Hyaline Membrane Disease - A Case Study

March 27, 2018 | Author: Mohammed BIen Manamba | Category: Respiratory Tract, Lung, Respiration, Anatomy, Respiratory System


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INTRODUCTIONAbout 1 in 20,000-30,000 newborn US infants will have RDS. Not all, but the vast majority are the result of HMD. Approximately half of neonates born at gestation age of 26-28 weeks will develop RDS, while about 30% of 30-31 gestation week neonates will develop it. Although prematurity is the primary risk factor, there are several other risk factors including maternal diabetes, cesarean section, asphyxia, rapid labor, and complications that reduce blood flow to the fetus . Internationally, RDS occurs less frequently than in the US but overall, it is more common in white premature infants (UChicago, 2013). RDS almost always occurs in newborns born before 37 weeks of gestation. The more premature the baby is, the greater is the chance of developing RDS. RDS is more likely to occur in newborns of diabetic mothers. Rapid, labored, grunting respirations usually develop immediately or within a few hours after delivery, with retractions above and below the breastbone and flaring of the nostrils and the extent of atelectasis (lung collapse) and the severity of respiratory failure progressively worse. Not all infants with RDS have signs of respiratory distress; extremely low birth weight newborns (i.e., < 1000 g) may be unable to initiate respirations at birth because their lungs are so stiff; they may fail to initiate breathing in the delivery room. The incidence of RDS can be reduced by assessment of fetal lung maturity to determine the optimal time for delivery. When a fetus must be delivered prematurely, giving betamethasone systemically to the mother for at least 24 hours before delivery induces fetal surfactant production and usually reduces the risk of RDS or decreases its severity. If untreated, severe RDS can result in multiple organ failure and death. However, if the newborn's ventilation is adequately supported, surfactant 1 | Page production will begin and RDS will resolve by 4 or 5 days. Recovery is hastened by treatment with pulmonary surfactant (Medicine, 2012) The incidence is estimated at 6 per 1000 births. Respiratory distress presents in the first few hours of life in a premature baby. Symptoms include tachypnoea, expiratory grunting, nasal flaring. The infant may or may not be cyanosed. Substernal and intercostal retractions may be evident. Risk factors include maternal diabetes, greater prematurity, prenatal asphyxia and multiple gestation. Associated abnormalities are those that can occur in prematurity: intracranial haemorrhage, necrotising enterocolitis, patent ductus arteriosus, delayed developmental milestones, hypothermia and hypoglycaemia (Agrawal, & Knipe, et. Al 2014). RDS occurs in more than half of babies born before 28 weeks gestation, but only in less than one-third of those born between 32 and 36 weeks. Some premature babies develop RDS severe enough to need a mechanical ventilator (breathing machine). The more premature the baby is, the higher the risk and the more severe the RDS (LVH, 2014). Respiratory distress syndrome (RDS) of the newborn is an acute lung disease caused by surfactant deficiency, which leads to alveolar collapse and noncompliant lungs. Previously known as hyaline membrane disease, this condition is primarily seen in premature infants younger than 32 weeks’ gestation. The radiographic features of RDS are seen in the images below. A normal film at 6 hours of life excludes the diagnosis of RDS. Classic respiratory distress syndrome (RDS) is a bell-shaped thorax is due to generalized under aeration. Lung volume is reduced, the lung parenchyma has a fine granular pattern, and peripherally extending air bronchograms are present. Moderately severe respiratory distress syndrome (RDS) is a reticulogranular pattern is more prominent and uniformly distributed than usual. The lungs are hypoaerated. Increased air bronchograms are observed. 