Respiratory Distress Syndrome

Hyaline Membrane Disease

Islamic university Nursing College

Respiratory Distress Syndrome (Hyaline Membrane Disease)

Causes:

 Immature development of the respiratory

system or inadequate amount of surfactant in

the lungs.

RDS is the leading cause of respiratory failure in

preterm neonates. It is more common in males

than females.

Predisposing Factors:

Premature infant.

Asphyxia at birth.

Infant of diabetic mothers.

Cesarean Section delivery.

Previous history of hyaline membrane disease

(HMD) in sibling.

Multiple pregnancies.

Pathophysiology of HMD:

• During intrauterine life, the alveoli are collapsed.

Crying of the neonate at birth creates enough negative

pressure to open the collapsed alveoli. Alveoli do not

collapse at expiration because of the presence of

lipoprotein material called surfactant which decreases

the surface tension inside the alveoli, thus preventing

their collapse during expiration.

Path physiology of HMD:

If surfactant is deficient, the alveoli cannot

be easily distended during inspiration

which leads to respiratory distress and

hypoxemia.

Assessment Criteria of RDS:

Clinical Manifestations:

• Tachypnea (80 to 120 breaths/min).

• Dyspnea.

• Substernal retraction.

• Fine inspiratory crackles.

• Audible expiratory grunt.

• Flaring of the nares.

• Cyanosis or pallor.

As the disease progress:

Flaccidity.

Unresponsiveness

Apnea.

Diminished breath sounds

Severe RDS is associated with

Shock like state.

Diminished cardiac output and

bradycardia.

Low systemic blood pressure.

Diagnostic Tests:

• Chest x-ray shows congested lung field with

a ground- glass appearance that represents

alveolar atelectasis, and dark streaks.

• Respiratory and metabolic acidosis is

determined by blood gas analysis.

Therapeutic Management

• Maintain adequate ventilation and oxygenation.

Oxygen should be warmed and humidified

Maintain a neutral thermal environment

Therapeutic Management

Maintain acid-base balance

by correct respiratory

acidosis through assisted

ventilation and correct

metabolic acidosis by IV

administration of sodium

bicarbonate.

Maintain adequate hydration & electrolytes level.

Nutrition is provided by parenteral therapy during the

acute stage.

Surfactant therapy installed in trachea.

Nipple and gavage feeding are contraindicated in any

situation that creates a marked increase in respiratory

rate because of the greater hazards of aspiration.

Nursing Management Nursing Diagnoses:

• Infective breathing pattern related to surfactant

deficiency, alveolar instability, and pulmonary

immaturity.

• Impaired gas exchange related to immature

• alveolar structure and inability to maintain lung

expansion.

Nursing Diagnoses:

• Ineffective airway clearance related to obstruction

or inappropriate positioning of endotracheal tube.

• Risk for injury related to acid-base imbalance,

oxygen levels, carbon dioxide levels from

mechanical ventilation.

Planning

The goals of nursing management are the same as for

any high- risk neonate with special emphasis on

respiratory needs to:

Facilitate respiratory effort, maintain air exchange and

oxygenation.

- Prevent complications.

Implementation

Nursing management includes all the

nursing skills required for any high-risk

neonates.

In addition special skills and observations

as: Suctioning is performed only as

necessary.

Implementation

Hyperoxygenation and a closed suction

system can be used to minimize

complication during suction.

Skin inspection and care.

Changing position.

Mouth care is also important.

Evaluation

• The effectiveness of nursing intervention is determined

by continual reassessment and evaluation of care

based on:

• Frequent measurement of neonate’s vital signs.

• Observation of signs and symptoms of respiratory

distress syndrome.

Prevention of HMD

prevention of premature delivery.

Administration of corticosteroids to the mother (24

hours to 7 days before delivery).

Prophylactic administration of artificial surfactant

into trachea of premature neonate.

Prognosis

• RDS is a self- limiting disease if mild, and following a period of

deterioration (approximately 48 hrs) and in the absence of complications,

affected neonates begin to improve by 72 hours.

Prognosis

• Neonates who survive the first 96 hours

have a reasonable chance of recovery.

Surfactant therapy decreased the use of

long term ventilation and decreased

period of stay in hospital. It also improves

the outcome.