it is

reversible yet it may take some time, especially with children, they might have difficulty
breathing in a year or two but eventually can be cured from the disease. Medications such
as Albuterol, furosemide and Dexamethasone can be of help in managing the patient’s
disease. We can also help the patient by implementing a nutritional diet and letting their
lungs grow and develop. Home oxygenation may also be provided if the patient has been
successfully discharged for home care. Successful treatment of BPD reduces the
patient’s risks for further respiratory infection, damaged alveoli, bronchospasm, and
respiratory failure. In cases where this neonatal disease is not treated well, further
inflammation may occur resulting in increased work of breathing and more lung
complications including apnea and infections. Respiratory failure may occur and most
likely will result in death.
41
DIAGNOSTICS
Chest X-ray
A chest x-ray is the most common way of diagnosing a patient with respiratory
distress symptoms, it is a safe non-invasive test that produces an image of the chest and
the internal organs. An X-ray is a type of imaging test that employs very little radiation to
create images of the body's organs, tissues, and bones. It can aid in identifying anomalies
or disorders of the blood vessels, bones, heart, and lungs when directed toward the chest.
Chest X-rays can also reveal if your lungs are encircled by fluid, air, or both. With
bronchopulmonary dysplasia, it will show haziness and hyperinflation of the lungs due to
the inflammation.
Findings: There was evidence of coarsened interstitial patterns and hyperinflation.

Diffuse haziness, streaky densities, and scattered small abnormal lucencies are
observed. There are signs of mild cardiomegaly.
Arterial Blood Gas
ABG tests analyze the quantities of carbon dioxide and oxygen in your blood. It
also tests the pH level of your body, which is typically balanced when you're healthy.
According to Roberts (2015), arterial Blood Gas measures the amounts of oxygen
and carbon dioxide in your blood using a sample taken from an artery in your body. The
pH balance, also referred to as the acid-base balance, of your blood is also examined
during the test.
42
The amount of oxygen and carbon dioxide in your blood is typically tightly regulated
by your body because low blood oxygen levels (hypoxemia) can cause a number of
serious conditions and harm specific organ systems, particularly your brain and heart.
Particularly in emergency situations, arterial blood gas tests can assist medical
professionals in interpreting conditions that affect your respiratory system, circulatory
system, and metabolic processes (how your body turns the food you eat into energy).
Arterial blood gas tests in patients with bronchopulmonary dysplasia may reveal
acidosis, hypercarbia, and hypoxia, and with increased oxygen.
Date: August 30, 2022 (5:15 PM)
ABG Element Result Normal Range
pH 7.20 7.34 –7.42
PaCO2 62 mmHg 32 – 41 mmHg
PaO2 40 mmHg 62 – 92 mmHg
Temp 34.8°C 35.5 °C – 36.5°C (Axillary)
BE (B) -8 mmol/L -6 – -2 mmol/L
HCO3 21 meq/L 19 – 23 meq/L
SaO2 92% 90 – 95%
Interpretation: Uncompensated Respiratory Acidosis with Corrected Hypoxemia
High-Resolution Computed Tomography
A non-invasive diagnostic imaging process called a computed tomography scan (CT

or CAT scan) creates cross-sectional images of the body in both the horizontal and
vertical planes. These images are frequently referred to as slices. They can then be
43
printed or examined on a computer monitor as cross-sectional images of the area being
researched.
Compared to standard X-rays, CT scans provide more precise images of every

area of the body, including the bones, muscles, fat, and organs. When compared to
standard X-ray exams, CT scans of internal organs, bone, soft tissue, and blood arteries
are clearer and offer more information. Radiation exposure is also minimized during CT
scans. To make the organs or tissues more visible, a dye may be ingested or injected into
a vein.
Findings: Hyperaeration and parenchymal lesions in all segments seen on the

scan. HRCT scans at the level of carina (B) and liver dome (C)
Complete Blood Count
A typical blood test that is frequently included in a routine checkup is a complete

blood count. Complete blood counts can be used to identify a number of conditions, such
as infections, anemia, immune system diseases, and blood cancers.
A small needle will be used by a medical professional to draw blood from a vein in
your arm and a small amount of blood will be collected into a test tube or vial after the
needle has been inserted. The needle may sting slightly as it enters or exits your body.
Usually, this only needs a few minutes.
44
Date: August 30, 2022 (5:24 PM)
Results Indication Reference Range

(Infants)
RBC 4.40 — 4.0 – 5.0 x10^6/uL
Hemoglobin 118 — 101 – 121 g/L
Hematocrit 0.37 — 0.31 – 0.38
WBC 16.78 (High) ↑ 6.0 – 13.5 x10^3/uL
Neutrophils 79 — 50 – 70%
Lymphocytes 64 — 20 – 60%
Monocytes 15 — 3 – 12%
Eosinophils 5 — 0.5 – 5%
Basophils 1 — 0 – 1%
Platelet count 305 — 206 – 459 x10^3/uL
Interpretation: Patient’s complete blood count results show elevated white blood cells
indicating an occurrence of possible infection. Platelet count is normal. The red blood
cells, hemoglobin, and hematocrit levels are within normal range
45
Mechanical Ventilation Set-Up Computation
46
47
DRUG STUDY
Generic Name: Albuterol
Brand Name: Salbutamol, Ventolin

Drug Classification: Beta-2
adrenergic agonist
Mode of Action: Albuterol acts on
beta-2 adrenergic receptors to relax
the bronchial smooth muscle. It also
inhibits the release of immediate
hypersensitivity mediators from
cells, especially mast cells. Although albuterol also affects beta-1 adrenergic receptors,
this is minimal and has little effect on the heart rate.
Dosage:
• Adults and children older than 12 years of age—2.5 milligrams (mg) in the
nebulizer 3 or 4 times per day as needed.
• Children 2 to 12 years of age—0.63 to 1.25 mg in the nebulizer 3 or 4 times per
day as needed.
• Neonates — 1 ml or 1 mg in the nebulizer, sometimes combined with 1cc plain
normal saline solution
Indication/s:
• Relief and prevention of bronchospasm in patients with reversible obstructive

airway disease
• Inhalation: Treatment of acute attacks of bronchospasm
• Prevention of exercise-induced bronchospasm
• Unlabeled use: Adjunct in treating serious hyperkalemia in dialysis patients; seems
to lower potassium concentrations when inhaled by patients on hemodialysis
48
Contraindications:
• Contraindicated with hypersensitivity to albuterol, tachyarrhythmias, tachycardia

caused by digitalis intoxication; general anesthesia with halogenated
hydrocarbons or cyclopropane (these sensitize the myocardium to
catecholamines); unstable vasomotor system disorders; hypertension; coronary
insufficiency, CAD; history of CVA; COPD patients with degenerative heart
disease.
• Use cautiously with diabetes mellitus (large IV doses can aggravate diabetes and
ketoacidosis); hyperthyroidism; history of seizure disorders; psychoneurotic
individuals; labor and delivery (oral use has delayed second stage of labor;
parenteral use of beta2-adrenergic agonists can accelerate fetal heart beat and
cause hypoglycemia, hypokalemia, pulmonary edema in the mother and
hypoglycemia in the neonate); lactation; the elderly (more sensitive to CNS
effects).
Side Effects:
• fast or irregular heart rate
• chest pain
• shakiness
• nervousness
• headache
• nausea
• vomiting
• dizziness
• sore throat
• runny nose
49
Adverse Effects:
• CNS: Restlessness, apprehension, anxiety, fear, CNS stimulation, hyperkinesia,

