Respiratory Assessment Flashcards
What are the physiological differences in the respiratory system in children?
Lungs are smaller
Muscles they use are slightly different
Fewer alveoli sacs
Immature ribcage
Risk of inhalation
Respiratory rate is higher
Airway (larynx high in neck, epiglottis long and rests against soft plate, less head tilt to open airway)
Large tongue in relation to jaw size (could cause obstruction is child is unconscious, children with down’s syndrome have larger tongues)
Funnel shape - narrowest point at cricoid cartilage
Small diameter of airway - easily blocked by secretions or blood, thickened mucus may obstruct which is why children have lots of chest infections
What are the differences in childrens breathing?
Small children are dependent on contraction of the diaphragm to breathe, means they are more easily fatigued and ribs are more horizontally inserted, which contributes less to chest expansion
Child’s ribcage and sternum are cartilaginous and elastic and are therefore prone to recession
A child’s primary response to respiratory distress is to increase in respiratory rate and effort of breathing, which can cause hypoxia and tachypnoea
Children can’t take a big deep breath and adjust the tidal volume
What is hypoxia?
Low oxygen in tissues
What is tachypnoea?
Fast, shallowing breathing due to low oxygen in tissues
What are the implications of the physiological differences?
Smaller upper and lower airways
Compliant chest wall
Relatively inefficient respiratory muscle
Susceptibility to infection
What may be the main compromises in children with a respiratory disease?
Colour, nasal flaring, grunting, head bobbing, recession, accessory muscle use, position, facial expression, wheeze or stridor
What are the 3 E’s?
Effort - how much effort is the child putting in to breathe (regular or irregular breathing, prolonged expirations, one sided chest)
Efficacy - efficacy of their breathing, chest expansion and air entry (air entry, measure saturations)
Effect - what effect does this have on the body (breathless, colour, rate)
Explain how we assess a respiratory assessment.
Use the AB part of ABCDE, prioritise care and instigate interventions as appropriate, consider all elements of the respiratory system, and always document trends and what happens. Observe the child (colour, position, behaviour), hear the child (airway and breathing sounds), fell the child (skin temp and hydration), count the child (respiratory rates). Also consider the 3 E’s and assess the child on that.
What is irregular breathing normal in?
Respiratory conditions, neonates/infants, head injuries, pain and metabolic disorders
What condition is prolonged expirations normal in?
Asthma
What condition may have a one sided chest rise when breathing?
Pneumothorax
How do babies breathe?
Only through their nose, they can breathe through the mouth but its a struggle
What may a child in distress use to exert a greater effort to breathe?
Tachypnoea and tachycardia
Increased work of breathing
Use of accessory muscles
Alter position
Coughing
What is the outcome if a child using a greater effort to breathe is left?
Reduced respiratory effort
Hypoxia
Apnoea and bradycardia
Medical emergency
What are common upper airway respiratory conditions?
Croup, epiglottitis, foreign body (inhalation/obstruction), stridor
