All of the following symptoms would be seen in a client with respiratory distress syndrome (RDS), EXCEPT?

NORCET -4 , 2023

Child Health Nursing (Pediatrics)

Hard

Appeared in: NORCET -4 , 2023

Explanation

Subcostal retractions, the inward movement of the abdomen below the ribs, are a general sign of increased work of breathing.
While they can be present in an infant with RDS, they are not a specific component of the Silverman-Anderson score, which is the standard tool for grading RDS severity.
This scoring system specifically assesses intercostal (between the ribs) and xiphoid (at the sternum) retractions.
Therefore, in the context of specific RDS assessment criteria, subcostal retraction is the correct exception.

Option A: Nasal flaring is a classic sign of RDS, representing the infant's effort to reduce airway resistance. It is a key component of the Silverman-Anderson score.
Option B: Tachypnea (rapid breathing) is an early and cardinal sign of RDS. It is the body's primary compensatory mechanism for hypoxia and decreased lung compliance.
Option D: Expiratory grunting is a hallmark sign of RDS. It is a physiological attempt to create auto-PEEP to prevent alveolar collapse. It is a critical component of the Silverman-Anderson score.

Visual 1: Diagram: The Silverman-Anderson score, illustrating the five criteria (chest movement, intercostal retraction, xiphoid retraction, nasal flaring, expiratory grunt) and their scoring from 0 to 2.
Visual 2: Illustration: Different types of chest retractions in a neonate, clearly labeling suprasternal, intercostal, subcostal, and xiphoid retractions to help differentiate them.

Clinical Relevance

Nursing practice connection: Use the key finding related to Specific clinical signs of neonatal Respiratory Distress Syndrome (RDS) and its standardized assessment to guide bedside assessment, documentation, and the next nursing action.
Accurate assessment using the Silverman-Anderson score is crucial for grading the severity of RDS and guiding timely interventions like CPAP, surfactant administration, or mechanical ventilation.
Early recognition of the hallmark signs (grunting, flaring, retractions) allows for prompt intervention, which is critical in preventing respiratory failure and long-term complications like bronchopulmonary dysplasia in preterm infants.
What if? If an infant displayed prominent see-saw respirations (chest and abdomen move in opposite directions) in addition to marked grunting and flaring, their Silverman-Anderson score would be high (likely greater than 6). This indicates severe distress and impending respiratory failure, necessitating immediate escalation of care, likely to intubation and mechanical ventilation.

How to Approach the Question

This is a negative-framing ('EXCEPT') question, which requires you to identify the option that is not a core feature of the condition.
First, identify the central topic: Respiratory Distress Syndrome (RDS) in a neonate.
Recall the classic, hallmark signs of RDS. These include grunting, nasal flaring, and tachypnea.
Evaluate the options provided. All are general signs of respiratory distress.
The key to differentiating them is to recall the specific, standardized assessment tool for RDS, the Silverman-Anderson score.
This score includes intercostal/xiphoid retractions, grunting, and flaring, but does not include subcostal retractions as a distinct criterion. This makes subcostal retractions the correct exception.

Concept Tested & Keywords

Concept Tested: Specific clinical signs of neonatal Respiratory Distress Syndrome (RDS) and its standardized assessment.
Stem keywords: respiratory distress syndrome, RDS, symptoms, client
Lead-in keywords: EXCEPT
Negative lead-in flag: Question asks for the exception (symptom NOT typically used for primary assessment).

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