2 | Page Severe respiratory distress syndrome (RDS) is a Reticulogranular opacities are present throughout both lungs, with prominent air bronchograms and total obscuration of the cardiac silhouette. Cystic areas in the right lung may represent dilated alveoli or early pulmonary interstitial emphysema (PIE). The incidence and severity of RDS are inversely related to gestational age. RDS is the most common cause of respiratory failure during the first days after birth. In addition to prematurity, other factors contributing to the development of RDS are maternal diabetes, cesarean delivery without preceding labor being the second born of twins, perinatal asphyxia, perinatal infection, and patent ductus arteriosus. Complications of RDS are numerous, both acute and chronic. Infants with RDS are at risk of developing alveolar rupture and pulmonary interstitial emphysema, infection, intracranial hemorrhage, chronic lung disease (bronchopulmonary dysplasia), retinopathy of prematurity, impairment, and sudden death (Do, P., Lin, EC. et. al.2014). 3 | Page neurologic Through the study. It will also educate the people especially with those endometriosis and vulnerable individuals to seek medical care in order to prevent such disease. This will serve as an instrument to gain more knowledge that will help the patient to become aware about the proper management and care for endometriosis. The patient can also alleviate her condition through complying with the recommendations suggested by the researchers. 4 | Page . we were able to identify cues related to the precipitating factors and predisposing factors of the disease. The hospital institutions can also benefit with this case study for it provides information about hyaline membrane disease (also known as respiratory disease syndrome) in newborn. how the complication started and how it affects the physiologic aspect of the patient’s body. The case study could also provide the institution with the ideal medications and interventions or management. The case study is also essential for us nursing students for it provides information about the concerned disease and supplies the lacking knowledge of the students. in which we were able to give nursing diagnosis based on our understanding.Significance of the Study The significance of the study is to learn deeper regarding the case of the patient. They could also use this as references for it provides thorough assessment findings that may be associated when experiencing endometriosis. Case Objectives General Objective: This study aims to determine what is hyaline membrane disease specifically in the newborn. Conduct a physical examination from head to toe. 6) Trace the pathophysiology of the disease 7) Enumerate and conduct a drug study on drugs administered to the patient with its pharmacological uses and effects as well as nursing responsibilities to be observe in relation to the patient’s condition. 9) Discuss the prognosis about the case with its justification. DEFINITION OF DIAGNOSIS 5 | Page . Specific Objectives: 1) Discuss the introduction of the disease including its incidence and 2) 3) 4) 5) prevalence rate of HMD Conduct review of the systems. 8) Formulate effective nursing care plans. Define the what HMD all about Discuss the anatomical parts of affected area and explain functions of each part. These lipoproteins function to decrease surface tension at the air-liquid interface of the lung and also play a role in host defense against infection and inflammation thus leaking an exudate that forms the hyaline membrane from which the name of the disease is derived (UChicago. hypoxemia and hypercarbia that in turn lead to respiratory acidosis (UChicago. Acidosis causes vasoconstriction that impairs the endothelial and epithelial integrity in the lungs. 2013). Consequences include ventilation-perfusion mismatch. expiratory grunting.Hyaline membrane disease (HMD). whether or not a baby has a patent ductus arteriosus (a heart condition). It can cause babies to need extra oxygen and help breathing. 2013). The course of illness with hyaline membrane disease depends on the size and gestational age of the baby. Hyaline membrane disease (HMD) is a life threatening pulmonary disease primarily of the premature infant caused by surfactant deficiency and resulting in respiratory distress syndrome (RDS) (UChicago. The infant may or may 6 | Page . the severity of the disease. the presence of infection. Pulmonary surfactant is a complex lipoprotein composed of phospholipids and apoproteins synthesized by alveolar type 2 epithelial cells and airway Clara cells. is one of the most common problems of premature babies. more commonly called respiratory distress syndrome (RDS). or surfactant deficiency refers to lung pathology which results from insufficient production of surfactant. Impairment in the synthesis and/or secretion of surfactant leads to an increase in dead space due to atelectasis and a decrease in lung compliance. RDS typically worsens over the first 48 to 72 hours before improving with treatment (LVH. Symptoms include tachypnoea. and whether or not the baby needs mechanical help to breathe. Respiratory distress presents in the first few hours of life in a premature baby. 2014).lung disease of prematurity. nasal flaring. 