The Child with Respiratory Alterations - Lecture Notes Flashcards
One of the most common illnesses in children
Respiratory
Nasopharynx
smaller, easily occluded during infection
Lymph tissue (tonsils, adenoids)
grows rapidly in early childhood; atrophies after age 12
Small oral cavity and large tongue
increases risk of obstruction
- especially in unconscious child
Smaller nares
easily occluded
Long, floppy epiglottis
vulnerable to swelling which results in obstruction
Larynx and glottis
higher in neck, increasing risk of aspiration
Immature thyroid, cricoid, and tracheal cartilages
may easily collapse when neck is flexed
Fewer muscles are functional in airway
less able to compensate for edema, spasm, and trauma
Large amounts of soft tissue and loosely anchored mucous membranes lining airway
increase risk of edema and obstruction
smaller lung capacity and underdeveloped intercostal muscles
give children less pulmonary reserve
Higher respiratory rates and demands for O2 in young children
makes hypoxia easy to occur
where is the airway the smallest?
airway is smallest at the cricoid for children younger than 8 years - can be occluded very easily.
what gender is more susceptible to airway obstruction and respiratory distress?
male children
Infant and Toddler breathing
- barrel-chested
- rely heavily on the diaphragm for breathing
- lack the firm bony structure to ribs/chest makes child more prone to retractions when in respiratory distress
CREBS
Cough
Rate/regularity
Effort (work of breathing)
Breath sounds
Saturation
Quality of Respirations
Rate, regularity, symmetry, effort, accessory muscles, breath sounds, ability to speak (not able to speak is a big sign of respiratory distress)
Respiratory Distress Associated Observations
Retractions, nasal flaring, head bobbing, snoring, grunting, colour, chest pain, clubbing, cough
Respiratory Assessment (QQAPBS)
Quality of Respirations
Associated Observations
Quality of pulse
Position of the child
Behaviour change
Signs of dehydration
Respiratory Distress
what you see initially, showing signs that this child is having difficulty breathing
Respiratory Failure
when the child can no longer maintain effective gas exchange. there is either functional or structural failure of the mechanisms of respiration
Clinical Manifestations of Respiratory Distress (3)
Hypoxemia: lack of oxygen in the blood
Hypercapnia: too much carbon dioxide
Alveolar hypoventilation: not enough gas exchange is taking place at the alveoli that are not being ventilated properly
3 things that can cause alveolar hypoventilation
- O2 need exceeds O2 intake. Mismatch between supply and demand
- Airway partially occluded: foreign body, edema, swelling, mucus production
- Transfer of O2 and CO2 in the alveoli is disrupted: between alveoli and capillary Ventilation perfusion mismatch
Progression of Respiratory Failure/Arrest: Cardinal Signs (DTTR)
- Restlessness
- Tachypnea
- Tachycardia
- Diaphoresis
Subtle, not that particular to any one condition. See there if a child was frightened. Important to notice and take into consideration the entire history of the child
Early Decompensation (less obvious): they were managing ok and now they are starting to not manage as well
- mood changes
- headache
- increased WOB
- hypertension
- exertional dyspnea
- anorexia
- increased cardiac output & urinary output
- CNS symptoms (anxiety, confusion, restlessness, irritability, depressed LOC)
- nasal flaring
- retractions
- expiratory grunting
- wheezing/prolonged expiration
Severe Hypoxia
- hypotension
- depressed respiration
- dyspnea
- bradycardia
- cyanosis
- stupor and coma
Early Recognition is the Goal
important to watch for early signs and intervene early so the child doesn’t go into respiratory arrest. Children’s hearts are usually pretty healthy - most don’t have cardiac arrest, they would have respiratory arrest which if not corrected will eventually cause their heart to fail as well. And if they go into cardiac arrest they have a really poor prognosis
Continuum of Respiratory Failure: Initial Signs (DTTRP)
Physiology: the child is attempting to compensate for an oxygen deficit and airway blockage. The oxygen supply is inadequate; behaviour and vital signs reflect compensation and beginning hypoxia
- restlessness
- tachycardia
- tachypnea
- diaphoresis
- pale
Continuum of Respiratory Failure: Early Decompensation (CNGHHHAMW)
Physiology: the child uses accessory muscles to assist oxygen intake; hypoxia persists and efforts now waste more oxygen than is obtained
- Confusion
- nasal flaring
- grunting
- head bobbing
- headache
- hypertension
- anxiety & irritability
- mood changes
- seesaw respirations
- Wheezing
Continuum of Respiratory Failure: Imminent Resp Arrestd (CNNDBS)
Physiology: the oxygen deficit is overwhelming and beyond spontaneous recovery. Cerebral oxygenation is dramatically affected; central nervous system changes are ominous
- Dyspnea/bradypnea
- bradycardia
- seesaw respiration’s
- cyanosis
- no air movement
- no wheezing
