oxygenation: the pediatric patient Flashcards
PHYSIOLOGICAL DIFFERENCES BETWEEN CHILDREN AND ADULTS
- smaller and shorter airway
- larger tongue
- nose breathers
- belly/diagram breathers
- increased rate and effort
- retractions
- vagal nerve
- eustation tube
NORMAL RESPIRATORY RATES IN CHILDREN
INFANT (<1YR)
30-60
TODDLER(1-3)
24-40
PRESCHOOLER(4-5)
22-34
SCHOOL AGE (6-12) 18-30
ADOLESCENT
12-16
OXYGENATION ASSESSMENT GUIDELINES
- position of comfort
- vital signs
- respiratory effort
- lung auscultation
- color
- cough
- 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
CLINICAL MANIFESTATIONS OF RESPIRATORY DISTRESS AND FAILURE
- mild distress/initial signs of failure (compensating )
- moderate distress/early decompensation
- severe distress / imminent failure or arrest
GENERAL CARE STANDARDS
- oxygen /O2 sats
- CPT/PD and suction
- incentive spirometer
- saline nose drops
- antibiotics
- isolation
GENERAL CARE STANDARDS
- rest
- reduce fever
- hydration
- nutrition
- cough medications
- positioning
CATEGORIZATION OF RESPIRATORY TRACT INFECTIONS
- upper respiratory tract
- croup syndromes
- lower respiratory tract
UPPER RESPIRATORY TRACT INFECTION (URI)
- tonsillitis:GABHS
- tonsillitis and adenoidectomy
- safety education
URI: OTITIS MEDIA
-immobile , red or yellow, bulging TM
- symptoms
otalgia
fever
otorrhea
crying
fussy
tendency to pull or rub ear
rolls head from side to side
OTITIS MEDIA
therapeutic management
- high dose amoxicillin
- myringotomy , tympanoplasty/PE tubes
-teaching and nursing care management
CROUP SYNDROMES
general term for a group of symptoms characterized by:
- barking/brassy or seal like cough
- inspiratory stridor
- respiratory distress
- swelling /obstruction in the region of the larynx
Includes:
- laryngotracheobronchitits(LTB) : subglottic
- epiglottis :supraglottic
LARYNGOTRACHEOBRONCHITIS
- obstruction (subglottic)
- slower onset, URI symptoms lead to cough and hoarseness
- medical management “steeple sign”
- nursing management : teaching
EPIGLOTTITIS
- obstruction (supraglottic)
- cherry red edematous epiglottis
- usually caused by haemophilus influenza (H.Flu)
EPIGLOTTITIS CLINICAL MANIFESTATIONS
- dysphagia
- dysphonia
- stridor aggrevated when supine
- drooling
- high fever
- toxic appearance
- froglike croaking sound
- agitated/apprehensive
- tripod sitting
SAFETY ALERT
EPIGLOTTITIS CONTINUED
at risk :
- 2-4 yrs old
- teaching vaccination
medical management
- diagnosis
- treatment
Nursing teaching
RESPIRATORY SYNCYTIAL VIRUS / BRONCHIOLITIS
- inflammation and obstruction of bronchioles
- Highest risk :
- less than 2 yrs
- chronic lung disease
- congenital lung disease
- preterm, less than 35 weeks
CLINICAL MANIFESTATIONS
- rhinorrhea
- increased cough and wheezing
- tachypnea
- unstable O2 stats
Begins as URI
DIAGNOSIS
- rhinorrhea
- increasing respiratory distress
- chest x ray
- positive RSV swab of nasopharyngeal secretions
TREATMENT
-ribavirin aerosol (controversial)
- RSV immunoglobulin (synagis)
prevention
Nursing care
EBP article
question 1
PULMONARY DYSFUNCTIONS NOT CAUSED BY INFECTIOUS AGENTS
- foreign body aspiration
- asthma
- cystic fibrosis
FOREIGN BODY ASPIRATION
- symptoms
- Heimlich and back blows
- bronchoscopy
nursing care
teaching
ASTHMA
-reactive airway disease
-pathophysiology :
chronic inflammatory disorder of airways
-classification for children 5 years and older
ASTHMA CONTINUED
PRIMARY PREVENTION who's at risk -infants -usually starts between 3 and 8 yrs -atopy (allegies) - complex disorder -genetic predisposition
MEDICATION
MDI
aerochamber/spacer
nebulizer
CYSTIC FIBROSIS
- autosomal recessive trait
- exocrine gland dysfunction that produces multisystem involvement
- mutated gene on chromosome 7
CF PATHOPYSIOLOGY
CFTR: cystic fibrosis transmembrane regulator
- abnormal chloride movement
-increased viscosity of mucus gland secretion
CF DIAGNOSIS
- history
- quantitative sweat chloride test (>60 is diagnostic)
- chest x ray
- stool fat and or enzyme analysis
CF GOALS
- prevent/ minimize pulmonary complications
- adequate nutrition for growth
- assist in adapting to chronic illness
AREAS FRO ASSESSMENT IN CF
NUTRITION
pancreatic ducts
bile ducts
SEXUALITY
OXYGENATION
lungs
ELIMINATION/NUTRITION
small intestine
coping and adaption
COLLABORATIVE CARE
-prevent colonization of pathogens and move secreations
-aerosol : bronchodilators, and pulmozyme /DNase
- daily CPT/PD
flutter valve (PEP therapy), vibrating vests
-antibotics
NUTRITION
pancreatic ducts
- malabsorption
- fibrosis eventual CFRD
Bile Ducts
- decreased bile
- decreased ADEK
- portal hypertension
TREATMENT FOR CF
- ursodiol/actigall
- supplemental tube feedings
- ADEK vitamin
- increase calories and protein
- insulin
PATIENT CETERED CARE
- therapy at home
- prognosis
- lung transplant
- CF foundation
- family support
COMMON NURSING DIAGNOSIS FOR CHILDREN WITH RESPIRATORY SYMPTOMS
- ineffective airway clearance
- impaired gas exchange
- ineffective breathing pattern
- activity intolerance
- fluid volume deficeit
- fear/anxiety
- risk for spread of infection
