Respiratory System Flashcards
All structures function in air distribution, except:
ALVEOLI
- gas exchange of oxygen and carbon dioxide
Upper Airway Structures
- oronasopharynx
- pharynx
- larynx
- eustachian tube and sinuses
- upper part of trachea
Lower Airway Structures
- trachea
- bronchi
- bronchioles
- alveoli
Diameter of Infant’s Trachea
- approx 4 mm
- presence of edema = increased mucus = bronchospasm = air passage diminished = air flow resistance = increased work of breathing
Diameter of Adult’s Trachea
20 mm
Nose
- nose breathers until 4 weeks
- little mucus (cleansing agent) = susceptible to infection
- very small nasal passage = excess mucus = airway obstruction
Sinuses
INFANTS: born with maxillary and ethmoid sinuses
6-8 YEARS OLD: develop frontal and sphenoid sinus = young children are less susceptible to sinus infection
- frontal sinus = assoc. with infection
Throat
INFANT: tongue relative to oropharynx = larger than adults
- posterior displacement of tongue = severe airway obstruction
EARLY SCHOOL AGE: enlarged tonsillar and adenoidal tissue even in absence of illness = increased incidence of airway obstruction
Cricoid Cartilage
- hyaline cartilage ring that fully encircles trachea
LESS THAN 10 YEARS OLD: underdeveloped = narrowing of larynx
- mucus and edema = air flow resistance = increased effort
Larynx and Glottis
placed higher in the neck = increased chance of aspiration of foreign material in lower airways
Muscles Supporting the Airway of Children
- less functional than adults
= large amount of soft tissues surrounding trachea and mucus membranes lining the airway = less securely attached compared to adults - increases risk of airway edema and obstruction
- upper airway obstruction = tracheal collapse during inspiration
Bifurcation of Trachea
- contributes to risk of aspiration
CHILDREN: 3rd thoracic vertebra
ADULT: 6th thoracic vertebra
Bronchi and Bronchioles
narrower in infants and children compared to adults = increased risk of airway obstruction (bronchitis/ asthma)
Alveoli
- develop at app. 24 weeks of gestation
TERM INFANT: 50 million alveoli
AFTER BIRTH: growth slows until 3 months of age
7-8 YEARS OLD: 300 million (same with adult)
Chest Wall
- highly compliant (pliable) and fail to support lungs adequately
- respiratory effort diminished = functional residual capacity of lungs greatly reduced
- lack of support, tidal volume of infants and toddlers = independent to diaphragm
- diaphragm movement impaired = intercostal muscles cannot lift chest wall = respiration further compromised
Metabolic Rate and Oxygen Need
- children have higher metabolic rate than adults
- resting respiratory rate = faster
- demand for oxygen = higher
- respiratory distress = develop hypoxemia faster than adults
Fetal Lung Development: Week 4
laryngotracheal groove forms on floor foregut
Fetal Lung Development: Week 5
left and right lung buds push into pericardioperitoneal canal (primordial of pleural cavity)
Fetal Lung Development: Week 6
- descent of heart and lungs into thorax
- pleuroperitoneal foramen closes
Fetal Lung Development: Week 7
lung buds divide into secondary and tertiary bronchi
Fetal Lung Development: Week 24
bronchi divide 14 more times and respiratory bronchioles develop
Fetal Lung Development: Birth
additional 7 division of bronchi
Fetal Lung Histology: Stage 1
PSEUDOGLANDULAR PERIOD (5-17 weeks)
- all major elements of lungs formed except those involved with gas exchange (alveoli)
Fetal Lung Histology: Stage 2
CANALICULAR PERIOD (16-25 weeks)
- bronchi and terminal bronchioles increase in lumen size and lungs become vascularized
Fetal Lung Histology: Stage 3
TERMINAL SAC PERIOD (24 weeks- birth)
- more terminal sacs developed with capillaries lined with type I alveolar cells/ pneumocytes
- type II pneumocytes (defenders) secrete surfactant = decrease surface tension forces and aids with expansion of terminal sacs
Fetal Lung Histology: Stage 4
ALVEOLAR PERIOD (late fetal period- 8 years)
- 95% of mature alveoli develop after birth
NEWBORN: only 1⁄6 to 1⁄8 of the adult number of alveoli and lungs appear denser on x-ray
Defenses of RS
- filtering particles
- warming and humidifying inspired air
- absorbing noxious gases in vascular upper airway
Defense: Lymphoid Tissues
- includes focal, lingual and adenoid = form protective circle around entrance
- localizes and contains invading organisms so that they could be destroyed
Defense: Mucous Blanket
secretes sticky mucus where organisms adhere
Defense: Ciliary Action
carry microorganisms and foreign agents away from lungs to be coughed out or swallowed by px
Defense: Epiglottis Reflex
- protect RT from invading foreign materials including infectious exudates from URT
- prevent microorganisms from being aspirated from LRT
Defense: Cough Reflex
- expulsive force
