INTRODUCTION

About 1 in 20,000-30,000 newborn US infants will have RDS. Not all,

but the vast majority are the result of HMD. Approximately half of neonates
born at gestation age of 26-28 weeks will develop RDS, while about 30% of
30-31 gestation week neonates will develop it. Although prematurity is the
primary risk factor, there are several other risk factors including maternal
diabetes, cesarean section, asphyxia, rapid labor, and complications that
reduce blood flow to the fetus . Internationally, RDS occurs less frequently
than in the US but overall, it is more common in white premature infants
(UChicago, 2013).
RDS almost always occurs in newborns born before 37 weeks of
gestation. The more premature the baby is, the greater is the chance of
developing RDS. RDS is more likely to occur in newborns of diabetic mothers.
Rapid, labored, grunting respirations usually develop immediately or within a
few hours after delivery, with retractions above and below the breastbone and
flaring of the nostrils and the extent of atelectasis (lung collapse) and the
severity of respiratory failure progressively worse. Not all infants with RDS
have signs of respiratory distress; extremely low birth weight newborns (i.e., <
1000 g) may be unable to initiate respirations at birth because their lungs are
so stiff; they may fail to initiate breathing in the delivery room.
The incidence of RDS can be reduced by assessment of fetal lung
maturity to determine the optimal time for delivery. When a fetus must be
delivered prematurely, giving betamethasone systemically to the mother for at
least 24 hours before delivery induces fetal surfactant production and usually
reduces the risk of RDS or decreases its severity.
If untreated, severe RDS can result in multiple organ failure and death.
However, if the newborn's ventilation is adequately supported, surfactant

1 | Page

production will begin and RDS will resolve by 4 or 5 days. Recovery is

hastened by treatment with pulmonary surfactant (Medicine, 2012)
The incidence is estimated at 6 per 1000 births. Respiratory distress
presents in the first few hours of life in a premature baby. Symptoms
include tachypnoea, expiratory grunting, nasal flaring. The infant may or may
not be cyanosed. Substernal and intercostal retractions may be evident.
Risk factors include maternal diabetes, greater prematurity, prenatal asphyxia
and multiple gestation.
Associated abnormalities are those that can occur in prematurity:
intracranial haemorrhage, necrotising enterocolitis, patent ductus arteriosus,
delayed

developmental

milestones,

hypothermia

and

hypoglycaemia

(Agrawal, & Knipe, et. Al 2014).

RDS occurs in more than half of babies born before 28 weeks
gestation, but only in less than one-third of those born between 32 and 36
weeks. Some premature babies develop RDS severe enough to need a
mechanical ventilator (breathing machine). The more premature the baby is,
the higher the risk and the more severe the RDS (LVH, 2014).
Respiratory distress syndrome (RDS) of the newborn is an acute lung
disease caused by surfactant deficiency, which leads to alveolar collapse and
noncompliant lungs. Previously known as hyaline membrane disease, this
condition is primarily seen in premature infants younger than 32 weeks
gestation.
The radiographic features of RDS are seen in the images below. A
normal film at 6 hours of life excludes the diagnosis of RDS. Classic
respiratory distress syndrome (RDS) is a bell-shaped thorax is due to
generalized under aeration. Lung volume is reduced, the lung parenchyma
has a fine granular pattern, and peripherally extending air bronchograms are
present.

Moderately severe respiratory distress syndrome (RDS) is a

reticulogranular pattern is more prominent and uniformly distributed than

usual. The lungs are hypoaerated. Increased air bronchograms are observed.
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Severe respiratory distress syndrome (RDS) is a Reticulogranular

opacities are present throughout both lungs, with prominent air bronchograms
and total obscuration of the cardiac silhouette. Cystic areas in the right lung
may represent dilated alveoli or early pulmonary interstitial emphysema (PIE).
The incidence and severity of RDS are inversely related to gestational age.
RDS is the most common cause of respiratory failure during the first days after
birth. In addition to prematurity, other factors contributing to the development
of RDS are maternal diabetes, cesarean delivery without preceding labor
being the second born of twins, perinatal asphyxia, perinatal infection, and
patent ductus arteriosus.
Complications of RDS are numerous, both acute and chronic. Infants
with RDS are at risk of developing alveolar rupture and pulmonary interstitial
emphysema, infection, intracranial hemorrhage, chronic lung disease
(bronchopulmonary

dysplasia),

retinopathy

of

prematurity,

impairment, and sudden death (Do, P., Lin, EC. et. al.2014).

