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72 Cards in this Set
- Front
- Back
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Respiratory Assessment in Infants and Children and Adults (3) -initial impression |
-Consciousness:Level of consciousness(eg. Unresponsive, irritable, alert) -Breathing: Increased work of breathing, absent or decreased respiratory effort, or abnormal sounds heard without auscultation -Color: Abnormal skin color, such as cyanosis, pallor, mottling. |
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ABCDE Model of Assessment
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A irway: B reathing C irculation D isability E xposure |
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Airway assessment
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-Is the airway open -Look for movement of the chest and abdomen.-Listen for air movement and breath sounds |
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Breathing assessment
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Respiratory Rate Respiratory Effort Chest Expansion and Air movement Lung and Airway sounds 02 sat by pulse oximetry |
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Circulation assessment
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Heart rate and rhythm Pulses (both peripheral and central) Capillary refill timeSkin color and temperature Blood pressure |
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Disability: assessment
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Evaluation of neurologic function -Severe Cerebral Hypoxia may present with the following neurologic signs: -Decreased Level of consciousness -Loss of muscular tone -Generalized seizures -Pupil dilation |
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Exposure assessment
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perform a focused physical examination
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Normal Respiratory Rates Infant (<1 year)
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30-60Breaths /min
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Normal Respiratory Rates Toddler (1-3 years)
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24-40Breaths /min
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Normal Respiratory Rates Preschooler (4-5 years
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22-34Breaths /min
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Normal Respiratory Rates School age (6-12)
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18-30Breaths /min
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Normal Respiratory Rates Adolescent
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12-16
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“Quiet” tachypnea in PEDS : -usually -s/sx |
without signs of increased respiratory effort. -Usually non pulmonary problems -High fever -Pain Mild metabolic acidosis associated with dehydration or DKA -Sepsis without PneumoniaCongestive heart failure (early)Severe anemiaSome cyanotic heart defects |
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Bradypnea in PEDS def +s/sx
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Breathing is both slow and irregular -Muscle fatigue -CNS injury or infection of CNS -Hypothermia -Medication that depress respiratory drive |
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Apnea PEDS
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cessation of breathing for 20 seconds or cessation for less than 20 seconds if accompanied by bradycardia, cyanosis or pallor.
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Increased respiratory effort results from
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-conditions that increase resistance to airflow (eg. Asthma, bronchiolitis) -Stiff or difficult to inflate lungs (eg, pneumonia, pulmonary edema, or pleural effusion). -Non pulmonary diseases such as DKA, salicylate ingestion, may increase respiratory rate and effort. |
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Signs of Increased Respiratory Effort
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Nasal Flaring Retractions Head bobbing Seesaw respirations/ Prolonged inspiratory or expiratory times Open-mouth breathing Gasping Use of accessory muscles Grunting |
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Subcostalretraction -breathing difficulty |
Retraction of the abdomen, just below the rib cage -Mild to moderate |
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Substernalretraction -breathing difficulty |
Retraction of the abdomen at the bottom of the breastbone -Mild to moderate |
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Intercostalretraction -breathing difficulty |
Retraction between the ribs -Mild to moderate |
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Supraclavicularretraction -breathing difficulty |
Retraction in the neck, just above the collarbone Severe |
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Suprasternalretraction -breathing difficulty |
Retraction in chest, just above the breastbone -Severe |
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Sternalretraction -breathing difficulty |
Retraction of the sternum towards the spine. -severe |
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Tidal Volume:
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volume of air inspired with each breath
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Normal Tidal Volume PEDS
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approximately 5-7 mL/kg
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inspiration should be
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symmetric
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asymmetric chest expansion could indicate
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Asymmetric chest expansion: airway obstruction, atelectasis, pneumothorax, hemothorax, pleural effusion, mucous plug, or foreign body aspiration.
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Stridor def -sign of -seen in |
Stridor: coarse, usually higher-pitched breathing sound typically heard on inspiration. Stridor is a sign of upper airway (extrathoracic) obstruction and may indicate that the obstruction is critical and requires immediate intervention. -FBAO, Croup, Congenital airway abnormalities (larynomalacia), acquired airway abnormalities (eg, tumor or cyst). Upper airway edema (eg, allergic reaction). |
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Grunting def -seen in |
Short low-pitched sound heard during expiration. It often helps to keep the small airways and alveolar sacs in the lungs open. This is an attempt to optimize oxygenation and ventilation. -Pneumonia, pulmonary contusion, Acute Respiratory Distress syndrome (ARDS). |
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Gurgling:
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is a bubbling sound heard during inspiration or expiration. It results from upper airway obstruction due to airway secretions, vomit, or blood.
