Assignment
Pediatric/ Oxygenation Case Study
Cara is a 9-month old infant delivered by C-section at 28 weeks gestation secondary to premature rupture of the amniotic membranes. She weighed 1.1 kg at birth and required mechanical ventilation at birth until she was 5 months of age. Currently she still requires 38% oxygen by tracheostomy collar to maintain her O2 saturations greater than 92%. Currently she weighs 4.9 kg and receives gastrostomy feedings of 80 mL every 4 hours (given over 2 hours via infusion pump) as a result of severe GER. Prior to her daytime feedings she receives metoclopramide 0.5 mg per gastric tube. She requires trach suctioning approximately every two hours for thick yellow secretions. She is given an Albuterol inhaler every 4 hours and ipratropium inhaler every 8 hours. She also receives an iron supplement. Before being discharged from the hospital at 7 months old she was diagnosed with bronchopulmonary dysplasia (BPD) into the care of her parents, Carolyn and Josh. She also has a 4 yo brother, Alex, at home.
Cara was brought to the hospital yesterday following a call from her mother stating that she had been experiencing respiratory distress at home. Her mother is reported by the nurse to be very involved with the care insisting on doing all the care including g-tube feedings and trach care/ suctioning. The staff reports that the care is appropriate but that mother Carolyn appears very tired. She leaves only long enough to get a cup of coffee and a snack twice a day. Questions are appropriate and she spends all day holding and caring for Cara.
Task
I. What is the purpose of the prescribed metoclopramide? Is the current dose safe? What is the purpose of each of the inhalers? What further, if any medications and /or treatments would you want to see prescribed?
II. What further assessments are needed of Cara's current condition?
III. What is the pathophysiology of BPD? Include treatments and potential complications.
IV. Is there a relationship between BPD and GER?
V. During your assessment of Cara, you note she responds to her mother's voice by turning to and tracking of the sound. She rolls form her back to her side with no evidence of head lag. She is unable to sit up without support and does not verbalize. Her palmar grasp has disappeared; and she is able to demonstrate pincer grasp. How does Cara compare to other children at this age?
VI. Following a chest x-ray and culture, Cara is diagnosed with streptococcal pneumonia and prescribed cefazolin sodium 200 mg IV every 8 hours. Why is this medication prescribed? Is this dose safe? Would you question the dosage?