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neurologic

Significance of the Study

The significance of the study is to learn deeper regarding the case of
the patient; how the complication started and how it affects the physiologic
aspect of the patients body.
This will serve as an instrument to gain more knowledge that will help
the patient to become aware about the proper management and care for
endometriosis. It will also educate the people especially with those
endometriosis and vulnerable individuals to seek medical care in order to
prevent such disease. The patient can also alleviate her condition through
complying with the recommendations suggested by the researchers.
The hospital institutions can also benefit with this case study for it
provides information about hyaline membrane disease (also known as
respiratory disease syndrome) in newborn. They could also use this as
references for it provides thorough assessment findings that may be
associated when experiencing endometriosis. The case study could also
provide the institution with the ideal medications and interventions or
management.
The case study is also essential for us nursing students for it provides
information about the concerned disease and supplies the lacking knowledge
of the students. Through the study, we were able to identify cues related to the
precipitating factors and predisposing factors of the disease, in which we were
able to give nursing diagnosis based on our understanding.

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Case Objectives
General Objective:
This study aims to determine what is hyaline membrane disease
specifically in the newborn.
Specific Objectives:
1) Discuss the introduction of the disease including its incidence and
2)
3)
4)
5)

prevalence rate of HMD

Conduct review of the systems.
Conduct a physical examination from head to toe.
Define the what HMD all about
Discuss the anatomical parts of affected area and explain functions

of each part;
6) Trace the pathophysiology of the disease
7) Enumerate and conduct a drug study on drugs administered to the
patient with its pharmacological uses and effects as well as nursing
responsibilities to be observe in relation to the patients condition;
8) Formulate effective nursing care plans;
9) Discuss the prognosis about the case with its justification;

DEFINITION OF DIAGNOSIS

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Hyaline membrane disease (HMD), more commonly called respiratory

distress syndrome (RDS), is one of the most common problems of premature
babies. It can cause babies to need extra oxygen and help breathing. The
course of illness with hyaline membrane disease depends on the size and
gestational age of the baby, the severity of the disease, the presence of
infection, whether or not a baby has a patent ductus arteriosus (a heart
condition), and whether or not the baby needs mechanical help to breathe.
RDS typically worsens over the first 48 to 72 hours before improving with
treatment (LVH, 2014).
Impairment in the synthesis and/or secretion of surfactant leads to an
increase in dead space due to atelectasis and a decrease in lung compliance.
Consequences include ventilation-perfusion mismatch, hypoxemia and
hypercarbia that in turn lead to respiratory acidosis (UChicago, 2013).
Acidosis causes vasoconstriction that impairs the endothelial and
epithelial integrity in the lungs, Hyaline membrane disease (HMD) is a life
threatening pulmonary disease primarily of the premature infant caused
by surfactant deficiency and resulting in respiratory distress syndrome (RDS)
(UChicago, 2013).
Pulmonary

surfactant

is

complex

lipoprotein

composed

of

phospholipids and apoproteins synthesized by alveolar type 2 epithelial cells

and airway Clara cells. These lipoproteins function to decrease surface
tension at the air-liquid interface of the lung and also play a role in host
defense against infection and inflammation thus leaking an exudate that forms
the hyaline membrane from which the name of the disease is derived
(UChicago, 2013).
Hyaline membrane disease also known as neonatal respiratory distress
syndrome,lung disease of prematurity, or surfactant deficiency refers to lung
pathology which results from insufficient production of surfactant. Respiratory
distress presents in the first few hours of life in a premature baby. Symptoms
include tachypnoea, expiratory grunting, nasal flaring. The infant may or may
6 | Page

