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Case presentation respiratory distress syndrome Prepared by arunima Ann (Nicu). DEMOGRAPHIC DATA Case number : 326 Age: newborn Date of birth : 11-12-201 Sex :female A.O.G: 28wks Weight: 1.1kg Diagnosis: preterm, respiratory distress syndrome. PHYSICAL ASSESSMENT.
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Case presentation respiratory distress syndrome Prepared by arunima Ann (Nicu)
DEMOGRAPHIC DATA • Case number : 326 • Age: newborn • Date of birth : 11-12-201 • Sex :female • A.O.G: 28wks • Weight: 1.1kg • Diagnosis: preterm, respiratory distress syndrome
PHYSICAL ASSESSMENT • Vital signs • Temperature is 36.2 0c. Baby is in incubator with humidity of 70% • Heart rate • Heart rate is 164bpm • Respiration • Baby is on SIMV mode with PIP18, PEEP5, & rate of 40,Fio2 is 25%. • One dose of Survanta given. CXR shows mild RDS. Baby is tachypnic.
GENERAL MEASUREMENT • Head circumference : 26cm. • Chest circumference : 24cm. • Weight : 1.1kg. • Length : 37cm.
SKIN • Acrocyanosis at birth. Skin reddened and thin so blood vessels early seen. Lanugo is present all over the body. UVC is present on the umbilicus. Umbilicus is drying. • HEAD: Head appears large in proportion to the body.A.F is soft and flat • EYES: Eyes are symmetrical in position. No abnormal discharge. • NOSE: Nostrils are patent bilaterally. Nasal flaring are present. No nasal discharge. Obligate nose breathers • MOUTH AND THROAT: Uvula midline. Oral secretion is present Mucosa is moist. Tongue moves freely and does not protrude.
NECK: Turns to side to side. clavicle intact. evident xiphoid process • CHEST: nipples symmetrical • ABDOMEN: dome shape, soft to palpate,UVC present, cord dry at base, bowel sound present on auscultation • GENITALIA: clitoris and labia minora slightly large voiding ad equating me conium passed with in 24 hrs • BACK: Intact spine without masses or opening. • EXTRIMITERS: Full range of motion. ten fingers and toes .creases are located only in front of the sole.
PATIENT HISTORY • Maternal medical history: 36 old mother with G2P1A0 and LSCS was done due to PET and HELLP syndrome • PATIENT HISTORY: • Present medical history: Baby girl 28 weeks gestational age was delved in KING KAHLID HOSPITAL by LSCS due to severe PET and HELLP syndrome • APGAR score was 5/1 and 7/5.baby was intubated immediately and given the first dose of Survanta and connected to mechanical ventilator with setting of PIP18,PEEP5 and RR 60/mt .
INTRODUCTION OF RDS • RDSalso known as hyaline membrane disease. It occurs almost extremely premature infants .incidence and severity of RDS are related inversely to gestational age of the newborns ETIOLOGY : • Preterm babies • LSCS • Multiple pregnancy • Maternal diabetics • Delivery complications • Me conium stained • Infections • Rapid labor
DISEASE DISCUSSION • The lungs are developmentally deficient in a material called surfactant, which allows the alveoli to remain open throughout the normal cycle of inhalation and exhalation • Surfactant is a complex system of lipids, proteins and glycoprotein’s which are produced in specialized lung cells called Type II cells or Type II pneumocytes. The surfactant is packaged by the cell in structures called lamellar bodies, and extruded into the alveoli. The lamellar bodies then unfold into a complex lining of the alveoli. This layer reduces the surface tension of the fluid that lines the alveolar walls.
During exhalation the walls of the alveoli come in contact and surface tension tends to cause them to stick together, preventing re-inflation. By reducing surface tension, surfactant allows the alveoli to re-expand with inspiration. Without adequate amounts of surfactant, the alveoli collapse and are very difficult to expand. • Microscopically, a surfactant deficient lung is characterized by collapsed alveoli alternating with hyper aerated alveoli, vascular congestion and, in time, hyaline membranes.
Hyaline membranes are composed of fibrin, cellular debries, red blood cells, rare neutrophils and macrophages. They appear as an eosinophilic, amorphous material, lining or filing the alveolar space and blocking gas exchange. • As a result, blood passing through the lungs is unable to pick up oxygen and unload carbon dioxide from the alveolar spaces . Blood oxygen levels fall and carbon dioxide rises, resulting in rising blood acid levels and hypoxia . Structural immaturity , as manifest by low numbers of alveoli, also contributes to the disease process.
PATHOPHYSIOLOGY PREMATURITY Decreased surfactant Increased alveoli surface tension Co2 retention Hypoxemia atelectasis Respiratory Acidosis Pulmonary vasoconstriction Capillary damage Fibrin exudate respiratory distress syndrome/hyaline membrane disease
SIGNS AND SYMTOMS • Bluish color of the skin and mucus membrane • Apnea • Decrees urine out put • Grunting • Nasal flaring • Hypothermia • Shallow breathing and rapid breathing
DIAGNOSTIC EVALUVATION • ABG: shows low O2 and excess acid in the body fluid • Chest x-ray: shows lungs have a characteristic ground glass appearance with often develops 6-12 after birth • Lab test: at birth PH-7.40,PCO2-68,HCO3-25.4,BE—1
NURSING INTERVENSTIONS • Promoting adequate gas exchange • Maintain thermoregulation • Promoting adequate nutrition and hydration • Encouraging parental attachment
TREATMENT • Infant will be given warm, moist o2 intubated a breathing machine can be life saving especially • High level of co2 in arteries • Low blood o2 in arteries • Low blood PH acidity • A treatment with C-PAP delivers slightly pressurized air through nose and can help the airway open • Antibiotics
PROGNOSIS • Condition worsens for 2-4 days some infants will die due to RDS during 2-7 days of life COMPLICATIONS OF RDS • Pneumothorax • Septicemia • BPD • PDA • Pulmonary hemorrhage • NEC • Retinopathy of prematurity(ROP)
MANAGEMENT OF NEONATAL RESPIRATORY DISTRESS INFANT WITH RDS Infant with RDS Mild tache/grunting Severe grunting Observe for10-20mt suggest no yes Resolve spontaneously resuscitate Chest x-ray Clinical improvement no o2 Nicu Ventilation,nicu,lab test
NURSING HEALTH TEACHING • Instruct the parents about, • Kangaroo care, • Breast Feeding • Proper covering of the baby[warm blanket] • Ensure that the family receives information on routine well baby care. • Before discharge, parents should feel comfortable in their abilities to care for the infant. • Educate them,importance of regular health care, periodic eye examinations, and developmental follow up with the parents
CONCLUSION • Presented a case of preterm new born baby with respiratory distress • Baby relived from signs and symptoms of RDS • Thermoregulation maintained • Baby discharged after good care with Mixavit and iron drops
BIBLIOGRAPHY • Maternal and Child Health Nursing by Adele Pillitteri 5th edition; volume 1 page 426- 433;page 329-332 • Lippincott Manual of Nursing Practice 9th edition • Lange clinical manual neonatology fifth edition-by Gomella,Douglas,Fabien • Neonatal resuscitation 5th edition