This document provides information on respiratory distress syndrome (RDS), including its definition, etiology, pathophysiology, signs and symptoms, investigations, management, nursing diagnoses, and nursing interventions. RDS is a disease in newborns related to deficiency of surfactant in the lungs, leading to respiratory distress. Key factors that can decrease surfactant and contribute to RDS include prematurity, hypothermia, asphyxia, and having a diabetic mother. Management involves supportive care like oxygen supplementation and ventilation support if needed, as well as more aggressive treatments like surfactant replacement therapy for very preterm infants.

1. RESPIRATORY DISTRESS
SYNDROME

2. INTRODUCTION TO RESPIRATORY
SYSTEM
contd…………
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Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli

3. INTRODUCTION TO RESPIRATORY
SYSTEM
contd…………
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 3

7. Definition:
• Hyaline membrane disease (HM) is a disease
manifesting within 6 hrs of birth being related to
deficiency of surfactant in the alveoli, leading to acute
respiratory distress with fatal termination if not treated
promptly.
Etiology:
1.Deficiency of surfactant in the pulmonary alveoli.
2.Small alveoli which are difficult to inflate and tend to
collapse with expiration.
3.Weak and excessively complaint chest wall.

8. 4. Contributing factors are any factors that
decreases surfactant: such as
• Premature and immature alveolar lining cells
• Acidosis
• Hypothermia
• Asphyxiated newborn
• Infant with diabetic mother

9. Pathophysiology Prematurity
( Immature lung with underdeveloped and un inflated alveoli
Decreased surfactant
Increased alveoli surface tension
Atelectasis
Hypoxaemia Co2 retension
Acidosis
Pulmonary vasoconstriction and hypo profusion
Capillary damage
Plasma leak
Firinogen
Fibrin ( Hyalin membrane )

10.  As the diseases progress
– Peripheral edema increases
– Muscle tone decreases
– Cyanosis increases
-- Body temperature drops
-- Bradycardia may occur
-- Diminished breath sounds
 Secondary signs and symptoms
∀ • Hypotension
∀ • Edema of the hands and feet
∀ • Absent bowel sounds
∀ • Decreased urine out put

11.  Expiratory grunting
 Sternal , suprasternal , substernal and
intercostals retraction progressing to paradoxical
seesaw respirations
 Inspiratory nasal flaring
 Tacypnea
 Cyanosis
 Decreased breath sounds and dry “ Sandpaper”
breath sounds
 Pulmonary edema

12. Investigation
 Antenatal period
 Examination of the amniotic fluid
Lecithin sphingomyelin ratio ;
- > 2 full maturation
- 1.5 – 1.99 borderline maturation
- < - associated with sever RDS
 Laboratory tests :
- Paco2 elevated
- Partial pressure of arterial oxygen – low
- Blood PH – low due to metabolic acidosis
- Calcium – low
- Serum glucose – low

15.  Chest X- ray
 “ Ground glass appearance” or “ White
wash lung”
 Blood gas analysis
Low po2 < 50mmhg, Paco2 > 50 mmHg and acidosis
indicates respiratory failure
Management :
Supportive
1. Maintain of oxygenation – Pao2 at 60 to 80 mmHg , t
prevent hypoxia
2. Maintenance of normal body temperature .
3. Maintenance of fluid , electrolytes and acid base balance –
Metabolic acidosis buffered with sodium bicarbonate
4. Maintenance of nutrition – Iv dextrose 10 % in
water usually required

16. 5. Antibiotic as needed to treat infection .
6. Constant observation of complication – Pneumothroax ,
DIC , PDA
7. Prevent hypotension
8. Maintain a hematocrit of 40% to 45% .
9. Maintenance of respiration with ventilation support , if
necessary
Aggressive :
7. Administration of exogenous surfactant in to lungs early in
the diseases
8. Especially beneficial in the very low birth weight infant
9. May be given preventively to VLBW infant at birth
10. Surfactant replacement therapy
11. Prophylactic surfactant therapy ; infants at increased risk
of RDS , infant of less than 30 weeks gestational age ,
infants with a birth weight of less than 1,250g

17. • Treatment initiated after infant is stabilized in the
delivery room or within 30 minutes of life .
• Benefits of surfactant ; increased oxygen requirement
• Antibiotics – To prevent infection ; Ampicillin 200mg/
kg IV 12 hrly with Gentamicin 5mg/kg IV 12 hrly .
Complication
• Intra ventricular hemorrhage.
• Bronchopulmonary.
• Pulmonary hemorrhage
• Pneumothroax
• Retrolental fibroplasias
• Neurological abnormalities

18. Nursing Diagnosis
1.Impaired gas exchange related to diseases
process
2.Imbalanced nutritional less than body
requirement related to prematurity and
increased energy expenditure on breathing
3.Ineffective thermoregulation related to
immaturity .
4.Impaired parenting related to separation from
the neonate due to hospitalization .

19. Nursing Intervention
• Promote adequate gas exchange
 Administer supplemental oxygen .
 Measure oxygen concentration every hour
and recorded
 Monitor ABG levels as appropriate .
Observe the infants response to oxygen therapy .
 Position the infant to allow for maximal lung
expansion.
 Suction as needed
 Observe for complication

20. Promote adequate Nutrition and Hydration :
Administer IV fluids or enteral feeding as ordered
 Observe IV sites for infiltration or infection
 Provide adequate caloric intake and output chart
 Administer medication as per order .

21. Encouraging parental attachment :
♦ Identify factors that may prohibit the parents visitation
and communication .
♦ Call the parents daily them an the infants condition .
♦ Demonstrate for the parents how they can touch and
speak to the child
♦ Provide the parents with information concerning
the disease process.