Oxygenation Flashcards
Head Bobbing
The child’s head move forward each time he/she takes a breath. This is caused by the use of neck muscles to assist in breathing.
Grunting
A sound heard on expiration caused by sudden closure of the glottis in an attempt to prevent alveoli from collapsing.
Nasal Flaring
A compensatory symptom that increases upper airway diameter and reduces resistance and work of breathing
Retractions
Sinking in of soft tissues occurs when lung compliance is poor or airway resistance is high. Types of retractions:
- Subcostal - below the ribcage
- Intercostal - between the ribcage
- Substernal - below the sternum
- Suprasternal - above the sternum
- Supraclavicular - above the clavical
Important Associated Observations of Respiratory Depression
- tachypnea
- color changes of the skin (mottling, pallor, and cyanosis of the nailbeds or around the mouth - circumoral)
- chest pain (may be compliant in older children)
- cough
- changes in alertness (low oxygen levels may cause children to act very tired, or decrease awareness)
- changes in behavior (restless, irritable, apprehensive)
Nursing Management of Patient with Oxygenation Issues
- Provide Supportive Care (things you do without a doctor’s order)
- Ensure adequate hydration (infants with RR greater then 60 typically NPO)
- Elevate HOB - keep airway open
- Administer analgesics for pain
- Provide supplemental oxygen
- Suctioning
- Complete respiratory assessments
Nursing Management of Patient with Oxygenation Issues
- Providing Family Education
- stress importance of adhering to prescribed medications
- handwashing
- teach that child may continue to tire easily over the next 1-2 weeks
- infants may continue to need small, frequent feedings
- cough should lessen over time
- pain management
- immunization status
Cough
Serves as a protective mechanism and an indicator of irritation
- Cough medication should not be given to children
- OTC cough medicines should not be given to a child younger than 6
Upper Respiratory Infections: Acute Nasopharyngitis
- The common cold
- Usually caused by rhinoviruses, influenza, parainfluenza, and adenovirus
- Viral particles spread through the air or person-to-person contact
- Occur more frequently in the winter
- Higher incidence among children who attend daycare/school, or exposed to second-hand smoke
- symptoms: fever in younger children, low-grade fever in older children, nasal discharge, nasal congestion, coughing sneezing
- resolves 10-14 days
Therapeutic Management of Nasopharyngitis
- acetaminophen
- elevate head
- saline nose drops
- cool mist humidifier (doesn’t produce as much bacteria/mold)
- What does not work? antibiotics, nasal decongestant, cough medicine, antihistamines
Otitis Media
Behind the eardrum
- inflammation of the middle ear with the presence of fluid
- 6 months to 2 years common age
- causes bulging eardrum
Acute Otitis Media (AOM)
- Rapid onset of signs and symptoms
- Lasts 1 - 3 weeks
- Viral: most common, due to blocked Eustachian tubes from edema or URI and resolves without treatment
- Bacterial causes:
- Clinical manifestations: otalgia (earache), fever, crying, irritability, lethargy, and loss of appetite
Otitis Media with Effusion (OME)
fluid in middle ear space without symptoms of acute infection
- not pus, just fluid (ex: kids with allergies)
Chronic otitis media with effusion: OME lasting longer than 3 months
- can cause hearing damage
Otitis Externa (OE)
Swimmers ear
- infection and inflammation of the skin of the external ear canal
- caused by bacteria (Pseudomonas and staph), or fungi (Aspergillus)
- moisture in the canal contributes to pathogen growth, and changing pH in the ear contributes to inflammation
Therapeutic Management of Ear Infections: AOM
Viral - no antibiotics needed
- acetaminophen may be given to relieve pain and fever
- decision to prescribe antibiotics is up to medical provider
Therapeutic Management of Ear Infections: OM/OME
Referral to ENT is needed to evaluate for Tympanostomy tubes (Pressure-equalizing tubes)
- allow antibiotics to go down easily
Therapeutic Management of Ear Infections: OE
- Administer antibiotic or antifungal eardrops
- Wick is placed in the ear canal occasionally
- Analgesics
- Warm compress
- Education on prevention
Viral Pharyngitis/ Viral Tonsilitis
- Usually self-limited and does not require therapy beyond symptomatic relief
- Throat cultures positive for Group A Strep - 100% accurate
- or positive rapid strep test
- antibiotics: (Penicillin or Amoxicillin)
- alternative antibiotics: macrolides and cephalosporins
Terms associated with tonsillitis
Viral infections last 7-10 days
- Acute: 1-3 weeks
- Chronic: longer than 3 months
- Kissing tonsils (grade 4+): muffled voice, can’t swallow, sleep apnea
- Tonsillar crypts and stones
Therapeutic Management of Tonsillitis
- Viral tonsillitis - symtomatic care
- Positive throat cultures - antibiotics
- Surgery: T&A (Tonsillectomy & Adenoidectomy)
- Surgery is done on an outpatient basis
Tonsillectomy Post-op Care
- Pain relief: analgesics, popsicles, ice collar
- Minimize activity or interventions that precipitate bleeding: coughing, clearing throat, blowing nose
- Observe for post-op hemorrhage
primary: not common - within 24 hrs of surgery
secondary: most common at day 5 to 10 post-op
signs: frequent swallowing, fresh blood in vomitus - Hospitalized children may need 02 monitored
Stridor
heard on inspiration in the neck area; caused by narrowing of upper airway (laryngeal obstruction)
Does not come from the lungs
Foreign body stuck in the airway
Rhonchi
a continuous, low pitched sound in larger airways
- Congestion
- Can actually go away or decrease with repositioning and coughing
Wheezing
high pitched due to narrowed airways (inspiratory or expiratory breathing)
- Can’t go away
Rales/Crackles
intermittent, brief, repetitive sounds caused by small collapsed airways popping open
- tiny popping sound is alveoli opening up
Assessment of Respiratory function
- Auscultate the lung fields
- Respiratory rate
- Regularity
- Symmetry of movements
- Depth
- Effort expended in respiration
- Use of accessory muscles of respiration
- Respirations are best determined when the child is sleeping, or quietly awake
Documentation: Assessment of respiratory function
- Identify location
- Identify if sound is referred
- Heard on inspiration or expiration or both
