Oxygenation Flashcards
Difference between Children and Adult airway
children: funnel, smaller and less developed
adult: cylinder
General Physiological Differences Children and Adults
- smaller and shorter airway
- larger tongue
- nose breathers
- belly/diaphragm breathers
- increased rate and effort
- retractions
- vagal nerve
- eustation tube
Accessory Muscle Use in Children
-use of accessory muscles may present as head bobbing in young children
Retractions
- infants and young children have immature chest muscles and cartilagious ribs making the chest wall very flexible
- negative pressure created by the downward movement of the diaphragm is increased in cases of respiratory distress, and the chest wall is pulled inward causing retractions
- intercostal retractions are seen in mild respiratory distress
As respiratory distress severity increases…
substernal and subcostal retractions are seen
in cases of severe distress…
supraclavicular and suprasternal retractions occur as the accessory muscles are used
Normal bpm for infant
less than a yr
30-60
Normal bpm for toddler
1-3 yrs
24-40
Normal bpm for preschooler
4-5 yrs
22-34
Normal bpm for school age
6-12 yrs
18-30
Normal bpm for adolescent
13-18 yrs
12-16
Oxygenation Assessment Guidelines
- position of comfort (tripod, sitting up, refuse to lay down)
- vital signs
- respiratory effort (apnea, decreased RR, retractions)
- lung auscultation (crackles, wheezing)
- color (late sign)
- cough (cough up and swallow is bad)
- behavior change
Respiratory Distress
- any respiratory condition can progress to respiratory distress
- if not managed can lead to respiratory failure
- hypoxemia that persists when supplemental oxygen is given is a sign of respiratory failure
General Care Standards
- Oxygen/O2 sats (greater or equal to 93 percent is ok)
- CPT/PD and suction (only with mucus, can cause irritation which means more secretions)
- IS (if 5 or over)
- saline nose drops (loosens secretions)
- antibiotics (only for bacterial infections)
- isolation
- rest (but let them play, means feeling better)
- reduce fever (no ibuprofen under 6 mths)
- hydration
- nutrition
- cough medications
-positioning (HOB elevated)
Categorization of Respiratory Tract Infections
- Upper Respiratory Tract
- Croup Syndromes
- Lower Respiratory Tract
tonsilitis
- mostly viral infection
- group A beta hemolytic strep (strep throat)
- change toothbrush
- AB 24-48 hrs
**tonsillectomy: bleeding precaution, look for frequent swallowing
- inspect back of throat
- no red drinks or foods
- avoid coughing
Otitis Media
- immobile
- red or yellow bulding TM
- symptoms: otalgia, fever, otorrhea, crying, fussy, tendency to pull or rub ear, rolls head from side to side
- Eustachian tube is flat and can’t drain fluid
- tx with AB
Therapeutic management of otitis media
- high dose amoxicillin
- myringotomy: Tympanoplasty/PE tubes
- pressure equalizing tubes used to put eat drops in ear
Croup Syndromes
general term for a group of symptoms characterized by:
- “barking/brassy” or “seal-like” cough
- inspiratory stridor, at rest equals bad, with activity equals ok if better at rest
- respiratory distress
- swelling/obstruction in the region of the larynx
Croup Syndromes includes…
- laryngotracheobronchitis: subglottic
- epiglottitis: supraglottic
Laryngotracheobronchitis
-obstruction (SUBglottic) BELOW VOCAL CORDS
-slower onset, URI symptoms lead to cough and hoarseness
(viral)
- medical management (steeple sign)
- airway narrows at top
-nursing management: teaching
- supportive mainly
- hydration
- IVF
- O2
-Epinephrine…vasoconstriction will reduce edema and decrease inflammation
Epiglottitis
- obstruction (SUPRAglottic)
- cherry red edematous epiglottis
- usually caused by Haemophilus influenzae (H.Flu) (bacteria)
- HIB vaccine
Clinical Manifestations of Epiglottitis
- dyspnea
- dysphonia
- stridor aggravated when supine
- drooling
- high fever
- toxic appearance
- froglike croaking sound
- agitated/apprehensive
- tripod sitting
-safety alert: can develop quickly (6 hrs) have intubation ready
At risk for epiglottitis
- 2 to 8 year olds
- teaching: vaccination (HIB vaccine)
- tx: AB 12-24 hr for improvement
- O2 if needed, limit activity, hydration
Respiratory Syncytial Virus/ Bronchiolitis
-inflammation and obstruction of bronchioles
