Respiratory distress

1. Prepared By:
Nisha Ghimire
Sushmita Poudel
Aliza Poudel
Devi Rana
Namuna Karki

2. The term respiratory distress
syndrome are most often applied to
the severe lung disorder in neonate
which is primarily related to lung
immaturity.
It is responsible for more infants
death and neurological complications.

3. Respiratory distress syndrome is a
syndrome of premature neonates that
is characterized by progressive and
usually fatal respiratory failure
resulting from atelectasis and
immaturity of lungs.
It was formerly known as Hyaline
membrane disease.

4. The breathing rate is usually more than
60 breaths per min and/or use of
accesory muscle of respiration which
maybe accompanied by grunting.
Surfactant production starts around
20wks of life and peaks at 35wks .
Therefore any neonate less than 35 wks
is prone to develop RDS, without
surfactant infants are unable to keep
their lungs inflated.

5. The

6. Prematurity
Asphyxia
Hypothermia
Maternal Anaemia
Pre eclampsia
Maternal diabetes
Caesarian section

7. Pulmonary risk factors:
> Pneumonia
>Pneumothorax
>Congenital Malformation
>Upper airway obstruction eg:
meconium aspiration syndrome

8. Non- pulmonary risk factors :
>Sepsis
>Cardiac defect
>Exposure to cold
>Hypoglycemia
>Metabolic acidosis
>Acute blood loss

9. In RDS, the basic abnormality is
surfactant deficiency. It is lipoprotein
containing phospholipids produced by
type II alveolar cells of lungs and helps
to reduce surface tension in alveoli.

10. During expiration,
Absence of surfactant
Surface tension increases
Alveoli collapse

11. During inspiration,
More negative pressure is needed
to keep alveoli patent.
Due to all these conditions,
Inadequate Oxygenation
Increased work of breathing
Hypoxemia and acidosis

12. Pulmonary vasoconstriction
Right to left shunting across foramen
ovale
Worsens Hypoxia
Respiratory failure

13. Tachypnea (< or = 80 – 120 breaths
per min) [Wong’s]
Dyspnea
Pronounced intercostals or substernal
retractions
Fine inspiratory crackles
Audible expiratory grunt
Flaring of external nares
Cyanosis or pallor

14. Manifestation as the disease progress
> Apnea
> Flaccidity
> Absent spontaneous movement
> Unresponsiveness
> Diminished breath sound
> Mottling
> In severe condition - shock like state

16. History taking
Physical examination
Chest x-ray :ground glass appearance
ABG
Pulse oxymetry
Pulmonary function test
Shake test
Downe’s score

18. SHAKE TEST :
It can be done on the
gastric aspirate to determine lung
maturity.Mix 0.5 ml of gastric aspirate
with 0.5 ml of absolute alcohol in a
test tube and shake for 15 sec.
Formation of bubbles indicate
adequate surfactant and less chance
of RDS.

19. Score 0 1 2
Respiration
(rate/min)
<60 60-80 >80 or
apnea
Cyanosis Nil in room
air
+nt in 40 %
oxygen
+nt in >40%
oxygen
Retraction none Mild Moderate to
severe
Grunting None Audible with
sthethescope
Audible
without
stethescope
Air entry Clear Delayed or
Decreased
Barely
audible
DOWNE’S SCORE:

20. Total score in normal infant: 0
Mild: 1 - 3
Moderate : 4 - 6
Severe : 7 - 10

21. MEDICAL MANAGEMENT
> Neonates suspected to have RDS need
to be treated in NICU.
>Administer IV fluids and oxygen .start
oxygen therapy @4-6 lit/min.
>Maintain oxygen saturation between
90-95%.
>Administration of exogenous
surfactant through ET tube directly
into trachea.

22. > Medicines:
Antibiotics : aminoglycosides, amoxicillin ,
ampicillin , cotrimoxazole and procaine
penicillin usually given for 7-10 days.
Muscle relaxants : pancuronium
Diuretics: furosemide
Antacids : sodium bicarbonate, sodium citrate
Indomathacin : if patent ductus arteriosus

23. > Supportive management :
Maintain adequate hydration and
electrolyte status.
Administer anti pyretics to reduce
fever.
Maintain acid base balance.
No nipple or gavage feeding : increase
respiratory rate and chance of
aspiration.
IV line for fluid/hydration,nutrition
and medication.

24. ASSESSMENT:
 History taking
 Physical examination
 Downe’s score
 Shake test

25. Nursing diagnosis:
 Ineffective breathing pattern related to
surfactant deficiency and alveolar
instability.
 Impaired gas exchange related to
immature pulmonary function.
Altered nutriton :less than body
requirement related to feeding
difficulties.

26. Altered body temperature related to
prematurity.
 Parental anxiety related to disease
condition.
 Risk for injury (brain injury)related to
hypoxemia.

27. Nursing interventions:
 Assess pre-term infant for respiratory
and general status :oxygen saturation
,cyanosis , ABG, axillary temperature,
respiratory pattern
 Maintain airway and administer
oxygen @4-6 lit/min.
 Provide ventilatory support in case of
need.

28.  Perform gentle chest percussion,
vibration and postural drainage based
on assessed need and infant
tolerance.
 Monitor for signs of hyperthermia
(flushing,tachycardia, altered level of
consciousness) and hypothermia
(decreased activity, respiratory
distress deterioration, cool mottled
extremities)

29.  Place the infant in radiant warmer ,
incubator.
 Use environmental control : warm
cloths warm, well ventilated room etc
for decreasing heat loss.
 Position the infant to facilitate open
airway on the side with head
supported in aliment by a small
folded sheet (SMITING POSITION).

30.  Quick gentle suctioning (not more
than 5 sec)with fine catheter as
needed.
 Maintain neutral thermal environment
to decrease metabolic requirement
and to conserve oxygen utilization.
 Maintain parenteral nutrition , avoid
oral feeding or through tube if child is
in distress.

31.  Maintain optimal nutrition pattern of
infant
 Once baby is breathing without
distress NG feeding is started.
 Involves parent in the care of children
and allow frequent visit to encourage
and promote infant - parent bonding.

32.  Skin care with frequent position
change.
 Mouth care.
 Psychological support and provide
adequate information about child’s
condition.

33. Patent ductus arteriosus
Congestive cardiac failure
Intraventricular hemorrhage
Retinopathy of prematurity
Pneumonia
Sepsis
Necrotizing enterocolitis
Neurologic sequele