Infant+Case+Study

__**Infant Case Study:**__

An eleven-month old male infant was admitted 2 days ago with a diagnosis of Respiratory Syncytial Virus (RSV). The infant has an elevated temperature, heart rate, and respiratory rate and required oxygen via nasal cannula to keep his saturations > 92%. Active orders include IV fluids, Ribaviron aerosol, IV corticosteroids and antibiotics for 4 days. This new mother tries to spend as much time with her baby as possible, but has a full-time job that provides health insurance and she doesn't feel that she should stay away from it.

You are the incoming nurse starting a 3-day stretch of 12 hour shifts. You expect to be assigned to this infant each day for continuity of care. As you receive the report above, you begin to brainstorm about how to approach this patient and what your interventions will look like related to what you know about this baby's developmental level and needs. Answer the following questions keeping these things in mind. You may add to the discussion with text, videos, or pictures.

1. **__It's 0700 on day 1 of your stretch, and your patient is crying and his RR has increased to 64 breaths/minute and his SaO2 = 89%. No one is in the patient's room. What would you do? What are the priorities for this baby?__**
 * The primary goal would be to get the SaO2 back up and the respirations back down.
 * Infant assessment should start at the moment the nurse entered the room by looking for safety elements and calming down the crying baby. This state of agitation, possible separation anxiety may raise infant's respiration rate and change the SaO2 readings.
 * Given the high respirations (normal 30-60) and the fact that the infant is in the hosptal for a respiratory virus increase the infant's supplemental O2 first while picking up and calming the child and further assessing.
 * The infant may need some reassurance that someone will be there if they cry, so just holding, singing or rocking, even playing with the child may be all the child need to calm them down.
 * Observing the environment around the baby that might be causing any discomfort to the baby.
 * Assess the infant's breath sounds to make sure there are no adventitious breath sounds or any other pulmonary complications.
 * To fully assess the child it may be necessary to undress the child also.
 * During hospitalization, if the parents are not able to be with the infant, the baby may be inconsolable due to separation anxiety. If the mother can not be present maybe another family memeber with whom the baby is familial may be encourage to acompany him during the hospital stay.
 * Since the mother is not present and the nurse is the primary care giver, should try to establish a trust relationship with the infant while I perform my initial assessment.
 * First priority (this would not be first priority. I think it would be soemthing else) (First priority would be to clear to the airway if mucus has occluded it, or if not, medication therapy to dilate the bronchioles.)
 * I would decide what interventions to provide based on my assessment findings.
 * While administering medications may be important, there may not be a need to medicate the baby.

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2. __**It's 1800 on day 2 of your stretch. The infant's vital signs are improving and O2 is being weaned. The baby is awake and alert as you finish your charting. What would you do?**__
 * I will make sure I know the trending, interventions, medicines, procedures that helped the baby, so I can have these as a good reference for future experiences and better patient outcomes.
 * keep monitoring the child's VS to make sure that they are tolerating being weaned off the oxygen while promoting mother-baby and baby-family bonding is very important. Even though the infant is alert and awake and showing signs of improvement, the O2 SAT should closle monitored in case the patient once agin shows signs of distress from being weaned off the oxygen.
 * The baby is starting to feel better, and he/she is probably in a better mood. Playing/interacting with the baby to provide stimuli and attention to promote trust based on the infant's psychosocial stage of trust vs. mistrust.
 * I would play and provide attention to the baby while he/she is alert and maybe get other things done such as feeding, diaper changes, and bathing.
 * I would see if the mother was available to come in and visit to promote the mommy-baby relationship.
 * Encourage only immediate family as infant is still recovering and immunocompromised.
 * This is a great time to begin teaching mom about s/s of RSV as well as other precautions to avoid infection:
 * Signs and symptoms that are associated with RSV
 * Signs and symptoms of increasing respiratory distress.
 * Frequent handwashing
 * Avoid anyone who is sick
 * Don't smoke around the baby
 * Teach this new mother is how to care for her child using Ericksons Stages of Devolopment.
 * Give her extra resources that she could refer to throught the childs devolopmental years which would improve patient outcomes now and in the future as well.
 * The video below is related to premature babies and the importance of bonding, but the concepts can be applied to any infant.