insomnia, tremor, drowsiness, irritability, weakness, vertigo, headache
• Cardiovascular: Cardiac arrhythmias, tachycardia, palpitations, PVCs (rare),
anginal pain
• Dermatologic: Sweating, pallor, flushing
• Gastrointestinal: Nausea, vomiting, heartburn, unusual or bad taste in mouth
• Genitourinary: Increased incidence of leiomyomas of uterus when given in higher
than human doses in preclinical studies
• Respiratory: Respiratory difficulties, pulmonary edema, coughing, bronchospasm,
paradoxical airway resistance with repeated, excessive use of inhalation
preparations
Drug Interaction:
• Albuterol interacts with certain drugs that can affect its mechanism of action or
increase the risk of a side effect, examples of these drugs include propranolol,
methacholine, midodrine, linezolid.
• Interaction with these drugs can result in increased blood pressure, increased risk
of cardiovascular disease, and irregular heartbeat.
RT Responsibilities:
• Use minimal doses for minimal periods; drug tolerance can occur with prolonged
use,
o Rationale: To avoid overdosing and this can help lower the risk of side
effects
• Maintain a beta-adrenergic blocker (cardioselective beta-blocker, such as atenolol,
should be used with respiratory distress) on standby in case cardiac arrhythmias
occur.
50
o Rationale: To observe proper precaution incase of complications. Always
be mindful of the patient’s allergy from certain drugs and food. Allergies can
cause interaction with the drug that can result in adverse reactions.
• Monitor patient’s respiratory rate, oxygen saturation and lungs sound before and
after administering albuterol
o Rationale: To note changes and to monitor improvements.
• Observe any changes in heart rhythm, episodes of palpitations, chest pain,
shortness of breath, fatigue, and weakness.
o Rationale: To monitor patient status and to observe the effect of the drug
on the patient.
• If the prescribed dose is more than one inhalation, allow at least 2 minutes of the
interval between inhalations.
o Rationale: To avoid drug overdose.
• Advise the patient or the guardian to always rinse the patient’s mouth after each
use since the albuterol inhaler can cause an unusual taste.
o Rationale: To avoid discomfort due to unusual taste.
• Observe patient safety, careful not to place the albuterol inhalation into the eyes.
o Rationale: Albuterol can hurt the patient’s eyes and can cause eyesight
problems if not treated.
• Keep the albuterol inhaler away from flame or sources of heat and high
temperature.
o Rationale: Exposure to extreme heat can damage the packaging of the
albuterol.
• Always remind the patient or the guardian that taking other medications must be
consulted to the physician.
o Rationale: Other medications might interact with the albuterol and will cause
adverse effects.
51
DRUG STUDY
Generic Name: Furosemide

Brand name: Lasix
Drug Classification: Loop Diuretics
Mode of Action: Furosemide promotes diuresis by
blocking tubular reabsorption of sodium and chloride in
the proximal and distal tubules, as well as in the thick
ascending loop of Henle. This diuretic effect is achieved
through the competitive inhibition of sodium-potassium-chloride cotransporters (NKCC2)
expressed along these tubules in the nephron, preventing the transport of sodium ions
from the lumenal side into the basolateral side for reabsorption. This inhibition results in
increased excretion of water along with sodium, chloride, magnesium, calcium, hydrogen,
and potassium ions. Furosemide exerts direct vasodilatory effects, which results in its
therapeutic effectiveness in the treatment of acute pulmonary edema.
Dosage form:
• PO (Children >1 mo): 2 mg/kg as a single dose; 1–2 mg/kg every 6–8 hr (maximum
dose = 6 mg/kg).
• PO (Neonates): 1–4 mg/kg/dose 1–2 times/day.
• IM IV (Children): 1–2 mg/kg/dose every 6–12 hr; Continuous infusion– 0.05
mg/kg/hr, titrate to clinical effect.
• IM IV (Neonates): 1–2 mg/kg/dose every 12–24 hr.
Indication/s:
• Treatment of choice for bronchopulmonary Dysplasia.
• Indicated for the treatment of edema associated with congestive heart failure,
cirrhosis of the liver, and renal disease, including the nephrotic syndrome, in adults
and pediatric patients.
52
Contraindication/s:
• Contraindicated in patient infants with anuria.
• Furosemide is contraindicated in patient infants with anuria,and in patients with a
history of hypersensitivity to furosemide.
• Contraindicated in patients in hepatic coma or in states of severe electrolyte
depletion until the condition is improved or corrected.
Side Effects:
• Fever
• Dizziness
• Diarrhea
• Stomach cramps
• Rashes
• Nausea
• Muscle cramps
• Rapid/irregular heartbeat
Adverse Effects:
• Gut (gastrointestinal or GI) reactions like pancreatitis, jaundice, anorexia,
cramping, diarrhea, constipation, nausea, and vomiting
• Systemic hypersensitivity reactions like severe anaphylactic shock, necrotizing
angiitis, and interstitial nephritis
• Central nervous system (CNS) reactions like vertigo, headaches, blurred vision,
tinnitus, and hearing loss.
• Blood reactions like anemia, leukopenia, thrombocytopenia, and eosinophilia
• Hypersensitive skin reactions like rash, itching, hives, photosensitivity, exfoliative
dermatitis, and Steven-Johnson syndrome
• Heart reactions and an increase in triglyceride and cholesterol levels
53
Drug interactions:
Furosemide may interact with:
• Sucralfate
• Cisplatin
• Cyclosporine
• Ethacrynic acid
• Lithium
• Methotrexate
• Phenytoin
• Antibiotics
• Heart or blood pressure medications
• Laxatives
• Salicylates such as aspirin, or steroids.
Avoid taking furosemide with the said drugs, avoid combining or taking it together to
prevent further complications and to prevent the alteration of the mechanism of action of
the drug.
• Check the physician's order.
o Rationale: This is to avoid medical errors.
• Always observe proper dosing.
o Rationale: To avoid overdosing the patient and to maximize the
effectiveness of the drug.
• Check the patient’s allergy and hypersensitivity.
o Rationale: Some patients are allergic to furosemide, always verify before
drug consumption.
• Patient’s vital signs must be properly observed.
o Rationale: Always take note of the patient’s vital signs changes to assess
the patient’s progress.
• Measure and record weight to monitor fluid changes.
54
o Rationale: Monitoring patient’s fluid changes of the patient to track
patient’s body fluid.
• Do not expose to light, may discolor tablets or solution; do not use discolored
drugs or solutions.
o Rationale: It may alter the drug compound and can possibly cause errors.
• Reduce dosage if given with other antihypertensives; readjust dosage gradually
as BP responds.
o Rationale: To avoid further complications.
55
DRUG STUDY
Generic Name: Dexamethasone

Brand Name: Decardon/DexPak
Drug Classification: Corticosteroids
Mode of action:
Dexamethasone is a potent
glucocorticoid with no mineralocorticoid
property. It exerts its action in
decreasing inflammation by suppressing
the migration of cells known as
polymorphonuclear leukocytes of PMN and reducing capillary permeability. Through this
activity, it stabilizes the cell and lysosomal membrane. Dexamethasone also stimulated
increased surfactant production in the lungs of premature infants. It also has the ability to
inhibit proinflammatory cytokines and prostaglandin synthesis.
Dosage:
In infant patients, the initial dose of dexamethasone may vary depending on the
specific disease entity being treated. The range of initial doses is 0.02 to 0.3 mg/kg/day
in three or four divided doses (0.6 to 9 mg/m²bsa/day).
Indication/s:
• Dexamethasone is used to treat many different inflammatory conditions such as
allergic disorders and skin conditions.
• Dexamethasone is also used to treat ulcerative colitis, arthritis, lupus, psoriasis,
and breathing disorders.
Contraindication/s:
• Hypersensitivity to dexamethasone or any component of the formulation.
• Systemic fungal infections.
56
Side Effect/s:
• Fever
• Nausea/Vomiting
• stomach irritation
• rapid weight gain
• sleep problems
• dry skin
• muscle pain
Adverse Effect/s:
• Cardiovascular: Bradycardia, cardiac arrhythmia, cardiomegaly, circulatory shock,
edema, embolism (fat), heart failure (in susceptible patients), hypertension,
myocardial rupture (after recent myocardial infarction), syncope, tachycardia,
thromboembolism, thrombophlebitis, vasculitis.
• Dermatologic: Acne vulgaris, allergic dermatitis, alopecia, atrophic striae,
diaphoresis, ecchymoses, erythema of skin, facial erythema, fragile skin,
hyperpigmentation, hypertrichosis, hypopigmentation, inadvertent suppression of
skin test reaction, perianal skin irritation (itching, burning, tingling; following rapid
IV injection; more common in females, with higher doses; sudden onset with
resolution in <1 minute)
• Endocrine & metabolic: Decreased serum potassium, fluid retention, growth
suppression (children), hirsutism, hypokalemic alkalosis, menstrual disease,
negative nitrogen balance (due to protein catabolism), sodium retention, weight
gain
• Nervous system: Amyotrophy, emotional lability, euphoria, headache, increased
intracranial pressure, intracranial hypertension (idiopathic; usually following
discontinuation), malaise, myasthenia, neuritis, neuropathy, paresthesia,
personality changes, seizure, vertigo.
• Respiratory: Pulmonary edema
57
Drug Interaction/s:
• Dexamethasone may interact with antibiotic, aspirin, vaccines, isoniazid,
naproxen, ibuprofen, digoxin, furosemide, bumetanide, rivaroxaban, Amphotericin
B. Interaction with these drugs may harm your body and may not process
potassium properly.
• Check and verify the doctor’s order
o Rationale: To prevent medical errors, health complications and rapid
disease progression.
• Observe rights in medication administration such as giving the right drug to the
right patient using the right route at the right time.
o Rationale: Improper use of right medication can lead to potentially harmful
medication errors, and potentially lessen the effectiveness of the therapy.
• Administer accurately because adverse reactions and tolerance might occur.
o Rationale: Appropriate administration will ensure that medicines are used
safely.
• Assess pulse for rhythm.
o Rationale: Taking the pulse allows us to find out what the patient's heart
rate is and to assess the strength, regularity, and character of the pulse.
Irregularities might indicate a heart problem and must be investigated.
• Auscultate lungs for presence of adventitious breath sounds that may signal
pulmonary edema, airway resistance or bronchospasm.
o Rationale: To confirm various medical conditions
• Assess patients for skin rash frequently during therapy.
o Rationale: skin assessment is essential for holistic care
• Place the infant patient in a position of comfort to facilitate optimum rest and sleep.
o Rationale: To make the infant calmer and more relaxed. The usual practice
is to position the newborn in supine (face‐up) position during ventilation and
sleep.
58
DRUG STUDY
Generic Name: Palivizumab