2013). Hyaline membrane disease also known as neonatal respiratory distress syndrome. in which a membrane composed of proteins and dead cells lines the alveoli (the tiny air sacs in the lung). it remains a principal clinical problem (ICNHSF. however. HEALTH HISTORY Biographical Data 7 | Page . retractions. et. The word "hyaline" comes from the Greek word "hyalos" meaning "glass or transparent stone such as crystal. making gas exchange difficult or impossible. The clinical diagnosis is made in preterm infants with respiratory difficulty that includes tachypnea. 2012).not be cyanosed. al 2014). is the commonest respiratory disorder in preterm infants. It is caused by a deficiency of a molecule called surfactant (Medicinet. Respiratory disease syndrome (RDS). also known as hyaline membrane disease. grunting respirations." The membrane in hyaline membrane disease looks glassy. nasal flaring and need for INCREASE FIO2. Hyaline membrane is now commonly called respiratory distress syndrome (RDS). Substernal and intercostal retractions may be evident (Agrawal & Knipe. especially the premature infant. 2004). In the last three decades. introduction of antenatal steroids and exogenous surfactant has greatly improved outcomes in RDS. Hyaline membrane disease: A respiratory disease of the newborn. Current Health Status 8 | Page . 2014 Place of Birth: Cotabato Provincial Hospital. Amas Kidapawan City Classification: Phil Health NICU Admission: December 9. 2014 Chief Complain: Fetal Distress Admitting Diagnosis: Hyaline Membrane Disease of Newborn Reason for Seeking Healthcare The mother was admitted at the hospital last December 9. Dangao-an Magpet.Name: Bb. She delivered her baby (the patient) as Normal spontaneous vaginal delivery (NSVD). the health care practitioners decided that the baby must be admitted for further management and evaluation of the case. Due to fetal distress of the baby after he was born. Boy L Sex: Male Marital Status: Single Age: Newborn Occupation: N/A Present address: Crossing Kamatis. 2014 due to labor pain. North Cotabato Date of Birth: December 09. Amas Kidapawan City Religion: Born Again Citizenship: Filipino Tribe: Illonggo Health Insurance: Phil Health Hospital: Cotabato Provincial Hospital. She was going to the gravel area where her husband is working. She told me that she was exposed from heat of the sunlight. the baby was delivered via normal spontaneous vaginal delivery. married and has a living child. Her mother is a farmer. fetal distress occurs. The mother was occasionally smoking but not drinking. he has no past health history but the mother has. Past Health History Since the patient was a newborn. G 1P1A0.Prior to admission. Sometimes the mother was going outside with her friends and having fun. After which. 9 | Page . Gynecological History The mother is a 19 year old. 19 y. rheumatoid arthritis Pt’s Father. alcoholic .o. Asthmatic Kuya 1. 28 y.Family History Grandfath er. 21 y. well and alive Grandmother. well and alive Grandfath er. 57 y. 58 y. 34 y. 58 y. well and alive Patient.o. well and alive . Osteoporo sis Sister 1. rheumatoid arthritis Kuya.o.o. 54 y. 32 y. 25 y.o.o.o. well and Sister. newborn. cough Pt’s Mother.o.o. diagnosed of having Hyaline Membrane Disease 10 | P a g e Grandmother.o. has an endotracheal tube attached to him with mechanical ventilator. According to the mother. There was no mass on head. chest circumference of 27 cm. When the patient called.Review of Systems General Survey The patient was manifesting difficulty of breathing. He has no signs of cyanosis. Respiratory System When the watchers asked about the patients breathing pattern. there were cheesy like substances (vernix caseosa) on his neck. There were no exudates on the nose. he turns to