Lung Surfactants

Lung Surfactants Nursing Pharmacology Study Guide

Lung Surfactants NCLEX Nursing Pharmacology Review

Nursing Pharmacology Guide on Lung Surfactants

Surfactants in the lungs are naturally occurring compounds or lipoproteins containing lipids and apoproteins that lower surface tension in the alveoli, allowing the alveoli to expand for gas exchange.

Lung surfactants are medications that are administered to premature newborns who do not have enough surfactants in their lungs in order to help these organs expand and function properly.

Lung surfactants are instilled directly into the trachea (intratracheal route) and will begin to act immediately upon administration.

Actions of Lung Surfactants

Lung surfactants aim to prevent respiratory distress syndrome (RDS), which occurs at the alveolar level. This condition common in premature babies who are born before their lungs have fully grown and their surfactant levels are still inadequate.

A surfactant is required to reduce the surface tension in the alveoli, allowing them to remain open and enable gas flow. The alveoli do not expand and cannot receive air if surfactant levels are inadequate, resulting in impaired gas exchange, low oxygen levels, and generalized discomfort throughout the body as cells cannot obtain the oxygen they require to thrive.

The goal of treatment is to inject a surfactant into the lungs to prevent atelectasis and allow them to expand.

Another indication of lung surfactants is in the treatment of acute respiratory distress syndrome (ARDS).

ARDS is defined as a progressive loss of lung compliance and an increase in hypoxia. It has various causes, which include severe injury to the body, such as cardiovascular collapse, major burns, severe trauma, or rapid depressurization. ARDS is treated by reversing the underlying cause of the problem and providing ventilation support.

Indications of Lung Surfactants

Lung surfactants are used to achieve the following goals:

  • To treat infants with RDS
  • To treat infants at high risk of developing RDS (birth weight 1, 350g, birth weight >1, 350g with evidence of respiratory immaturity) as a preventative measure
  • To treat ARDS in adults
  • Being tested to treat adults who have been close to drowning

Side Effects and Adverse Effects of Lung Surfactants

  1. Side Effects

The side effects of lung surfactants in infants may include:

  • endotracheal tube reflux
  • skin paleness
  • endotracheal tube obstruction
  • need for dose interruption

2. Adverse Effects

The following are some of the adverse effects of using lung surfactants:

  • Patent ductus arteriosus
  • Bradycardia
  • intraventricular hemorrhage
  • hypotension
  • Pneumothorax
  • pulmonary air leak
  • pulmonary hemorrhage
  • Apnea
  • Sepsis and infection
  • Hematuria or blood in the urine

Contraindications and Cautions Against Lung Surfactants

Lung surfactants are contraindicated in patients with congenital anomalies that are incompatible with life after the neonatal period. T

hey should also not be given to infants whose lungs are already matured based on laboratory results.

Patients with congenital diaphragmatic hernia are not eligible for lung surfactants. The patient should also be hemodynamically stable before giving lung surfactants.

Nursing Considerations for Lung Surfactants

Some nursing considerations may be the following specifically for patients taking lung surfactants:

  • Assess for contraindications and cautions that may be possible. This could be done by the healthcare provider at the time of birth
  • Determine the infant’s exact weight to ensure that the doses are accurate. 
  • Perform a physical examination to establish baseline data for evaluating the drug’s effectiveness and the occurrence of any drug-related side effects.
  • To evaluate perfusion, assess the skin temperature and color.
  • To assess the drug’s and drug delivery’s effectiveness, keep track of respirations, unusual sounds, endotracheal tube placement and patency, and chest movements.
  • Monitor the infant’s vital signs, such as blood pressure, pulse, and arterial pressure.
  • Monitor drug effectiveness by measuring blood gases and oxygen saturation.
  • To check for sepsis, take a temperature and a complete blood count.
  • Continuously monitor the patient during administration and until he or she is stable and administer life support if necessary.
  • Placement of the endotracheal tube should be correct. To ensure adequate drug delivery, ensure proper placement of the endotracheal tube with bilateral chest movement and lung sounds.
  • Examine how drugs should be administered. To review the specific technical aspects of administration, have staff watch the manufacturer’s teaching video before using it on a regular basis.
  • Suction the child. Suction the infant right away after administration, but don’t suction for another 2 hours unless clinically necessary to give the drug time to work.
  • Provide assistance. Provide support and encouragement to the patient’s parents, explaining how the drug is used in the teaching program to help them cope with their infant’s diagnosis and treatment.
  • Continue to take other precautions. Continue to take other supportive measures related to the infant’s immaturity, as this is only one aspect of the medical care that premature infants require.
  • Keep an eye on the patient’s reaction to the medication. These include improved breathing, alveolar expansion).
  • Keep an eye out for any negative consequences, such as pneumothorax, patent ductus arteriosus, bradycardia, or sepsis.
  • Evaluate the teaching plan’s effectiveness and provide support to parents as needed.
  • Keep an eye on the effectiveness of other measures to help the patient and keep him or her stable.
  • Evaluate and measure the effectiveness of the other supportive measures related to the immaturity of the infant.

