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Discussion

Meconium Birth

I am working on a care plan for a patient that had thick meconium staining and variable decels. The newborn was delivered lady partslly and was reported to not have suffered MAS. My diagnosis is risk for meconium aspiration since there was not actual aspiration but I am stuck on interventions. I have notify doctor, notify respiratory, monitor FHR, and educate and encourage patient. I feel like im missing something. Please help..any and all input is appreciated!

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    • Experts

    Unless the kid is now swimming around in a swimming pool of meconium how is this kid at continued risk for meconium aspiration now that he/she is born?

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    • Author

    The scenario is based on me being the L&D nurse attending the delivery. So thats why I assumed risk.. I also considered fetal asphyxia based on the variable decels not exactly sure though

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    Just some things to consider. Since there was no noticeable meconium aspiration maybe the diagnosis should be "Risk of Respiratory Distress due to possible meconium aspiration".

    I would change the intervention "monitor FHR" to monitor respiratory effort. oxygen saturation, and HR.

    Change educate patient to educate parents.

    I hope you do not think I am being critical.

    Best Wishes

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    • Author

    Sorry I didn't add that info to the original post

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    The scenario is based on me being the L&D nurse attending the delivery. So thats why I assumed risk.. I also considered fetal asphyxia based on the variable decels not exactly sure though

    So baby is born...

    What are the risks to baby if baby swallowed mec? Where would the mec go? What could happen with mec there? This is a "risk for" with great interventions possible.

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    • Author

    I agree there are multiple interventions for the newborn, however I can limited to the delivery only. Another person in my class is assigned the "nusery nurse" and those interventions would be part of their plan of care. This limitation is what's making me confused. My interventions would only be for during labor not after birth.

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    Buy a good care plan book. It will give you ideas. Heck, they are probably online now.

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    I agree there are multiple interventions for the newborn however I can limited to the delivery only. Another person in my class is assigned the "nusery nurse" and those interventions would be part of their plan of care. This limitation is what's making me confused. My interventions would only be for during labor not after birth.[/quote']

    So even though baby is born...you are supposed to write the care plan as if baby isn't born?

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    • Experts

    If you are the L&D nurse, you need to include all of the normal, routine diagnoses for a full term neonate. So start there -- with all the regular stuff that all newborns need in L&D.

    Then, add any extra things related to the high risk aspects. What would you assess/do for a baby who had experienced intrauterine distress? The doctor/midwife reported that he/she didn't see any meconium past the vocal cords ... but what would you assess/do to be on the safe side (in case a little meconium had been aspirated but not detected by the MD/midwife at delivery?

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    Risk for fetal distress due to meconium present in fluid?

    Look at NRP and see what interventions they list :)

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    I agree there are multiple interventions for the newborn, however I can limited to the delivery only. Another person in my class is assigned the "nusery nurse" and those interventions would be part of their plan of care. This limitation is what's making me confused. My interventions would only be for during labor not after birth.

    Not really. L&D nurses care for infants in the immediate post-partum period before they are transferred to the newborn nursery (or specialty care nursery/NICU depending on the level of care the baby requires). As an L&D nurse, there are interventions/assessments you need to do for the baby as soon as it is born.

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