A 6-month-old infant with a history of bronchopulmonary dysplasia (BPD) presents with increased irritability, difficulty in breathing, and an oxygen saturation of 85% on room air. The nurse notes pronounced intercostal and subcostal retractions and diffuse wheezing and crackles upon auscultation. What is the nurse's priority action in this scenario?

B) Increase the supplemental oxygen to maintain saturation levels above 92%

A) Administer bronchodilator therapy as prescribed

B) Increase the supplemental oxygen to maintain saturation levels above 92%

C) Notify the healthcare provider about the potential need for an echocardiogram

D) Position the infant in a prone position to improve breathing

A 6-month-old infant with a history of bronchopulmonary dysplasia presents with increased irritability, difficulty breathing, and an oxygen saturation of 85% on room air. The infant is now showing intercostal and subcostal retractions, diffuse wheezing, and crackles. Which nursing intervention is most appropriate to prioritize in this scenario?

B) Increase the oxygen flow rate to maintain saturation above 92% and monitor closely.

A) Administer a bronchodilator as prescribed and reassess respiratory status.

B) Increase the oxygen flow rate to maintain saturation above 92% and monitor closely.

C) Initiate chest physiotherapy to help clear secretions and improve lung function.

D) Position the infant in a semi-Fowler's position to facilitate easier breathing.

An infant diagnosed with moderate pulmonary hypertension and mild right ventricular hypertrophy is being treated with diuretics and pulmonary vasodilators. During a follow-up assessment, the nurse notes that the infant exhibits signs of increased respiratory effort and fatigue. Which nursing intervention is most appropriate to address the infant's anemia and support overall treatment goals?

D) Collaborate with a dietitian to optimize iron-rich formula intake.

A) Increase the frequency of feedings to provide more calories and nutrients.

B) Administer supplemental oxygen to reduce respiratory effort.

C) Encourage kangaroo care to enhance infant bonding and relaxation.

D) Collaborate with a dietitian to optimize iron-rich formula intake.

An infant diagnosed with moderate pulmonary hypertension and mild anemia is being treated with diuretics and pulmonary vasodilators. Which nursing intervention is most critical to include in the care plan to address the infant's current condition and prevent further complications?

A) Monitor the infant's electrolyte levels and fluid balance closely.

B) Prepare the infant for potential surgical intervention to correct structural heart anomalies.

C) Educate the parents on performing chest physiotherapy to enhance lung function.

D) Initiate a high-calorie diet to promote weight gain and improve the infant's energy levels.

An infant in the NICU shows signs of feeding intolerance, including increased gastric residuals and occasional vomiting, after recent improvements in respiratory status with diuretics. Given the infant's current condition, what should the nurse prioritize in the plan of care?

B) Reassess the caloric density of the formula to ensure sufficient nutrition.

A) Increase the frequency of feedings to promote weight gain.

B) Reassess the caloric density of the formula to ensure sufficient nutrition.

C) Initiate antibiotic therapy to address potential underlying infection.

D) Encourage more aggressive respiratory physiotherapy to manage atelectasis.

The infant in the case is exhibiting signs of feeding intolerance and has a plateau in weight gain. Which nursing intervention would be most appropriate to address these issues while considering her current condition and treatment plan?

A) Increase the frequency of feeds with smaller volumes

B) Switch to a formula with higher caloric density

C) Withhold all feeds and initiate total parenteral nutrition (TPN)

D) Continue the current feeding regimen but add probiotics to promote digestion

An infant in the neonatal unit is being monitored for feeding intolerance, exhibiting mild abdominal distension and hypoactive bowel sounds. Laboratory findings suggest an inflammatory process. The healthcare team has adjusted feeding strategies and initiated antibiotic therapy. Which nursing intervention is most appropriate to support the infant's gastrointestinal function and nutritional status?

B) Position the infant in a semi-upright position during and after feedings to facilitate gastric emptying.

A) Encourage frequent small volume feedings to minimize gastrointestinal stress.

B) Position the infant in a semi-upright position during and after feedings to facilitate gastric emptying.

C) Implement strict fluid restriction to prevent further abdominal distension.

D) Delay all feedings until bowel sounds return to normal to prevent further intolerance.

An infant in the NICU is being treated for feeding intolerance with abdominal distension, hypoactive bowel sounds, and elevated inflammatory markers. The nursing team is considering interventions to support the infant’s nutrition and growth. Which of the following nursing actions is most appropriate to prioritize at this time?

B) Monitor abdominal girth and bowel sounds before and after each feeding.

A) Initiate enteral feeds with increased volume to promote weight gain.

B) Monitor abdominal girth and bowel sounds before and after each feeding.

C) Administer probiotics and MCT oil as per the nutritionist's recommendations.

D) Increase the frequency of chest physiotherapy to address respiratory symptoms.

An infant in the neonatal intensive care unit is being treated for early necrotizing enterocolitis (NEC) and a confirmed bloodstream infection with Staphylococcus epidermidis. Which of the following nursing interventions is most critical to prioritize at this time?

