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Questions and Answers
What is the most common cause of respiratory failure in preterm neonates?
What is the function of surfactant in the lungs?
Which factor predisposes a neonate to respiratory distress syndrome?
What is a common clinical manifestation of respiratory distress syndrome?
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What happens to the alveoli at birth when crying creates negative pressure?
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Which diagnostic test is commonly used to confirm respiratory distress syndrome?
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What is the therapeutic management for a child with ARDS?
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What is a common nursing diagnosis for a child with ARDS?
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What interventions are involved in caring for a child with ARDS in the ICU?
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How can HMD (RDS) be prevented?
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What is the prognosis of RDS if it is mild with no complications?
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Why is nipple and gavage feeding contraindicated in situations with marked increase in respiratory rate?
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Study Notes
Respiratory Distress Syndrome (RDS)
- RDS is a respiratory disorder specific to neonates, resulting from lung immaturity and deficiency in surfactant.
- It is most commonly seen in premature infants.
- RDS is the leading cause of respiratory failure in preterm neonates.
Causes and Predisposing Factors
- Immature development of the respiratory system or inadequate amount of surfactant in the lungs.
- Predisposing factors include:
- Premature infant
- Asphyxia at birth
- Infant of diabetic mothers
- Cesarean Section delivery
- Previous history of hyaline membrane disease (HMD) in sibling
- Multiple pregnancies
Pathophysiology of HMD
- During intrauterine life, the alveoli are collapsed.
- Crying of the neonate at birth creates enough negative pressure to open the collapsed alveoli.
- Surfactant, a lipoprotein material, decreases the surface tension inside the alveoli, preventing their collapse during expiration.
- If surfactant deficient, the alveoli cannot be easily distended during inspiration, leading to respiratory distress and hypoxemia.
Assessment Criteria of RDS
- Clinical manifestations include:
- Tachypnea (80 to 120 breaths/min)
- Substernal retraction
- Fine inspiratory crackles
- Audible expiratory grunt
- Flaring of the nares
- Cyanosis or pallor
- As the disease progresses:
- Flaccidity
- Unresponsiveness
- Apnea
- Diminished breath sound
Diagnostic Tests
- Chest x-ray shows congested lung field with a ground-glass appearance, representing alveolar atelectasis.
- Respiratory and metabolic acidosis is determined by blood gas analysis.
Therapeutic Management
- Maintain adequate ventilation and oxygenation
- Oxygen should be warmed and humidified
- Maintain a neutral thermal environment
- Maintain acid-base balance by correcting respiratory acidosis through assisted ventilation and correcting metabolic acidosis by IV administration of sodium bicarbonate.
- Maintain adequate hydration and electrolytes level
- Nutrition is provided by parenteral therapy during the acute stage
- Surfactant therapy is installed in the trachea
- Nipple and gavage feeding are contraindicated in any situation that creates a marked increase in respiratory rate.
Nursing Diagnosis and Interventions
- Infective breathing pattern related to surfactant deficiency, alveolar instability, and pulmonary immaturity.
- Impaired gas exchange related to immature alveolar structure and inability to maintain lung expansion.
- Ineffective airway clearance related to obstruction or inappropriate positioning of endotracheal tube.
- Risk for injury related to acid-base imbalance, oxygen levels, carbon dioxide levels from mechanical ventilation.
- Interventions include:
- Close monitoring of oxygenation and respiratory status
- Frequent measurement of neonate’s vital signs
- Assessment of cardiac output, perfusion, fluid and electrolyte balance, and renal function
- Blood gas analysis, acid-base status, and pulse oximetry are important evaluation tools
- Skin inspection and care
- Changing position
- Mouth care
- Nutritional support
- Suctioning is performed only as necessary
Prevention and Prognosis
- Prevention of HMD (RDS):
- Prevention of premature delivery
- Administration of corticosteroids to the mother (24 hours to 7 days before delivery)
- Prophylactic administration of artificial surfactant into the trachea of premature neonate
- Prognosis of HMD (RDS):
- RDS is a self-limiting disease if mild, and following a period of deterioration (approximately 48 hours) and in the absence of complications, affected neonates begin to improve by 72 hours.
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Description
Test your knowledge on Respiratory Distress Syndrome (RDS), a respiratory disorder specific to neonates resulting from lung immaturity and surfactant deficiency. Learn about the causes, symptoms, and predisposing factors of RDS in premature infants.