Brand name: Synagis
Drug Classification: Monoclonal antibody
Mode of Action: Palivizumab binds to the
fusion glycoprotein of RSV. This prevents its
binding and uptake by host cellular receptors.
Palivizumab exhibits neutralizing and fusion-
inhibitory activity against RSV. These
activities inhibit RSV replication or spread. It is
given to prevent the development of lower
respiratory tract disease in pediatric patients.
Dosage:
Pediatric patients 24 months of age or less:
• 15 mg/kg IM once a month during RSV season (the first dose should be
administered prior to commencement of the RSV season and the remaining doses
should be administered monthly throughout the RSV season).
Indication/s:
• Palivizumab is used to prevent serious lung disease caused by respiratory

syncytial virus in premature infants, and infants born with certain lung disorders or
heart disease.
• Palivizumab works best in children who are 24 months old or younger at the
beginning of RSV season (6 months or younger for premature infants).
• Palivizumab will not treat a child who is already sick with RSV disease.
• Recommended for infants <24 months of age who have chronic lung disease (e.g.,
bronchopulmonary dysplasia [BPD]), history of premature birth (gestational age
≤35 weeks), or hemodynamically significant congenital heart disease (CHD). May
59
reduce severity of RSV infection and reduce frequency and duration of RSV-
related hospitalizations in these high-risk infants.
Contraindication/s:
• Palivizumab should not be given to a child who has had a severe allergic reaction
to it.
Side Effects:
• Allergic reactions: hives, severe rash, itching; rapid or difficult breathing; blue-
colored lips, skin, or fingernails; muscle weakness, being hard to wake up;
swelling of the face, lips, tongue, or throat. Note: Discontinue use if allergic
reaction is experienced.
• Common side effects of palivizumab may also include fever and rash.
Adverse Effects:
• Upper respiratory tract infection
• Otitis media
• Fever
• Rhinitis
• Hernia
• Elevated serum AST concentration.
Drug Interaction:
• Synagis (palivizumab) may interact with certain medications or supplements.
Always let the doctor and pharmacist know about any other medications or
supplements (including prescribed and over-the-counter medications, vitamins,
and dietary or herbal supplements) that the patient is currently taking.
60
• Check the physician's order.
o Rationale: This is to avoid medical errors.
• Always observe proper dosing.
o Rationale: To avoid overdosing the patient and to maximize the
effectiveness of the drug.
• Check the patient’s allergy and hypersensitivity.
o Rationale: Some patients are allergic to furosemide, always verify before
drug consumption.
• Patient’s vital signs must be properly observed.
o Rationale: Always take note of the patient’s vital signs changes to assess
the patient’s progress.
• Always remind the patient or the guardian that taking other medications must be
consulted to the physician.
o Rationale: Other medications might interact with the albuterol and will cause
adverse effects.
• Keep palivizumab and all other medicines out of the reach of children.
• Rationale: This is to avoid wrong and inappropriate consumption of the
drug.
• Use this medication only for the indication prescribed.
• Rationale: To ensure patient’s safety from further complications.
• Advise patient’s guardians to contact their healthcare provider immediately for
signs or symptoms of hypersensitivity reactions.
• Rationale: This is to avoid complications and to manage the side effects and
adverse reactions.
61
RESPIRATORY CARE PLAN 1
August 30, 2022
Name: Baby A.S.G
Age: 28-day old preterm infant (25 weeks gestation)

Sex: Male
Height: 32.6 cm
Weight: 1.65 lbs (0.75 kgs)
Physician: Dr. J. R. Evangelista
Admission Date: August 30, 2022 (5:00 PM)
Admitting Diagnosis: Severe Bronchopulmonary Dysplasia
Subjective
“Patient is intubated.”
Objective
Vital Signs
Date and Time: August 30, 2022 (5:00 PM)
Blood Pressure 65/40 mmHg 39/16 mmHg – 59/36 mmHg
Heart Rate 180 bpm 120 – 160 bpm
Respiratory Rate 75 cpm 30 – 60 cpm
Oxygen Saturation 92% 90 – 95% (Neonates)
62
Motor Response 1 No response
GCS Score 3 Unresponsive
As of 5:00 PM, the patient is unresponsive. The eye, verbal, and motor responses
are all absent.
Physical Assessment
Head
Upon inspection, the shape of the infant’s head appears to be microcephalic, with
no noted deformities and lesions. The amount of hair looks normal, greyish in color, and
evenly distributed over the scalp.
Upon palpation, the hair is fine and somehow oily. No palpable mass, lumps, or
tenderness noted.
Eyes
Upon inspection, the patient’s eyebrow has evenly distributed hair, has intact skin
and is symmetrically aligned. Both brows have equal movement. The conjunctiva appears
to be dry, capillaries sometimes evident, and sclera appears anicteric. The eyeballs are
sunken. The cornea is transparent, shiny and smooth. Details of iris are visible. The iris
is black, flat and round.
63
Upon assessing the pupils for light reaction, pupils are noted to be equally round
and immediately reactive to light accommodation. Both eyes have a pupillary diameter of
2mm.
Upon palpation, lumps were not noted on both eyelids and conjunctiva is palpable.
Ears
Upon inspection the patient’s external canal is dry, has presence of hair follicles,
no pus or blood noted. Normal voice tones are audible to patients. Sound is heard on
both or localized at the center of the head.
Upon palpation, the ear is without any tenderness, lump, and mass. The pinna
recoils after being folded.
Nose
Upon inspection, the nasal septum is located midline. Nasal flaring is noted due to
use of accessory muscles in breathing. No lesions observed. A nasogastric tube is
attached on the right nostril.
Upon palpation, there was no tenderness noted. No bone and cartilage deviation
are observed.
Mouth
Upon inspection, the lips were bluish and dry. The blue coloring is caused by an
evident low amount of oxygen in blood. Gums are in excellent health. A 6.0 cm long
uncuffed endotracheal tube with 2.5 mm internal diameter is attached in the mouth.
Upon palpation, there was no inflammation and swelling noted. No gum bleeding
is indicated. The tongue is thick and lumpy white. The surface is rough and no lesions are
noted.
64
Neck
Upon inspection, the trachea is located midline. Bruises and lesions were not
noted. Use of accessory muscle specifically the sternocleidomastoid and supraclavicular
muscles were evident. No lumps were noted. Jugular vein is not distended. A CV line on
the right side of the neck is present.
Thorax and Lungs
Upon inspection, no deformity of the chest is seen. The spine is straight and in a
vertical position. No deformities and lesions noted. A single ECG lead is present on the
left side of the chest.
Upon palpation, the patient's chest is warm to touch. Chest rise is noted to be fast
and irregular due to abnormal breathing patterns.
Upon percussion, there is a presence of dullness.
Upon auscultation, crackles and occasional expiratory wheezing were noted.

