CASE PRESENTATION ON

RESPIRATORY DISTRESS SYNDROME

1. DEMOGRAPHIC DATA:-

Name of patient:- B/O Jyoti Raikwar

Father’s name:- Mr. Rahul Raikwar.

Age/Sex:- 3 days and male

Date of admission: -

Religion: - Hindu.

Date of birth and time: -

Address:- Nehru nagar, Bhopal

Diagnosis:- RDS (Respiratory distress syndrome).

Meaning of diagnosis:- Respiratory distress syndrome is pulmonary immaturity and

inability to produced sufficient lung suffocation.

2. Chief complaints:-
o Difficulty in breathing.
o Tachypnaea.
o Pre-maturity.
o Low birth weight
3. Family History:-
a. Family tree- Patient is living in a nuclear family along with his parents. There is no history
of Diabetes Mellitus, Bronchial Asthma, and Hypertension etc. in patient’s family.
b) family composition:
Name of the Family Relationship Age Gender Education occupation Health
Member with patient (yrs) status
Rahul raikwar Father 25 Male 12 th Farmer Good
Jyotiraikwar Mother 21 Female 10 th House wife Good
B/o jyotiraikwar Him self 4days Male - - Patient

c) Family income in rupees per month - Rs.2500 /month.

d)Per Capita Income- = 2500/3
= 833 /member.
e) Religion – He belongs to a Hindu family.
f) Environmental History – Three family members are living in akaccha house containing two
room. No proper ventilation. They use fire-wood for cooking. They drink corporation water.

4. Birth History
a) Prenatal history – he is a non-consanguineous child. Age of the mother during pregnancy was 21
years. There is no history of infectious disease like TORCH during prenatal period. There was no
exposure to radiations during prenatal period. Patient’s mother did not take any teratogenic medicine
during her prenatal period. She had taken only iron and folic acid tablets during pregnancy Injection
TT was given during her prenatal period.
b) Natal history – before the completion of 9 months the baby was delivered in hospital with normal
vaginal delivery. Birth weight of the child was about 1.58 kg.
c) Postnatal/Neonatal history – Child not cried immediately after birth.

5. Immunization history:
S. No. Age Vaccine Route Remarks Given/
Not Given
1. At birth BCG ID
OPV zero Oral
Hepatitis B- 1 IM

PHYSICAL EXAMINIATION-

General appearance –

 Nourishment:- malnourished.
 Body build:- thin
  Health:- unhealthy
 Activity:- dull

AnthroprometricExamination:-

 Weight:- 1.58 kg
 Height:- 35 cm
 Head circumference:- 24 cm
 Chest circumference:- 21cm
 Mid-arm circumference:- 7 cm.

Vital Sign:-

 Temperature:- 36.4 Celsius.

 Respiration:- 40 b/m.
 Pulse- 148b/m

MENTAL STATUS:-

 Consciousness:- conscious.
 Look:- dull

POSTURE:-

 Body curve:- normal curved

 Movement:-less movement.

SKIN CONDITION:-

 Colour:- pinkish blue

 Lesion and infection:- absent
 Rash:-absent
 Nails:- pink

HEAD:-

 Hair colour:- black

 Scalp:- clean
 Face:- dull

EYE:-
  Eye lashes:- normal
 Eye ball:- normal
 Sclera:-white
 Conjunctiva:- pink

EAR:-

 External ear:- normal

 Hearing:- normal

MOUTH AND PHARYNE:-

 Lip:- pink
 Odor:- foul
 Cleft lip palate:- absent
 Colour of tongue:- pink

NECK:-

 Lymph nodes:-absent
 Thyroid glands:- not palpate.

CHEST:-
 Expansion:- bilateral
 Mark of injury:-no.
 Pattern of respiration:- slow.

ABDOMEN:-
 Inspection:- not distended.
 Palpation:- no tenderness.
 Auscultation:- bowel sound present.
 Generalized edema:- no

BACK:-
 Any abnormality:- no

EXTRIMITIES:-
 Upper extremities:- presence of joint and reflex are presents.
 Lower extremities:-properly moveable.

