Respiratory Disorders Flashcards
Explain why anatomic size is a significant variable in respiratory tract infection in a child.
- Chest relatively round at birth
- Thyroid, cricoid, tracheal cartilages immature
- Nasopharynx & nares smaller
- Ribs, diaphragm are more horizontal;
- abdominal breathing
- Fewer muscles functional in airway
- Small oral cavity; large tongue
- Long, floppy epiglottis
- Larynx & glottis higher in airway
- Large amounts of soft tissue along airway
- Chest wall is more pliable
- Lymph tissue grows rapidly in childhood
Describe the three types of respiratory insufficiency. (respiratory emergencies)
- Respiratory distress
- Increased work of breathing WITH adequate gas exchange
- Respiratory failure
- Inability to maintain adequate oxygenation
- Respiratory arrest
- Cessation of respiration
- What are the two lifesaving procedures a nurse should be able to implement to treat aspiration of a foreign body?
- Backslaps
- abdominal thrusts (heimlech)
(Suction, Expert consultation (Radiology studies; endoscopy)
Tracheostomy as needed)
Describe respiratory distress.
- Airway is open
- Tachypnea
- Increased respiratory effort
- Normal respiratory sounds possible
- Tachycardia
- Agitation
- Pale
What are the symptoms of a child in early respiratory distress and severe respiratory distress?
- Early
- Restless/Irritable
- Tachypnea/Tachycardia
- Infant/Child with RR >60 at risk for apnea secondary to ↑ CO2 & ↑ WOB
- Increased effort – retractions, nasal flaring, head bobbing, grunting
- Late
- Decrease in respiratory rate or irregular pattern
- Diminished breath sounds
- ↓ LOC (drowsiness)
- Skin color (cyanosis)
- Apnea/Bradycardia
What are early signs of respiratory distress?
- Restless/Irritable
- Tachypnea/Tachycardia
- Infant/Child with RR >60 at risk for apnea secondary to CO2 & WOB
- Increased effort – retractions, nasal flaring, head bobbing, grunting
So, we want to intervene before pt gets to resp failure.
If pt displaying these signs of distress, be aware. Pt may rapidly progress to resp failure
What are the cardinal signs of respiratory failure?
- Airway obstruction possible
- Slow respiratory rate
- Decreased respiratory effort
- Progresses to no respiratory effort
- Abnormal respiratory sounds
- Bradycardia
- Decreased LOC
- Cyanosis
- Can occur without distress*
- Cause = respiratory depression
What are late signs of respiratory distress/resp failure?
- Decrease in respiratory rate or irregular pattern
- Diminished breath sounds
- decr LOC (drowsiness)
- Skin color (cyanosis)
- Apnea/Bradycardia
List strategies that may be used to manage acute respiratory distress and failure in children.
- Support compensatory efforts of child
- Elevate HOB
- Allow patient to assume “position of comfort”
- Minimize sources of stress – cluster care
- Suction as needed (Yankauer/Neosucker)
- Humidified O2
- Do not give oral feeds/fluids if RR > 60
- NGT for abdominal distention
- Respiratory distress → Respiratory failure
- Intubate/Ventilate
The quieter the child, ________________________
the greater the cause for concern!!
If any of these signs occur, get medical help immediately!
Inability to swallow
Absence of voice sounds
Increasing respiratory distress
Acute onset of drooling (sign of supraglottic obstruction)
Describe the different oxygen delivery methods and what percent oxygen is delivered by each.
- “Blow-by” – unreliable
- Nasal Cannula – ¼-4 L
- (5-8L heated/humidified – Optiflow/Vapotherm)e
- Venturi Face Mask – 24%-48% variable
- Simple Face Mask – 6-10 L (40-60%)
- Non-rebreather Mask – 100%
- Bag-valve Mask (BVM)
- Bi-pap/CPAP
- Intubation/Mechanical Ventilation
What are the abnormal breath sounds?
