RDS

POST CONFERENCE PRESENTATION TAYLOR XENOS, STUDENT RN

ETIOLOGY

∴  Complex respiratory disease related to immaturity of lung tissue ∴  Manifested by signs of severe respiratory distress

•  Beginning at or within few hrs. of birth •  Worsens over 24-72 hrs.

RISK FACTORS

∴  Prematurity <34 wks. •  Immature respiratory system •  Decreased pulmonary surfactant

∴  Maternal diabetes •  Persistently high ♀ blood sugars or macrosomic infant result in early delivery

∴  Spontaneous birth ∴  Maternal/fetal stress during delivery ∴  Cesarean delivery

•  Lung fluid not expectorated ∴  Asphyxia, acidosis, MAS + sepsis

PATHOPHYSIOLOGY

∴  Lack of surfactant in lungs •  Decrease in surface tension to allow alveoli to remain open when air is exhaled

∴  Leads to atelectasis (partial or complete collapse of lung), labored breathing, respiratory acidosis + hypoxemia

∴  Blood flow to lungs decrease ∴  Alveoli become necrotic ∴  Capillaries are damaged ∴  Lungs become noncompliant or “stiff”

DIAGNOSIS

∴  Clinical manifestations ∴  Silverman-Anderson Index ∴  ABG reveals hypoxemia + respiratory acidosis ∴  CXR reveals “ground glass”, diffuse atelectasis, "

and ⇣ lung volume ≫ May be difficult to distinguish between RDS +

pneumonia in infants with respiratory distress

CLINICAL MANIFESTATIONS

∴  Tachypnea 80-120 breaths/min.

∴  Dyspnea

∴  Pronounced intercostal or substernal retractions

∴  Fine respiratory crackles

∴  Audible expiratory grunt

∴  Flaring of external nares

∴  Cyanosis or pallor

Clinical Manifestations of RDS •  Tachypnea •  Dyspnea •  Pronounced intercostal or !

substernal retractions •  Fine inspiratory crackles •  Audible expiratory grunt •  Flaring of the external nares •  Cyanosis or pallor

☞  Not all infants born with RDS manifest these "characteristics. Extremely-low-birth-weight infants may"

have respiratory failure and shock at birth d/t "physiologic immaturity

TREATMENT

∴  Administer surfactant as ordered ∴  Institute thermoregulation ∴  Prevent hypotension ∴  Prevent hypovolemia ∴  Correct respiratory acidosis with

ventilator support ∴  Correct metabolic acidosis by

administering sodium bicarbonate

NURSING INTERVENTIONS ∴  Continuous monitoring + close observation ∴  Obtain necessary specimens for lab ∴  Continuous pulse oximetry ∴  Pharmacologic interventions ∴  Provide oxygen therapy ∴  Suction as indicated (not endotracheal) ∴  Maintain thermoregulation ∴  Provide parenteral nutrition ∴  Avoid oral feedings ∴  Cluster nursing activities ∴  Education of parent(s)/caregivers ∴  Provide emotional support ∴  Utilize Silverman-Anderson Index

SIL

VER

MA

N-A

ND

ERS

ON

IN

DEX

SILVERMAN-ANDERSON INDEX (CONT.)

∴  Performed in addition to frequent APGAR ∴  Normal infants have a cumulative score close to 0 ∴  Severely depressed infants score close to 10

CLINICAL OUTCOMES

∴  Room air or oxygen saturation >90% ∴  Respiratory rate <60 breaths/min. ∴  Blood pH >7.35

RESOURCES

∴  http://www.ceu.org/cecourses/981117/ch11b.htm ∴  http://emedicine.medscape.com/article/165139-treatment ∴  http://learnpediatrics.com/files/2010/07/RespiratoryDistress.pdf