Nursing care plan for Respiratory distress in newborn syndrome

Respiratory distress syndrome is also known as hyaline membrane disease (HMD). It causes the greatest risk in premature infants. Respiratory distress syndrome (RDS) is the condition when the neonate has difficulty breathing due to surfactant deficiency at birth. It is the commonest clinical problem faced by preterm infants and is directly proportional to structurally immature and surfactant-deficient lungs.

Progressive and high-frequency respiratory insufficiency, breathlessness due to immaturity and atelectasis of the lungs characterize the RDSNB. It is reported that although it has been linked to a qualitative and quantitative dysfunction of the pulmonary surfactant system, its replacement has been associated with a sustained improvement in lung function and a reduction in the mortality rate

• Low gestational age
• Impaired synthesis of pulmonary surfactant
• Prematurity of the lungs structurally and functionally
• terminal alveoli with insufficient surfactants

The gestational age is the main risk factor in causing respiratory distress syndrome. The preterm infants will be with immature lungs and with insufficient surfactants which leads to increased surface tension in the alveoli and reduced lung compliance, leading to increased work of breathing; hypoventilation, leading to respiratory acidosis; increased intrapulmonary shunting and severe hypoxaemia; fall in lung compliance to 25 per cent; and increased dead space.

• Tachypnoea (respiratory rate >60/minute);
• Nasal flaring (from the use of alae nasi as accessory muscles);
• Sternal and intercostal recession (due to the compliant chest wall and noncompliant lungs);
• Central cyanosis;
• Apnoea;
• Expiratory grunt (caused by the infant exhaling against a closed glottis, which maintains a high residual air volume in the lungs preventing alveolar collapse).

Diagnosis is confirmed by history, blood gases showing impaired respiratory function, and an X-ray demonstrating the classic reticulogranular or ‘ground glass’ appearance and air bronchograms (radiolucent air-filled airways).

Primary nursing care plan for respiratory distress in a newborn

• Progressive and high-frequency respiratory insufficiency
• Breathlessness due to immaturity
• Atelectasis of the lungs
• Other diagnosis associated with nursing care
• Varying degrees of tachypnea
• Nasal flaring
• Retractions
• Moaning
• Cyanosis

Where the apnoea may result secondary to the hypoxemia and respiratory failure. And also in some cases, there’s evidence of reduced vascular murmur due to the severity and due to the disseminated micro atelectasis.

By observing the severity of respiratory distress, an intensive nursing care plan for respiratory distress is needed to prevent and to decrease the mortality rate.

The condition can be prevented, or the severity reduced, by antenatal administration of betamethasone. The course of the disease is altered by exogenous surfactant therapy and assisted ventilation.

Attention to thermoregulation and oxygenation can decrease the severity of RDS.

Non-respiratory management of RDS

Temperature control is an important facet of the care of the infant with respiratory distress and both hypothermia and hyperthermia should be avoided. The temperature should be maintained in the neutral thermal range.

Internal feeding should generally be avoided in infants with significant respiratory distress (oxygen requirements greater than 35 per cent). During the initial stabilisation, intravenous fluid therapy is useful if it can be started easily but premature infants do not necessarily require an IV immediately. Exposure to manipulation and cold stress may do more harm than good in this situation. Attention to the prevention of hypoglycaemia is, however, an important part of an ongoing nursing care plan for acute respiratory failure.

Minimal handling is important and can be facilitated by the use of monitors to help assess the infant’s status (cardiorespiratory, temperature and oxygen saturation monitors should be used whenever possible).

Antibiotics – commence penicillin and gentamicin therapy after initial investigations.

Respiratory management of RDS

Airway
Placing the unwell infant in the prone position rather than supine may provide a clear airway. Ensure the infant has full cardiorespiratory and saturation monitoring when placing prone. Repeated suctioning of the pharynx is not required and may cause apnoea and hypoxia.

OxygenBoth too much and too little oxygen are bad for preterm infants, hypoxia is much more dangerous over the short period while awaiting transport.

Monitoring of oxygen

Capillary acid-base status (CAB) allows monitoring of pCO2 and pH. High pCO2>70 is an indication for intubation 

Arterial blood gases (ABG) – accurate assessments can be made from samples taken from indwelling arterial lines which are usually performed in an intensive care setting, aiming to keep pO2 between 50 and 80 mm Hg. Assessment of oxygen requirements from arterial ‘stabs’ is not reliable.

Non-invasive monitoring – oxygen saturation monitors may be attached to the infant’s right hand (pre-ductal). The desired range for infants is 91 – 95 percent.

Cyanotic threshold – keep the ambient oxygen concentration 5 to 10 percent above the level at which the infant is noted to be cyanosed if saturation monitoring is unavailable.
 

Administration of oxygen

Oxygen concentrations up to 40 per cent may be achieved through the oxygen port into an incubator.

Above 40 per cent is achieved using warmed, humidified gas delivered via a headbox if CPAP is not available. If using a headbox, flow rates of at least 8-10 l/min are required to avoid rebreathing of carbon dioxide.

Pharmaceutical management

Surfactant administration should be considered in any premature intubated infant with a presumed diagnosis of RDS.

Dosages

Initial recommended dose is 200 mg/kg/dose (2.5  mL/kg), up to 2 repeat doses of 100 mg/kg may be considered at 12 hourly intervals.

Nursing care plan for acute respiratory failure 

• Identifying and treating the cause and other related symptoms.
• Administering the oxygen as prescribed by the physician in an appropriate way
• Placing the infant in a prone position to clear the airway
• Restricting the fluid intake as prescribed
• Providing respiratory treatment as described
• Injecting the surfactants with proper dosage

Documentation guidance

• Respiratory status of the infant is recorded
• The vital signs are evaluated
• To rule out any complications or side effect
• Documenting the response to treatment.

As the patient recovery is ensured by a post-operative nursing care plan for lower respiratory tract infection and nursing care plan for upper respiratory tract infection, post-operative care becomes the vital element of the curing process. Postoperative nursing care plan for lower respiratory tract infection and nursing care plan for upper respiratory tract infection for individuals might be easy and may be short term or long term and may entail some procedure.

From the warmth of her/his home, a patient is much better off, more so if long term nursing care is required for recovery. Aiding this kind of care is our care team of home services. Included in service are our group of nurses and other caregivers as needed. They would come and visit you and offer good care within the confines of your home. Therefore, if you require care at home, look no further and reach out to us.