Nursing Care Plan for Meconium Aspiration

Pathophysiology

Meconium is the sterile substance that is produced in the baby’s intestines during gestation and is normally passed like 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 baby’s airway.

Etiology

Physiologic stress on the baby is the normal cause for 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

Patient will maintain adequate breathing  with respiratory rate and oxygen saturation within normal range

Meconium Aspiration Nursing Care Plan

Subjective Data:

  • Mother’s report of yellow/green discharge

Objective Data:

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

Nursing Interventions and Rationales

  1. Assess respiratory status

    • Rate
    • Effort (retractions, grunting)
    • Oxygen saturation
    • Auscultate for rales or rhonchi
  2. Meconium aspiration can result in varying degrees of respiratory distress for the infant

  3. Bulb suction mouth and nose or use endotracheal suction to remove secretions

    • Method depends on 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.

  4. Administer oxygen via hood or positive pressure

  5. Maintain oxygen saturation at 90-95%. Mechanical ventilation may be necessary.

  6. Assist with insertion of umbilical artery catheter

  7. 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.

  8. Administer surfactant therapy and medications as necessary

    • Surfactant is often given for replacement and to remove meconium
    • Antibiotics may be given empirically

  9. Monitor hemoglobin levels

  10. Hemoglobin level is an indicator of effective oxygen carrying capacity

  11. Monitor blood pressure

  12. Worsening blood pressure may indicate pulmonary hypertension or pulmonary air leak syndrome

  13. Monitor for signs of Acute Respiratory Distress Syndrome (Arterial Blood Gases)

  14. 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.


References

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