Exam 3: Gas Exchange Flashcards
What puts pediatric patients at a higher risk for hypoxemia?
Smaller numbers of alveoli
Respiratory distress syndrome (RDS)
Lung disorder affecting mostly preterm infants, resulting from lung immaturity and deficiency of surfactant
Incidence and severity reduced by giving mother corticosteroids (betamethasone) before birth
What is the most common risk factor for RDS?
Premature infants
Incidence is inversely related to gestational age and birth weight
Risk factors for RDS
Infants of diabetic birthing mother
Multiple birth
C-section (absence of preceding labor)
Precipitous delivery
Perinatal asphyxia
Cold stress
Previous birth of infant with RDS
Clinical manifestations of RDS
GFR (grunting, flaring, retractions)
Tachypnea >60 breaths/min
May see apnea >20 seconds
Cyanosis
Diagnosis: X-ray shows ground glass appearance
When does the severity of RDS peak?
Around 6 hours
If untreated = BP may decrease; respiratory failure
Nursing interventions/therapeutic management for RDS
Airway
Thermo regulation
Prevent infection (antibiotics)
Nutritional support
Decrease stress
Improve oxygenation and ventilation
Surfactant replacement
Mechanical ventilation
High-frequency ventilation
Inhales nitric oxide
ECMO
Croup
Upper airway swelling generally caused by viruses
Acute spasmodic croup = abrupt onset at night
Laryngotracheobronchitis (LTB) = most common
LTB Croup
Children 3 months-3 years most at risk
Viral pathogens; starts with URI symptoms, varying degrees of swelling of the larynx that extends to the trachea and bronchi
Symptoms: Hoarseness, inspiratory stridor, bark-y cough, possible low grade fever, tachypnea, restlessness
Steeple sign on x-ray due to swelling in tissue
Priority nursing concern = airway obstruction
What type of retractions would you expect to see initially in a child with croup?
Suprasternal
Supraclavicular
Croup treatment
Corticosteroids: IV or PO Dexamethasone, Methylprednisone
Bronchodilators: Nebulized epinephrine
Albuterol, Racemic epinephrine (onset: minutes; lasts: 1-2 hours), concern about rebound effect after epinephrine wears off
Nursing interventions for Croup
Breathing, air exchange (resp. assessment)
Comfort (HOB elevated)
Positioning
Humidified air or oxygen
Hydration (insensible loss)
Cool mist humidifier at home
Parent education for Croup
Hydration
Medications
Cool mist humidifiers
When to call provider:
Red flag syndrome
- Expiratory stridor
- Severe retractions
- Increased RR
- Cyanosis, duskiness
Epiglottitis
Bacterial; Ages 2-8 years
Etiology: Haemophilus influenza, strep/staph
Disease process: Inflammation of epiglottis and glottis
Life threatening: edema occurs rapidly
Clinical manifestations of epiglottitis
Dystonia (hot potato mouth)
Dysphagia
Drooling
Distress
Tripod position
High fever, restlessness
NEVER attempt to inspect the mouth or throat
Nursing interventions for Epiglottitis
NPO
No throat cultures or examinations of the mouth (could precipitate closure)
Prepare for intubation (emergency equipment at bedside, tracheostomy)
Administer antibiotics
Airway and breathing (positioning, resp. assessments, oxygen)
Assess LOC
Comfort (avoid crying, minimize interruptions)
Fluid balance (IV hydration)
Antibiotic therapy (bacterial)
Maintenance fluid calculations
100 ml x 1st 10 kg
50 ml x 2nd 10 kg
20 ml x rest of kg
What is the most effective primary prevention measure to minimize the incidence of epiglottitis in children?
Haemophilus Influenza B Vaccine
Bronchiolitis (RSV)
Acute inflammation and obstruction of the bronchioles and small bronchi
Etiology: Bacterial infection, viral infection (RSV = contact precautions)
Populations at risk: Infants under 6 months, immunocompromised, chronic lung disease
Family education for RSV
Prophylactic protection (Synagis)
Strict hand hygiene
Symptoms of worsening distress:
Increased WOB
Unable to eat due to RR
Lethargy
Cyanosis
Decreased respirations
Clinical manifestations of RSV
Progresses from URI to lower tract infection
Increased WOB
Cough, runny nose, retractions, nasal flaring, wheezing, crackles, cyanosis
Diagnosis: Nasopharyngeal culture, chest x-ray
Therapeutic management of RSV
Supportive treatment
Supplemental oxygen, CPAP
Keep airway patent and clear, suction
Isolation
Bronchodilators (racemic epinephrine)
Hydration, calculate maintenance fluids
Antipyretics
Elevator HOB
Use of bulb syringe before feeds
Cystic Fibrosis
Autosomal recessive chronic progressive disease
Patho: Multi-system disease process
Disrupts the sodium-chloride ion cellular transport system
Dysfunction of the exocrine glands
Tenacious amounts of sticky, thick mucus
Must give pancreatic enzymes before eating
Clinical manifestations of Cystic Fibrosis
Newborn: Meconium ileus, abdominal distention, vomiting, no stool
Cough, frequent respiratory infections, wheezing
Dyspnea
Paroxysmal cough
Atelectasis
Cyanosis
Barrel-chest
Steatorrhea
Delayed growth
Salty skin
Low Na, glucose instability
Diagnostic testing for CF
Genetic testing
Newborn (state) screening
Sweat chloride test
Routine testing: PFTs
Therapeutic management for CF
Airway clearance
Chest physiotherapy
High frequency chest oscillation Mucolytics
Bronchodilators (Dilate then vibrate)
Encourage physical activity (swimming)
Prevent infection
Management infection
Flu vaccine
Promote optimal nutrition (infant may need fortification of breast milk)
Family support is key
