CASE STUDY: Pre Labor Infant with Respiratory Distress Syndrome

A 1.5-kg male is delivered via vaginal delivery because of preterm labor at 33 weeks’ gestation. Apgar scores are 7 and 8 at 1 and 5 minutes,
respectively. The infant is cyanotic and requires CPAP immediately after delivery. He has subcostal retractions, grunting, and nasal flaring.
Auscultation reveals decreased air entry in the lung fields throughout. Temperature is 98.2°F (36.8°C), pulse is 175 beats per minute, and
respiratory rate is 70 breaths per minute. He requires an Fio2 of 0.4. His chest radiograph is shown in image #3

Case 3: Respiratory distress syndrome is characterized by diffuse, bilateral, ground glass fields with air bronchograms secondary to diffuse
atelectasis.

NURSING CARE PLAN

 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Impaired After 5-7 days INDEPENDENT:  Parents will need to work  After 5-7 days of
-A 1.5-kg male is Gas of nursing  Teach parents the cause of with health care provider nursing
delivered via exchange interventions, preterm birth. to arrange for best care interventions,
vaginal delivery related to the infant will  Discuss the meaning of RDS for preterm infant. the infant was
because of preterm immaturity maintains a problem.  Discussing the main able to
labor at 33 weeks’ of stable problem will decrease the demonstrate
gestation. newborn’s respiratory  Encourage the mother to panic and anxiety of the improve the
-The infant is lungs and rate, and verbalize the fears and mother. ventilation and
cyanotic and lack of depth with concerns.  Can help the mother to will be free from
requires CPAP surfactant assistive reduce the anxiety and any signs and
immediately after as evidence respiratory  Discuss the importance of stimulate identification of symptoms of
delivery. He has by an aids in place. proper ventilation to an coping behaviours RDS such as
subcostal average infant.  This will make the mother subcostal
retractions, respiratory cooperate to the retractions,
grunting, and nasal rate of COLABORATIVE: treatment regimen grunting, and
flaring. 70/60 P/M,  Maintain the respiratory nasal flaring.
new onset program as prescribed,  Signs of increasing  The mother will
OBJECTIVE: of subcostal such as oxygen by ET tube respiratory distress may be able to
Apgar scores are 7 retractions, or ventilator. denote lessening air define the
and 8 at 1 and 5 grunting,  Maintain a neutral thermal exchange. accurate
minutes, and nasal environment so infant’s  A neutral thermal meaning of RDS
respectively. flaring. temperature remains environment minimizes and importance
stable. the risk of cold stress, of proper use
Vital Signs:  Administer surfactant via which increase metabolic ventilation to
PR: 175 per min. ET tube as per protocol. demands for oxygen her infant
RR: 70 per min.  The surfactant restores precisely.
BT: 98.2°F (36.8°C) the naturally occurring
lung surfactant to
improve lung compliance.

NURSING CARE PLAN

Prematurity of Newborn

Assessment Diagnosis Plan Intervention Rationale Evaluation

Subjective:  Ineffective breathing After 30 minutes of nursing INDEPENDENT:  (1) assessment provides After 30 minutes of
n/a  pattern related to interventions, the infant will (1) assess RR and information about nursing
  immature neurologic experience an effective pattern   neonate’s ability to initiate interventions, goal is
Objective:   and delayed pulmonary breathing pattern (2) provide and sustain an effective partially met, the
- Preterm birth development as manifested by   respiratory assistance breathing pattern  infant experienced
(34 wks.' and2days)     as needed (oxygen (2) assistance helps the an effective
- With Oxygen hood (Rationale) -  hood)   newborn by clearing the breathing pattern as
regulated at 10 liters per  A premature lung is Infant’s RR is between40 and (3) position infant on airway and promoting manifested by
minute   structurally 60  side with a rolled oxygenation 
- RR:58 cycles/min - underdeveloped -  blanket behind his (3) lying on the side - Infant’s RR
Episodes of apnea (6- for post-natal life. To Infant will experience back position facilitate breathing was between 30 and
10secs)   add, no apnea    60
- O2 saturation of 91%  the premature delivery    (4) provide tactile (4)Stimulation of – Infant experienced
and the inadequate stimulation during the sympathetic nervous sy less episodes of apn
pulmonary periods of apnea   stem is possible to ea
surfactant. A terminate apnea with a
deficiency in surfactant, closed-loop mechanical
which functions to decr pulsating or vibrating
ease the surface tensio system. 
n within the alveoli. Wit
hout surfactant, the inf
ant experiences diffuse 
atelectasis, decreased p
ulmonary compliance, v
entilation perfusion mis
matching. 
 
 
 
References:

Reuter, S., Moser, C., & Baack, M. (2014). Respiratory distress in the newborn. Pediatrics in review, 35(10), 417–429.
https://doi.org/10.1542/pir.35-10-417

JoAnne Silbert-Flagg, DNP, CPNP, IBCLC, FAAN, Adele Pillitteri, PhD, RN, PNP. (2017). Maternal and Child Health Nursing: Care of the Childbearing
and Childrearing Family (8th ed). Wolters Kluwer Health,