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Respiratory Distress Syndrome
Hyaline Membrane Disease
Islamic university Nursing College
Respiratory Distress Syndrome (Hyaline Membrane Disease)
Causes:
Immature development of the respiratory
system or inadequate amount of surfactant in
the lungs.
RDS is the leading cause of respiratory failure in
preterm neonates. It is more common in males
than females.
Predisposing Factors:
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. Alveoli do not
collapse at expiration because of the presence of
lipoprotein material called surfactant which decreases
the surface tension inside the alveoli, thus preventing
their collapse during expiration.
Path physiology of HMD:
If surfactant is deficient, the alveoli cannot
be easily distended during inspiration
which leads to respiratory distress and
hypoxemia.
Assessment Criteria of RDS:
Clinical Manifestations:
• Tachypnea (80 to 120 breaths/min).
• Dyspnea.
• Substernal retraction.
• Fine inspiratory crackles.
• Audible expiratory grunt.
• Flaring of the nares.
• Cyanosis or pallor.
As the disease progress:
Flaccidity.
Unresponsiveness
Apnea.
Diminished breath sounds
Severe RDS is associated with
Shock like state.
Diminished cardiac output and
bradycardia.
Low systemic blood pressure.
Diagnostic Tests:
• Chest x-ray shows congested lung field with
a ground- glass appearance that represents
alveolar atelectasis, and dark streaks.
• 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
Therapeutic Management
Maintain acid-base balance
by correct respiratory
acidosis through assisted
ventilation and correct
metabolic acidosis by IV
administration of sodium
bicarbonate.
Maintain adequate hydration & electrolytes level.
Nutrition is provided by parenteral therapy during the
acute stage.
Surfactant therapy installed in trachea.
Nipple and gavage feeding are contraindicated in any
situation that creates a marked increase in respiratory
rate because of the greater hazards of aspiration.
Nursing Management Nursing Diagnoses:
• 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.
Nursing Diagnoses:
• 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.
Planning
The goals of nursing management are the same as for
any high- risk neonate with special emphasis on
respiratory needs to:
Facilitate respiratory effort, maintain air exchange and
oxygenation.
- Prevent complications.
Implementation
Nursing management includes all the
nursing skills required for any high-risk
neonates.
In addition special skills and observations
as: Suctioning is performed only as
necessary.
Implementation
Hyperoxygenation and a closed suction
system can be used to minimize
complication during suction.
Skin inspection and care.
Changing position.
Mouth care is also important.
Evaluation
• The effectiveness of nursing intervention is determined
by continual reassessment and evaluation of care
based on:
• Frequent measurement of neonate’s vital signs.
• Observation of signs and symptoms of respiratory
distress syndrome.
Prevention of HMD
prevention of premature delivery.
Administration of corticosteroids to the mother (24
hours to 7 days before delivery).
Prophylactic administration of artificial surfactant
into trachea of premature neonate.
Prognosis
• RDS is a self- limiting disease if mild, and following a period of
deterioration (approximately 48 hrs) and in the absence of complications,
affected neonates begin to improve by 72 hours.
Prognosis
• Neonates who survive the first 96 hours
have a reasonable chance of recovery.
Surfactant therapy decreased the use of
long term ventilation and decreased
period of stay in hospital. It also improves
the outcome.