INTRODUCTION
BIOGRAPHICAL INFORMATION
Name : Ku.Suman
Age :11yrs
sex : female
address : Indrachhok,Durg
religion : Hindu
ip.no :65398
admission unit : pediatric ward -1
date of admission : 5/12/12
date of history taking : 6/12/12
Informant :mother
diagnosis: Respiratory distress syndrome
PRESENT HISTORY
chief complaints with duration
Suman was admitted with the complaint of anorexia, chest pain , weakness and dyspnoea.
History of present illness
Suman is suffering from chest pain,anorexia,breathing difficulty,cough,and weakness,since 3
days and she was bought by her parents to the district hospital,durg and admitted in
paediatric ward under the consultation of Dr.prafuljain.
Past medical history
Past illness,hospitalations.
There is no past medical history
Allergies :there is no known history of allergies
Medications :my patient was not taking any medication.
Birth history
NATAL
Place of birth : district hospital durg
Mode of delivery : normal delivery
Gestational age: 37 weeks
Birth weight : 2.5 kg
Any congenital abnormalities : no
FAMILY HISTORY
Type of family : nuclear family
s.no members Age/sex Education Occupatio income Health
n status
1 Mr.Rajendra 33yrs/m 6th class Labour 3000/month Good
2 Mrs.Sarita 29yrs/f 2nd class House wife - Good
3 Suman 11yrs/f 4th class _ _ Poor
4 Sunita 8yrs/f _ _ Good
_
KEY
Female - 33yrs
29yrs
Male -
patient -
11yrs 8yrs
GROWTH AND DEVELOPMENT
Stage Book picture Patient picture
Physical development
gross moter Gross motor
Weight control Present
Cardio vascular fitness Present
Physical activity, Present
Team sports Present
Fine moter Playing musical instruments Present
Manipulative skills Present
Psychosocial Interest in how things are Present
development made and run
Increase activities outside Present
home
Increase interactions with Present
peers
Starts collections of items Present
Psychosexual Secondary sexual Present
Development characterstics
present
Close relationships with
others of their own and sex
Cognitive present
development Identify their relationships to
each other
present
Stored memories past
experiences to evalvate
present
communication and
Language development
language
present
development
articulation
present
vocabulary
present
moral and spiritual
sense of morality
development
interest in religion present
Stage Book picture Patient picture
Emotional Sense of trust Present
development
Shyness, shame Present
Sense of identity Present
Sensory development Sense of smell Present
Sense of touch present
IMMUNIZATION
Age Vaccine Remark
At birth OPV,BCG Done
6th week DPT,HEPB Done
10th week OPV,DPT Done
9th month Measles Done
15th month MMR Done
16-24th month OPV,DPT Done
5-6years DT Done
At 10and16 year T.T Done
ELIMINATION PATTERN
Bowel pattern : regular
Bladder : normal
NUTRITIONAL PATTERN
Recent weight : 36kg
Expected weight : 40kg
Appitate: good
Degree of malanutrition: actual weight/expected weight*100
36/40*100=90%
24 HOURS RECALL DIET
Time Diet items
Morning
9am 1cup milk
2 roti
1cup potatosabji
Lunch
12pm 1 plate rice
1 cup dhal
Dinner
9pm 1 plate rice
1 cup dhal
1 cup potatosabji
PHYSICAL EXAMINATION
General observation
Complexation :fair
Level of consciousness : conscious
Body odor : no
Vital signs
Temperature :98.6f
Respiration : 28breaths/min
Pulse rate :86beats/min
BP :120/80 mmhg
Anthropometric measurements
Height :127cm
Weight :36kg
Coiour :fair
Edema :no
Moisture : dry
Temperature : 98.6f
Turgor : poor
Texture : dryness
Any abnormal discharge : no
HAIR
Change in texture : britle hair
Characteristics : brown in colour equally distributed
Lice :present
HEAD
Skull/cranium size,shape : normal
Movements : normal
For head : no scars
EYES
Expression : good
Eyelids : normal
Lacrimation : normal