Who is at highest risk for Respiratory Syncytial Virus/ Bronchiolitis
- under 2 years
- chronic lung disease
- congenital heart disease
- preterm, less than 35 wks
Clinical Manifestations of Respiratory Syncytial Virus/ Bronchiolitis
- rhinorrhea
- increased cough and wheezing
- tachypnea
- unstable O2 sats
- full of snot, rhonchi and wheezing
*Begins as URI
Diagnosis of Respiratory Syncytial Virus/ Bronchiolitis
- Rhinorrhea
- increasing respiratory distress
- chest x-ray
- **positive RSV swab of nasopharyngeal seretions
-can cause pneumonia
Treatment of Respiratory Syncytial Virus/ Bronchiolitis
-ribavirin aerosol (controversial)
- RSV immunoglobulin (Synagis) *prevention not treatment
- can’t use AB
- only for high risk (PT, lung dz, less than 2)
-given every 28-30days
Pulmonary Dysfunctions not caused by infectious agents
- foreign body aspiration
- asthma
- cystic fibrosis
Foreign Body Aspiration
- symptoms: choking, cyanotic, can’t talk, cough
- heimlich and back blows (less than 1 yr)
- bronchoscopy
- teaching
- lay on side
- monitor for breathing
- wait for swallow and gag reflex to come back
Asthma
- reactive airway disease: for kids less than 3 happens only when sick
- pathophysiology: chronic inflammatory disorder of airways
- classification for children 5 years and older
Primary Prevention: Whos ar risk?
- infants
- usually starts between 3-8 years
- atopy (allergies)
- ALLERGY TRIAD: asthma, eczema, rhinitis
- complex disorder
- genetic predisposition
Cystic Fibrosis
- autosomal recessive trait
- exocrine gland dysfunction that produces multisystem involvement
- mutated gene on chromosome 7
- greatest effect in lung
Pathophysiology of CF
- CFTR: cystic fibrosis transmembrane regulator
- abnormal chloride movement leads to increased viscosity of mucous gland secretion
Diagnosis of CF
- history
- quantitative sweat chloride test
- chest xray
- stool fat and/or enzyme analysis
- salty sweat
Goals of CF
- prevent/minimize pulmonary complications
- adequate nutrition for growth
- assist in adapting to chronic illness
Signs of distress
- increased RR
- retractions
- head bobbing
Clinical Manifestations of Mild distress and initial signs of failure (compensating)
- increased HR
- increased RR
Clinical Manifestations of moderate distress/early decompensation
- retractions
- nasal flaring
- anxiety
- irritability
- head bobbing
- grunting
Clinical Manifestations of severe distress/imminent failure or arrest
- cyanosis
- bradycardia
- apnea
Nursing care of RSV/Bronchiolitis
- nutrition, hydration, small and frequent feeds
- handwashing to prevent spread
- duration of illness lasts 3-4 days peak 3-4 days
Goal of asthma treatment
- open airway
- symptoms helped with meds
- decrease of attacks
- chronic remodeling and changes in airways
Short term asthma meds
- bronchodilator (albuterol)
- ipotropium bromide
- corticosteroids
- IV Mag (bronchodilator)
Long term asthma meds
- advair (combo med)
- long acting bronchodilators
- allergy med (singulair)
- NSAID
- cromolyn sodium
Secondary Prevention of Asthma
- MDI: younger kids
- aerochamber/spacer: take 6 breaths in and out
- nebulizer: easiest to use for child
Peak flow meters
shows how well they are
- establish personal best
- blow into
- shows if they are getting worse
Oxygenation assessment for CF: Bronchi
- chronic pneumonia
- generalized obstructive emphysema
- clubbing
- infections
**isolation
Collaborative care for CF
- prevent colonization of pathogens and move secretions
- aerosol: bronchodilators
- daily CPT/PD
- flutter valve (PEP therapy, vibrating vests
- AB
- resp tx is given before food because they get nauseated from tx
Elimination assessment for CF
- meconium illeus
- bowel obstruction
Nutrition assessment for CF
- pancreatic ducts: malabsorption and fibrosis, eventual CFRD
- bile ducts: decreased bile, decreased ADEK, portal HTN
CF Tx
- ursodiol/actigall
- supplemental tube feedings
- ADEK vitamins
- increase calories and protein
- insulin?
- *Pancreatic enzymes
-ursodiol/actigal
improves bile flow and prevents gallstones
pancreatic enzymes
- take with meals/snacks
- can open capsule and sprinkle on food
- enzyme can burn, irrtate teeth and mouth
- take as directed
Alternative to IS
- blowing bubble
- pin wheel
- blowing out birthday candles
