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IRDS

IRDS

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Published by: Justin Ahorro-Dionisio on Dec 10, 2010
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12/10/2010

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Calamba Doctors’ CollegeParian Calamba City, LagunaSY 2010 – 2011
Case PresentationOf Infant Respiratory Distress Syndrome
Submitted by:Bajado, Christian DaveBautista, Maria CindyCorcelles, JayConcepcion, GraziellaDel Fuerte, Heidi AvedizDena, Pauline CharmineDomino, JonnavelFlores, MelsonGutierrez, Mary GraceIsturis, ShaddyIli, Charie MayMariano, Resti
 
Introduction
Infant Respiratory Distress Syndrome (IRDS) or the Hyaline Membrane Disease.IRDS is a most often applied to severe lung disorder that carries the highest risk in terms of long-termrespiratory and neurologic complications. It is seen almost exclusively in preterm infants. The disorder is rare indrug-exposed infants or infants who have been subjected to intrauterine stress, like pre-eclampsia or hypertension.The pathologic feature of IRDS is a hyaline-like membrane formed from exudates of an infant’s bloodthat begins to line the bronchioles, alveolar ducts, and alveoli. This membrane prevents exchange of oxygen andcarbon dioxide at the alveolar-capillary membrane. The cause of RDS is a low level or absence of surfactant,the phospholipid that normally lines the alveoli and reduces surface tension on expiration to keep the alveolifrom collapsing on expiration.Common clinical manifestations of IRDS are tachypnea, pronounced intercostals or substernalretractions, fine inspiratory crackles, audible expiratory grunt, flaring of the external nares, and cyanosis or  pallor.The diagnosis of IRDS is made on the basis of clinical manifestations in radiographic studies.Radiographic findings characteristic of IRDS include 1) a diffuse granular pattern over both lung fields thatclosely resembles ground glass and represents alveolar atelectasis, and 2) dark streaks or bronchograms, withinthe ground glass areas that represent dilated, airfield bronchioles. Pulse oximetry and carbon dioxidemonitoring, as well as pulmonary functions studies, assist in differentiating pulmonary and extra pulmonaryillness and are used in the management of IRDSThe treatment of IRDS involves immediate establishment of adequate oxygenation and ventilation andsupportive care and measures required for any preterm infant, as well as those instituted to prevent further complications associated with preterm birth. The supportive measures most crucial to a favorable are to 1)maintain adequate ventilation and oxygenation, 2) maintain acid-base balance, 3) maintain a neutral thermalenvironment, 4) maintain adequate tissue perfusion and oxygenation, 5) prevent hypotension, and 6) maintainadequate hydration and electrolyte status.IRDS is a self-limiting disease. After a period of deterioration, and in the absence of complications,affected infants begin to improve by 72 hours. Often heralded by the onset of diuresis, this improvement has been attributed primarily to increase production and greater availability of surface active material
 
Nursing Theory
Roy’s Adaptation Model
Background:The most well-known of the Californian theorist was Sister Calista Roy, a student of DorothyJohnson’s who was also a teacher of Nursing at Mount Saint Mary’s College in Los Angeles. The major of Roy’s theory is on behavioral science concepts, with the individual described as a participant in bio-psycho-social adaptive systems. Patients are described as being under varying degrees of stress and their goal is to adaptto that stress.Major Concepts:1.SystemA system is “a set of parts connected to function as a whole for some purpose and that does so byvirtue of the interdependence of its parts”. In addition to having wholeness and related parts,“systems also have inputs, outputs, and control and feedback processes”2.Adaptation Level“Adaptation level represents the condition of the life processes described on three levels asintegrated, compensatory, and compromised”. A person’s adaptation level is “constantlychanging point, made up of focal, contextual, and residual stimuli, which represent the person’sown standard of the range of stimuli to which one can respond with ordinary adaptiveresponses”.3.Adaptation ProblemsAdaptation problems are “broad areas of concern related to adaptation. These describe thedifficulties related to the indicators of positive adaptation.4.Focal stimulusThe focal stimulus is the “internal or external stimulus most immediately confronting the humansystem”.5.Contextual StimuliContextual stimuli “ are all other stimuli present in the situation that contribute to the effect of the focal stimulus”. That is, “contextual stimuli all the environmental factors that are present tothe person from within or without but which are not the center of the person’s attention andenergy.

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