PERINATAL/PEDIATRIC FINAL CASE STUDY
OVERVIEW
Using the material covered in this course:
Students will complete a comprehensive case study on a neonatal/pediatric respiratory client. The purpose of this case is to test the knowledge of the respiratory care student’s ability to critically think and perform in the emergency care of a neonatal/pediatric patient.
Comment on the appropriateness of diagnostic and therapeutic interventions. This assignment should be well-constructed, complete and concise. The reader should be able to build a coherent picture of the patient’s problems in his/her mind, as the case study unfolds.
Write a case report base on one of the two scenarios provided below.
Each student must submit a case study. This is not a group activity.
Report must be 3 to 4 pages long, in paragraph form, time new roman, size 11 font, double spaced. Margins should be set at no greater than 1”. Include an additional cover page with the following information:
• A title.
• Your name, class information and date of report should follow several lines later.
• THIS ASSIGNMENT MUST BE WRITTEN IN PARAGRAPH FORM
• an additional page for references in AMA citation style. See:
https://www.library.illinois.edu/learn/research/citation/ama.html
You will be graded on your application of respiratory care skills into the treatments and interventions. Support you presentation with references from the literature on the disease process and the AARC CPG. Always use citations for information that you learned from a book or article. See the grading rubric posted in moodle.
REFERENCES
Your sources must be journals, periodicals, and textual references. Make sure you support your ideas with facts and figures.
OPTIONAL APPENDIX (does not count in the pages required)
All charts, visuals and other related items must be placed here (no charts in the body of the report please) and referenced in the report.
CASE STUDY 1
OBJECTIVES
• As part of this case, the student will be able to:
• Demonstrate his/her ability to gather the equipment that should be prepared in the ED prior to the arrival of a pediatric patient in full cardiopulmonary arrest.
• Demonstrate his/her ability to recognize indications for intubation of a /neonatal pediatric patient.
• Estimate appropriate endotracheal tube size for the patient’s age.
• Demonstrate his/her ability to assess proper placement of the ETT in the trachea.
• Calculate the appropriate size suction catheter to be used when the endotracheal tube size is given.
• Choose appropriate mechanical ventilator settings for a pediatric patient.
• Interpret arterial blood gas results.
• Complete a patient assessment and make appropriate mechanical ventilator changes in accordance to the patient assessment findings.
THE PATIENT
You are called to the ED to await the arrival by ambulance of a 32 lbs, 18 month old male with a 5 day history of coughing, congestion, fever and runny nose. His only medications are acetaminophen and a cough syrup prescribed by the pediatrician 2 days prior. His mother stated that an hour ago he developed audible wheezing and his lips turned blue which prompted her to call 911.
VS as reported by EMS: TEMP 103.9, HR 170, RR 48, BP 112/74, oxygen saturation 78% on room air at the scene. Patient was placed on a NRM and O2 sat rose to 90%. EMS reports administering 2 albuterol 2.5 mg tx in route to the ED.
Write a Narrative (No question and answer format please) case study that answers the following questions:
What should you do to prepare for this patient?
Upon arrival the patient appeared pale and irritable, with severe respiratory distress. A neb tx is in progress. Peripheral and central cyanosis is present. Diffuse wheezes were heard bilaterally. The patient’s oxygen saturation decreased to the 70’s when crying, but returned to the 90’s. A CXR and an EKG were done.
At this time, what initial actions should be taken?
(include any appropriate procedures that should be performed)
Based on your assessment, what would be the indications for intubating the patient? What equipment will you need? Describe the procedure and your role during the intubation.
Post intubation, BBS indicate rhonchi, what is your next step?
Next the physician requests that you to set the ventilator on the appropriate settings.
What ventilator settings do you choose?
• Mode =
• PIP (peak inspiratory pressure) or VT =
• f (frequency) =
• FiO2 (fraction of inspired oxygen) =
• PEEP (positive end expiratory pressure) =
• IT (inspiratory time) for PC (pressure control) =
• Or Flow for VC (volume control) =
• Alarms=
How do you assess the effectiveness of the ventilator settings you chose?
Assuming that an ABG was obtained prior to intubation, provide, interpret and explain the anticipated results (must fit the clinical situation)
What do you need to appropriately monitor the patient at this point?
What types of diagnostic testing are appropriate at this point? Explain your answer.