not be cyanosed. Substernal and intercostal retractions may be evident

(Agrawal & Knipe, et. al 2014).
Hyaline membrane disease: A respiratory disease of the newborn,
especially the premature infant, in which a membrane composed of proteins
and dead cells lines the alveoli (the tiny air sacs in the lung), making gas
exchange difficult or impossible. The word "hyaline" comes from the Greek
word "hyalos" meaning "glass or transparent stone such as crystal." The
membrane in hyaline membrane disease looks glassy. Hyaline membrane is
now commonly called respiratory distress syndrome (RDS). It is caused by a
deficiency of a molecule called surfactant (Medicinet, 2012).
Respiratory disease syndrome (RDS), also known as hyaline
membrane disease, is the commonest respiratory disorder in preterm infants.
The clinical diagnosis is made in preterm infants with respiratory difficulty that
includes tachypnea, retractions, grunting respirations, nasal flaring and need
for INCREASE FIO2. In the last three decades, introduction of antenatal
steroids and exogenous surfactant has greatly improved outcomes in RDS;
however, it remains a principal clinical problem (ICNHSF, 2004).

HEALTH HISTORY
Biographical Data
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Name: Bb. Boy L

Sex: Male
Marital Status: Single
Age: Newborn
Occupation: N/A
Present address: Crossing Kamatis, Dangao-an Magpet, North Cotabato
Date of Birth: December 09, 2014
Place of Birth: Cotabato Provincial Hospital, Amas Kidapawan City
Religion: Born Again
Citizenship: Filipino
Tribe: Illonggo
Health Insurance: Phil Health
Hospital: Cotabato Provincial Hospital, Amas Kidapawan City
Classification: Phil Health NICU
Admission: December 9, 2014
Chief Complain: Fetal Distress
Admitting Diagnosis: Hyaline Membrane Disease of Newborn

Reason for Seeking Healthcare

The mother was admitted at the hospital last December 9, 2014 due to
labor pain. She delivered her baby (the patient) as Normal spontaneous
vaginal delivery (NSVD). Due to fetal distress of the baby after he was born,
the health care practitioners decided that the baby must be admitted for further
management and evaluation of the case.
Current Health Status

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Prior to admission, the baby was delivered via normal spontaneous

vaginal delivery. After which, fetal distress occurs.
Past Health History
Since the patient was a newborn, he has no past health history but the
mother has. Her mother is a farmer. She told me that she was exposed from
heat of the sunlight. She was going to the gravel area where her husband is
working. Sometimes the mother was going outside with her friends and having
fun. The mother was occasionally smoking but not drinking.
Gynecological History
The mother is a 19 year old, married and has a living child; G 1P1A0.

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Family History

Grandfath
er, 57 y.o,
Osteoporo
sis

Sister 1,
28 y.o,
well and
alive

Grandmother, 58
y.o, rheumatoid
arthritis

Kuya, 25
y.o,
alcoholic
, cough

Pts Mother,
19 y.o, well
and alive

Grandfath
er, 54 y.o,
Asthmatic

Kuya 1,
34 y.o,
well and
alive
Patient, newborn, diagnosed
of having
Hyaline Membrane Disease

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Grandmother, 58
y.o, rheumatoid
arthritis