side but can’t vocalize. his hair was equally distributed and his nails were already long. His skin was dry but warmth to touch with uneven skin tone and has a reddish color on his cheek. they answered that sometimes they observe fast chest pumping and sometimes 10 | P a g e . neck and no signs of any injuries or fractures. has no lesion. the baby has symmetrical head and eyes with no eye exudates. positive blood secretion after pressing the ambobag. His head and extremities were flexed with a head circumference of 36 cm. a height of 44 cm and a rectal temperature of 36.8 C (manifest that his rectum is patent). abdominal circumference of 23 cm. Integumentary System No lesion was noted when the researcher conducted physical assessment but was noted a cleft lip like shape that is maybe due to the ET tube that was connected to the patient. skin is intact. HEENT The patient was still a newborn. weight of 1.5 kg. His respiratory rate was 86 cycles per minute with nasal flaring and has an irregular heart beat that were playing at a minimum of 87 beats per minute and a maximum of 146 beats per minute. But an increase of WBC on the lab results indicates that there are infection present but the leukocytes of the patient is fighting it. There was no infection occurs yet as evidenced by the latest temperature of 36. The mother told the researcher that she didn’t noticed any tremors or unusual movements of the baby but she was worried because the baby did not suck yet. Infections The patient was still a newborn. According to the vital sign. Cardiovascular System When the mother was asked about the activity of her baby. Musculoskeletal The patient was still a newborn. Neurological The patient was still a newborn. she replied “usahay active. He has already positive in almost all reflexes normally found in newborn. she didn’t observed any bluish discoloration in the child.slow. his RR was 86 cycles per minute and it indicates tachypnea since the normal range of respiratory rate in newborn was 30 – 60 cycles per minute only. 11 | P a g e . Gastrointestinal The mother told the researcher that the patient poops once but not eating nor drinking yet. Genitourinary The patient was already urinates and consumed 1 diaper only.8 C with no other signs of infection. usahay dili” (sometimes active but sometimes he isn’t). Relationship When the mother asked about what she feels about the baby. she replied that they are happy because there were new gift they have had received from god but lonely because of the situation of their baby. 12 | P a g e . Her mother was smoking occasionally but not drinking alcoholic beverages. Occupational Health Patterns 13 | P a g e . Personal Habits The patient was still a newborn. Recreation and Hobbies The patient was still a newborn. His mother claimed that she is undergone a complete prenatal check-up in the hospital. His mother was waking up early in the morning at around 5:00 am. Her mother was walking everyday usually early in the morning.PSYCHOSOCIAL PROFILE Health Practices and Beliefs The patient was still a newborn. Sleep/ Rest Pattern The patient was still a newborn. Activity and Exercise Pattern The patient was still a newborn. Typical Day The patient was still a newborn. His mother was eating nutritious food 3 times a day with 2 – 3 times of her snacks. Nutritional Pattern The patient was still a newborn. But they still observe sanitation. 14 | P a g e . Her mother was a vendor and sometimes exposed to dust and sun for her husband is working at sand and gravel and construction. she answered that if its god’s will then it will happen. Family Roles and Relationships He has a very supportive family. When her mother asked about religious influences. Cultural/ Religious Influences The patient was still a newborn. His mother didn’t left him alone.The patient was still a newborn. Environmental Health Patterns Their environment can be described as not free with chemicals because they are surrounded by farms. 146 beats per minute (bpm) Anthropometric Measurement Head Circumference – 36 cm Chest Circumference – 27 cm Abdominal Circumference – 23 cm Weight – 1. 2014 at 2:00 pm Temperature – 36. He has an ET Tube connected to mechanical ventilator on his mouth.PHYSICAL ASSESSMENT Date Assessed: December 09.86 cycle per minute (cpm) Pulse Rate (PR) .8°C Respiratory Rate (RR) .5 kg Height – 44 cm 15 | P a g e . Vital Signs December 09. 