what is an appropriate nursing intervention for a neonate with respiratory distress syndrome (rds)? This is a topic that many people are looking for. bluevelvetrestaurant.com is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, bluevelvetrestaurant.com would like to introduce to you Neonatal Respiratory Distress Syndrome (NRDS). Following along are instructions in the video below:
Guys. Its me the coasters perfectionist. One more time continuing our great playlist on on pulmonology today well talk about neonatal respiratory distress syndrome or n or d mommy has diabetes for example mommy is having hyperglycemia thumbs up.
But the baby is having hypoglycemia. Thumbs them this baby has lots of insulin insulin inhibits. The production of surfactant.
When you have less surfactant you have higher surface tension. You have a higher likelihood that your lungs may collapse with that being said now lets get started in the previous video. Ive talked about surfactant.
Which is anti surface tension. Highly recommended that you watched the previous video. Before watching this video.
As you know the alveolus has type 1 noma sites for gas exchange and type 2. Numa sites for surfactant production. This yellow line is the surfactant creating an interface between the air here and the water here.
When you separate the air from the water you decrease the surface tension and you protect your lungs from collapsing. We have talked about illicit ins fingal myelin ratio before normally were talking about after 28th week of the station it should be 2 or higher neonatal respiratory distress syndrome also known as hyaline membrane disease there is decreased surfactant increased surface tension the lungs are more likely to collapse. Causes prematurity is the most common cause especially less than 28 to 8 weeks of gestation incidence is inversely proportional to the gestational age.
Lets say that the baby reached 40. This is a higher gestational age. Therefore lower incidence of neonatal rds same thing with birth weight the higher your birth weight the less the incidence of neonatal rds diabetic.
Mother is an important pause and well talk about this in the next slide. In brief mommy has hyperglycemia right right okay. Lets say that mommy has type 2 diabetes.
So she has some insulin okay. But the insulin has insensitivity or decreased tolerance to glucose therefore mommy cannot use the insulin. But the answer is there glucose can pass through the placenta.
But insulin cannot so mommy can only give some glucose to the baby. She cannot give him or her insulin the baby developed hyperplasia of the pancreatic beta cell to counteract this glucose this is gonna increase insulin secretion in the baby he didnt get it from mommy. He made it himself leading to hypoglycemia and decreased surfactant production in the baby therefore his lungs are more likely to collapse next c section.
Why a normal delivery like vaginal delivery. While the babys head is being squeezed through the vaginal canal. The skull is squeezed and there is increased stress and the major stress hormone in your body.
Is cortisol. When you have stress. Cortisol goes up to counteract the stress cortisol increases surfactant production as with multiple births s vixia.
Precipitous delivery which results in a very rapid labor maternal history of n rds. Again the best predictor of future behavior is past behavior. If you have been an honest person for 40 years youre more likely to be honest in the next year.
But if you are a scum burger for 30 years youre more likely to be a scum burger in the next year. The best predictor of future behavior is past behavior same thing with risk factors. If i had three heart attacks before and im having cardiac chest pain now odds are its a heart attack here is the story of the diabetic mug here is mommy with hyperglycemia.
She has hyperglycemia if she has type 2 diabetes probably answer in his normal or increased. If she is type 1 insulin is decreased okay only the glucose can pass through the placenta the insulin cannot glucose faster than the goes to the babys blood babys gonna respond hyperplasia of the beta cells in the islets of langerhans in his pancreas leading to increase insulin. Secretion and when you increase insulin secretion endogenously.
You will increase the c peptide increase internally to decrease surfactant increasing surface tension neonatal respiratory distress syndrome in chris answer is gonna fade as a fat using getting glucose into the cell and getting potassium into the cell. The baby will end up with hypoglycemia and hypokalemia and since we are feeding the fat. The baby is gonna have increased body weight one of the causes of increased body weight in a newborn is a diabetic mother i hope this makes sense to prevent new natal.
Distress syndrome. Give one of the three hormones that stimulate surfactant corticoids thyroxine or prolactin no surfactant increases surface tension increased surface tension. 8.
Electus is the into perfusion without ventilation li into a vq mismatch on gross examination grows here doesnt mean disgusting it means on large scale opposite to microscopic growth. You only look at the lung.
The lungs are not to be dark and airless why airless. It has collapsed baby due to lack of surfactant need to increase surface tension. This lung has no residual volume or minimal air.
If the lung collapsed before the baby breathe in any air thats gonna lead to a lung. Thats dark and airless and has no residual volume and no minimal air when autopsy the lung will sink in water and ive talked about this before if the baby died before breathing in any oxygen or any air. This is what is going to happen you get a piece of his lung and put this long in like a glass of water its gonna sink to the bottom.
Why it doesnt have any air no residual volume and no minimal air. But if this baby was born alive and then killed the lungs will float because they have minimal air. Its gonna float and thats how forensic pathologists argue in court cases on microscopic exam.
This lung is collapsed. Alveoli are collapsed with intellectus damage to the pulmonary vessels leakage of proteins proteins stained pink on agent. A alveoli aligned by pink or hyelin membranes not actually a membrane.
