Asian Journal of Healthy
and Science
p-ISSN: 2980-4302
e-ISSN: 2980-4310
Vol. 3 No. April 4, 2024
Nursing Care for
Mrs. D with a Medical Diagnosis of Babies with Low Birth Weight
Nadila Nur Azmi¹,
Uni Wahyuni2, Melati
Puspitasari3, Nugeraha Risdiyanto4, Afni Wulandari 5
1,2,3,4,5Institut
Teknologi dan Kesehatan Mahardika, Cirebon, West Java, Indonesia
Email: nadila.nurazmi331@gmail.com1, uni.wahyuni@mahardika.ac.id2, melatipus13@gmail.com3, nugeraharisdiyanto9@gmail.com4, Afnialifa@gmail.com5
Abstract
Babies with low birth weight is a condition where a baby is born with a
weight of less than 2,500 grams. Such babies face a higher risk of mortality
compared to those born with normal weight due to the immaturity of their organ
systems, including the lungs, kidneys, heart, immune system, and digestive
system. Babies with low birth weight often struggle to adapt to their
environment, leading to instability in physiological functions such as
temperature, heart rate, and oxygen saturation. This can result in hypothermia,
increased heart rate, decreased respiratory frequency, recurrent apnea, and
reduced SpO2 levels. This study aims to describe the nursing care provided to
By.Ny.D, a patient with a medical diagnosis of babies
with low birth weight in the Perinatology Room at Waled Hospital, Cirebon
Regency. A qualitative research design with a case study approach was employed.
The subject of the case study was By.Ny.D, observed over
three days from January 22nd—24th, 2024. The primary
nursing issues identified were ineffective breathing patterns and nutritional
deficits. After three days of nursing care, the study concluded that the
problems of ineffective breathing patterns and nutritional deficits remained
unresolved, necessitating the continuation of the planned interventions.
Keywords: Babies with Low Birth Weight,
Ineffective Breathing Pattern, Nutritional Deficit.
INTRODUCTION
Babies with low birth weight are still a problem because it is one of the factors
causing infant death. According to the World Health Organization (WHO), a baby with low birth weight is a
baby born with a birth weight of less than 2,500 grams
Babies with low birth weight have a serious impact on the quality of future
generations because it can slow down the growth and development of children
Complications that can be
experienced by babies with low
birth weight include asphyxia, aspiration risk, failure to breathe
spontaneously and regularly shortly or a few minutes after birth, hypothermia
or thermoregulatory disorders, nutritional disorders, and the risk of infection
Babies with low birth weight are at high risk of developing ineffective breathing
patterns, where inspiration and/or expiration do not provide adequate
ventilation due to narrowing of the airway or the baby's own pulmonary vascular
imagination
The main cause
of babies with low birth weight is
premature birth (<37 weeks of age), so babies with low birth weight do not have enough time in the mother's
womb to grow and gain weight
According to the World Health
Organization (WHO), in 2020, globally, there are around 5 million neonatal
deaths per year, as much as 98%. There are 4.5 million infant deaths under five
years old, 7.5% of which occur in the first year of life
The role of nurses is very
important to reduce mortality and morbidity due to babies with low birth weight; therefore, providing health education about
pregnancy, fulfilling nutrition during pregnancy, caring for babies with low birth weight, and fulfilling the right
physiological needs will greatly help the growth and development of babies. The
role of nurses is also to carry out nursing care or independent actions and
collaboration in the management of babies with low birth weight, as well as several other nursing actions that are in
accordance with nursing intervention standards.
The data and information
above show that patients with babies with low birth weight diagnosis need more
comprehensive attention and treatment, so nurses are required to increase their
in-depth knowledge of the disease. From this description, the researcher is
interested in conducting a case study by providing nursing care to patients
with babies with low birth weight
diagnoses
to meet patient needs. In accordance with the background that has been stated,
the purpose of this study is to describe nursing care in By.Ny.D
patients with a medical diagnosis of low birth weight (BBLR) in the
Perinatology room of Wales Hospital, Cirebon Regency. The aims of this study
are to assess the effectiveness of current nursing care practices, identify
areas for improvement, and provide recommendations for enhancing patient
outcomes in cases of low birth weight.
RESEARCH
METHODS
This type of research uses
a qualitative approach with case studies as the main method. The subject in
this study is By.Mrs.D has a medical diagnosis of babies with low birth weight. The case study was
carried out in the Perinatology Room of Waled Hospital, Cirebon Regency for 3
days of assessment, namely on January 22nd—24th, 2024.
The data collection method used is through observation, interviews with the
baby's parents, and analysis of documents such as patient medical records.
After the data is collected, the researcher will prepare a nursing care plan
and implement and evaluate the nursing care that has been provided to the
patient.
