Respiratory Distress Syndrome Lab Report

Neonatal RDS is a condition of increasing respiratory distress commencing at or shortly after birth (BAPM-2006). It’s the single most important cause of morbidity and mortality in preterm infants (Greenough, et al 2004). Typically RDS affects preterm infants with the incidence being inversely proportional to the gestational age (Stewart 2005) Approximately 60% of those born before 28 weeks gestation are affected (Fraser, et al 2004) Incidence also increases in infants of diabetic mothers those born via elective caesarean section (Fraser, et al 2004) and perinatal asphyxia (Rodriguez, 2003).

I was well versed with the patient’s medical history and current treatment, as I was the Long Call IM PGY – II Resident who supervised the medical intern when this patient was being downgraded from the ICU to the medical floor on 5/20/17 (and even suggested to the medical intern to add in her notes that the patient would benefit from statins, ACE inhibition and Spironolactone given CAD, CVA and HFrEF (LVEF < 35%.) The medical team subsequently started the patient on Atorvastatin 40 MG PO QHS, Lisinopril 10 MG PO QD and Spironolactone 12.5 MG PO QD.

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.

IW is currently taking Naproxen. IW is taking gabapentin but states that it has not helped as he has some grogginess. Patient has 50% relief with current medications.

Sudden Acute Respiratory Syndrome is a highly contagious virus that is contracted when the victim touches a surface or sneezes. It is believed that SARS primarily attacks the lungs but it is not fully understood if it is the only organ affected. Some liver abnormalities have occurred but it is not fully known if the disease attacks the liver as well. The virus is believed to have originated from China, but it was diagnosed in a Vietnamese hospital by Dr. Carlo Urbani. Both the doctor and the patient died from SARS complications.

1.16. Explain the standard set of nursing observations that are completed on an individual who is in respiratory distress? Blood pressure, L&S manual or machine, SPo2 used on finger, ear or nose, Respirations for full minute, HR manual or through machine, neurovascular observation and capillary refill, pain scale, alert scale (Chrisp & Taylor, 2011)

He indicated with Carson, she was deficient in enzymes requiring daily injections of an enzyme. The child was healthy at birth. He doesn’t recall how regularly he attended the OBYN visits. The father stated that he was present for sonograms.

According to the WHO preterm birth complications are the leading cause of death among children under the age of 5, and responsible for nearly 1 million deaths in 2013.1 Many therapies have emerged with advancements in perinatal and neonatal care including antenatal steroids, exogenous surfactants and ventilation advancements that have lead to the rise in the survival of premature infants. However, prematurity is still associated with many morbidities, such as need for prolonged ventilatory support, intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP). Of these, respiratory distress syndrome (RDS) is the most common cause of morbidity, with an incidence of 42% in infants weighing 501-1500gms.2

ROS: Psychiatric - History of bipolar disorder. He is on clonazepam 2 mg three times daily for this. He is also on Lamictal, as above, for this in addition to controlling seizures. Integumentary - He is not having rash or other difficulty with Lamictal.

These numbers make BPD one of the most common chronic lung diseases diagnosed in children. Infants diagnosed as having BPD are usually born more than 10 weeks before their due day and have low birth weights less than 2 pounds. These preterm infants have pulmonary issues due to underdeveloped lungs and lack of surfactant, which leads to the initial diagnoses of respiratory distress syndrome. The lack of surfactant and collapsed lungs make it difficult for the infant to breathe to get adequate oxygenation. These infants are then treated with surfactant therapy, and they often require extra ventilatory support. If an infant doesn’t improve, they often placed on nasal continuous airway pressure (NCPAP) or ventilators for long periods of time. Studies show that NCPAP can decrease the risk of BPD by generating pressure as well as improving exhalation (Mola, 2014) . If the preterm infant still requires prolonged mechanical ventilation to obtain a PO2 of greater than 50 mmHg at its official due date or 28 days since supplemental oxygen was first applied, additional testing is performed to confirm a true diagnosis of BPD. Infants with BPD often experience abnormal changes in the cells of the smaller airways leading to injured airways and damaged pulmonary vasculature due to the prolonged ventilation. The baby’s

Acute respiratory distress syndrome (ARDS) is characterized by ventilation and perfusion mismatching that leads to hypoxic respiratory failure. Ashbaugh and colleagues first defined it in 1967 when they described 12 patients with severe acute respiratory failure (Ferguson et al., 2012). “These patients had severe hypoxemia that was refractory to supplemental oxygen, but which in some cases was responsive to the application of positive end-expiratory pressure (PEEP)” (Ferguson et al., 2012, p. 1574). Autopsy also revealed widespread pulmonary inflammation, edema and hyaline membranes (Ferguson et al., 2012).

In the article, Acute lung injury and acute respiratory distress syndrome: Two challenging respiratory disorders, I learned about how difficult it is to diagnose a deadly respiratory disorder. Acute lung injury and acute respiratory distress (ARDS) is a secondary illness resulting from a primary disease that has been largely ignored by the veterinary community, but initial early recognition of the disease is paramount to providing a full recovery. This compounding disorder primarily affects the lungs and its associated passages and membranes in the respiratory system which becomes deadlier as it progresses. The three phases of this disease are the exudative phase, the proliferative phase, and the fibrotic phase. In order to suspect this

Blood gas analysis may be performed to determine if high concentration oxygen therapy is needed (Bush & Thomson, 2007). The management of fever would be a part of care plan when the infant is febrile due to infection (Axton & Fugate 2009).

I have put together our new Respiratory Chemical Inventory list. Our list is located in our yellow Material Safety Data Sheet binder.

Respiratory distress syndrome (RDS) is a common lung disorder that mostly affects preterm infants. RDS is caused by insufficient surfactant production and structural immaturity of the lungs leading to alveolar collapse. Clinically, RDS presents soon after birth with tachypnea, nasal flaring, grunting, retractions, hypercapnia, and/or an oxygen need. The usual course is clinical worsening followed by recovery in 3 to 5 days as adequate surfactant production occurs. Research in the prevention and treatment of this disease has led to major improvements in the care of preterm infants with RDS and increased survival. However, RDS remains an important cause of morbidity and mortality especially in the most preterm infants. This chapter reviews the most current evidence-based management of RDS, including prevention, delivery room stabilization, respiratory management, and supportive care.