Its like lots of pink substances like this when you look under the microscope. If he are not very sophisticated. Youll see oh looks like a membrane thats why they called it hyelin.
Which means pink membrane disease what are the clinical manifestations of a baby born with respiratory distress syndrome. But he is alive okay all right early onset tachypnea within minutes whoo later answer to kip nia think other condition for respiratory distress syndrome that a kidney has to be early respiratory difficulty no wonder we called respiratory distress syndrome. There is no surfactant prominent and grunting if you want to listen to the voice of grunting.
You should google. It intercostal retraction due to respiratory fatigue. Nasal flaring hypoxemia hypercapnia into respiratory acidosis.
The guy is not breathing edema harsh tubular breath. Sounds could be normal or could be diminished. Normally when we put a stethoscope on the lung.
We do not hear tubular breast. And we hear vesicular breaths and they likely they sound like this those are vesicular but in cases of respiratory distress syndrome. They are tubular why okay let me explain this we have two types of waves.
We have mechanical waves lets go back to physics. And we have electromagnetic waves mechanical waves. Such as sound electromagnetic waves.
Such as light got. It okay. Light travels better in air better than water better than solid sound is the opposite.
It travels better in solid than water than air. If you replace the air in the alveoli with solid membrane called hyaline membrane. You will increase sound conduction.
Thats why now the sound is not visible er its tubular and it sounds like this this is the tubular sound. What else fine inspiratory crackles crackles. Okay.
Im an egyptian guy so im the best guy like the most qualified to explain this to you crackles happen. When you have air and water mixed together. There is a device in egypt called the hookah okay.
I dont know why people do this weird thing. But they do it okay is actually some water and i believe it has some nicotine or something like thats inside of it all right. And then they give you like this kind of a hose and you smoke.
So. It has water. It has air water and air equals bubbles.
They are going to form bubbles. The sound. When you inspire and inhale and suck in this hookah or this disgusting unhealthy stuff looks like crackles or sound.
Likes crackles like this here are some crackles. Lets do it with inhalation inhalation exhalation and by the way these hookers have flavors they have apple flavors mango flavors etc when sir isaac newton saw an apple he discovered gravity when steve jobs saw an apple he created apple incorporated when egyptians saw an apple they created a hookah with an apple flavor just to demonstrate crackles anyways progressive worsening of cyanosis enters me its called respiratory distress syndrome if you are not breathing you will get cyanosis hypotension apnea irregular breathing intraventricular hemorrhage.
The kid can bleed into his or her brain after diagnosis neonatal rds abg. Why because there is hypoxia there is hypercapnia there is respiratory acidosis in respiratory acidosis ph is low thats the definition of acidosis in respiratory acidosis pco2 is high thats the definition of respiratory acidosis. The lungs are trying im sorry the kidneys are trying to compensate for aspetto acidosis.
Lets make a meta alkalosis to compensate how do you want to do an alkalosis. He doing alkalosis by increasing the base or the alkali and increase bicarbonate radiology chest x. Ray ground glass appearance.
Very important fine reticular granularity of the parenchyma and the air bronco gramps due to the destruction. And the hyaline membrane stuff like that biopsy you see a beautiful not so beautiful pink hyaline membrane. Its pink because it has proteins and as you know proteins stained pink complications of neonatal rds death could be perinatal or neonatal.
Both in rds and ard a saline to respiratory acidosis or respiratory alkalosis. Because it depends on hypoventilation hyperventilation. If the kid is to kipnuk.
Its kind of a respiratory alkalosis. If it is not breathing the respiratory acidosis oxygen toxicity because this care is gonna get oxygen were giving him oxygen. But too much oxygen can lead to free radical damage of the lungs.
The retina leading to blindness called the retinopathy of prematurity and small airway called bronchopulmonary dysplasia. Which could be permanent. Which is bad patent ductus arteriosus.
This doctors arteriosus should close when should it close it should close when the kid breathe is in what closed it the oxygen but in respiratory distress syndrome. There is no oxygen the patent ductus arteriosus is not gonna be closed like normal people its gonna be persistent ductus arteriosus or persistent pda leading to those are some complications of nearing rds. We continue necrotizing enterocolitis or neck.
No ventilation therefore low p. Big a o2 therefore low p. Small a o2.
We have talked about this in previous videos. Intestinal ischemia entry of gut bacteria. Because some of these bacterias are anaerobes.
They hate oxygen when they hit oxygen and even have oxygen theyre gonna love you theyre gonna go to your gut and those bacterias are not pretty and they will lead to necrotizing enterocolitis. And if you do radiography on people. With necrotizing enterocolitis you find something called pneumatosis intestinalis.
Which sounds exactly like medicos is perfection. Alice. And i have a lovely.
Name. Pulmonary hemorrhage. Or interventricular hemorrhage.
Those are complications. Alveolar air leak leading to air under the skin emphysema air in the pleural cavity pneumothorax edema ileus oliguria. Because urine volume is the fifth vital sign.
