Respiration Flashcards
Infants chest?
- Occupies 1/3 trunk
- Triangle shape — narrow upper chest
- Lower ribs flare
- Ribs horizontal with narrow spaces for stability
- Diaphragm minimal dome shape and moves inferiority
- Accessory muscles are ineffective except upper traps
Adult chest?
- Occupies 1/2 trunk
- Rectangle shape — upper chest is wider
- No flaring
- Downward rotation, wider intercostal spacing for mobility
- Diaphragm is done shaped and moves in all three planes
- All accessory muscles function while breathing
When does a child’s rib cage look most like an adult
7-8 years old
What are you assessing during your subjective observation
Postural alignment
Skin
Respiratory pattern
What muscles are working/any imbalances
Children with CP often have…
Elevated chest — can’t integrate abdominals to bring rib cage down
Flattened anterior chest
Rib Flaring
Small intercostal spaces
Children with hypotonia, like DS, have what kind of characteristic in their chest?
Rib flaring
What does a blueish tint around the mouth indicate?
Cyanosis - poor oxygen exchange.
Huge red flag — contact pediatrician
Abdominal breathing occurs?
Babies! Until about 6 months old.
Abdominal thoracic breathing occurs?
Starts around 6-8 months when the child can sit up against gravity, actively rotate and extend trunk.
What are some adult breathing patterns?
Chest dominant
Abdominal dominant
Balance/equal
Ant/lat/post chest
Why would a child wear an abdominal binder?
To optimize muscle function for postural demands.
When should you take the child’s heart rate?
After child has sat quietly for 5 minutes for resting HR
Take during last 10 seconds of walking to get active HR
HR has been shown to be an accurate and convenient estimate of energy expenditure. There is a linear relationship between HR and O2 uptake during walking for normal children and children with CP
What are the average HRs throughout childhood?
Premature infant — 120-180bpm
Newborn — 120-160 bpm
Infant — 100-140 bpm
Child — 80-120 bpm
What are average respiratory rates throughout childhood
Premature infant - 60-80 breathes per min
Newborn - 40 breathes per min
Infant - 30-40 breathes per min
Child - 25-30 breathes per min
Can we work on expiratory and inspiratory volume with children?
Sure can
What is the number of syllabus pronounces per breath?
8-10 syllable phrases
How long should a timed “ah” or “oh” normally take during a controlled exhalation
10-12 seconds
How do we assess coughing?
- See if they can cough
- Note the quality and strength of cough // if they can even do it
- Do we see the three phases?
What are the 3 phases of a couch
Inhalation
Thoracic pressure (hold)
Quick exhalation (forced out)
How do you do the cough assist in sitting
Stand behind patient
Hands are on both sides of ribs
rotational component
Look up and over right shoulder and rotate down and opposite so down and to the left.
go in both directions
How do you do cough assist in side lying?
still aiming for that rotational component
1. Stand at their bottom and face their head
2. Hands on the ribs to help with the expulsion and pressure forward to clear the lungs.
3. Stabilize the pelvis.
4. Inhale - rotate back - come forward and cough pushing down and in to help with the cough.
*want the rotation to come from thoracic spine.
What are the developmental considerations when examining thoracic expansion?
Younger kids will have more movement in their belly. As child gets older you will see more and more involvement of their chest.
*measuring chest expansion is a really good thing to see on prognosis notes for any changes in their breathing patterns.
Where do you measure chest expansion?
- Axila
- Xiphoid
- Lowest rib — halfway between xiphoid and umbilicus
tape measure wrapped around their back and crossed over in front of them at each landmark. Look at 10 breaths and take an average. Then look at 3 deep breaths and take that average.
What are some ways to measure respiratory endurance?
Treadmill
Bike
6MWT
TUDST
HR
EEI
Fx measures
