IDENTIFICATION DATA
Client Name : Krishna sharma
Age : 26 year
Gender : female
Address : tilak nagar bhilwara
Education : secondary education
Occupation : house wife
Religion : hindu
Date Of Admission : 12-06-2019
Diagnosis : Meconium aspiration syndrome
Ward : female ward
Marital Status : married
Gravida : G1T0P0A0L1
Duration Of Marriage : 3 YEAR
HISTORY COLLECTION
Present Chief Complains :
Illness
Bluish color skin
Low blood pressure
Altered blood pressure
Family History :
28 year 26 year
fetus
History Of Illness :
A. Present Medical History :
Patient comes the hospital with low blood pressure and bluish skin color
B. Past Medical History :
Patient has no past medical history of illness.
Obstetrical History : G1T0P0A0L1
Menstrual History
Age of menses – 18 year
L.M.P. – December 2018
Interval of delivery – irregular
Duration – 29 days
Personal history :
Smoking – no
Alcohol – no history of alcohol
Bath – daily
Skin – normal
Elimination – normal
Exercise – not habitual
Rest & sleep – normal sleep pattern is about 8 hour per day
GENERAL PHYSICAL EXAMINATION
A ) Vital Sign :-
S.N. Vital Sign Pt. value Normal value Remark
1 Temperature 98.6 oF 98.6 oF normal
2 Pulse 80 beats/min 72 beats/min normal
3 Respiration 21breath/min 20-24breath/min normal
4 Blood pressure 110/70 mmhg 120/80 mmhg normal
B) Head : size & shape is normal
C) Eye : vision – normal & no glasses
D) Ear : no discharge, normal hearing process
E) Nose : normal
F) Throat : normal
SYSTEMIC EXAMINATION
1) Respiratory System
Respiratory rate : 21 breath/min
Dyspnea : absent
Lung sound : normal
Thoracic cage : symmetrical
Movement : normal
2) G.I. system
Bowel sound : abnormal
Abdomen pain : moderate to severe
Appetite : decrease
3) Cardiovascular system
Heart rate : 81 beats/min
Heart sound : normal
4) Musculoskeletal system
Range of motion : abnormal
Contracture : absent
Dyspnea : present
Movement : normal
Appetite : decreased
Abdominal pain : moderate to severe
5) Integumentry System
Skin integrity : normal
Edema : present
6) Genitourinary system
Color of urine : blood sustained
Nature of urine : alkaline
Dysuria : absent
Incontinence : present
7) Reproductive system
Position of uterus : ante version
Amenorrhea : last two and half month
Uterine dysfunction : presence of bleeding
Vulva veginal : vaginal bleeding present
DISEASE DISCRIPTION
DEFINITION
Meconium is a dark green fecal material produced in the intestines of a fetus before birth.
After delivery, your newborn will pass meconium stools for the first few days of life.
Stress that your baby experiences before or during birth may cause your baby to pass
meconium stool while still in the uterus. The meconium stool then mixes with the amniotic
fluid that surrounds the fetus.
Your baby may then breathe the meconium and amniotic fluid mixture into their lungs
shortly before, during, or right after birth. This is known as meconium aspiration or
meconium aspiration syndrome (MAS).
Although MAS is often not life-threatening, it can cause significant health complications
for your newborn. And, if MAS is severe or untreated, it can be fatal.
ETIOLOGY
MAS may occur when your baby experiences stress. Stress often results when the amount
of oxygen available to the fetus is reduced. Common causes of fetal stress include:
a pregnancy that goes past the due date (more than 40 weeks)
difficult or long labor
certain health issues experienced by the mother, including hypertension (high blood
pressure) or diabetes
an infection
The fetus doesn’t begin to produce meconium until later in pregnancy, so as a pregnancy
goes past its due date, the fetus has the potential to be exposed to meconium for a longer
period of time.
As pregnancy progresses to term and beyond, the amount of amniotic fluid is also
decreased, which concentrates the meconium. As a result, MAS is more common in
overdue newborns as compared to term newborns. MAS is rare in preterm newborns.