2014 General Survey Baby Boy L was asleep with an ongoing IVF of D10W + Ca infusing well at right metacarpal vein. His skin was dry but warmth to touch with uneven skin tone and has a reddish color on his cheek. His eyes are edematous maybe due to vaginal delivery was occur. his hair was equally distributed and his nails were already long. Mucous membrane were pink and moist. there were cheesy like substances (vernix caseosa) on his neck. His nares were patent with a small amount of white to colorless discharges. His pinna ere flexible. He has positive tonic reflex. there was a diamond shape like that the researcher was observed and a triangular shape like on the posterior portion. He has no signs of cyanosis. Assessing the Chest His chest when palpated has no lesion or masses noted. 16 | P a g e . with minimal saliva and crying so loud but interrupted sometimes. without deformity and aligns with the external canthus of the eyes. frenulum of tongue and lip were intact but wasn’t a good sucker. He has soft face with symmetrical facial movements.Head-to-Toe Scan Assessing the Integumentary Systems No lesion was noted when the researcher conducted physical assessment but was noted a cleft lip like shape that is maybe due to the ET tube that was connected to the patient. He has anteroposterior:lateral chest with equal chest excursion but increases rapidly due to difficulty of breathing. eyes were equal and symmetrical. Assessing the HEENT When his anterior fontanels was gently palpated. His urethral opening is at the tip of penis. startle reflex. 5 counts on the left hand.5 counts on the right hands and 5 counts each on both feet. C curve of spine with no dumpling. plantar grasp reflex. the researcher noted that muscles are symmetrical and with equal muscle tone and arms and leg are symmetrical in size and movement. 17 | P a g e . and babinski reflex. equal gluteal folds. Assessing the Neurological When checked with reflex test. palmar grasp reflexes. has full range of motion with no clicks heard. tonic neck reflex. When the prepuce was retracted the baby cries. When arms and legs are extended. warm to touch with no lesions noted. He has positive bowel sound. knee reflex. Assessing the Rectum The patient’s anus is patent with meconium stool and positive anal reflex. Assessing the Male Genitalia The patient already urinates. the patient are positive with moro reflex. His liver edge is palpable 2 – 3 cm and also the tip of the spleen and kidneys. scrotum is edematous and has palpable testes.Assessing the Abdomen His abdomen is round in shape. Assessing the Musculoskeletal The patients toes and fingers are complete as counted. He was experiencing difficulty of breathing.37 – 0.47 Justification High white blood cell count is an increase in disease-fighting cells (leukocytes) circulating in your blood. no available source of fluids)  Low availability of oxygen (smoking. Basic Test Result WBC 14. Laboratory and Diagnostic Result A. Cough reflex is absent and bronchial and bronchovesicular breath sounds were audible. Low count of hemoglobin indicates a reduction in either the number of size of RBC’s. HEMATOLOGY Date: 12 – 09 – 14 Table No. High white blood cell count is also called leukocytosis.FOCUSED ASSESSMENT Assessing the Respiratory System His respiratory rate is 86 cycles per minute and it was above the normal range.40 – 0. there is a scattered crackles heard on the chest.9 HGB 203 HCT 0. high altitude. pulmonary fibrosis)  Genetic 18 | P a g e (congenital heart . it may implies that patient has anemia. Upon auscultation.54 F: 0. A high hematocrit means the percentage of red blood cells in a person's blood is above the upper limits of normal and it can cause:  Dehydration (heat exhaustion.607 Reference Values 5-10 x 10 g/L M: 140 160g/L F: 120 140g/L M: 0. A hematologic result presents risk for infection due to increase of a white blood cell that is the primary indicator of infection in the body.047 0. Summary of Pertinent Findings Baby boy L.04 – 0.35  Cor pulmonale (COPD. 19 | P a g e .39 0. a newborn baby was admitted at the hospital due to difficulty of breathing and was diagnosed of having a Hyaline membrane disease.16 Lymphocyte 0. Normal Elevated lymphocyte indicates that the body has experienced an invasion of foreign cells. chronic sleep apnea. pulmonary embolisms) (Davis.diseases)  Erythrocytosis (overproduction of red blood cells by the bone marrow orpolycythemia vera) Monocytes 0.25 – 0. 