Causes of Neonatal Respiratory Distress Syndrome
List of causes of Neonatal Respiratory Distress Syndrome
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Neonatal Respiratory Distress Syndrome)
that could possibly cause Neonatal Respiratory Distress Syndrome includes:
Neonatal Respiratory Distress Syndrome Causes: Book Excerpts
Neonatal Respiratory Distress Syndrome as a symptom:
Conditions listing Neonatal Respiratory Distress Syndrome
as a symptom may also be potential underlying causes of Neonatal Respiratory Distress Syndrome.
Our database lists the following as having
Neonatal Respiratory Distress Syndrome as a symptom of that condition:
Medical news summaries relating to Neonatal Respiratory Distress Syndrome:
The following medical news items are relevant to causes of Neonatal Respiratory Distress Syndrome:
Related information on causes of Neonatal Respiratory Distress Syndrome:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Neonatal Respiratory Distress Syndrome may be found in:
Causes of Neonatal Respiratory Distress Syndrome: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Neonatal Respiratory Distress Syndrome.
Cyanotic Newborn:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Transposition of the great vessels (TGV)
–The most common cardiac cause of cyanosis in the newborn
–Aorta connected to RV and pulmonary artery
connected to LV
–PE, ECG normal
–CXR: Normal or egg-on-string
- Tetralogy of Fallot
–Most common cyanotic heart disease
–Right ventricular hypertrophy, pulmonary stenosis, VSD, and an overriding aorta
–Associated with 22q11 deletion
–Murmur; reduced PVM; R-axis deviation,
RVH
- Critical pulmonary valve stenosis
–Thickened pulmonary valve
–Murmur; reduced PVM; RVH
- Pulmonary atresia
–No flow from RV to pulmonary artery, so pulmonary blood flow depends on ductus arteriosus
–PE normal; reduced PVM; reduced R-sided forces with normal axis
- Tricuspid atresia
–No inflow into R ventricle, causing R ventricular hypoplasia
–With or without murmur; reduced PVM; reduced R-sided forces with L-axis deviation
- Truncus arteriosus
–Single outlet to ventricles divides into aorta and pulmonary arteries
–VSD always present
–PE normal; possibly increased PVM; ECG
normal
- Total anomalous pulmonary venous return
–Cardiac cause of cyanosis that mimics respiratory disease with respiratory distress and “white-out” of lungs
–Consider for patients who appear to have bad respiratory disease
–With or without murmur; increased PVM; ECG normal
- Ebstein anomaly
–The tricuspid valve is displaced down into the R ventricle, usually with severe tricuspid regurgitation with R-to-L atrial level shunting
–Murmur; huge heart; R atrial enlargement (tall P waves)
- Other: Respiratory most common, polycythemia, hypoglycemia
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Accessory muscle use:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Acute respiratory distress syndrome (ARDS). In ARDS, a life-threatening disorder, accessory muscle use increases in response to hypoxia. It’s accompanied by intercostal, supracostal, and sternal retractions on inspiration and by grunting on expiration. Other characteristics include tachypnea, dyspnea, diaphoresis, diffuse crackles, and a cough with pink, frothy sputum. Worsening hypoxia produces anxiety, tachycardia, and mental sluggishness.
❑ Airway obstruction. Acute upper airway obstruction can be life-threatening — fortunately, most obstructions are subacute or chronic. Typically, this disorder increases accessory muscle use. Its most telling sign, however, is inspiratory stridor. Associated signs and symptoms include dyspnea, tachypnea, gasping, wheezing, coughing, drooling, intercostal retractions, cyanosis, and tachycardia.
❑ Amyotrophic lateral sclerosis. Typically, this progressive motor neuron disorder affects the diaphragm more than the accessory muscles. As a result, increased accessory muscle use is characteristic. Other signs and symptoms include fasciculations, muscle atrophy and weakness, spasticity, bilateral Babinski’s reflex, and hyperactive deep tendon reflexes. Incoordination makes carrying out routine activities difficult for the patient. Associated signs and symptoms include impaired speech, difficulty chewing or swallowing and breathing, urinary frequency and urgency and, occasionally, choking and excessive drooling. ( Note: Other neuromuscular disorders may produce similar signs and symptoms.) Although the patient’s mental status remains intact, his poor prognosis may cause periodic depression.
