Nursing Prioritization Delegation Assignment Q 33

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You are providing nursing care for a newborn infant with respiratory distress syndrome (RDS) who is receiving nasal CPAP ventilation. What complications should you monitor for this infant?

  

     A. Pulmonary embolism

     B. Bronchitis

     C. Pneumothorax

     D. Pneumonia

    

    

Correct Answer: C. Pneumothorax

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The most common complications after birth for infants with RDS is pneumothorax. Alveoli rupture and air leaks into the chest and compresses the lungs, which makes breathing difficult. Pulmonary air leak syndromes such as pneumothorax and pneumomediastinum may also present as respiratory distress, but the onset of symptoms may be more acute.

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Option A: Complications of neonatal respiratory distress syndrome are related mainly to the clinical course of RDS in neonates and the long term outcomes of the neonates. While surfactant therapy has decreased the morbidity associated with RDS, many patients continue to have complications during and after the acute course of RDS.

Option B: Acute complications due to positive pressure ventilation or invasive mechanical ventilation include air-leak syndromes such as pneumothorax, pneumomediastinum, and pulmonary interstitial emphysema. There is also an increase in the incidence of intracranial hemorrhage and patent ductus arteriosus in very low birth weight infants with RDS, although independently linked to prematurity itself.

Option D: BPD is a chronic complication of RDS. The pathophysiology of BPD involves both arrested lung development as well as lung injury and inflammation. Besides a surfactant deficiency, the immature lung of the premature infant has decreased compliance, decreased fluid clearance, and immature vascular development, which predisposes the lung to injury and inflammation, further disrupting the normal development of alveoli and pulmonary vasculature.

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