Chapter 23: Pulmonary Non-infectious Irritation: Foreign Body Aspiration Flashcards
Foreign Body Aspiration (FB)
any solid or liquid substance that becomes caught in the respiratory tract and blocks air passage
- young children at greater risk of aspirating foreign bodies b/c of curiosity and the habit of putting things in the mouth
- most common among toddlers (can occur at any age)
Most frequent aspirated objects
- peanuts
- popcorn
- hot dogs
- vegetable matter
- fruit gel snacks
What Happens During FB
in the child, the aspirated object may stay in the same place of obstruction or move with air; there is a possibility that if the child forcefully coughs, the object may be spit out
-During the presence of FB, the bronchioles and bronchi may become larger during inspiration and smaller during expiration
-small objects may cause little damage, and large objects may occlude the whole airway passage, causing more severe symptoms
>a sharp object blocks the airway and can lead to severe trauma, and may have complications such as inflammation and abscess, atelectasis, and emphysema
Signs + Symptoms: Laryngeal FB
- rapid onset of hoarseness
- chronic, croupy cough
- aphonia (inability to speak)
- unilateral wheezing
- recurrent pneumonia
Signs+ Symptoms: Tracheal FB
- history of brassy cough
- hoarseness
- dyspnea
- possible cyanosis
- homophonic wheeze (musical and having the same sound)
- audible slap and palpable thud sound produced by the momentary expiratory effect of the FB at the subglottic level
Signs + Symptoms: Bronchial FB
- most objects are aspirated into the the right mainstem bronchus because it is at a less acute angle than the left mainstem bronchus
- initial findings similar to that of tracheal or laryngeal FB aspiration
- blood-streaked sputum
- metallic taste (if metal object aspirated)
- may have a few initial symptoms if the object did not cause obstruction and was non-irritating
- homophonic wheeze
- emphysema-like changes result in hyporesonance or hyperresonance
- diminished breath sounds
- crackles, rhonchi, and wheezes
Diagnosis
- history and physical signs
- in children, an FB is suspected in the presence of acute or chronic pulmonary lesions
- x-ray exam with fluoroscopic examination can be helpful in locating the site of aspirated object
- definitive diagnosis is through bronchoscopic examination
Prevention
- educate patients and caregivers
- avoid giving nuts, uncooked carrots, or other foods that broken into pieces to infants and children before the molars have erupted; balloons, marbles, coins, tiny toys, or toys with small pieces (e.g. button eyes or beads)
- keep toxic substances out of reach
- do not force feed
Nursing Care
- monitor vital signs
- assess level of consciousness
- explain any procedures to parents to help allay anxieties
- child may be placed on NPO status, and family is encouraged to follow medical regimen
- can provide a cool-mist vaporizer and administer antibiotic therapy if deemed appropriate
- in community, be skilled in Heimlich Maneuver
Medical Care
-if a large object has been swallowed, it may be difficult for the child to remove the FB spontaneously by coughing; the child will need instrumental assistance to remove the obstruction
>delays in treatment may lead to swelling in the obstructed site and inflammation may set in, hampering the removal of the object
-the FB may also adhere to the lumen of the air passage
-medical management= removal of FB from respiratory tract by direct laryngoscopy or bronchoscopy; child is hospitalized during and after the procedure for observation of laryngeal edema and respiratory distress
Education/ Discharge
- safety precautions to avoid FB aspiration
- toys must not have small detachable parts and food should be cut into small bits appropriate for the child’s age
Heimlich Maneuver on a conscious child older than 1 year of age
- Standing behind the child wrap your arms around the child’s waist. With the fist of one hand, place the thumb side against the child’s abdomen, slightly above the umbilicus. Grasp the fist with the other hand
- Squeeze the child’s abdomen using quick inward and upward thrusts
- Continue the thrusts until the obstruction has been relieved or the child becomes unconscious
- establish unresponsiveness by tapping and shouting “are you alright?”
- If the child is unresponsive and apneic or gasping, call for help or activate the emergency response system
- Begin CPR starting with 30 chest compressions
- Each time the airway is opened using a head-tilt, chin-lift, check for an object and if visible, remove it. Never perform a blind finger-sweep
Heimlich Maneuver on an Infant
- Lay the infant on your arm or thigh with the infant’s head face down
- Give five blows to the infant’s back using the heel of your hand
- If the airway obstruction continues, turn the infant over with head down and give five chest thrusts using two fingers at a distance of 1 fingerbreadth below the nipple level in midline
- Do not perform abdominal thrusts on the infant b/c it can damage the liver
- Check the infant’s mouth for any obvious obstructions that can be removed
- Do not perform a blind fingers-weep to retrieve an object
- if necessary, repeat the sequence and ask for help to call 911
- If the infant becomes unconscious, begin CPR with chest compressions
- After 30 compressions, open airway
- Before beginning rescue breathing, check mouth for FB. Remove if object is visible- not not blind finger-sweep
- Attempt ventilation and follow with chest compressions until object is removed
- Activate emergency response system after 2 minutes if no response
Pediatric Respiratory Emergency Assessment: What you would find in a Critical Situation
- Airway: completely or severely obstructed
- Breathing Rate: may be slow, absent, or very fast with periods of slowing
- Breathing effort: absent or greatly increased with periods of weakness
- Breath Sounds: grunting, faint, or absent
- Skin Color: pale, mottled, or blue
- Inspection: normal, decreased, or absent chest movement
- Actions: immediately open airway, suction, give high-concentration oxygen with assisted ventilation, and transport
Pediatric Respiratory Emergency Assessment: What you would find in a Unstable Situation
- Airway: partially obstructed, excessive secretions or blood
- Breathing rate: increased
- Breathing effort: increased
- Breath sounds: wheezing or stridor, decreased breath sounds
- Skin color: pink or pale
- Inspection: normal or decreased chest movement
- Action: move at moderate pace; give high-concentration oxygen; prepare for transport; reassess frequently
