Question

You are assessing Bianca, an 11-month-old girl, in the Pediatric Clinic today. Bianca requires continuous oxygen via nasal prongs at 0.5 L/min. Her mother understands Bianca has a chronic lung disease. She has tried to wean the baby from the oxygen during the nighttime, but Bianca’s O2 saturation will drop to 90% and her respiratory rate will increase. The baby was born at 27 weeks gestation, weighed 960 g at birth and was ventilated for the first 14 days of life. She has been on continuous oxygen since birth.

* There is a student nurse observing today. Outside the exam room, she asks you if Bianca has asthma. How will you respond? Provide rationales for your response. Include the pathophysiology of Bianca’s disease.

* Considering the lung disease Bianca has, what would you be concerned about as she gets older?

*Following hospital discharge, what services and resources might Bianca and her family need? Are there any future psychological or developmental needs that should be considered for Bianca, her parents or siblings?

Answer 1

1. I will tell her that the child is suffering of chronic lung disease which is different from asthma. Chronic lung disease has developed because of use of ventilator when he was prematurely born and was not able to breath.chronic lung disease involve scaring of lung tissue not inflammatory bronchoconstriction which is common in asthma.

Pathophysiology

hypoxemia, mechanical ventilation, leads to lung injury that attracts macrophages and neutrophils . There is increased proinflammatory cytokines and altered growth factor production that in turn results in surfactant dysfunction, failure of alveogenesis, elastin deposition in lung tissue . This results in increased airway and vascular resistance causing sign and symptoms of bronchopulmonary dysplasia.

2. as she will grow older, there are chances of her getting respiratory infections frequently. She may have developmental delay as compared to kids of her age. She may encounter problem in feeding.

3. She may need oxygen therapy whenever required. They may need breathing machines at home. She may need frequent hospital visits.yes she may have different developmental needs and parents will have to give extra care to Bianca. She may have slow growth so provision of high calorie food should be made. She may have vision or other system diseases for which adequate provisions may be required to make so as to carry out activities of daily living.