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Wheezing:
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high pitched or low pitch (rhonchi) whistling or sighing sound heard most often during expiration. It is heard less frequently during inspiration. This sound typically indicates lower airway obstruction, especially of smaller airways. -Isolated inspiratory wheezing suggests FBAO, |
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Crackles:
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aka rales, are sharp, crackling inspiratory sounds
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Moist crackles: -seen in |
indicate accumulation of alveolar fluid. (eg. Pneumonia and pulmonary edema) |
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Dry crackles: -seen in |
are more often heard with atelectasis (small airway collapse)
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Normal Heart Rate Newborn to 3 months -Awake Rate -Mean -Sleeping rate |
85-205 140 80-160 |
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Normal Heart Rate 3 months to 2 years -Awake Rate -Mean -Sleeping rate |
100-190 130 75-160 |
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Normal Heart Rate 2 years to 10 years -Awake Rate -Mean -Sleeping rate |
60-140 80 60-90 |
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Normal Heart Rate > 10 year -Awake Rate -Mean -Sleeping rate |
60-100 75 50-90 |
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In healthy children the heart rate may due what with respiratory cycle
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In healthy children the heart rate may fluctuate with the respiratory cycle, increasing with inspiration and slowing down with expiration -Sinus arrhythmia |
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O2 Saturation in children
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>94%
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o2 sat
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-Is the percent of total hemoglobin that is saturated with O2 -This saturation does not indicate the amount of O2 delivered to the tissues. O2 delivery is the product of arterial O2 content (oxygen bound to hemoglobin plus dissolved O2) and cardiac output. -O2 saturation does not provide information about effectiveness of ventilation (CO2 elimination). *** If the heart rate displayed and the pulse oximeter is not the same as the heart rate determined by ECG monitoring , the saturation reading is not reliable. |
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inadequate O2 delivery to the tissues: skin color and temp s/sx
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Pallor Mottling Cyanosis Acrocyanosis Peripheral cyanosis Central cyanosis |
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hypotension Term neonates (0-28days)Systolic Blood Pressure
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< 60
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hypotension Infants (1-12 months)Systolic Blood Pressure
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<70
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Hypotension Children 1-10 year Systolic Blood Pressure
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< 70 + (age in years x 2)
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Hypotension Children > 10 yearsSystolic Blood Pressure
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< 90
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Hypoxemia %
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< 95%
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Hypoxemia
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Low Arterial O2 tension (PaO2 that is associated with a low O2 saturation assessed by pulse oximetry (SpO2).
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Signs of Tissue HYPOXIA
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Tachycardia (early sign) Tachypnea Nasal Flaring, retractions Agitation, anxiety, irritability Pallor Cyanosis (late sign) Decreased level of consciousness (late sign) Bradypnea, apnea (late sign) Bradycardia (late sign) |
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Mechanisms of Hypoxemia (3) |
Alveolar hypoventilation Diffusion defect Ventilation /perfusion (V/Q) imbalance |
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Alveolar hypoventilationcauses
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CNS infection Traumatic brain injury Drug overdose Neuromuscular weakness Apnea |
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Diffusion defectCauses
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Pulmonary edema Interstitial pneumonia Alveolar proteinosis |
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Ventilation /perfusion (V/Q) imbalanceCauses
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Pneumonia Atelectasis ARDS Asthma Bronchiolitis Foreign body |
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Hypercarbia
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is the increased CO2 tension in the arterial blood (PaCO2). When hypercarbia is present, ventilation is inadequate.
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Hypercarbia New trend is towards
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precise measurement of PCO2 -Exhale CO2 detectors |
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Normal spontaneous breathing is accomplished with
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minimal work.: quiet and unlabored, smooth inspiration and passive expiration
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Factors with increased work of breathing
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-Increased airway resistance (upper and lower) -Decreased lung compliance -Use of accessory muscles of respiration -Disordered central nervous system control of breathing. |
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Airway resistance is increased by:
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-Reduced size of conducting airways -Airway-constriction -Inflammation -Turbulent airflow=Airflow become more turbulent when the flow rate is increased. |
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When airway resistance increases,
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work of breathing increases.
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Lung Compliance
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refers to the distensibility of the lung, chest wall or both.
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With low lung compliance,
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the lungs are stiffer -More effort is needed to inflate the alveoli |
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Signs of Respiratory Problems Upper Airway Obstruction -Breath sounds |
-Stridor (typically inspiratory)Barking coughHoarseness
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Signs of Respiratory Problems Lower Airway Obstruction -Breath sounds |
Wheezing (typically expiratory)Prolonged expiratory phase
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Signs of Respiratory Problems Lung Tissue Disease -Breath sounds |
GruntingCracklesDecreased breath sounds
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Signs of Respiratory Problems Disordered Control of Breathing -Breath sounds |
normal
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Upper airway obstruction by etiology
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-Croup -Anaphylaxis -FBAO |
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Mild croup:
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Occasional barking cough, little or no stridor at rest, absent or mild retractions
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Moderate croup:
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Frequent barking cough, easily audible stridor at rest, retractions at rest, little or no agitation, good air entry by auscultation of the peripheral lung fields.
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Severe croup:
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Frequent barking cough, prominent inspiratory and occasional expiratory stridor, marked retractions, significant agitation, decreased air entry by auscultation of the lungs
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Impending Respiratory Failure: aka
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Barking cough(may not be prominent in the child’s respiratory effort is growing weaker because of severe hypoxemia and hypercarbia), audible stridor at rest (can be difficult to hear with failing respiratory effort), retractions (may not be severe if respiratory effort is failing), lethargy or decreased level of consciousness, and, sometimes, pallor or cyanosis despite administration of supplementary O2, poor air movement on auscultation
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Croup Mild Interventions
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steroids, dexamethasone
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Croup Moderate to severe Interventions
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-Administer Humidified O2 -NPO -Administer nebulized epinephrine -Observe for at least 2 hours after giving nebulized epi to ensure continued improvement (no recurrence of stridor). -Adm. Dexamethasone -Possible adm. Heliox (helium oxygen mixture) for severe disease |
