Respiratory assessment Flashcards
Which lung has the most lubes?
Right lung has three lobes
Left only has two
What are the differences in the airways of respiratory systems in childhood?
- Birth/Infancy - larynx high in neck with cricoid C3/C4. - this is normally where an airway is placed and prone to breakage as its made of thin cartilage.
- Epiglottis - long and rests against the soft palate so is prone to collapse (so should never use a tongue compressor when examining in case of collapse)
- Less head tilt to open the airway (when unconcious head falls so must place in neutral position if too far back then airway resicted)
- Large tongue related to jaw size (obstruction when unconcious especially down syndrome even bigger tongue)
- Funnel shaped - narrow at cricoid cartilage (straighten as growing and is narrowest at vocal cords)
- Small diameter of airway.
What are the differences in the breathing of respiratory systems in childhood?
- Alveoli development - always there but closed as a turn over time - 20 million at birth then 300-400 million at 18 months
- breathing using diaphragm
- Dependant on contractions of diaphragm to breath (independant at 28 weeks) (makes children fatigue as less twitch fibres and ribs horizontally inserted contributing to less chest expansion)
- Rib cage and sternum - cartilaginous and compliant (elastic) prone to recession (bendy rib cage not solid)
- Primary response to distress increases rate and effort of breathing - hypoxia - tachypnoea ( not change their tidal volume not change amount of air being breathed)
What are the implications of the physiological differences in children’s respiratory system?
- Smaller upper and lower airways - block movement of mucus and reduce coughing (prone to infection as airways swell and reduce diameter)
- Compliant chest wall
- Relatively inefficient respiratory muscle (less energy so gives up more quickly)
- susceptibility to infection - linked to smaller upper and lower airways
- position of other organs - heart and stomach (common vomiting as diaphragm hits stomach) and liver (grows at infancy to remove mothers blood)
What to consider when child presented in health setting?
- Upper thoracic differences
- nose to trachea (chocking is common as baby can’t suck swallow or breath as crying can’t breath through nose)
What are some indicators of respiratory compromise in children?
- tachypnoea and tachycardia
- Colour (palembang dark around area, motalling (lips is late flag already quite developed)
- Nasal flaring
- Tracheal tug
- Grunting
- Head bobbing (open airways)
- recession (0-6 years before ribs develop)
- accessory organs use (arms/leg movement)
- position (pushed up or laying with bottom in air to straighten airway)
- Facial expression (fear)
- behaviour (worry if push mum away as don’t know who mum is)
- Audible noises - wheeze or strider rasping noise
- Efficacy of breathing - 3Es - chest expansion and air entry bilaterally
ASK IF THIS IS NORMAL BEHAVIOUR!
What ate the 3Es of efficacy of breathing?
- Effort - how hard are they working
- Efficiency - how efficient is the work they’re doing
- effect - what effect is this having?
Describe the structural respiratory assessment
- AB of ABCDE assessment - prioritise care and instigate interventions as appropriate (especially giving O2)
- Nose to diaphragm assessment considering link between systems
- Documentation of trends
- Assess - observe, hear, feel and count respiratory rate.
- Consider - palpations, percussion and auscultation
- Leave child where they are comfortable
- Breathing effort
- Breathing efficacy
- Breathing effect
What should you observe and assess during a structural physical assessment?
Colour
Position
Behaviour
Work of breathing
Wide eyes
What should you listen to during a respiratory structural assessment?
Airways and breathing sounds
Frequency
Pitch and sound
Ask their name and how old they are? - if can’t complete a sentence then be very worries
Crying
What should be felt for in a respiratory structural assessment?
Chest
Skin temperature
Hydration
lumps
altered shape
pain and tenderness
What are normal respiratory rate for newborns?
44 respirations per minute
Whats the normal respiratory rate for infants?
20-40 rests per minute
Whats the noraml respiratory rates of children (1-7 years)?
18-30 resps per minute
Whats the normal respiratory rate for adults (older than 7 years)?
12-20 resps per minute
