The respiratory distress syndrome is also called hyaline membrane disease which majorly affects the preterm babies. The clinical features of the condition include retractions, nasal flaring, tachypnea, and granting respirations (Monica et al, 2017). RDS is stated to affect approximately 40,000 infants every year in US. The condition affects mostly infants who are less than 35 weeks of maturity but there are also instances where the older children are affected due to lack of proper maturation of the lungs.
The main cause of RDS is the insufficient pulmonary surfactant. The immature and the surfactant –deficit lungs cause the decrease in the tendency of atelectasis and compliance (Jobe, 2017). The other elements in the preterm babies that could cause a high risk of atelectasis include weak walls of chests and the minimal alveolar radius. With atelectasis, the perfused but with poor ventilation could cause hypoventilation of alveolar hence hypoxemia. Severe hypoxemia and hypo perfusion may cause a reduction in the amounts of oxygen delivered, lactic acidosis as well as anaerobic metabolism. Hypoxemia and acidosis could further lead to the pulmonary vasoconstriction due to the alteration of the oxygenation process.
Some elements like volutrauma may trigger the production of inflammatory chemokines and cytokines which may cause the damage of the epithelial and endothelial cells. The damage causes a decrease in the function and production od the surfactants and the rise in the endothelial permeability and could end up in pulmonary edema (Martin, 2017). The leakage of the proteins to the alveolar spaces increases the surfactant insufficiency further leading to the inactivation of surfactants.
Macroscopically, the lungs seem solid, congested and atelectatic. When using a microscope, the pulmonary edema is seen and the diffuse alveolar atelectasis. The clinical feature is the RDS are seen after delivery or within the first four hours after birth. Tachypnea characterizes RDS and the condition is due to the efforts to raise the minute ventilation to compensate for the high dead space and the reduced tidal volume. Retractions happen when the baby has to produce high inside pressure to enlarge the less compliant lungs. Grunting on the other hand could be due to some closure of glottis when there is forced expiration with attempts to sustain the FRC.
The nursing management of the infant with RDS is necessary with the aim of preventing the occurrence of acidosis and hypoxemia (Monica et al, 2017). The other goal is to optimize the fluid sustenance where the fluid is managed to avoid being in excess hence reducing the chances of pulmonary edema. The other objective of management of RDS is to decrease the metabolic needs and increase the nutrition provided. Proper management methods reduce the chances of damaging the lungs due to oxygen toxicity and volutrauma. There are three main methods used in the treatment and prevention of RDS which include giving antenatal glucocorticoids, applying airway pressure and surfactant replacement therapy.
The administration of surfactants is said to enhance the oxygenation and it reduces the ventilator necessities. The method has become accepted universally for the preterm babies who are likely to develop RDS (Fraser, 2020). There are some preparations made before the surfactants are admitted to the bronchi directly. Two strategies are used when administering the surfactants. There is the administration of the prophylactic surfactants which are given after the child is delivered and there is the rescue which is given when the RDS has developed. Prophylactic doses given are advantageous since they replace the surfactant before RDS is formed fully.
Ventilation is another management strategy with the aim of maintaining sufficient oxygenation. The oxygenation process is enabled through the engagement of the damaged alveoli and raising the surface area that is available for the process of exchange of gases (Fen et al, 2017). Nitric oxide could also be given through the ventilator system that helps the preterm infants who have severe RDS. The process of administering nitric oxide causes pulmonary vasodilation which in accompaniment enhances the oxygenation. The blood gases should also be evaluated to guide the management of ventilation and to reduce the chances of retinopathy prematurity caused by the increased levels of oxygen. The monitoring could be done through umbilical artery catherisation.
Jack had grunting respirations after a few hours of delivery which indicated that he had a pulmonary pathology. The pathology in the infant is a sign that the lungs have a decreased volume or the FRC (functional residual capacity). The infant has to breathe despite the partially closed glottis which raises the FRC and keeps the alveoli of the newborn patent (Jobe, 2017). A neonate who experiences the grunting sign has to be provided with a continuous positive airway pressure or ventilation began to help support the breathing process. The other finding from the neonate in the case study was the sub-sternal recessions which usually occur due to the chest walls that are compliant while the lungs are non-compliant.
Jack also had pink mucous membranes and dusky feet and hands an indication of cyanosis. In an infant with RDS, there could be development of hypoxemia resulting in the delivery of insufficient oxygen levels to the body (Kearl et al, 2018). The infant also presented with acidosis and increased levels of carbon dioxide. The above condition happens when the surfactant in inadequate making the alveoli to collapse
(Martin, 2017). When the alveoli collapse, the infant finds problems breathing such that the baby has to put in more effort while trying to inflate the collapsed airways. The lung function continues to deteriorates and this makes the infant to take in less oxygen. The result is the accumulation of more carbon dioxide in the bloodstream. The increased levels of carbon dioxide cause the acid in the blood to also rise causing a condition by the name acidosis. The condition may also have some effects on some other body organs. If treatment is not given early enough, the infant may get exhausted breathing and therefore a ventilator is used to help the process of breathing. Looking at the respiratory rates of Jack, they are raised and presents at 70. The normal respiratory rates of an infant should be between thirty and sixty for every minute. The condition is called tachypnea caused by the need to raise the minute ventilation to compensate for the high dead space and the reduced tidal volume.
Regarding the family centered care, we find that Michelle who is the mother of Jack offers psychosocial support to the infant. Michelle goes to the hospital and in some way has adopted to the hospital environment. She has to go and check on her son each day in the hospital which shows concern and care. Studies reveal that the nurses have to give guidelines and expectations to the parents about the activities and performances to their babies in the nursery units (Aylott, 2018).
Michelle had interest in knowing the routine in the hospital so that she would also be part of the team to care for Jack. In the case study, we find that the nurse demonstrated effective communication skills and listened to Michelle carefully about her concerns to her son. The process of the nurse listening to Michelle and giving her a chance to be part of the caregivers to Jack makes the mother feel respected hence getting some confidence to the health professionals about providing care to her baby. Furthermore, a good relationship between mother and the caregiver works for the good of the infant since quality care is provided to the baby. Also from researches, the positive attitude between the mother and the infant could enhance the interactions between the staffs who are in charge of the provision of care to the patient.
Aylott, M. (2018). Care of the neonate. Foundation Studies for Caring: Using Student-Centred Learning, 354.
Fen, X. U., Luo, J., Hongping, L. I., Huang, Y., & Lin, H. (2017). Systematic review of the effectiveness of intratracheal injection of pulmonary surfactant in the treatment of neonatal respiratory distress syndrome. Journal of Clinical Pediatrics, 35(3), 223-228.
Fraser, D. (2020). PART 3 Pathophysiology: Management and Treatment of Common Disorders. Core Curriculum for Neonatal Intensive Care Nursing E-Book, 394.
Jobe, A. H. (2017). Pathophysiology of respiratory distress syndrome. In Fetal and neonatal physiology (pp. 1604-1619). Elsevier.
Kearl, C. R., Young, L., & Soll, R. (2018). Surfactant therapy guided by tests for lung maturity in preterm infants at risk of respiratory distress syndrome. The Cochrane database of systematic reviews, 2018(11).
Martin, R. (2017). Pathophysiology, clinical manifestations, and diagnosis of respiratory distress syndrome in the newborn. U: UpToDate, Garcia-Prats JA, Kim MS ur: UpToDate.
Monica, N. F., Pamela, S., Juan, Q. L., & Li, J. (2017). Recent understanding of Pathophysiology, Risk factors and treatments of Neonatal Respiratory Distress Syndrome: A review. Sci Lett, 5(1), 70-78
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