Nursing Care Plan for Patients on Lung Surfactants

Possible Nursing Diagnoses

The following nursing diagnoses may be related to lung surfactant drug therapy:

Nursing Assessment

InterventionsRationales
Assess the patient for signs and symptoms of respiratory distress syndrome or any other respiratory condition.To confirm the indication for administering lung surfactants.
Check the patient’s vital signs.The vital signs of the patient that will receive lung surfactants should be stable and should be checked closely due to the probable side effect of bradycardia and hypertension.
Assess the infant’s tracheal region.The lung surfactants will be administered through the trachea, also known as the intratracheal route. Assessment of the trachea is needed: To check for any potential problems with administration.
To ensure that the right form of lung surfactants is given through the right route.  
Check the infant’s medical history for congenital anomalies that are incompatible with life after the neonatal period, or for the presence of congenital diaphragmatic hernia.Lung surfactants are not recommended for infants with congenital anomalies that are incompatible with life after the neonatal period, or for the presence of congenital diaphragmatic hernia.  
Ensure that the laboratory tests result confirm prematurity of the lungs.Lung surfactants are not required for infants who have mature or developed lungs.
Assess the skin temperature and color.  To evaluate perfusion.

Nursing Planning and Intervention

InterventionsRationales
Educate the parent or guardian about the action, indication, common side effects, and adverse reactions to note when using lung surfactants. Obtain consent once all questions of the parent or guardian has been answered.To inform the parent or guardian on the basics of lung surfactants and allow time for them to ask questions prior to giving consent.
Check for the proper placement of the endotracheal tube with bilateral chest movement and lung sounds.To ensure adequate drug delivery.
When preparing the lung surfactant, ensure the following measures:
Check for any discoloration in the vial (the drug’s normal color is off white to light brown)Ensure that the drug came out of the fridge that is 2 to 6 degrees CelsiusWarm the drug for at least 20 minutes in room temperature before drawing up for the babyDo not shake the drugUnopened or unused vials can be stored back into the fridge within 24 hours.    
To make sure that the drug’s efficacy is not compromised.
Assist the physician in the intratracheal administration of the lung surfactants.To ensure the safe and effective delivery of care.
Check for the proper placement of the endotracheal tube with bilateral chest movement and lung sounds.To ensure adequate drug delivery.
Suction the infant right away after administration, but don’t suction for another 2 hours unless clinically necessary to give the drug time to work.To make sure that the airway remains patent after administering the lung surfactant.

Nursing Evaluation

InterventionsRationales
Ask the parent or guardian to repeat the information about lung surfactants.To evaluate the effectiveness of health teaching on lung surfactants.
Monitor the patient’s heartbeat and breathing. Perform a complete set of vital signs frequently.To ensure that the lung surfactants did not cause any dysrhythmia, hypertension, infection, or sepsis. Ensure that a full set of vital signs are 

Monitor the patient’s response to lung surfactants.To check if the lung surfactants are effective or if the dose needs to be adjusted.
Monitor for any difficulty of breath or poor airway clearance.Lung surfactants may cause poor airway clearance.
Routinely check the infant for any signs of bleeding.Intracranial bleeding or hemorrhage is a sign of adverse reaction to lung surfactants. This is an emergency and must be dealt with as soon as possible.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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