INTRODUCTION:

During my clinical posting at GMCH, NICU I came across a newborn baby of Ajeda Khatun
who has been diagnosed with Respiratory Distress Syndrome (RDS). I have collected some data
from her mother regarding her birth history and present condition which I used to give care to the
patient according to the baby’s need and try to study more about the disease condition so that I
will be able to know more about the condition and to give more proper care to the baby. And also
it will help me in writing my Case study.

1. IDENTIFICATION OF THE PATIENT:

i. Name: B/O Ajeda Khatun.

ii. Age: 1month 3 days.

iii. Sex: Female.

iv. Religion: Islam.

v. Date of admission: 17/03/2022.

vi. Hospital No: 129448/22.

vii: MRD no: 28284.

viii: Ward: NICU.

ix: Bed No: Inborn bed no 4.

x: Address: Kharpetia, Darrang district, Assam.

xi: Provisional Diagnosis: Respiratory Distress Syndrome (RDS).

xii: Name of Operation: The patient had not gone any surgery and procedure.

xiii: Source of health care: GMCH.

xiv: Date of discharge: 23/04/2022

2.DATE AND TIME OF HISTORY COLLECTION: 19.04.2022 at 10:30 am.

3.INFORMANT: Mother.

4.HISTORY OF ILLNESS OF THE PATIENT: On date 17/03/2022 the baby brought to

NICU from labor room with respiratory distress. The baby was having difficulty in breathing and
also baby was having Low Birth Weight (LBW) i.e. 1.5 kg. Further physician’s diagnosed as
Respiratory Distress Syndrome (RDS). The baby was sick and lethargic since the time of
admission. The patient heart rate was 156 b/min at the time of admission and oxygen level was
85%. At present the patient is in Oxygen 4 ml/hr and getting Nasogastric tube feeding.

5. CHILD’S PERSONAL DATA:

A.PRE-NATAL HISTORY:

i.Pregnancy (LMP/EDD):

LMP-25/09/2021.

EDD- 02/07/2022

ii. Maternal health: The mother had attended all the pre-natal check-up and investigations were
done timely. Mother got all the immunization during her pregnancy period and she did not have
any complications after delivery of the baby.

iii.Weight gain: Mother gain weight about 10 kg during her pregnancy.

iv.Medicine taken: Mother took iron and folic acid medications during her pregnancy.

B.NATAL:

i.Place of delivery and conduction of delivery: Normal Vaginal Delivery done in Guwahati
Medical College & Hospital.

ii. Labor (spontaneous/induce): Spontaneous labor.

iii. Complications: There were no complications to the mother during and after delivery.

C.NEONATAL:

i. Color at delivery: Blue skin color (Cyanosis).

 ii. Activity of the infant: Alert.

iii. Breathing abnormality: Grunting sound and fast breathing present.

iv. Birth weight and length: 1.5 kg & 32 cm.

v. Problem occurred immediately after birth: Difficulty in breathing, fast breathing and
meconium aspiration was present immediately after birth.

D.POSTNATAL:

i. Duration of hospitalization: 1 month 3 days.

ii. Problems with baby’s breathing or feeding: The patient is in oxygenation 4 ml/hr and she is
under tube feeding 20 mi/ 3 hourly.

iii. Color (cyanosis/jaundice): Cyanosis present.

iv. Bowel movement: Bowel sound present.

E.GROWTH AND DEVELOPMENT:

1. Physical growth and development:

a) Physical or biological:

Parameters Expected Actual

i.Height 50 cm 40 cm.

ii.Weight 2.5 kg 1.5 kg

iii.Head circumference: 33-35 cm 30 cm

iv. Chest Circumference 30-33 cm 29 cm

v.Mid arm circumference 11-12 cm 9.8 cm

 b) Motor and self-care:

i.Gross motor:

AGE EXPECTED MILESTONES ACTUAL MILESTONES

YES/NO
Newborn  Lies in flexed position with hands YES
clenched.
 Head lags behind when baby is NO
pulled up from supine to sitting
position.

ii. Fine motor development:

AGE EXPECTED MILESTONES ACTUAL MILESTONES

YES/NO
Newborn  Grasp reflex is strong. YES
 Baby can grasp an object placed in YES
head but drops it immediately.

