Respiratory and ABG's Flashcards
pH
7.35 - 7.45
PACO2
45-35
HCO3
22-26
Respiratory
PACO2
Metabolic
HCO3
Children chest shape
round - flattens with growth
Children lung capacity
alveoli # is diminished at birth
Children respiratory structurally….
supple and compliant. Retractions are common for infant through age 5. They are abdominal breathers.
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.
Increased CO2 levels in children….
-are toxic. S/S are increased restlessness and solemnance.
W.O.B.
work of breathing
Clubbing
only seen with chronic hypoxia
Retractions
intercostal suprasternal clavicular substernal subcostal
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.**
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
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
