NPS: Assess Patient Status & Changes Flashcards
Describe the localization of an acute upper airway obstruction (UAO)
Acute airway obstruction secondary to supra glottis issues may present as: Inspiratory stridor, prolonged Inspiratory phase, and muffled cry/voice. Glottis issues causing UAO present as: high pitched Inspiratory stridor wi weak and hoarse cry/voice. Subglottic problems present as: Expiratory stridor, normal cry/voice, and brassy cough. Other signs include sniffing position, dysphagia, drooling.
Discuss acute upper airway obstruction
Upper airway obstruction present in 15% of critically ill infants/children and is viral/infectious. Consider trauma, foreign bodies, neck trauma, burns, congenital abnormalities, rumors, and severe allergic reactions. Most common cause of infant and pediatric upper airway obstruction is the tongue (proportional larger than that of an adult and more easily displaced)
Explain the use of a chest CT
Used to evaluate the heart and blood vessels. Maybe used to diagnose pneumonia and subsequent complications, primary lung tumor or pulmonary metastasis, diseases of airway, congenital birth defects and trauma to pulmonary structures or blood vessels.
Discuss use of sleep studies in infants and pediatric patients
Sleep results in significant alterations in control of and function of the respiratory system; may produce clinically important problems in upper airway function and exchange of gas in both normal patients with respiratory or central nervous issues/diseases. Cardiopulmonary sleep studies indicated with: central sleep apnea, bronchopulmonary dysplasia, cystic fibrosis, asthma, neuromuscular disease, alveolar hypoventilation syndromes, and infant apnea or bradycardia. These studies evaluate: sleep state, respiration, cardiac rhythm, muscle activity, gas exchange & snoring
Discuss the indices that are monitored in a sleep study
Respiration- indicate adequacy of ventilation, distinguish between central and obstructive apnea, & severity of respiratory dysfunction. Parameters assessed are chest and abdominal wall movement, airflow detection at mouth/nose; for oxygen & carbon dioxide retention. Quantitative measurement of airflow is used to evaluate central hypoventilation.
How do neurological disorders affect respiratory function?
Respiration accomplished by respiratory muscles (diaphragm and intercostals) which are innervated by nerves. Neurological disorders weaken muscles used in respiration. Result in hypoventilation and eventual respiratory failure. PFTs utilized to evaluate impacts of neurological disorders on respiratory function via FVC
Describe measures for improving respiratory function in neurological disorders…
Avoid respiratory infections, influenza vaccine, & other preventative immunizations, cough assist, monitor & treat scoliosis, identify hypoventilation, treat sleep apnea, aerosolized breathing treatments (mucolytics, decongestants, antibiotics, bronchodilators,) IPPB, chest currais, ventilatory assist devices, BiPap, and tracheostomy.
Discuss level of consciousness, neurologic status, and respiratory function
Brain stem contains medullary reticular formation that serves to house the inspiratory and expiratory centers. Certain patterns can indicate progression of suppression or damage to levels of the nervous system. Ex. Sleepiness with sighing and yawning as a sign of diffuse cerebral cortex dysfunction, Cheyne-Stokes respiration (cresendo-decrescendo pattern with apneic periods) shows involvement of dienchephelon or upper mesencephalon.