Decreased air movements are also heard. Prolonged expiration at 1:3 was recorded. Air
trapping and presence of secretions were evident.
Abdomen
Upon inspection, there are no scars and lumps noted. The abdomen is distended.
Upon palpation, enlarged and tender liver were not noted. Bowel sounds are
tympanic and normoactive in all four quadrants upon auscultation.
Upon percussion, the abdomen is tympanic in all areas of the abdomen.
65
Upper Extremities
Upon inspection, there are no skin rashes observed. Signs of cyanosis are seen
on patients' hands and nails. On the right hand, a pulse oximeter is attached with a
reading of 92% Sp02. Capillary refill test is 4 seconds.
Upon palpation, no tenderness and deformity were present.
Lower Extremities
Upon inspection, the legs are thin in shape and signs of cyanosis are evident in
the nail beds. No scars and bruises were noted.
Laboratories
Arterial Blood Gas
Date: August 30, 2022 (5:15 PM)
pH 7.20 7.34 –7.42
SaO2 92% 90 – 95%
Interpretation: Uncompensated Respiratory Acidosis with Corrected Hypoxemia
66
Date: August 30, 2022 (5:24 PM)
Results Indications Reference Range

(Infants)
RBC 4.40 — 4.0 – 5.0 x10^6/uL
Hematocrit 0.37 — 0.31 – 0.38
WBC 16.78 (High) ↑ 6.0 – 13.5 x10^3/uL
indicating an occurrence of possible infection. Platelet count is normal. The red blood
cells, hemoglobin, and hematocrit levels are within normal range.
67
Diagnostic Tests
Chest X-ray
Findings: There was evidence of coarsened interstitial patterns and hyperinflation.

Diffuse haziness, streaky densities, and scattered small abnormal lucencies is observed.
There are signs of mild cardiomegaly.
Figure 01. PA Chest X-ray
Findings: Hyperaeration and parenchymal lesions in all segments seen on scan.
Figure 02. HRCT scans at level of carina (B) and liver dome (C)
68
Medications
Drug Dosage Date of Administration
Albuterol 1 mg/kg (q4) August 30, 2022
Furosemide 1–2 mg/kg/dose (q12) August 30, 2022
Dexamethasone 0.3 mg/kg (q24) August 30, 2022
Mechanical Ventilator Setup
Date: August 30, 2022 (5:00 PM)
TYPE MODE PPEAK PMEAN PIP/PEEP iTIME SEN. I:E RATIO
141 Bennett A/C 24 13 15 5 0.50 s 0.5 1.3:1
fTOT VTE VETOT FiO2 HI-PRESSURE ALARM
52 70 2.95 50% 40
Analysis
Abnormal breathing pattern related to difficulty in breathing secondary to severe
bronchopulmonary dysplasia as evidenced by the use of accessory muscles, nasal
flaring, marked upper and lower chest retractions, paradoxical respiration, rapid breathing
rate, reduced PaO2, and hypercapnia.
Planning
That within 72 hours of providing care, the patient will experience the following:
• Improvement of blood pressure from 65/40 to normal range of 39/16 to
59/36 mmHg;
69
• Improvement of heart rate from 180 bpm to normal range of 120-160 bpm;
• Improvement of respiratory rate from 75 cpm to normal range of 30-60 cpm;
• Improvement of temperature from 35.0 degrees Celsius to normal range of
35.5 degrees Celsius to 36.5 degrees Celsius;
• Improvement of arterial blood gas values;
o pH from 7.20 to normal range of 7.34-7.42
o PaCO2 from 62 mmHg to normal range of 32-41 mmHg
o PaO2 from 40 mmHg to normal range of 62-92 mmHg
o Temperature from 34.8 degrees Celsius to normal range of 35.5 to
36.5 degrees Celsius
o Base excess (B) from -8 mmol/L to normal range of -6 to -2 mmol/L
• Clearance of airway secretions;
• Improvement of breath sounds; and
• Normal breathing pattern.
Interventions
INDEPENDENT RATIONALE
INTERVENTIONS
Monitor vital signs and ventilatory To monitor baseline data.

status.
Monitor the patient’s breath Breath sounds are indicators that show whether the
sound. care is effective or if there is a worsening condition
of the patient.
Maintain adequate nutrition. To provide energy and sustain the patient all
throughout the treatment process.
Maintain fluid balance. To minimize the risks of developing cor pulmonale,

pulmonary edema, and congestive heart failure.
70
Maintain PaO2 at levels ideal to To prevent pulmonary hypertension resulting from
neonates. hypoxemia as well as oxygen toxicity
Perform chest physiotherapy and To remove excessive secretions from the airways
suctioning when indicated and improve the respiration.
Maintain adequate To prevent mucus plugging.

humidification.
DEPENDENT INTERVENTIONS RATIONALE
Hook the infant for pulse oximetry To monitor oxygen saturation status of the patient.
monitoring.
Perform arterial blood gas To continuously assess the patient's oxygen and
extraction and analysis. carbon dioxide levels in the body.
Administer oxygen therapy To provide support and improve the infant’s

oxygenation.
Administer diuretics like To reduce fluid build up in the lungs and improve
Furosemide respiratory function.
Bronchodilator Therapy To keep the infant’s airways open.
Surfactant Replacement Therapy To treat the surfactant deficiency that may have
(Survanta) cause respiratory distress to the infant
71
Evaluation
After the 8-hour shift, as evidenced by the chart below, the goal was unmet.
• Vital signs still show abnormal values.
• Crackles and wheezing remain audible during auscultation.
• Dullness during percussion is present.
• Abnormal breathing patterns still persist.
• Arterial blood gas values have not shown any improvement.
• Oxygenation remains below normal levels.
Time BP HR RR Temp SpO2 pH PaCO2 HCO3 PaO2
5 PM 65/40 180 75 35.0 92 7.20 62 21 40
7 PM 68/35 177 70 35.4 90 7.19 55 24 46
9 PM 70/30 172 72 36.2 90 7.25 60 19 39
11 PM 66/45 179 69 35.1 91 7.23 64 20 42
Recommendations
• Continue to provide medications as ordered by the physician.
o To alleviate the signs and symptoms
• Assess for the patient's response to medication.
o To assess for the efficacy of the medication and discontinue when found
ineffective.
• Regularly monitor vital signs.
o To assess whether the patient’s health condition is improving or
deteriorating.
• Continue to monitor the infant’s arterial blood gas values.
o To note whether there are changes in the oxygenation and ventilation status
of the patient.
72
• Conduct periodic suctioning of the endotracheal tube.
o To remove the retained secretions that may be present in the airway.
• Continue to monitor and assess the patient’s breathing pattern and breath sounds.
o To assess whether crackles and wheezing are still present.
• Continue to provide bronchodilator medications to the patient.
o To keep the airways open and prevent further use of accessory muscles
when breathing
• Ensure proper and optimal nutrition of the infant.
o To provide energy and promote optimal health during the treatment
process.
• Always monitor the delivered oxygen to the patient.
o Excessive levels of delivered oxygen may cause further damage of the
lungs of the neonate.
• Routinely monitor mechanical ventilator values
o To reduce the risk of further injuries secondary to Bronchopulmonary
Dysplasia.
• Regularly drain the ventilator tubings.
o To prevent the accumulation of condensates on the tubings which may pose
risks for infection on the infant.
73
September 2, 2022
Name: Baby A.S.G

