1. NURSING
DIAGNOSIS
RESPIRATORY
DISTRESS
SYNDROME

2. Impaired Gas
Exchange
 May
be Related to:
Inadequate Surfactant
Level
 Altered oxygen supply
 Cold stress
As possibly evidenced by:

tachypnea

use of accessory
muscle

pallor or cyanosis

changes in ABGs


3. Impaired
Spontaneous
Ventilation

May be Related to:
 Respiratory muscle fatigue
 Metabolic factors
Possibly evidenced by:
 Dyspnea
 Increased metabolic rate
 Restlessness
 Use of accessory muscles
and,
 Abnormal ABGs

4. NURSING
RESPONSIBILITIES
RESPIRATORY
DISTRESS
SYNDROME

5. Nursing
Responsibilities
 Airway
stabilization
 Airway management
 Oxygen therapy
 Thermoregulation
 Blood gas monitoring
 Family involvement
therapy

6. Airway Stabilization
and Comfort


Nursing the naked infant
supine in an incubator will
allow observation of chest
movement, and arterial and
venous lines. The head should
ideally be slightly extended to
stabilize the tube and prevent
laryngeal trauma.
Side-lying postures tend to
lessen hip and shoulder
rotation and abduction. In any
position the infant should be
supported with flexible
boundaries of, for example,
rolled blankets.

7. Blood Gas
Monitoring


Blood gases must be
monitored as a guide to
ventilatory management
and to minimize the risk of
retinopathy of
prematurity from
inappropriate use of high
levels of oxygen (McGurk,
2003).
Non-invasive methods
such as pulse oximetry
and carbon dioxide
tension monitors are
useful trend detectors but
should not be used in
isolation.

8. Thermoregulation


Neonates have poorly
developed mechanisms for
thermoregulation and
maintenance of a neutral
thermal environment is a
perpetual challenge. Core
temperature should be
maintained at 37°C to
minimize oxygen
consumption and acidosis.
To minimize heat loss, it is
recommended that sick
infants are nursed in an
incubator with a controlled
temperature, or an open
cot with an overhead
heater controlled by a
temperature probe on the
skin.

9. Fluid and electrolyte
balance


RDS delays the onset of
normal postnatal diuresis,
and edema often appears
after 24-48 hours.
Meticulous attention to
fluid and electrolyte
balance is crucial to avoid
fluid overload, which
contributes to
complications such as
patent ductus arteriosis
and chronic lung disease.
To an extent, a humidified
environment can help but
insensible losses should be
an essential part of the
fluid balance equation.

10. Parent Health
Education


It is vital that the parents feel
involved. Their anguish
begins as soon as they know
they are to deliver a
preterm infant who may
have RDS, and the moment
of birth, which should be a
happy time, is fraught with
worry. The admission of their
baby to the neonatal ICU,
attached to a plethora of
machinery, can be
devastating (Strange, 2002).
Family-centred care is an
appropriate framework for
the neonatal ICU (Turrill,
1999).

11. CRITICAL CARE
AREA
EQUIPMENTS
RESPIRATORY
DISTRESS
SYNDROME

12. Infusion Pump
 An
infusion
pump infuses fluids,
medication or nutrients
into a patient's circulatory
system. It is generally
used intravenously,
although
subcutaneous, arterial an
d epidural infusions are
occasionally used.

13. Incubator

Infants are cared for in
incubators or "open
warmers." Some low birth
weight infants need
respiratory support ranging
from extra oxygen (by
head hood or nasal
cannula) to continuous
positive airway pressure
(CPAP) or mechanical
ventilation. Public access is
limited, and staff and
visitors are required to take
precautions to reduce
transmission of infection.

14. Continuous Positive
Airway Pressure
(CPAP)
 As
a treatment or
therapy, CPAP uses mild
air pressure to keep an
airway open.
 In some preterm infants
whose lungs haven't
fully developed, CPAP
improves survival and
decreases the need for
steroid treatment for
their lungs.

