Rds ppt.

1,516 views

Published on

0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,516
On SlideShare
0
From Embeds
0
Number of Embeds
7
Actions
Shares
0
Downloads
59
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Rds ppt.

  1. 1. NURSING DIAGNOSIS RESPIRATORY DISTRESS SYNDROME
  2. 2. Impaired Gas Exchange  May be Related to: Inadequate Surfactant Level  Altered oxygen supply  Cold stress As possibly evidenced by:  tachypnea  use of accessory muscle  pallor or cyanosis  changes in ABGs 
  3. 3. Impaired Spontaneous Ventilation  May be Related to:  Respiratory muscle fatigue  Metabolic factors Possibly evidenced by:  Dyspnea  Increased metabolic rate  Restlessness  Use of accessory muscles and,  Abnormal ABGs
  4. 4. NURSING RESPONSIBILITIES RESPIRATORY DISTRESS SYNDROME
  5. 5. Nursing Responsibilities  Airway stabilization  Airway management  Oxygen therapy  Thermoregulation  Blood gas monitoring  Family involvement therapy
  6. 6. Airway Stabilization and Comfort   Nursing the naked infant supine in an incubator will allow observation of chest movement, and arterial and venous lines. The head should ideally be slightly extended to stabilize the tube and prevent laryngeal trauma. Side-lying postures tend to lessen hip and shoulder rotation and abduction. In any position the infant should be supported with flexible boundaries of, for example, rolled blankets.
  7. 7. Blood Gas Monitoring   Blood gases must be monitored as a guide to ventilatory management and to minimize the risk of retinopathy of prematurity from inappropriate use of high levels of oxygen (McGurk, 2003). Non-invasive methods such as pulse oximetry and carbon dioxide tension monitors are useful trend detectors but should not be used in isolation.
  8. 8. Thermoregulation   Neonates have poorly developed mechanisms for thermoregulation and maintenance of a neutral thermal environment is a perpetual challenge. Core temperature should be maintained at 37°C to minimize oxygen consumption and acidosis. To minimize heat loss, it is recommended that sick infants are nursed in an incubator with a controlled temperature, or an open cot with an overhead heater controlled by a temperature probe on the skin.
  9. 9. Fluid and electrolyte balance   RDS delays the onset of normal postnatal diuresis, and edema often appears after 24-48 hours. Meticulous attention to fluid and electrolyte balance is crucial to avoid fluid overload, which contributes to complications such as patent ductus arteriosis and chronic lung disease. To an extent, a humidified environment can help but insensible losses should be an essential part of the fluid balance equation.
  10. 10. Parent Health Education   It is vital that the parents feel involved. Their anguish begins as soon as they know they are to deliver a preterm infant who may have RDS, and the moment of birth, which should be a happy time, is fraught with worry. The admission of their baby to the neonatal ICU, attached to a plethora of machinery, can be devastating (Strange, 2002). Family-centred care is an appropriate framework for the neonatal ICU (Turrill, 1999).
  11. 11. CRITICAL CARE AREA EQUIPMENTS RESPIRATORY DISTRESS SYNDROME
  12. 12. Infusion Pump  An infusion pump infuses fluids, medication or nutrients into a patient's circulatory system. It is generally used intravenously, although subcutaneous, arterial an d epidural infusions are occasionally used.
  13. 13. Incubator  Infants are cared for in incubators or "open warmers." Some low birth weight infants need respiratory support ranging from extra oxygen (by head hood or nasal cannula) to continuous positive airway pressure (CPAP) or mechanical ventilation. Public access is limited, and staff and visitors are required to take precautions to reduce transmission of infection.
  14. 14. Continuous Positive Airway Pressure (CPAP)  As a treatment or therapy, CPAP uses mild air pressure to keep an airway open.  In some preterm infants whose lungs haven't fully developed, CPAP improves survival and decreases the need for steroid treatment for their lungs.