2014). Diminished blood flow through the lungs of the fetus is a result of the partial closing of the arterioles in the lungs. blood passing through the lungs cannot pick up oxygen to deliver throughout the body. At the time of birth. however. Fetus Since the oxygen supplied to the fetus comes from the placenta. blood flow through the lungs is markedly diminished compared to that which is required following birth. several changes need to take place for the lungs to take over the vital function of supplying the body with oxygen. This results in the majority of blood flow diverted away from the lungs through the ductus arteriosus.Anatomy and Physiology of the Respiratory System During intrauterine life. the lungs serve no ventilatory purpose because the placenta supplies the fetus with oxygen. The alveoli (air sacs) of the fetus are filled instead with fluid that has been produced by the lungs. Thus. Since the fetal lungs are fluid filled and do not contain oxygen. the lungs contain no air. 20 | P a g e . Birth At birth. the infant can develop problems in two areas: • Fluid may remain in the alveoli. In fact. 21 | P a g e . In an attempt to establish normal respirations. several changes occur whereby the lungs take over the lifelong function of supplying the body with oxygen. the alveoli are filled with “fetal lung fluid. Fetal Lung Fluid At birth.” It takes a considerable amount of pressure in the lungs to overcome the fluid forces and open the alveoli for the first time. as the infant takes the first few breaths. • Blood flow to the lungs may not increase as desired. the first several breaths may require two to three times the pressure required for succeeding breaths. Mouth (oral cavity). Air sacs (alveoli) The lungs take in oxygen. Airways (bronchi). a waste product of the cells. 22 | P a g e . Airways (bronchi and bronchioles). Lungs The upper respiratory tract includes the Nose. how quickly fluid leaves the lungs depends on the effectiveness of the first few breaths. They also get rid of carbon dioxide. The remaining fluid passes through the alveoli into the lymphatic tissues surrounding the lungs. Lungs.Approximately one-third of fetal lung fluid is removed during vaginal delivery as the chest is squeezed and lung fluid exits through the nose and mouth. which the body's cells need to live and carry out their normal functions. The lower respiratory tract includes the Voice box (larynx). Fortunately. Nasal cavity and Sinuses. Windpipe (trachea). The respiratory system is made up of the organs involved in the interchanges of gases and consists of the Nose. Voice box (larynx). the first few breaths of most newborn infants are generally effective. expanding the alveoli and replacing the lung fluid with air. Windpipe (trachea). Throat (pharynx). The right lung has 3 lobes.The lungs are a pair of cone-shaped organs made up of spongy. or the thorax (the part of the body between the base of the neck and diaphragm). Surfactant is normally released into the lung tissues where it helps lower surface tension in the airways. most babies have developed enough surfactant. When you breathe. The left lung has 2 lobes. Bronchioles end in tiny air sacs called alveoli Breathing in babies. By about 35 weeks gestation. This helps keep the lung alveoli (air sacs) open. 23 | P a g e . They are enveloped in a membrane called the pleura. The lungs are separated from each other by the mediastinum. Premature babies may not have enough surfactant in their lungs and may have difficulty breathing. Esophagus. Windpipe (trachea). In the lungs. An important part of lung development in babies is the production of surfactant. This is a substance made by the cells in the small airways and consists of phospholipids and protein. Thymus gland and Lymph nodes. They take up most of the space in the chest. an area that contains the following Heart and its large vessels. the mainstem bronchi divide into smaller bronchi Then into even smaller tubes called bronchioles. pinkish-gray tissue. the air: Enters the body through the nose or the mouth then Travels down the throat through the voice box (larynx) and windpipe Goes into the lungs through tubes called mainstem bronchi: One mainstem bronchus leads to the