iii. Psychosocial, psychosexual and spiritual development:

AGE EXPECTED MILESTONES ACTUAL MILESTONES

YES/NO

Newborn  Baby established basic trust. YES

 Oral stage- Baby can suck. NO
 Undifferentiated the beginnings of YES
faith are established.
 iv. Sensory development:

AGE EXPECTED MILESTONES ACTUAL MILESTONES

YES/NO

Newborn  Protective blinking reflex is present. YES

v. Language and speech development:

AGE EXPECTED MILESTONES ACTUAL MILESTONES

YES/NO
Newborn  Baby startles to loud noises. YES
 Baby responds to human voice. YES
 Baby makes comfort sounds during NO
feeding.
 Baby begins to coo. YES.

vi. Play stimulation (visual, auditory, tactile, and kinetic):

AGE EXPECTED MILESTONES ACTUAL MILESTONES

YES/NO

Newborn  Baby pupil reacts to light. YES

 Baby responds to sounds with cry or YES
eye movement.
 F. HEALTH MAINTENANCE:

i. Immunization:

AGE NAME OF THE VACCINES YES NO

Newborn BCG YES

OPV YES
OPV-Zero Dose YES
Hep B YES

G. NUTRITIONAL HISTORY:

i. Initiating and duration of breastfeeding: Baby was not initiated yet. The baby is having
difficulty in breathing and LBW therefore the baby was getting Nasogastric tube feeding.

H. SOCIO-ECONOMIC HISTORY:

i. Status of family: Middle class family.

ii. Monthly family household income: Monthly income is 8,000-12,000.

iii. Source of income: The source of income in their family is the baby’s father and her uncle.
They both are Daily laborer.

iv. Type of house: Good housing pattern.

v. Lighting and ventilation: Good lighting and ventilation.

vi: Sanitary and drainage system: Proper sanitary and proper drainage.

vii: Water supply: 24 hours water supply from their own hand pump.

I.FAMILY HISTORY:

i. Type of family: Joint Family.

ii. No. of family members: 10 members.

 iii. Family status:

NAME AG SEX EDUCATIO OCCUPAT RELATION IMMUNI HEALT

E N ION SHIP ZATION H
STATU
S
Rakidul Islam 68Y M 8 Passed Household Grandfather Not sure Arthritis
Sunaina Begum 55 Y F Illiterate Housewife Grandmother Not sure HTN
Ikbal Islam 48 Y M 10 Passed Daily laborer Uncle Not sure Healthy
Rehena Begum 30 Y F 5 passed Housewife Aunty Not sure Healthy
Bitu Islam 18 Y M Class 10 Student Brother immunized Healthy
Biki Islam 10 Y M Class 7 Student Brother immunized Healthy
Ikram Islam 35 Y M 12 Passed Daily laborer Father Not sure HTN
Ajeda Khatun 21 Y F 10 Passed House wife Mother Immunized Healthy
Afrina Begum 6Y F Class 2 Student Sister Immunized Healthy
B/O Ajeda 6 F Newborn Newborn Patient Immunized RDS
Khatun DA
YS

iv. Family pedigree:

v. Family history of illness: In their family the Patient father is having hypertension from last 2
years. Patient Grandfather is having Arthritis from last 5 years and grandmother is having
hypertension from last 12 years. Rest of the family members are healthy.

6. PHYSICAL EXAMINATION:

i. Vital parameters:

DATE: 19/04/2022

PARAMETER EXPECTED ACTUAL REMARKS

TEMPERATURE 97.5 degree -99.3 degree F 98 degree F Normal

PULSE 70-190 b/min 156 b/min Normal
RESPIRATION 40-60 b/min 65b/min High

ii. Head to toe examination:

a) General appearance: Baby appearance is clean and lethargy and difficulty in taking breath.
b) Skin: Bluish skin color (cyanosis). Skin fold is present, no lesions are present over hand and
leg.
c) Head and Neck:
 Skull: Fontanelles feel soft and flat.
 Facial expressions: Patient cried.
 Eyes and visions: Eyes are symmetrical in shape, no discharge, no conjunctivitis
and patient vision is normal as observed.
 Ears: Both sides of the ears are symmetrical in shape; there is no abnormal
discharge from the ears.
 Nose: Position is normal, absent of any discharge, nasal flaring seen.
 Mouth and throat: Color of lips is pink and dryness is present, cracked lips. No
redness and swelling present in the mouth and throat.