  15. 15. Positive end expiratory pressure (PEEP)  Positive end expiratory pressure (PEEP) is routinely used when ventilating preterm infants, and high levels are recommended in those with severe respiratory distress syndrome (RDS). Elevation of PEEP increases lung volume, as does surfactant administration.
  16. 16. Pulse Oximeter A pulse oximeter is a medical device that indirectly monitors the oxygen saturation of a patient's blood (as opposed to measuring oxygen saturation directly through a blood sample) and changes in blood volume in the skin, producing a photoplethysmogram .
  17. 17. Food for Thought… It is not how much you do but how much love you put in the doing. ---Mother Theresa
  18. 18. To do what nobody else will do, a way that nobody else can do, in spite of all we go through; is to be a nurse… ---Rawsi Williams
  19. 19. Short Quiz: 1. A nurse in the newborn nursery is monitoring a preterm newborn infant for respiratory distress syndrome. Which assessment signs if noted in the newborn infant would alert the nurse to the possibility of this syndrome? A. Hypotension and Bradycardia B. Tachypnea and retractions C. Acrocyanosis and grunting D. The presence of a barrel chest with grunting
  20. 20. 2. A nurse on the newborn nursery floor is caring for a neonate. On assessment the infant is exhibiting signs of cyanosis, tachypnea, nasal flaring, and grunting. Respiratory distress syndrome is diagnosed, and the physician prescribes surfactant replacement therapy. The nurse would prepare to administer this therapy by: A. Subcutaneous injection B. Intravenous injection C. Instillation of the preparation into the lungs through an endotracheal tube D. Intramuscular injection
  21. 21. 3. Which action best explains the main role of surfactant in the neonate? A. Assists with ciliary body maturation in the upper airways B. Helps maintain a rhythmic breathing pattern C. Promotes clearing mucus from the respiratory tract D. Helps the lungs remain expanded after the initiation of breathing
  22. 22. 4. The highest-priority nursing diagnosis for a neonate experiencing RDS is: A. Altered Nutrition: More Than Body Requirements B. Alterations in Parenting C. Acute Pain D. Impaired Gas Exchange, related to inadequate lung surfactant
  23. 23. 5. Neonatal RDS can also be the result of the following conditions. A. Mother with DM B. Caesarean Section Delivery C. Both A & B D. None of the above
  24. 24. 6. CPAP is a treatment or therapy for RDS. CPAP stands for? A. Continuous Pressure- Airway Positive B. Complementary Positive Airway Pressure C. Continuous Positive Alveolar Pressure D. Continuous Positive Airway Pressure
  25. 25. 7. A medical device that indirectly monitors the oxygen saturation of a patient's blood (as opposed to measuring oxygen saturation directly through a blood sample) and changes in blood volume in the skin, producing a photoplethysmogram. A. Pulse Oximeter B. CPAP C. PEEP D. Arterial Blood Gas (ABG)
  26. 26. 8. Surfactants are primarily made up of? (select all that apply) A. Lipids B. Proteins C. Glycoproteins D. Carbohydrates
  27. 27. 9. What is/are the primary diagnostic procedures to rule out RDS? (select all that apply) A. Pulse Oximetry B. Chest X-ray C. CBC D. Bacteriology
  28. 28. 10. What is the most commonly used Surfactant?
  29. 29. Answers… 1. A nurse in the newborn nursery is monitoring a preterm newborn infant for respiratory distress syndrome. Which assessment signs if noted in the newborn infant would alert the nurse to the possibility of this syndrome? A. Hypotension and Bradycardia B. Tachypnea and retractions C. Acrocyanosis and grunting D. The presence of a barrel chest with grunting The infant with respiratory distress syndrome may present with signs of cyanosis, tachypnea or apnea, nasal flaring, chest wall retractions, or audible grunts.