C) Monitoring for signs of metabolic imbalance due to total parenteral nutrition (TPN)

A) Initiating enteral feeds to promote gastrointestinal function

B) Administering broad-spectrum antibiotics to manage the infection

C) Monitoring for signs of metabolic imbalance due to total parenteral nutrition (TPN)

D) Increasing physiotherapy sessions to improve lung expansion

An infant diagnosed with early necrotizing enterocolitis (NEC) is receiving total parenteral nutrition (TPN) after enteral feeds were halted. The infant's blood cultures have also returned positive for Staphylococcus epidermidis. The nurse should prioritize which of the following interventions to ensure comprehensive and safe care for this patient?

A) Monitoring the infant's glucose levels every 6 hours to prevent hyperglycemia.

B) Increasing the frequency of respiratory assessments to monitor for potential lung complications.

C) Administering antibiotics via the same line as the TPN to ensure timely treatment of infection.

D) Encouraging early resumption of enteral feeds to promote gastrointestinal recovery.

bronchopulmonary dysplasia - Nursing Case Study

Pathophysiology

• Primary mechanism: Immature lung development in preterm infants leads to inadequate alveolarization and vascularization, increasing susceptibility to lung injury and reduced gas exchange efficiency.

• Secondary mechanism: Mechanical ventilation and oxygen therapy, although life-saving, can induce oxidative stress and volutrauma, causing inflammation and fibrosis, which further impair lung function and development.

• Key complication: Chronic lung disease may result in long-term respiratory issues, including reduced lung capacity and increased risk of respiratory infections, impacting overall growth and development in affected infants.

Patient Profile

Demographics:

6-month-old female, not applicable

History:

• Key past medical history: Premature birth at 28 weeks gestation, history of mechanical ventilation for respiratory distress syndrome

• Current medications: Supplemental oxygen therapy, diuretics, bronchodilators

• Allergies: None known

Current Presentation:

• Chief complaint: Increased respiratory effort and poor feeding

• Key symptoms: Tachypnea, wheezing, retractions, failure to thrive

• Vital signs: Heart rate 165 bpm, respiratory rate 62 breaths per minute, oxygen saturation 88% on room air, temperature 37.3°C

Section 1

Change in Patient Status:

During a routine follow-up visit, the mother reports that her 6-month-old daughter has been increasingly irritable, with noticeable difficulty in breathing, especially during feeding times. The infant's current oxygen saturation is 85% on room air, which necessitates an increase in supplemental oxygen to maintain adequate levels above 92%. On examination, the infant shows pronounced intercostal and subcostal retractions, indicating a significant increase in respiratory effort. Auscultation reveals diffuse wheezing and crackles, which suggest worsening pulmonary function.

In light of these symptoms, the primary concern is the potential progression of bronchopulmonary dysplasia (BPD) with developing pulmonary hypertension, a known complication in preterm infants with chronic lung disease. The increased respiratory effort and hypoxia, despite supplemental oxygen, raise suspicions of right ventricular strain due to persistent pulmonary hypertension. This situation warrants further investigation to assess the cardiac function and pulmonary pressures. An echocardiogram is ordered to evaluate the right heart pressures and to identify any signs of cor pulmonale, which could complicate the management of BPD and significantly affect the infant's prognosis and quality of life.

The clinical team discusses the need for a multi-disciplinary approach, involving a pediatric pulmonologist and cardiologist, to optimize the management of both respiratory and potential cardiac complications. Adjustments in the current therapeutic regimen are considered, including the potential introduction of pulmonary vasodilators and increased monitoring of nutritional status to support the infant's growth and development. This change in patient status underscores the complexity of managing chronic lung disease in preterm infants and highlights the need for continuous reassessment and adaptation of the care plan to ensure the best possible outcomes.

Section 2

New Diagnostic Results:

Following the initial assessment, the echocardiogram results reveal moderate pulmonary hypertension with elevated right ventricular pressures, confirming the suspicion of right ventricular strain. There is no evidence of ventricular septal defect or other structural heart anomalies, but the presence of mild right ventricular hypertrophy suggests prolonged exposure to increased pulmonary pressures. This finding is consistent with the infant's symptoms and indicates a need for prompt intervention to prevent further cardiac compromise.

In addition to the echocardiogram, a complete blood count and metabolic panel are conducted to assess the infant's overall health status. The results show mild anemia, which could contribute to the infant's increased respiratory effort and fatigue. Electrolyte levels are within normal ranges, but there is a slight increase in the levels of inflammatory markers, indicating a possible low-grade infection or ongoing inflammatory process in the lungs, which could exacerbate her respiratory condition.

Given these diagnostic results, the clinical team decides to initiate a treatment plan that includes the use of diuretics to manage fluid overload and reduce cardiac strain. Pulmonary vasodilators are also considered to lower pulmonary pressures and improve oxygenation. Furthermore, the team emphasizes the importance of optimizing the infant's nutritional support to address the anemia and support growth. Regular follow-up appointments are scheduled to closely monitor the infant's response to the new treatment regimen, with adjustments made as necessary to manage the evolving complications associated with bronchopulmonary dysplasia and pulmonary hypertension. This comprehensive approach aims to stabilize the infant's condition and improve her quality of life.

