Name: Carla Navarro
Critical Thinking Map
Medical Diagnosis:
Pathophysiology (In your own
words):
Left pulmonary hypoplasia
-The lungs (left lung in this
case) do not form properly.
Concept(s):
-Chronic hypercapnic and
hypoxemic respiratory failure
-Cardiac Dysfunction
-Pulmonary hypertension
Exemplar(s):
-Breathing difficulties
-high blood pressure
-mechanical ventilation
Complications/Potential
Complications (Physiologic
Adaptation(s)/Reduction of
Risk Potential):
-Chronic lung disease,
-Growth retardation,
-Recurrent respiratory
infections,
-Chest wall deformities,
-Hearing deficits,
-Inability to feed,
-pneumothorax
-Death (in most pediatric
cases)
Date: April 11, 2022
Psychosocial Concerns
(Psychosocial Integrity):
-Caregiver role strain (if the
patient survives) due to long
term follow up and care of
condition and related
conditions.
-Parents socially withdrawal
from friends/family or from
baby due to inability to handle
seeing baby in this condition or
having to discuss the matter.
-Depression/anxiety in parents
relating to needing to make
ethically informed decisions
about their baby.
-Financial concerns from
parents due to numerous
amounts of procedures and
screenings that need to be
performed on baby.
Name: Carla Navarro
Critical Thinking Map
Assessment (Physiological Adaptation)
**performed by the student
Date: April 11, 2022
General:
V/S:
W: 4.49 kg
RR: 42 br/min
MAP: 76mmHG
BP: 108/62
SPO2: 92% oxygen therapy
Bag valve mask
F/R: 33L/min
Temp: 97.7
HR: 137bpm
Appearance: Ill
Hydration: WNL
Skin: normal for ethnicity
Eye: pupils are equal, round, and reactive to light, normal to conjunctiva
HENT: normocephalic, anterior fontanelle open/soft/flat
Throat: trachea in place.
Resp: symmetrical chest wall expansion
RR: 42 br/min
Pattern: regular
Breath sounds: coarse bilaterally
Support: vent (nitric oxide 5ppm)
Cardiovascular: Normal rate, reg rhythm, good pulses equal in all extremities.
GI: soft, nondistended
Musculoskeletal: Normal ROM, no deformity
Integumentary: Warm, dry
Neurologic: normal motor function. No focal deficits
Sedated and neuromuscularly paralyzed with medication.
Attempts made as recommended by provider to be weaned off of neuromuscular
Name: Carla Navarro
Critical Thinking Map
Date: April 11, 2022
paralysis, complicated with repeated episodes of de-sats and poor MV.
Respiratory support via vent support (cont. goal is that SPO2 >80%).
Steroid was increased by provider to minimize inflammation/fibrosis.
Diuretics were prescribed for improved fluid balance.
Patient has IV access @ L radial artery RLE Picc, RUE Picc
Labs and Diagnostics (Reduction of
Risk Potential)
BMP:
Na+ = 137
K+ = 4.1
Cl = 87
CO2 = 39
Glucose level = 108
BUN = 16
Creatinine = 0.12
Mag = 2.0
Calcium = 10.5
Albumin = 4.1
Alk Phos = 368
AST = 35
ALT = 38
Bili Total = 1.2
Planning and Goals (short term and long
term goals)
**Actual priority problems with
prioritized goals
At risk for impaired gas exchange related to tissue damage as evidenced by hypoxemia:
-Infant/child will maintain clear lung fields and remain free of signs of respiratory
distress throughout the entire shift today.
At risk for infection related to chronic respiratory distress:
-Infant will not experience a respiratory infection throughout remaining hospitalization
stay.
Name: Carla Navarro
Critical Thinking Map
Date: April 11, 2022
Nursing Interventions (Basic Care and
Comfort, Safety and Infection Control)
**What did the student/nurse perform
throughout the day
-Assessed respiratory rate, depth, and effort including rapid breathing, use of accessory
muscles, grunting sounds and flaring of nostrils.
-Observed for any changes of skin color especially capillary refill and color of mucous
membranes.
-Assessed oxygen saturation using pulse oximetry during feedings, sleeping, and crying.
-Assisted with trachea care by suctioning fluid buildup.
-Assisted with removal of secretions through suctioning via sterile technique.
-Assessed for rise in temperature or diminished breath sounds.
-Changed the baby’s diaper to keep baby clean and dry.