15. Positive end
expiratory pressure
(PEEP)

Positive end expiratory
pressure (PEEP) is routinely
used when ventilating
preterm infants, and high
levels are recommended in
those with severe
respiratory distress
syndrome (RDS). Elevation
of PEEP increases lung
volume, as does surfactant
administration.

16. Pulse Oximeter
A
pulse oximeter is
a medical device that
indirectly monitors the
oxygen saturation of a
patient's blood (as
opposed to measuring
oxygen saturation
directly through a
blood sample) and
changes in blood
volume in the skin,
producing
a photoplethysmogram
.

17. Food for Thought…
It is not how much you do but how much
love you put in the doing.
---Mother Theresa

18. To do what nobody else will do, a way that
nobody else can do, in spite of all we go through;
is to be a nurse…
---Rawsi Williams

19. Short Quiz:
1. A nurse in the newborn nursery is monitoring a
preterm newborn infant for respiratory distress
syndrome. Which assessment signs if noted in the
newborn infant would alert the nurse to the
possibility of this syndrome?
A. Hypotension and Bradycardia
B. Tachypnea and retractions
C. Acrocyanosis and grunting
D. The presence of a barrel chest with grunting

20. 2. A nurse on the newborn nursery floor is caring
for a neonate. On assessment the infant is
exhibiting signs of cyanosis, tachypnea, nasal
flaring, and grunting. Respiratory distress syndrome
is diagnosed, and the physician prescribes
surfactant replacement therapy. The nurse would
prepare to administer this therapy by:
A. Subcutaneous injection
B. Intravenous injection
C. Instillation of the preparation into the lungs
through an endotracheal tube
D. Intramuscular injection

21. 3. Which action best explains the main role of
surfactant in the neonate?
A. Assists with ciliary body maturation in the upper
airways
B. Helps maintain a rhythmic breathing pattern
C. Promotes clearing mucus from the respiratory
tract
D. Helps the lungs remain expanded after the
initiation of breathing

22. 4. The highest-priority nursing diagnosis for a
neonate experiencing RDS is:
A. Altered Nutrition: More Than Body Requirements
B. Alterations in Parenting
C. Acute Pain
D. Impaired Gas Exchange, related to inadequate
lung surfactant

23. 5. Neonatal RDS can also be the result of the
following conditions.
A. Mother with DM
B. Caesarean Section Delivery
C. Both A & B
D. None of the above

24. 6. CPAP is a treatment or therapy for RDS. CPAP
stands for?
A. Continuous Pressure- Airway Positive
B. Complementary Positive Airway Pressure
C. Continuous Positive Alveolar Pressure
D. Continuous Positive Airway Pressure

25. 7. A medical device that indirectly monitors the
oxygen saturation of a patient's blood (as
opposed to measuring oxygen saturation directly
through a blood sample) and changes in blood
volume in the skin, producing
a photoplethysmogram.
A. Pulse Oximeter
B. CPAP
C. PEEP
D. Arterial Blood Gas (ABG)

26. 8. Surfactants are primarily made up of? (select all
that apply)
A. Lipids
B. Proteins
C. Glycoproteins
D. Carbohydrates

27. 9. What is/are the primary diagnostic procedures to
rule out RDS? (select all that apply)
A. Pulse Oximetry
B. Chest X-ray
C. CBC
D. Bacteriology

28. 10. What is the most commonly used Surfactant?

29. Answers…
1. A nurse in the newborn nursery is monitoring a
preterm newborn infant for respiratory distress
syndrome. Which assessment signs if noted in the
newborn infant would alert the nurse to the
possibility of this syndrome?
A. Hypotension and Bradycardia
B. Tachypnea and retractions
C. Acrocyanosis and grunting
D. The presence of a barrel chest with
grunting
The infant with respiratory distress syndrome may
present with signs of cyanosis, tachypnea or apnea, nasal
flaring, chest wall retractions, or audible grunts.

