Module 3.1: Respiratory Distress Syndrome

acute respiratory distress syndrome (ARDS)

-Can affect both children and adults -Occurs because of a direct or indirect injury to lungs caused by shock, sepsis, or trauma triggering the inflammatory processes and disrupting surfactant production.

What treatment would be provided to an infant suspected of having respiratory distress syndrome?

-Exogenous suacant, mechanical ventilation, and oxygen

The development of a hyaline membrane within the infant alveoli reduces which process? Gas exchange Lung stretch Surfactant production Airway pressure

Gas exchange

When compliance of the lung tissue is lost, how is the work of breathing affected? It is decreased. It is increased. It remains unaffected. It cannot be measured.

It is increased.

What tissue blocks the production of surfactant

hyaline membrane

In caring for a premature infant with respiratory distress syndrome, the nurse understands that the infant's ability to ventilate depends on the ability to: (Select all that apply.) inflate the alveoli and maintain their open status. transition from in utero to breathing on their own. produce surfactant. maintain a patent ductus.

inflate the alveoli and maintain their open status., transition from in utero to breathing on their own., produce surfactant.

Infants born before the gestational age of 26 weeks are likely to have hyaline membrane disease because: surfactant is not mature in the infant's lungs. surfactant is not produced in the lungs until the 26th week. surfactant is washed out of the baby's lungs when the baby is in utero. surfactant is produced as the baby moves through the birthing canal.

surfactant is not produced in the lungs until the 26th week.

When an infant experiences respiratory distress syndrome, the lack of surfactant makes each breath the infant takes is as hard as the first breath taken. This is due to: the high surface tension in alveoli causing them to collapse. the weak muscles of respiration in the infant. retractions of the chest wall. poor pulmonary circulation.

the high surface tension in alveoli causing them to collapse.

S/S of infant respiratory distress syndrome

-Expiratory grunting, nasal flaring, chest wall retractions, see-saw respiration, silverman-anderson index score: 7, generalized cyanosis, heart rate > 150-180, fine inspiratory crackles, tachypnea rates>60, chest x-ray shoes hypoaration, under expansion, and ground-glass pattern.

S&S of ARDS

-Hypoxemia, hypoxia, crackles and rhonxhi due to fluid accumulation, SaO2 decrease is an early sign, diagnositc criteria Pa02/Fi02 ration less than or equal to 200, no cardiogenic etiology. Chest x-ray shows "white out"

Primary TX of infant respiratory distress syndrome

-Mechanical ventilation: reduces airflow and improves gas exchange -Prophylactic exogenous surfactant via nebulizer or nasal -Corticosteroids as preventative therapy if at risk of preterm delivery -Antibiotics for positive cultures -Prone or side-lying position ONLY if on continuous monitoring of cardiopulmonary status and oxygenation monitoring since the risk for SIDS is increased in infants in the prone position.

Complications/outcomes of ARDS

-Mortality associated with ARDS remains at 50-70% -ARDS can quickly lead to acute respiratory failure -It is difficult to diagnose and can prove fatal within 48 hours of onset

Complications/outcomes of Infant respiratory distress syndrome

-Most newborns survive -mechanical ventilation may cause bronchopulmonary dysplasia and chronic respiratory insufficiency.

Stages of ARDs

-Phase 1: Injury reduces normal blood flow to the lungs. Platelets aggregate and release histamine, serotonin, and bradykinin -Phase 2: Those substances (especially histamine) inflame and damage the alveolocapillary membrane, increasing capillary permeability -Phase 3: Capillary permeability increases, proteins and fluids leak out, increasing interstitial osmotic pressure and causing pulmonary edema -Phase 4: Decreased blood flow and fluids in the alveoli damage surfactant and impair the cells ability to produce more. As a result, alveoli collapse, impending gas exchange, and decreasing lung compliance -Phase 5: Sufficient oxygen can't cross the alveocapillar membrane, but carbon dioxide can and is lost with every exhalation. Oxygen and carbon dioxide levels decrease in the blood. Phase 6: pulmonary edema worsens, inflammation leads to fibrosis and gas exchange is further impeded.

Primary TX for ARDS

-Remove causative factors -High concentration oxygen -Mechanical ventilation -antibiotics, bronchodilators, exogenous surfactant -Prone or side-lying position.

What symptoms should you look for if you suspect ARDS?

-Restlessness, tachypnea, tachycardia, listen for crackles and rhonchi. A nonresponse to oxygen would indicate there was fluid in the lungs preventing oxygen absorption. Arrhythmia

Infant Respiratory Distress Syndrome

-Usually affects premature babies -Occurs when the lung structure (which produces surfactant) is not fully matured -This causes wet lung tissue to stick together. -Lung collapse happens much faster in premature babies than others

What events may occur in a patient who has ARDS?

-_Fluid accumulation in the lungs interstitum, alveolar spaces, and small airways, causing the lungs to stiffen and pulmonary edema to develop.

All causes of respiratory distress syndrome

-result in decreased lung compliance, atelectasis, partial or complete collapse of the lung which is then followed by hypoxia -These events eventually lead to lung edema, and impaired gas exchange resulting in the formation of a hyaline membrane-the scar tissue that blocks production of surfactant

A 5-day-old infant is listless, has rapid breathing and heartbeat, is not eating, and has a temperature of 100.2°F. Upon assessment, the nurse notes retractions and accessory muscle use as the infant breathes. Which condition does this infant likely have? Acute respiratory distress syndrome Infant respiratory distress syndrome Influenza COVID-19

Acute respiratory distress syndrome

Which of the following diagnostic tests would be performed to confirm acute respiratory distress syndrome (ARDS)? Select all that apply. Skin testing Arterial blood gases Blood cultures Pulmonary function tests Toxicology screen

Arterial blood gases, Blood cultures, Toxicology screen Toxicology screen is used to identify drug ingestion. Skin testing is used to identify specific allergens in the diagnosis of asthma. Pulmonary function tests can diagnose asthma as well as chronic bronchitis and emphysema.

True or false: Lack of surfactant is a factor in both infant respiratory distress syndrome and acute respiratory distress syndrome.

True

RDS chart

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