Pediatric Respiratory Conditions Objectives Differentiate the pediatric respiratory system assessment considerations Describe nursing interventions for respiratory distress Provide an overview of pediatric respiratory conditions underlying pathophysiology identify assessments diagnostic tests to detect differentiate disorder describe management strategies essential nursing considerations Respiratory System Overview Upper airway includes mouth nose pharynx larynx trachea Lower structures are the lungs bronchioles alveoli diaphragm 3 lobes on right and 2 on left lungs proteins support lung tissue growth some kids can grow out of airway disease Gas exchange occurs in the alveoli Key Definitions of Gas Exchange Ventilation through inspiration expiration Movement of air into and out of the lungs Diffusion is the exchange of gases from the alveoli to the circulation Perfusion is the movement of oxygenated blood from the lungs to the tissue Breathing is an autonomic response Hold breath slow down HR You are a nurse caring for an infant with mild respiratory distress Which of the following represents a difference in pediatric physiology when compared to adults A Infant oxygen consumption is lower in proportion to body surface area B The cilia in an infant s airway are nonfunctional so they are prone to infection C Infants have fewer accessory muscles available for use and are unable to compensate D The smaller diameter of the infant s airways make them prone for occlusion airway is size of baby finger particularly if they don t have good neck muscles and cant hold their head up Physiological Differences Infants Supine prone to abdominal distention reflux aspiration If laying prone that is better for reflux activity doesn t keep airway open the right amount Narrow airways Obligate nose breathers Large glottis epiglottis Bony cage muscular differences smaller the baby diminished muslces Diaphragmatic breathers Soft pliable airways 1 if intubating you wouldn t use a cuff in ET tube it would interrupt circulation in airway Newborns immature periodic breathers irregular rate shallow respirations CWM Normal rate 30 40 Tachypnea is first sign of respiratory distress Breathing rate of 60 Shorter airway bacteria infection prone Less RI 3 mo More RI in infants If infants get sick they can get very sick respiratory distress systemic stress Snot infants difficult to clear airway and then when you try to clear their airway they get upset and produce more snot Pediatric Physiological Differences Cricoid cartilage below vocal cords upper airway obstruction Large epiglottis obstruction Soft cartilaginous airways More alveoli with age more surface for gas exchange Communal living more prone to respiratory infections Day care school siblings More ventilatory capacity with age Higher metabolism higher RR higher O2 consumption General Signs of Respiratory Distress in Children Changes in breath sounds and rate Listen R to L then upper to lower See if there is a difference in the base Mucus discharge cough Feeding nasal occlusion affects suck swallow reflex Increased work of breathing effort Fever systemic illness N V Fever in a child 38 5 treatment necessary before that is the fight flight response so you want them to have a fever Color pale cyanosis late sign mottling legs and arms see this 1 st Changes in behavior Facial expression air hunger Recognize early v late signs Which of the following indicates the most ominous sign of respiratory distress in an infant A Tachycardia B Nasal flaring C Cyanosis D Retractions Differences in Assessment Approach of children developmental issues Might want to do some assessment when child is sleeping Infants Children Adolescents Air Entry Nasal flaring Open mouth Head bobbing means increase work of breathing Look at trends Work of breathing How much energy does breathing take Retractions Tugging Accessory muscles Diminished or absent breath sounds Continuous vs intermittent Minimal vs marked Pectis chest chest almost caves in Differences in Breath Sounds Depth Aeration Wheezing air force through narrow passages Grunting using lower accessory muscles to push air out Stridor always upper airway problems larygnl tracheal edema Crackles Coarse breath sounds Cough is it productive Referred upper airway noise Apnea cessation of breathing for 20 seconds Look for tracheal tugging Differences in Interventions Oxygen always guided by clinical assessment Pulse oximetry 98 100 on room air If delivering oxygen you want it to be 98 99 Chronic resp problem lower 88 92 Acute 96 98 Chest PT loosens secretions CDB coughing and deep breathing Medications Humidity loosens upper airway problem hydration Suctioning using NSS nose gtts Nutrition clear liquids is the most important including chicken soup full liquids given thicker secretions Environment calm low lights no smoking around child elevate HOB Respiratory Insufficiency same for children as adults but children fall into it quicker Inadequate oxygen supply in the blood tissues and or Inadequate carbon dioxide removal Normal ABG s pH acid base status 7 35 acidosis gi metablolic respiratory respiratory pCO2 is controlled by lungs hyperventilate lose carbon dioxide respiratory alkaolis hypoventilate hold co2 respiratory acidosis HCO3 is controlled by kidneys metabolic component acidotic state bicarb will increase pO2 indicates effectiveness of oxygenation 80 100 infant 60 80 adult infants and small children need more oxygen when they are developing their brains Effective Gas Exchange Clear airways consider pediatric airways Normal lungs and chest wall Adequate pulmonary circulation Now consider conditions that may affect each of these areas ineffective airway rising co2 or diminished ability to oxygenate Predisposing Conditions Obstructive lung disease resistance to air flow aspiration infection anomaly Restrictive lung disease impaired lung expansion resp distress syndrome pneumonia cystic fibrosis Primary inefficient gas transfer CO2 retention resp depression secondary to head trauma drug overdose pulmonary diffusion defect Respiratory Failure Cardinal signs continuum restlessness respiratory effort tachypnea tachycardia diaphoresis unable to oxygenate or retaining co2 likely to die pick up early Recognizing Signs of Respiratory Failure Progressive deterioration is less easily recognized early signs include h a exertional dyspnea nasal flaring retractions diminished breath sounds in bases Abrupt vs Progressive abrupt Emergency PE