❑ Asthma. During acute asthma attacks, the patient usually displays increased accessory muscle use. Accompanying it are severe dyspnea, tachypnea, wheezing, a productive cough, nasal flaring, and cyanosis. Auscultation reveals faint or possibly absent breath sounds, musical crackles, and rhonchi. Other signs and symptoms include tachycardia, diaphoresis, and apprehension caused by air hunger. Chronic asthma may also cause barrel chest.
❑ Chronic bronchitis. With chronic bronchitis, a form of COPD, increased accessory muscle use may be chronic and is preceded by a productive cough and exertional dyspnea. Chronic bronchitis is accompanied by wheezing, basal crackles, tachypnea, jugular vein distention, prolonged expiration, barrel chest, and clubbing. Cyanosis and weight gain from edema account for the characteristic label of “blue bloater.” A low-grade fever may occur with secondary infection.
❑ Emphysema. Increased accessory muscle use occurs with progressive exertional dyspnea and a minimally productive cough in this form of COPD. Sometimes called a pink puffer, the patient will display pursed-lip breathing and tachypnea. Associated signs and symptoms include peripheral cyanosis, anorexia, weight loss, malaise, barrel chest, and clubbing. Auscultation reveals distant heart sounds; percussion detects hyperresonance.
❑ Pneumonia. Bacterial pneumonia usually produces increasedaccessory muscle use. Initially, this infection produces a sudden high fever with chills. Its associated signs and symptoms include chest pain, a productive cough, dyspnea, tachypnea, tachycardia, expiratory grunting, cyanosis, diaphoresis, and fine crackles.
❑ Pulmonary edema. With acute pulmonary edema, increased accessory muscle use is accompanied by dyspnea, tachypnea, orthopnea, crepitant crackles, wheezing, and a cough with pink, frothy sputum. Other findings include restlessness, tachycardia, ventricular gallop, and cool, clammy, cyanotic skin.
❑ Pulmonary embolism. Although signs and symptoms vary with the size, number, and location of the emboli, pulmonary embolism is a life-threatening disorder that may cause increased accessory muscle use. Typically, it produces dyspnea and tachypnea that may be accompanied by pleuritic or substernal chest pain. Other signs and symptoms include restlessness, anxiety, tachycardia, a productive cough, a low-grade fever and, with a large embolus, hemoptysis, cyanosis, syncope, jugular vein distention, scattered crackles, and focal wheezing.
❑ Spinal cord injury. Increased accessory muscle use may occur, depending on the location and severity of the injury. An injury below Ll typically doesn’t affect the diaphragm or accessory muscles, whereas an injury between C3 and C5 affects the upper respiratory muscles and diaphragm, causing increased accessory muscle use.
Associated signs and symptoms of spinal cord injury include unilateral or bilateral Babinski’s reflex, hyperactive deep tendon reflexes, spasticity, and variable or total loss of pain and temperature sensation, proprioception, and motor function. Horner’s syndrome (unilateral ptosis, pupillary constriction, facial anhidrosis) may occur with lower cervical cord injury.
❑ Thoracic injury. Increased accessory muscle use may occur, depending on the type and extent of injury. Associated signs and symptoms of this potentially life-threatening injury include an obvious chest wound or bruising, chest pain, dyspnea, cyanosis, and agitation. Signs of shock, such as tachycardia and hypotension, occur with significant blood loss.
Other causes
❑ Diagnostic tests and treatments. Pulmonary function tests (PFTs), incentive spirometry, and intermittent positive-pressure breathing can increase accessory muscle use.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Infant respiratory distress syndrome:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Although airways and alveoli of a neonate’s respiratory system are present by 27 weeks’ gestation, the intercostal muscles are weak and the alveolar capillary system is immature. The premature neonate with IRDS develops widespread alveolar collapse due to a lack of surfactant, a lipoprotein pres-ent in alveoli and respiratory bronchioles. Surfactant lowers surface tension and helps prevent alveolar collapse. This surfactant deficiency results in widespread atelectasis, which leads to inadequate alveolar ventilation with shunting of blood through collapsed areas of lung, causing hypoxemia and acidosis.