Eyebrows :equal eventlydistuributed
Conjunctive :clear
Sclera : moist
Cornea : smooth,moist
EARS
Appearance : normal
Discharges :no discharge
Lesions : not present
Any abnormalities : nil
NOSE
Appearance : no DNS
Discharges : no discharge
Patency : good
sense of smell : good
MOUTH AND THROAT
Lips : dry
Tongue : coated
Teeth : intact
Gums :no bleeding
buccal mucus : normal
Palate :normal
Tonsils :no enlargement
Taste :normal
Neck
General :range of motion
Trachea :centrally located
Lymph nodes :not enlarged
Thyroid glands :not enlarged
Salivary glands :present
Cysts and tumour:absent
CHEST AND RESPIRATORY
Inspection :shape and size are elevated
Palpation :tenderness found
Percussion :resonance
Auscultation : wheezing sounds
CARDIOVASCULAR SYSTEM
Inspection :normal
Palpation :normal
Percussion : normal
Auscultation :normal
ABDOMEN
Inspection:normal
Palpation :normal
Percussion :normal
Auscultation :normal
BACK
Spine, curvature :normal
Symmetry :present
Tenderness : absent
GENITALIA
Bladder : present
Urethral opening : Present
Infection : Absent
Female genital : Normal
EXTREMITIES
Deformities : nil
Swelling\Eclema : Absent
Muscles : normal strength
Lymph nodes : Not enlarged
Joints : normal range of motion
Finger and toes : Normal
Nails : Normal
CENTRAL NERVOUS SYSTEM
Birth injuries : Absent
Seizures :Absent
Speech : Normal
Sensory motor : Respond to touch and
other stimuli changes
Gait changes : Normal
Cognitive changes : Well oriented and conscious
URINARY SYSTEM
Urinary tract infection : No
Any abnormalities : Nil
GASTRO- INTESTINAL SYSTEM
Diarrhea : Absent
Constipation : Absent
Bleeding : Absent
Worm infestation : Absent
PSYCHSOCIAL HISTORY
General states of the family : Good
Relationship with the friends and family : Good
Activities of daily living : Self
Play activity : Good
School programme : Good
Hobbies : Playing, dancing
LABORATORY INVESTIGATIONS
S.N INVESTIGATION PATIENT NORMAL REMARK
O VALUE VALUE
1. HB 10gm% 12-14gm% Less
2. WBC 9000/dl 11000/dl Normal
3. Leucocytes 28% 25-33% Normal
4. Sodium 134meq/dl 135-145meq/dl Normal
5. x-ray Bilateral Done
infiltrates
6. pulmonary function test Decrease Done
respiratory flow
DISEASE CONDITION
DEFINITION
According to O.P.Ghai
Neonatal respiratory distress syndrome (RDS) is most commonly seen in premature infants. The
condition makes it difficult to breathe.
According to Wikipedia
Respiratory distress syndrome (RDS) is a breathing disorder that affects newborns. RDS rarely
occurs in full-term infants. The disorder is more common in premature infants born about 6
weeks or more before their due dates.
CAUSES
Neonatal RDS occurs in infants whose lungs have not yet fully developed.
The disease is mainly caused by a lack of a slippery, protective substance called surfactant,
which helps the lungs inflate with air and keeps the air sacs from collapsing. This substance
normally appears in fully developed lungs.
Neonatal RDS can also be the result of genetic problems with lung development.
The earlier a baby is born, the less developed the lungs are and the higher the chance of neonatal
RDS. Most cases are seen in babies born before 28 weeks. It is very uncommon in infants born
full-term (at 40 weeks).
In addition to prematurity, the following increase the risk of neonatal RDS:
A brother or sister who had RDS
Diabetes in the mother
Cesarean delivery
Delivery complications that reduce blood flow to the baby
Multiple pregnancy (twins or more)
Rapid labor
The risk of neonatal RDS may be decreased if the pregnant mother has chronic, pregnancy-
related high blood pressure or prolonged rupture of membranes, because the stress of these
situations can cause the infant's lungs to mature sooner.
