Children and Respiratory conditions Flashcards
What is respiratory distress?
- Increased work of breathing: tracheal tugging (retraction of the subnotchal), intercostal and substernal indrawing, retractions, using accessory muscles, grunting (Trying to inflate lungs more to increase the amount of oxygen), nose flaring, belly breathing, supraclavicular movement
- Hands and feet go pale
- May turn cyanotic/blue
- Absent lung sounds
What are some key differences in the pediatric respiratory system compared to adults?
- Upper airway is shorter and more narrow than an adult airway
- Pediatric airway is more conical, it is more cylindrical in adults (more likely to choke, does not need security measures to keep trach or tube in place)
- Newborns are obligatory nose breathers, rely on the diaphragm
- Larynx is more flexible and easily stimulated to spasm
- Intercostal muscles are not fully developed
- Higher respiratory rate, irregular pattern
- Higher metabolic rate
- Fewer alveoli
- Right bronchus enters the lung at a steeper angle
- Cartilage surrounding the trachea is more flexible
- Eustachian tubes are shorter and more horizontal
- Tonsils and lymphoid tissue is larger
- Decreased immune function
Why are children at greater risk for respiratory distress?
- Size and shape of airway
- Anatomy of their respiratory system
- Fewer alveoli
- High metabolic rate
- Decreased immune function
- More frequent URI’s – upper respiratory infections
What are some causes of respiratory distress in children?
- Infection – viruses
- Asthma – could be an environmental reason, genetic (if family has a history of asthma)
- Trauma
- Inability to clear secretions
- Foreign body aspiration – because of the anatomy of their airway
- Sedation – kids can easily get over-sedated
What are some early signs of respiratory distress? What are some late signs?
Early signs: tachypnea, hyperpnea, tachycardia, restlessness/irritability
Late signs: Nasal flaring, indrawings/retractions, grunting, tracheal tug, head bobbing, stridor, abdominal breathing, pallor, mottling or cyanosis
What to look for in pediatric respiratory assessment?
- Look - inspect for WOB, SOB, rate, rhythm depth, colour, chest wall, cough, clubbing, presence of sputum, any use of accessory muscles
- Listen - Auscultate all lung fields, breath sounds should be equal bilaterally, - administer ventolin if no breath sounds
- Feel - palpate for tenderness, expansion, symmetry, temperature, diaphoresis, lymph nodes, tactile fremitus, subcutaneous ephysema. percuss for resonant sounds, dull over organs
What are some developmental considerations when assessing the respiratory system in infants or toddlers?
Infants:
- Compare awake to asleep, everything is going to be faster when awake
- Observe before arousal
- SOB often followed by a deep breath
- Assess while parent is feeding or comforting them, closer to baseline, check for aspiration
Toddlers:
- Assess on parents lap
- use distraction
- assess on teddy, or mom or dad first
What are some developmental considerations when assessing the respiratory system in preschoolers?
- Let them help you ie/ with IV – let them see the IV touch the catheter and the syringe – lets them feel more comfortable with them, they don’t know what it is, let them get familiar with it
- Let them play with equipment
- Blow bubbles
- Encourage parental presence
What are some developmental considerations when assessing the respiratory system on school-age children?
- Kids love to understand – have to explain why a kid needs bloodwork or why you’re doing something ie/ do you know why mummy brought you in today? When you don’t feel good, having soup helps, and sleeping, but sometimes we need to check just in case so you can get better. So we need to check your blood, just a little
- Play a game
- Provide explanations
- Give them a job
- Encourage active participation
What are some developmental considerations when assessing the respiratory system on adolescents?
- Downplay symptoms
Ie/ coming with scrotal pain, don’t tell their parents that –worried about testicular torsion - Observe activity tolerance
- Maintain privacy
- Have to ask parents to step out during assessment
- Treat them as their own person
- Use humour
What are some nursing interventions for respiratory illness?
Ease Respiratory Efforts: Positioning, Oxygen, Suctioning, Humidity, Medications,
Promote Rest: Quiet time, Limit crying when possible – reason to keep mom
Promote comfort: pain management, suctioning
Reduce spread of infection: isolate for symptoms, hand hygiene, PPE, antibiotics and education
Reduce temperature: antipyretics and cool compress
Promote hydration: PO (always best), IV, breastmilk
Provide nutrition: support choice, prevent aspiration
Family support: psychosocial support, encouragement
Monitoring: signs and symptoms of respiratory distress, dehydration, O2 monitoring, ins and outs and effectiveness of medication/treatment
What are some diagnostic tests for resp conditions?
- Arterial Blood Gas (ABG) / Cap. Gas
RT does cap gas – see how well they are perfusing with their oxygen. Will tell CO2 level (should be 35-45), ph = 7.35-7.45, compensatory vs noncompensatory - Chest X-ray
- Computed Tomography (CT)
- Magnetic Resonance Imaging (MRI)
- Bronchoscopy – can help remove foreign objects, but will also look for narrowing of airways, can do lung biospies for cf
- Pulmonary Function Test – looking for lung volumes and lung capacities (uses spirometer)
- Sweat Test – for kids with cf
- Sputum Culture
What are some important things to remember when caring for a child with a trach?
- Always have trach care box with the child
- reason for trach and trach size
- inspect insertion site, trach tube and trach ties
- frequent suctioning
- must be humidified
- constant observation
- emergency equipment on standby
What is the pathophysiology of Respiratory Syncytial Virus (RSV)?
- Outbreak during the winter or rainy season
- Causes overproduction of IgE
- Large amount of mucos in their lungs and bronchiole wall is swollen, but the other is nice and patent
- Trachea of a child is a diameter of their pinkyfinger – if lose airway, can close up very fast
- Can quickly obstruct
- Results in airway obstruction
- RSV is like the common cold, it can cause bronchiolitis
What is the epidemiology of Respiratory Syncytial Virus (RSV)?
- By age 3, most children have been infected with RSV at least once
- In Canada, RSV most frequent cause of hospitalization in children less than 2 with bronchiolitis
- 1 % of general pediatric population will be admitted to hospital of which 1% will require ICU care… mortality rare in general population
- In northern Canada, Indigenous children have one of highest rates of RSV bronchiolitis hospitalizations in the world… with a 1% mortality rate – don’t have much access to care, education and when they should access care