IRDS occurs almost exclusively in neonates born before 37 weeks’ gestation (in 60% of those born before the 28th week). The incidence is greatest in the 1,000 to 1,500 g birthweight group. Infants of diabetic mothers, those born by cesarean delivery, second-born twins, infants with perinatal asphyxia, and those delivered suddenly after antepartum hemorrhage are more commonly afflicted.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Accessory muscle use:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acute respiratory distress syndrome (ARDS)
In ARDS—a life-threatening disorder—accessory muscle use increases in response to hypoxia. It’s accompanied by intercostal, supracostal, and sternal retractions on inspiration and by grunting on expiration. Other characteristics include tachypnea, dyspnea, diaphoresis, diffuse crackles, and a cough with pink, frothy sputum. Worsening hypoxia produces anxiety, tachycardia, and mental sluggishness.
Airway obstruction
An acute upper airway obstruction can be life-threatening; fortunately, most obstructions are subacute or chronic. Typically, this disorder increases accessory muscle use. Its most telling sign, however, is inspiratory stridor. Associated signs and symptoms include dyspnea, tachypnea, gasping, wheezing, coughing, drooling, intercostal retractions, cyanosis, and tachycardia.
Amyotrophic lateral sclerosis (ALS)
Because ALS affects the diaphragm more than the accessory muscles, increased accessory muscle use is characteristic of this disorder. Other signs and symptoms include fasciculations, muscle atrophy and weakness, spasticity, bilateral Babinski’s reflex, and hyperactive deep tendon reflexes. Incoordination makes carrying out routine activities difficult for the patient. Associated signs and symptoms include impaired speech; difficulty chewing or swallowing and breathing; urinary frequency and urgency; and, occasionally, choking and excessive drooling. ( Note: Other neuromuscular disorders may produce similar signs and symptoms.) Although the patient’s mental status remains intact, his poor prognosis may cause periodic depression.
Asthma
During acute asthma attacks, the patient usually displays increased accessory muscle use accompanied by severe dyspnea, tachypnea, wheezing, productive cough, nasal flaring, and cyanosis. Auscultation reveals faint or possibly absent breath sounds, musical crackles, and rhonchi. Other signs and symptoms include tachycardia, diaphoresis, and apprehension caused by air hunger. Chronic asthma may also cause barrel chest.
Chronic bronchitis
In this form of COPD, increased accessory muscle use may be chronic and is preceded by a productive cough and exertional dyspnea. Chronic bronchitis is accompanied by wheezing, basal crackles, tachypnea, jugular vein distention, prolonged expiration, barrel chest, and clubbing. Patients with chronic bronchitis are sometimes called “blue bloaters” because of the cyanosis and weight gain from edema that commonly occur. Low-grade fever may occur with secondary infection.
Diffuse infiltrative (or fibrotic) lung disease
In diffuse infiltrative lung disease, progressive pulmonary degeneration eventually increases accessory muscle use. Typically, though, the patient reports progressive dyspnea on exertion as his chief complaint. He may also have a cough, anorexia, weakness, fatigue, vague chest pain, tachypnea, and crackles at the base of the lungs.
Emphysema
Increased accessory muscle use occurs with progressive exertional dyspnea and a minimally productive cough in this form of COPD. These patients are sometimes called “pink puffers” because of their characteristic pursed-lip breathing, tachypnea, and a pink or red complexion. Associated signs and symptoms include peripheral cyanosis, anorexia, weight loss, malaise, barrel chest, and clubbing. Auscultation reveals distant heart sounds; percussion detects hyperresonance.
Pneumonia
Bacterial pneumonia initially produces sudden high fever with chills. Associated signs and symptoms include increased accessory muscle use, chest pain, productive cough, dyspnea, tachypnea, tachycardia, expiratory grunting, cyanosis, diaphoresis, and fine crackles.
Pulmonary edema
In acute pulmonary edema, increased accessory muscle use is accompanied by dyspnea, tachypnea, orthopnea, crepitant crackles, wheezing, and a cough with pink, frothy sputum. Other findings include restlessness, tachycardia, ventricular gallop, and cool, clammy, cyanotic skin.
Pulmonary embolism
Although signs and symptoms vary with the size, number, and location of the emboli, this life-threatening disorder may cause increased accessory muscle use. Common findings include dyspnea and tachypnea that may be accompanied by pleuritic or substernal chest pain. Other signs and symptoms include restlessness, anxiety, tachycardia, productive cough, low-grade fever and, with a large embolus, hemoptysis, cyanosis, syncope, jugular vein distention, scattered crackles, and focal wheezing.