Sex: Male
Height: 32.6 cm
Subjective
“Patient is still intubated.”
Objective
Vital Signs
Date and Time: September 2, 2022 (5:05 PM)
Heart rate 135 bpm 120 – 160 bpm
Respiratory rate 59 cpm 30 – 60 cpm
Temperature 36.2 °C 35.5 °C – 36.5°C (Axillary)
O2 saturation 91% 90 – 95% (Neonates)
74
Motor Response 2 Extension to pain
GCS Score 4 Comatose patient
As of 5:05 PM, the patient showed a motor response to pain. The eye and verbal
are all absent.
Physical Assessment
Head
Upon inspection, the appearance of the patient’s head is microcephalic and
symmetrical. Lesions and deformities are not seen on the patient’s head. The patient’s
hair is evenly dispersed over the scalp with greyish in color.
Upon palpation, the scalp of the patient is oily and sweaty due to the exertion of
effort to breathe. Masses, lumps, or tenderness were not noted.
Eyes
Upon inspection, the eyes are symmetrically aligned, the patient's eyebrows are
evenly distributed and are synchronous in movement. The conjunctiva of the patient is
evidently dry and the sclera is anicteric. Sunken eyeballs are noted with equal eyelids.
The patient’s cornea is transparent with no whitening or lesions present. The iris is black,
flat and round.
Upon assessing whether the pupils are responsive to light, it is visible that both
pupils constrict briskly and are equally round with a pupillary diameter of 2 mm.
75
Upon palpation, no lumps and tenderness were apparent on both eyelids.
Ears
Upon inspection, discharges from the external canal are not found. The patient’s
ears are symmetrically aligned and in normal shape with no lesions, inflammation or
deformities. The pinna is helical-shaped and both ears have normal hearing.
Upon palpation, swelling is not evident as well as tenderness and lumps. The pina
recoils after folding them.
Nose
Upon inspection, septum is located midline with a nasogastric tube attached to the
patient’s right nostril. There is no evidence of mucus discharge, nostrils are not
obstructed, and lesions are not present. The patient is still experiencing nasal flaring.
Upon palpation, no deformities are noted as well as tenderness on the patient’s

nose.
Mouth
Upon inspection, only minimal cyanosis around the mouth is noted. Lesions and
ulcerations are not found. Patient’s mouth is attached to a 6.0 cm long uncuffed
endotracheal tube with 2.5 mm internal diameter.
Upon palpation, the patient's gum is in good condition with no inflammation and
swelling present. The tongue is bumpy and thick. There are no lesions visible, and the
surface is rough.
Neck
Upon inspection, there are no presence of lesions, swelling, and bruises. The
trachea is located midline. Sternocleidomastoid and supraclavicular muscles were not
evidently seen for breathing. There is no presence of jugular vein distention and there is
a CV line on the right side of the patient’s neck.
76
Upon palpation, the trachea is located midline, there were no lymph nodes and no
indications of protruding tumors.
Thorax and Lungs
Upon inspection, there are no obvious chest deformities with straight and vertical
spine. Lesions and abnormalities were not found. On the left side of the chest, there is
only one ECG lead used to monitor the patient’s heart rhythm and electrical activity.
Upon palpation, the patient's chest feels warm with fast and erratic rising of the
chest as a result of aberrant breathing patterns.
Upon percussion, dullness is noted to be present.
Upon auscultation, crackles and sporadic wheeze during expiration were heard.
There are also audible reduced air movements with an expiration at 1:2. Air entrapment
and secretions are minimal.
Abdomen
Upon inspection, the abdomen is distended with no bumps or scars visible.
Upon palpation, no enlarged and tender liver were noted.
Upon percussion, tympanic abdomen was noted, except in areas of the liver and
bladder.
Upper Extremities
Upon inspection, no skin rashes were present. There is a presence of minimal

cyanosis on the patient’s nails and there is a pulse oximeter connected to the patient’s
right hand with a reading of 91% SpO2.
Upon palpation, the patient is warm and febrile with no presence of edema.
Masses, lesions or bruises were absent with a capillary refill test of 4 seconds.
77
Lower Extremities
Upon inspection, presence of cyanosis is now slightly evident in the nail beds.
Scars and bruises were not present.
Upon palpation, there was no tenderness and no edema observed.
Laboratories
Arterial Blood Gas
Date: September 2, 2022 (5:13 PM)
pH 7.30 7.34 –7.42
Temp 36.2 °C 35.5 °C – 36.5°C (Axillary)
SaO2 91% 90 – 95%
Interpretation: Partially Compensated Respiratory Acidosis with Corrected Hypoxemia
78

(Infants)
RBC 4.67 — 4.0 – 5.0 x10^6/uL
Hematocrit 0.35 — 0.31 – 0.38
WBC 15.23 (High) ↑ 6.0 – 13.5 x10^3/uL
which indicate possible infection. Platelet count has increased within the normal value.
The red blood cells, hemoglobin, and hematocrit levels remain within the normal range.
79
Diagnostic Tests
Chest X-ray
Findings: There are no significant changes in diffuse haziness, streaky densities,

and scattered abnormal lucencies observed. The presence of mild cardiomegaly is still
present.
Findings: No significant changes in hyperaeration from the patient and

parenchymal lesions are still evident in all segments.
Figure 02. Pulmonary hyperinflation was found in the anterior segment of right upper
lobe with parenchymal lesions in the anterior-posterior segment of both right and left
lobe (A)
80
Medications
Albuterol 1 mg/kg (q4) September 2, 2022
Furosemide 1–2 mg/kg/dose (q12) September 2, 2022
Dexamethasone 0.3 mg/kg (q24) September 2, 2022
Date: September 2, 2022 (6:25PM)
TYPE MODE PPEAK PMEAN PIP/PEEP iTIME SENS I:E RATIO
141 Bennett A/C 28 12 15 5 0.50 s 0.5 1.3:1
50 75 3.05 50% 40
Analysis
Ineffective breathing pattern related to dyspnea secondary to bronchopulmonary
dysplasia as evidenced by nasal flaring, abnormal breathing pattern, dullness upon
percussion, presence of air entrapment and secretions.
81
Planning
• Improvement of blood pressure from 60/35 to normal range of 39/16 to
59/36 mmHg;
• Improvement of arterial blood gas values:
o PaO2 from 60 mmHg to normal range of 62-92 mmHg
o Bicarbonate (HCO3) from 27 mEq/L to normal range of 19-23 mEq/L
• Clearance of airway secretions; and
• Improvement of breath sounds;
Interventions
INTERVENTIONS

status.
of the patient.


82

humidification.
monitoring.

oxygenation.
83
Evaluation
After the 8-hour shift, as evidenced by the chart below, the goal was partially met.
• The patient's vital signs show improvement on some parameters with the blood
pressure still elevated.
• Crackles and wheezing during expiration are only heard slightly during
auscultation.
• Breathing patterns have improved as well as the arterial blood gas values.
• Dullness during percussion is now minimal.
• Oxygenation has returned to normal.
5 PM 60/35 135 59 36.2 91 7.30 48 27 60
7 PM 70/40 128 54 35.1 90 7.33 45 25 64
9 PM 65/40 135 49 35.7 90 7.35 42 26 67
11 PM 75/45 130 52 36.0 93 7.34 40 20 75
Recommendations
ineffective.
deteriorating.
84
of the patient.
when breathing
process.
Dysplasia.
85
September 5, 2022
Name: Baby A.S.G

Sex: Male
Height: 32.6 cm
Subjective
“Patient is still intubated.”
Objective
Vital Signs
Date and Time: September 5, 2022 (5:15 PM)
Heart rate 128 bpm 120 – 160 bpm
Respiratory rate 60 cpm 30 – 60 cpm
O2 saturation 90% 90 – 95% (Preterm Neonates)
86
Motor Response 4 Withdrawal from pain
GCS Score 6 Comatose patient
As of 5:15 PM, the patient has still shown motor response to pain through
withdrawal. The eye and verbal responses are all absent.
Physical Assessment
Head
Upon inspection, the patient’s head appears to be small, which is considered as
microcephalic and is symmetrical. There are no lesions and deformities seen and the
patient’s hair is evenly distributed with grey color over the scalp.
Upon palpation, the patient’s scalp is dry and no palpable masses, lumps, or
tenderness were noted.
Eyes
Upon inspection, the patient’s eyes are symmetrical and the eyebrows move
synchronously with evenly distributed hair. The conjunctiva is dry and the sclera is
anicteric. Equal eyelids are noted with the presence of sunken eyelids. The transparency
of the patient’s cornea is noted without any whitening or lesions present. The iris is black,
flat and round.
87
Upon assessing for the light reaction of the patient’s pupils, it is noted that both
pupils are equally round and briskly reactive to light stimulation. Both eyes have a
pupillary diameter of 2 mm.
Upon palpation, there were no lumps and tenderness palpated.
Ears
Upon inspection, no discharges from the external canal were found. Both ears are
symmetrical, in normal shape, and without lesions or inflammation or deformities. The
pinna is helical-shaped and the left and right ears of the patient have normal hearing.
Upon palpation, swelling is not evident as well as tenderness and lumps. The pina
recoils after folding them.
Nose
Upon inspection, the location of the nasal septum is in the midline. Nasal flaring is
not present. A nasogastric tube is connected to the patient’s right nostril with no evidence
of mucus discharge. Unobstructed nostrils are noted without any lesions.
Upon palpation, no abnormalities such as deformities and tenderness are felt on

