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23 Cards in this Set
- Front
- Back
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Pediatric variations
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1. Surfactant production 28 weeks
2. Increased O2 consumption 3. Apneic pauses, irregular, inc RR (infant) 4. Normal for infants to have rapid respiratory rate (30-60 breaths per minute) followed by apneic pauses 5. Abd distention ↓ diaphragm movement 6. Obligate nose breather (infant), use of abdominal muscles 7. Increased resistance (15x in infant) – tracheal diameter triples 8. Decreased # and branching of alveoli (8 y) - number inc 10x 9. Trachea bifurcates sooner 10. Thin chest wall, compliant (inc work of inspiration) 11. Immature supporting cartilage 12. Eustachian tubes narrow, level til 5y 13. Obstructions from anatomy (tissue-lymphoid; position – tongue) 14. Immature immune system 15. Net: Easily obstructed airways, ↓ gas Xchg, atelectasis, ↓ reserves |
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What is surfactant?
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The substance that allows the alveoli to stay open and not collapse on itself when air is inflated into it
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What is surface tension?
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Think about the first time balloon is being blown up, that difficulty is due to surface tension
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Compliance
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1. Measure of chest wall and lung tissue recoil
2. Ability to return to resting state 3. Represents the ease of breathing 4. Types of lung tissue that impact recoil 5. Hydration, blood volume, pneumothorax, asthma 6. Flexible rib cage infants and young children increases compliance 7. Changes in compliance ↑WOB |
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Resistance
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1. Largely determined by airway size
2. Tissue factors: Chest wall muscle, lung tissue 3. Airway factors: Turbulence, diameter 4. Any inflammation will decrease 5. Small airway changes result in exponential resistance changes 6. Net: ↑ WOB |
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Work of Breathing
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1. Depends on compliance, resistance, airways
2. Younger - limited reserves, more dependent on O2, tire, cardiac arrest 3. Compensation - Increased RR, shallow; Grunting, flaring, retracting 4. Overcome obstruction from either increased resistance (inflammation, mucus, reactive) or decreased compliance (atelectasis, overdistention) 5. Result – shunting - hypoxia |
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Natural Respiratory Defenses
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1. Especially important in children d/t anatomical and physiologic variations present: Mucous, cough
2. Many diseases impede the mechanisms 3. Malnutrition and fatigue also impede 4. Dehydration impedes by drying up mucous 5. Diminished humoral defenses in young child |
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Pulmonary Edema
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1. Vital signs (T, P, R)
2. Mentation - restless, alertness, playfulness 3. Skin - cap refill, color, temp, diaphoresis 4. ENT - TM (tympanic membrane), Rhinorrhea, throat red, drooling, voice muffling 5. Chest – WOB; Observe ease/effort, rhythm, position; GFR; Lung sounds; Head bobbing, seesaw, stridor 6. Cough - sound, pattern 7. Hydration Assessment 8. Chronic Deviation - clubbing, barrel chest |
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Pulse Oximetry
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1. Oxyhemoglobin Dissociation Curve: PaO2 100 = 98% ; PaO2 60 = 90%
2. Mode: concentration needed, age of child; nasal cannula - ¼ @ 6L; Face mask – 55%@ 3-5L; Mist @ 10-15L; Oxygen hood – 80-100% @ 10-15L 3. Nursing Care: ensure uninterrupted O2 delivery, assess response |
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Aerosol Therapy
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1. Deposits medication directly into airway via nebulization using air or oxygen. Usually intermittent but can be continous.