d)Chest: Chest is normal in shape and symmetrical, Chest movement is symmetrical . Nipples
placement are normal.

e) Lungs: Normal position, not fully developed, heavy breath sound, irregular breathing pattern.

f) Abdomen: Abdomen is normal in shape, bowel sound present, umbilical is normal in shape
and no abnormalities seen.
 g) Rectum and Anus: Rectum and anus are in normal position. No abnormalities seen like
anorectal malformation.

7. INVESTIGATIONS:

SL NO DATE NAME OF THE FINDINGS NORMAL REMARKS

INVESTIGATION VALUE

1 19.04.2022 Creatinine 0.90 mg/dl 0.66-1.25mg/dl Normal

2 19.04.2022 Sodium 123 mmol/l 137-145 mmol/l Low
3 19.04.2022 Potassium 4.80 mmol/l 3.5-5.1 mmol/l Normal
4 19.04.2022 Calcium 6.7 mg/dl 8.40-10.20 mg/dl Low
5 19.04.2022 Magnesium 1.6 mg/dl 1.6-2.3 mg/dl Normal
6 19.04.2022 Urea 51 mg/dl 19.26-42.8 mg/dl High
7 19.04.2022 CRP 28.40 Mg/L 0-10 Mg/L High
8 19.04.2022 Haemoglobin 17.7 mg/dl 16.00-18.00 mg/dl Normal
9 19.04.2022 RBC 5.22 u/L 4.50-5.50 u/L Normal
10 19.04.2022 WBC 6.91 u/L 4.00-11.00 u/L Normal

Chest X-ray: Chest X-ray shows underdeveloped lung.

8. ABOUT THE DISEASE:

RESPIRATORY DISTRESS SYNDROME (RDS)

INTRODUCTION:

Respiratory distress syndrome is a disease characterized by respiratory distress within That 6 hrs
of birth and cyanosis due to surfactant ,deficiency in the alveoli Respiratory distress syndrome
(RDS) occurs in babies born early (premature) whose lungs are not fully developed. The earlier
the infant is born, the more likely it is for them to have RDS and need extra oxygen and help
breathing. RDS is caused by the baby not having enough surfactant in the lungs. RDS is a
common breathing disorder that affects newborns.

DEFINITION:

Respiratory distress syndrome is defined as a respiratory disorder chiefly of newborn premature

infants that is characterized by deficiency of the surfactant coating the inner surface of the lungs
resulting in labored breathing, lung collapse, and hypoxemia.

INCIDENCE:

The incidence of RDS was 100% at 26 or less weeks of gestation, 57.14% at 32 weeks, and
3.70% at 36 weeks. The mortality with RDS was 41 (43.61%).

RELATED ANATOMY AND PHYSIOLOGY:

Anatomy of a child’s lung is very similar to that of an adult. The lungs are a pair of air-filled
organs consisting of spongy tissue called lung parenchyma. Three lobes or sections make up the
right lung, and two lobes make up the left lung. The lungs are located on either side of the thorax
or chest and function to allow the body to receive oxygen and get rid of carbon dioxide, a waste
gas from metabolism. To understand the anatomy of the pediatric lung and lung disease in
children, it is important to take a look at the entire respiratory system.

The anatomy of the pediatric respiratory system can be divided into 2 major parts:

1. Pediatric Airway Anatomy: Outside of the thorax (chest cavity) includes the

supraglottic (epiglottis), glottic (airway opening to the trachea), and infraglottic
(trachea) regions. The intrathoracic airway includes the trachea, two mainstem bronchi,
bronchi and bronchioles that conduct air to the alveoli.
2. Pediatric Lung Anatomy: Lung anatomy includes the lung parenchyma are subdivided
into lobes and segments that are mainly involved in the gas exchange at the alveolar level.

