Chapter 19: Respiratory Distress Syndrome (RDS) (Newborn)

Question 1

Respiratory Distress Syndrome (RDS)

Answer 1

developmental respiratory disorder affecting preterm newborns because of lack of lung surfactant and underdeveloped alveolar saccules
-there is a diffuse atelectasis (parts of the lung are not expanded), with congestion and edema in the lung spaces
-Lecithin sphingomyelin (L/S) ratio and phosphatidylglycerol (PG) levels are low and inadequate to keep the immature alveoli of the lungs open
>lung compliance is diminished and significantly adds to the infants work of breathing

Question 2

Signs and Symptoms of RDS

Answer 2

begin shortly after birth

• expiratory grunting
• nasal flaring
• cyanosis in room air
• rapid breathing (tachypnea)
• labored breathing with retractions
• decreased breath sounds, often with rales

Question 3

Diagnosis

Answer 3

if untreated

• arterial blood gas values show oxygenation deficits with hypercarbia (high CO2) and metabolic acidosis
• pulse oximetry can help determine hypoxia

Question 4

Prevention

Answer 4

• proactive healthcare teaching to prevent preterm birth
• if preterm birth is inevitable, mother is given betamethasone (Celestone or Soluspan) in an attempt to increase surfactant production in newborn in utero

Question 5

Nursing Care

Answer 5

airway maintenance and oxygenation are priority
>oxygen therapy:
-humidified oxygen
-continuous positive airway pressure (CPAP)
-conventional mechanical ventilation
-bilevel ventilators
-high-frequency oscillating ventilation
-high-frequency jet ventilation
-nitric oxide (for patients with subsequent persistent pulmonary hypertension)
-extracorporeal membrane oxygenation (in worse cases)

Question 6

Medical Care

Answer 6

-first-line = continuous positive airway pressure because it is less damaging to lung tissue
-if CPAP not adequate enough, mechanical ventilation with positive end-expiratory pressure is needed
-oxygen hood; often used to keep baby in a oxygen-rich environment for a short period of time; easy to use and easy access for procedures and assessment
-nasal cannula; continuous flow of low level oxygen (1-2 L/min) to supplement newborns own intake
>oxygen by mask is unreliable method for newborn

Question 7

If Mechanical Ventilation is needed, how is it performed?

Answer 7

an endotracheal tube is placed by a clinician certified
>done by inserting an endotracheal tube orally to create an open secure airway to which the ventilator can be attached
-generally “weaned” from mechanical ventilation or CPAP as soon as possible to avoid complications of oxygen such as bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP)

Question 8

Medications

Answer 8

after an airway has been established, the administration of synthetic surfactant within 15 to 30 minutes of birth is required
-it is administered through a catheter in the endotracheal tube
>for newborns less than 1000g, it is given to coat the alveoli to keep them open so that they can perfuse with oxygen
>newborns greater than 1000g benefit any time during the first 2 to 6 hours of life
>continued mechanical ventilation after administration helps the medication to be spread throughout lung tissue

Question 9

Beractant (Survanta)

Answer 9

surfactant

• lowers minimum surface tension and increases pulmonary compliance and oxygenation in preterm newborns
• prevents and treats RDS in newborns
• only absorbed in lungs
• monitor heart rate and respiratory rate
• give within 15 minutes of birth to premature newborns
• suction before administration
• warm vial 20 minutes to room temp
• do not suction for 1 hour after administration
• adverse effects: hypotension, transient bradycardia, oxygen desaturation, increased nosocomial infection