Jamaica Louise Q.

Macalino BSN 3-A

RESPIRATORY DISTRESS SYNDROME (RDS)

RDS occurs when the lungs are immature. Its seen almost exclusively in premature neonates and carries a high risk of long term respiratory and neurologic complications. What causes it RDS is characterized by poor gas exchange and ventilator failure. Its caused by a lack of pulmonary surfactant, a phospholipid secreted by the alveolar epithelium that normally appears in mature lungs. Surfactant coats the aleveoli, keeping them open so that gas exchange can occur. In premature neonates, the lungs may not fully develop and, therefore, may not have a sufficient amount of surfactant. This leads to: Atelectasis Increased work of breathing Respiratory acidosis Hypoxemia As atelectasis worsens, pulmonary vascular resistance increases which decreases blood flow to the lungs. Blood then shunts from right to left, perpetuating fetal circulation by keeping the foramen ovale and ductus arteriosus patent. The alveoli may become narcotic, and the capillaries may become damaged. Ischemia allows fluid to leak into the interstitial and alveolar spaces, causing a hyaline membrane to form. This membrane hinders respiratory function by decreasing the compliance of the lungs. RDS is a common lung disorder in premature infants. In fact, nearly all infants born before 28 weeks of pregnancy develop RDS. RDS might be an early phase of bronchopulmonary or BPD. This is another breathing disorder that affects premature babies. RDS usually develops in the first 24 hours after birth. If premature infants still have breathing problems by the time they reach their original due dates, they may be diagnosed with BPD. Some of the life-saving treatments used for RDS may cause BPD. Some infants who have RDS recover and never get BPD. Infants who do get BPD have lungs that are less developed or more damaged than the infants who recover. Infants who develop BPD usually have fewer healthy air sacs and tiny blood vessels in their lungs. Both the air sacs and the tiny blood vessels that support them are needed to breathe well. Other names: Hyaline membrane disease

Neonatal respiratory distress syndrome Infant respiratory distress syndrome Surfactant deficiency

Risk factors for RDS include: Prematurity Maternal diabetes Stress during delivery that produces acidosis in the neonate Symptoms Increased in respiratory rate Labored breathing Substernal retractions Rales upon auscultation Expiratory grunting Nasal flaring Cyanosis Apneic episodes Flaccidity Unresponsiveness Exams and Test Blood gas analysis (shows low oxygen and excess acid in the body fluids) Radiographic evaluation (alveolar atelectasis shows diffuse, granular pattern that resembles ground glass and diluted bronchioles shown by darks streaks within granular pattern) Blood, urine, CSF cultures, serum calcium and ABG measurements How its treated RDS treatment after birth is mainly supportive and includes general measures used to treat premature neonates, including: Thermoregulation Oxygen administration Mechanical ventilation Prevention of hypotension Prevention of hypovolemia Correcting respiratory acidosis by ventilatory support Correcting metabolic acidosis with the administration of sodium bicarbonate Parenteral feedings Oxygen therapy Administration of antibiotics, sedatives, paralytics and diuretics Administration of surfactant Glucocorticoid(Celestone) artificial surfactant given at birth before the first breath or after diagnosis of RDS; effective after 72nd hour; hastens lung maturity Nursing Interventions Provide continuous monitoring and close observation

Obtain necessary specimens for laboratory testing Continuous monitoring of pulse oximetry Administer oxygen as ordered Anticipate the need for ventilator support, including mechanical ventilation, continuous positive airway pressure, or positive end-respiratory pressure Suction the neonate as indicated Institute measures to maintain thermoregulations Provide parenteral nutrition Cluster nursing activities to provide the neonate with rest periods; disturb the neonate with RDS as little as possible to decrease oxygen consumption Administer drugs as ordered Provide meticulous mouth and skin care Educate the parents about the disease, treatments and procedures as well as what to expect and provide emotional support during the acute stage