Spinal cord injury
An injury below Ll typically doesn’t affect the diaphragm or accessory muscles, whereas an injury between C3 and C5 affects the upper respiratory muscles and diaphragm, causing increased accessory muscle use.
Associated signs and symptoms of spinal cord injury include unilateral or bilateral Babinski’s reflex; hyperactive deep tendon reflexes; spasticity; and variable or total loss of pain and temperature sensation, proprioception, and motor function. Horner’s syndrome (unilateral ptosis, pupillary constriction, facial anhidrosis) may occur in lower cervical cord injury.
Thoracic injury
Increased accessory muscle use may occur, depending on the type and extent of the injury. Associated signs and symptoms of this potentially life-threatening injury include an obvious chest wound or bruising, chest pain, dyspnea, cyanosis, and agitation. Signs of shock, such as tachycardia and hypotension, occur with significant blood loss.
Other causes
Diagnostic tests and treatments
Pulmonary function tests, incentive spirometry, and intermittent positive-pressure breathing can increase accessory muscle use.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Respirations, grunting:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Asthma
Grunting respirations may be apparent during a severe asthma attack, usually triggered by a upper respiratory tract infection or an allergic response. As the attack progresses, dyspnea, audible wheezing, chest tightness, and coughing occur. Patients may have a silent chest if air movement is poor. Immediate bronchodilator therapy is needed.
Heart failure
A late sign of left-sided heart failure, grunting respirations accompany increasing pulmonary edema. Associated features include a productive cough, crackles, jugular vein distention, and chest wall retractions. Cyanosis may also be evident, depending on the underlying congenital cardiac defect.
Pneumonia
Life-threatening bacterial pneumonia is common after an upper respiratory tract infection or cold. Pneumocystis carinii pneumonia commonly affects children infected with human immunodeficiency virus. It causes grunting respirations accompanied by high fever, tachypnea, a productive cough, anorexia, and lethargy. Auscultation reveals diminished breath sounds, scattered crackles, and sibilant rhonchi over the affected lung. As the disorder progresses, the patient may also develop severe dyspnea, substernal and subcostal retractions, nasal flaring, cyanosis, and increasing lethargy. Some infants display GI signs, such as vomiting, diarrhea, and abdominal distention.
Respiratory distress syndrome
The result of lung immaturity in a premature infant (less than 37 weeks’ gestation) usually of low birth weight, this syndrome initially causes audible expiratory grunting along with intercostal, subcostal, or substernal retractions; tachycardia; and tachypnea. Later, as respiratory distress tires the infant, apnea or irregular respirations replace the grunting. Severe respiratory distress is characterized by cyanosis, frothy sputum, dramatic nasal flaring, lethargy, bradycardia, and hypotension. Eventually, the infant becomes unresponsive. Auscultation reveals harsh, diminished breath sounds and crackles over the base of the lungs on deep inspiration. Oliguria and peripheral edema may also occur.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Respiratory distress syndrome:
Causes
(Handbook of Diseases)
Although the airways and alveoli of a neonate’s respiratory system are present by the 27th week of gestation, the intercostal muscles are weak and the alveoli and capillary blood supply are immature. In respiratory distress syndrome, the premature neonate develops widespread alveolar collapse because of lack of surfactant, a lipoprotein present in alveoli and respiratory bronchioles.
Surfactant normally lowers surface tension and aids in maintaining alveolar patency, preventing collapse, particularly at end expiration. But a deficiency results in widespread atelectasis, which leads to inadequate alveolar ventilation with shunting of blood through collapsed areas of lung, causing hypoxia and acidosis.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Acuterespiratory distress syndrome:
Causes
(Handbook of Diseases)
ARDS can result from any one of several respiratory and nonrespiratory causes:
aspiration of gastric contents
sepsis (primarily gram-negative), trauma (lung contusion, head injury, long bone fracture with fat emboli), or oxygen toxicity
viral, bacterial, or fungal pneumonia or microemboli (fat or air emboli or disseminated intravascular coagulation)
drug overdose (barbiturates, glutethimide, narcotics) or blood transfusion
smoke or chemical inhalation (nitrous oxide, chlorine, ammonia)
pancreatitis, hypertransfusion, cardiopulmonary bypass
near drowning.
Altered permeability of the alveolocapillary membranes causes fluid to accumulate in the interstitial space. If the pulmonary lymphatics can’t remove this fluid, interstitial edema develops. The fluid collects in the peribronchial and peribronchiolar spaces, producing bronchiolar narrowing.