the patient’s nose.
Mouth
Upon inspection, no evidence of cyanosis around the mouth is noted. There are
no lesions or ulcerations in the patient’s mouth and a 6.0 cm long, uncuffed endotracheal
tube with a 2.5 mm internal diameter is connected to the patient's mouth.
Upon palpation, the patient’s gums are healthy and do not have any swelling or
inflammation. The tongue has thick, rough skin and no obvious lesions are observed.
88
Neck
Upon inspection, no tumors, swelling, or bruises are seen. The trachea is located
in the midline. Use of sternocleidomastoid and supraclavicular muscles were not noted
anymore. There is a CV line on the patient’s right side of the neck, but there is no evidence
of jugular vein distention.
Thorax and Lungs
Upon inspection, there are no evident chest defects upon assessment, and the
spine is upright and straight. There were no abnormalities or lesions observed. Only one
ECG lead is implanted on the left side of the chest to track the patient's heartbeat and
electrical activity.
Upon palpation, the chest of the patient feels warm and an improved breathing
pattern is noted.
Upon percussion, there is a presence of minimal dullness.
Upon auscultation, crackles and wheezing are still heard minimally. Expiratory time
has improved. Presence of secretions is still noted.
Abdomen
Upon inspection, there are no scars and lumps noted. The distention of the
abdomen has slightly improved.
Upon palpation, enlarged and tender liver were not noted.
Upon percussion, tympanic in all areas of the abdomen is noted.
89
Upper Extremities
Upon inspection, no skin rashes and cyanosis were present. The patient’s right
hand is connected to a pulse oximeter with a reading of 90% SpO2.
Upon palpation, the patient is warm and febrile without any edema present.
Masses, lesions, or bruises are not seen. The capillary refill test is 4 seconds.
Lower Extremities
Upon inspection, the legs are thin in shape and signs of cyanosis are not evident
in the nail beds with signs of improvement. No scars and bruises were noted.
Laboratories
Arterial Blood Gas
pH 7.33 7.34 –7.42
SaO2 90 % 90 – 95%
Interpretation: Partially Compensated Respiratory Acidosis with Normal Oxygenation
90

(Infants)
RBC 4.83 — 4.0 – 5.0 x10^6/uL
Hematocrit 0.35 — 0.31 – 0.38
WBC 14. 55 (High) ↑ 6.0 – 13.5 x10^3/uL
Interpretation: There are significant changes in the interpretation of the complete blood
count results. Patient’s complete blood count results still show elevated white blood cells
but is gradually returning back to normal. Platelet count is normal. The red blood cells,
hemoglobin, and hematocrit levels remain the normal range.
91
Diagnostic Tests
Chest X-ray
Findings: The chest x-ray result noted slight improvements. Hyperinflation is still
present but minimal. Significant changes in haziness, densities, and small abnormal
lucencies were observed. The case of mild cardiomegaly has also significantly changed.
92
Findings: Only minimal linear and subpleural opacities, bronchial wall thickening
and areas of low attenuation are seen in the results of HRCT in patients with BPD.
Figure 02. HRCT scan of patient with Bronchopulmonary Dysplasia (A)
Medications
Albuterol 1 mg/kg (q4) September 5, 2022
Furosemide 1–2 mg/kg/dose (q12) September 5, 2022
Dexamethasone 0.3 mg/kg (q24) September 5, 2022
93
Date: September 5, 2022 (7:15PM)
TYPE MODE PPEAK PMEAN PIP/PEEP iTIME SENS I:E RATIO
141 Bennett A/C 26 14 15 5 0.50 s 0.5 1.3:1
57 68 3.0 50% 40
Analysis
Lung tissue damage related to difficulty in respiration secondary to
bronchopulmonary dysplasia as evidenced by presence of secretions, minimal crackles
and wheezing and dullness upon percussion.
Planning
• Improvement of blood pressure from 90/40 mmHg to normal range of 39/19
to 59/36 mmHg;
• Improvement of arterial blood gas values:
o Bicarbonate (HCO3) from 25 mEq/L to normal range of 19-23 mEq/L
• Clearance of airway secretions; and
• Improvement of breath sounds;
94
Interventions
INTERVENTIONS

status.
of the patient.



humidification.
monitoring.
95
oxygenation.
Evaluation
After the 8-hour shift, as evidenced by the chart below, the goal was partially met.
• Blood pressure is still elevated.
• The rest of the vital signs already show normal values.
• Crackles and wheezing are still heard during auscultation but only minimal.
• Dullness during percussion has slightly diminished.
• Breathing patterns have slightly improved.
• Arterial blood gas values have shown improvement.
• Oxygenation is normal.
5 PM 60/40 128 60 35.6 90 7.33 40 25 40
7 PM 60/50 125 64 35.8 89 7.35 43 23 46
9 PM 50/60 132 57 36.2 91 7.38 39 22 55
11 PM 70/40 138 60 35.9 90 7.41 42 19 63
96
Recommendations
ineffective.
deteriorating.
of the patient.
when breathing
process.
Dysplasia.
97
• Begin weaning when the ventilator parameters of the infant have shown readiness
to be gradually decreased from ventilator support.
o To allow the patient to breathe independently without the assistance of a
machine
98
PULMONARY REHABILITATION
On behalf of the American Thoracic Society Assembly on Pulmonary

Rehabilitation, Holland et al. (2021) defined pulmonary rehabilitation as the cornerstone
treatment for people with chronic respiratory diseases. Pulmonary rehabilitation has also
been defined by Wouters (2019) as a comprehensive intervention based on a thorough
patient assessment followed by patient-tailored therapies designed to improve the
physical and psychological condition of patients with chronic respiratory disease and to
promote the long-term adherence to health-enhancing behaviors.
For patients with bronchopulmonary dysplasia, although there is no known

treatment for BPD, it can be managed by limiting future lung damage and giving the
baby's lungs the care, they need to develop and repair. Babies with BPS are typically
treated in a hospital setting where they can be closely watched. The following categories
of drug therapy and respiratory care treatment protocols are possible:
Drug Therapies
Diuretics: The amount of fluid in and around the alveoli is reduced with the use of
this type of medications. Typically, they are taken orally one to four times a day.
Bronchodilators: These drugs aid in relaxing the muscles that surround the
airways, which opens up the airways wider and facilitates better breathing. By placing a
mask over the baby's face and using a nebulizer or inhaler with a spacer, they are often
administered as an aerosol.
Corticosteroids: These drugs lessen and/or prevent lung inflammation. They
assist in lowering mucus production and reducing edema in the windpipe. Similar to
bronchodilators, they are typically administered as an aerosol with a mask using a
nebulizer or an inhaler with a spacer.
Viral Immunization: The risk of respiratory tract infections, particularly respiratory
syncytial virus, is higher in children with BPD (RSV). Infants with moderate or severe BPD
are given monthly injections of a drug that aids in RSV season infection prevention.
99
Cardiac Medications: In certain newborns with BPD, specialized drugs may be
necessary to relax the muscles around the blood vessels in the lung, allowing the blood
to flow more freely and lowering the heart's workload.
Respiratory Care Treatment Protocols