RESULTS
AND DISCUSSION
Result
The results of the case
study at the assessment stage were obtained by a male patient (By.Ny.D) born on January 18, 2024, with a gestational age of 34
weeks. Mrs. D's baby was born spontaneously with the help of midwives at PONED
PKM Losari, with a birth weight of 1,900 grams and a body length of 45 cm. Baby
Mrs. D is the second child of Mrs. D and Mr. A. Baby Mrs. D was taken to Waled
Hospital, Cirebon Regency, because the baby's condition during childbirth did
not cry immediately, born with babies with low birth weight, the baby had shortness of breath and cyanosis with
an APGAR score of 8. The assessment was carried out on January 22nd,
2024, when the assessment of a 5-day-old baby was done in an incubator, using an
oxygen nasal cannula 3 LPM; the baby was using OGT. Currently, his weight is
1,750 grams, the baby's body length is 45 cm, the head circumference is 30 cm,
the chest circumference is 32 cm, the abdominal circumference is 32 cm, and the
upper arm circumference is 8 cm.
The results of the
physical examination showed that the baby's general condition was weak, the
level of consciousness of the mentis compos, temperature 36.9°C, pulse
127x/min, respiration 45x/min, oxygen saturation 97%. Small baby posture, small
face and lots of lanugo around the face, head shape larger than the baby's
body, soft palpable anterior and posterior fontanelles, clean scalp, no visible
enlargement of the thyroid gland on the neck, weak swallowing reflex,
symmetrical eyes, anemic conjunctiva, non-icteric sclera, isocor pupils, good
eye hygiene, clean baby ears odorless, height and location of ear tips with
outer chantus eye normal, the baby's nose is symmetrical and intact, there is
no septal deviation, there is breathing of the nasal lobes, there is a
milia/miliaria on the cheeks, the mouth is intact, the lips are pink, the
sucking reflex is weak, the rooting of
the baby's reflex is present, the chest shape is symmetrical, there is no
pigeon chest, there is chest retraction when breathing, the baby uses breathing
auxiliary muscles, vesicular lung sounds, no additional breathing sounds such
as wheezing/Ronchi, regular heart sounds, babies use nasal respiratory aids oxygen
nasal cannula 3 LPM, flat abdominal shape, intestinal noise, no distension, no
palpable mass in the abdomen, genetalia there is a penis, testicles there are
2, anus has holes, meconium has come out, baby skin is reddish, baby skin is
thin, skin is warm palpable, baby skin is moist, CRT < 2 seconds, and the integrity of the fingers and toes of
each hand/foot has 5 fingers.
The results of laboratory
support examinations on January 18th, 2024
obtained the results of the baby's blood type, namely O with rhesus +, routine
hematology results obtained hemoglobin values of 20.3, hematocrit 61, platelets
179, leukocytes 16.7, MCV 114.0, MCH 37.0, MCHC 32.4, erythrocytes 5.57,
basophils 1, eosinophils 1, rod neutrophils 0, segment neutrophils 41,
lymphocytes % 49, monocytes % 9 and GDS values 55. Babies receive cefotaxime
drug therapy 2 x 85 mg intravenously and an infusion of erisanbe 4 x 0.5 ml.
After
conducting data analysis, it was obtained that the nursing diagnosis that appeared
in the case was ineffective breathing pattern b.d impotence ddd nasal lobe
breathing in the baby, nutritional deficit b.d inability to digest food d.d
weak sucking and swallowing reflexes, and risk of hypothermia d.d low birth
weight.
The nursing care plan is
made and prepared in accordance with the Indonesia Nursing Standards (SDKI,
SLKI, and SIKI) and then will be implemented in accordance with the nursing
diagnoses that have been determined for 3x24 hours of treatment. The
implementation of nursing diagnosis of ineffective breathing patterns consists
of monitoring breathing patterns, monitoring additional breathing sounds,
monitoring the frequency, rhythm, depth, and effort of breathing, monitoring
oxygen saturation, sucking on the self-suction for less than 15 seconds if
necessary, providing nesting positions, and administering oxygen. The
implementation carried out in the nursing diagnosis of nutritional deficit such
as monitoring the amount of nutrients entered, monitoring the baby's weight,
monitoring the presence of nausea and vomiting, assessing the baby's ability to
suck and swallow, checking residues, providing nutrients such as special babies with low birth weight
formula
milk through an OGT hose. The implementation carried out in the nursing
diagnosis of hypothermia risk such as monitoring the baby's body temperature,
monitoring the baby's vital signs, monitoring skin turgor, and keeping the
baby's body warm/providing a warm environment.
The nursing evaluation of
Mrs. D's baby is carried out after 3x24 hours of care, which will be discussed
and included in the discussion.
