paediatric ITU Flashcards
pads
consider attention span / co-operation
patient therapist interaction is difference vs adults
communication syle
consider family /carer
physiological difference
between adult and child
increased compliance in chest wall
decreased compliance in lungs
meaning decreased FRC and increased work of breathing
decreased % of T1 muscle fibres in diaphragm
diaphragm more prone to fatigue –> less able to withstand respiratory distress
increased metabolic rate ov O2 consumption
–> hypoxaemia develops more rapidly
preferential ventilation of upper lung when positioned in side lying
ensure SaO2 maintenance when repositioning
anatomical difference
decrease d of airways
increase ariway resistance
increase respiratory difficulties with any inflammation of airways
preferential nasal breathers
NG tubes
narrow d and increase WOB
ensure nasal passages are cleared of secretions
larger tonsils and tongue
increase airway obstruction
floppy cartilage
predisposes to airway collapse
more horizontal ribs and more cylindrical
lack of bucket handle and pump handle movement, unable to increase lung volumes
poorly developed intercostal muscles
nearly solely reliant on diaphragm for respiration
immature cilia
increased accumulation of secretions, mucus plugging
decreased alveolar surface area
decreased space for gas exchange
increased heart size in infants
less room for lung expansion
poor collateral ventilation in infancy
increased risk of atelectasis during RTI
collateral ventilation
Adults have a developed respiratory system therefore more collateral ventilation
Functional in paediatrics:
Pores of Kohn: 1-2 years (intra aveolar)
Canals of Lambert: 4-6 years (Bronchiol-aveolar)
Channels of Martin: Develop in pathology (Interbronchial)
ITU assessment
NB Respiratory +/- neurological if appropriate depending on PC Subjective Assessment Objective Assessment Problem List Treatment Plan Goals
subjective assessment in ITU
Presenting complaint
History of presenting complaint
Past medical history
Respiratory (normal chest status)
Orthopaedic (spinal deformities)
Neurological (reduced cough, risk of aspiration)
Bone health (osteopenia, osteoporosis)
Seek information from parents/carers if present
Information from staff nurse/ medical staff /ICIP including update on medical /nursing status
Tolerance of interventions / handling over last 12 – 24 hours
subjective assessment
birth history
Birth history
Particularly relevant for neonates and children with post natal problems
Method of delivery (immediate delivery, trauma)
Gestation and weight (lung development)
? SCBU (length of time, ventilation, oxygen requirements)
Chronic lung disease
subjective assessment developmental history family history medications other considerations
Developmental History Normal level of cognition and functioning Local service, specialised equipment used Family history Parents and siblings fit and well? Smokers, pets at home? Recent travel? Genetics Parental responsibility Child protections issues medications at home nebulisers patch - hyoscine order of medications Pain relief, sedation due? How does the child respond to handling? Apnoeas? Bradycardias? When was the last feed? Can the child cooperate? What is the parents’ understanding? Consent for respiratory treatment
objective assessment
observation Environment in ITU (Emergency bell, trolley, MIE set, suction) Your patient: Breathing pattern Colour (pink, pale, cyanosed) Level of alertness Are they puffy periorbitally, peripherally Position Lines: ETT, arterial line, catheter
ventilation
is the patient intubated and ventilated
nasally vs oral
what ventilation mode is the patient on
ventilation modes
vitals
Main modes in ICU: SIMV(PC)+PS PRVC CPAP+PS (weaning mode) HFOV NIV (CPAP+BiPAP)
Aim TV’s 6-8mls/kg
4-6mls/kg in adults
baseline vitals from subjective exam if known respiratory pathology neuro GCS temp HR RR BP SaO2 CRT PEWS
objective assessment
auscultation
palpation
expansion
auscultation air entry added sounds: creps wheeze stridor if extubated
palpation
any palpable remits
expansion
signs of respiratory distress
/WOB
tachypnoea nasal flare tracheal tug recession - intercostal, subcostal, substernal mild moderate severe grunting paradoxical breathing preparation and tense sternal retraction intercostal retractions
cough
if known respiratory condition may have an objective PCF measurement
if cough is strong or weak effective, dry or wet
chest x-ray considerations
position of ETT if intubated exposure and rotation of x-ray chest shape bones lung fields NG tube placement compare to previous if appropriate
blood
white cell count
Hb
platelets
CRP