Pts
Father,
21 y.o,
well and

Sister, 32
y.o, well
and alive

Review of Systems
General Survey
The patient was manifesting difficulty of breathing, has an endotracheal
tube attached to him with mechanical ventilator, has no lesion, skin is intact,
positive blood secretion after pressing the ambobag. There was no mass on
head, neck and no signs of any injuries or fractures. His head and extremities
were flexed with a head circumference of 36 cm, chest circumference of 27
cm, abdominal circumference of 23 cm, weight of 1.5 kg, a height of 44 cm
and a rectal temperature of 36.8 C (manifest that his rectum is patent). His
respiratory rate was 86 cycles per minute with nasal flaring and has an
irregular heart beat that were playing at a minimum of 87 beats per minute and
a maximum of 146 beats per minute.
Integumentary System
No lesion was noted when the researcher conducted physical
assessment but was noted a cleft lip like shape that is maybe due to the ET
tube that was connected to the patient. His skin was dry but warmth to touch
with uneven skin tone and has a reddish color on his cheek. He has no signs
of cyanosis, there were cheesy like substances (vernix caseosa) on his neck,
his hair was equally distributed and his nails were already long.
HEENT
The patient was still a newborn. According to the mother, the baby has
symmetrical head and eyes with no eye exudates. When the patient called, he
turns to side but cant vocalize. There were no exudates on the nose.
Respiratory System
When the watchers asked about the patients breathing pattern, they
answered that sometimes they observe fast chest pumping and sometimes
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slow. According to the vital sign, his RR was 86 cycles per minute and it
indicates tachypnea since the normal range of respiratory rate in newborn was
30 60 cycles per minute only.
Cardiovascular System
When the mother was asked about the activity of her baby, she replied
usahay active, usahay dili (sometimes active but sometimes he isnt). she
didnt observed any bluish discoloration in the child.
Gastrointestinal
The mother told the researcher that the patient poops once but not
eating nor drinking yet.
Genitourinary
The patient was already urinates and consumed 1 diaper only.
Musculoskeletal
The patient was still a newborn. He has already positive in almost all
reflexes normally found in newborn.
Neurological
The patient was still a newborn. The mother told the researcher that
she didnt noticed any tremors or unusual movements of the baby but she was
worried because the baby did not suck yet.
Infections
The patient was still a newborn. There was no infection occurs yet as
evidenced by the latest temperature of 36.8 C with no other signs of infection.
But an increase of WBC on the lab results indicates that there are infection
present but the leukocytes of the patient is fighting it.
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Relationship
When the mother asked about what she feels about the baby, she
replied that they are happy because there were new gift they have had
received from god but lonely because of the situation of their baby.

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PSYCHOSOCIAL PROFILE
Health Practices and Beliefs
The patient was still a newborn. His mother claimed that she is
undergone a complete prenatal check-up in the hospital.
Typical Day
The patient was still a newborn.
Nutritional Pattern
The patient was still a newborn. His mother was eating nutritious food 3
times a day with 2 3 times of her snacks.
Activity and Exercise Pattern
The patient was still a newborn. Her mother was walking everyday
usually early in the morning.
Recreation and Hobbies
The patient was still a newborn.
Sleep/ Rest Pattern
The patient was still a newborn. His mother was waking up early in the
morning at around 5:00 am.
Personal Habits
The patient was still a newborn. Her mother was smoking occasionally
but not drinking alcoholic beverages.

Occupational Health Patterns

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The patient was still a newborn. Her mother was a vendor and
sometimes exposed to dust and sun for her husband is working at sand and
gravel and construction.
Environmental Health Patterns
Their environment can be described as not free with chemicals because
they are surrounded by farms. But they still observe sanitation.
Cultural/ Religious Influences
The patient was still a newborn.

When her mother asked about

religious influences, she answered that if its gods will then it will happen.
Family Roles and Relationships
He has a very supportive family. His mother didnt left him alone.

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PHYSICAL ASSESSMENT
Date Assessed: December 09, 2014
General Survey
Baby Boy L was asleep with an ongoing IVF of D10W + Ca infusing well
at right metacarpal vein. He has an ET Tube connected to mechanical
ventilator on his mouth.
Vital Signs
December 09, 2014 at 2:00 pm
Temperature 36.8C
Respiratory Rate (RR) - 86 cycle per minute (cpm)
Pulse Rate (PR) - 146 beats per minute (bpm)
Anthropometric Measurement
Head Circumference 36 cm
Chest Circumference 27 cm
Abdominal Circumference 23 cm
Weight 1.5 kg
Height 44 cm

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Head-to-Toe Scan
Assessing the Integumentary Systems
No lesion was noted when the researcher conducted physical
assessment but was noted a cleft lip like shape that is maybe due to the ET
tube that was connected to the patient. His skin was dry but warmth to touch
with uneven skin tone and has a reddish color on his cheek. He has no signs
of cyanosis, there were cheesy like substances (vernix caseosa) on his neck,
his hair was equally distributed and his nails were already long.
Assessing the HEENT
When his anterior fontanels was gently palpated, there was a diamond
shape like that the researcher was observed and a triangular shape like on the
posterior portion. He has soft face with symmetrical facial movements. He has
positive tonic reflex. His eyes are edematous maybe due to vaginal delivery
was occur, eyes were equal and symmetrical. His pinna ere flexible, without
deformity and aligns with the external canthus of the eyes. His nares were
patent with a small amount of white to colorless discharges.