- propels foreign materials our of LRT
Defense: Tracheobronchial Dynamics
TRACHEOBRONCHIAL TREE: elongates, dilates on inspiration and shortens narrows during expiration
Defense: Position Changes
helps in draining tracheobronchial passage which gives problem in airway obstruction)
Defense: Lymphatics
DRAINING TERMINAL BRONCHIOLES: invades foreign microorganisms which are filtered and destroyed in the regional lymph nodes
Defense: Humoral Defenses
removed or destroyed by phagocytes immunoglobins (immunoglobin A: secreted by bronchial epithelium)
Physical Assessment of Respiratory Illness
- cough
- rate. depth of respirations
- retractions
- restlessness
- cyanosis
- clubbing of fingers
- adventitious sounds
- chest diameter
PA: Retractions
- sinking in of soft tissues relative to the cartilaginous bony thorax
- nose flaring
PA: Stridor
high pitched noisy respiration
PA: Grunting
- occurs on expiration
- might occur with alveolar collapse
- sign of pain in older children
- suggest pneumonia
PA: Wheezing
continuous musical sound originating from vibrations in narrowed airways
PA: Clubbing
proliferation of tissues on terminal phalanges
PA: Cough
- protective mechanism
- indicator of irritation
Auscultation: Wheezing
CLEARS WITH COUGH: secretion in lower trachea
DOES NOT CLEAR WITH COUGH: obstruction of bronchioles
Auscultation: Rales
- crackling sound
- alveoli filled with fluid
Percussion
- note for non-resonant sounds
FLAT OR DULL: percussed over partially consolidated lung tissue like pneumonia
TYMPANY: percussed with pneumothorax, air in pleural cavity
Palpation
- palpate sinuses for tenderness in children
- enlargement or tenderness of lymph nodes of head and neck
ALTERATION IN TACTILE FREMITUS: decreased in barrel chest, absent in atelectasis
COMPARE CENTRAL AND PERIPHERAL PULSES: weak = poor perfusion
- central pulses in carotid in femoral artery (middle of body: neck and groin)
Lab: Arterial Blood Gas Analysis (ABG)
measures oygen and carbon dioxide
Lab: Arterial Blood Gas Analysis (ABG)
measures oygen and carbon dioxide
Lab: Pulse Oximetry
estimate arterial oxygen saturation: 95-100%
Lab: Transcutaneous Oxygen Monitoring
monitor oxygenation and ventilation
Respiratory Alcalosis
cause hyperventilation
Respiratory Acidosis
cause hypoventilation, trapping carbon dioxide in alveoli
Lab: Nasopharyngeal Culture
provide information on microorganisms causing the diseases in URT
Lab: Pulmonary Function Test
- non-invasive test that show how well lungs are working
- measures lung volume, capacity, flow rate, and gas exchange
Lab: Sputum Analysis
ask older children to breathe in and out several times, cough deeply, and cough out mucus they have raised into a sterile specimen container
Lab: Xray, CT Scan, MRI
- evaluates respiratory tract
- shows areas of infiltration or consolidation in lungs
MRI: detailed image of chest cavities
- when done in children, it requires sedation for best results
Therapeutic: Humidification
- method of artificial warming and humidifying of RT for mechanically ventilated px
NEBULIZER: aims to deliver computed amounts of drug aerosols
STEAM INHALATION: warm steaming that helps loosed thick mucus, making it easier for child to cough
Therapeutic: Expectorant Therapy
- coughing
- mucus clearing devices
- chest physiotherapy: postural drainage in combination with other techniques (manual percussion, vibration)
Therapeutic: Improve Oxygenation
- oxygen admn
- pharmacologic
- incentive spirometry
- breathing techniques
- tracheostomy: emergency intubation, suctioning technique
- endotracheal intubation: assisted ventilation
- lung transplantation: prolong life expectancy improve QOL of px
Therapeutic: Oxygen Delivery Systems
- venturi mask
- hudson mask
- trauma mask
- nasal cannula
Nursing Care Management of Pediatric Client with Mechanical Ventilator
- prevent accidental/ unplanned extubation
- positioning for optimum ventilation
- suctioning airway prn
- monitor for potential SE of mechanical ventilator
- prevent infection
- ensure adequate humidification
- provide support, comfort, and reassurance to child and family
Nursing Care Management of Pediatric Client with Mechanical Ventilator
- prevent accidental/ unplanned extubation
- positioning for optimum ventilation
- suctioning airway prn
- monitor for potential SE of mechanical ventilator
- prevent infection
- ensure adequate humidification
- provide support, comfort, and reassurance to child and family
Acute Nasopharyngitis
- common cold
- most frequent infectious (toddler: 10-12/yr ; school age and adolescent: 4-6/yr)
- incubation period: typically 2-3 days
- most common during rainy season, fall, and winter
AN Causes
- rhinovirus
- coxsackie virus
- respiratory syncytial virus
- adenovirus
- parainfluenza
- influenza virus
- stress factors
AN Assessment
