Respiratory and ABG's Flashcards by Kirsten Love

7.35 - 7.45

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PACO2

45-35

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HCO3

22-26

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Respiratory

PACO2

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Metabolic

HCO3

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Children chest shape

round - flattens with growth

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Children lung capacity

alveoli # is diminished at birth

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Children respiratory structurally….

supple and compliant. Retractions are common for infant through age 5. They are abdominal breathers.

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Respiratory Rate in Children

as infant it is irregular
normalizes as they get older
O2 consumption is higher in proportion to their body size when compared to adults.

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Increased CO2 levels in children….

-are toxic. S/S are increased restlessness and solemnance.

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W.O.B.

work of breathing

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Clubbing

only seen with chronic hypoxia

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Retractions

intercostal
suprasternal
clavicular
substernal
subcostal

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Diagnostic Studies used for respiratory disorders

cbc/diff
abg
oximetry
bronchoscopy
ventilator scan
cxr
pft
throacentesis
sputum culture
nasal-pharyngeal swab
** when cbc shows low hgb, packed rbcs may be needed.**

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Methods of O2 delivery:

Hoods
Tents: wet, cold air. Change wet bedding, prevent chill
Nasal Cannula
Masks
NRB: can deliver up to 100% O2
Ventilators
ECMO: heart/lung machine. Seen with ARDs, meconium asperation

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Methods of Tx:

incentive spirometer
postural drainage aka pulmonary toileting
Aerosols: MDIs
Tracheostomy: 2-person procedure; 1 finger under the tie; xtra trach - 1 sm, 1 same size

Psychosocial Implications of respiratory illness

frightening to child and family
acute episodes and chronic stress
developmental needs must be met/maintained with optimal activity and exercise levels while still managing the respiratory problem.

Complications of strep

upper respiratory
acute rheumatic fever & acute glomerulonephritis
heart, joints, valves take a hit!
Tx: antibitoics for 10 days. (PCN, E-MYCIN)

Tonsillectomy

upper respiratory
no straws
no ibuprofen or ASA x 1 wk before surgery
removal of palatine tonsils
post op: cool liquids, no dairy, no suction, ice collar, no spicy foods, Tylenol 3
Monitor for bleeding (swallowing, tachycardia, pallor, emesis of frank blood)
Side lie position

Otitis Media

middle ear infection
decrease after age 5
small child’s anatomy is different. ET is short, straight, wide.
don’t let bottle deed in supine position
smoking in the house is also a trigger

Untreated ear infections can lead to:

hearing loss
meningitis
mastoiditis
perforated ear drum

Treatment of ear infections:

reduce pain and fever
antibiotics
myringotomy with tubes
adenoidectomy (pharyngeal tonsils)
hearing screening
eliminate tobacco smoke
feed infants in upright position

Myringotomy w/ tubes: avoid lake water, no diving, use ear plugs, don’t blow nose, tubes out does not constitute and emergency.

croup

is a term used to describe a symptom complex of acute respiratory manifestations:

seal bark cough
hoarseness
inspiratory stridor
respiratory distress from edema of laryngeal area

LTB

laryngeotracheo bronchitis

- is a viral infection of the larynx, trachea, and bronchi

Epiglottitis

is a bacterial infection of the epiglottis and surrounding area; potentially fatal - cherry red and swollen epiglottis - covered by H flu Croup: normally seen 3mos to 3 yrs, boys more than girls, Fall/Winter, follows URI.

LTB Physical findings

``` inspiratory stridor tachypnea tachycardia restlessness cyanosis retractions barky cough low-grade fever previous URI ```

Epiglottitis physical findings

``` high fever muffled voice sore throat difficulty swallowing excessive drooling refusal of food and fluids sniffing position breathing through mouth ```

Bronchitis

- lower airway - associated with URI, allergies, environment - persistent non-productive cough - more than 10 days suspect pneumonia

RSV

- respiratory syncytial virus bronchitis - acute viral infection - fall through winter - affects epithelial cells causing infiltration of the bronchi and bronchioles with mucous and exudate; varying degrees of obstruction

RSV Transmission

- through direct contact - RSV cases can room together - Respigam: RSV immunoglobulin given Nov-Apr - NP swab for ELISA test - TX: symptoms

Pneumonia

- lower respiratory tract - Viral (usually RSV) - Bacterial: lobar involvement, consolidation - Pneumococcal: immunize now - Foreign body aspiration: meconium, formula, objects, hydrocarbonds.

Asthma

an intermittent, reversible, obstructive disorder of the respiratory tract caused by bronchial smooth muscle constriction, mucosal edema, and excess mucous production.

Asthma Triggers

``` allergens weather changes URI irritants exercise emotions food/medications ```

Asthma medications

``` beta adrenergic agents corticosteroids chromalyn sodium serevent methylaxanthines MDI/nebulizer fluids ```

Bronchopulmonary Dysplasia (BPD)

immature lungs suffer barro trauma/injury prolonged ventilation is cause -defined as a chronic pulmonary disease that may develop in VLBW and premature infants, infants with PHTN, pneumonia and cyanotic heart disease.

CF defined

- multisystem disorder related to aberrant exocrine gland dysfunction - most common lethal genetic disorder among white children - 1 in 29 Caucasians are carriers - Life expectancy is 30 years - autosomal recessive 1: 4 to have it 2: 3 risk of carrying it - Lungs, pancreas, reproductive organs affected - Pancreas may auto-digest itself.

CF testing

- management is supportive - lung transplantation is possible - amalayxe, lipase, protease - Vit A, D, E, K - Fatty stools - Sweat chloride test - Males: sterile - Females: plugged/blocked cervix

S/S of pneumothorax

``` tachycardia pallor dyspnea cyanosis increased work of breathing ```