Which of the following clinical manifestations are commonly seen in a child with respiratory distress syndrom… - NORCET-7 Mains-2024

NORCET-7 Mains-2024

Child Health Nursing (Pediatrics)

Easy

Appeared in: NORCET-7 Mains-2024

Explanation

Dyspnoea (difficulty breathing), intercostal retractions (chest sinking in), and nasal flaring are the cardinal signs of increased work of breathing in a neonate.
These signs occur in RDS because the lack of surfactant makes the lungs stiff and difficult to inflate, forcing the infant to use accessory muscles to breathe.
According to the Nelson Textbook of Pediatrics, these signs, along with tachypnoea and expiratory grunting, characteristically appear within minutes to hours after birth in a premature infant with RDS.
The presence of this triad is a strong indicator of significant respiratory compromise requiring immediate medical attention.

Option A: RDS initially causes tachypnoea (rapid breathing) as a compensatory mechanism. Bradypnoea (slow breathing) is a late and dangerous sign indicating respiratory muscle fatigue and impending respiratory failure.
Option B: These are non-specific systemic and gastrointestinal symptoms. They are not primary signs of respiratory distress and are more indicative of conditions like sepsis or gastroenteritis.
Option D: These are gastrointestinal symptoms, unrelated to the primary pulmonary pathology of RDS. They point towards an abdominal issue.

Visual 1: Photograph - A neonate exhibiting signs of respiratory distress, with labels pointing to nasal flaring and intercostal/substernal retractions. This helps visualize the clinical signs mentioned in the correct option.
Visual 2: Diagram - Pathophysiology of RDS, showing a comparison between a normal alveolus with surfactant and a collapsed alveolus in an RDS lung without surfactant. This explains the underlying cause of the symptoms.

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical signs of Respiratory Distress Syndrome (RDS) in neonates to guide bedside assessment, documentation, and the next nursing action.
Early recognition of dyspnoea, retractions, and nasal flaring is critical for nurses to initiate timely interventions like oxygen therapy, CPAP, and surfactant administration, which can significantly improve outcomes.
A key nursing role is continuous monitoring of respiratory effort. An increase in retractions or grunting indicates worsening distress.
What if? If a grunting infant suddenly becomes quiet, stops grunting, and has a slowing respiratory rate (bradypnoea), the nurse should not interpret this as improvement. This is an ominous sign of exhaustion and impending respiratory arrest, requiring immediate emergency intervention and escalation.

How to Approach the Question

Step 1: Identify the core concept of the question, which is the clinical presentation of Respiratory Distress Syndrome (RDS).
Step 2: Recall the pathophysiology of RDS: it's a problem of lung mechanics (stiff, collapsing alveoli) in premature infants due to surfactant deficiency.
Step 3: Predict the signs. Because the lungs are hard to expand, the infant will have to work very hard to breathe. Look for signs of increased work of breathing.
Step 4: Evaluate the options. Option C (Dyspnoea, intercostal retractions, nasal flaring) directly describes the classic signs of increased work of breathing.
Step 5: Eliminate the other options. Bradypnoea (Option A) is the opposite of the initial compensatory response (tachypnoea). Options B and D list gastrointestinal symptoms, which are not the primary signs of a respiratory disease.

Concept Tested & Keywords

Concept Tested: Clinical signs of Respiratory Distress Syndrome (RDS) in neonates.
Stem keywords: respiratory distress syndrome (RDS), clinical manifestations, child
Lead-in keywords: Which of the following
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

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