Discussion
Ineffective Breathing
Patterns
In
the case of Mrs. D's babies with low
birth weight, the patient was using an oxygen
nasal cannula 3 LPM. The baby appeared weak, had a respiration rate of 45x/min,
exhibited nasal flaring and chest retraction during breathing, and used
accessory muscles for respiration. Vesicular breath sounds were present without
additional sounds like wheezing or rhonchi. These observations indicate an
ineffective breathing pattern, where inspiration and/or expiration do not
provide adequate ventilation (Tim Pokja SDKI DPP PPNI, 2018).
One
of the interventions implemented was positioning the baby in a nesting
position. Adjusting the sleep position of newborns is a key role of neonatal
nurses in providing routine care. Incorrect positioning can lead to changes in
physiological status, such as increased respiratory rate, pulse frequency, and
decreased oxygen saturation. Conversely, correct positioning can improve sleep
quality and increase clinical outcomes, including improved lung function and
increased oxygen saturation. Research from various countries supports that
nesting positioning can optimize lung function in premature babies
Nursing
care for ineffective breathing patterns showed improvements in oxygenation
status, including pulse, respiration, and body temperature, following the
implementation of nesting positioning. This technique requires special
attention and expertise to create a comfortable position for the baby, using a cloth
to support the head, chest, hands, and feet, making the baby feel as though it
is being hugged, which can provide calmness and comfort despite the use of
breathing aids
Evaluation
of Mrs. D's baby after 72 hours of treatment on January 25, 2023, showed
subjective results that could not be studied, and objective results included
the continued use of an oxygen nasal cannula at 3 LPM, a respiration rate of
38x/min, and oxygen saturation of 99%. Nasal flaring and chest retraction were
still present, and accessory muscles were still being used. The assessment
concluded that ineffective breathing patterns had not been resolved, and the
plan was to continue the current interventions.
Nutrient Deficit
Mrs.
D's baby was using an orogastric tube (OGT) and was fasting on the first day of
assessment due to cloudy residue in the OGT tube. The baby had weak sucking and
swallowing reflexes and experienced weight loss from 1,900 grams at birth to
1,750 grams during treatment. This indicated a nutritional deficit, where the nutritional
intake was insufficient to meet metabolic needs (Tim Pokja SDKI DPP PPNI,
2018).
Providing
adequate nutrition to premature babies with low birth weight is crucial. It is
expected that proper nutrition will help these babies achieve growth and
development comparable to full-term babies and lead to a good quality of life.
Challenges in providing nutrition arise due to the weakness and underdeveloped
organ function of premature infants, making oral nutrition difficult. Breast
milk is particularly important as it fulfills the nutritional balance required
for growth and development and is easily digestible. It contains essential
nutrients like proteins, carbohydrates, fats, vitamins, and minerals and also provides protection against infections and diseases
while aiding in the immune system and brain development
The
intervention for diagnosing nutritional deficits included monitoring nutrient
intake, assessing the baby's ability to suck and swallow, checking for residues
in the OGT, and providing nutrition through the OGT. This implementation was
carried out over 72 hours. On the first day, cloudy residue in the OGT tube
prevented the administration of breast milk. The baby had weak sucking and
swallowing reflexes, cried frequently, and was in an incubator. By the second
day, there was no cloudy residue, and the baby received 2x5 cc of breast milk
per shift through the OGT without vomiting, although the sucking reflex was weak and the swallowing reflex was moderately strong. By the
third day, no cloudy residue was present, and the baby received 2x5 cc of
breast milk per shift through the OGT, showed good sucking reflex and strong
swallowing reflex, and did not vomit.
Nursing
care for the nutritional deficit diagnosis showed a weight gain of
approximately 100 grams after 72 hours of intervention, although the baby’s
weight remained low. Consequently, the intervention was continued. The
summative evaluation on January 25th, 2023, indicated that the baby
was still using the OGT, receiving 5 cc of breast milk through the tube, and
did not vomit. There was no residue, and the baby demonstrated good sucking and
strong swallowing reflexes. However, the nutritional deficit problem was not
fully resolved, and the intervention continued.
CONCLUSION
In
the above case, the nursing problems found were ineffective breathing patterns
and nutritional deficits. Nursing care plans are made in accordance with
Indonesia's Nursing Intervention Standards. The implementation is carried out
on Mrs. D's baby for 3x24 hours of care, where the implementation is carried
out in accordance with the nursing care plan that has been made. The results of
the evaluation after 3 days of treatment found that the nursing problem of
breathing patterns was ineffective and the nutritional deficit had not been
resolved, so the intervention was still continued as
planned.
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Copyright holders:
Nadila Nur Azmi, Uni Wahyuni, Melati
Puspitasari, Nugeraha Risdiyanto, Afni Wulandari (2024)
First publication right:
AJHS - Asian Journal of Healthy
and Science
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