Henry with Transient Tachypnea and Sepsis Risk Case Study Answer

Diagnosis of Henry

Henry was born at a period of 38 weeks gestation and it was an emergency lower segment cesarean (LSC). Henry weighed about 3.4 kg and after 10 minutes of delivery, it was noticed that nasal flaring, grunting, and recessing were observed. Upon diagnosis it was concluded that Henry was diagnosed with transient tachypnea of the newborn (TTN), along with it there is also a possibility of sepsis. TTN is a respiratory disorder and it is usually observed shortly after the delivery of the baby. Transient means that it is short-lived, in most cases it is less than 24 hours and tachypnea means rapid breathing. It is mainly caused due to delay in the clearance of fetal lung fluid after birth (Jha et al., 2022). This leads to ineffective gas exchange, tachypnea, and respiratory distress. Other than this the newborn might also be at risk of sepsis, in most cases neonatal sepsis is caused due to bacteria such as E coli, a few strains of streptococcus, and Listeria. Several maternal risk factors affect this condition, such as maternal asthma and gestational diabetes. It has been mentioned that blood gas of Henry is found to be acidic, this condition is called respiratory acidosis. This condition mainly occurs when the lungs are unable to remove all the carbon dioxide which is produced by the body. Alveolar ventilation is used to clear all the CO2 output and decrease the PaCO2. It is also known as hyperventilation and this results in an increase in pH (Chavan et al., 2022).

Management of Henry’s Condition 

Henry has been diagnosed with respiratory acidosis, in this condition the level of CO2 is increased in the blood. In this condition, the body is unable to remove all the carbon dioxide which is produced by the body. Due to this blood and other body fluids become too acidic. In the newborn primary respiratory acidosis is a highly common problem in the newborn. It is mainly caused due to aspiration or infection, chronic lung disease, and pulmonary hypoplasia. An effective method that can be used to treat this condition is alveolar ventilation. The major reason for respiratory acidosis is the failure of ventilation along with the accumulation of carbon dioxide (Bruschettini et al., 2022). The main disturbance is due to an increase in the arterial partial pressure of CO2. In addition to it, it also works towards reducing the ratio of arterial bicarbonate to arterial pCO2, and hence pH of blood is decreased (Alhassen et al., 2021). Ventilation is helpful because it directly works on the respiratory muscles, in addition to it, it also reduces the generation of lactate and CO2 from the muscles, and this improves acidosis. The effect of mechanical ventilation along with positive pressure on the venous might return and it is beneficial for the patient. In the patient with respiratory acidosis, there is volume overload which will decrease the venous return and this decreases the amount of pulmonary edema which is being generated. To properly provide the best care it is necessary to have a clear understanding of the machine to use. The most common indication for use of mechanical ventilation is if the patient has experienced acute respiratory failure and it can be hypercapnic and hypoxic. Another important indication is when the baby is unable to breathe. In the neonates, the average tidal volume is about 4-6 ml/kg, this should be aimed. Since it is an infant special care needs to be taken (Bruschettini et al., 2020).

Role of Nurses in Providing Better Care to Neonates 

Nurses play an important role in taking care of the baby, hence, they should be aware of the condition present and provide the best care. The baby should be presented with a nasogastric tube (NGT), as this helps in the respiration process. In this, a tube is inserted through the nose and it moves down the throat and esophagus and then into the stomach. This tube has multiple benefits however, giving drugs, food and liquids are major advantages. However, in this case, NGT is used so that the baby can breathe easily, and hence, the survival rate is increased. Other than this minimal handling in neonates should be adopted. It is a process used by the staff or the clustering care to handle the neonates (Gupta et al., 2021). It is important to follow because it will help to safeguard and reduce the stress in the babies. When the parents are involved in care it reduces the stress of care among the infants. The nasal cannula is used and it is a short prong that delivers oxygen through the nose of the baby. The nurse should also take care of the positioning of the baby, if the proper position of the baby is maintained then it makes breathing easier. The baby should be kept in a settled and comfortable position. It is also vital to regularly monitor the baby, vital signs, output chart, gas monitoring, and blood gas should be monitored regularly (Moresco et al., 2021). Blood gas monitoring is highly essential as it is a non-invasive estimation of the oxygenation level. The main goal of oxygen therapy in neonates is oxygen therapy, and it is aimed to maintain adequate PaO2 and SaO2 levels. This assists in minimizing cardiac work and hence makes the process of breathing easy. When the baby is monitored regularly it allows for to detection of any abnormalities present and immediate action can be taken. The purpose of obtaining blood gases in a neonate is to determine if the baby is adequately ventilating or perfusing. The skin integrity of the neonates should also be checked and it should be protected (Yadav et al., 2022).

References

Alhassen, Z., Vali, P., Guglani, L., Lakshminrusimha, S., & Ryan, R. M. (2021). Recent advances in pathophysiology and management of transient tachypnea of newborn. Journal of Perinatology: Official Journal of the California Perinatal Association, 41(1), 6–16. https://doi.org/10.1038/s41372-020-0757-3

Bruschettini, M., Hassan, K.O., Romantsik, O., Banzi, R., Calevo, M.G., & Moresco, L. (2020). Interventions for the management of transient tachypnoea of the newborn ‐ An overview of systematic reviews. The Cochrane Database of Systematic Reviews, 2020(3), CD013563. https://doi.org/10.1002/14651858.CD013563

Bruschettini, M., Hassan, K.O., Romantsik, O., Banzi, R., Calevo, M.G., & Moresco, L. (2022). Interventions for the management of transient tachypnoea of the newborn - An overview of systematic reviews. The Cochrane Database of Systematic Reviews, 2(2), CD013563. https://doi.org/10.1002/14651858.CD013563.pub2

Chavan, S., Malwade, S.D., Kumari, S., Garud, B.P., & Agarkhedkar, S. (2022). Incidence, clinical features, and outcomes of transient tachypnea of the newborn at a tertiary care center in western India. Cureus, 14(4), e23939. https://doi.org/10.7759/cureus.23939

Gupta, N., Bruschettini, M., & Chawla, D. (2021). Fluid restriction in the management of transient tachypnea of the newborn. The Cochrane database of Systematic Reviews, 2(2), CD011466. https://doi.org/10.1002/14651858.CD011466.pub2

Jha, K., Nassar, G.N., & Makker K. (2022). Transient tachypnea of the newborn. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537354/

Moresco, L., Bruschettini, M., Macchi, M., & Calevo, M.G. (2021). Salbutamol for transient tachypnea of the newborn. The Cochrane database of Systematic Reviews, 2(2), CD011878. https://doi.org/10.1002/14651858.CD011878.pub3

Yadav, S., Lee, B., & Kamity, R. (2022). Neonatal respiratory distress syndrome. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560779/

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