Hypoxemia occurs as a result of fluid accumulation in alveoli and subsequent alveolar collapse, causing the shunting of blood through nonventilated lung regions. In addition, regional differences in compliance and airway narrowing cause regions of low ventilation and inadequate perfusion, which also contribute to hypoxemia.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Respirations, grunting:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Asthma
Grunting respirations and wheezing may be apparent during a severe asthma attack, usually triggered by an upper respiratory tract infection or an allergic response. As the attack progresses, dyspnea, chest tightness, and coughing occur. Patients may have a silent chest if air movement is poor. Immediate bronchodilator and corticosteroid therapy is needed.
Heart failure
A late sign of left-sided heart failure, grunting respirations accompany increasing pulmonary edema. Associated features include a productive cough, crackles, jugular vein distention, and chest wall retractions. Cyanosis may also be evident, depending on the underlying congenital cardiac defect.
Pneumonia
Life-threatening bacterial pneumonia is common after an upper respiratory tract infection or cold. Pneumocystis carinii (jiroveci) pneumonia commonly affects children infected with human immunodeficiency virus. It causes grunting respirations accompanied by high fever, tachypnea, nonproductive or scantly productive cough, anorexia, and lethargy. Auscultation reveals diminished breath sounds, scattered crackles, and sibilant rhonchi over the affected lung. As the disorder progresses, patients may also develop severe dyspnea, substernal and subcostal retractions, nasal flaring, cyanosis, and increasing lethargy. Some infants display GI signs, such as vomiting, diarrhea, and abdominal distention. Oxygen therapy is often needed.
Respiratory distress syndrome
The result of lung immaturity in a premature infant (less than 37 weeks’ gestation) usually of low birth weight, respiratory distress syndrome initially causes audible expiratory grunting along with intercostal, subcostal, or substernal retractions accompanied by tachycardia and tachypnea. Later, as respiratory distress tires the infant, apnea or irregular respirations replace the grunting. Severe respiratory distress is characterized by cyanosis, frothy sputum, dramatic nasal flaring, lethargy, bradycardia, and hypotension. Eventually, the infant becomes unresponsive. Auscultation reveals harsh, diminished breath sounds and crackles over the base of the lungs on deep inspiration. Oliguria and peripheral edema may also occur. This disease can occur in all age groups, as a result of aspiration, infection, embolism, shock, trauma, and other causes. Findings are similar in all ages.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Accessory muscle use:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acute respiratory distress syndrome
In acute respiratory distress syndrome (ARDS), accessory muscle use increases in response to hypoxia. It’s accompanied by intercostal, supracostal, and sternal retractions on inspiration and by grunting on expiration. Other characteristics of this life-threatening disorder include tachypnea, dyspnea, diaphoresis, diffuse crackles, and a cough with pink, frothy sputum. Worsening hypoxia produces anxiety, tachycardia, and mental sluggishness.
Airway obstruction
Acute upper airway obstruction can be life-threatening — fortunately, most obstructions are subacute or chronic. Typically, this disorder increases accessory muscle use. Its most telling sign, however, is inspiratory stridor. Associated signs and symptoms include dyspnea, tachypnea, gasping, wheezing, coughing, drooling, intercostal retractions, cyanosis, and tachycardia.
Amyotrophic lateral sclerosis
Typically, amyotrophic lateral sclerosis (ALS) affects the diaphragm more than the accessory muscles. As a result, increased accessory muscle use is characteristic. Other signs and symptoms of this progressive motor neuron disorder include fasciculations, muscle atrophy and weakness, spasticity, bilateral Babinski’s reflex, and hyperactive deep tendon reflexes. Incoordination makes carrying out routine activities difficult for the patient. Associated signs and symptoms include impaired speech; difficulty chewing or swallowing and breathing; urinary frequency and urgency; and, occasionally, choking and excessive drooling. ( Note: Other neuromuscular disorders may produce similar signs and symptoms.) Although the patient’s mental status remains intact, his poor prognosis may cause periodic depression.
Asthma
During acute asthma attacks, the patient usually displays increased accessory muscle use. Accompanying it are severe dyspnea, tachypnea, wheezing, productive cough, nasal flaring, and cyanosis. Auscultation reveals faint or possibly absent breath sounds, musical crackles, and rhonchi. Other signs and symptoms include tachycardia, diaphoresis, and apprehension caused by air hunger. Chronic asthma may also cause barrel chest.