right lung and one to the left lung. other factors in preterm infants that increase the risk of atelectasis are decreased alveolar radius and weak chest wall. Leakage of proteins into the alveolar space further exacerbates surfactant deficiency by causing surfactant inactivation. the lungs appear congested. anaerobic metabolism and subsequent lactic acidosis. With atelectasis. Other factors. Hypoxemia and acidosis may further impair oxygenation by causing pulmonary vasoconstriction. atelectatic and solid. An eosinophilic membrane composed of a fibrinous matrix of materials from the blood and cellular debris (the hyaline membrane) lines the visible airspaces that usually constitute dilated terminal bronchioles and alveolar ducts 24 | P a g e .PATHOPHYSIOLOGY The primary cause of RDS is inadequate pulmonary surfactant. Microscopically. The structurally immature and surfactant-deficient lung has decrease compliance and a tendency to atelectasis. diffuse alveolar atelectasis and pulmonary edema are seen. may initiate release of inflammatory cytokines and chemokines causing more endothelial and epithelial cell injury. Macroscopically. resulting in right-to-left shunting at the levels of the foramen ovale and ductus arteriosus. Severe hypoxemia and systemic hypoperfusion result in decreased O2 delivery. such as baro/volutrauma and high FIO2. The injury results in reduced surfactant synthesis and function as well as increased endothelial permeability leading to pulmonary edema. well perfused but poorly ventilated areas of lung lead to V/Q mismatch (with intra-pulmonary shunting) and alveolar hypoventilation with resultant hypoxemia and hypercarbia. Diagram of Pathophysiology 25 | P a g e . 26 | P a g e . ur 0 and 1 g inary doses) tract. and arrange sensitivity tests before and during therapy if expected response is not seen. anorexia. renal dysfunction. Name: Classificat ion: Antibiotic.  Genit ourina ry Pyuria.bone IM:17 to 39 and mcg/mL(50 joints:treat 0 and 1 g ment of doses) gynecologi cal infection:tr eatment of intraabdominal infections: treatment of septicemia and CNS CONTRA INDICATION  Hypersen sitivity to cephalosp horin SIDE EFFECTS  ADVERSE REACTIONS  GI Nausea. administer these drugs separately. flatulence. including pseudomembra nous colitis. Cephalospo rin 10 | P a g e DOSE/ ROUTE Actual: 150 mg ivtt INDICATION  Treatment of infection of lower desired: respiratory IV : 45 to tract. dysuria. diarrhea. abdominal pain or cramps. reversible NURSING RESPONSIBILITIES  ☻ Assess for liver and renal dysfunction ☻ Culture infection.Drug Study DRUG MECHANISM NAME OF ACTION Generic  Inhibits Name: mucopeptide Ceftazidime synthesis in bacterial cell Brand wall. ☻ Powder and reconstituted solution darken with storage. Warning: ☻ Do not mix with aminoglycoside solutions. vomiting. K available in case hypoprothrombinemi a occurs ☻ Discontinue if hypersensitivity occurs ☻ Teach SO that . ☻ Have Vit. skin 90 and skin mcg/mL(50 structure. colitis. hemorrhage. difficulty breathing. pain at injection site. anemia. lymphocytosis. leukocytosis. thrombocytope nia. neutropenia. patients may experience upset stomach or diarrhea but must report severe diarrhea.infections including meningitis caused by susceptible strains and specific microorgan isms: concomita nt antibiotic therapy.  Hema tologi c Eosinophilia. . 11 | P a g e interstitial nephritis. decreased platelet function. thrombocytosis. hematuria. toxic nephropathy. fatigue. aplastic anemia. candidal overgrowth. including StevensJohnson syndrome.Hepatic Hepatic function impairment. cholestatic jaundice. erythema multiforme. Miscellaneo us Hypersensitivity . serum 12 | P a g e . abnormal LFT results. toxic epidermal necrolysis. phlebitis. polyarthritis. thrombophlebiti s.sickness–like reactions (eg. skin rashes. and pain at injection site.  cc 13 | P a g e . arthralgia. fever). 10 | P a g e . will be able to maintain airway patency. . span of my care the pt. ti kulban pud ko bai” Objectives:  Increased and sometimes decreased fast chest expansion  Respiratory rate of 86 cycles per minute 10 | P a g e NSG. DIAGNOSIS Ineffective Airway Clearance related to decreased lung expansion due to fluid accumulatio n as evidenced by changes of repiratory rate PLAN At the end of 8 hr.  