Oxygen Therapy: Oxygen therapy is used to treat hypoxemia, decrease the work
of breathing, and decrease myocardial work. Because of the hypoxemia that often
develops in BPD, supplemental oxygen may be required. It should be noted that
prolonged exposure to supplemental oxygen should be minimized to reduce
complications of BPD. Some physicians prefer allowing lower than normal SaO2 values
in the low-birth-weight infants.
Bronchopulmonary Hygiene Therapy Protocol: Because of the excessive
airway secretions and accumulation associated with BPD, a number of bronchial hygiene
treatment modalities may be used to enhance the mobilization of bronchial secretions.
Mechanical Ventilation Protocol: Mechanical ventilation may be necessary to
provide and support alveolar gas exchange and eventually return the patient to
spontaneous breathing.
The following should also be noted by the healthcare professionals:

• Tell the parents what medications to administer, their proper dosages, and any
potential side effects of the recommended drugs.
• Inform the family members about the benefits and disadvantages of taking the
medicine.
• Describe the prescription to the patient and their family member, the medicine
components and the possible side effects.
Exercise
The chronic disease bronchopulmonary dysplasia affects prematurely born infants with
underdeveloped lungs. After long-term oxygen use or mechanical ventilation to help them
breathe, their lungs and airways suffer damage, which results in the condition. Since
100
patients with this disease are neonates, they are not capable to perform exercises and
even usual body movements because the neonate patient is intubated and most of the
time, unconscious.
Exercise can be later on executed or carried out if the patient survives or recovers. But
there is limited information concerning the exercise performance of long-term survivors
of bronchopulmonary dysplasia. The patient’s health status will always matter before
considering the application of exercises later on after the recovery.
Treatment
There is no specific cure for bronchopulmonary dysplasia but there are treatments
and management that we can consider. These treatments aim to reduce or completely
remove the need for supplemental oxygen. The patient’s capacity to breathe on their own
and lung function both improve with treatment. Treatment includes:
• Increasing calories will boost your baby's nutrition and aid in the development of
their lungs.
• Limiting fluid intake and using diuretics to lessen the fluid in their lungs.
• Working continuously to wean your infant from oxygen as tolerated
putting a breathing tube in your baby's windpipe through surgery (tracheostomy).
Using medication to avoid infections.
Your baby's health will progressively become better over several months following
therapy. Their lungs will continue to develop and mend throughout this period in
preparation for independent breathing.
Health Teaching
Knowledge, comprehension, and preparation are all enhanced through health
teaching. Patients, as well as the guardians must be informed about the following:
• Home oxygen: Bronchopulmonary dysplasia patients are prone to hypoxia and
oxygen therapy is used as an aid and management. Home supplemental oxygen
allows infants to be discharged earlier from the neonatal unit.
101
• Medications: proper intake and administration of drugs or medicines must be
followed in order to avoid complications and adverse effects.
• Proper feeding and nutrition: babies with BPD will commonly be fed with an NG
tube (i.e. a tube inserted into the stomach) to increase calorie intake. Increased
calorie intake improves the infant’s nutrition which helps their lungs develop.
Outpatient Follow-up
Bronchopulmonary dysplasia typically causes the most issues in infancy and the
early years of childhood, with symptoms subsiding by 2 or 3 years of age and treatment
coming to an end at the latest at age 5 years. However, it's possible that the lungs don't
mature normally, which can later result in other lung issues. Because of this, it is strongly
advised that children with BPD have regular checkups, immunizations, and consultations
with a pediatric lung expert, at the very least throughout their first few years of life.
After discharge, growth may continue to be delayed. Lung issues in an infant
patient could last throughout adulthood. Many newborns with BPD go on to struggle with
reactive airway disease, asthma, and exercise intolerance throughout their lives. They
might also be more prone to infections like flu or the common cold. These viruses may
have more severe symptoms, and they may take longer to heal. Hospitalizations on a
regular basis are typical, particularly in people with moderate to severe BPD.
Diet
Since BPD patients are neonates, they are not capable of consuming foods or
certain supplements. They are instead fed through a nasogastric tube and the goal is to
increase their calorie intake in order to improve their nutrition which helps their lungs
develop.
After recovery, a proper diet should be observed to improve nutrition for better health
status. A physician or a nutritionist can contribute to this matter.
102
Spiritual
Engaging in a journey onwards spiritual growth, healthcare professionals are also
wired to assist in spiritual management. It is accepted as a justified way to alleviate
patient’s anxiety and help in keeping patient’s psychological balance.
The following may be helpful for the patient and to the family:
• Encourage the family members to ask for guidance and pray during the recovery
of the patient’s therapy.
• Encourage close ones and significant others to help and promote spiritual
wellness.
• Encourage positive reframing to a patient’s family. Finding something to be
grateful about in a challenging situation.
• Provide spiritual meetings to the family member to give hope and gratitude.
• Support patients within their own faith tradition.
103
PATIENT PROGNOSIS
Baby A.S.G is a male infant who was born prematurely at 25 weeks gestation in
Southern Philippines Medical Center on August 2, 2022 at 4:35 PM. As born prematurely,
one of the complications encountered was breathing problems and evidence of bluish
discoloration around the lips or cyanosis which indicates poor oxygen circulation in the
blood. Baby A.S.G was admitted immediately afterbirth. Oxygenation and other health
support was provided.
After 28 days of providing respiratory support, Baby A.S.G has shown significant
nasal grunting, intercostal retractions, crackles and wheezing during auscultation,
abnormal breathing pattern and an increased work of breathing. Further bluish
discoloration was also noted in the infant's lips and nail beds. Arterial blood gas samples
have shown elevated carbon dioxide levels and reduced oxygenation. To identify the
underlying cause of these signs and symptoms, a chest x-ray and high-resolution
computed tomography was conducted. Results have revealed diffuse haziness, streaky
densities, and hyperaeration. Mild cardiomegaly was also noted. All of which led to the
diagnosis of severe bronchopulmonary dysplasia due to prematurity and prolonged
exposure to high levels of oxygen and positive pressure ventilation for 28 days already.
BPD has historically been defined as the need for supplemental oxygen at 28 days in
infants born at less than 32 weeks gestation. Additionally, BPD is split into three severity
groups. BPD may result in abnormal lung development, pulmonary emphysema, and
pulmonary hypertension.
During Baby A.S.G’s hospitalization, the respiratory therapy students,
cardiopulmonary services staff, nurses and along with the physicians worked hand in
hand to establish a care plan and were able to comply with the patient’s needs. Those
are the maintenance of adequate nutrition, fluid balance, ideal PaO2 levels, and adequate
humidification, performing chest physiotherapy and suctioning, administration of oxygen
therapy at levels ideal for premature neonates, administration of diuretics, corticosteroids,
and bronchodilators. Along with these procedures are the patient monitoring of vital signs
and arterial blood gas values to identify changes or improvement. The mechanical
ventilator set-up was also monitored during rounds.
104
There were three care plans used for Baby A.S.G’s treatment and management.
The first respiratory care plan was not successful enough to bring improvements to the
patient’s health status. During the second respiratory care plan, improvements were seen
already. On the third respiratory care plan, further improvements were observed.
Oxygenation has returned to normal. Breathing patterns have slightly improved. Arterial
blood gas values are now normal. However, crackles and wheezing are still heard
minimally during auscultation. Dullness during percussion is still present. The rest of the
vital signs already show normal values except for the blood pressure which remained
elevated.
Based on the observations above, the RT student researchers have granted the
patient a good prognosis. Maintenance of ideal oxygen levels and ventilator parameters
have been observed. Medications were regularly given and the patient is tolerating the
treatment. Adequate humidification, nutrition, and fluid balance are well provided. All of
which shall be provided until the infant is 38 weeks postmenstrual age and independent
enough to live without the support of machines in order to breathe normally. Successful
treatment of BPD has been observed in the patient, thereby, reducing the risks for further
respiratory infection, damaged alveoli, bronchospasm, and respiratory failure. Weaning
may be initiated as soon as the infant’s status has qualified in the criteria for gradually
decreasing the ventilator support.
Respiratory Therapist Management