Chronic bronchitis
With chronic bronchitis, a form of COPD, increased accessory muscle use may be chronic and is preceded by a productive cough and exertional dyspnea. Chronic bronchitis is accompanied by wheezing, basal crackles, tachypnea, jugular vein distention, prolonged expiration, barrel chest, and clubbing. Cyanosis and weight gain from edema account for the characteristic label of “blue bloater.” Low-grade fever may occur with secondary infection.
Emphysema
With emphysema, a form of COPD, increased accessory muscle use occurs with progressive exertional dyspnea and a minimally productive cough. Sometimes called a “pink puffer,” the patient will display pursed-lip breathing and tachypnea. Associated signs and symptoms include peripheral cyanosis, anorexia, weight loss, malaise, barrel chest, and clubbing. Auscultation reveals distant heart sounds; percussion detects hyperresonance.
Pneumonia
Bacterial pneumonia usually produces increasedaccessory muscle use. Initially, this infection produces sudden high fever with chills. Its associated signs and symptoms include chest pain, productive cough, dyspnea, tachypnea, tachycardia, expiratory grunting, cyanosis, diaphoresis, and fine crackles.
Pulmonary edema
With acute pulmonary edema, increased accessory muscle use is accompanied by dyspnea, tachypnea, orthopnea, crepitant crackles, wheezing, and a cough with pink, frothy sputum. Other findings include restlessness, tachycardia, ventricular gallop, and cool, clammy, cyanotic skin.
Pulmonary embolism
Although signs and symptoms vary with the size, number, and location of the emboli, this life-threatening disorder may cause increased accessory muscle use. Commonly, it produces dyspnea and tachypnea that may be accompanied by pleuritic or substernal chest pain. Other signs and symptoms include restlessness, anxiety, tachycardia, productive cough, low-grade fever and, with a large embolus, hemoptysis, cyanosis, syncope, jugular vein distention, scattered crackles, and focal wheezing.
Spinal cord injury
Depending on the location and severity of a spinal cord injury, increased accessory muscle use may occur. An injury below Ll typically doesn’t affect the diaphragm or accessory muscles, whereas an injury between C3 and C5 affects the upper respiratory muscles and diaphragm, causing increased accessory muscle use.
Associated signs and symptoms of spinal cord injury include unilateral or bilateral Babinski’s reflex; hyperactive deep tendon reflexes; spasticity; and variable or total loss of pain and temperature sensation, proprioception, and motor function. Horner’s syndrome (unilateral ptosis, pupillary constriction, facial anhidrosis) may occur with lower cervical cord injury.
Thoracic injury
With thoracic injury, increased accessory muscle use may occur, depending on the type and extent of injury. Associated signs and symptoms of this potentially life-threatening injury include an obvious chest wound or bruising, chest pain, dyspnea, cyanosis, and agitation. Signs of shock, such as tachycardia and hypotension, occur with significant blood loss.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Respirations, grunting:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Asthma
Grunting respirations may be apparent during a severe asthma attack, usually triggered by an upper respiratory tract infection or an allergic response. As the attack progresses, dyspnea, audible wheezing, chest tightness, and coughing occur. Patients may have a silent chest if air movement is poor.
Heart failure
A late sign of left-sided heart failure, grunting respirations accompany increasing pulmonary edema. Associated features include a productive cough, crackles, jugular vein distention, and chest wall retractions. Cyanosis may also be evident, depending on the underlying congenital cardiac defect.
Pneumonia
Life-threatening bacterial pneumonia is common after an upper respiratory tract infection or cold. Pneumocystis carinii pneumonia commonly affects children infected with human immunodeficiency virus. It causes grunting respirations accompanied by high fever, tachypnea, a productive cough, anorexia, and lethargy. Auscultation reveals diminished breath sounds, scattered crackles, and sibilant rhonchi over the affected lung. As the disorder progresses, the patient may also develop severe dyspnea, substernal and subcostal retractions, nasal flaring, cyanosis, and increasing lethargy. Some infants display GI signs, such as vomiting, diarrhea, and abdominal distention.
