I had a baby today that was brought to the hospital 21 hours after a home delivery (Midwife even had to perform rescue breathing but they still didn't come to the hospital for 21 hours, I guess that's another thread entirely), anyway, he was delivered with meconium stained fluid which he apparently aspirated. By the time he got to the ER he was in septic shock. 15 days later (today) he's coming along quite well. My question is, My priority diagnosis is Risk for infection/actual, what would be to other appropriate diagnoses for this baby? I'm having a hard time find anything in the careplan books. Would I just follow a careplan for pneumonia? I'm just kinda stuck. Any help is very much appreciated.
Nov 17, '06
Oy! Careplans. The bane of my nursing school existence. Care plan for 15 days of life with MAS?
Look at oxygen exchange
Knowledge deficit (always a good filler diagnosis)-signs/sx of infection
Pneumonia is probably a good place to start.
Was kiddo vented? I'm assuming he was never on ECMO if he's doing well at 15 days unless he had a really short run.
About the not coming to the hospital for 21 hours-people who homebirth tend to not want to come to hospitals unless it is a true emergency. Babies are notorious for having subtle signs of infection. Maybe they weren't picked up by the MW (though I'm really hoping this is an isolated case) IME MW's tend to transfer if there's mec in the fluid (unless it's terminal).
I'm not very helpful am I? Sorry.
Nov 17, '06
You can't have a diagnosis that says "Risk for Infection" for an actual infection. By the nature of saying "Risk for", the nursing diagnosis is a potential
problem. So, your little patient either has, or doesn't have an infection. You said he was admitted with septic shock. That's an infection with shock. For an actual infection, you need to look at the signs and symptoms displayed by the patient to decide on the proper nursing diagnosis since there is no NANDA diagnosis for infection. Infection is a medical diagnosis.
Other possible nursing diagnoses you could use are:
- Ineffective Tissue Perfusion R/T decreased systemic vascular resistance
- (Risk for) Impaired Gas Exchange R/T meconium aspiration and/or excess production of mucus
- Ineffective Thermoreguloation R/T infectious process
- Imbalanced Nutrition: less than body requirements R/T poor sucking reflex
- Ineffective Protection R/T inadequately functioning immune system
Nov 17, '06
Thank you so much for your replies!! I finished up my paperwork last night and it's good to know that I was on the right track. There are those times when you are working on this stuff that you just hit the wall and have no more information left in your brain. LOL!!!
The baby was brought to the children's hospital because they were fairly certain he would need to be put on ECMO. He was on HFOV for several days and managed to turn around. It's hard to know what neurological damage he may have suffered, but he's doing sooo much better and that's a relief. Thanks again for all the help!! It is truly appreciated.
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