Nursing Care Plan (NCP) for Meconium Aspiration

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Outline

Pathophysiology

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.

Etiology

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.

Desired Outcome

The patient will maintain adequate breathing with respiratory rate and oxygen saturation within the normal range

Meconium Aspiration Nursing Care Plan

Subjective Data:

  • Mother’s report of yellow/green discharge

Objective Data:

  • Yellow/green urine
  • Yellow/green staining of fingernails or skin
  • Expiratory grunting 
  • Cyanosis 
  • Retractions 
  • Nasal flaring
  • Tachypnea

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Assess respiratory status:

Rate

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 
Monitor blood pressure 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. 

Writing a Nursing Care Plan (NCP) for Meconium Aspiration

A Nursing Care Plan (NCP) for Meconium Aspiration starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

  • https://www.hopkinsmedicine.org/health/conditions-and-diseases/meconium-aspiration-syndrome
  • https://www.chop.edu/conditions-diseases/meconium-aspiration
  • https://kidshealth.org/en/parents/meconium.html
  • https://www.stanfordchildrens.org/en/topic/default?id=meconium-aspiration-90-P02384
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Transcript

Hi everyone, today, we’re going to be creating a nursing care plan for meconium aspiration. So, let’s get started. So, we’re going to go over the pathophysiology first. So, meconium is the sterile product 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. Some nursing considerations: we will want to do a full respiratory assessment, vital signs, suctioning, monitoring, O2, hemoglobin, administer medications, and monitoring for signs of ARDS. Desired outcome: the patient will maintain adequate breathing with respiratory rate and oxygen saturation within normal rate. 

So, we’re going to go ahead and get started on the care plan. We’re going to have some subjective data and we’re going to have some objective data. So, what are we going to see with these patients? One of the things is there’s going to be yellow, green urine. You’re going to notice this with the baby, and some nasal flaring, yellow, green urine is pretty classic right there. Mom can also report yellow, green discharge, yellow, green staining of the fingernails or skin. There could be respiratory grunting, and some retractions. 

So, interventions that we want to do, we want to assess the respiratory status and vital signs. So, we want to check their rate. You want to see their respiratory effort. If there are any retractions or grunting, you want to check their oxygen saturation. want to make sure you’re auscultating for those are the meconium aspiration can result in varying degrees of respiratory distress for the infant. With blood pressure: worsening blood pressure can indicate pulmonary hypertension or pulmonary air leak syndrome. So, you want to monitor for that. Another intervention we’re going to be doing is bulb suctioning. We want to do that in the mouth and the nose using endotracheal suction to remove those secretions. The method depends on the severity of the aspiration and the quality of respirations. The idea is to clear the airway, however necessary. You want to avoid using the finger to clear the secretions, as it may only push them further down into the airway. Another intervention we want to be doing, is to administer oxygen, and that can be done through a hood or through positive pressure. You want to maintain oxygen saturation at 90 to 95%, although medical or mechanical ventilation may be necessary to make sure we’re assisting with the insertion of the 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. We also want to make sure we’re administering surfactant. So, surfactant therapy is often given for replacement and to remove meconium. You may also be giving antibiotics for prophylactic infection. Another intervention we’re going to be doing, we’re going to be monitoring their hemoglobin levels. Hemoglobin level is an indicator of an effective oxygen carrying capacity. Another thing we want to make sure we want to monitor for signs of ARDS. Fluid meconium in the lungs can initiate an inflammatory process that can lead to severe respiratory distress, which requires mechanical ventilation and other invasive interventions for the newborn. 

And that is our completed care plan. We’re going to go over some of the key points here. So, meconium aspiration is when the meconium is passed in utero and is mixed with amniotic fluid. The baby may inhale. The meconium-stained fluid commonly causes physiologic stress on the baby. Some subjective and objective data. You’re going to see yellow, green disc charge, expiratory, grunting, retractions, and nasal flaring. You want to do a full respiratory assessment, vital signs, monitor those hemoglobin levels, administer O2, and make sure you’re suctioning the mouth in the nose. We want to make sure we’re administering medications and monitor for signs of ARDS in the infant. And there you have a, at the end of that care plan.

We love you guys, go out, be your best self today, and as always happy nursing.

 

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