- stridor
- wheezing
- crackles
- ronchi
When would you hear stridor?
- Foreign body
- Croup
- Swelling in the throat, abscess or tumor
- laryngospasm
- epiglottitis
When would you hear wheezing?
- asthma
- bronchitis
- pneumonia
- allergic reaction
- foreign body inhaled into lung
When would you hear crackles?
- pneumonia
When would you hear ronchi?
- pneumonia
- cystic fibrosis
- chronic bronchitis
What is the defn of respiratory failure?
Inability to maintain adequate oxygenation
What is happening with an airway obstruction?
Not enough oxygen is getting in/out.
What is respiratory distress/failure caused by inadequate effort?
can be resp depression from meds, or getting too tired, paralysis due to Cspine injury
What kind of pulmonary abnormalities can causes respiratory distress/failure?
BPD, asthma, pleural effusion, pneumonia
What can cause respiratory distress/failure of the upper airway?
- anaphylaxis
- epiglottitis
- croup
- foreign body
- abscess or tumor
What can cause respiratory distress/failure of the lower airway?
- bronchiolitis
- cystic fibrosis
- asthma
What types of lung tissue disease can cause respiratory distress/failure?
- pneumonia
- pulmonary edema
What types of CNS issues can cause respiratory depression/failure?
- pharmacological/chemical (overdose)
- neurological (head trauma)
What are 4 causes of respiratory distress/failure?
- upper airway issues
- lower airway issues
- lung tissue disease
- CNS causes
How can you help manage respiratory distress?
try to calm pt to (1) decrease oxygen demand & (2) reduce fatigue (child working harder – gets tired, stops breathing (3) increase oxygen delivery – more effective breaths
How can you support the compensatory efforts of the child?
- Elevate HOB
- Allow patient to assume “position of comfort”
- Minimize sources of stress – cluster care
- Suction as needed (Yankauer/Neosucker)
- Humidified O2
- Do not give oral feeds/fluids if RR > 60
- NGT for abdominal distention
How do you support worsening respiratory distress leading to respiratory failure?
intubate/ventilate
Describe different types of oxygen delivery methods.
- “Blow-by” – unreliable
- Nasal Cannula – ¼-4 L
- (5-8L heated/humidified – Optiflow/Vapotherm)e
- Venturi Face Mask – 24%-48% variable
- Simple Face Mask – 6-10 L (40-60%)
- Non-rebreather Mask – 100%
- Bag-valve Mask (BVM)
- Bi-pap/CPAP
- Intubation/Mechanical Ventilation
What are some causes of metabolic acidosis?
- Diabetes
- Kidney Failure
- Shock
What are some causes of respiratory acidosis?
- pneumonia
- drug overdose
What are some causes of metabolic alkalosis?
- Vomiting
- Diuretics
What are some causes of respiratory alkalosis?
- Anxiety
- Pain
- Fever
What are disorders of the upper airway?
- Anaphylaxis
- Croup (laringotracheobronchitis - LTB)
- Epiglottitis (med emergency)
What are disorders of the lower airway?
- bronchiolitis
- asthma
- cystic fibrosis
What is an example of lung tissue disease?
Pneumonia
What is the patho & s/s of anaphylaxis?
- exaggerated hypersensitive allergic reaction to a trigger
- s/s
- itching, hives, cough, dyspnea, pallor, wheezing, stridor, sweating, tachycardia, respir distress that could lead to failur
What is the patho & s/s of Croup (Laryngotracheobronchitis - LTB)?
develops dt inflammation of larynx, trachea and bronchi, caused by viral resp infection.
S/s
usually abrupt and worsens at night. barky, brassy cough, hx or URI, inspiratory stridor, resp distress, low grade fever, tracheal narrowing on x-ray (steeple sign)
What is the patho & s/s of epiglottitis?
- Patho
- Acute, severe inflammation of the epiglottis.