30. 2. A nurse on the newborn nursery floor is caring for a
neonate. On assessment the infant is exhibiting signs of
cyanosis, tachypnea, nasal flaring, and grunting.
Respiratory distress syndrome is diagnosed, and the
physician prescribes surfactant replacement therapy.
The nurse would prepare to administer this therapy by:
A. Subcutaneous injection
B. Intravenous injection
C. Instillation of the preparation into the lungs
through an endotracheal tube
D. Intramuscular injection
The aim of therapy in RDS is to support the disease until
the disease runs its course with the subsequent development of
surfactant. The infant may benefit from surfactant replacement
therapy. In surfactant replacement, an exogenous surfactant
preparation is instilled into the lungs through an endotracheal tube.

31. 3. Which action best explains the main role of
surfactant in the neonate?
A. Assists with ciliary body maturation in the upper
airways
B. Helps maintain a rhythmic breathing pattern
C. Promotes clearing mucus from the respiratory tract
D. Helps the lungs remain expanded after the initiation
of breathing
Surfactant works by reducing surface tension in the lung.
Surfactant allows the lung to remain slightly expanded,
decreasing the amount of work required for inspiration.

32. 4. The highest-priority nursing diagnosis for a
neonate experiencing RDS is:
A. Altered Nutrition: More Than Body Requirements
B. Alterations in Parenting
C. Acute Pain
D. Impaired Gas Exchange, related to inadequate
lung surfactant
The lungs of infants with respiratory distress
syndrome are developmentally deficient in a material
called surfactant, which helps prevent collapse of the
terminal
air-spaces
(the
future
site
of
alveolar development) throughout the normal cycle of
inhalation and exhalation.

33. 5. Risk for Neonatal RDS can be increased with the
following conditions.
A. Mother with DM
B. Caesarean Section Delivery
C. Both A & B
D. None of the above
Risk for developing neonatal RDS:
-A brother or sister who had RDS
-Diabetes in the mother
-Cesarean delivery
-Delivery complications that reduce blood flow to the baby
-Multiple pregnancy (twins or more)
-Rapid labor

34. 6. CPAP is a treatment or therapy for RDS. CPAP
stands for?
A. Continuous Pressure- Airway Positive
B. Complementary Positive Airway Pressure
C. Continuous Positive Alveolar Pressure
D. Continuous Positive Airway Pressure
As a treatment or therapy, CPAP (Continuous Positive
Airway Pressure )
uses mild air pressure to keep an airway open.

35. 7. A medical device that indirectly monitors the
oxygen saturation of a patient's blood (as opposed
to measuring oxygen saturation directly through a
blood sample) and changes in blood volume in the
skin, producing a photoplethysmogram.
A. Pulse Oximeter
B. CPAP
C. PEEP
D. Arterial Blood Gas (ABG)

36. 8. Surfactants are primarily made up of? (select all
that apply)
A. Lipids
B. Proteins
C. Glycoproteins
D. Carbohydrates
Surfactant
is
a
complex
system
of lipids, proteins and glycoproteins which are produced in
specialized lung cells called Type II cells or Type II
pneumocytes.

37. 9. What is/are the primary diagnostic procedures to
rule out RDS? (select all that apply)
A. Pulse Oximetry
B. Chest X-ray
C. CBC
D. Bacteriology
-A blood gas analysis shows low oxygen and excess acid in the
body fluids.
-A chest x-ray shows the lungs have a characteristic "ground
glass" appearance, which often develops 6 to 12 hours after
birth.
-Lab tests are done to rule out infection and sepsis as a cause
of the respiratory distress.

38. 10. What is the most commonly used Surfactant?
If the baby's condition worsens, an endotracheal
tube (breathing tube) is inserted into the trachea and
intermittent breaths are given by a mechanical device. >
exogenous preparation of surfactant, either synthetic or
extracted from animal lungs, is given through the breathing
tube into the lungs. (commonly used surfactants is
SURVANTA, derived from cow lungs, which can decrease
the risk of death in hospitalized very-low-birth-weight
infants by 30%.)

39. THANK YOU!
Group 6
Loraine Valle
Karen Taopo
Charmaine Del Rosario
Jett Arr Jun Plocios