Evaluation of Interventions
-Infant/child remained with clear lung fields and free of signs of respiratory distress
throughout the entire shift today.
-The infant remained free of experiencing a respiratory infection throughout the entire
shift however, it is unknown as to whether or not the infant remained this way
throughout the rest of her hospitalization stay.
Name: Carla Navarro
Medication Name
(Generic) and Drug
class
Critical Thinking Map
Patient’s Dose,
Route, and
Frequency
Methylprednisolone 4mg = 0.4mL, IV
(corticosteroid)
push, Soln-Inj Q6hinterval
Furosemide
(Diuretic)
5mg = 0.5mL, IV
piggyback, Q6h,
1mg/kg
Date: April 11, 2022
Why is patient
receiving this
medication?
Nursing
considerations
(labs, assessment,
etc.)
Side effects and
Major adverse
effects
Patient Teaching
Glucocorticoids are
effective in the
treatment of chronic
lung disease of
prematurity and
regulate the
inflammatory
response
Assess for
potassium
depletion,
hypertension,
edema and cardiac
symptoms.
Mood changes
Behavior changes
Hypertension
Renal Impairment
Epilepsy
Increase potassium,
calcium, and
protein intake.
Prescribed to
infants with chronic
lung disease to
improve pulmonary
mechanics.
Monitor daily
weights, intake and
output ratios,
amount and location
of edema, lung
sounds, skin turgor,
and mucous
membranes.
Hypotension,
Dehydration,
Vascular clot
formation,
Ototoxicity
(tinnitus, hearing
impairment,
deafness, vertigo,
and sense of
fullness in ears).
Do not discontinue
suddenly.
Name: Carla Navarro
Critical Thinking Map
Date: April 11, 2022
Name: Carla Navarro
Critical Thinking Map
Date: April 11, 2022
Patient Teaching (Health Promotion, Safety and Infection Control, and Management of Care):
Educate parents:
Pulmonary hypoplasia does present a lot of challenges. At times this might feel overwhelming. You don’t have to go it alone. The
doctors, nurses, social workers, and other members of the care team are here to help you and your baby. Please approach any of
them about resources that can be of help to you and your family.
You play a big role in your baby’s treatment. Keep a record in a notebook or in your phone of:
-your baby’s procedures, medicines, and any symptoms that you notice the baby is experiencing.
-any questions you have for the care team.
Also, please practice safe infection prevention strategies before making direct contact with your baby (e.g., washing hands before
touching the baby, limiting the number of people who come into contact with your baby, and ensuring baby’s diaper is changed
when wet or soiled).
Patient Summary (SBAR Format):
S-A 3-month-old baby in the PICU has been recently experiencing episodes of hypoxemia when agitated/moving.
B-Baby has been admitted to the PICU since birth due to being born with left pulmonary hypoplasia.
A-General:
V/S:
W: 4.49 kg
RR: 42 br/min
MAP: 76mmHG
BP: 108/62
Name: Carla Navarro
Critical Thinking Map
Date: April 11, 2022
SPO2: 92% oxygen therapy
Bag valve mask
F/R: 33L/min
Temp: 97.7
HR: 137bpm
Appearance: Ill
Hydration: WNL
Skin: normal for ethnicity
Eye: pupils are equal, round, and reactive to light, normal to conjunctiva
HENT: normocephalic, anterior fontanelle open/soft/flat
Throat: trachea in place.
Resp: symmetrical chest wall expansion
RR: 42 br/min
Pattern: regular
Breath sounds: coarse bilaterally
Support: vent (nitric oxide 5ppm)
Cardiovascular: Normal rate, reg rhythm, good pulses equal in all extremities.
GI: soft, nondistended
Musculoskeletal: Normal ROM, no deformity
Integumentary: Warm, dry
Neurologic: normal motor function. No focal deficits
Sedated and neuromuscularly paralyzed with medication.
Attempts made as recommended by provider to be weaned off of neuromuscular paralysis, complicated with repeated episodes of
de-sats and poor MV.
Respiratory support via vent support (cont. goal is that SPO2 >80%).
Steroid was increased by provider to minimize inflammation/fibrosis.
Diuretics were prescribed for improved fluid balance.
Name: Carla Navarro
Critical Thinking Map
Date: April 11, 2022
Patient has IV access @ L radial artery RLE Picc, RUE Picc
R-Continue PICU care and management of respiratory failure along with medication administration continuation. Maintain IV
access.