Baby was born via C-section with symptoms of perinatal asphyxia including no crying, grunting sounds and a low Apgar score. The baby is currently in the SNCU being treated for perinatal asphyxia. Nursing care plans to address ineffective breathing patterns, risk of infection, fluid deficits and family knowledge deficits. Treatments include oxygen, monitoring of breathing and vital signs, feeding support and family education.

1. ABHILASHI COLLEGE OF NURSING
CASE PRESENTATION
ON
PERINATAL ASPHYXIA
SUBMITTED TO SUBMITTED BY
Mrs. Pallavi Mehra Mrs. Swati Sharma
Associate professor (child health nursing ) M.Sc nursing 1st year
Abhilashi college of nursing Abhilashi college of nursing
SUBMITTED ON:

2. IDENTIFICATION DATA
Name: Baby of Geeta Devi
Sex: male
Date of admission: 4 June 2022
Date of birth: 4 june 2022
Time of birth: 11:19 A.M.
Birth weight: 2.8 kgs
Ward: SNCU
CR Number: 9853
Address: Vill. Banayat P.O. Randhara Teh. Sadar Distt. Mandi Himachal Pradesh
Religion: Hindu
Education: 10th pass
Monthly income of family: 20,000
Diagnosis: Perinatal Asphyxia
CHIEF COMPLAINTS
Baby was born in Zonal Hospital Mandi on 4 june 2022 with the complaints of
 Heart rate was not audible

3.  Baby did not cried after birth
 Grunting sound was present
HISTORY OF PRESENT ILLNESS
PRESENT MEDICAL HISTORY
Baby was born on 4th june , 2022 at 11:19 AM. Baby cried immediately after birth. Apgar scoring was 4 on 1min and 7 at 5 mins.
Baby did not responded to tactile stimulation so bag and mask ventilation was provided to baby for 30 seconds. Heart rate reached at
109 beats per minutes but baby was cyanotic so baby was put on oxygen.
PRESENT SURGICAL HISTORY
There is no relevant surgical history.
HISTORY OF PAST ILLNESS
PAST MEDICAL HISTORY
There is no significant past medical history.
PAST SURGICAL HISTORY
There is no past surgical history.
TRAUMA
There is no history of any kind of fractures or bruises during birth or after birth.
BIRTH HISTORY
G1 P1 A0 L1
ANTENATAL HISTORY

4. First Trimester
Pregnancy was confirmed by UPT at 15th Day. History of vomiting , Nausea , USG done. History of folic acid present.
Second trimester
Quickening felt at 4th month. T1 T2 covered. Iron and calcium supplements taken.
Third trimester
History of Ultrasonography done at 7th and 9th month of pregnancy.
NATAL HISTORY
Baby delivered by lower segmental cessarian section at 39weeks+5days of gestation.
POST NATAL HISTORY
No complaints was reported by mother in postnatal period. Baby did not cried after birth for 30 seconds.
IMMUNIZATION HISTORY
There was no immunization history.
DIETARY HISTORY/FEEDING HISTORY
Baby is on orogastric feed 8ml/3 hrly.
PERSONAL HISTORY
Hygiene good
Sleepand rest adequate i.e, 16-18 hours per day.
Elimination passes stool 5-6 times per day and passes urine adequately.

5. FAMILY HISTORY
Family tree KEY:
MALE
FEMALE
PATIENT
Family composition
Name Age/sex Relation with
baby
Education Occupation Income Health status
Mr Rajender
kumar
30 years/M Father 10th pass Labourer 20,000 Healthy
Mrs Geeta Devi 26 years/F Mother 10th pass Housewife - Healthy
Baby of Geeta 1/365days Patient - - - Perinatal
asphyxia
Type of family: nuclear
&Support person: father and mother

6. Food preferences: Roti, dhal& sabji.
Food allergy: No allergy from any food to family
Fluids: Family takes enough water
Tea/ coffee: Family prefers tea.
HISTORY OF ILLNESS IN FAMILY
There is no history of any disease like Tuberculosis, Diabetes Mellitus, Hypertension etc. in family.
SOCIAL DATA
Social economic status
Family monthly income – Rs. 20,000
Housing type:
Toilet: Indian
Electricity: Electricity facility available
Drinking water source : Tap water
Pattern of health care: PHC is present at 2km distance
Transport facility: Available
INVESTIGATION
S.NO DATE INVESTIGATION PATIENT VALUE NORMAL
VALUE
REMARKS
1. 04-06-2022 Haemoglobulin 18.1gm/dl 16-20 gm/dl Normal