Section 3

As the clinical team implements the new treatment plan, they observe the infant's response closely. In the first few days, there is a noticeable improvement in her respiratory status. The use of diuretics has effectively reduced fluid overload, resulting in decreased respiratory effort and improved oxygen saturation levels, which now consistently range between 92-95% on supplemental oxygen. However, the infant's heart rate remains slightly elevated at around 160 beats per minute, prompting the team to continue monitoring for potential cardiac stress.

Despite the initial positive response, new complications arise. The infant begins to exhibit signs of feeding intolerance, characterized by increased gastric residuals and occasional vomiting after feeds. This prompts a reassessment of her nutritional regimen, with the team considering potential adjustments in caloric density and feeding intervals to alleviate gastrointestinal discomfort and ensure adequate caloric intake. Additionally, the infant's weight gain has plateaued, indicating a need for further intervention to address her growth and development needs.

The increase in inflammatory markers remains a concern, as the team suspects an underlying infection or persistent inflammatory process. A repeat chest X-ray reveals patchy atelectasis, suggesting areas of lung collapse, which may be contributing to the ongoing respiratory challenges. This finding underscores the need for continued respiratory support and possibly the initiation of antibiotic therapy to address any underlying infection. As the team discusses these developments, they emphasize the importance of a multidisciplinary approach, involving pediatric cardiology, nutritionists, and infectious disease specialists, to tailor the treatment plan and optimize the infant's outcomes.

Section 4

As the clinical team continues to monitor the infant closely, they decide to focus on the new complication of feeding intolerance, which has become increasingly concerning. Upon reevaluation, the team notes that the infant's abdominal examination reveals mild distension and hypoactive bowel sounds. Laboratory tests show a slight elevation in C-reactive protein (CRP) and white blood cell count, suggesting a possible inflammatory or infectious process contributing to her symptoms. To mitigate the feeding intolerance, the team opts to reduce the volume of feeds while increasing the caloric density, allowing for the necessary nutrients without overwhelming her gastrointestinal system.

Despite these adjustments, the infant's weight gain remains stagnant, and her growth chart shows no significant increase in percentiles. Recognizing the critical need to support her development, a nutritionist is consulted to devise a more comprehensive nutritional plan. This plan includes the introduction of medium-chain triglycerides (MCT) to enhance caloric intake efficiently and the consideration of probiotics to support gut flora and reduce gastrointestinal distress. Concurrently, the pediatric cardiologist evaluates the infant's elevated heart rate and rules out any immediate cardiac dysfunction, attributing it instead to the ongoing respiratory and nutritional stressors.

In response to the persistent signs of possible infection, the team initiates a broad-spectrum antibiotic regimen while awaiting culture results to guide more targeted therapy. The repeat chest X-ray findings of patchy atelectasis prompt the respiratory therapist to implement increased physiotherapy sessions, focusing on techniques to aid lung expansion and improve ventilation. As the days progress, the team remains vigilant, continually reassessing the infant's response to these interventions, understanding that her fragile condition requires a dynamic and responsive approach to care.

Section 5

In the following days, the infant’s clinical status began to show signs of change. The respiratory therapist noted improvements in lung expansion following the increased physiotherapy sessions. The infant’s oxygen saturation levels stabilized, consistently ranging between 92-95%, which was an improvement from previous fluctuating readings. However, the infant's heart rate remained elevated, averaging around 170 beats per minute. The pediatric team continued to monitor this closely, considering the elevated heart rate as a potential indicator of ongoing stress or underlying issues.

Despite the stabilization of respiratory parameters, the feeding intolerance persisted, prompting further investigation. A repeat abdominal ultrasound was performed, revealing mild bowel wall thickening, suggestive of early necrotizing enterocolitis (NEC). This finding necessitated an immediate shift in the clinical approach. Enteral feeds were halted to prevent further gastrointestinal strain, and total parenteral nutrition (TPN) was commenced to ensure the infant received adequate nutrition without exacerbating gastrointestinal complications. The nutritionist, in collaboration with the neonatologist, carefully calibrated the TPN to meet the infant's caloric and micronutrient needs, monitoring her electrolytes and glucose levels to prevent metabolic imbalances.

Concurrently, the results from the blood cultures returned positive for Staphylococcus epidermidis, confirming a bloodstream infection. The antibiotic regimen was adjusted accordingly to target this specific pathogen effectively. With these developments, the clinical team prioritized a multidisciplinary approach, ensuring each aspect of the infant's care was meticulously coordinated. This included frequent reassessment of her clinical status, laboratory values, and response to nutritional interventions. Through this comprehensive and dynamic management strategy, the team aimed to stabilize the infant's condition and support her gradual recovery and growth.