GENITALIA :-
  Genital organs:- normal

RECTUM:-
 Any abnormality:- no

ELIMINATION PATTERN:-
 Bowel frequency:- 5 time in a day.
 Color:-greenish
 Consistency:- semisolid.
 Bladder frequency:- 6-7 times in a day.
 Color:-pale
 Amount:- 40 ml
 RESPIRATORY DISTRESS SYNDROME
INTRODUCTION:-
Respiratory Distress Syndrome is an acute disorder that occurs almost exclusively in pre-
mature infants. It may also develop in neonates whose mother have diabetes or in infants delivered
by cesarean section. It is diagnosed soon after birth because of the obvious respiratory distress and
can be expected to continue for 3-5 day. It is also called as hyaline membrane disease or infant
respiratory distress syndrome.
DEFINITION:-
 Respiratory distress syndrome is syndrome in premature infants caused by developmental
insufficiency of surfactant production and structural immaturity in the lungs.
 RDS is a syndrome of respiratory difficulty in newborn infants caused by a deficiency of a
molecule called surfactant. It occurs in newborn before 37 week of gestation.

ANATOMY AND PHYSIOLOGY OF LUNGS

LUNGS:-

Lungs are the principal organ of respiration they are two in number lying one on each side of the
chest cavity. The two lungs are separated in the middle by heart and other structure of mediastinum

SHAPE:- Lung is conical shape .The apex of the lung above rising slightly over the clavicle. The
base of the lung is near the diaphragm
LOBES:- Each lung is divided into by means of fissure The right lung, which is bigger has three
lobes The left lung has two lobes each lobe is composed of a number of lobules. Each lobe contain a
small bronchial tube divides and subdivide and ends finally in air sac

PLEURA:-It is a serous membrane which covers the lung It is made of two layer. The inner layer is
called as “visceral layer” it is very close to the lungs. The outer layer is called as the “parietal layer”.
The space between these two layers is filled with pleural fluid.

PHYSIOLOGY OF LUNGS:-

1. Transport of O2 to tissue and excretion of CO2.

2. Excretion of volatile substance like ammonia which may be toxic.
3. Regulation of temperature through loss of heat in the expired air.
4. Maintenance of pH of blood.
5. Regulation of water balance through excretion of water vapors.
INCIDENCE;-
It ranges from 75% at round 28 weeks to 52% at 30 weeks of gestation use of exogenous surfactant
has significantly reduced the risk of neonatal death by 10% .
ETIOLOGY:-

IN GENERAL IN PATIENT
 Me conium aspiration.  Prematurity.
 Airway obstruction.  Low birth weight.
 Pneumonia.  Male baby.
 Pulmonary edema.  Me conium aspiration.
 Birth trauma.
 Preterm baby.
 Genetic factors.
 Male baby.
 Multiple pregnancies.
 Intracranial injury.
PATHOPHYSIOLOGY:-

Immature lungs of premature infant

`Increased pulmonary vascular resistance Deficiency of pulmonary

surfactant

Decreased pulmonary blood flow Decreased lung

compliance

Decreased lung metabolism. Decreased alveolar

ventilation.

Respiratory distress syndrome.

CLINICAL MANIFESTATION:-

IN GENERAL IN PATIENTS
 Fast breathing.  Fast breathing.
 Fast heart rate.  Fast heart rate.
 Blue discoloration of the skin.  Blue discoloration of the skin.
 Apnea.  Apnea.
 Low blood sugar.
 Nasal flaring.
 Expiratory grunting
 Cerebral cyanosis.
DIAGNOSTIC EVALUSION:-

IN GENRAL IN PATIENTS
 Blood culture.  Serum bilirubi:- 5.6 mg/dl.
 Blood glucose calcium levels.  Blood test.
 Serum electrolyte levels.  Physical examination
 Echocardiography.
 Chest x-ray.
 Physical examination

MANAGEMENT OF RDS:-

1. Monitoring of the baby condition: - to monitor the baby skin condition, following
clinical observations are to be done-
 Rectal or skin temperature should be noted hourly till stable.
 Hourly monitoring of respiratory rate.
 Skin color
 Activity, responsiveness and cry of the baby
 Urine output.
2. Intravenous infusion for maintain acid base balance and nutritional status of the 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 parentral nutrition.
3. Warmth and humidity:- the baby skin temperature should be maintained at around 36.5C
either by keeping the baby in incubator or radiant warmer.
4. Administration of vitamin E:- treatment of respiratory dsitree syndrome, requires
administration of high concentration oxygen which may lead to the development of
bronchopulmonary dysplasia and retrolental fibroplasia. Vitamin E being a biologic
antioxidant, inhibits the peroxidation of membrane lipids, thereby reducimng chances of
retrolental fibroplasia and bronchopulmonary dysplasia. So low birth weight or preterm
babies, receiving oxygen therapy may be administered vitamin E in a dose of 100 IU/ kg/ day
intramuscularly from birth onwards.
5. Antibiotic:- antibiotics are routinely administered to treat any pulmonary infection, if present
and due to continuous invasive procedure being done on the baby.
PHARMACOLOGICAL MANAGEMENT:-