7. 2. 04-06-2022 WBC COUNT (TC) 27.0 4-11/cu.mm Abnormal
3. 04-06-2022 Platelet count 1.98 lacs 1.5-4.5 lacs Normal
4. 04-06-2022 Bilirubin 0.76 mg/dl 0.10- 0.30 mg/dl Normal
MEDICATION
S.NO TRADE NAME PHARMCOLOGICAL
NAME
DOSE FREQUENCY ROUTE ACTION
1. Inj. Cefotaxim Taxim 125 mg BD IV Antibiotics
2. Inj calcium
gluconate
Calcium gluconate 2ml BD IV Antiarrhythmic
PHYSICAL EXAMINATION
1. Anthropometric measurements
Weight 1.925 kg
Length 48cm
Head circumference 34cm

8. Chest circumference 31cm
2. Vital signs
Temperature: 102◦F
Pulse rate: 148/min.
Respiratory rate: 50/min.
Blood pressure 65/30 mm of hg
3. Skin
Color blue
Lenugo present on forehead, shoulder and buttocks
Vernix caseosa absent
Texture normal
Edema Absent
Mangolian spots Absent
Milia present over nose and cheeks
4. Head
Shape symmetrical
Size normal
Fontanelles open and present
Caput succedenum Absent
Forcep Marks Absent
Encephalocele Absent
Hair Normally distributed
Hair color black
Scalp clear
5. Face
Symmetry normal
Paralysis Absent
Abnormal movements Absent
Milia Present

9. 6. Eyes
edema Absent
Conjuctivitis Absent
Color of Sclera White
Eye lids normal
Discharge Absent
7. Nose
Patency patent
Nasal bridge normal
Nasal discharge Absent
Nasal flaring Absent
Milia present
8. Ear
Size normal
Position normal
Recoil of Pinna normal
Hearing normal
Low set ears Absent
9. Mouth
Lips moist
Color blue
Cleft lip/palate absent
Tongue tie absent
Extra teeth absent
Oral teeth absent
10. Neck
Mobility poor
Stiffness absent
Webbed neck absent

10. Skin folds Absent
Range of motion normal
11. Chest
Development of nipple normal
Witches milk absent
Symmetry normal
Chest expansion poorly expanded. Retractions present
Breath sounds variable sounds present
Auscultation grunting present
12. Abdomen
Distension Absent
Wharton’s jelly present
Veins & arteries 2 arteries 1vein
Umbilical cord no infection
Bowl sounds present
13. Genetalia
Testis descended
Scrotal sac normal & dark brown in color
Rugae present
14. Hips
Dislocation absent
Gluteal folds present
15. Spine
Spina bifida absent
Tufts of hair absent
Dimple absent
Any other congenital abnormality absent
16. Extremities
Fracture absent

11. Movements poor
Syndactyly / polydactly absent
Club foot absent
17. Neurological assessment
Reflexes
Rooting present
Sucking weak sucking reflex
Blinking present
Swallowing present
Gagging present
Sneezing and coughing present
Doll’s eye present
Palmer grasp present
Stepping/dancing partially developed
Moro (startle) partially complete
Glabbellar tap present
Babinski present
Ventral suspension present
CONCLUSION/INTERFERENCE:
Baby is comfortably lying on the radiant warmer. Body movements are poor. General appearance and the systems of the baby are
normal except respiratory system. Respiratory system has major deviations which are the symptoms of diseased condition. Chest
expansion is not normal sand baby is lethargic. Breathing pattern is altered and so as respirations, which results in dysnea.

12. BIRTH ASPHAXIA
INTRODUCTION-Asphyxia means lack of oxygen. Birth asphyxia happens when a baby's brain and other organs do not get enough
oxygen before, during or right after birth. This can happen without anyone knowing. Without oxygen, cells cannot work properly.
Waste products (acids) build up in the cells and cause temporary or permanent damage.
DEFINITION- Perinatal asphyxia, neonatal asphyxia or birth asphyxia is the medical condition resulting from deprivation of oxygen
to a newborn infant that lasts long enough during the birth process to cause physical harm, usually to the brain.
CAUSES
Some causes of birth asphyxia may include
Book picture Patient picture
 Inadequate oxygenation of maternal blood due to
hypoventilation during anesthesia, heart diseases,
pneumonia, respiratory failure
 Low maternal blood pressure due to hypotension e.g.
compression of vena cava and aorta, excess anaesthesia
 Inadequate relaxation of uterus due to excess oxytocin
 Premature separation of placenta
 Placental insufficiency
 Knotting of umbilical cord around the neck of infant
 Too little oxygen in the mother's blood before or during
birth
 Problems with the placenta separating from the uterus too
soon
 Very long or difficult delivery
 Problems with the umbilical cord during delivery
 A serious infection in the mother or baby
 High or low blood pressure in the mother
 Baby's airway is not formed properly
 Baby's airway is blocked
 The baby's blood cells cannot carry enough oxygen
(anemia)