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3. **__It's 1500 on day 3 of your stretch and the physician has written discharge orders for this patient after his last dose of IV antibiotic @ 1800. Mother is present @ the bedside, the baby is crying in his crib but the mother is sitting in a chair talking on her cell phone. What do you do?__**
 * Provide an example for the mother.
 * Play with the baby and provide attention and stimuli.
 * By repsonding to the child at this time the stage of trust vs. mistrust is promoted.
 * When the mom finishes her conversation, the nurse should begin the care and ask for the mother's help to get her involved.
 * I also will consider providing some teaching to the mother regarding baby's future care.
 * Education for the mother would also be necessary to ensure that the infant is going to get the proper care it needs after leaving the hospital.
 * I would compliment the mother on bringing the child in for help and ask if she had questions about RSV, how it was passed on to her child (droplets in the air), if she has support at home to help with my patient, and try to get her to open up.
 * Involve the mother by asking what she does at home to calm baby, what kinds of foods are babies favorites, what activities are babies and if there was anything she was finding especially hard as a relatively new mother.
 * These questions are great because they are non confrontational and help further build a repore with the mother.
 * It would be helpful if we phrased all the questions in an open ended manner. This technique tends to provide the most open and honest answers.
 * It would also give the mom a feeling of being involved with having an active role in helping the child to feel better.
 * I would try to find out why the mother doesn't want to console the child.
 * A mother not consoling her infant can be a RED FLAG in some situations. Maybe she has other children at home that she's afraid to contaminate with RSV, so she doesn't want to touch the baby? Maybe she's been holding the baby the last six hours and now she's frustrated? Sometimes we immediately think the worst of people, but it could just be a simple reason.
 * I think we should always to get answers first instead of judging first. Maybe she's afraid of all the equipment and scared she may mess something up?
 * Finding out why she's not consoling the child will help to determine which intervention will help her most. This is absolutely true. We can't help the mother help the child unless we know the reason she is not comforting it.
 * Explain to the mother the importance of touching and having skin to skin contact with her baby. Ask questions about how the parents are coping.

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4. **__You provide discharge instructions for this patient, including the prescription for nebulizer treatments @ home. What teaching would you provide related to medications and follow-up appointments, to help the mother attend to her baby's priority developmental needs?__** __**The link below will help you explore RSV and important aspects of care and patient education.**__
 * Educating the mother on the preventative measures and also controlling the spread of the infection is important.
 * I would stress the importance of hand washing before and after making contact with the baby.
 * Teach parents and siblings not to kiss the baby directly on their mouth or too close to their nose.
 * Encourage parents/family members/visitors not to smoke in the home.
 * If they go outside to smoke, tell them to keep a shirt outside and smoke in that shirt, and then to leave that shirt outside before coming inside.
 * Keep the baby from crowds of people.
 * It is also important to teach parent that patting the back of the child is a another way of breaking the mucus to relieve chest congestion.
 * Using saline nasal drops can also to help break mucus in the nose before bulb suctioning.
 * I will educate mother on cleaning and keeping suctioning equipment and nebulizers from the reach of child and other siblings to prevent the spread of infection.
 * Regularly disinfecting infant's toys is also important to prevent infection.
 * I will educate the mother on the benefits of using a humidifier at the bed side while baby sleeps, to help with breathing.
 * I would aslo educate on the proper way to administer any mediaction that would stop the symptoms and prevent worsening symptoms from occuring.
 * The mother needs to know how important it is to do these nebulizer treatments so that her child will keep getting better instead of relapsing.
 * I would also stress the importance of keeping and attending the follow up appointments, to make sure there are no early signs or symptoms of any other respiratory infections and that this episode of RSV has completely cleared.
 * When to call the doctor if she sees any changes in her child.
 * Infant with complication such as RSV might have an increase risk of aspiration, as such I will teach the mother how to administer PO meds to prevent aspiration. I will educate the mother to use the actual cup, spoon, or syringe that was provided with oral medication during administration instead of using the regular spoon with inaccurate measurment. I will remind parent to provide suctioning for the child as needed.
 * Educate on the importance of immunizations.
 * We could also give the mother a copy of the latest immunization schedule for her to keep as a reminder. For a new working mother, remembering these dates and scheduling for time off may be hard at first.
 * I will start providing mom with some education material on prevention of RSV. It may also be beneficial to the new mother if there were some support groups that she could attend, so that she can know that she's not alone (  ).
 * The mother needs to know that her child is now more prone to get future asthma as a complication of SRV. To do this I will provide mom with some material regarding asthma.

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