The Child Respiratory System

 Mouth and Nose 

 Pharynx – cavity located behind the mouth
 Larynx – part of the windpipe that contains the vocal cords
 Trachea – also referred to as the windpipe, conducts into and out of the lungs
 Lungs – a pair of spongy air filled organs.
 Bronchial tubes – passages that carry the air and divide and branch as the travel through
the lungs
 Bronchioles – tiny passages surrounded by bands of muscle that transport air throughout
the lungs. Bronchioles continue to divide into smaller and smaller units until they reach
microscopic air sacs called alveoli
 Lung Alveoli – clusters of balloon-like air sacs
 Lung Interstitium – Thin layer of cells between alveoli that contain blood vessels and
help support the alveoli
 Pulmonary Blood Vessels – tubes that carry blood to the lungs and throughout the body
  Lung Pleura – thin tissue that covers the lungs
 Lung Pleural Space – area lined with a tissue called pleura and located between the lungs
and the chest wall
 Diaphragm – a muscle in the abdomen that assist with breathing
 Lung Mucus – sticky substance that lines the airways and traps dust and other particles
inhaled
 Lung Cilia – microscopic hair-like structures that extend from the surface of the cells
lining the airway. Covered in mucus, cilia trap particles and germs that are breathed in.

Anatomy of a Child’s Lung and the Breathing (Inspiration and Expiration)

Breathing is the process that moves air in (inspiration) and moves air out (expiration) of the
lungs through inhalation and exhalation.  As the lungs expand and contract, oxygen rich air is
inhaled and carbon dioxide is removed. Breathing begins at the mouth and nose where air
is inhaled. The air travels to the back of the throat, into the trachea and then divides into the
passages known as the bronchial tubes. The bronchial tubes continue to divide as the go deeper
into the lungs and the air is carried to the alveoli. Oxygen passes through the walls of the alveoli
and into the blood vessels that surround these tiny sacs. Once oxygen enters the blood vessels, it
is carried out of the lungs and to the heart where it can be pumped throughout the body to other
organs and tissue. When the cells use oxygen, they produce a waste product called carbon
dioxide. The carbon dioxide is carried by the blood vessels back to the lungs. Through exhaling,
the carbon dioxide is carried back out of the lungs where it can exit through the mouth or nose.

Physiology:

The lungs take in oxygen. The body's cells need oxygen to live and carry out their
normalfunctions. They also get rid of earbon dioxide. This is a waste product of the cells. The
lungs are 2 cone-shaped organs. They are made up of spongy, pinkish-gray tissue. They take up
most of the space in the chest, or the thorax (the part of the body between the base of the neck
and diaphragm). They are inside a membrane called the pleura. The lungs are separated by an
area (called the mediastinum) that has the following:

 Heart and its large vessels

  Windpipe
 Food pipe (esophagus)
 Thymus gland
 Lymph nodes
The right lung has 3 lobes. The left lung has 2 lobes. When you breathe, the air:
 Enters the body through the nose or mouth.
 Travels down the throat through the voice box and windpipe.
 Goes into the lungs through tubes (mainstem bronchi):
 One of these tubes goes to the right lung and one goes to the left lung
 In the lungs, these tubes divide into smaller bronchi
 Then into even smaller tubes called bronchioles
 Bronchioles end in tiny air sacs called alveoli.
RISK FACTORS/ETIOLOGY:

BOOK PICTURE PATIENT

PICTURE
 Prematurity: If the baby is premature, they may not make enough surfactant yet.  Present.
When there is not enough surfactant, the tiny alveoli collapse with each breath, as
the alveoli collapse, damaged cells collect in the airways they further affect
breathing which leads to RDS.
 Maternal diabetes: Because of metabolic derangements the mother production  Absent.

of surfactant will be inadequate which can leads to RDS.