13. RISK FACTORS
 Increasing or decreasing maternal age
 Premature rupture of membranes
 Meconium-stained fluid
 Multiple births
 Lack of antenatal care
 Low birth weight infants
 Malpresentation
 Augmentation of labour with oxytocin
 Antepartum hemorrhage
 Severe eclampsia and pre-eclampsia
 Antepartum and intrapartum anemia
SYMPTOMS OF BIRTH ASPHYXIA:
Symptoms of asphyxia in a baby at the time of birth may include:
Book picture Patient picture
 Baby is not breathing or breathing is very weak
 Skin color is bluish or pale
 Heart rate is low
 Muscle tone is poor or reflexes are weak
 Too much acid is in the blood (acidosis)
 The amniotic fluid is stained with meconium (first stool)
 The baby is experiencing seizures
 Baby is not breathing or breathing is very weak
 Skin color is bluish or pale
 Heart rate is low
 Muscle tone is poor or reflexes are weak

14. PATHOPHYSIOLOGY
Interruption of placental blood flow
Fetal hypoxia, hypercarbia, and acidosis.
Circulatory and noncirculatory adaptive mechanisms exist that allow the fetus to cope with asphyxia and preserve vital organ function
With severe and/or prolonged insults, these compensatory mechanisms fail
Hypoxic ischemic injury, leading to cell death
DIAGNOSIS:
Apgar Score
Signs Indicators 0 1
2
score
Color of skin Appearance All blue, pale
Pink body, blue
hands and feet
All pink
Heart rate Pulse No pulse
Less than 100
beats per minute
More than 100
beats per minute
Reflex response to stimulation of
the nose (by touching it with a
Grimace
No response to
stimulation
Grimace Sneeze, cough

15. finger or a catheter)
Muscle tone Activity
Limp, no
movement
Some bending of
arms and legs
Active movement
Breathing Respiration No breathing Irregular, slow Good cry
Patient score:
Activity/muscle tone
 1 point: limbs flexe
P: Pulse/heart rate
 2 points: greater than 100 beats per minute
G: Grimace (response to stimulation, such as suctioning the baby’s nose)
 0 points: absent
A: Appearance (color)
 1 point: body pink but extremities blue
R: Respiration/breathing
 1 point: irregular, weak crying
Baby score was -5/10
At birth, doctors and nurses check your baby's condition carefully and give a number rating from 0 to 10. This number is called an
Apgar score. The Apgar rates skin color, heart rate, muscle tone, reflexes and breathing effort. A very low Apgar score (0 to 3) lasting

16. longer than five minutes may be a sign of birth asphyxia. A baby who has not had enough blood flow or oxygen to its body may have
abnormal breathing, poor circulation, lethargy (lack of energy), lack of urine output and blood-clotting abnormalities.
TREATMENT
 A= Establish open airway: Suctioning, if necessary endotracheal intubation
 B= Breathing: Through tactile stimulation, PPV, bag and mask, or through endotracheal tube
 C= Circulation: Through chest compressions and dedications if needed
 D= Drugs: Adrenaline .01 of .1 solution
 Hypothermia treatment to reduce the extent of brain injury
Babies with mild asphyxia at birth are given breathing support until they can breathe well enough on their own, and then are closely
monitored.
Babies with more serious asphyxia may need mechanical ventilation (a breathing machine), respiratory therapy, fluid and medicine to
control blood pressure and prevent seizures. Doctors may need to delay feedings to give the baby's bowel time to recover.
When needed, we can provide these advanced treatment options:
 High-frequency ventilation is a form of more gentle mechanical ventilation (breathing assistance) that sends small, rapid puffs
of air into your baby's lungs. It is used instead of conventional breathing machines, which sometimes need high pressure and
thus may damage fragile newborn lungs.
 Inhaled nitric oxide is used to treat respiratory failure and high blood pressure in the lungs (pulmonary hypertension). Nitric
oxide is given directly through a breathing tube into the windpipe. This helps the lungs' blood vessels open (dilate) so they can
carry oxygenated blood into the body.
 Hypothermia. Research shows that cooling the baby's internal body temperature to 33.5 degrees C (about 91 degrees F) for up
to 72 hours can help protect the baby's brain from damage during the second stage of asphyxia. This stage, called

