session 8 The Paediatric airway and respiratory conditions Flashcards
describe the unique characteristic of the paediatric airway - infant, child, adolescent
the biggest difference between infant/ child an adult is an infant and childs have smaller diametere cricoid ring that is like a funnel shape compared to an adult that is wider an more cylindrical. The infants smaller upper an lower airways make it harder to breathe when obstruction further reduces the space. Infants and children have larger tongues and shorter necks with a horse shoe shaped epiglottis.
what are the characteristics of a child in distress?
nasal flaring head bobbing tracheal tug sternal recession accessory muscles used see saw breathing tachypnoea tachycardia tripod positioning feeding less less wet nappies
what is the nursing care for acute respiratory distress in an infant with bronchiolitis
PNA to determine cause of infection Hydration and nutrition - NGT as most are too fatigue to eat, 2/3rds maintenance fluid given oxygen delivery apnoea monitoring promote rest and comfort
what is the nursing care for acute respiratory distress in an infant with asthma
Nurse would perform a focused assessment
vital signs - electrolytes can reduce potassium = hypokalaemic, salbutamol if given can give a reading of ^HR
work of breathing -
ability to talk in sentences, phrases, single words (severe)
chest examination
chest ascultation
describe the technique of how to correctly open an infant, child and adolescent airway and how to provide mask ventilation
infant - neutral head position with jaw support
child - sniffing postion
adolescent - backward head tilt with pistol grip
mask ventilation ( choose correct bag and mask dependant on childs weight ) - c grip, seal around face to prevent leak, ** cannot use air viva to just administer oxygen- there is a valve that only opens when the bag is squeezed, therefor if just held on patients face without bagging the patient with not receive oxygen only built up CO2
Describe the technique for inserting a Guedal airway in an infant, child and adolescent
Measure from the centre of the incisors to the angle of the mandible
In infants or children, insert under direct vision - insert concave side down using a tongue depressor.
In an adult: concave side up; pass to the back of the hard palate, then rotate 180o to concave side down
describe the choking management for a infant and child
Assess and send for help
If child is not coughing and conscious: bend child forward and give 5 back blows (check if obstruction is removed), 5 chest thrusts - assess and repeat
If the child is not conscious: open airway, 2 breaths, CPR 15:2 check for FB (foreign body)
IF child has an effective cough: encourage coughing, support and assess continuously
Describe the algorithm for infant and child basic life support.
DRSABCD danger responsive send for help open airway normal breathing check pulse, start CPR attach defibrillator
describe correct compression technique on an infant, child and adolescent
Hand placement is lower half of sternum with compression depth 1/3 of chest
Infant: two fingers or two thumbs
Child: one hand
Adult: two hands
What are the two reasons why a child will arrest?
Respiratory obstruction/ respiratory arrest
hypovolaemic shock
what is involved in a paediatric respiratory assessment?
Airway - is the patient talking or crying, inspiratory noises such as stridor or grunting
Breathing - what is their effort/ work of breathing - effort and efficacy. Listen to breath sounds by ascultating and listening to both sides of the chest. Are there any signs of inadequate oxygen. If child is in hypoxic state but O2 sat are showing ok then a blood gas needs to be done(only for a deteriorating pt)
Circulation - efficacy: look at circulation - what is th HR and BP doing ( remember paeds will maintain BP when really unwell) Perform a central capillary refill for a better indication( press thumb on chest for 5 secs and release - should come back within 2 secs- if not child is really unwell)
Disability - does the child struggle after play - this is normal. If the child struggles at rest - child is unwell. Is there any nasal discharge ( babies breathe through their nose rather than theri mouth) suctioning may be required to improve vital signs. Hypoxic children will be agitated and restless with a reduced GCS ( listen to the parent when comments are made like their child has never been this sick or my child is really sick)