 Absent.
 Meconium aspiration syndrome: In case of meconium aspiration syndrome
newborn breathes a mixture of meconium and amniotic fluid into the lungs
around the time of delivery which cause RDS.  Absent.
 Caesarean section: RDS caused by surfactant deficiency is described in term
babies also after cesarean section, especially when carried out before the onset of
labour.  Present.
 Pulmonary causes: Pulmonary causes like congenital malformation, pneumonia,
pleural effusion, edema of lungs, bleeding from lungs can leads to RDS.
 Non pulmonary causes: Non pulmonary causes such as Sepsis, exposure to cold,  Absent.
acute blood loss also can cause RDS.
PATHOPHYSIOLOGY:

Respiratory distress syndrome (RDS) is caused by deficiency of surfactant. It is needed to

decrease the alveolar surface tension preventing lung collapse.

Immature lungs in premature baby

Surfactant deficiency

Collapse of alveoli

Atelectasis,Dyspnea, tachypnea

Hypoxia, Hypercapnia, Acidosis

Pulmonary vasoconstriction shunting of blood from pulmonary to systemic circulation

Reduced pulmonary blood flow

Ischemic necrosis of surfactant cells and vasculature

Effusion of protein- like material into alveolar spaces

Formation of hyaline membrane

Fig: Pathophysiology of RDS

 CLINICAL MANIFESTATIONS:

BOOK PICTURE PATIENT

PICTURE
 Rapid shallow respiration: Because of surfactant deficiency or  Present.
underdeveloped lung anatomy the baby shows symptom like rapid shallow
respiration.
 Expiratory audible grunting: Because of significant respiratory distress the  Present.
baby shows symptom like expiratory audible grunting.
 Nasal flaring: Due to increases upper airway diameter and reduces resistance  Present.

and work of breathing can shows symptoms like nasal flaring in the baby.
 Intercostal, subcostal and xiphoid retractions: In RDS due to reduced air  Absent.
pressure inside the lungs shows symptoms like intercostals,subcostal and
xiphoid retractions.
 Duskiness with increase cyanosis: Due to absolute increase in the  Present.
deoxygenated hemoglobin shows symptoms like duskiness with increase
cyanosis.
 Chest wall retractions: In RDS, there is lack of air pressure which causes the  Absent.
skin and soft tissue in the chest wall in to sink in that shows symptoms like
chest wall retractions.

DIAGNOSTIC EVALUATION:

1. Physical examination: Most neonates who have Respiratory distress syndrome experience
breathing difficulty at birth within. 2 hours after birth. Silverman retraction score is a very good
method of assessing severity of respiratory distress. Nasal flaring is also present, which indicates
respiratory distress. Auscultation of chest reveals diminished breath sounds. As the baby's
condition worsens, bradycardia or tachycardia occurs. These infants are generally flaccid
hypoactive and motionless. They assume typical frog-legged position. The neonate may have
pallor, oedema, hypothermia and shock like state in severe condition.
2.Chest X-ray of baby shows areas of atelectasis and an air bronchogram shows air filled
bronchi.
3. Arterial blood gas analysis is done which shows arterial pco2, above 65mm of Hg (though the
normal upper limit is 45mm Hg), an arterial po2, of 40mm Hg (though the normal limit is 50mm
Hg) and PH below 7.15 when normal PH is 7.35-7.45.
4. Shake test is done on gastric aspirate withdrawn from the neonate in the first hour of life.
Normal saline 0,5 ml is mixed with same amount of gastric aspirate and the resulting 1 ml is
added to 1ml of 95% ethanol. The mixture is shaken well for 15 seconds and kept aside. After 15
minutes, the test tube is viewed against a black background. A complete ring of bubbles is seen
on the meniscus. This is a positive test which indicates that surfactant is present and baby is
normal. If there is absence of bubbles or ring of bubbles on meniscus is incomplete, it indicates
negative test i.e. surfactant deficiency and the infant probably has Respiratory distress syndrome.
MANAGEMENT:

Respiratory distress is the most common lte threatening emergency in premature nenton,
The principles of management of Respiratory distress syndrome include-
i. Improving ventilation to enhance oxygenation.
ii. Correction of acidosis
iii. Maintenance of thermo neutral environment
iv. Adequate nutrition
Management of baby with RDS includes: -
1. Monitoring of the baby's condition:
To monitor the baby's condition, following clinical observations are to be done:-
 Rectal or skin temperature should be noted hourly till stable and thereafter every 4 hourly.
 Hourly monitoring of respiratory rate.
 Noting the severity of retraction and grunting.
 Status of peripheral pulse and B.P.
 Skin color
 Apneic episodes
 Activity, responsiveness and cry of the baby.
 Urine output.
2. Intravenous infusion for maintaining acid-base balance and nutritional status of baby:-
It is advisable to start intravenous infusion in all the babies with Respiratory distress syndrome
because oral feeding may not be possible with the baby as oral feeding has the risk of aspiration.
The infant needs to be given nasogastric feeding or total parenteral nutrition to prevent tissue
catabolism. 7.5% soda bicarb should be administered to the baby in dose of 3-8 meq/kg in 24
hours or the dose of soda bicarb may be calculated according to the baby's PH.
3. Ventilatory support:
Infants with hyaline membrane disease are handicapped by decreased lung compliance and
alveolar collapse during expiration, Administration of oxygen under positive pressure would
prevent alveolar collapse and ensure gas exchange throughout the respiratory cycle. PAP
(Continuous Positive Airway Pressure) is indicated and useful in infants with decreased lung
compliance. CPAP should be started if arterial oxygen saturation remains below 50mm of Hg
even though the neonate is getting oxygen more than 60%. While the baby is on CPAP, arterial
blood gases should be closely monitored so that oxygen concentration and PAP pressures are
adjusted.
4. Oxygen via hood:
After weaning the baby from the ventilator, oxygen should be administered via hood to maintain
PaO2, between 50-80 mm Hg or a saturation of 90-95%.
5. Warmth and humidity:
The baby's skin temperature should be maintained at around 36.5°C either by keeping the baby
in the incubator or radiant warmer. The infant should be nursed in a thermoneutral environment
having humidity of above 60%.

6. Surfactant therapy;
Several clinical trials have proved the effectiveness of surfactant therapy in both prevention and
management of respiratory distress. It improves the chances of neonate's survival by improving
lung compliance and oxygenation. Surfactant of human origin (Survanta, Infasurf), porcine
origin (Curosurf) and synthetic preparations (Exosurf, DPPC/PG or ALEC) are available.
Adequate oxygenation, ventilation and monitoring should be started before administering
surfactant therapy. Surfactant is administered intratracheally via ET tube in a dose of 100 mg/kg
body weight. Depending on the baby's condition, repeated doses of surfactant need to be
administered. The therapy leads to improved oxygenation and reduction in oxygen dose required
by the patient. The adverse effects of surfactant therapy include apnea, hypotension, pulmonary
hemorrhage and bradycardia.
7. Antibiotics:
Antibiotics are routinely administered to treat any pulmonary infection, if present and due to
continuous Invasive procedures being done on the baby. Septic screening and periodic cultures
from endotracheal tube and blood are taken to guide antimicrobial therapy.
Nursing Management:
 Preterm with Respiratory distress syndrome should be prevented from infection by using
isolation and aseptic precautions.
 The critically ill infant should be minimally handled.
 These infants should be positioned with head elevated, to reduce the pressure on diaphragm.
 Airway should be kept patent and opened by extending the head slightly. This can be done by
placing a folded sheet or towel under the baby's shoulders.
 As the baby requires oxygen administration for long duration via face mask or nasal prongs,
soothing antibiotic ointment can be applied to irritated skin surface.
 Keep the baby warm by placing the baby in incubator/radiant warmer,
 Monitor vital signs regularly.
 Endotracheal suctioning should be done as required, using strict aseptic techniques. Monitor
oxygen saturation while suctioning the baby.
 Measure baby's weight daily to assess adequacy of fluid administration.
 Administer intravenous fluids/Nasogastric feed and medications as prescribed by the
physician.
Prevention of Respiratory Distress Syndrome:
The best way to prevent Respiratory distress syndrome is by reducing the incidence of
prematurity by appropriate management of high risk pregnancies and by avoiding unnecessary or
poorly timed cesarean sections. Delivery of very small fetus should be delayed as long as
possible in order to increase the level of maturity. Pregnancy can be prolonged with bed rest that
inhibits premature labour. If pregnancy cannot be maintained to term, surfactant should be
administered to fetus in utero and mother should be given injection Betamethasone or
Dexamethasone, 1-7 days before delivery as it helps in maturation of fetal lungs.
 11. PROGNOSIS NOTE: Prognosis with treatment is excellent; mortality is < 10%. With
adequate ventilatory support alone, surfactant production eventually begins, and once production
begins, RDS resolves within 4 or 5 days. However, in the meantime, severe hypoxemia can
result in multiple organ failure and death.
In case of my patient the prognosis seems to be good.

