Paediatric respiratory care

Question 1

communication

Answer 1

got to communicate with child= the child, family/main caregiver, the MDT, assessment and treatment requires an age appropriate approach, can a baby drink their milk without getting breathless or spluttering? can a child keep up in sports/carry their bags to school?

Question 2

anatomical and physiological respiratory differences

Answer 2

up until the age of 3 the rib cage is soft and cartilaginous, rib cage is placed horizontally in relation to the sternum, poorly developed intercostal muscles (increased RR/ depth)

Question 3

airway differences

Answer 3

airway diameters are small and therefore increased airway resistance and WOB. less cartilaginous support of airways predisposes them to collapse, poorly developed vilia at birth increases risk of sputum retention, no collateral ventilation, less alveoli- reduced SA for gas exchange

Question 4

VQ and respiratory differences

Answer 4

V- distributed to the uppermost lung because of the soft ribcage, Q remains best in dependent region, FRC is sometimes below closing volumes due to complaint rib cage and immature respiratory control (increased risk of atelectasis, infants have higher resting metabolic rate and higher oxygen requirements, children have less type 1 muscle twitch fibres- fatigue

Question 5

extra subjective information

Answer 5

PMH- birth history as development of respiratory system may be abnormal.
SH-consent/family dynamics (main carer, consent child protection), FH- genetic illness?, progression of illness- speed of deterioration and or recovery

Question 6

additional information

Answer 6

feeding due to risk of coughing need to consider NG fee/vomiting and its affect on treatment
sleeping- need to sleep/rest regularly
IV/drugs- may affect your ability to move the child or be at risk if child moves

Question 7

extra objective assessment

Answer 7

be aware that babies find it difficult to control their temperature- shivering uses respiratory muscles and uses up oxygen. so care is needed when assessing- keep fatigued

Question 8

adaptations to objective assessment- observations

Answer 8

activity level- lifeless/passive/sleepy, irritable/agitated (sign of hypoxia), still and withdrawn could be severe respiratory distress, cyanosis/, mottling, pallor/sweaty, monitors/apnoea alarms, IVs

Question 9

adaptations to objective assessment- palpation and auscultation

Answer 9

palpation- tactile fremitus can be prominent
auscultation- be quick- heat loss, increased RR and reduced volume (difficult to hear), combine with palpation, move child around as secretions can be quiet but obvious when child is moved,

Question 10

adaptations to objective assessment- CXR

Answer 10

no control on inspiration, heart size is bigger (>50% diameter of chest), ribs= horizontal, humeral head may be cartilage and the epiphyseal plate may be evident, thymus on children <2 years old may be visible

Question 11

clinical signs of respiratory and cardiac distress

Answer 11

recession- intercostal, subcostal and sternal
abnormal breath sounds, tracheal tug, increased RR, expiratory grunting, stridor, nasa; flaring, cyanosis, head
cardiac= tachycardia and bradycardia, hypertension or hypotension

Question 12

clinical signs of other/general

Answer 12

neck extension, altered conscious level, sweating, pallor, head bobbing (accessory muscles), irritability/restlessness, reduced activity, reluctance to feed, headache, reduced cry

Question 13

paediatric treatment

Answer 13

always uses a combination of techniques, involve/inform carers, liit treatment times as child can tire quickly, make it fun- motivate the child, always have oxygen ready due to rapid deterioration T

Question 14

treatment techniques

Answer 14

mannual techniques, positioning/ postural drainage, breathing exercises, adjuncts, exercise/mobilisations, suction

Question 15

adaptations to treatment- mannual techniques

Answer 15

head supported throughout, with fingers/ tenting, monitor throughout, 15-30 secs, precautions same as adults, enough force to make them wobble

Question 16

adaptations to treatment- postural drainage

Answer 16

head down should be avoided as it facilitates GOR and splits diaphragm, use modified PD

Question 17

adaptations to treatment- breathing exercises

Answer 17

2 years olds may understand blowing which leads to larger breath in, blowing should be limited to near the child’s expiratory volume to prevent airway closure, children can be taught deep breathing and huffing at 5-6 years

Question 18

activities for a 3 year old to increase volume

Answer 18

laugh, play musical instrument, play with straw and ball, trampoline exercise, bubbles