Rapid onset of acute dyspnea may reflect pulmonary embolus. respirations maybe shallow and rapid with prolonged expiration compared to inspiration. NSG. INTERVENTION  Assess and monitor Respiratory rate  Note for the degree of dyspnea.Nursing Care Plan ASSESSMENT NEED Date:12 – 09 – 14 Time: 04:30 pm Activity – Exercis e Pattern Subjective: “Usahay paspas muginhawa. anxiety and respiratory distress) RATIONALE  Tachypnea is usually present. (restlessness .  To reduce potential infection..  To assess causative or contributing factors about infection. span of my care the pt.  Includes teaching about ways to reduce potential for 11 | P a g e RATIONALE . INTERVENTION  Observe for localized signs of infection at surgical infections. NEED NSG. DIAGNOSIS Activity Impaired – Gas Exercise Exchange Pattern PLAN At the end of 8 hr.  To limit exposures and reduce contamination  To reduce bacterial colonization.ASSESSMENT Date:12 – 09 – 14 Time: 4:30 pm Subjective: “Ara man sing makina nga nakabutang sa iyang ba’ba tisahay mabal-an ko nga lisod siya kaginhawa” Objectives:  Episodes of dyspnea  In ability to move scretions. will be able demonstrat e improved ventilation and adequate oxygenatio n of tissues by ABG’s within client’s normal range and be free from any signs of respiratory distress.  Premature discontinuation of treatment when clients feel well may result in return of infection and potentiation of drug resistantstrains.  Change surgical wound dressing daily.  Emphasize necessity of taking antibiotics as directed. NSG.  Stress proper hygiene.  To reduce potential infection.  Premature discontinuation of treatment when clients feel well may result in return of infection and potentiation of drug resistantstrains.  Change surgical wound dressing daily. will be able to recognize pt’s watcher need for and seek assistance to prevent complicatio n. ASSESSMENT Date: 12 – 09 .  Emphasize necessity of taking antibiotics as directed. INTERVENTION  Observe for localized signs of infection at surgical infections.  Stress proper hygiene. 12 | P a g e .  To limit exposures and reduce contamination  To reduce bacterial colonization.  Redness and swelling on the sight NEED Health percepti on – health manage ment pattern NSG.14 Time: 4:30 pm Subjective: “may ara sang tubo nga gikabit sa akong bata” Objectives:  ET Tube attached to the mouth of the baby.post operative infection. span of my care the pt. RATIONALE  To assess causative or contributing factors about infection. DIAGNOSIS Risk for trauma / Suffocation Scientific basis: Invasive procedures may increased risk for trauma PLAN At the end of 8 hr. NSG.  Includes teaching about ways to reduce potential for post operative infection. 13 | P a g e . Damage to other organs such as the brain may also occur which is due to a combination of factors including hypoxia and intraventricular hemorrhage. 10 | P a g e .Prognosis Typically. 2013). The goal is to support the infant while the lungs begin producing surfactant. Many infants with HMD suffer the complications of oxygen and ventilation therapy but recover within the first couple of years of life as the lung tissue is replaced with new and functional tissue. so it is imperative to begin therapy early and monitor organ damage (UChicago. Providing adequate nutritional requirements is also important for recovery and growth. the symptoms worsen a few days after birth but slowly improve afterwards. CP.htm 11 | P a g e . “Hematocrit Blood Test” . 2014. Knipe. R. H. Al 2014 Hyaline membrane disease” http://radiopaedia.org /articles/hyaline-membrane-disease Davis. http://www.com/ hematocrit_blood_test/page5_em.emedicinehealth. et.Bibliography Agrawal. ucsfbenioffchildrens.asp?articlekey=10677 Uchicago. P.com /script/main/art.org/symptoms/high-white-blood-cellcount/basics/definition/sym-20050611 Medicinet.edu/page/hyaline-membrane-diseasehmd 12 | P a g e . “Hyaline Membrane Disease Imaging “. Lehigh Valley Hospital. Hyaline membrane disease” http://www.lvhn.Do.com/article/409409-overview ICNHF. https://pedclerk.org /pdf/manuals/25_RDS. 2012. 2013.mayoclinic..medicinenet. http://www. http://www. EC. Lin. “Hyaline Membrane Disease”. http://emedicine. High white blood cells”.medscape. et.bsd. http://www. al.org/conditions_treatments/childrens_care/newborn_issu es/hyaline_membrane_disease_respiratory_distress_syndrome/learn_a bout_hyaline_membrane_disease/treatment Mayoclinic. 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