GRACIOUS COLLEGE OF NURSING

ABHANPUR RAIPUR (C.G.)

CHILD HEALTH NURSING
CASE PRESENTATION ON
MECONIUM ASPIRATION SYNDROME

SUBMITTED TO :- SUBMITTED BY:-

MRS. LEELAWATI YADAY MAM FILIMINA VAIBHAV
LECTURER (CHILD HEALTH NURSING) MSc. NURSING 1ST YEAR
GRACIOUS COLLEGE OF NURSING GRACIOUS COLLEGE OF NURSING
ABHANPUR, RAIPUR (C.G.) ABHANPUR, RAIPUR (C.G.)

CASE PRESENTATION
DEMOGRAPHIC DATA / IDENTIFICATION DATA
  Child name - Lakhan Yadav
 Age - 3 days
 Sex - Male
 Date of birth - 5/07/2019
 Developmental age - Newborn (3rd day)
 Ward - Nursery
 I.p. no. - 950175
 Religion - Hindu
 Nationality - Indian
 Address - Santoshi Nagar, Raipur
 Date of admission - 5/07/2019
 Chief complaint - Breathing difficulty, fever, poor feeding
 Source of information - Mrs Rekha Yadav
 Provisional diagnosis - Breathing difficulty
 Diagnosis - Meconium Aspiration Syndrome

SOCIO ECONOMIC DATA

 Residence - Santoshi Nagar, Raipur
 Housing - Pakka house
 Water supply - Tube well
 Ventilation - Adequate
 Electricity - Adequate
 Waste disposal - Proper excreta
 Family income - 10,000/month
 Source of income - Labour
 Total family member - 3
 Family relationship - Good
 Communication facilities- Good
 Recreational facilities - Poor

FAMILY HISTORY
S. NAME AGE SEX RELATIONSHIP EDUCATION HEALTH
NO STATUS
.
1. Nageshwar 30 Male Father 12th pass Good
Yadav years
2. Rekha yadav 28 Female Mother 11th pass Good
years
3. Lakhan yadav 3 days Male Patient Nil Poor

FAMILY TREE
 30 Y/M 28Y/F

3rd day/M

INDEX
Male

Female

Client

Death

BIRTH HISTORY-
1. Antenatal history -
 Antenatal check-up - 3 time’s antenatal check-up is done.
 Immunization - Immunization against Tetanus Toxoid is done.
 Any complication - No significant

2. Neonatal history-
 Hospital - Dr.B.R.A.M.
 Type of delivery - Normal
 Time to birth - 3:45 PM

3. Postnatal history-
 Breast feeding - Breast feeding is interrupted
 Complication - No significant

IMMMUNIZATION HISTORY
S. No. VACCINE DOSE ROUTE REMARK
1. BCG 0.05 ml Intradermal Done
2. OPV 2 drops Oral Done
3. Hep B 0.5 ml Intramuscular Done

PERSONAL HISTORY
  Hygiene - Good
 Sleep - 12 hours
 Elimination - 5-6 times
 Habit - poor
 Exercise - inadequate
 Rest - no proper rest
 Play - nil
 Hobbies - nil
 Special talent - nil
 Relationship with others - poor
 Expressions of emotions - dull
 Behavioural problems - present
 Schooling - nil

PAST HISTORY OF ILLNESS

There are no any history of past medical or surgical illness.

PRESENT HISTORY
The client suffer from breathing difficulty, tachypnoea, fever, cough and grunting.

NUTRITIONAL STATUS
 Breast feeding - Interrupted
 Weaning - nil
 Present diet - expressed breast milk
 Type of diet - liquid diet
 Time of feeding - as prescribed

PHYSICAL EXAMINATION
General appearance
 Position - normal
 Posture - normal
 Look - dull
 Body built - thin
 Consciousness - conscious
 Presence of developmental abnormalities - nil

Anthropometric assessment
 Weight - 2.5 kg
 Height/length - 45 cm
 Mid arm circumference - 11 cm
  Head circumference - 36 cm
 Chest circumference - 34 cm

Vital signs
 Temperature - 100‫ﹾ‬F
 Pulse - 160 beats/min
 Respiration - 35 breath/min
 Blood pressure - 80/50 MM of HG

HEAD TO TOE ASSESSMENT

Skin
 Colour - pale, bluish colour of skin, vernix caseosa
 Lesion/scar - no scar
 Desquamation - absent
 Lanugo - present
 Milia - absent
 Edema - mild
 Presence of birth marks – no any birth marks