Mucous

membrane were pink and moist, frenulum of tongue and lip were intact but
wasnt a good sucker, with minimal saliva and crying so loud but interrupted
sometimes.
Assessing the Chest
His chest when palpated has no lesion or masses noted. He has
anteroposterior:lateral chest with equal chest excursion but increases rapidly
due to difficulty of breathing.

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Assessing the Abdomen

His abdomen is round in shape, warm to touch with no lesions noted.
He has positive bowel sound. His liver edge is palpable 2 3 cm and also the
tip of the spleen and kidneys.
Assessing the Rectum
The patients anus is patent with meconium stool and positive anal
reflex.
Assessing the Male Genitalia
The patient already urinates. When the prepuce was retracted the baby
cries. His urethral opening is at the tip of penis; scrotum is edematous and has
palpable testes.
Assessing the Musculoskeletal
The patients toes and fingers are complete as counted; 5 counts on the
left hand,5 counts on the right hands and 5 counts each on both feet; has full
range of motion with no clicks heard, equal gluteal folds, C curve of spine with
no dumpling. When arms and legs are extended, the researcher noted that
muscles are symmetrical and with equal muscle tone and arms and leg are
symmetrical in size and movement.

Assessing the Neurological

When checked with reflex test, the patient are positive with moro reflex,
knee reflex, startle reflex, tonic neck reflex, palmar grasp reflexes, plantar
grasp reflex, and babinski reflex.

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FOCUSED ASSESSMENT
Assessing the Respiratory System
His respiratory rate is 86 cycles per minute and it was above the normal
range. He was experiencing difficulty of breathing. Upon auscultation, there is
a scattered crackles heard on the chest. Cough reflex is absent and bronchial
and bronchovesicular breath sounds were audible.
Laboratory and Diagnostic Result
A. HEMATOLOGY
Date: 12 09 14
Table No.
Basic Test

Result

WBC

14.9

HGB

203

HCT

0.607

Reference
Values
5-10 x 10
g/L

M: 140 160g/L
F: 120 140g/L
M: 0.40
0.54
F: 0.37
0.47

Justification
High white blood cell count is an
increase in disease-fighting cells
(leukocytes) circulating in your
blood. High white blood cell count
is also called leukocytosis.
Low
count
of
hemoglobin
indicates a reduction in either the
number of size of RBCs. it may
implies that patient has anemia.
A high hematocrit means the
percentage of red blood cells in
a person's blood is above the
upper limits of normal and it can
cause:
Dehydration (heat exhaustion,
no available source of fluids)
Low availability of oxygen
(smoking,
high
altitude,
pulmonary fibrosis)
Genetic

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(congenital

heart

diseases)
Erythrocytosis
(overproduction of red blood cells
by
the
bone
marrow
orpolycythemia vera)

Monocytes

0.047

0.04 0.16

Lymphocyte

0.39

0.25 0.35

Cor
pulmonale
(COPD,
chronic sleep
apnea,
pulmonary
embolisms)
(Davis, 2014).
Normal
Elevated lymphocyte indicates
that the body has experienced an
invasion of foreign cells.

Summary of Pertinent Findings

Baby boy L, a newborn baby was admitted at the hospital due to
difficulty of breathing and was diagnosed of having a Hyaline membrane
disease.
A hematologic result presents risk for infection due to increase of a
white blood cell that is the primary indicator of infection in the body.

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Anatomy and Physiology of the Respiratory System

During intrauterine life, the lungs serve no ventilatory purpose because
the placenta supplies the fetus with oxygen. At the time of birth, however,
several changes need to take place for the lungs to take over the vital function
of supplying the body with oxygen.
Fetus
Since the oxygen supplied to the fetus comes from the placenta, the
lungs contain no air. The alveoli (air sacs) of the fetus are filled instead with
fluid that has been produced by the lungs.

Since the fetal lungs are fluid filled and do not contain oxygen, blood
passing through the lungs cannot pick up oxygen to deliver throughout the
body. Thus, blood flow through the lungs is markedly diminished compared to
that which is required following birth. Diminished blood flow through the lungs
of the fetus is a result of the partial closing of the arterioles in the lungs. This
results in the majority of blood flow diverted away from the lungs through the
ductus arteriosus.