Day 1: In the 1st day of my care i.e. on date 19/04/2022 the Oxygen level was 86% with 4 ml/hr
oxygenation through nasal prong. Pulse rate was 156 b/min and respiratory rate was 65b/min.
The baby skin color was bluish in color.

Day 5: In the 5th day of my care i.e. on 25/04/2022 the baby oxygen level was 98% with 2 ml/hr
oxygenation. Pulse rate was 148 b/min and respiratory rate was 50/min. The baby’s bluish skin
color seems to be decreased. Hence, can conclude that patient condition was improving.

12. HEALTH EDUCATION:

DURING HOSPITALIZATION DURING DISCHARGE

 To explain the mother about the disease
condition, what is respiratory distress syndrome
and about ongoing treatment.
 To explain the mother to wash her hand properly
before touching the baby.
 To explain the mother before excreting breast
milk she should clean nipple side properly.
 To explain the mother if the baby isn’t breathing
properly, the medical staff may provide
breathing with ambu bag.If the baby continues to
be unwell with not breathing, they might use a
ventilator (artificial breathing machine).
 To advice the mother to inform immediately to
on duty nurse or doctor if she notice any
changes.
 To explain the parents to check the
breathing pattern of the baby, whether
breathing is rapid.
 To explain the condition of the baby to the
parents, what are the steps to be followed
during discharge.
 To explain the parents to observe the baby
carefully for any changes in skin color or
breathing.
 To explain the parents what are the
medications that the baby should be taken
at home.
 To explain the mother about the
breastfeeding, it’s benefits and she should
give only breastfeeding till 6 months.
 To explain the parents to maintain their
 hygiene along the hygiene of the baby.
 To explain the parents to come for regular
check-up.

13 .CONCLUSIONS:

Respiratory distress syndrome of the newborn affects approximately one percent of newborns
and is one of the leading causes of mortality in preterm infants. RDS most common problem in
the NICU demanding careful and appropriate respiratory care 30% of neonatal deaths & 70% of
preterm deaths. Goals of management should be Provide adequate support to allow recovery,
Minimize complications and be vigilant. Most neonates with respiratory distress can be treated
with respiratory support and noninvasive methods. Oxygen can be provided via bag/mask, nasal
cannula, oxygen hood, and nasal continuous positive airway pressure. Ventilator support may be
used in more severe cases.

From the above case study I can conclude that if proper care and treatment
given to the patient then the prognosis is generally good.

14. BIBLIOGRAPHY:
 Panchali Pal, Care of Neonates: High Risk Neonate, Textbook of Pediatric Nursing,1st
Edition (Reprint) First Floor, Putlibowli, Hyderabad-500095. India, ParasMedical Publisher,
2020.
 Parul Datta, The Newborn Infant: High risk neonates, Pediatric Nursing, Second Edition,
4838/24, Ansari Road, Daryaganj, New Delhi-110002, India, Jaypee Brothers Medical
Publishers (P) Ltd, 2009.
 Mosby’s, A textbook of Nursing drug reference, first South Asia Edition, published by
Elsevier.

CPMS COLLEGE OF NURSING

 NEONATAL CASE PRESENTATION

ON

RESPIRATORY DISTRESS SYNDROME (RDS)

SUBJECT: - OBSTETRICS & GYNAECOLOGY NURSING

DATE OF PRESENTATION:

SUBMITTED TO SUBMITTED BY
MAAM SANGEETA PAUL THOLEH LALRAMDINI JONGTE
ASSISTANT PROFESSOR ROLL NO.-10
OBSTETRICS & GYNAECOLOGY NURSING M.Sc (N) 2nd YEAR
CPMS COLLEGE OF NURSING CPMS COLLEGE OF NURSING