Respiratory Distress Syndrome (RDS) (Hyaline Membrane Disease)
- Definition: Severe impairment of respiratory function in premature newborn.
- Pathophysiology: Lack of surfactant (a substance that prevents alveolar walls from "sticking together" during expiration) results in atelectasis, impaired perfusion of lungs, and reduced pulmonary compliance.
- Etiology: Delivery of infant prior to ability to produce surfactant. Usually occurs in infants weighing less than 5 lb or who are of less than 37 weeks’ gestation.
- Manifestations: Tachypnea, tachycardia, inspiratory retractions, expiratory grunt, cyanosis, and abnormal ABGs.
- Med Tx: Artificial surfactant via ET tube. Theophylline to relax bronchi and pulmonary vessels and to stimulate respiratory center. Supplemental O2 and assisted ventilation if needed. IV hydration and control of electrolytes.
- Nsg Dx: Impaired gas exchange, potential for injury, altered parenting, knowledge deficit (parents).
- Nsg Care: Monitor respiratory status. Monitor response to all treatments. Maintain neutral thermal environment. Weigh daily. Monitor I&O. (Urine output = 2 mL/kg/h with sp. gr. of 1.005 to 1.010.). Limit stimuli and handling to reduce O2 need. Encourage parent-infant bonding.
- Prognosis: Mortality during first 24 hours = 50%; after 72 hours’ survival, mortality = 10%.