IX.

ECOLOGIC MODEL

A. Hypothesis
• Hyaline Membrane Disease is a disease that almost all of the pre-term baby can suffer.
Because the lungs of the neonates are not fully developed. The air sacs collapse
because there are no enough surfactants which help the lungs inflate with air and
keep the air sacs from collapsing and prevent the child from breathing properly.

Just like other patients in NICU our patient also suffer from Hyaline Membrane Disease.
It is sometimes called Infant respiratory distress syndrome (IRDS), neonatal respiratory
distress syndrome or respiratory distress syndrome of newborn. This is probably due to
immature or not fully develops lungs. She sometimes experience hypothermia and
tachycardia when she is being held every time or whenever the incubator is open.

B. Pre-disposing Factors

Host
-pre-term baby
-lungs are immature

Agent
-cesarean delivery
-patient mother was pre-eclamptic
-genetic(if one of her relatives also suffer on this disease before)

Environment
-living conditions
-economic level
Ecologic Model

Host

Agent

C. Analysis

The agent-host-environment model is primarily use in predicting illness rather

than promoting wellness, although identification of risk factors that result from the interactions
of agent, host, and environment are helpful in promoting and maintaining health. Because each
of the agent-host-environment factors constantly interacts with others, health is an ever changing
state. Health is seen when all three elements are in balance while illness is seen when one, two,
or all three elements are not in balance

(Fundamentals of Nursing by Kozier 2004)

Hyaline membrane disease (HMD), also called respiratory distress syndrome (RDS), is one of
the most common problems of premature babies. It can cause babies to need extra oxygen and
help breathing. The course of illness with hyaline membrane disease depends on the size and
gestational age of the baby, the severity of the disease, the presence of infection, whether or not a
baby has a patent ductus arteriosus (a heart condition), and whether or not the baby needs
mechanical help to breathe.

HMD occurs when there is not enough of a substance in the lungs called surfactant. Surfactant is
normally released into the lung tissues where it helps lower surface tension in the airways. This
helps keep the lung alveoli (air sacs) open. When there is not enough surfactant, the tiny alveoli
collapse with each breath. As the alveoli collapse, damaged cells collect in the airways and
further affect breathing ability. These cells are called hyaline membranes. The baby works harder
and harder at breathing, trying to re-inflate the collapsed airways.

As the baby's lung function decreases, less oxygen is taken in and more carbon dioxide builds up
in the blood. This can lead to increased acid in the blood called acidosis, a condition that can
affect other body organs. Without treatment, the baby becomes exhausted trying to breathe and
eventually gives up. A mechanical ventilator (breathing machine) must do the work of breathing
instead.

D. Conclusion

We therefore conclude that our client is suffering from Hyaline Membrane

Disease. Probably due to her age of gestation or to her immature lungs. Other risk factors may
also involve such as if her mother was a diabetic, pre-eclamptic, or one of their family suffers on
this disease before.

E. Management

Specific treatment for HMD will be determined by your baby's physician based on:

• your baby's gestational age, overall health, and medical history

• extent of the condition
• your baby's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

MEDICAL MGT

• O2 with continuous positive airway pressure (CPAP) and IV fluids to stabilize the
blood sugar, blood salts, and blood pressure

• ET tube insertion

• Exogenous surfactant e.g. Survanta

• Extracorporeal membrane oxygenation (ECMO) to directly put oxygen in the
blood if a breathing machine can't be used

• Inhaled nitric oxide to improve oxygen levels