Hair
 Colour - lanugo present
 Distribution of hair on head - adequate
 Cleanliness - present

Head
 Shape and size - enlarged head
 Fontanels
1. Anterior - not closed
2. Posterior - not closed
 Sutures - not closed
 Presence of infections/lesions/dandruff/lice - nil
 Movement of head - nil
 Head holding - nil
 Birth trauma - absent
 Forceps mark - absent
 Caput succedaneum - absent
 Cephalhematoma - absent
Face
 Expression - poor
 Asymmetry - present
 Edema - mild edema
 Sinus tenderness - depressed sinus
 Paralysis - absent

Eyes
 Eyebrows - equal distribution
 Eye lashes - nil
 Distance between eyes - present
 Conjunctiva - no any infection

Ears
 Shape and size - normal
 Position - normal
 Any discharges - no any discharge
 Hearing ability - startle reflex is not fully develop about loud noise

Nose
 Patency - normal
 Discharge - no any discharge
 Deviated septum - no any deviation
 Nasal bridge - depressed, nasal flaring
 Nasolabial folds - absent

Mouth and throat

 Colour of lips - pink
 Lesions at the corner of lips - while plaques present
 Cleft lips or cleft palate - absent
 Number of teeth, evidence if dental carries - nil
 Staining of teeth, malocclusion & extra or missing teeth - nil
 Gum bleeding - absent
 Tongue - coated tongue
 Tonsils - enlargement

Neck
 Lymph nodes - enlargement
 Pharynx - normal
 Voice - not properly
 Movement of neck - restricted
Chest
 Size and shape - barrel chest, asymmetry
 Symmetry of chest - no
 Presence of chest retractions - present, expiratory grunting
 Breath sound - abnormal, grunting sound
 Heart sound - normal

Cardiovascular system
 Heart rate - 120 beats/min
 Heart sound - normal
 Cyanosis - present
 Pulse rate - 160 beats/min

Abdomen
 Size and shape - asymmetry
 Observation - enlarged abdomen
 Palpation - soft abdomen
 Percussion - abdominal distension
 Auscultation - bowel sound
 Congenital abnormalities - absent

Limbs
 Any deformity - absent
 Knock knees - absent
 Edema - absent
 Paralysis - absent
 Clubbing of figures - absent
 Number of fingers & toes - 10
 Deformities of feet - absent
 Any infection/tenderness/swelling - nil

Spine & back - No any spinal cord deformity, no any protrusion

Genitalia
Male
 Urethral opening - present, normal
 Any abnormality - no any abnormality

Anus & Rectum

 Observe for patency of anus - normal
 Presence of fissures &fistula - absent
 Rectal prolapsed - absent
  Perianal erythema - absent

Neurological examination
 Characteristics of cry - less cry
 Posture of head, neck and extremities - asymmetry
 Neurological reflexes - sucking, swallowing and blinking reflex is
present
 Motor co-ordination - absent
 Muscle tone - limited
 Sense of touch or pain - nil
 Presence of meningeal irritation - absent

REFLEXES
 Sucking reflex - present
 Swallowing reflex - present
 Blinking reflex - present

GROWTH AND DEVELOPMENT ASSESSMENT:-

S. NO BOOK PICTURE CHILD’S PICTURE
1. Physical/biological development
 Height
45 cm
 Weight
2.5 kg
 Head circumference 36 cm
 Chest circumference 34 cm
 Mid upper arm circumference 11 cm

2. Motor development
 Gross motor - Lies in flexed position
with hands clenched. Turns head to side Present
when prone.
 Fine motor - Holds hand in tight fist. Present
Can grasp an object placed in the hand
but drops it immediately.
3. Intellectual development Absent
Sensorimotor stage
4. Psychosexual development
 Oral stage - Gratification needs centre Present
on mouth as in breast feeding and
sucking.
5. Moral development Absent
 Preconventional morality stage
6. Spiritual development Absent
Primal faith
7. Social development Loss active loves
8. Language development
 Receptive - Startles to loud voice Absent
 Expressive - Cries when hungry or Present
uncomfortable
9. Play Not active
10. Behavioural problems No any behavioural problem

INFERENCE:- My client has less growth and development from normal growth and
development

MEDICATION:-
S. Name of drug Dosage Route Mode of Contra- Side Nurses
No action indication effects Responsibility
1. Tab. 50 mg Oral Antibiotic Pregnancy Diarrhoea Follow 5
Ceftriaxone rights of
drugs
2. Tab. Pantop 10 mg Oral Proton pump Pregnancy Headache administration
inhibitors &
3. Tab Septran 50mg Oral Antibiotic Pregnancy Diarrhoea observe the
drug
4. Tab zinc 20mg Oral Mineral Osteoporosis Vomiting reaction
supplement
 DISEASE CONDITION
MECONIUM ASPIRATION SYNDROME