Respiratory distress syndrome
The result of lung immaturity in a premature infant (one who’s less than 37 weeks’ gestation) usually of low birth weight, respiratory distress syndrome initially causes audible expiratory grunting along with intercostal, subcostal, or substernal retractions; tachycardia; and tachypnea. Later, as respiratory distress tires the infant, apnea or irregular respirations replace the grunting. Severe respiratory distress is characterized by cyanosis, frothy sputum, dramatic nasal flaring, lethargy, bradycardia, and hypotension. Eventually, the infant becomes unresponsive. Auscultation reveals harsh, diminished breath sounds and crackles over the base of the lungs on deep inspiration. Oliguria and peripheral edema may also occur.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Respiratory Distress and Apnea:
Principal Causes of Respiratory Distress (Neonatal)
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Upperrespiratory tract obstruction
- Lower respiratory tract disorders
- Transienttachypnea of the newborn
- Respiratory distress syndrome (hyalinemembrane disease)
- Meconium aspiration and other aspirationsyndromes
- Pneumonia
- Pulmonary air leaks
- Pulmonary hemorrhage
- Bronchopulmonary dysplasia
- Congenital malformations of the lungs,bronchi, diaphragm, and rib cage
- Lung agenesis and aplasia
- Pulmonary hypoplasia
- Pulmonary sequestration
- Lobar emphysema
- Cystic lung lesions
- Bronchogeniccyst
- Congenital cystic adenomatoid malformation
- Intrapulmonary cysts
- Congenital pulmonary lymphangiectasia
- Chylothorax
- Bronchial malformations
- Diaphragm lesions
- Congenitaldiaphragmatic hernia
- Diaphragmatic eventration
- Diaphragmatic paralysis or paresis
- Rib cage anomalies
- Persistent fetal circulation
- Cardiac disorders
- Hematologic disorders
- Anemia
- Polycythemia
- Metabolic disorders
- Hypothermia
- Hypoglycemia
- Metabolic acidosis
- Neurologic and muscle disorders
- Braindisorders
- Spinal cord injury
- Neuromuscular disorders
- Drugs
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Accessory muscle use:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acute respiratory distress syndrome (ARDS).In ARDS, a life-threatening disorder, accessory muscle use increases in response to hypoxia. It's accompanied by intercostal, supracostal, and sternal retractions on inspiration and by grunting on expiration. Other characteristics include tachypnea, dyspnea, diaphoresis, diffuse crackles, and a cough with pink, frothy sputum. Worsening hypoxia produces anxiety, tachycardia, and mental sluggishness.
Airway obstruction.Acute upper airway obstruction can be life-threatening—fortunately, most obstructions are subacute or chronic. Typically, obstruction increases accessory muscle use. However, its most telling sign is inspiratory stridor. Associated signs and symptoms include dyspnea, tachypnea, gasping, wheezing, coughing, drooling, intercostal retractions, cyanosis, and tachycardia.
Amyotrophic lateral sclerosis.Typically, this progressive motor neuron disorder affects the diaphragm more than the accessory muscles. As a result, increased accessory muscle use is characteristic. Other signs and symptoms include fasciculations, muscle atrophy and weakness, spasticity, bilateral Babinski's reflex, and hyperactive deep tendon reflexes. Incoordination makes carrying out routine activities difficult for the patient. Associated signs and symptoms include impaired speech, difficulty chewing or swallowing and breathing, urinary frequency and urgency and, occasionally, choking and excessive drooling. ( Note: Other neuromuscular disorders may produce similar signs and symptoms.) Although the patient's mental status remains intact, his poor prognosis may cause periodic depression.
Asthma.During an acute asthma attack, the patient usually displays increased accessory muscle use. Accompanying it are severe dyspnea, tachypnea, wheezing, a productive cough, nasal flaring, and cyanosis. Auscultation reveals faint or possibly absent breath sounds, musical crackles, and rhonchi. Other signs and symptoms include tachycardia, diaphoresis, and apprehension caused by air hunger. Chronic asthma may also cause barrel chest.
Chronic bronchitis.With chronic bronchitis, a form of COPD, increased accessory muscle use may be chronic and is preceded by a productive cough and exertional dyspnea. Chronic bronchitis is accompanied by wheezing, basal crackles, tachypnea, jugular vein distention, prolonged expiration, barrel chest, and clubbing. Cyanosis and weight gain from edema account for the characteristic label of “blue bloater.” A low-grade fever may occur with secondary infection.
