Meconium is the sterile substance that is produced in the baby’s intestines during gestation and is normally passed like a stool for the first few days after birth. When meconium is passed in utero and mixed with amniotic fluid, the baby may inhale, or aspirate, the meconium-stained fluid. Meconium does not usually develop before 34 weeks gestation, so this is usually found in babies born at term. The aspiration of meconium can occur before or during labor and immediately after delivery. This thick meconium can irritate and block the baby’s airway.
Physiologic stress on the baby is the normal cause of the passage of meconium in utero. This stress can be caused by maternal hypertension, decreased amount of amniotic fluid, maternal infection, insufficient placenta, fetal hypoxia due to the umbilical cord being wrapped around the neck, or maternal drug use.
The patient will maintain adequate breathing with respiratory rate and oxygen saturation within the normal range
Meconium Aspiration Nursing Care Plan
- Mother’s report of yellow/green discharge
- Nasal flaring
- Expiratory grunting
- Yellow-green staining of fingernails or skin
- Yellow-green urine
Nursing Interventions and Rationales
- Assess respiratory status
- Effort (retractions, grunting)
- Oxygen saturation
- Auscultate for rales or rhonchi
Meconium aspiration can result in varying degrees of respiratory distress for the infant
- Bulb suction mouth and nose or use endotracheal suction to remove secretions
- The method depends on the severity of aspiration and quality of respirations.
- The idea is to clear the airway however necessary.
- Avoid using a finger to clear secretions as it may only push them farther into the airway.
- Administer oxygen via hood or positive pressure
Maintain oxygen saturation at 90-95%. Mechanical ventilation may be necessary.
- Assist with the insertion of umbilical artery catheter
An umbilical artery catheter will minimize agitation and stress of frequent monitoring of blood pH and blood gases by giving direct access to the umbilical artery.
- Administer surfactant therapy and medications as necessary
- Surfactant is often given for replacement and to remove meconium
- Antibiotics may be given empirically
- Monitor hemoglobin levels
Hemoglobin level is an indicator of effective oxygen-carrying capacity
Worsening blood pressure may indicate pulmonary hypertension or pulmonary air leak syndrome
- Monitor for signs of Acute Respiratory Distress Syndrome (Arterial Blood Gases)
Fluid and meconium in the lungs can initiate an inflammatory process that can lead to severe respiratory distress, requiring mechanical ventilation and other invasive interventions for the newborn.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
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