If you are sophisticated enough fetal hypoglycemia. Despite maternal hyperglycemia and we have talked about this before hypoglycemia is going to lead to seizure and new neuronal damage decrease surfactant production leading to neonatal rds if grunting disappears and cyanosis increases. The baby is getting old.
But the grunting. The bad sound is disappearing. Yes.
Thats why the kid is not breathing. Its not good news honey. Think the kid was doing those and now hes dead like this.
Oh. The sounds disappeared yes. But his life could disappear soon.
Unless. You act quickly doofus.
How to prevent neonatal rds. Avoid. Unnecessary c.
Sections. Before the 39th week. And as dr.
Thomas. Sole. The famous economist at stanford university.
Said in life. There are no solutions. There are trade offs c.
Sections. Are excellent okay they are revolutionary. Although they are not that new they are kind of c section due to caesar.
So its not that new so its great. But every great things as great side effects c sections. There is no passage through the birth canal.
There is no stress there is no cortisol there is increased risk of neonatal respiratory distress syndrome especially if he or she is premature antenatal steroids steroid increases surfactant production antenatal before before childbirth gives steroid tamami given to women before 34th week of gestation betamethasone or dexamethasone before 34 during the 34th. It doesnt matter. This was prenatal also we have postnatal surfactant administration and we administered it through the trachea.
Give steroids. Plus surfactant hashtag synergism syringes amines one plus one equals three which is a mathematical insanity. But a pharmacological reality prevention of complications give a glucose.
If the kid can suffer from hypoglycemia you give glucose how to treat neonatal rds. This kid is gonna stay in the neonatal icu also known as nicu. Im sorry this kid is not going home okay.
No matter how much you tell me this i want to take this kid home no. No no no no no no no he has noon. Itll rds has to stay in the nicu.
We will administer surfactant directly into the trachea continuous monitoring with abg heart rate respiratory rate science and we will monitor cyanosis and grunting if cyanosis increases and grunting is decreasing bad news. And we should intubate arterial cath touch x. With mommy skin to skin contact get this kid close to mommy human beings are not moist robot.
So that you can treat in the lab. No skin to skin contact with mommy why does that happen there are some theories. But the exact like mechanism is not fully understood.
But when you keep the kid closer to mommy is gonna get a better outcome hopefully. Many times in many cases. But if you get him closer to daddy huh worse outcome.
Its a silly joke place in an incubator if necessary give warm humidified oxygen. Yes. Because there is a vq mismatch due to hypoventilation or beer to the the stupid membrane.
So the problem is not a shunt okay. There is only intracardiac shunt. Where oxygen is useless.
No no in this case oxygen is helpful watch my videos on tissue hypoxia okay some pearls for the pros maternal diabetes increased risk of all of this neonatal rds neonatal hypoglycemia why because insulin the baby we do to hyperplasia of the pancreatic beta cells. In two hypotheses. We have discussed this in this video kelcey me polycythemia why polycythemia.
This is an appropriate increase in ipoh. This is secondary polycythemia and its an absolute polycythemia. Its not a relative macrosomia.
This baby has increased body weight. Why because insulin feeds the fat myocardial dysfunction jaundice congenital malformation.
Oh. Horrible macrosomia insulin feeds. The feds insulin feeds.
Two main tissues adipose tissue skeletal muscles. How remember glute. 4.
Which is insulin dependent every other glute is insulin independent to enter station complications compared to the firstborn twin. The second twin has a higher risk of neonatal rds and asphyxia. Which is bad by the way talking about the firstborn and the second born on average.
Not talking about twins talking in general. The firstborn has a higher iq and a higher body weight than the second born or the third born or stuff like that when i first heard or like read the study. I was amazed because im a firstborn well.
I dont know the iq of my brothers. Im pretty sure im have more body weight than them im more obese than them they are thin. And here is a challenge for you those of you who think that genes and environment can explain everything okay explain to me why the firstborn is on average a little smarter than the others.
They have the same genes because they came from the same mommy and daddy. And they had the same environment. They like were born in the same household they went to the same school probably lived in the same neighborhood.
So explain to me why the first one has increased iq some inspiration if you believe that if you have like a low iq. You are doomed okay listen to this there was a professor at stanford. And he was looking at the physics.
Students in stanford. And he was looking at people who had iq greater than 140 and iq. Less than 140 and then he followed them for 50 years.
And he found that two of them were awarded that nobel prize in physics. The two were of iq below. 140.
You know how many got nobel prize from the group. Which has an iq of greater than 140. The answer is zero.
So. The idea my iq is low. I can never make it today wam call the wambulance and cry me a river as henry ford said whether do you think you can or do you think you cant either way youre right.
Its up to you guys. And as walter d. Went play set lifes battles.
Dont always go to the stronger or faster man. But sooner or later the man who wins is the man who thinks he can thank you for watching please subscribe and join the tribe hit the red corner fight and smash like follow me on facebook. I have more than 100 cases.
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And study. Hard. This is medical zeus perfect nails.
Which sounds exactly as pneumatosis intestinalis that you see in necrotizing enterocolitis. See you then .
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