Chapter 23: Caring for the Child with a Respiratory Condition Flashcards
The Respiratory System
-consists of the upper respiratory tract: nose, nasal cavity, sinuses. pharynx, larynx, and trachea
-consists of lower respiratory tract: lungs, bronchi, bronchioles, and alveoli
>the anatomy and physiology of the respiratory system in children differs from that of the adult population
Ventilation
(breathing)
-involves taking in oxygen through the nose and mouth and then delivering it to the lungs
-the nose has cilia (small hair-like projections) and mucus-producing cells that line the nostrils to prevent small particles from entering the nasal cavity; the mucus is a protective mechanism to trap foreign matter that enters the nasopharyngeal cavities
-the oxygen then passes from the pharynx to the larynx
>to prevent any food or liquid from entering the larynx, the epiglottis closes over the opening of the larynx during swallowing
>a cough reflex expels foreign bodies
-from the larynx, air passes through the trachea, which branches into the left and right bronchi; the bronchi divide into smaller branches called bronchioles; the bronchioles end in a cluster of air sacs called the acinus
-individual air sacs, called alveoli, exchange oxygen and carbon dioxide; oxygen exchange with the blood-stream occurs in the capillaries; oxygen attaches to the red blood cells and is transported to the rest of the body
-carbon dioxide diffuses from the bloodstream into the alveolus where it is transported out of the body during exhalation
Growth and Development
a child with a respiratory system condition can easily become overwhelmed and burdened with the disease process and extensive medical therapies
-alterations in oxygenation and perfusion can impact the child’s ability to participate in physical activity and play; b/c of these factors, the child with a respiratory condition is vulnerable to alterations in regular growth and development
>while treating and preventing respiratory complications, focus on promoting regular growth and development is essential
-nursing care of the child with a respiratory condition should maintain a balance of disease symptom management and promotion of regular growth and development; this can be accomplished by providing developmentally appropriate toys that promote oxygenation and the stimulation needed for growth
-ex: bubbles and pinwheels are toys that promote deep breathing and lung expansion as well as the development of motor skills and fine motor movement
-the nurse should understand the child’s abilities and limitations and provide growth and development activities that are appropriate; activity that supports airway maintenance and adequate oxygenation is essential
-the child should be encouraged to participate in activities and allowed to rest as needed
>the child with a respiratory condition such as cystic fibrosis and asthma require lifelong medical care and often need frequent hospitalization
-frequent hospital admissions can result in delays or regression of developmental milestones based on environmental changes and social isolation; the nurse should educate the family about strategies to prevent disease regression and hospital readmissions to avoid this
Developmental Aspects of The Respiratory System: Newborn
-airway of the newborn is narrow and more easily occluded than that of the adult
-obligatory nose breathers; they do not use their mouth for breathing
-the cough of a newborn is usually non-productive b/c they produce little respiratory mucus; b/c they lack this cleansing function, more susceptible to respiratory infections
-have a highly developed sense of smell, and the mucous membranes are highly vascular
-ethmoid and maxillary sinuses are present at birth, though the frontal and sphenoid sinuses are not fully developed until 6 to 8 years of age
-lymphoid tissues, or tonsils, are absent at birth and grow more rapidly in the child than any other tissue