PATHOPHYSIOLOGY:
Lack of surfactant
Poor gas exchange
Right –to –left shunting and hypoxemia results
Fluid and fibrin leak from the pulmonary capillaries
Hyaline membrane to form in the bronchioles, alveolar duct, and alveoli
CLINICAL MANIFISTATION
BOOK PICTURE PATIENT PICTURE
Cough Present
Dyspnea Present
Wheezing Present
Grunting Present
Nasal flaring Present
Decreased urine output Present
Generalised chest tightness and Present
dyspnea
Malaise Present
Tachycardia Present
Cyanosis Present
EXAMS AND TESTS
A blood gas analysis shows low oxygen and excess acid in the body fluids.
A chest x-ray shows the lungs have a characteristic "ground glass" appearance, which often
develops 6 to 12 hours after birth.
Lab tests are done to rule out infection and sepsis as a cause of the respiratory distress.
TREATMENT
High-risk and premature infants require prompt attention by a neonatal resuscitation team.
Despite greatly improved RDS treatment in recent years, many controversies still exist.
Delivering artificial surfactant directly to the infant's lungs can be enormously important, but
how much should be given and who should receive it and when is still under investigation.
Infants will be given warm, moist oxygen. This is critically important, but needs to be given
carefully to reduce the side effects associated with too much oxygen.
A breathing machine can be lifesaving, especially for babies with the following:
• High levels of carbon dioxide in the arteries
• Low blood oxygen in the arteries
• Low blood pH (acidity)
It can also be lifesaving for infants with repeated breathing pauses. There are a number of
different types of breathing machines available. However, the devices can damage fragile lung
tissues, and breathing machines should be avoided or limited when possible.
A treatment called continuous positive airway pressure (CPAP) that delivers slightly pressurized
air through the nose can help keep the airways open and may prevent the need for a breathing
machine for many babies. Even with CPAP, oxygen and pressure will be reduced as soon as
possible to prevent side effects associated with excessive oxygen or pressure.
A variety of other treatments may be used, including:
• Extracorporeal membrane oxygenation (ECMO) to directly put oxygen in the blood if a
breathing machine can't be used
• Inhaled nitric oxide to improve oxygen levels
It is important that all babies with RDS receive excellent supportive care, including the
following, which help reduce the infant's oxygen needs:
• Few disturbances
• Gentle handling
• Maintaining ideal body temperature
NURSING CARE PLANE GIVEN
According to NANDA,S format of nursing of diagnosis
Ineffective breathing pattern related to inflammatory or infectious process as
evidenced by tachypnea increased work of breathing nasal flaring.
Alteration in comfort pain related to disease condition as manifested by pain score of
4/10
Sleep pattern disturbance related to discomfort.
Alter comfort level as manifested by fattige due to sever breathing difficulty
Knowledge deficit related to disease condition, treatment and follow up
HEALTH EDUCATION
Rest and sleep
Proper semi fowler position should be given.
Exercise
Advice the patient to do breathing exercise
Ask to do passive and active exercise
Personal hygiene
Provide health education about the importance of personal hygiene
Avoid all exposure to dust
clene soiled surface floors with wet mop each week
Avoid outdoor activity when pollution is high
Diet
Avoid cold foods
Advice the patient to take well balanced diet with good nutritive value.
Medications
Take medicine in time
Do not discontinue medicine without doctor’s order.
Follow up care
If there is any complication consult and doctors.
BIBLIOGRAPHY:-
WWW.google.com
www.wikipedia.com
www.medline.com
Duttaparul ,text book of paediatric nursing,
secondedition,jaypeebrothersmedical publisher ,new Delhi, page no
121
Pillitleri Adele. Child health nursing)care of child and family,Lippincott
publishers, newyork,page no: 429
T.m assume beevi,text book of paediatric nursing, first edition, Elsevier
health Science publication, India, page no : 644
Singh meharban,text book of care of new-born ,sixth edition sage
publication, new Delhi, page no : 538
Ghaio.p,text book of essential pediatrics,seventh edition,CBS
publication,new Delhi page no : 365
Marlowr.Dorothy, Redding a.barbara, Text book of paediatric nursing.
Sixth editionPublished by Elsevier, India, page no : 95
Kyle Terri, text book of essentials of paediatric nursing, first edition,
chine page no : 583
