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.