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304 > Week 1 > Flashcards

Week 1 Flashcards

1
Q

History assessment in children

A
  • Birth history
  • Family history
  • Past medical history
  • Current history and medical management
  • Medication: analgesia, sedation
  • Nursing/medical staff re recent progress i.e. progress overnight, stability, tolerance to handling, feeding and rest to plan timing of physio input, recent investigations, management plan
  • liaisewith domiciliary care team
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2
Q

Assessment - medical obs

A
  • Temp
  • HR
  • BP
  • RR, apnoeic spells
  • ABGs/SpoO2
  • level and type of resp support
  • BO, feeding, sleep, medications
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3
Q

Normal Values for children

A

Neonate:
RR - 40-60
HR - 100-200
BP (sys) - 60-90
BP (dias) - 30-60

Infant:
RR - 20-30
HR - 100-180
BP (sys) - 70-130
BP (dias) - 45-90

Child:
RR - 15-20
HR - 70-150
BP (sys) - 90-140
BP (dias) - 50-80

Teen:
RR - 10-15
HR - 60-90
BP (sys) - 95
BP (dias) - 60-90

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4
Q

Observation assessment in paeds

A
  • Settings and mode of ventilation support
  • Analgesia
  • Inspection of child: consciousness, breathing pattern, respiratory rate, WOB, colour, activity level and consciousness, attachments and incisions, posture and movements
  • Upper respiratory secretions
  • Tactile fremitus
  • Auscultation
  • Observed or elicited cough
  • Other objective measures as indicated such as exercise tolerances, breathlessness, muscle length/strength etc.
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5
Q

Respiratory distress in infants

A

Respiratory
- Tachypnoea
- Recession
- Nasal flaring
- Expiratory grunting
- Cyanosis
- Altered breath sounds

Cardiac
- Brady>tachycardia

Other
- Neck extension
- Head bobbing
- Pallor/blotching
- Altered consciousness
- Reluctant to feed

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6
Q

Cough frequency and quality

A

Frequency
- Daytime cough score
- Verbal descriptive tool
0 = no cough
1 = cough for one or two short periods only
2 = cough for more than two short period
3 = frequent coughing but does not interfere with school or other activities
4 = frequent coughing which interferes with school or other activities
5 = cannot perform most unusual activities due to severe coughing

quality
- Productive cough
- persistent or chronic moist or wet cough (moist = bronchitis or secretions below vocal cords, tight = inflammation, asthma
- Expectoration (6+ years)
- Need deep inspiration for effective cough
- Cough quality may tell you more than auscultation
- Quality of end expiratory gives assessment of secretions present

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7
Q

Assessment of breath sounds

A

Auscultation
- More difficult in young children, reduced size and number of lung tissue, greater transmission of sound and poorer localisation
- May be difficult to hear secretions in medium bronchi - always compare to cough quality
- Useful for assessment to re-assess comparisons
- Check for forced expiration or other end-expiratory sound
- Common on breath sounds and add sounds
- Palpation for tactile fremitus

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8
Q

Investigations in paeds

A
  • Diagnositic imaging
  • Microbiology
  • ABG’s
  • Bronchoscopy
  • RFT
  • FEV1
  • QoL
  • Sputum cultures
  • Viral cultures
  • Bronchoscopy
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9
Q

Short term management

A
  • Increased airflow and lung volumes
  • Decreased pain
  • Increased airway clearance
  • Cough
  • Breathing patterns
  • Increased gas exchange
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10
Q

Long term management

A
  • Airway clearance
  • Activity/exercise
  • Education
  • Adherence
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11
Q

Positioning

A

PD positions anatomically favour the gravity direction movements of secretions toward the airway opening

Wary of reflux in infants, no HDT

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12
Q

Manual techniques

A

Used when more active techniques are not appropriate if child is very young, weak, intellectually impaired or unconscious

Percussion alone can increase TV
Vibrations can increase effectiveness of expiration
Contraindications apply for specific neonates

Percussion
- 1min intervals in infants to prevent hypoxia or bronchospasm
- More effective during TEE
- Stabilise head in infants

Vibrations
- In direction of chest wall movement on exhalation
- Increased flor rate enhances forced expiration
- PEFR with vibes > HFCWO

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13
Q

Suctioning

A
  • Used when no other way to clear secretions effectively
  • Continuous suction used
  • Ensure adequate oxygenation pre and post suction
  • Take no more than 10-15 seconds to reduce patient discomfort and risk hypoxia
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14
Q

Breathing exercises

A
  • Position and movement to increase ventilation
  • Blowing games
  • ACBT
  • Autogenic drainage: controlled breathing technique aimed at keeping compressed airway segment behind mucous, requires concentration and cognitive skill, good for removing mucous plugging
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15
Q

PEP

A
  • Re expansion of lungs and secretion removal
  • Dependent on collateral ventilation
  • Prolongation of open airway to permit secretion movement - good for dynamic airways to collapse
  • May reduce paroxysmal cough
  • Expiratory resistance through mouth piece
  • Airway pressure 10-20cmH20
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16
Q

FET

A

relaxed breathing - huff - cough

Low volume - peripheral secretions
High volume - proximal secretion

17
Q

HFCC (Vest)

A

Loosens secretions of chest wall - changes rheology of sputum
Done in conjunction with FET and breathing exercises (other ACT)

Treatment cycle - 46- per session

3 min: high frequency/low pressure ‘hummingbird’
2 min: low frequency/high pressure ‘thumper