SYMPTOMS
Respiratory distress is the most prominent symptom of MAS. Your infant may breathe
rapidly or grunt during breathing. Some newborns may stop breathing if their airways are
blocked by meconium.
Your baby may also exhibit the following symptoms:
a bluish skin color, which is called cyanosis
limpness
low blood pressure
PATHOPHYSIOLOGY
(a) airway obstruction, lung atelectasis causing hypoxia and increased pulmonary
vascular resistance (PVR)
(b) chemical pneumonitis
(c) pulmonary inflammation due to release of cytokines. This causes airway
edema and hypoxia
(d) surfactant dysfunction and
(e) development of persistent pulmonary hypertension (PPHN).
Not all the infants with meconium aspiration will develop MAS. Features of respiratory
distress develop immediately after birth in only 5–10% infants.
The infant manifests with tachypnea, nasal flaring, intercostal retractions and cyanosis.
DIAGNOSIS
(f) Aspiration of meconium from the trachea at birth
(g) Signs of respiratory distress
(h) Radiologically hyperinflated lung fields, flattened diaphragm with coarse and
patchy infiltration
(i) Cyanosis.
MANAGEMENT
Proper intrapartum monitoring and care
Amnio infusion in oligohydramnios—may reduce cord compression, grasping and
intrapartum aspiration
Maintenance of
(a) Thermoneutral environment
(b) Minimum handling
(c) To correct metabolic abnormalities
(d) Circulatory support (N. Saline or whole blood)
(e) Airway and oral suctioning may be needed
Liberal oxygen supply
Antibiotic coverage, as meconium invites infection
In a severe case arterial blood gas analysis should be done
Inhaled nitric oxide or surfactant therapy may be beneficial
General management includes correction of hypoxia, acidosis, hypoglycemia and
hypocalcemia. Mechanical ventilation is required where PO2 is less than 50 mm Hg
and PCO2 is above 50 mm of Hg. Complications like airleak (pneumothorax),
PPHN, bronchopulmonary dysplasia or chronic lung diseases are common. New
modalities of therapy have reduced mortality to < 5%.
NURSING DIAGNOSIS
1. Bluish discoloration of the skin due to meconium aspiration syndrome.
2. Decrease blood pressure related to MAS.
3. Imbalanced nutrition less then body requirement to disease condition.
4. Airway obstruction due to MAS.
5. Knowledge defecit related to MAS.
IMPLEMENTAT-
NURSING
ASSESMENT GOAL ION WITH EVALUATION
DIAGNOSIS
RATIONAL
Sub. Data Air way To improve the -Monitor pulse Patient has been
obstruction gas exchange oximetry and report improved gas
Patient say that due to O2 saturation. exchange.
her baby is meconium
crying. aspiration -Assess the
syndrome. respiratory rate
Obj. data-
We observe -Monitor if there is
that chance of an increase in anxiety
that difficulty
in breathing. -Encourage deep
breathing exercise
-Administer oxygen
if needed
IMPLEMENTAT-
NURSING
ASSESMENT GOAL ION WITH EVALUATION
DIAGNOSIS
RATIONAL
Patient looks Imbalanced To maintain -To provide frequent The nutritional
weak due to nutrition less nutritional diet of the patient
infection and then body status have been
blood loss requirement -To provide liquid or improved and
to disease semi solid diet only maintained.
condition.
-To administer iron
preparationand
vitamin
-To provide chlorine
and nutrition
-To administer
antibiotics
medication that
prescribe by the
physician
HEALTH EDUCATION
Teach the patients relatives to take care of the patient give support on giving prose’s
of mother.
To control the spread of infection.
Give the nutritional need of the patient.
Report to physician if any abnormality seen.
Advice to the patient not to do heavy work.
Advice patient for do general daily activity.
Advice patient to take a healthy or well balanced diet.
Instruct patient about to take plenty of water.
BIBLIOGRAPHY
S.N. Book name Author Edition Page no.
1 Internet - - -
2 OBG Dc. dutta 8th 550
