A nurse assesses a newborn. Which findings indicate respiratory distress? (Select all that apply.)
Grunting
Nasal flaring
Cyanosis around mouth
Strong cry
Retractions
Correct Answer : A,B,E
Neonatal respiratory distress syndrome occurs due to surfactant deficiency and high alveolar surface tension. Clinical presentation involves compensatory mechanisms like expiratory grunting and intercostal pull to maintain functional residual capacity. Failure to stabilize leads to hypoxemia and acidosis.
A. Grunting: This audible expiratory sound results from the glottis closing against a partially expired breath to increase end-expiratory pressure. It prevents alveolar collapse in infants with decreased lung compliance. This finding is a hallmark sign of increased work of breathing.
B. Nasal flaring: Involuntary widening of the nostrils reduces upper airway resistance and increases the tidal volume during inspiration. It is an early physical manifestation of respiratory effort in newborns. This reflex helps maximize oxygen intake during physiological stress.
C. Cyanosis around mouth: Perioral blue discoloration, or circumoral cyanosis, is often a benign finding related to peripheral vasomotor instability in the first 24 hours. While central cyanosis is critical, perioral changes alone are less indicative of true respiratory failure.
D. Strong cry: A vigorous, loud cry indicates adequate vital capacity and neurological integrity in the neonatal period. It suggests the infant is capable of effective gas exchange and has sufficient muscular strength. This finding contradicts a diagnosis of acute distress.
E. Retractions: Visible sinking of the soft tissues around the ribs and sternum occurs when negative intrathoracic pressure is excessively high. It signifies the use of accessory muscles to overcome stiff, non-compliant lungs. Significant retractions indicate a high risk for exhaustion.
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Related Questions
Correct Answer is C
Explanation
Management of preterm labor primarily utilizes tocolytic therapy to provide a window for the administration of antenatal corticosteroids. These medications, such as betamethasone, accelerate fetal lung maturation and reduce the incidence of neonatal respiratory distress syndrome. Delaying birth even by 48 hours significantly improves neonatal outcomes.
A. "To avoid all complications.": No medical intervention can guarantee the avoidance of all neonatal or maternal complications. Preterm birth, even if delayed, still carries risks of intraventricular hemorrhage and necrotizing enterocolitis. The goal is risk mitigation, not total elimination of all adverse events.
B. "To prevent contractions permanently.”: Tocolytics are only effective at temporarily suppressing uterine activity, typically for 48 to 72 hours. They do not permanently halt the physiological process of labor once it has begun. The delay is a strategic pause rather than a cure for prematurity.
C. "To allow fetal maturation.": The primary objective is to gain time for the fetal lungs, brain, and gut to develop further under the influence of exogenous steroids. Every day gained in utero increases the production of pulmonary surfactant. This reduces the duration of neonatal intensive care.
D. "To eliminate infection risk.”: Prolonging pregnancy in the presence of ruptured membranes may actually increase the risk of chorioamnionitis. Delaying birth is intended to address developmental immaturity, not to treat or eliminate existing maternal infections. Infection often necessitates immediate delivery regardless of gestational age.
Correct Answer is D
Explanation
Amniotic fluid is a complex biological solution with a neutral-to-alkaline pH ranging from 7.0 to 7.5. Rupture of membranes alters the acidic environment of the vaginal vault, which typically maintains a pH of 4.5 to 5.5. Determining the fluid chemistry is essential to confirm a diagnosis of premature rupture.
A. Glucose test: While glucose is present in amniotic fluid, its concentration is not specific enough to differentiate it from other vaginal secretions or maternal urine. It is not a standard diagnostic tool for identifying membrane rupture in clinical settings. This test lacks the necessary diagnostic sensitivity.
B. CBC: A complete blood count is used to monitor for systemic infection or chorioamnionitis following a prolonged rupture. It does not provide direct evidence of the presence of amniotic fluid itself. It serves as a secondary assessment for complications rather than a primary confirmatory test.
C. Lipid panel: Serum lipid concentrations have no clinical relevance to the diagnosis of membrane integrity. Testing for cholesterol or triglycerides provides no information regarding the contents of the vaginal pool. This is an inappropriate diagnostic approach for suspected amniotic fluid leakage.
D. pH test with a nitrazine strip: Nitrazine paper changes color from yellow to blue when exposed to the alkaline pH of amniotic fluid. This biochemical shift provides a rapid bedside confirmation of the presence of liquor in the vagina. It is a reliable method for detecting rupture of membranes.
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