Case Studies Unit 1

RSPT 2353Case Studies Unit 1Key Name: Date: 2007 Case study # 1 You are in the L&D. Your patient is a BF term infant who is the 3000 gram child of a G2 P2 who had a history of urinary tract infection last month. The baby presents with the following s/s: Baby is floppy, peripherally cyanotic, with HR 45 bpm and RR 75 bpm. She grimaces with suctioning.

She has marked intercostal & xiphoid retractions, slight lag between belly and chest on respirations, audible grunting with stethoscope and minimal flaring with each breath. 1. Calculate the Silverman score. Is 7  +2 for marked intercostal retractions  +2 for marked xiphoid retractions  +1 for slight lag  +1 for grunting  +1 for flaring

2. Calculate the APGAR score is 5  0 for floppy  1 for color  1 for HR  2 for respiratory rate  1 for grimace 3. Based on her gestation and wt determine her growth. This baby is an AGA, appropriate wt for her gestational age 4. List the high risk factors with this infant. She is at increased risk of an intrauterine infection due to the mom’s illness and she is showing s/s of increased WOB and severe tissue hypoxemia that requires intervention now to prevent deterioration and a need for CPR Case study #2 Your patient is a LAM infant who was born at 27 weeks, at 1250 grams. Mom a 45 yo who is G5 P2 A2. She drinks heavily and smokes. Baby is floppy and unresponsive to tactile stimulation, centrally cyanotic, with HR 12 bpm and RR 95 bpm. He has marked inspiratory intercostal & xyphoid retractions, seesaw respirations, audible grunting and marked flaring with each breath.

1. Calculate the Silverman score: is 10  +2 for intercostal  +2 for xiphoid retractions  +2 for seesaw  +2 for audible grunting  +2 for flaring 2. Calculate the APGAR score: is 3  +0 for floppy  +1 for HR  +2 for respirations [for this score, even tachypnea is better than irregular breathing]  +0 for failure to respond to tactile stimulation  +0 for color 3. Based on his gestation and his wt calculate his growth. This baby is AGA 4. List the high risk factors with this infant.  Mom’s smoking puts baby at risk for SGA now and for SIDS & asthma later in life  Mom’s age puts baby at risk for Downs  Mom’s drinking puts baby at increased risk for fetal alcohol syndrome  Mom’s poor pregnancy history puts this fetus at risk for premature labor  Baby is premature which puts it at risk for lung, and GI tract problems  Baby’s terrible APGAR and Silverman scores suggest immediate attention is needed to resuscitate this infant

Case study # 3 You are in the L&D. Your patient is a BF term infant 2800 gram baby born of a G4 P3 who has a history of urinary tract infection last month.

The baby presents with the following s/s: Baby has good muscle tone, is peripherally cyanotic, with HR 145 bpm and RR 55 bpm. She starts to scream when she is suctioned. She has marked intercostal & xyphoid retractions, slight lag between belly and chest on respirations, audible grunting without stethoscope and mild flaring with each breath. 1. Calculate the Silverman score: is 8 1. +2 for intercostal 2. +2 for xiphoid retractions 3. +1 for lag 4. +2 for grunt 5. +1 for flaring

2. Calculate the APGAR score: is 9  +2 for muscle tone  +1 for color  +2 for HR  +2 for RR  +2 for cry 3. Based on her gestation and hr wt calculate her growth.  SGA 4. List the high risk factors with this infant.  Mom’s infection puts her at risk for intrauterine infection  Her Silverman’s are quite high and imply that she needs immediate intervention before it starts to affect her APGAR score at 5 minutes of age. 5. When this baby was born, describe the changes in fetal circulation when her PA02 rose from zero torr to 70 torr.  Once the PA02 rose to normal, the pulmonary capillaries started to vasodilation. This caused the pulmonary HTN to drop so that the RV and RA pressures both dropped which will close the FO. 6. Describe the changes at birth created by this infant’s Pa02 rising from 38 torr to above 60 torr.  When the Pa02 rose to a normal level, the PDA closed so that blood from the pulmonary artery will not be shunted away from the pulmonary capillary bed. 7. List the two conditions that closed the Foreman Ovale.  Drop in the right atrial pressure caused by the decreased pulmonary capillary bed pressure  Rise in the left atrial pressure due to increased systemic blood pressure once the placenta and the baby are separated.

Case study #4 Your patient is a LAM infant who was born at 31 weeks, at 1250 grams. Mom is a 45-year-old who is G5 P2 A2. She has suffered PROM.

Baby is floppy, and grimacing only when suctioned. He is centrally cyanotic, with HR 12 bpm and RR 95 bpm. His BP is 45/27 mmHg. He has marked inspiratory intercostal & xyphoid retractions, see-saw respirations, audible grunting without stethoscope and mild flaring with each breath.

1. Calculate the Silverman score: is 9  +2 for intercostal  +2 for xiphoid retractions  +2 for seesaw  +2 for grunting  +1 for flaring

2. Calculate the APGAR score: is 4  +o for activity  +0 for color  +1 for HR  +2 for RR  +1 for grimace

3. Based on his gestation and his wt calculate his growth.  Baby is AGA 4. List the high risk factors with this infant.  Mom’s age is a high risk factor for Downs Syndrome  Mom’s poor track record during pregnancies puts the baby at risk for premature labor  PROM puts the baby at risk for intrauterine infections: sepsis or pneumonia  He is premature and his APGAR and Silverman score are bad which puts him at risk for tissue hypoxemia and the problems associated with this 5. Do you feel the VS for this infant are WNL for his age and gestation?  The HR needs to be between 120 to 170 bpm. So HR too low  The RR needs to be between 40- 60 bpm, so RR too high  The Blood pressure needs to be 48/25 MAP35 mmHg-- so blood pressure is WNL