Infant: Respiratory Flashcards
Newborns are automatic nose breathers until age __
2-3 months
when do children use their diaphragm to breathe? and what does it cause?
under 6 years of age
causes retractions in resp distress due to negative pressure
What are the assessment focus for respiratory illness?
- position of comfort
- vital signs
- lung auscultation
- respiratory effort
- colour
- cough
- behaviour change
- family history
When does respiratory failure occur?
body can no longer maintain effective gas exchange
What are the inital signs of respiratory failure/distress? (4)
attempt to compensate for O2 deficit and airway blockage
restlessness, tachypnea, tachycardia, diaphoresis
What are the early decompensation signs of resp. distress? (10)
use accessory muscles to assist O2 intake, hypoxia persists and efforts waste more O2 than obtained
initial signs plus
irritability
difficult to console
retractions
grunting
wheezing
nasal flaring
headache
hypertension
confusion
What are the late signs of resp. distress? (7)
- quiet chest : O2 deficit overwhelming
- poor air entry, weak cry
- apnea (cessation of breathing for longer than 20 secs), gasping, dyspnea
- deterioration in systemic perfusion (mottling)
- cyanosis
- bradycardia
- Lethargic
- decreased LOC
What is the patho of respiratory failure?
- Begins with hypoventilation of alveoli- Occurs when: O2 needs exceed O2 intake (ex. Lung injury, occlusion, gas exchange interrupted)
- Poor ventilation of alveoli → hypoxemia (lower blood O2 levels) and hypercapnia (excess CO2 in blood)
then hypoxia (low O2 levels in tissues) occurs and resp failure begins
What is the patho of acute respiratory distress syndrome? (ARDS)
- ARDS = acute resp failure (severe hypoxemia) caused by lung injury that does not respond to supplemental oxygen
Injury causes inflammatory-immune response and alveolar-cap damage
Ex of injuries: sepsis, pneumonia, smoke inhalation, near drowning
Increased permeability of damaged alveolar capillary membrane = pulmonary edema = decreased lung compliance and functional residual capacity, decreased airflow = VQ mismatch and hypoxemia
What is croup?
- broad classification of upper airway illnesses that result from inflammation and swelling of the epi-glottis and larynx
Swelling usually extends into trachea and bronchi
What are the viral croup syndromes?
Viral croup syndromes include spasmodic laryngitis (spasmodic croup) and laryngotracheo-bronchitis (LTB).
What are the bacterial croup syndromes?
Bacterial croup syndromes include bacterial tracheitis and epiglottitis
What is RSV?
- respiratory pathogen
- cause of lower resp tract disease in infants
- Most common cause for bronchiolitis
is RSV contagious?
yes
does rsv increase risk of asthma and wheezing?
yes
What is bronchiolitis?
lower resp tract illness that occurs when infecting agent (virus or bacterium) causes inflammation and obstruction of small airways (bronchioles)
Who is at risk for contracting RSV?
- Preemie: under 32 week = high risk
- Congenital heart disease
- Immune compromise
- Chronic Disease
- Low birth weight
What is the patho of bronchiolitis?
- inflammation of airways and bronchospasm (muscles that line bronchi tighten)
- airway lining swells and produces excessive mucous: Leads to nasal discharge and wet productive cough
- air trapping in lungs: Swelling & mucus = partial airway obstruction during expiration and bronchospasms
- Hyperinflation of alveoli
- Hypoxemia: high CO2 and low PO2
What S&S does bronchiolitis start with? (7)
- Irritability/fussiness/more sleepy
- Rhinitis (nasal congestion, sneezing, itching)
- cough
- low grade fever
- poor feeding
- Dehydration (if sick for a while)
Then tachypnea becomes noticeable (greater than 70 breaths)
What are the severe symptoms of bronchiolitis? (9)
- Increased respiratory rate
- Increased HR
- Grunting
- Retractions
- Crackles or wheezing
- Cough
- Nasal flaring
- More lethargic and poor feeding
- cyanosis
what are the 10 treatments in order for bronchiolitis?
- isolation
- humified O2
- hydration (oral or IV)
- Nutrition
- nasal suctioning
- increased HOB
- decreasing stress
- monitoring (I&O, weight, mucous mem, colour, etc)
- medications
- RSV prophylaxis/vaccination
Why do we use humified O2?
Humidified O2 helps loosen secretions
Why is hydration important with RSV?
Losing fluid through insensible water loss with increased respirations
What are the medications for RSV? and its rationale
- Tylenol: for fever and keeping metabolic rate down
- nebulized 3% hypertonic saline: to increase intravascular fluid volume
- nebulized bronchodilators (ventolin) - If theres significant airway narrowing
- Antibiotics: only if child has bacterial infection
