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Infant respiratory distress syndrome (IRDS)

also known as Neonatal respiratory distress syndrome, respiratory distress syndrome of newborn, and previously called hyaline membrane disease.

It is a syndrome in premature infants caused by developmental insufficiency of surfactant production and structural immaturity in the lungs.

It can also result from a genetic problem with the production of surfactant associated proteins. RDS affects about 1% of newborn infants and is the leading cause of death in preterm infants.

Manifestations:

  1. tachypnea
  2. cyanosis
  3. glassy appearance of the alveolar membranes

Pathology:

Chest tube assessment and care

 

Complications resulting in the need for a chest tube:

  1. Pleural effusion
  2. Hemothorax
  3. Empyema (pus)
  • Symptoms:

 

  1. Dyspnea
  2. Cough
  3. Chest Pain
  4. Fever
  5. Malaise

 

Mediastinal Chest tube purpose:

  • removal of blood or fluid from around the heart

 

Documentation:

  1. Volume of drainage (date and time)
  2. Suction Rate
  3. Nature of drainage (measure and character)
  4. mark on pneumothorax container then replace when full

 

Drainage System Troubleshooting:

  • No tidling indicates the system is not patent or that lungs have expanded to normal
  • Intermittent bubbling is normal, if continuous bubbling occurs the tube has been displaced
  • rapid bubbling may indicate air leak around incision or tear in pulmonary pleura

 

Assessments:

  1. Patient
  2. Site
  3. Tubing
  4. Timing = q15min for first hr after insertion, then q4h

 

Patient Assessment:

  1. vital signs
  2. oxygen saturation
  3. level of orientation
  4. respiratory assessment
  • signs and symptoms of increased respiratory distress:
  • displaced trachea
  • decreased breath sounds over both affected and unaffected sides
  • marked cyanosis
  • asymmetrical chest movements
  • chest pain:
  • sharp, stabbing chest pain – indicative of tension pneumothorax
  • pain on inspiration – indicative of hemothorax or pneumothorax
  • hypotension
  • tachycardia
  • pain scale
  1. Hg and Hct

 

Site assessment:

  1. Chest tube Dressing and surrounding insertion site -norm = Dry and Intact
  2. Drainage
  3. Subcutaneous emphysema
  4. Sudden increase in drainage of more than 70ml may indicate new thoracic bleeding

 

Tubing assessment:

  • tight system connections
  • appropriately taped
  • tubing not kinked, or obstructed
  • prevent dependent loops
  • avoid milking or stripping the drainage in tubing

 

Drainage Unit Chambers:

  • Set upright
  • insure drainage collector is below the level of the patient`s chest
  • ensure tidling is occurring with patient inspirations and expiration
  • lung re-expansion may have occurred if no tidling occurs and 2-3 days have passed
  • An air leak may be indicated by fluid bubbling left to right when facing system.
  • assess the suction level is as per doctors orders
  • sudden halt in drainage may indicate clot or other blockage in the drainage system
  • Know expected drainage colour when assessing

 

Clamp tubing (but only for seconds) when:

  • locating leaks
  • replacing the system
  • as per physicians orders to trial if pneumothorax has resolved
  • 2 non-toothed clamps should be at the patient`s bedside at all times

Types of Pneumothorax

 

Pneumothorax: abnormal presence of air in the pleural cavity

Types of pneumothorax:

  1. Closed pneumothorax
  2. Open pneumothorax
  3. Spontaneous pneumothorax: Air in the pleural space that is ideopathic in nature, however is often the result of underlying disease, termed a secondary pneumothorax.
  4. Traumatic pneumothorax
  • Flail chest: A severe traumatic injury of the rib cage
  • integrity of the rib cage is compromised as multiple osseous fragments respond as an independent segment from the rest of the chest wall during inspiration and expiration.
  • The rib fragments are drawn inwards with each inspiration and pushed outwards with each expiration.

 

Flail Chest Symptoms:

  • Dyspnea
  • Chest pain
  • Crepitus
     

  1. Tension pneumothorax: life-threatening condition that results from a progressive deterioration and worsening of a simple pneumothorax, associated with the formation of a `one-way valve` of air entering the space but not leaving.

 

Pneumothorax manifestations:

  1. Tachypnea
  2. Dyspnea
  3. Restlessness
  4. Anxiety
  5. Tachycardia
  6. Cyanosis
  7. Use of accessory breathing muscles
  8. Decreased or absent breathing sounds
  9. Decreased movement on the affected side

 

Tension Pneumothorax (one way air leak)

  • air moves into the pleural space and becomes trapped
  • increased positive pressure in pleural space results in lung compression.
  • Mediastinal shift to opposite side
  • the opposite lung is compressed.

Pulmonary Fibrosis

A condition characterized by deposition of fibrous tissue in the lung. It decreases lung compliance and results in a restrictive ventilatory defect as seen on pulmonary function testing. A chronic lung inflammation with progressive scarring of the alveolar walls that can lead to death.

Physiology:

Fibrosis, build up of tissue, changes the surface area of lung tissue available for gas exchange. Decreased gas exchange at the lungs results in impaired oxygenation of the body tissues.

Etiology:

Prolonged inflammation, infection or disease of the lungs results in activation of an immune response. Immune cells trigger fibroblasts that replaced damaged lung cells with tough, fibrous cells creating scar tissue or fibrosis in the place of the former healthy lung tissue.

Manifestations:

  1. Dyspnea
  2. Dry cough

Sighing respirations

 

Breathing punctuated by frequent sighs may be seen in neurotics and those with hyperventilation syndrome (psychologically or physiologically based, involving breathing too deeply or too rapidly).

Bates, Barbara. 1974. A Guide to Physical Examination. J.B. Lippincott Company, Toronto.

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