- Abrupt onset and rapid progression
- Caused by bacterial respiratory infection
- S/s
- Sore throat and difficulty swallowing
- drooling, “croaking” or stridor
- restlessness, anxiety
- hyperextension of neck,
- characteristic “tripod” position
- x-ray shows epiglottal enlargement (thumb sign)
What is the cause, patho, s/s, of bronchiolitis?
- patho
- obstruction of the small airways
- seasonal illness starting in Fall and ending in Spring
- Spread by direct CONTACT with secretions
- causes/triggers
- most commonly causes by viral respiratory infection
- respiratory syncytial virus (>80%)
- most commonly causes by viral respiratory infection
- s/s
- cough, rhinorrhea, wheezing, retractions, crackles, dyspnea, tachypnea
What is the cause, patho, s/s, of asthma?
- patho
- chronic inflammation of the airways with reversible episodes of obstruction, caused by an increased reaction of the airways to various stimuli
- most common cause of missed school days
- causes/triggers
- pets, cockroaches, dust mites, pollens, molds, infections, exercise, weather change, cigarettes’ smoke, scented products, chemicals
- s/s
- cough, (especially at night, after physical activity, lasting >1 week), chest tightness, shortness of breath, wheezing, respiratory distress
What is the cause, patho, s/s, of cystic fibrosis?
- patho
- most common genetic disease in the US that affects the respiratory, GI, endocrine, reproductive and integumentary systems
- causes/triggers
- inherited autosomal recessive disorder of the exocrine glands. Causes incr viscosity of bronchial mucus
- s/s
- respiratory: wet, chronic cough, wheezing, dyspnea, clubbing, hypoxia, hypercapnia, acidosis, barrel chest, sinusitus, nasal polyps, repeated bacterial infections
- GI: meconium ileus at birth (<10% of newborns with CF), bulky foul smelling stools, delayed G&D
- Endocrine: mucus blocks the pancreatic ducts so unable to digest fats, may develop diabetes d/t pancreatic scarring
- Liver: increased LFTs and gallstones
- Reproductive sys: females - delayed puberty, difficulty with conception. males -sterile
- integumentary: excessive sodium loss from sweat glands
What is the cause, s/s, of pneumonia?
- causes/triggers
- primary infection or aspiration (chemical or vomitous)
- s/s
- increased WOB
- Decr sats despite incr in oxygen delivery and/or mode of ventilation
- possible fever (febrile or hypothermic)
- coarse or crackles (junky)
- chest pain
- tachypnea
What are neurological causes, s/s of respiratory distress?
- causes
- trauma (closed head injury), neuromuscular disease (muscular dystrophy, SMA), central hypoventilation syndrome, seizures, hydrocephalus
- s/s
- variable respiratory rate
- variable respiratory effort
- respirations become ineffective causing an inability to oxygenate and/or ventilate
What are pharmacological/chemical causes, s/s of respiratory distress?
- causes
- any med either given or potentially taken
- s/s
- variable respiratory rate
- variable respiratory effort
- respirations become ineffective causing an inability to oxygenate and/or ventilate
What is the intervention/management of anaphylaxis?
- Allow position of comfort
- epinephrine IM, SQ, ET
- Oxygen
- Antihistamines
- Steroids
- Fluids
What is the intervention/management of croup (largyngotraceobronchitis LTB)?
- Allow parent to STAY w/child
- do not upset the child
- allow position of comfort
- cool mist oxygen therapy
- nebulized epinephrine (racemic epi) - for stridor
- corticosteroids (IM, IV, PO) - dexamethasone
- fluids
What is the intervention/management of epiglottitis? med emergency
- Allow parent to STAY w/child
- do not upset the child
- allow position of comfort
- have tracheostomy and intubation equipment readily available
- IV antibiotic therapy
- IV corticosteroids
- 7-10 days oral antibiotics after IV therapy
What is the appropriate education for epiglottitis? med emergency
- encourage family to participate in care
- keep pt calm and decrease stimuli as much as possible
- importance of Hib Vaccine
- prevention = immunizations
What is the appropriate education for croup (LTB)?