INTRODUCTION:-
Meconium aspiration syndrome (MAS) also known as
neonatal aspiration of meconium is a medical condition affecting newborn infants.
Neonates born to mother with thick or thin meconium stained liquor can aspirate
meconium into lungs and develop respiratory distress. This is known as meconium
aspiration syndrome. Aspiration of meconium can occur in utero, during birth or
immediately after birth. Thick meconium aspiration can block large and small airway
causing areas of atelectasis and emphysema which can progress to develop air leak
syndrome like pneumothorax.

DEFINITION:-
1. Meconium aspiration syndrome is respiratory distress in a newborn who has aspirated
a green, sterile fecal material called meconium into the lungs before or around the
time of birth.
-According to Wikipedia
2. Neonates aspirate meconium into the lungs in utero, during delivery or immediately
after birth, and develop respiratory distress. This is termed Meconium aspiration
syndrome (MAS).
-According to Suraj Gupta

INCIDENCE:-
Meconium aspiration syndrome occur in 5-10% of births. About
13% of all deliveries have meconium staining of amniotic fluid (MSAF). Around 6%
of such neonates aspirate meconium into the lungs in utero, during delivery or
immediately after birth. It generally occurs in term or post term newborn who are
immature or small for gestational age.

ETIOLOGY:-

S.NO. IN TEXTBOOK IN PATIENT

1. Fetal hypoxia or fetal asphyxia Present
2. Children born after 37 weeks Absent
3. Prolonged gestation Absent
4. Placental dysfunction Absent
5. Maternal hypertension, diabetes, anaemia, aging, drug Absent
abuse
6. Viral pneumonia, Bacterial pneumonia, Aspiration Present
pneumonia
7. Fetal distress Present

PATHOPHYSIOLOGY:-

Due to physiologic maturational event

(For e.g. plasma protein leaking into the airway from epithelial)

A response to acute hypoxic events

If an infant inhales this mixture before, during or after birth, it may be sucked deep
into the lungs

The material may block the airway

Efficiency of gas exchange in the lungs is lowered

The meconium stained fluid is irritating inflaming airway

Pneumonia

Meconium aspiration syndrome

CLINICAL MANIFESTATION:-
S.NO. IN TEXTBOOK IN PATIENT
1. Respiratory distress Present
2. Tachypnoea Present
3. Grunting Present
 4. Retractions Present
5. Cyanosis Present
6. High fever Present
7. Cough Present
8. Pneumothorax Absent
9. Vomiting Absent
10. Abdominal distension Present
11. Nasal flaring Present
12. Barrel shaped chest Present

DIAGNOSTIC EVALUATIONS:-

1. Blood examination:- Blood examination shows the following:-

 Haemoglobin percentage - 2 to 6 gm/dl

 RBC count - 2 to 3 million/cmm
 Haematocrit values are reduced, MCV, MCH, MCHC values are low.
 Reticulocyte count increased or may be low.
 WBC count may be reduced or sometimes increased.
 Platelet count is usually normal or increased.
 Serum bilirubin level is moderately elevated.
 Serum iron level is high.

2. Physical examination:- Lung sound (coarse, crackly sound), low APGAR score
after birth.

3. Blood gas analysis:- Hypoxemia, some degree of metabolic acidosis, decreased

oxygen and increased carbon dioxide, low blood acidity.

4. Chest x-ray:- Patchy or streaky areas in lungs, hyperinflation, diaphragmatic

flattering, patchy atelectasis and consolidation

5. Urine analysis:- Urine colour may appear dark brown.

MANAGEMENT:-

1. Suctioning:- Prevention of meconium aspiration begins with suctioning the mouth,

nose and posterior pharynx just after the head is delivered and the chest is still
compressed in the birth canal. Following delivery, the need for tracheal suctioning is
based on infant assessment. Infants who are vigorous with strong, stable respiratory
effort, good muscle tone and heart rate greater than 100 beats/min should not undergo
tracheal suctioning but should be closely monitored. On the other hand, infants who
demonstrate poor respiratory effort, low heart rate and poor tone should be rapidly
 intubated, suctioned appropriately and resuscitated according to clinical status post
suctioning.