>by age 7, tonsils present at adult size
-trachea is approximately 4mm in diameter about diameter of a drinking straw (size of the infant’s or child’s little finger)
-lung tissue is immature at birth
Developmental Aspects of The Respiratory System: Children
-children younger than 6 are abdominal breathers; the intercostal muscles are too weak to facilitate respiration, causing the child to rely on the use of the diaphragm for inspiration
-the epiglottis of children age 8 and younger is longer and flaccid (floppy), making it more susceptible to swelling that can lead to airway occlusion
-the epiglottis is small and does not close properly, and the larynx and the glottis are higher in the younger child’s neck, which makes the child more prone to aspiration
-the thyroid, cricoid, and tracheal cartilages are immature and are easily collapsible with flexion of the neck; there are fewer functional muscles in the neck, and increased amount of soft tissue makes the younger child more susceptible to infection and edema
-trachea is shorter and narrower in diameter than adults; b/c of the narrow lumen of the trachea, excess mucous production can easily produce an obstruction
-by age 6, diameter of trachea is 12 mm
-a child trachea bifurcates (separates into 2 branches) at the third thoracic vertebra
-in addition to higher level of bifurcation, the angle of the right bronchus (one of the two large branches of the trachea) is much sharper in children
>the right bronchus is shorter, wider, and more vertical than the left, therefore, inhaled foreign bodies more often lodge in the right bronchus
-have less alveolar surface for gas exchange
Developmental Aspects of The Respiratory System: Toddler
- respiratory system has expanded to hold a greater volume; decreasing risk of infection
- the tonsils and adenoids are increasing in size
- eustachian tubes remain short and horizontal during the toddler and preschool years, providing easier access for nasal bacteria to enter the ear
Developmental Aspects of The Respiratory System: Adolescent
- adults trachea 18 to 20 mm in diameter
- trachea bifurcates at sixth thoracic vertebra
- respiratory structure approximately adult size and capacity
The Respiratory System and The Child
because the respiratory system is undergoing a process of development during childhood, the child is more prone to develop respiratory problems
-the child does not have the immunity that adults have to many infectious agents, therefore, respiratory infections occur more frequently in pediatric populations
Congenital Respiratory Conditions
- Asthma
- Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF)
- Cystic Fibrosis
- Tonsillitis
- CROUP
- Acute Epiglottitis
- Bronchitis and Respiratory Syncytial Virus (RSV)
- Pertussis
- Foreign Body Aspiration
Arterial Blood Gas Values: Birth, Cord, Full Term
- PCO2: 31-66 mm Hg
- PO2: 60-70 mm Hg
- HCO3: 17-24 mEq/L
- pH: 7.32-7.49
- O2 Sat: 40-90%
Arterial Blood Gas Values: 2 months- 2 years
- PCO2: 26-41 mmHg
- PO2: 80-95 mm Hg
- HCO3: 16-23 mEq/L
- pH: 7.34-7.46
- O2 Sat: 95-99%
Arterial Blood Gas Values: Child
- PCO2: 35-45 mm Hg
- PO2: 80-95 mm Hg
- HCO3: 22-26 mEq/L
- pH: 7.35-7.45
- O2 Sat: 95-99%
Arterial Blood Gas Values: Adult
- PCO2: 35-45 mm Hg
- PO2: 80-95 mm Hg
- HCO3: 22-26 mEq/L
- pH: 7.35-7.45
- O2 Sat: 95-99%
Arterial Blood Gas Values
> Birth, Cord, Full Term:
- PCO2: 31-66 mm Hg
- PO2: 60-70 mm Hg
- HCO3: 17-24 mEq/L
- pH: 7.32-7.49
- O2 Sat: 40-90%
> 2 months- 2 years
- PCO2: 26-41 mmHg
- PO2: 80-95 mmHg
- HCO3: 16-23 mEq/L
- pH: 7.34-7.46
- O2 Sat: 95-99%
> Child
- PCO2: 35-45 mmHg
- PO2: 80-95 mmHg
- HCO3: 22-26 mEq/L
- pH: 7.35-7.45
- O2 Sat: 95-99%
> Adult:
- PCO2: 35-45 mmHg
- PO2: 80-95 mmHg
- HCO3: 22-26 mEq/L
- pH: 7.35-7.45
- O2 Sat: 95-99%
Average Respiratory Rates in Children
- Preterm: 40-70
- Newborn: 30-50
- 1 Year: 20-40
- 3 Year: 20-30
- 6 Year: 16-22
- 10 Year: 16-20
- 14 Year: 14-20
- 18 Years: 16-20
