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Respiratory Distress in Newborns (Nursing)

by Jacquelyn McMillian-Bohler

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    00:01 The first disorder we'll talk about is respiratory distress.

    00:05 So the risk factors for respiratory distress include: a birthing person that has a diagnosis related to diabetes.

    00:12 This could be Type 1 diabetes, Type 2 diabetes, or gestational diabetes.

    00:18 A cesarean birth without labor.

    00:20 This is an important distinction.

    00:22 If a patient does not labor and the baby does not have an opportunity to go into the birth canal and have the squeeze on the chest, that will evacuate all of that fluid, it's very likely that they may experience difficulty breathing once they're born.

    00:37 Babies are not very good multitaskers.

    00:40 So anytime one system is in distress, all the rest of the systems can also be affected.

    00:46 So in the case of an infection, which is what sepsis is, the baby's body is trying to fight off the infection, which then makes it difficult for the body to concentrate on breathing, leading to respiratory distress.

    00:59 Similar situation with hypothermia.

    01:02 If the baby is cold, trying to maintain the temperature becomes something the body has to work to do.

    01:08 Therefore, it makes it difficult to concentrate on breathing.

    01:13 Hypoglycemia.

    01:14 Again, similar situation.

    01:16 If the body is working to maintain euglycemia it then cannot focus its energy on respiratory function.

    01:24 I want to talk about Respiratory Distress Syndrome alongside respiratory distress.

    01:30 But please recognize that Respiratory Distress Syndrome is an entirely different disorder.

    01:35 The number one risk factor for respiratory distress syndrome is prematurity.

    01:40 But risk factors can also include a diabetic birthing person and anything that can lead to surfactant inactivation.

    01:48 So that would include things like meconium aspiration syndrome, or pulmonary hemorrhage.

    01:54 Symptoms of respiratory distress include tachypnea or rapid breathing.

    01:59 Nasal flaring. Remember, that's when the nares move as a way to help get oxygen into the nose.

    02:05 Grunting, that's the sound the baby might make.

    02:08 And it sort of sounds like... [grunting] The nurse may also note retractions in the chest wall.

    02:17 Because of poor development of the muscles in the chest wall, the skin actually gets sucked in in between the ribs during inspiration.

    02:26 The nurse may also notice central cyanosis.

    02:29 We talked about acrocyanosis being normal.

    02:32 Remember, blue hands and feet.

    02:34 But central cyanosis where the cyanosis is located on the trunk.

    02:38 So the head, the chest, the center part of the body is always a sign of abnormality.

    02:45 Also with respiratory distress, and this is a late sign.

    02:48 The nurse may note decreased muscle tone.

    02:50 So the baby may be more flaccid than normal.

    02:55 When we think about assessment, in general, vital signs, the entire vital signs set.

    03:00 So this includes temperature, respiration, and pulse oximetry.

    03:04 So getting an actual count of the oxygen saturation.

    03:08 And when we use a pulse ox the right hand or wrist is always better.

    03:13 We may monitor labs as well, checking for acid base balance, and also ruling out infection with the CBC.

    03:21 We can also check blood glucose to make sure that the client is euglycemic.

    03:26 Remember, they're not good multitaskers.

    03:29 And if one system is down, it can affect every other system.

    03:33 Treatment for respiratory distress includes putting the baby in an appropriate position which is supine with the head in a neutral position.

    03:42 It's also important during respiratory distress that we clear the airway.

    03:46 There may be mucus leftover.

    03:48 Remember, our risk factors thinking about a cesarean birth or something along those lines.

    03:53 We can clear the nasal passages using a bulb syringe.

    03:57 What's the order? Mouth first and then nose? Perfect.

    04:02 If we're unable to clear the passage with the bulb syringe, then the next step would be to use deep mechanical suctioning.

    04:08 So using a suction catheter and actually going down through the nares or through the mouth in order to clear the respiratory tract.

    04:15 To help get more oxygen to the newborn, we could use a bag, a mask, or a neopuff, which is what you see demonstrated in this picture here.

    04:24 We can also take it a step further with a nasal cannula which would allow for continuous flow of oxygen or CPAP.

    04:31 And if neither of those are working, we would take it one step further, which would be intubation.

    04:38 Other strategies for treatment include maintaining temperature.

    04:41 So we want to support thermal regulation and avoid cold stress.

    04:46 So remember the four ways that babies lose heat, we want to look out for each of them.

    04:51 To avoid hypoglycemia, it's important that we make sure that the baby's eating well.

    04:56 So whether the baby is breast, chest, or bottle feeding, making sure the baby's feeding on schedule is very, very important.

    05:04 And finally making sure that we're not over stressing the baby.

    05:08 Because having a lot of people, or a lot of noise, or a lot of anything is going to ensure that the baby does not necessarily have all the energy they need to focus on basic functioning, like breathing.

    05:22 We talked about treatment.

    05:23 But can we prevent respiratory distress? Absolutely.

    05:27 There are two main ways we can do this.

    05:30 By maintaining appropriate temperature.

    05:32 We want to make sure that the baby does not lose heat through convection, conduction, evaporation, or radiation and make sure that the baby feeds on an appropriate schedule.

    05:42 Whether it's breast, chest, or bottle, making sure the baby feeds on demand, or every three to four hours, if it's bottle feeding, are definitely two ways we can prevent respiratory distress.

    05:53 Let's go back to respiratory distress syndrome.

    05:56 We talked about the risk factor for RDS.

    05:59 And the number one risk factor is prematurity.

    06:02 And the reason why this is a problem is because premature infants are less likely to have an adequate production of surfactant.

    06:09 So we're going to give artificial surfactant as the number one treatment.

    06:14 What does the surfactant do? Surfactant reduces the surface tension in the alveoli.

    06:20 And this prevents the alveoli from closing after each breath exhalation.

    06:26 The population we might want to consider having artificial surfactant ready for include extremely low birth weight infants, which we now know what that is, and any infants that are born premature.

    06:39 When we think about administration of artificial surfactant, we know that this will be given via ET tube or OG tube depending on the facility protocol.


    About the Lecture

    The lecture Respiratory Distress in Newborns (Nursing) by Jacquelyn McMillian-Bohler is from the course Newborn Complications (Nursing).


    Included Quiz Questions

    1. Diabetes
    2. Cesarean section
    3. Sepsis
    4. Tachycardia
    5. 40 weeks gestation
    1. Prematurity
    2. Diabetic birthing person
    3. Surfactant inactivation
    4. Surfactant activation
    5. Bradycardia
    1. A premature infant is less likely to produce surfactant.
    2. A premature infant is more likely to produce surfactant.
    3. A premature infant's GI system is less developed.
    4. A premature infant cannot breathe on its own.

    Author of lecture Respiratory Distress in Newborns (Nursing)

     Jacquelyn McMillian-Bohler

    Jacquelyn McMillian-Bohler


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