17. "reperfusion," is when normal blood flow and oxygen are restored to the brain. This treatment works best if it is started within
six hours after birth and can reduce brain damage. The baby must be at least 36 weeks' gestation (not more than four weeks
early) to qualify for this treatment.
 Extracorporeal membrane oxygenation (ECMO) is a form of extracorporeal life support. ECMO uses a heart-lung pump to
provide temporary life support when a baby's heart or lungs aren't functioning properly or need time to heal. With ECMO,
oxygen-poor blood is drawn into a machine that removes excess carbon dioxide, adds oxygen and then returns the oxygen-rich
blood to the baby's body. While on ECMO, your baby will be sedated and closely monitored by a nurse and an ECMO
specialist.
NURSING CARE PLAN
SNO PATIENTS PROBLEMS SOLVED NOT SOLVED PARTIALLY
SOLVED
1. Difficulty in breathing

2. Hypothermia

3. Not accepting feeds

4. Risk of infection

LIST OF NURSING DIAGNOSIS
1. Ineffective breathing pattern related to immaturity of respiratory organs as evidenced by tachpnea.
2. Risk of infection related to prematurity as evidenced by investigations.
3. Fluid volume deficit related to inadequate oral intake, vomiting , tachypnoea as evidenced by dehydrated skin and cracked lips.

18. 4. Knowledge deficit related to condition of the child as evidenced by question of the mother.
5. Altered family process related to situational crisis

19. ASSESSMENT NURSING
DIAGNOSIS
GOALS PLANNING RATIONALE IMPLEMENTATION EVALUATION
Subjective data:
Nurse informed
that baby did note
cried after birth
Objective data:
Respiratory rate
78b/min
Ineffective
breathing
pattern related
to immaturity
of respiratory
organs as
evidenced by
tachpnea.
Maintain
normal
breathing
pattern
 Assess the rate
and depth of
respirations.
 Administer
oxygen.
 Assess for chest
movements.
 Assess for any
signs of
cyanosis.
 Elevate the head
of the baby by
proving shoulder
roll.
.
 Helps in
knowing the
rates and
depth of
respiratons.
 Maintains
oxygen
saturation.
 Assess for
abnormal
chest
expansion.
 Helps in
assessing
early signs of
cyanosis.
 Helps in
promoting
normal
breathing
pattern.
.
 Rate and depth of
respiration
assessed.
 Oxygen
administered.
 chest movements
assessed.
 Check color of
nails, extrimities,
or tongue.
 Head of the baby
elevated.
Breathing pattern is
maintained. Now
respiratory rate is
32bb/min.

20. ASSESSMENT NURSING
DIAGNOSE
GOALS PLANNING RATIONAL IMPLEENTATION EVALUATION
Subjective data:
Nurse informs that
that baby feels
warm.
Objective data:
Temperature
100°C
Risk of
infection
related to
prematurity
as evidenced
by
investigations
Reduce the
chances of
infection in
baby.
 Assess the
condition of
baby.
 Monitor vital
signs 1 hrly.
 Monitor for
signs of
infection.
 Use aseptic
technique while
doing any
procedure.
 Hand washing
done before and
after procedure.
 Condition of
baby is
assessed.
 Tells about
the condition
of child.
 Help in
knowing
early signs
of infection.
 Prevent from
infection.
 Prevent
cross
infection.
 Help in forming
baseline data.
 Temp. - 100°C
Pulse- 146b/m
Resp.- 36b/m
 Signs of
infection
monitored like
temperature.
 Aseptic
precautions
followed.
 Hand

21. ASSESMENT NURSING
DIAGNOSIS
GOALS PLANNING RATIONALE IMPLEMENTATION EVALUATION
SUBJECTIVE
DATA:
Nurse informs
that baby had
four episodes of
vomiting and is
not tolerating
feed properly.
OBJECTIVE
DATA:
Baby’s skin looks
dull dehydrated.
Lips are cracked.
Fluid volume
deficit related
to inadequate
oral intake,
vomting, as
evidenced by
dehydrated
skin and
cracked lips.
To maintain
normal body
fluids s per
body’s
requirements.
 Record intake and
output charting.
 Monitor fluid
balance, skin
turgor, rapid pulse
and vital signs.
 Keep drip infusion
accuracy according
to the program.
 Perform oral
hygiene.
 Apply emollient
over cracked lips.
 To get the
base line
data.
 To know the
intensity of
deficiency
of fluids and
to know the
status of the
body.
 Accuracy
will help to
maintain
normal body
fluid
requirement.
 Oral
hygiene
reduces
infection.
 To provide
moisture to
the lips as
well as to
heal cracked
lips.
 Intake output of
fluids recorded.
 Monitored fluid
balance, skin
turgor and vital
signs.
 Accuracy of drip
infusion is
maintained.
 Oral hygiene
performed.
 Emollient i.e,
glycerine is
applied over lips.
Normal body
fluids
maintained as
per body’s
requirements.