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Birth
At birth, as the infant takes the first few breaths, several changes occur
whereby the lungs take over the lifelong function of supplying the body with
oxygen. In an attempt to establish normal respirations, the infant can develop
problems in two areas:
Fluid may remain in the alveoli;
Blood flow to the lungs may not increase as desired.

Fetal Lung Fluid

At birth, the alveoli are filled with fetal lung fluid. It takes a
considerable amount of pressure in the lungs to overcome the fluid forces and
open the alveoli for the first time. In fact, the first several breaths may require
two to three times the pressure required for succeeding breaths.
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Approximately one-third of fetal lung fluid is removed during vaginal

delivery as the chest is squeezed and lung fluid exits through the nose and
mouth. The remaining fluid passes through the alveoli into the lymphatic
tissues surrounding the lungs; how quickly fluid leaves the lungs depends on
the effectiveness of the first few breaths.

Fortunately, the first few breaths of most newborn infants are generally
effective, expanding the alveoli and replacing the lung fluid with air.

The respiratory system is made up of the organs involved in the

interchanges of gases and consists of the Nose, Mouth (oral cavity), Throat
(pharynx), Voice box (larynx), Windpipe (trachea), Airways (bronchi), Lungs
The upper respiratory tract includes the Nose, Nasal cavity and
Sinuses. The lower respiratory tract includes the Voice box (larynx),
Windpipe (trachea), Lungs, Airways (bronchi and bronchioles), Air sacs
(alveoli)
The lungs take in oxygen, which the body's cells need to live and carry
out their normal functions. They also get rid of carbon dioxide, a waste
product of the cells.

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The lungs are a pair of cone-shaped organs made up of spongy,

pinkish-gray tissue. They take up most of the space in the chest, or the
thorax (the part of the body between the base of the neck and diaphragm).
They are enveloped in a membrane called the pleura.
The lungs are separated from each other by the mediastinum, an area
that contains the following Heart and its large vessels, Windpipe (trachea),
Esophagus, Thymus gland and Lymph nodes.
The right lung has 3 lobes. The left lung has 2 lobes. When you
breathe, the air: Enters the body through the nose or the mouth then Travels
down the throat through the voice box (larynx) and windpipe Goes into the
lungs through tubes called mainstem bronchi: One mainstem bronchus leads
to the right lung and one to the left lung. In the lungs, the mainstem bronchi
divide into smaller bronchi Then into even smaller tubes called bronchioles.
Bronchioles end in tiny air sacs called alveoli Breathing in babies.
An important part of lung development in babies is the production of
surfactant. This is a substance made by the cells in the small airways and
consists of phospholipids and protein. By about 35 weeks gestation, most
babies have developed enough surfactant. Surfactant is normally released
into the lung tissues where it helps lower surface tension in the airways. This
helps keep the lung alveoli (air sacs) open. Premature babies may not have
enough surfactant in their lungs and may have difficulty breathing.

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PATHOPHYSIOLOGY
The primary cause of RDS is inadequate pulmonary surfactant. The
structurally immature and surfactant-deficient lung has decrease compliance
and a tendency to atelectasis; other factors in preterm infants that increase the
risk of atelectasis are decreased alveolar radius and weak chest wall. With
atelectasis, well perfused but poorly ventilated areas of lung lead to V/Q
mismatch (with intra-pulmonary shunting) and alveolar hypoventilation with
resultant hypoxemia and hypercarbia. Severe hypoxemia and systemic
hypoperfusion result in decreased O2 delivery, anaerobic metabolism and
subsequent lactic acidosis. Hypoxemia and acidosis may further impair
oxygenation by causing pulmonary vasoconstriction, resulting in right-to-left
shunting at the levels of the foramen ovale and ductus arteriosus. Other
factors, such as baro/volutrauma and high FIO2, may initiate release of
inflammatory cytokines and chemokines causing more endothelial and
epithelial cell injury. The injury results in reduced surfactant synthesis and
function as well as increased endothelial permeability leading to pulmonary
edema.
Leakage of proteins into the alveolar space further exacerbates
surfactant deficiency by causing surfactant inactivation. Macroscopically, the
lungs appear congested, atelectatic and solid. Microscopically, diffuse alveolar
atelectasis and pulmonary edema are seen. An eosinophilic membrane
composed of a fibrinous matrix of materials from the blood and cellular debris
(the hyaline membrane) lines the visible airspaces that usually constitute
dilated terminal bronchioles and alveolar ducts

