respiratory assessment (1) Flashcards
what do most respiratory problems in children look like?
mild, short, managed at home
what kind of problems involve alterations in the size and shape of parts of the respiratory tract
structural problems
what kind of problems involve alterations in gas exchange and threats to gas exchange (irritants and invaders)
functional problems
what is the infection rate like in kids less than 3 months old?
lower infection rate due to protective function of maternal antibodies (do a full work up)
what is a “full work up”
CBC, electrolytes, blood cultures, lumbar puncture (meningitis), urinalysis
describe resp infection rate at 3-6 months
infection rate increases due to disappearance of maternal antibodies and initiation of the production of the infants’ own antibodies (full work up)
describe resp infection rates at toddler/school age years
viral infection rate high (cough and touch)
why are peds at greater risk for airway obstruction?
shorter/narrow airway
what is the approximate size of an infant airway
4mm, size of a drinking straw
how big is the adult airway
20mm
how does the trachea grow during the first 5 years
in length rather than diameter (4mm)
newborns are obligatory nose breathers until how old
4 months
do infants 2-3 months old open mouth to breathe when nose is obstructed?
no
which parts of the resp system are bigger than others?
tongue and epiglottis (can cause obstructiob)
how many alveoli are there at birth and adulthood
birth= 25 million, not fully developed
adult= 300 million
at what age to alveoli increase in size and complexity
8 years old
at what age does the infant have enough muscles to react to irritants by bronchospasm and muscle contraction
5 months
how long are children diaphragmatic breathers?
6 years old
what are ribs like in pediatrics
mostly carilage
what do you visually assess in respiratory?
- symmetry of chest
- abdomen breathing
- color of skin
how long of not breathing classifies true apnea?
20 sec
normal respiratory rate of a child 1day-1 year old
30-60
what is the normal respiratory rate of a child 1 year-3 years old
24-40
what is the normal respiratory rate of a child 3 years-5 years
22-34
what is the normal respiratory rate of a child 5 years-12 years
18-30
what is the normal respiratory rate of a child 12 years and older
12-18
what do you assess for in respiratory palpation
deformities of chest wall and tactile fremitis
what part of the stethoscope do you use to listen
diaphragm
what parts of the lungs do you listen to anteriorly
upper and middle lobes
what parts of the lungs to you lsiten to posteriorly
upper and lower lobes
what are low pitched, swishing, soft expiratory sounds heard in older children
vesicular
What are medium pitched, hollow, blowing breath sounds that are heard equally on inspiration and expiration, heard in all ages
Bronchovesicular
What are hollow and higher pitched breath sounds than vesicular
Bronchial/tracheal
what is a normal pulse ox for children?
95-98
What can a change in muscle tone, becoming floppy, mean?
Hypoxia
What kind of sounds are from the lower airway, are heard at the end of inspiration, and is air passing through secretions in alveoli and bronchials
Fine crackles
What is a musical squeaking or hissing noise that is continuously heard during inspiration or expiration: louder on expiration. It is a Bronchospasm or anatomic narrowing of the bronchials
Wheeze
what is a coarse low pitched noise that sounds like a snore that is air passing through thick secretions that partially obstruct the larger bronchi and trachea
Sonorous rhonchi
what is a high pitched inspiratory crowing sound that originates in the layrynx or trachea. From Upper Airway Obstruction from swollen inflamed or lodged foreign body. Croup or epiglottis
Stridor
What are tight breath sounds?
High pitched or squeaking sounds. small Airways have more constriction
What are diminished or absent breath sounds
When the Airways become completely closed or almost closed
what is the sinking in of soft tissues relative to the cartilaginous and bony thorax
retractions
what retractions are below the ribcage “using abdominal muscles”
subcostals
what retractions are below the sternum
substernal
what retractions are between the ribs (anterior and posterior)
intercostals
what retractions are above the sternum
suprasternal
what retractions are above the clavicles
supraclavicular
which retractions indicate mild distress?
subcostal, substernal, mild intercostal
which retractions indicate moderate distress
subcostal, substernal, moderate intercostal
which retractions indicate severe distress?
subcostal, substernal, severe intercostal, suprasternal, supraclavicular
what is enlargement of the nostrils that helps reduce nasal resistance and maintain airway patency
nasal flaring
what does nasal flaring indicate?
severe distress
what does head bobbing indicate
severe distress
what does grunting indicate?
severe distress
what color changes indicate distress?
mottling, pallor, gray, cyanosis
when assessing a 4 year olds chest the nurse would expect:
a) movement of the chest wall to be symmetrical bilaterally and coordinated with breathing
b) respiratory movement to be throacic
c) anteroposterior diameter to be equal to the transverse diameter
d) retraction of the muscles between the ribs on respiratory movement
A
of the following respiratory system structures which one does not distribute air?
a) bronchiole
b) alveolus
c) bronchus
d) trachea
b) alveolus
the infant primarily relies on
a) mouth breathing
b) intercostal muscles for breathing
c) diaphragmatic abdominal breathing
d) all
c) diaphragmatic abdominal breathing
room air is what percent oxygen?
21%
what is the best way to stimualte deep breathing in a child
use games to extend expiratory time and pressure
what is an early and subtle sign of early hypoxia?
mood changes and restlessness
what is cardiac arrest in the pediatric population usually resulting from?
prolonged hypoxia
what is the cause of most respiratory infections in children
viruses
what is the reason that infection rate drastically increases in 3-6 months?
maternal antibodies have disappeared and the infants own antibody production is immature
