Meconium aspiration

Meconium Aspiration Nursing Diagnosis Interventions and Care Plans

Meconium Aspiration NCLEX Review Care Plans

Nursing Study Guide on Meconium Aspiration Syndrome

Meconium aspiration syndrome happens when the newborn displays respiratory distress caused by the ingestion and aspiration of meconium. 

Infants usually start their bowel movement after birth.

However, in some instances, they start producing meconium, their first stool, while still inside the mother’s womb.

This meconium can be ingested by the baby. In most cases, it does not cause any serious concerns.

If aspirated, it can obstruct the airways and lungs causing breathing issues and even infection.  

The prognosis for meconium aspiration syndrome is mostly excellent with very minimal side effects.

Rapid breathing can persist for days in some cases. If breathing problems occur, they normally go away after 2-4 days especially with monitoring and help from the health care team. 

Although severe lung damage is not commonly seen in meconium aspiration syndrome, issues with blood flow to and from the lung can still be noted in some cases.

This can cause what is called Persistent Pulmonary Hypertension of the Newborn or PPHN. 

Causes of Meconium Aspiration

Stress is the main cause of meconium aspiration. Infection, prolonged labor, prolonged pregnancy, and other conditions affecting pregnant women such as hypertension and diabetes can all cause reduced blood and oxygen delivery to the placenta and fetus, and this may result to fetal distress.

If stressed, the fetus usually gasps causing the ingestion and aspiration of amniotic fluid mixed with meconium.

Aspiration of meconium can also happen while the baby is being delivered or immediately after being born. 

Risk factors that increase the likelihood of meconium aspiration include:

  • Pregnancy beyond 40 weeks – the tendency of the fetus producing meconium increases as the pregnancy progresses
  • Reduced oxygen supply- low oxygen saturation causes stress, making the fetus gasp while inside the uterus
  • Diabetes – diabetes can cause issues with blood supply
  • Prolonged and difficult labor
  • Hypertension -issues with blood supply can cause stress to the fetus

Symptoms of Meconium Aspiration

The most prominent symptom of meconium aspiration syndrome is respiratory distress. The following symptoms are usually noted:

  • Low Apgar score
  • Bluish discoloration or cyanosis
  • Rapid breathing
  • Not breathing at all
  • Limpness or weak movements

Diagnosis of Meconium Aspiration

A midwife or a health care provider can perform tests to indicate the possible presence of meconium and if the newborn has meconium aspiration syndrome.

Most of these tests are part of the regular checks done during antenatal visits:

  • Fetal monitor showing a slow or high fetal heart rate. 
  • Green-tinged amniotic fluid when bag of water breaks. 
  • Low APGAR score. 
  • Course and crackly breath sounds on auscultation when baby is born. 
  • Blood gases can be performed and can show the following results:
  • Low blood pH
  • Low oxygen level
  • Increased carbon dioxide
  • Imaging – A chest xray may be performed as well to evaluate the lungs better.

Treatment for Meconium Aspiration

  1. Close monitoring. In some instances, babies who ingested and aspirated meconium are well enough that they do not need any treatment other than constant monitoring. However, if the breathing is compromised then a special team will need to look after the newborn. A newborn’s cry and activity level are the usual indicators if the baby will need further help. If the newborn is not crying and is not active, then the following are commonly performed:
    • Keep the newborn thermos-regulated
    • Stimulate the newborn
  2. Treatment of respiratory distress. If there is an obvious sign of respiratory compromise, an effort to address the breathing problem will be made. A low heart rate is usually noted in the presence of breathing issues as well.
    • Ventilation. The newborn will be ventilated using a bag-valve-mask. Air is pumped through the bag into the mask that is positioned on the newborn’s face covering the mouth and nose. 
    • Hospitalization. The newborn may require stay in the intensive care unit to be watched closely. 
  3. Other treatment methods can also be performed, such as:
    • Antibiotic treatment for possible infection
    • Assistance with breathing if unable to do so on his/her own. Attachment to a ventilator may then be needed to assist breathing. 
    • Oxygen support may be given to keep the levels normal.
    • Intravenous nutritional support may also be given. Breathing issues sometimes prevents the newborn from feeding through the mouth, hence other forms of nutrition delivery needs to be put ion place. 
    • The use of a warmer to maintain the newborn’s body temperature. 
    • In severe cases, the newborn may need to be injected with surfactants to help their lungs breathe. 
    • Also, in severe cases, nitic oxide (NO) can be given per inhalation to help gas exchange in the lungs and to improve blood flow. 
    • An extracorporeal membrane oxygenation (ECMO) may be used.

Prevention of Meconium Aspiration

Preventing meconium aspiration syndrome is centered in achieving a healthy pregnancy.

Regular visits and antenatal check ups will prepare the mother with helpful information regarding meconium and the possible issues that comes with it if ever the fetus ingests it.