Emphysema.Increased accessory muscle use occurs with progressive exertional dyspnea and a minimally productive cough in this form of COPD. Sometimes called a “pink puffer,” the patient will display pursed-lip breathing and tachypnea. Associated signs and symptoms include peripheral cyanosis, anorexia, weight loss, malaise, barrel chest, and clubbing. Auscultation reveals distant heart sounds; percussion detects hyperresonance.
Pneumonia.Bacterial pneumonia usually produces increased accessory muscle use. Initially, this infection produces a sudden high fever with chills. Its associated signs and symptoms include chest pain, a productive cough, dyspnea, tachypnea, tachycardia, expiratory grunting, cyanosis, diaphoresis, and fine crackles.
Pulmonary edema.With acute pulmonary edema, increased accessory muscle use is accompanied by dyspnea, tachypnea, orthopnea, crepitant crackles, wheezing, and a cough with pink, frothy sputum. Other findings include restlessness, tachycardia, ventricular gallop, and cool, clammy, cyanotic skin.
Pulmonary embolism.Although signs and symptoms vary with the size, number, and location of the emboli, pulmonary embolism is a life-threatening disorder that may cause increased accessory muscle use. Typically, it produces dyspnea and tachypnea that may be accompanied by pleuritic or substernal chest pain. Other signs and symptoms include restlessness, anxiety, tachycardia, a productive cough, a low-grade fever and, with a large embolus, hemoptysis, cyanosis, syncope, jugular vein distention, scattered crackles, and focal wheezing.
Spinal cord injury.Increased accessory muscle use may occur, depending on the location and severity of the injury. An injury below Ll typically doesn't affect the diaphragm or accessory muscles, whereas an injury between C3 and C5 affects the upper respiratory muscles and diaphragm, causing increased accessory muscle use.
Associated signs and symptoms of spinal cord injury include unilateral or bilateral Babinski's reflex, hyperactive deep tendon reflexes, spasticity, and variable or total loss of pain and temperature sensation, proprioception, and motor function. Horner's syndrome (unilateral ptosis, pupillary constriction, facial anhidrosis) may occur with lower cervical cord injury.
Thoracic injury.Increased accessory muscle use may occur, depending on the type and extent of injury. Associated signs and symptoms of this potentially life-threatening injury include an obvious chest wound or bruising, chest pain, dyspnea, cyanosis, and agitation. Signs of shock, such as tachycardia and hypotension, occur with significant blood loss.
Other causes
Diagnostic tests and treatments.Pulmonary function tests (PFTs), incentive spirometry, and intermittent positive-pressure breathing can increase accessory muscle use.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Respirations, grunting:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Asthma.Grunting respirations may be apparent during a severe asthma attack, usually triggered by an upper respiratory tract infection or an allergic response. As the attack progresses, dyspnea, audible wheezing, chest tightness, and coughing occur. Patients may have a silent chest if air movement is poor. Immediate bronchodilator therapy is needed.
Heart failure.A late sign of left-sided heart failure, grunting respirations accompany increasing pulmonary edema. Associated features include a productive cough, crackles, jugular vein distention, and chest wall retractions. Cyanosis may also be evident, depending on the underlying congenital cardiac defect.
Pneumonia.Life-threatening bacterial pneumonia causes grunting respirations accompanied by high fever, tachypnea, a productive cough, anorexia, and lethargy. Auscultation reveals diminished breath sounds, scattered crackles, and sibilant rhonchi over the affected lung. As the disorder progresses, the patient may also develop severe dyspnea, substernal and subcostal retractions, nasal flaring, cyanosis, and increasing lethargy. Some infants display GI signs, such as vomiting, diarrhea, and abdominal distention.
Respiratory distress syndrome.The result of lung immaturity in a premature infant (less than 37 weeks' gestation) usually of low birth weight, this syndrome initially causes audible expiratory grunting along with intercostal, subcostal, or substernal retractions; tachycardia; and tachypnea. Later, as respiratory distress tires the infant, apnea or irregular respirations replace the grunting. Severe respiratory distress is characterized by cyanosis, frothy sputum, dramatic nasal flaring, lethargy, bradycardia, and hypotension. Eventually, the infant becomes unresponsive. Auscultation reveals harsh, diminished breath sounds and crackles over the base of the lungs on deep inspiration. Oliguria and peripheral edema may also occur.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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