IN GENERAL:-

S.NO NAME OF DOSE ROUT ACTION

DRUGS`
1. Beta-methasone 12mg IM Antibiotic
2. Ketoconazole 2mg IV Antifungal
IN PATIENTS:-

S.NO NAME OF DRUGS DOSE ROUT ACTION

1. Inj.Vencomysin 2.5 mg IV Antibiotic
2. Inj. Aminophyllene 7mg to 10 ml NS IV Bronchodilator.
3. Inj. Dopamin 0.2ml to 50ml NS IV Sympothomimetic.
4. Inj. ISOP 7ml/ hours IV Electrolyte supplement.

NON PHARM ACOLOGY MANAGEMENT:-

 Oxygen Therapy.
 Correction of anemia, electrolyte imbalance.
 The baby should be placed in neonatal intensive care unit.
 Frequent monitoring of the arterial PO2, PCO2, PH and the base excess are to be determined
to diagnose metabolic and respiratory acidosis.
 Fluid and nutrition.

NURSING MANAGEMENT:-

1. Preterm with respiratory distress syndrome should be prevented from infection by using
isolation and aseptic techniques.
2. The critically ill infant should be minimally handled.
3. These infants should be positioned with head elevated, to reduce the pressure on diagram.
4. Airway should be kept patient and opened by extending the head slightly. This can be done
by placing a folded sheet or towel under the baby shoulders.
5. Keep the baby warm by placing the baby in incubator/ radiant warmer.
6. Monitor vital sign regularly.
7. Endotracheal suctioning should be done as required, using strict aseptic technique. Monitor
oxygen saturation while suctioning the baby.
8. Measure baby weight daily to assess adequacy of fluid administration.
 9. Administer intravenous fluids/ nasogastric feed and medication as prescribed by the
physician.

NURSING ASSESSMENT:-

 Monitor vital sign including temperature, pulse, respiration, SPO2.

 Take anthropometric examination like abdominal girth, weight, height head circumference,
chest circumference and mid arm circumference.
 Check all the laboratory test of baby.
 Check for the supply of O2 to the baby.
 Assess the feeding of baby and proper tube feeding to the baby

NURSING DIAGNOSIS:-

 Ineffective breathing pattern related to increase rate and decreased depth of respiration.
 Ineffective thermoregulation related to low birth weight as evidence by poor flexion and lack
of subcutaneous fat.
 Impaired gas exchange related to ventilation imbalance associated with decreased pulmonary
blood flow resulting from decreased cardiac output.
 Imbalance nutrition less than body requirement related to poor intake of feeding.
 Risk for infection related to immaturity body system.
 Ineffective family coping related to anxiety guilt and parting with the baby as a result of a
crisis situation.
HEALTH EDUCATION
1. DIET
 Advised the mother to give small and frequent meals and liquid supplements.
 Advised the mother to give carbohydrate, protein rich food stuffs.
 Advised the mother to restrict sodium rich foods.

2. PERSONAL HYGIENE
 Advised the child to keep himself clean always.
 Advised the child to bathe daily and change his clothes.
 Advised the mother to keep the home environment neat and tidy.

3. MEDICATIONS
 Advised the mother to give the medications on time as prescribed by the physician.
 Taught the mother about the action and side effects of the medications.

4. REST AND SLEEP

 Advised the mother to provide a comfortable wrinkle free bed and position for the
child to sleep.
 Advised the mother to avoid the disturbances that might irritate and prevent child
from sleeping.
 Advised the child to avoid heavy exercises and sports to prevent fatigue.

5. COMPLICATIONS
 Taught the mother about the complications of glomerulonephritis.
 Advised the mother to monitor and watch for the signs of sequlae.
 Advised the mother to bring the child back to the hospital if complications arise.

6. FOLLOW-UP
 Explained to the parents about follow up and its procedures.
 Advised the parents to bring the child to the hospital to aid in full recovery of the
child from the illness.
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