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Diagram of Pathophysiology

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Drug Study
DRUG
MECHANISM
NAME
OF ACTION
Generic
Inhibits
Name:
mucopeptide
Ceftazidime
synthesis in
bacterial cell
Brand
wall.
Name:
Classificat
ion:
Antibiotic,
Cephalospo
rin

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DOSE/
ROUTE
Actual:
150 mg ivtt

INDICATION

Treatment
of infection
of lower
desired:
respiratory
IV : 45 to
tract, skin
90
and skin
mcg/mL(50
structure,ur
0 and 1 g
inary
doses)
tract,bone
IM:17 to 39
and
mcg/mL(50
joints:treat
0 and 1 g
ment of
doses)
gynecologi
cal
infection:tr
eatment of
intraabdominal
infections:
treatment
of
septicemia
and CNS

CONTRA
INDICATION
Hypersen
sitivity to
cephalosp
horin

SIDE
EFFECTS

ADVERSE
REACTIONS

GI
Nausea;
vomiting;
diarrhea;
anorexia;
abdominal pain
or cramps;
flatulence;
colitis, including
pseudomembra
nous colitis.

Genit
ourina
ry
Pyuria; renal
dysfunction;
dysuria;
reversible

NURSING
RESPONSIBILITIES
Assess for liver and
renal dysfunction
Culture infection,
and arrange
sensitivity tests
before and during
therapy if expected
response is not seen.
Warning:
Do not mix with
aminoglycoside
solutions, administer
these drugs
separately.
Powder and
reconstituted solution
darken with storage.
Have Vit. K
available in case
hypoprothrombinemi
a occurs
Discontinue if
hypersensitivity
occurs
Teach SO that

infections
including
meningitis
caused by
susceptible
strains and
specific
microorgan
isms:
concomita
nt antibiotic
therapy.

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interstitial
nephritis;
hematuria; toxic
nephropathy.

Hema
tologi
c
Eosinophilia;
neutropenia;
lymphocytosis;
leukocytosis;
thrombocytope
nia;
thrombocytosis;
decreased
platelet
function;
anemia;
aplastic
anemia;
hemorrhage.

patients may
experience upset
stomach or diarrhea
but must report
severe diarrhea,
difficulty breathing,
fatigue, pain at
injection site.

Hepatic
Hepatic
function
impairment;
cholestatic
jaundice;
abnormal LFT
results.

Miscellaneo
us
Hypersensitivity
, including
StevensJohnson
syndrome,
erythema
multiforme,
toxic epidermal
necrolysis;
candidal
overgrowth;
serum

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sicknesslike
reactions (eg,
skin rashes,
polyarthritis,
arthralgia,
fever); phlebitis;
thrombophlebiti
s, and pain at
injection site.

cc

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Nursing Care Plan

ASSESSMENT

NEED

Date:12 09 14
Time: 04:30 pm

Activity

Exercis
e
Pattern

Subjective:
Usahay paspas
muginhawa, ti kulban
pud ko bai
Objectives:
Increased and
sometimes
decreased fast
chest expansion
Respiratory rate of
86 cycles per
minute

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NSG.
DIAGNOSIS
Ineffective
Airway
Clearance
related to
decreased
lung
expansion
due to fluid
accumulatio
n as
evidenced
by changes
of
repiratory
rate

PLAN
At the end
of 8 hr.
span of
my care
the pt. will
be able to
maintain
airway
patency.

NSG.
INTERVENTION
Assess and
monitor
Respiratory
rate

Note for the

degree of
dyspnea.
(restlessness
, anxiety and
respiratory
distress)

RATIONALE
Tachypnea is
usually present;
respirations maybe
shallow and rapid
with prolonged
expiration
compared to
inspiration.
Rapid onset of
acute dyspnea may
reflect pulmonary
embolus.

ASSESSMENT
Date:12 09 14
Time: 4:30 pm
Subjective:
Ara man sing makina
nga nakabutang sa
iyang baba tisahay
mabal-an ko nga lisod
siya kaginhawa
Objectives:
Episodes of
dyspnea
In ability to move
scretions.

