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RESPIRATORY DISTRESS SYNDROME (RDS) Formerly termed hyaline disease- most often occurs in pre-term infants, infants of diabetic

mothers, infants born with cesarean birth, or those who for any reason have decreased blood perfusion of the lungs, such as meconium aspiration. The pathologic feature of RDS is a hyaline-like (fibrous) membrane formed from exudates of an infants blood that begins to line the terminal bronchioles, alveolar ducts, alveoli. This membrane prevents exchange of oxygen and carbon dioxide at the alveolar-capillary membrane. CAUSES: -low level or absence of surfactant. ASSESSMENT: 1. low body temperature 2. nasal flaring 3. sternal and subcostal retractions 4. tachpnea (more than 60 respirations per minute) 5. cyanotic mucous membranes 6. seesaw respirations (on inspiration, the anterior chest wall retracts and the abdomen protrudes; on expiration, the sternum rises) 7. heart failure, evidenced by decreased urine output and edema of the extremities 8. pale grey skin 9. periods of apnea 10. bradycardia 11. pneumotharax Blood gas studies: respiratory acidosis Chest x-ray: reveal diffuse pattern of radio-opaque areas that look like ground glass (haziness) Therapeutic Management: 1. Endotracheal tube insertion at birth a) Surfactant replacement synthetic surfactant sprayed into the lungs by a syringe through endotracheal tube. b) Oxygen administration- to maintain correct PO2 and PH levels.

Extracorponeal membrane oxygenation (ECMO)- a means of

oxygenating blood during cardiac surgery to ensure adequate oxygenation Nitric Oxide- help to oxygenate newborn lungs through the administration of nitric oxide that causes vasodilation that helps to increase blood flow to alveoli when pulmonary hypertension is present. c.) ventilation Liquid ventilation- Involves the use of perfluorocarbons substances used in industry to assess leakage in pipes. d.) Muscle relaxant- pancuronium (pavulon) intravenously to allow mechanical ventilation to be accomplished at lower pressures. PREVENTION: 1) Preterm magnesium sulfate/ tarbutaline administration help prevent preterm births at 24th to 34th weeks of pregnancy. RDS Signs and symptoms - low body temperature - nasal flaring - sternal and subcostal retractions - tachypnea (more than 60 respirations per minute) - cyanotic membranes - seesaw respirations - heart failure, evidenced by decreased urine ouput and edema of the extremities - pale grey skin - periods of apnea - bradycardia - pneumothorax

LABOR stage I Complete dilation stage II Full dilatation and Birth of baby stage III Birth of the baby to Delivery of Placenta stage IV First 24 hours Components PATHOPHYSIOLOGY: Poor oxygen exchange Tissue hypoxia Release of lactic acid Increase carbon dioxide formation of hyaline membrane Passage Passenger Powers Psyche a. Diagonal Conjugate- 12cm b. Transverse diameter - 10.5-11cm c. Ischial tuberosity diameter NSVD CPD prolonged labor cord prolapsed fetal distress Casearian section

Severe acidosis Causes vasoconstriction and decreased tissue perfusion Impaired gas exchange RDS