Provide an admitting diagnosis for the patient and provide a rational for your choice.
An hour post mechanical ventilation ABG results are: 7.23 / 56 / 88 / 20 / 92%
Interpret, explain the results and take appropriate steps to correct it.
2 hours later, the patient is stable and moved to the Pediatric ICU (intensive care unit). What other lab, medication, test, and therapies are you expecting the medical staff to order?
Two days later you return to work the unit. There is an order to wean the patient from mechanical ventilation. How do you assess readiness? What would you suggest to the physician in terms of post extubation therapy for the patient? How would you proceed (based on your assessment)?
Was weaning successful? Explain Why or Why not?
CASE SUMMARY
In one paragraph (100 to 120 words) provide a summary of the case describing the course of hospitalization from the patient arrival in the ED to the current status of the patient for the benefit of the incoming therapist who has no knowledge of this patient’s case. This case summary should give him/her any information he/she may need in order to care for the patient properly. SBAR format recommended.
CASE STUDY 2
OVERVIEW
The purpose of this case is to test the knowledge of the respiratory care student’s ability to critically think and perform in the emergency care of a pediatric patient.
OBJECTIVES
• As part of this case, the student will be able to:
• Demonstrate his/her ability to gather the equipment that should be prepared in the ED prior to the arrival of a pediatric patient in full cardiopulmonary arrest.
• Demonstrate his/her ability to recognize indications for intubation of a pediatric patient.
• Estimate appropriate endotracheal tube size for the patient’s age.
• Complete the assessment that will help identify proper placement of the ETT in the trachea.
• Calculate the appropriate size suction catheter to be used when the endotracheal tube size is given.
• Choose appropriate mechanical ventilator settings for a pediatric patient.
• Interpret arterial blood gas results.
• Complete a patient assessment and make appropriate mechanical ventilator changes in accordance to the patient assessment findings.
THE PATIENT
You are called to the ED to await the arrival by ambulance of a 31 wk 1100 grams baby girl delivered in the field by EMS. The patient was intubated in the field and manually ventilated.
Write a Narrative (No question and answer format please) case study that answers the following questions:
What should you do to prepare for this patient?
Upon arrival the patient appeared to be in severe respiratory distress with peripheral cyanosis. The patient’s oxygen saturation is 88%. A CXR is done. The physician asks for your assistance in administering surfactant to the patient. Describe the procedure and the equipment you will need.
Following the procedure, what additional actions should be taken?
(any appropriate procedures that should be performed)
What size ETT will you expect to be used in this patient?
How do you assure ETT placement?
Next the physician requests that you to set the ventilator on the appropriate settings.
What ventilator settings do you choose?
• Mode =
• PIP (peak inspiratory pressure) or VT =
• f (frequency) =
• FiO2 (fraction of inspired oxygen) =
• PEEP (positive end expiratory pressure) =
• IT (inspiratory time) for PC (pressure control) =
• Or Flow for VC (volume control) =
• Alarms=
How do you assess the appropriateness of these ventilator settings?
Assuming that an ABG was obtained prior to intubation, provide, interpret and explain the results (must fit the clinical situation)
What else do you need to assess the patient at this point?
pH = 7.30; PaO2 = 62 PaCO2 = 58 HCO3 28 SaO2 = 93%;
Interpret, explain the results (must fit the clinical situation) and take appropriate steps to correct it.
The patient is moved to the NICU. What other lab, medication, test, and therapies are you expecting the medical staff to order?
The patient remained initially stable. However, 36 Hours later, PIP increased to 45 cm H2O and ABG results are worsening. The physician asked you to initiate HFOV.
What are you initial setting?
Two hours later an ABG is drawn and the results are as follows:
pH = 7.31; PaO2 =48; PaCO2 = 35; HCO3 18; SaO2 = 89%; drawn on 45% fio2
What adjustments, if any would you make?
Four days later you return to work the unit to find the patient on conventional ventilation. There is an order to wean the patient from mechanical ventilation. How do you assess readiness? How would you proceed (according to your assessment)?
Was weaning successful? Explain Why or Why not?
CASE SUMMARY
In one paragraph (100 to 120 words) provide a summary of the case describing the course of hospitalization from the patient arrival in the ED to the current status of the patient for the benefit of the incoming therapist who has no knowledge of this patient’s case. This case summary should give him/her any information he/she may need in order to care for the patient properly.