the nurse in a newborn nursery is monitoring a preterm newborn for respiratory distress syndrome. which assessment findings should alert the nurse to the possibility of this syndrome? (SATA)a. cyanosisb. tachypneac. hypotensiond. retractions e. audible gruntsf. presence of a barrel chest
A. CYANOSISB. TACHYPNEAD. RETRACTIONSE. AUDIBLE GRUNTS
The respiratory distress syndrome (RDS) is a common condition affecting premature newborns. It is caused by a deficiency of surfactant, which makes it difficult for the lungs to expand properly. Assessment findings that may indicate RDS in a preterm newborn include:
a. Cyanosis: This refers to a bluish discoloration of the skin or mucous membranes due to inadequate oxygenation. Cyanosis may be present in a preterm newborn if the lungs are not functioning adequately.
b. Tachypnea: This refers to a rapid respiratory rate, which may be a compensatory mechanism to improve oxygenation in the body. Tachypnea is often present in newborns with RDS.
d. Retractions: This refers to the inward movement of the chest wall during inspiration, which indicates increased effort of breathing. Retractions may be present in a newborn with RDS.
e. Audible grunts: This refers to a sound made during expiration that indicates airway obstruction or increased respiratory effort. Audible grunts may be present in a newborn with RDS.
Presence of a barrel chest (f) is a chronic condition and is unlikely to indicate RDS, while hypotension (c) is a sign of low blood pressure and may be caused by many different factors.
Therefore, the assessment findings that should alert the nurse to the possibility of respiratory distress syndrome in a preterm newborn are cyanosis, tachypnea, retractions, and audible grunts.
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