22. ASSESMENT NURSING
DIAGNOSIS
GOALS PLANNING RATIONALE IMPLEMENTATIONS EVALUATION
SUBJECTIVE
DATA: baby’s
mother says that
she want to know
about baby’s
treatment and
medication.
OBJECTIVE
DATA: Mother
asks about baby’s
treatment and
condition.
Knowledge
deficit related
to condition of
the baby as
evidenced by
mother’s
question.
Improve the
knowledge of
baby’s
mother
regarding
baby’s
condition.
 Explain about the
condition of the
baby to the mother.
 Teach the mother
about medications
and its side effects .
 Teach mother of
about feeding and
its benefits.
 Teach mother
about reasons for
various therapeutic
procedures.
 Explaining
disease
condition
will help
mother
knowing the
condition of
the baby.
 It helps in
preventing
cessation of
medication
 Mother will
know about
the benefits
of exclusive
breast
feeding.
 It will
increase the
confidence
of mother
and will
make her
comfortable.
 Diseased condition
of the baby is
explained.
 Mother is taught
about time, action
and side effects of
medication.
 Mother is taught
about feeding and
benefits of
exclusive breast
milk.
 Mother is taught
about the reasons
for various
therapeutic
procedures.
Knowledge of
child mother is
improved.

23. ASSESMENT NURSING
DIAGNOSIS
GOALS PLANNING RATIONALE IMPLEMENTATION EVALUATION
Subjective data;
Parents are anxious
about the condition
of child.
Objective data:
Parents look
anxious, confused.
Altered family
process related
to situational
crisis.
Prepare
parents for
home care.
 Anticipate grief
reaction.
 Explore
family’s
feelings
regarding their
child and their
ability to cope
with situation.
 Encourage the
family
members to ask
questions and
clarify the
doubts.
 It will help in
adjustment.
 Provide
psychological
support to the
family.
 Reduces
anxiety.
 Grief reaction
was anticipated.
 Family feelings
was explored
regarding child
and their ability
to cope with
situation.
 Family members
are encouraged
to ask questions
and clarify
doubts.
.

24. HEALTH EDUCATION
1. EXCLUSIVE BREAST FEEDING
 Give only breast milk to the baby as it has many benefits for the baby as well as for mother.
 Avoid formula feed.
 Give feed every 2 hourly to the baby.
2. HYGIENE
 Maintain the hygiene of the baby as well as of mother.
 Maintain skin care.
 Maintain cord hygiene.
 Always do hand washing before touching the baby.
 Clothes of the baby should be clean.
3. FOLLOW UP
 Come for follow up to hospital.
 Immunize the baby as per schedule in your nearby center.
 Routine follow up to clinic and health agencies.

25. PROGRESS NOTES
Day 1
Increased body temperature of the baby is maintained.
Day 2
Breathing difficulty is reduced as cough is reduced and normal sleeping pattern maintained.
Day3
Activity of baby improved by the third day.
Health education
Sr.
No.
Topic Content
1. Hygiene  I educated the mother thatalways do the hand washing before and after touching the baby. After doing the hand washing
applied hand sanitizer on the hand. I also told her that tell the same thing to other relatives in home. It helps to prevent the
baby from the infection. I also taught the mother that always change the diaper of the baby timely because it can develop
the rashes over the skin and after cleaning the clothes of the baby , provide proper sunlight to the clothes and it helps to kill
the infectious agent which can cause the infection to the baby.
2 Breast feeding Mother was educated regarding the importance of the breast feed for the baby. I taught the mother that mother milk help to
prevent the baby from the infection as the child is not having mature immune system so mother’s milk help the baby to kill

26. Conclusionand summary-
I Swati student of M.Sc. Nursing 1st year was posted in the of Zonal Hospital Mandi .The patient was admitted in the ward on
04/6/22 and discharged on 07/06/22.The length of the stay of the patient in the hospital was 3days. During the stay in the hospital
the need based care was provided to the patient. The prognosis of the patient was good.
the infectious agent so it is important to provide the breast feed to the baby for 6 months.
3 Immunization Mother was taught that gave all the vaccine to the baby according to the age and according to the age there is vaccines .
4. Developmental
assessment
Mother was educated that assess the milestones of the baby and according to age there is growth and development of the
baby so you can identify the any problem during development of the baby .

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