2. Avoids systemic effects of medication 3. Administered by RT 4. Most common medication – Albuterol; Atrovent, Pulmozyme in select situations 5. Nursing responsibilities: Assess effectiveness; Assess SE (tachycardia, jitteriness, restlessness) |
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Respiratory Failure
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1. Hypoxia and/or Hypercarbonia
2. Ineffective gas exchange 3. Increased WOB 4. Precedes cardiac arrest in children (in most cases) 5. Can be subtle until full respiratory arrest 6. Be aware of clinical situations when can arise 7. Be aware of clinical manifestations 8. Provide family support |
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General Nursing Care of the Child with Respiratory Deviation
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1. Signs and Symptoms
2. Monitor Respiratory Status closely 3. Promote Rest and comfort 4. Promote hydration and nutrition 5. Reduce Temperature and spread of infection 6. Family Support |
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Otitis Media
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1. Patho: Nasal discharge trapped against tympanic membrane by narrowed eustachian tube
2. Complications - Acute: mastoiditis, meningitis but uncommon; Long-term: delayed speech |
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Epiglottitis
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1. Bacterial, H.flu; croup disorder
2. Peak 3-8y 3. Epiglottis larger 4. Rapid onset; emergent situation 5. Epiglottis is edematous, can obstruct airway, child toxic 6. High fever, tripod sit, drooling, inc HR, voice muffling, resp distress 7. Mgmt: AIRWAY |
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Croup LTB
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1. Viral, upper airway
2. Peak 3 mos - 3 y 3. Gradual Onset 4. Mucosal edema at larnyx - causes inc airway resistance upon inspiration 5. Inspiratory stridor, seal bark, retractions (suprasternal, substernal), pallor, cyanosis, low grade fever 6. Mgmt: mostly OPD, unless respiratory distress; keep calm 7. If hospitalized – racemic epinephrine, monitor resp status |
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Bronchiolitis
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1. RSV causes 50% of cases
2. Synagis – high risk, monthly IM – can prevent 3. Transmission – contact, droplet 4. Peak 6 mos age, winter season 5. Patho: increased airway resistance and air trapping from edema, mucus, cellular debris in bronchioles, atelectasis 6. S/Sxs: fever, increased RR, adventitious sounds, retractions, cyanosis, apnea, ?feeding 7. Mgmt: infant hospitalize, supportive, assess respiratory function, isolation |
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Bacterial Pneumonia
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1. Etiology - Strep pneumonia most common but MRSA emerging
2. Signs and Symptoms 3. Can be multisystem, can be very serious 4. Complications - Emphysema; pleural effusion; Chest tube |
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Pertussis (Whooping Cough)
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1. Bacterial infection: Bordella pertussis; droplet and contact transmission
2. Occurs in infants, unimmunized and adolescents and adults; TdaP 3. Very serious in infants can cause seizures, apnea 4. Characteristic Whoop cough 5. Long illness (6 weeks), although not contagious after 48 hr on antibiotics (Erythromycin) |
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Foreign Body Aspiration
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1. Developmental - Age: 6 mos to 5 yrs
2. Common items: popcorn, hot dogs, balloons 3. Sudden onset, violent coughing 4. Often unilateral findings, wheezing 5. Sxs may resolve and then s/sx chronic infection 6. Remove: bronchoscopy |
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Aspiration Pneumonia
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1. Food, secretions, liquids enter lungs and create chemical pneumonitis
2. Symptoms similar to any pneumonia 3. Be aware of conditions that predispose 4. Chronic situations may require GT feeds and/or fundiplication 5. Can cause ARDS (Acute Respiratory Distress Syndrome) |
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Asthma
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1. Reversible, obstructive
2. Triggers reactive airway 3. Primarily an inflammatory disease 4. Complex interaction between inflammatory cells and lung tissue 5. Edema and inflammation narrow airway, further exacerbated by bronchospasm 6. Mucus builds 7. Airway obstruction results with decreased expiratory airflow 8. Hypoxemia results and is compounded by shunting 9. Symptoms - cough w/o cold earliest symptom (especially at night); tachypnea, tachycardia, retractions, orthopnea, restless, dec sats, inc exp time, SOB, wheezing, rhonchi |
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Asthma
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1. Teaching, teaching, teaching!!!
2. Management: PEFR (Zones = peak expiratory flow rate; Control of triggers 3. Pharmocology - MDI: Beta-Adrenergics, atrovent, steroids; Continuous nebs in hospital; Spacer use; Antileukotrianes (maintenance, not exacerbation); Oral or IV steroids w/acute “attack”; MgSO4 for “stubborn” situations; Rescue vs maintenance |
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Cystic Fibrosis
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1. Chronic, multisystem disorder, genetic; variable
2. Autosomal Recessive; defect in Cl transport across cell membrane which effects Na transport also 3. Diagnosis: sweat test (x2); NB screen; amnio 4. Patho: effects mucus producing glands of GI, resp, reproductive, & integument; chloride transport effected 5. Lungs: tacky sputum, blocks O2 transport 6. Intestine: malabsorption, FTT; reflux 7. Pancreas: decreased enzymes, protein/fat metabolism 8. Often develop DM in later teens, early 20s 9. Sweat Glands: inc sodium excretion 10. Treatment - vitamins, enzymes, fat supp, inc carbos/protein, GT for nighttime feeds, vest Rx, aerosols, MDI, antibiotics (tune-up), O2, anti-reflux meds, resp iso while in hospital |
