resp part 1 Flashcards
describe resp problems in children
- most produce mild symptoms, last a short time, and can be managed at home
- nurses need to assess current resp status quickly, monitor progress and anticipate potential complications
resp problems may result from structural probs, functional probs, or a combo. whats the difference between structural and functional probs?
structural: alterations in size and shape of part of the resp tract
functional: alterations in gas exchange and threats to gas exchange, can be due to irritants or invaders
whats the most common cause of resp infections in children
viruses
alterations in immune or neurologic function puts children at a higher risk of…
resp function compromise
describe infection rate in birth-3mo of age and what do we do if they have one
lower infection rate due to protective function of maternal antibodies
they get a full work up including CBC, electrolyte panel, blood cultures, urine cultures, and lumbar puncture to determine if they are septic, also get a resp swab
describe infection rate in children 3-6months of age
- infection rate increases due to disappearanc of maternal antibodies and initiation of the production of the infants own antibodies
- theres a little gap in protection
- they get a resp swab and a full or partial workup
describe infection rate in toddler/preschool years
viral infection rate is high
bc they have no sense of hygiene and theyre dirty and snotty and share it with everyone around them
describe the upper airway in newborns
- until 4 weeks of age, they are obligatory nose breathers
- only breathe through their mouths when theyre crying
- newborns do not know to voluntarily open their mouths to breath breathe when their nose is occluded
- nasal patency is essential for beathing and eating
- frequently require nsasal suctioning
describe differences kids have to adults with their resp systems
- lots of stuff is immatre/shorter/flabby so theres a lot of opportunity for obstruction and aspiration
- must be careful with neck and head positioning
- newborns dont have enough smooth muscle to stop irritants
- children are diaphragmatic breathers until about 6
- chest wall is less rigid
- if a child is in resp ditress you will most likely see retractions due to immaturity of the intercostal muscles
describe the airway of the infant
- diameter is much smaller so swelling takes away a lot of it when compared with swelling in adults
- speed of breathing, irritations/swelling, mucus/secretions all contribute to increasing airway resistance and making breathing harder for the little guys
whats included in the general resp assessment
- pulse ox
- cardiac resp monitor
- change in muscle tone
- behavior
- color
- LOC
is acute resp distress generally reversible?
yep
what is the most common cause of cardiac arrest in kids?
chronic hypoxia
describe using resp monitors with kids
- must validate findings by manually taking HR and RR and comparing
- initial prioirity is to assess patient if alarm is sounding then determine if its the patient or equipment that needs attention
describe what change in muscle tone may occur with resp compromise
- infants may become floppy
- older kids become limp with a lack of energy
what are some different changes in LOC that may occur with resp compromise
- irritability and confusion: early signs of hypoxia
- agitation: difficult to console or more easily bothered
- lethargy: decrease in LOC and indicates resp distress is worsening
what are some things to remember when assessing resp rate
- can use abdominal rise and fall for kids under 6
- use chest rise and fall for >6
- can also feel raise w hand on adb or chest or auscultate
- listen for 30secs then multiply by 2
what things are included in the focused resp assessment
- resp rate
- resp effort
- air entry
- adventitious lung sounds
whats included in assessing resp effort
- nasal flaring: helps to reduce nasal resistance and maintain patency
- retractions
- tracheal tug
- head bobbing
- grunting on exhalation
what do tight breath sounds indicate
small airay has severe bronchoconstriction
typically heard after wheezes
what do diminished breath sounds indicate
reduced air flow
what retractions indicate mild distress
- isolated intercostal
- sternal
what retractions indicate increasing distress
substernal and subcostal
what retractions indicate severe distress
suprasternal and supraclavicular
tracheal tugging
what is tracheal tugging
retractions on an inward puling movement of the trachea
name that adventitious breath sound!
- high pitched, inspiratory crowing sound
- originates in larynx or trachea
- upper airway obstruction
stridor
name that adventitious breath sound!
- course low pitched noise, sounds like a snore
- air passing through thick secretions that partially obstruct bronchi and trachea
- upper airway sound
rhonchi
name that adventitious breath sound!
- muscial squeaking or hissing
- caused by bronchospasm or anatomic narroing of bronchioles
- heard continuously through inspiration and expiration (typically louder on expiration)
wheeze
name that adventitious breath sound!
- heard on end of inspiration
- air passing through secretions in alveoli and bronchioles
- lower airway sound
crackles
whats included in care management of the resp system
- ease respiratory effort
- promote rest and comfort
- prevent spread of infection
- reduce temperature
- promote hydration
- provide nutrition
- provide family support and home care education
what are some ways you can easy resp effort and promote rest and comfort
- positioning to maintain patent airway
- elevating head/holding upright
- nasal suctioning
- apply supplemental O2 as ordered
why would you want to reduce body temp
fevers cause increase in metabolic demand and resp rate
what fam teaching would you want to provide for home care of resp issues
- teach infection prevention
- nasal suctioning
- signs and symptoms of worsening distress