NEED

NSG.
DIAGNOSIS
Activity Impaired

Gas
Exercise Exchange
Pattern

PLAN
At the end
of 8 hr.
span of my
care the pt.
will be able
demonstrat
e improved
ventilation
and
adequate
oxygenatio
n of tissues
by ABGs
within
clients
normal
range and
be free
from any
signs of
respiratory
distress..

NSG.
INTERVENTION
Observe for
localized signs
of infection at
surgical
infections.
Stress proper
hygiene.
Change
surgical
wound
dressing daily.
Emphasize
necessity of
taking
antibiotics as
directed.

To assess causative
or contributing
factors about
infection.
To limit exposures
and reduce
contamination
To reduce bacterial
colonization.
Premature
discontinuation of
treatment when clients
feel well may result in
return of infection and
potentiation of drug
resistantstrains.

To reduce potential
infection.
Includes
teaching about
ways to reduce
potential for

11 | P a g e

RATIONALE

post operative
infection.

ASSESSMENT
Date: 12 09 - 14
Time: 4:30 pm
Subjective:
may ara sang tubo
nga gikabit sa akong
bata
Objectives:
ET Tube
attached to
the mouth of
the baby.
Redness and
swelling on
the sight

NEED
Health
percepti
on
health
manage
ment
pattern

NSG.
DIAGNOSIS
Risk for
trauma /
Suffocation

Scientific
basis:
Invasive
procedures
may
increased
risk for
trauma

PLAN
At the end
of 8 hr.
span of my
care the pt.
will be able
to
recognize
pts
watcher
need for
and seek
assistance
to prevent
complicatio
n.

NSG.
INTERVENTION
Observe for
localized signs
of infection at
surgical
infections.
Stress proper
hygiene.
Change
surgical
wound
dressing daily.
Emphasize
necessity of
taking
antibiotics as
directed.

RATIONALE
To assess causative
or contributing
factors about
infection.
To limit exposures
and reduce
contamination
To reduce bacterial
colonization.
Premature
discontinuation of
treatment when clients
feel well may result in
return of infection and
potentiation of drug
resistantstrains.

To reduce potential
infection.

12 | P a g e

 Includes
teaching about
ways to reduce
potential for
post operative
infection.

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Prognosis
Typically, the symptoms worsen a few days after birth but slowly
improve afterwards. The goal is to support the infant while the lungs begin
producing surfactant. Providing adequate nutritional requirements is also
important for recovery and growth.
Many infants with HMD suffer the complications of oxygen and
ventilation therapy but recover within the first couple of years of life as the lung
tissue is replaced with new and functional tissue.
Damage to other organs such as the brain may also occur which is due
to a combination of factors including hypoxia and intraventricular hemorrhage,
so it is imperative to begin therapy early and monitor organ damage
(UChicago, 2013).

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Bibliography

Agrawal, R. Knipe, H. et. Al 2014 Hyaline membrane disease

http://radiopaedia.org
/articles/hyaline-membrane-disease

Davis, CP, 2014. Hematocrit Blood Test . http://www.emedicinehealth.com/

hematocrit_blood_test/page5_em.htm

11 | P a g e

Do,

P., Lin, EC. et. al. 2014. Hyaline Membrane Disease Imaging .
http://emedicine.medscape.com/article/409409-overview

ICNHF,
2004.
Respiratory
Disease
Syndrome.
http://www.ucsfbenioffchildrens.org
/pdf/manuals/25_RDS.pdf
LVHN, 2014. Lehigh Valley Hospital. Hyaline Membrane Disease.
http://www.lvhn.org/conditions_treatments/childrens_care/newborn_issu
es/hyaline_membrane_disease_respiratory_distress_syndrome/learn_a
bout_hyaline_membrane_disease/treatment

Mayoclinic,
2014.
High
white
blood
cells.
http://www.mayoclinic.org/symptoms/high-white-blood-cellcount/basics/definition/sym-20050611

Medicinet, 2012. Hyaline membrane disease http://www.medicinenet.com

/script/main/art.asp?articlekey=10677
Uchicago,
2013.
Hyaline
membrane
disease.
https://pedclerk.bsd.uchicago.edu/page/hyaline-membrane-diseasehmd

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