The following dependent and independent functions must be observed to help
improve the patient’s overall health and lung function:
• Physical Assessment. Monitor the patient’s vital signs and lung function. Monitor
for signs of abnormal breathing patterns and breath sounds, dyspnea, nasal
flaring, intercostal retractions, and labored breathing.
• Assist and monitor effects of treatment. Check for the patient's tolerance to the
medicine administered via nebulizer. Monitor patient’s oxygen levels and
hemodynamic support.
105
• Monitor mechanical ventilator set-up and wean if indicated. Regularly assess
for changes in ventilator parameters and check if the values qualify for gradual
decrease in ventilator support.
• Assess for clinical manifestations. Check for signs and symptoms that may
arise if the patient's health status is improving or deteriorating.
• Continue to assist the patient until fully recovered. Maintain adequate fluid
balance and optimal nutrition. Regularly clear the patient’s airway from sections by
suctioning and chest physiotherapy if tolerated. Maintain adequate humidification
to prevent further damage to the developing lungs.
• Educate the family members for home care of the infant once discharged.
Prior to discharge, the mother shall be trained on respiratory and nursing
procedures for home care so improvement of the infant’s condition will continue
outside of the hospital.
106
REFERENCES
American Lung Association (2020). Treating and managing bronchopulmonary dysplasia.
Retrieved on September 01, 2022 at www.lung.org website: https://www.lung.org/lung-
health-diseases/lung-disease-lookup/bronchopulmonary-dysplasia/treating-and-
managing.
Balest, A.L. (2021, July 13). Bronchopulmonary dysplasia (BPD). MSD Manual Professional
Edition; MSD Manuals. Retrieved on September 01, 2022 at
https://www.msdmanuals.com/professional/pediatrics/respiratory-problems-in-
neonates/bronchopulmonary-dysplasia-bpd.
Cleveland clinic. (2021, October 1). Diuretics: Types, uses and side effects. Retrieved on
September 06, 2022 at https://www.healthline.com/health/diuretics
Cleveland clinic. (2022, April 11). Bronchopulmonary dysplasia: symptoms, causes & treatment.
Retrieved on September 02, 2022 at
https://my.clevelandclinic.org/health/diseases/22675-bronchopulmonary-dysplasia.
Drugs.com (2022). Palivizumab. Retrieved on September 04, 2022 at

https://www.drugs.com/monograph/palivizumab.html
Hu, J., & Robinson, J. L. (2010). Treatment of respiratory syncytial virus with palivizumab: a
systematic review. World Journal of Pediatrics, 6(4), 296–300. Retrieved on September
04, 2022 at https://doi.org/10.1007/s12519-010-0230-z.
Kacmarek, R. M., Stoller, J. K., Heuer, A. J., Chatburn, R. L., & Kallet, R. H. (2019). Egan's
fundamentals of respiratory care. Elsevier. 12th edition.
KidsHealth. (2020, April). Bronchopulmonary dysplasia (BPD). Retrieved on September 01,

2022 at https://www.kidshealth.org/en/parents/bpd.html
107
Medcrine (2020, October 20). Dexamethasone: uses, dosage, mechanism of action and side
effects. Retrieved on September 02, 2022 at https://medcrine.com/dexamethasone/.
Merck manuals consumer version (2021, July) Bronchopulmonary dysplasia (BPD) - children’s
health issues. Retrieved on September 5, 2022, from
https://www.merckmanuals.com/home/children-s-health-issues/lung-and-breathing-
problems-in-newborns/bronchopulmonary-dysplasia-bpd.
National Heart, Lung, and Blood Institute (2022, March 24 ). Bronchopulmonary dysplasia
(BPD). Retrieved on September 01, 2022 at
https://www.nhlbi.nih.gov/health/bronchopulmonary-dysplasia.
Patient Worthy Website (2020, April 20). Bronchopulmonary dysplasia. Retrieved from Retrieved
on September 02, 2022 at https://patientworthy.com/bronchopulmonary-dysplasia/.
Jacob, S.V., Lands. L.C., Coates, A. L., Davis, G.M., MacNeish, C.F., Hornby, L., Riley, S.P., &
Outerbridge, E. W. (2022, July). Exercise ability in survivors of severe bronchopulmonary
dysplasia. American Journal of Respiratory and Critical Care Medicine, 155(6), 1925-
1929. https://doi.org/10.1164/ajrccm.155.6.9196097
RNpedia (2022). Furosemide nursing considerations & management. Retrieved on September

04, 2022 at https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-
notes/furosemide/.
Ellis, M.E. (2019). What to Know About Diuretics. Healthline; Healthline Media.
https://www.healthline.com/health/diuretics
Htun, Z. T., Schulz, E. V., Desai, R. K., Marasch, J. L., McPherson, C. C., Mastrandrea, L. D.,
Jobe, A. H., & Ryan, R. M. (2021). Postnatal steroid management in preterm infants with
evolving bronchopulmonary dysplasia. Journal of Perinatology: Official Journal of the
California Perinatal Association, 41(8), 1783–1796. https://doi.org/10.1038/s41372-021-
01083-w
108
Lingappan, K., Jiang, W., Wang, L., Moorthy, B. (2017). Sex-specific differences in neonatal
hyperoxic lung injury. [Internet]. Retrieved last 10 September 2022 from
https://journals.physiology.org/doi/full/10.1152/ajplung.00047.2016#B68.
Li, R., & Zhang, J. (2018, March). Diagnostic value of chest CT combined with x-ray for
premature infants with bronchopulmonary dysplasia. Medicine, 97(9), e9723.
https://doi.org/10.1097//MD.0000000000009723
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CASE-PRESENTATION-Bronchopulmonary Dysplasia

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CASE-PRESENTATION-Bronchopulmonary Dysplasia

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A Case Study on

Bronchopulmonary Dysplasia (BDP)

In Partial Fulfillment of the Requirements in

PEDIATRIC INTENSIVE RESPIRATORY

I. COVER PAGE ……………………………………………………………………… i

The most common adverse outcome of very preterm delivery is bronchopulmonary

Bronchopulmonary dysplasia symptoms can be the same as those caused by RDS

Name : Patient A.S.G

Age : 28 days old

Weight : 1.65 lbs (0.75 kg)

Birth date : August 2, 2022 (4:35 PM)

Birth delivery : Premature delivery (25 weeks gestation)

Place of Birth : Davao City

Religion : Roman Catholic

Date of Admission : August 30, 2022

Time of Admission : 5:00 PM

Manner of Admission : Inpatient

Hospital : Southern Philippines Medical Center

Attending Physician : Dr. M.J. Buenvenida

Chief Complaint : Bluish discoloration around the lips; tachypnea

Admitting Diagnosis : Severe Bronchopulmonary Dysplasia

Past Medical History

Present Health History

Date and Time: August 30, 2022 (5:00 PM)

Vital Sign Results Normal Values

Blood pressure 65/40 mmHg 39/16 mmHg – 59/36 mmHg

Heart Rate 180 bpm 120 – 160 bpm

Respiratory Rate 75 cpm 30 – 60 cpm

Temperature 35.0°C 35.5 °C – 36.5°C (Axillary)

Oxygen Saturation 92% 90 – 95% (Preterm Neonates)

Response Point Scale

Eye Response 1 No response

Verbal Response 1 No response

Motor Response 1 No response

GCS Score 3 Unresponsive

APGAR Scoring System

Assessed Sign Score Scale

Activity (Muscle Tone) 0 Absent

Pulse 2 >100 beats/min

Grimace (Reflex Irritability) 0 Flaccid

Appearance (Skin Color) 0 Blue, Pale

APGAR Score 3 Severely Depressed

Sign Score Scale

Upper Chest Retraction 2 See-saw

Lower Chest Retraction 2 Marked

Xiphoid retraction 1 Just visible

Chin Movement 2 Lips apart

Expiratory Grunt 1 Audible with Stethoscope

Silverman Score 8 Impending Respiratory Failure

Thorax and Lungs

Upon percussion, there is a presence of dullness.

Upon auscultation, crackles and occasional expiratory wheezing were noted.

Upon percussion, the abdomen is tympanic in all areas of the abdomen.

Upon palpation, no tenderness and deformity were present.

Upon palpation, no tenderness and edema were noted.

Erik Erikson’s Stages of Psychosocial Development

(Infancy from birth to 18 months)

CRISIS OUTCOME RATIONALE

Robert Havighurst’s Developmental Task

TASK MET/UNMET RATIONALE

Achieving UNMET At this stage, babies can

Establishing UNMET At this stage, children begin to define themselves

Developing UNMET At this stage, the person develops an integrated

Establishing a UNMET At this stage, the person obtains an occupation