-The following advice is commonly given to the mother to take note of:

-Greenish discoloration of the amniotic fluid when the bag of water breaks. 

-Fetal distress noted on fetal monitoring. 

-Presence of other conditions affecting the mother while pregnant such as hypertension and diabetes. 

Nursing Care Plans for Meconium Aspiration

Nursing Care Plan 1

Nursing Diagnosis: Hyperthermia related to inflammatory process or hypermetabolic state secondary to meconium aspiration syndrome, as evidenced by warm skin, an increase in body temperature, and tachycardia.

Desired Outcome: The infant will be able to establish normal core temperature as evidenced by temperature and heart rate within normal range for age.

InterventionRationale
Provide a tepid sponge bath for the infant.To help reduce the core body temperature.
Maintain sterility of the equipment that is used for the care of the infant.To ensure the safety of the infant and reduce the risk for infection.
Avoid sharing equipment with other infants.To reduce the risk of spreading any pathogens.
Administer anti-pyretics as prescribed.To help reduce the core body temperature.

Nursing Care Plan 2

Nursing Diagnosis: Fluid volume deficit related to failure of regulatory mechanism secondary to meconium aspiration syndrome.

Desired Outcome: Patient was able to establish a balance of fluid volume at a functional level as evidenced by adequate urinary output, urine with stable or normal specific gravity, stable vital signs, good skin turgor, moist mucous membranes, and prompt capillary refill and absence of edema.

InterventionRationale
Monitor the vital signs and inform the healthcare team for any alterations.To check for any effects of fluid volume deficit due to increased body temperature.
Moisten the lip and provide daily tepid sponge bath.To provide adequate oral care and skin care to the infant.
Monitor the urine output and its specific gravity.To check for any effects of fluid volume deficit due to increased body temperature.
Administer intravenous fluid replacement as prescribed.To replace any fluid losses.

Nursing Care Plan 3

Nursing Diagnosis: Ineffective Tissue Perfusion related to the altered transport of oxygen across alveolar and on capillary membrane secondary to meconium aspiration syndrome, as evidenced by weak peripheral pulses, peripheral edema, and inadequate urine output.

Desired Outcome: The infant will establish increased perfusion as evidenced by strong peripheral pulses, warm and dry skin, stable vital signs, absence of edema, and adequate urine output.

InterventionRationale
Monitor the vital signs, characteristics of pulse (such as quality and strength), changes in skin color,  status of edema, and inform the healthcare team for any alterations.To monitor the signs of ineffective tissue perfusion.  
Elevated the edematous extremities.To reduce oxygen demand and help manage edema.
Monitor the urine output and its specific gravity.To check for any effects of fluid volume deficit due to increased body temperature.
Administer intravenous fluid replacement as prescribed.To replace any fluid losses.

Nursing Care Plan 4

Nursing Diagnosis: Risk for Interrupted Breastfeeding related to the present condition of the infant, as evidenced by separation of the infant and the mother

Desired Outcome: The mother is able to learn and demonstrate techniques that can be done in order to sustain lactation until breastfeeding is started. She will be able to perform techniques on how to sustain the newborn with breast milk.

InterventionRationale
Demonstrate to the mother the proper use of manual piston-type breast pump. Allow the mother to demonstrate its use in front of the nurse.To help the mother deliver breast milk to the infant more efficiently.  
Inform the mother about scheduling the breast pumping every 3 hours during waking periods.To ensure that there is enough spacing between breast pumping sessions.
Educate the mother on the techniques to effectively store and use expressed breast milk. To ensure the safety and quality of breast milk. 
Provide privacy and a calm environment when the mother is breastfeeding.To promote privacy and relaxation while breast feeding and reduce anxiety levels.
Advice the mother to have enough rest periods and adequate hydration and nutritional intake.To promote the mother’s health and wellbeing while on breastfeeding. 

Nursing Care Plan 5

Nursing Diagnosis: Risk for Impaired parent-infant  attachment related to the physical illness of the neonate and hospitalization

Desired Outcome: The mother is able to demonstrate techniques to improve behavioral organization and attachment of the neonate. After discharge, the parents will both have a satisfactory interaction with the baby.

InterventionRationale
Assess the parent/s perceptions towards the illness of the infant and its effect to his/her growth and development.To allow the parent/s to open up about their feelings and thoughts about meconium aspiration and its effects to the neonate. To establish rapport.
Inform the parents about the child’s growth and development.To ensure that there is enough spacing between breast pumping sessions.
Involve the parent/s in the care of the infant while hospitalized, such as assisting in providing bath, oral and skin care. To improve the relationship between the parent/s and neonate. 
Provide positive feedback when the parents show nurturing behaviors to the infant.To provide re-assurance to the parent/s while caring for their baby.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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