Question

Written Assignment 1 Case Study - Clinical Scenario Charlotte is a 2 month old infant, she weighs 5kg and was born at 38 weeks gestation. Charlotte presented to the emergency department with a three day history of cold-like symptoms, including fever, runny nose and a cough. Charlotte's mother became concerned this evening when Charlotte developed difficulty breathing. History and family setting Charlotte was born via elective caesarean section at 38 weeks gestation with a birth weight of 3000gm. She was alert and vigorous at birth and required no resuscitation. Charlotte's father is a heavy smoker although he states he is trying to cut down. Charlotte's family is Vietnamese, and her mother and father appear to have a good command of English. Feeding Charlotte's mother has been experiencing some difficultly breast feeding Charlotte over the past few weeks, she has been providing Charlotte with a mixture of expressed breast milk (EBM) and formula. Charlotte's mother reports she swapped to the bottle feeds as was not sure if she was breast feeding Charlotte 'right', but that she was feeding well with this combination up until she became unwell three days ago when she started to refuse all feeds. She has only taken 100mls of formula in the past 18 hours. Current Status On examination, Charlotte has moderate subcostal and intercostal recession and some nasal flaring. She has an audible wheeze on expiration and scattered crackles on auscultation. Her oxygen saturations are 89% in room air and her respiratory rate is 65 breaths/min. Charlotte has copious nasal secretions, she is coughing intermittently and occasionally whimpers during your examination. Her cough is quite tight sounding. Charlotte's heart rate is 170 beats/min and her temperature is 38.1°C. Her peripheral capillary refill is 3 seconds and her hands and feet are cool to touch, however she remains pink and warm centrally. Charlotte's nappy is dry at present, and Charlotte's mother states her nappies today have been only slightly wet. Diagnosis Charlotte is diagnosed with bronchiolitis. The medical plan for Charlotte is as follows: - Administer oxygen via nasal prongs to maintain oxygen saturations greater than 90%. Consider High Flow Nasal Cannula Therapy if oxygen saturations remain persistently below 90% or work of breathing worsens. • Insert a nasogastric tube and start feeds at a continuous rate of 13ml/hr - Paracetamol 75mg four times a day, prn.

Answer 1

Answer - 1. Pathophysiology - Due to lower respiratory infection  

Inflammation in epithelium of bronchioles, mucous production, cell necrosis

Results mucous production, cellular edema more obstruction in airway

Clinical assessment -

Runny nose

Cough

Decrease appetite

Tachypnea (use accessory muscles for breathing)

Wheezing sound, grunting sound

Nasal flaring

Cynosis, hypoxia

Hyperinflation of lungs, incresed airway resistance, ventricular perfusion mismatch

Answer - 2 clinical rational

Adminster oxygen therapy via nasal pongs, it is essential for incresed oxygen saturation level in the body,because due to disease condition or airway obstruction, patient need a proper oxygen, oxygen improves respiratory function well. High flow of nasl cannula provides if oxygen saturation is below 90.

Nasogasteic feeding also necessary because baby can't get sufficient breast milk due to disease condition, if feeding well it improves nutrition status and hydration status of baby, helps for quick recovery.

Paracetamol 75 mg, four times a day will reduce fever and infection process or Inflammation.

Answer 3- Nursing priority as followings-

Nurses assess the airway status, breathing pattern, oxygen saturation of the patients, providing oxygen saturation via nasal pongs which helps baby to improve lungs function well and treat Hypoventilation, hypoxia, Cynosis and fatigue.

Nurse monitor the baby for respiratory failure require intubation or machanical ventilator.

Nebulization provides the baby for improving breathing patterns.

Monitor temperature of baby, give cold sponge or prescribed medicines by the physician which treat fever, or Inflammation.

Asses the feeding pattern of baby, if baby unable to feed breast milk, provide the feed via NG tube.

Educate the parents about disease condition, give information about wear mask, gloves, frequent wash hands with soaps.

Answer 4- Mother breast milk not sufficient, baby require breast milk by breastmilk bank which available in areas, other milk substitute like cows milk also best, which composition also same as mothers milk.

Answer 5- Bronchiolitis is lower respiratory tract infectious disease, disease caused by mainly unhigenic environment, improper handwashing, rsv virus.

Bronchiolitis affect the lungs cause Increse airway resistance, Hypoventilation,lungs hypoxia. The disease condition if not treated cause lungs atelectasis or respiratory failure conditions occur.

In ward intubation, mechanical ventilator, suction tube etc should be well managed if emergency situation happens.

Answer 6-ABG report ph-7.30,pco2 65.3,po2 65.2,hco3 28 the reports say the indication of respiratory acidosis, because of Lungs Hypoventilation, oxygen levels reducing, or increasing CO2 level.