2. Ventilation:- In case of MAS, there is a need for supplemental oxygen for at least
12 hours in order to maintain oxygen saturation of haemoglobin at 92% or more. The
severity of respiratory distress can vary significantly between newborns with MAS, as
some require minimal or no supplemental oxygen requirement and, in severe cases,
mechanical ventilation may be needed. The desired oxygen saturation is between 90-
95% and PaO2 may be as high as 90mmHg. In cases where there is thick meconium
deep within the lungs, mechanical ventilation required. In extreme cases,
extracorporeal membrane oxygenation (ECMO) may be utilise in infants who fail to
respond to ventilation therapy.

3. Inhaled nitric oxide (iNO):- Inhaled nitric oxide is a selective pulmonary

vasodilator and hence will decrease pulmonary arterial pressure if it gets into the
airways. Inhaled nitric oxide (iNO) acts on vascular smooth muscle causing selective
pulmonary vasodilation. This is ideal in the treatment of PPHN as it causes
vasodilation within ventilated areas of the lungs, decreasing the ventilation-perfusion
mismatch and thereby, improves oxygenation.

4. Surfactant therapy:- Meconium inactivates endogenous surfactant. Surfactant

improves gas exchange and decreases the oxygenation index. The need for ECMO has
significantly reduced since iNO and surfactant have been administered to infants with
severe MAS. Exogenous surfactant may be given every 6 hours and the dose may be
repeated as many times as needed. Surfactant can be given either a bolus therapy or
Broncho alveolar lavage.

5. High Frequency Jet Ventilation (HF JV):- The combination of atelectasis

and air trapping that occurs in MAS may be managed better with HF JV than high
frequency oscillation ventilation (HFOV). Use lower HF JV rate to avoid air trapping,
and higher PEEP to splint airways and allow meconium to evacuate.

6. Extra Corporeal Membrane Oxygenation (ECMO):- ECMO has been

used as a final rescue therapy in infants with severe and refractory hypoxemia
associated with MAS. Typically the infants more than 34 weeks gestation and more
than 2000 g weight with reversible cardiac/pulmonary failure and no major
neurological insult are potential candidates for ECMO.

7. Anti-inflammatory drugs:- Steroids may be beneficial in severe MAS with

apparent lung oedema, pulmonary vasoconstriction and inflammation.
Glucocorticoids have a strong anti-inflammatory activity and works to reduce the
migration and activation of neutrophils, eosinophils, mononuuclears and other cells.
Glucocorticoids reduce the migration of neutrophils into the lungs and decreasing the
adherence to the endothelium.

8. Antibiotics:- The presence of meconium increases the chances of positive cultures

from amniotic fluid in preterm and term infants. Infection/inflammation of the lungs
can lead to difficulty in breathing, reduced oxygen levels and pneumonia. Antibiotics
 have been used to prevent infection in babies exposed to meconium during delivery.
Treat with antibiotics until sepsis excluded.

9. Minimal handling:- Typically the infants with MAS are very sensitive to
handling. Frequency of routine cares and handling should be discussed with
consultant and senior nursing staff. Ensure pressure relieving devices are utilised.

NURSING MANAGEMENT:- Nursing care of an infant with meconium

aspiration syndrome include following:-

 Nursing Assessment:-
 During labour, continuously monitor the fetus for sign and symptoms of distress.
 Baby born with meconium stained liquor requires close observation for the
assessment of respiratory distress.
 Monitoring of oxygen during this period helps to assess severity of infant’s condition
and avoids hypoxemia.
 Monitor lung status closely, including breath sounds and respiratory rate.
 Frequently assess the neonate’s vital signs. Maintain adequate BP and perfusion.
 Maintain a neutral thermal environment.
 Minimal handling protocols to avoid agitation.
 Blood glucose and calcium level should be monitored and corrected if necessary.
 Fluid should be restricted as far as possible to prevent cerebral and pulmonary
edema.

 Nursing Care Plan:-

NURSING GOAL NURSING INTERVENTIONS EVALUATION
DIAGNOSIS
Ineffective To improve  Assess the general condition, After the
breathing pattern breathing vital signs and check APGAR interventions
related to meconium pattern and score of the client. client’s breathing
aspiration syndrome maintain patent pattern is
 Perform suctioning of the
as evidence by airway. improved.
mouth, nose and posterior
respiratory distress.
pharynx
(According to
Henderson’s  Provide well ventilation and
Virginia Needs supplemental oxygen as needed.
Theory)  Maintain oxygen saturation of
haemoglobin at 92% or more.
 Provide surfactant therapy to
improve gas exchange.

