6.1 Pediatric Airway and Assessment Flashcards
Differences in Respiratory System
- Pediatric airway is shorter and more narrow
- Shorter means distance between structures
- This makes it easier for bacteria/viruses and foreign objects to move down airway more quickly.
- Diameter of airway is also smaller
- Anything that alters respiratory tract for inflammation can cause serious damage/illness.
- Much harder for children to handle respiratory illness
Differences in Respiratory System
- Shorter Trachea
- Angle of bronchus is also much more acute
- Airways are more immature, smaller, and narrower.
- Compensation for children is harder
Lower Airway
- Younger children use their diaphragm for respiration (especially infants) with use of accessory muscles (intercostal muscles act as stabilizers)
- Children have fewer alveoli (but they have 9x as many at 12 as they did at birth)
- If gas exchange in interrupted there are significant changes
Respiratory Assessment
- Rate
- Depth
- Ease
- Nasal Patency
- Retractions
- Nasal Flaring
- Head Bobbing (SIGNIFICANT RESPIRATORY DISTRESS - Using neck muscles to pull in more oxygen)
- Grunting (Increases expiratory pressure to allow for more gas exchange. SIGNIFICANT RESPIRATORY DISTRESS)
- Adventitious Lung Sounds
Retractions
- Using accessory muscles to help breathe
Supraclavicular - Above the clavicle
Suprasternal - Above sternal notch
Intercostal - In between ribs
Substernal - Under sternum
Subcostal - Under ribs
- The higher the retractions the worse the child is
- Intercostal is typically the first retractions noticed, then substernal/subcostal. Upper retractions such as supraclavicular and suprasternal means they need to use higher and bigger muscles to pull in air (CONCERNING)
Cardiac System
- Pulse (Rate and Rhythm)
- Color (Pallor, Mottled, Cyanosis, Mucous Membranes)
Observations
Cough
- Dry, wet, brassy, croupy (what does it sound like)
- Is it forceful or weak
Change in behavior
- Lethargy, LOC, restlessness, irritable
- Restlessness (LACK OF OXYGEN)
Hydration Status
- Dry mucous membranes, tears, fontanels, skin turgor, urinary output
Mottling
- Lacey red/white appearance on the skin.
- Typically is a sign that there is enough oxygen going to the peripherals.
Auscultation
Adventitious Breath Sounds
- Rales (Crackles) - Indicates fluids
- Ronchi - Indicates secretions in larger airways
- Wheezing - Can be caused by inflammation
Nursing Care
Determine Baseline
- Children with chronic illnesses may have different baselines than normal children
ABCs
Determine if the cause can be alleviated
- What can I fix right now (such as choking or aspiration)
Supportive Care
- Hydration, treating signs and symptoms, treating fever, comfortable position, suctioning, oxygen.
Oxygenation
Parameters
- 95%+
- “Real World” - When child has respiratory condition, most providers will allow children to be 90% SPO2 while awake, or 88% when sleeping.
Increased Metabolic Needs
- When children has respiratory disease, the body undergoes stress and works hard to breathe and fight off infection
- This causes an increase need for calories and fluid
- The issue is, during respiratory illness, the body is focused on fighting off the disease, not much energy is left for eating. This is why dehydration is so common in children with respiratory illness.
- HYDRATION IS KEY
- OFFER CHILDREN SMALL FREQUENT FLUIDS (especially parents)
Differences in Respiratory System
- Narrower diameter making them more vulnerable to secretions and inflammation
- Distance between structures is shorter so organisms can move quicker down respiratory tract.
- Short eustachian tubes allow pathogens easy access to middle ear
- Deficiencies in immune system make children more susceptible to infection