- Teach caregiver signs of respiratory distress
- cool or moist air humidifier/vaporizer
- Feverl 100-101 is common
- stay w/child and keep calm
- infection prevention = hand washing
What is the appropriate education for anaphylaxis?
- know and avoid triggers
- always carry epi pen
What is the intervention/management of bronchiolitis?
- allow position of comfort
- oxygen
- suction secretions
- especially before feedings
- small frequent, feedings and oral fluids
- IV fluids if unable to take adquate PO
- may trial bronchodilators
What is the intervention/management of asthma?
- allow position of comfrot
- oxygen
- bronchodilators
- corticosteroids
- anticholinergics
- support breathing
- fluids
What is the appropriate education for bronchiolitis?
- prevention with GOOD handwashing
- Bulb suction technique
- suction prior to each feed
- small, frequent feedings
What is the appropriate education for asthma?
- compliance w/treatment plan
- trigger management
- medication use & delivery (controller vs. rescue meds, rinse mouth after inhaler, give bronchodilators first prior to steroid inhalers)
- asthma action plan (when to take meds & call/see PCP)
- Peak flow meter use & monitor PF daily
What is the intervention/management of CF?
- Respiratory: Chest Physiotherapy, Bronchodilators (albuterol, ipratropium), aerolized pulmozyme - decrease viscosity of mucous, antibiotlics (PO,IV,INH), oxygen
- Gastrointestinal: pacreatic enzymes w/meals and snacks, extra enzymes for high fat foods. Vitamins A, D, E, & K, Diet: high calorie, high fat, high SALT (b/c CF is salt wasting) may need suppl fats
- may not get enough fat PO
- Endocrine: diabetes mgmt as applicable
- Integumentary: replace lost electrolytes as applicable (risk heat exhaustion)
Classic signs of epiglottitis?
Drooling - may need to intubate
don’t stick anything in their mouth until then
What is the appropriate education for CF?
- compliance w/tx plan (rep meds, GI enzymes, diet, resp therapy)
- encourage physical exercise program
- follow-up w/specialist care team (pulm, endo, resp therapist, care coord, genetic counseling)
- resources & support services
What is the intervention/management of pneumonia?
- oxygen
- abx after sputum culture sent
- treat fever
- pulomonary toileting (CPT, breathing tx, suction etc)
- if wheezing, consider bronchodilator
What is the appropriate education for pneumonia?
- signs and symptoms to watch for and when to return to PCP or ED
- med admin instructions
- encourage hydration and rest
What is the intervention/management of neurological causes of respiratory distress?
- support breathing
- treat the cause (neurosurgery to decr intracranial pressure, etc)
What is the intervention/management of pharmacological/chemical causes of respiratory distress?
- support breathing
- reversal agents/antidotes
- narcan/naloxone - opioids
- romazicon/fslumazenil - benzodiazepine
- Do not reverse anti-seizure meds
What is BPD?
Breathing disorder primarily found in premature infants - abn development of lung tissue,
s/s resp. distress, grunting, nasal flaring, tachypnea, retractions
CPAP and oxygen - tx
meds: diuretics excess fluid - pulmonary edema can be issue, bronchodilators and steroids
small, short feeds, incr calorie and protein
risk: low birth rate, prematurity, mechanical ventilation & high levels of oxygenation
What is tonsillitis?
What is otitis media?
Types of retractions
subcostal retractions
intercostal retractions
supraclavicular retractions
suprasternal retractions
substernal retractions
belly breathing (not retractions)/mild subcostal
asthma
inspiratory wheezing
expiratory wheezing
= both is worse
louder wheezing (incr sounds) can actually be good