Altered tissue To improve  Assess quality and strength of After the

perfusion related to tissue perfusion peripheral pulses. interventions
impaired transport  Assess respiratory rate, depth client’s tissue
of oxygen across and quality. perfusion is
alveolar and  Assess skin for changes in improved.
capillary membrane colour, temperature and
as evidence by moisture.
cyanosis.  Provide oxygen therapy and well
(According to ventilation as needed.
Henderson’s  Provide a quiet and restful
Virginia Needs atmosphere.
Theory)

Hyperthermia To maintain  Assess the general condition and After the

related to normal body vital sign of the client. interventions
inflammatory temperature  Provide TSB to help lower down normal body
process as evidence the temperature. temperature is
by increased body  Ensure that all equipment used maintained.
temperature. for the infant is sterile,
(According to scrupulously clean.
Henderson’s  Do not share equipment with
Virginia Needs other infant’s to prevent spread
Theory) of pathogens.
 Administer Antipyretics as
ordered.

Interrupted The mother  Demonstrate use of manual After the

breastfeeding will identify piston-type breast pump. interventions
related to neonate’s and  Review technique for use of mother able to
present illness as demonstrate expressed breast milk. identify and
evidence by techniques to  Determine routine visiting demonstrate
separation of mother sustain schedule or advance warming techniques to
to infant. lactation until can be provided. sustain lactation.
(According to breastfeeding is  Provide privacy, calm
Henderson’s initiated. surroundings when mother
Virginia Needs breast feeds.
Theory)  Recommend for infant sucking
on a regular basis.

Fluid volume deficit To maintain  Monitor and record vital sign. After the
related to failure of fluid volume at  Note for the causative factors interventions
regulatory a normal that contribute to fluid volume neonate’s fluid
mechanism. functional deficit. volume maintained
(According to level.  Provide oral care by moistening at normal
Henderson’s lips and skin care by providing functional level.
Virginia Needs daily bath.
Theory)  Administer IV fluids
replacements as ordered.

NURSING THEORY APPLICATION:-

 My client name is Lakhan Yadav, 3 days old, admitted in nursery with the chief
complain of breathing difficulty, fever and poor feeding. According to client’s
condition, I’m choosing Virginia Henderson’s Needs Theory.

VIRGINIA HENDERSON’S NEEDS THEORY

Henderson’s considered the biological, psychological, sociological and spiritual
components. Henderson’s emphasized some concepts of society/environment.
Henderson explain how the factors of age, cultural background, physical and
intellectual capacities and emotional balance affect one’s health. Henderson believed
that nurses need a liberal education, including knowledge of science, social science
and humanities.
FOUR MAJOR CONCEPTS:-
1. Person/client - Recipient of care, including physical, spiritual, psychological and
sociocultural components.
2. Environment - All internal and external conditions, situation, circumstances and
influences affecting the person
3. Health - Degree of wellness or illness experienced by the person.
4. Nursing - Actions, characteristics and attributes of person giving care.

COMPLICATIONS:-
 Lung over expansion
 Pneumothorax
 Pulmonary hypertension
 Permanent brain damage
 Emphysema
 Atelectasis
 Pulmonary abscess
 Respiratory failure
 BIBLIOGRAPHY

BOOK REFERANCE:-
1. Data Parul, 2018, “Pediatric Nursing”, 4th edition, published by Jaypee Brothers
medical Publishers (P) Ltd, page no- 67-70
2. Ghai O.P, 2007, “Essential Pediatrics”, 6th edition, published by Dr. O.P. Ghai, Delhi-
110092, page no- 220-224
3. Kaur Navdeep, 2015, “Textbook of Advance nursing practice”, 1st edition, published
by Jaypee Brothers medical Publishers (P) Ltd, page no- 555, 570
4. Manivannan C, 2010, “Textbook of Pediatric Nursing”, 2nd edition, published by
EMMESS Medical Publishers, page no- 372-375
5. Marlow Dorothy R, 2013, “Textbook of Pediatric Nursing”, south esian edition,
published by Elsevier Indian Private Limited, page no- 953-955
6. Sherma Rimple, 2017, “Essentials of Pediatric Nursing”, 2nd edition, published by
Jaypee Brothers medical Publishers (P) Ltd, page no-138-141
7. Yadav Manoj, 2016, “Child health nursing”, published by S.Vikas and company
(Medical Publisher), page no- 335-336

NET REFERANCE:-
1. https://wwwhealthline.com>health
2. https://wwwmsdmanuals.com>home
3. https://emedicine.medscape.com>9
4. https://kidshealth.org>parents>me
5. Htpps://medlineplus.gov>article