  30. 30. 2. A nurse on the newborn nursery floor is caring for a neonate. On assessment the infant is exhibiting signs of cyanosis, tachypnea, nasal flaring, and grunting. Respiratory distress syndrome is diagnosed, and the physician prescribes surfactant replacement therapy. The nurse would prepare to administer this therapy by: A. Subcutaneous injection B. Intravenous injection C. Instillation of the preparation into the lungs through an endotracheal tube D. Intramuscular injection The aim of therapy in RDS is to support the disease until the disease runs its course with the subsequent development of surfactant. The infant may benefit from surfactant replacement therapy. In surfactant replacement, an exogenous surfactant preparation is instilled into the lungs through an endotracheal tube.
  31. 31. 3. Which action best explains the main role of surfactant in the neonate? A. Assists with ciliary body maturation in the upper airways B. Helps maintain a rhythmic breathing pattern C. Promotes clearing mucus from the respiratory tract D. Helps the lungs remain expanded after the initiation of breathing Surfactant works by reducing surface tension in the lung. Surfactant allows the lung to remain slightly expanded, decreasing the amount of work required for inspiration.
  32. 32. 4. The highest-priority nursing diagnosis for a neonate experiencing RDS is: A. Altered Nutrition: More Than Body Requirements B. Alterations in Parenting C. Acute Pain D. Impaired Gas Exchange, related to inadequate lung surfactant The lungs of infants with respiratory distress syndrome are developmentally deficient in a material called surfactant, which helps prevent collapse of the terminal air-spaces (the future site of alveolar development) throughout the normal cycle of inhalation and exhalation.
  33. 33. 5. Risk for Neonatal RDS can be increased with the following conditions. A. Mother with DM B. Caesarean Section Delivery C. Both A & B D. None of the above Risk for developing neonatal RDS: -A brother or sister who had RDS -Diabetes in the mother -Cesarean delivery -Delivery complications that reduce blood flow to the baby -Multiple pregnancy (twins or more) -Rapid labor
  34. 34. 6. CPAP is a treatment or therapy for RDS. CPAP stands for? A. Continuous Pressure- Airway Positive B. Complementary Positive Airway Pressure C. Continuous Positive Alveolar Pressure D. Continuous Positive Airway Pressure As a treatment or therapy, CPAP (Continuous Positive Airway Pressure ) uses mild air pressure to keep an airway open.
  35. 35. 7. A medical device that indirectly monitors the oxygen saturation of a patient's blood (as opposed to measuring oxygen saturation directly through a blood sample) and changes in blood volume in the skin, producing a photoplethysmogram. A. Pulse Oximeter B. CPAP C. PEEP D. Arterial Blood Gas (ABG)
  36. 36. 8. Surfactants are primarily made up of? (select all that apply) A. Lipids B. Proteins C. Glycoproteins D. Carbohydrates Surfactant is a complex system of lipids, proteins and glycoproteins which are produced in specialized lung cells called Type II cells or Type II pneumocytes.
  37. 37. 9. What is/are the primary diagnostic procedures to rule out RDS? (select all that apply) A. Pulse Oximetry B. Chest X-ray C. CBC D. Bacteriology -A blood gas analysis shows low oxygen and excess acid in the body fluids. -A chest x-ray shows the lungs have a characteristic "ground glass" appearance, which often develops 6 to 12 hours after birth. -Lab tests are done to rule out infection and sepsis as a cause of the respiratory distress.
  38. 38. 10. What is the most commonly used Surfactant? If the baby's condition worsens, an endotracheal tube (breathing tube) is inserted into the trachea and intermittent breaths are given by a mechanical device. > exogenous preparation of surfactant, either synthetic or extracted from animal lungs, is given through the breathing tube into the lungs. (commonly used surfactants is SURVANTA, derived from cow lungs, which can decrease the risk of death in hospitalized very-low-birth-weight infants by 30%.)
  39. 39. THANK YOU! Group 6 Loraine Valle Karen Taopo Charmaine Del Rosario Jett Arr Jun Plocios

×