Respiratory Assessment of the Pediatric Flashcards
Respiratory Assessment
Normal breathing in children is evidence by quiet inspiration and passive expiration at age appropriate rates
Normal heart rate is higher in younger children and decreases with age
Overserve movement of chest or abdomen
Chest or abdomen movement without breath sounds can indicate total airway obstruction and basic life support maneuvers are indicated
Stridor
- High pitched sounds heard on inspiration (stridor) often indicated of upper airway conditions whereas expiratory noises are more often associated with lower airway obstruction
- Causes of stridor can include
- Croup
- Foreign body aspiration
- Congenital or acquired airway abnormalities
- Allergic reaction
- Edema after a procedure
treatment fo Stridor
Inhaled epinephrinevia a nebulizer and intravenous steroids are common used t otreat stridor
Common Causes of Lower Airway Obstruction
Bronchiolitis and Asthma
Wheezing
When wheezing is noted inhaled bronchodilators are indicated
If the patient is able to use a metered dose inhaler (MDI) repeated inhalation can act quickly to imprve aeration
When a patient is unable to use a MDI appropriately or sever symptons are present deliver bronchodilators with a nebulizer
Nebulizer Treatment
More than one nebulizer treatment is needed to relieve airway inflatmmation. A common approach is to deliver 3 consectutive treatments
If a patient continues to be symptomatic continuous bronchodilators therapy may be delvered with a nebulizer attached to an infusion pump set to administer a bronchodilator continuously
Frequent reassessment of any patient reciveing continuous bronchodilator therapy is essential
Inhaled Bronchodilator Side Effects
Tachypnea secondary to beta 1 effect of inhaled bronchodiltos may occur
Heliox
Heliox an inhaled mixture of helium and O2is beneficial in case of some airway conditions in children
Head Bobbing
Head bobbing is noted by the chin up and neck extended during inspiration with chin falling during expiration and seesaw respiration indicted by chest retraction and abdomen expanding during inspiration is a sign of impending respirtory failure
Child Alertness
It is important to assess child’s level of alertness which can range from fully awake, agitated, minimally responsive, to unresponse
Whena child is minimally responsive or unresponsive children we nened to question their ability to protect their airway
Adolsecent (16-22 yr)
Normal RR and HR
16-22 breath/min
60-80 b/min
School Age (6-12 yr)
Normal RR and HR
18-30 breath/min
70-90 b/min
School Age (6-12 yr)
Normal RR and HR
18-30 breath/min
70-90 b/min
Preschooler (4-5 yr)
Normal RR and HR
22-34 breath/min
70-90 b/min
Toddler (1-3 yr)
Normal RR and HR
24-40 breath/min
80-100 b/min
Infants (<1 yr)
Normal RR and HR
30-60 breath/min
90-120 b/min
Goal of Oxygen Therapy
The goa of oxygen therapy is to provide adequate tissue oxygenation
Oxygen therapy is most frequently adjusted according to O2 saturataion levels
Oxygen Therapy and Oxygen Saturations
Infants and children recieveing O2 therapy will have variable o2 saturatio target ranges depending on age and underlying condition
Lower saturation levels are targeted in infants <32 weeks gestation as exposure to supplemental O2 in premature infants is a risk factor for the development of retinopathy of prematurity (ROP) which is cause through abnormal vascularization which in the most severe cases will lead to retinal detahemnt, babies <1500g are most susceptible
Oxygen Therapy and PPHN
Infants with PPHN should have a higher targetd saturation level in order to advoid pulmonary constrction associated with hypoxemia
Pre ductal saturation should be measure in order to get an indication in saturated blood beign delivered to the brain
Oxygen Therapy and Cardiac Anomalities
Newborns wil certain cardiac anomlaies are dpendant on intracardiac shunts and an increased saturation in newborns will promote the constriction of the ductus arteriosus
Hyperoxia can increase aortic pressure and systemic vascular resistance decreasing the cardiac index and O2 transport in children with acyanotic congenital heart disease
Air Entrainment Mask
Age: >/= 3
FiO2: High Flow 0.24-1
Advantages:
