Pediatric Respiratory Flashcards
Respiratory Distress s/s
increased RR
accessory muscle use
intercostal recessions
subcostal recessions
nasal flaring
head bobbing
cyanosis
abnormal airway noises
lung resistance
determined by airway size, smaller = more resistance / larger = less resistance
lung compliance
measurement of how much lungs can expand
tachypnea < 2 months
> 60 breaths
tachypnea 2-12 months
> 50 breaths
tachypnea 1-5 years
> 40 breaths
tachypnea 6-12 years
> 30 breaths
tachypnea 12 + years
> 20 breaths
pH level
7.35 - 7.45`
PaO2 level
75 - 100 mmHg
PaCO2 level
35 - 45 mmHg
SaO2 level
94 - 100%
HCO3 level
22 - 26 mEq / L
pH LESS than 7.35
acidic pH
PaCO2 MORE than 45
acidic level
HCO3 LESS than 22
acidic level
HCO3 MORE than 26
alkalosis level
ROME
respiratory
opposite
metabolic
equal
Respiratory Acidosis levels
pH is < 7.35
PaCO2 > 45
Respiratory Alkalosis levels
pH is > 7.45
PaCO2 < 35
Metabolic Acidosis level
pH is < 7.35
HCO3 < 22
Metabolic Alkalosis levels
pH > 7.45
HCO3 > 26
compensated
pH is NORMAL
PaCo2 and HCO3 are ABNORMAL
partially compensated
pH is ABNORMAL
PaCO2 and HCO3 are ABNORMAL
uncompensated
pH is ABNORMAL
PaCO2 is ABNORMAL
or
HCO3 is ABNORMAL
stridor
seen with croup
Croup s/s
bark like cough
hoarse voice
dehydration
fever
rhinorrhea
stridor on inspiration!!!
racemic epinephrine
medication used commonly with croup
racemic epinephrine SE
patients often rebound after taking this medication
- if given more than 3x = automatic hospital admission
early s/s of Respiratory Failure
pallor
tachycardia
tachypnea
anxious
irritability
delayed capillary refill!!!
late s/s of Respiratory Failure
hypotension
cyanosis
apnea
prolonged apnea periods
> 20 seconds
Respiratory Failure intervention
immediately give pressurized O2
Respiratory failure management
recognize apnea > 20 seconds
max out vents and O2
treat underlying cause
obstructive respiratory failure
laryngospasm
CF
COPD
asthma
restrictive Respiratory Failure
scoliosis
pneumothorax
signs of shock
tachycardia and delayed capillary refill
smaller blood volume
leads to hypovolemia and impaired perfusion
decrease BP
always a late sign of something going wrong
-resp failure or shock
post respiratory arrest
give O2
check perfusion
neuro care
temperature management
electrolyte
blood sugar
chronic respiratory disease
cystic fibrosis
bronchopulmonary dysplasia
cystic fibrosis
genetic disorder, overproduction of mucus throughout the body
cystic fibrosis picture
salty skin
delayed growth / poor weight gain
frail form
meconium ileus at birth
affects lungs and pancreas
CF pancreas
does not produce digestive / pancreatic enzymes
-mucus blocks the ducts not allowing enzyme production
salty skin CF
chloride is not being reabsorbed into the skin due to mucus blockage
CF digestive issues
cannot break down carbs / fat / protein
-common to have diabetes
CF calories
these must be 2x more than normal because breathing for them burns calories
CF treatment
only “treatment” is a lung transplant
CF medications
bronchodilators
muctolytic
antibiotics
NSAID
contraceptives !!
pancreatic replacement therapy
bronchodilators
albuterol
levalbuterol hydrochloride
opens airways and relax muscles
muctolytic
dornase alfa
hypertonic saline
thins / breaks up mucus allowing patients to cough it up!!!
-inhaled
antibiotics
varies, normally penicillin
-prophylaxis and oral
-tx breakthrough infections
NSAID
Ibuprofen
piroxicam
decrease pulmonary deterioration
improves FEV1
decrease lung infection reoccurance
contraceptives
oral, IM, IUD, rings, etc.
condition is genetic so females NEED to be on these
**pregnancy can decrease lung function
pancreatic enzyme replacement
replaces the pancreatic enzymes that are missing
-taken with every meal and snack!!!
other CF meds
proton pump inhibitor : GERD tx
stool softener : decrease constipation r/t mucus
corticosteroids : decrease inflammation with infection
education for pt with CF and constipation
encourage fluids!!
CF self image
have lots of meds
constant coughing
medical devices
nutritional deficit
CF independence concerns
vulnerable
loss of power
life shortening
no cure
limited peer interaction
what is important to remember about 2 CF patients
they CANNOT be near each other!!!
CF metabolic concerns
delayed puberty
delayed weight gain
delayed menarche
short stature
pulmonary toileting
using percussion / vibration vest
postural drainage
controlled coughing
hydration
vibration vest
used for CF patients, done at bedtime and 1-2 hours post meals
bronchopulmonary dysplasia
respiratory disorder in premature infants
-characterized by stiff lung tissue
**NO SURFACTANT
BPD treatment
high concentration O2 for weeks to years
-intubated immediately after birth BUT START LOW
INSURE
intubation
surfactant
extubation
BPD interventions
alleviate resp effort
ventilation = low setting
nutrition = fluid restriction
meds
intake / output
respiratory risk factors
air pollutants / quick temperature change - asthma, CF. BPD
malnutrition - CF
genetics - CF and BPD
trach diagnosis
cystic fibrosis
cerebral palsy
quadrapaligics
spinal muscle atrophy
cuffed trachs
direct airflow through airway tube into lungs
uncuffed trach tubes
should be used on children < 8 years
-cuffed causes extubation problems (laryngeal edema)
peds trach tubes
are flexible to allow for movement with the patient
trach suctioning peds
only suction for 2-3 seconds (max 5)
sterile in hospital
keep tight around neck - only 1 finger between
trach home care
clean as possible
teach how to reinsert and suctioning
oxygen when needed
cap for speech