18
Q

Physical activity

A

Improve CP fitness and muscle strength
Decreases breathlessness
Promotes feeling of wellbeing
Increases FEV1 and sputum clearance
Does not replace ACT

19
Q

ACT

A
  1. Get air behind secretions
    - Exercise, PEP, breathing, inhaled agents (bronchodilators)
  2. Unstick/loosen secretions
    - Manual techniques, OPEP, inhaled mucolytics (hypertonic saline)
  3. Mobilise secretions
    - Manual techniques, increase speed of expiratory airflow, FET, ACBT, AD, positioning, inhaled agents (normal saline - osmotic effect)
  4. Clear secretions
    - Cough or suction
20
Q

Common resp conditions in childhood

A

Other
- Inhaled foreign body
- Chronic lung disease

Respiratory tract infections
- URTI
- LRTI

Respiratory disease
- Asthma
- Bronchiectasis
- Cystic fibrosis

21
Q

Inhaled foreign body

A

Aspiration of foreign body into respiration tract

  • Commonly between 1-3 years
  • Usually right main bronchus
  • Clinical features
  • Wheeze
  • Respiratory distress
  • Gas trapping distal to blockage on CXR
  • Bronchiectasis a complication

Physiotherapy management
- Never treat before bronchoscopy

22
Q

Chronic lung disease

A

Seen in ex-preterm and LBW infants
Cause
* long ventilation times
* reduced surfactant
* long term O2 exposure
* chorioamnionitis

-Clinically often on home O2 and have chronically high CO2
-Poor lung compliance and may have increased WOB
-Often more at risk of developing acute respiratory illnesses like RSV bronchiolitis and pneumonia
- Outcome is variable but usually will do well if survive > 2 years
though may still be more prone to increased respiratory infections
during childhood
- High risk group for developmental delay

23
Q

URTI: Acute Laryngotracheobronchitis

A
  • Viral illness
  • Causes inflammation and oedema of airways
  • Occurs between 6 months to 4 years
  • Lasts 1-10 days and can re-occur

Clinical features
* Coryzal
* Harsh barking cough
* Stridor particularly at night
* The loudness of the stridor is not a good guide to the
severity of the obstruction
* Respiratory obstruction

Physiotherapy
* Only if child is intubated and secretions are thick and difficult to clear

24
Q

URTI: Epiglottitis

A
  • Haemophilus influenzae (Hib)
  • Very dangerous – between 1-7 years

Clinical features
* Severe sore throat
* High temperature
* Stridor and dysphagia
* Neck extended
* Airway obstruction

Management
* Intubate and ventilate
* Secretion removal only in intubated child

25
Q

LRTI: Bronchiolitis

A

Bronchiolar Inflammation
* affects infants / babies
* widespread lung inflammation
* increased WOB, respiratory distress

  • Viral illness – very common in winter

Clinical features
* Bronchospasm
* Respiratory distress
* Coryzal symptoms
* Lethargy and poor feeding

CXR
* Patchy areas of collapse and consolidation on CXR

Auscultation
* widespread insp crackles and exp wheeze +/- audible stridor

26
Q

LRTI: Pneumonia

A
  • Disease process in peripheral airspaces
  • Central airways usually clear
  • Various organisms typically affect different ages of kids

Clinical features
* Pyrexia
* Dry cough
* Tachypnoea
* Loss of appetite
* Increased WOB
* Consolidation on CXR
* Phases
* Consolidation
* Harsh breath sounds
* Resolution
* Crackles, moist cough

Management:
- In sputum retention - percussion, positioning, PEP and FET will aid AC

27
Q

LRTI: Pertussis

A
  • Whooping cough - highly contagious but vaccine available
  • Very dangerous in children under 6 months or respiratory compromised
  • Paroxysmal cough
  • Thick tenacious sputum
  • Patchy collapse and consolidaition on CXR

Management
* VIP to remove secretions
* May need to ventilate and paralyse to stop paroxysmal cough
* Minimal handling - position for V/Q mismatch
* Physio C/I in acute stages – coughing
* Subacute phase: ACT if mucus plugging, don’t demand cough

28
Q

Acute asthma

A
  • Chronic inflammatory process
  • Wheezing
  • Breathlessness
  • Cough
  • Increased smooth muscle responsiveness
  • Variable triggers; Pollens, dust mites, tobacco smoke, food, exercise
  • Airway obstruction from mucous plugging
  • Inflammation and narrowing of the airways
  • Links with anxiety in adolescence
29
Q

Bronchiectasis

A

Abnormal and chronic dilation of the bronchi leading to bronchial obstruction causing chronic collapse and secretion retention in distal areas. Acute exacerbations lead to URTI and LRTI

Signs and symptoms:
* Asymptomatic when not exacerbated, cough productive of sputum daily +/- restricted ADL’s

  • Characterized by exacerbations…
  • increased sputum,
  • haemoptysis,
  • SOB,
  • decreased ex tolerance,
  • fevers

Management
- AB therapy
- Monitoring
- Secretion clearance ACBT, manual techniques, mucolytics, FET, OPEP/PEP
- Exercise

30
Q

Cystic fibrosis

A

Genetic multisystem disorder characterised by disturbances in fluid and electrolyte across epithelial surfaces.

Effects more seen in respiratory and digestive systems (progressive) with…
- Excessive thickened mucous
- Poor clearance, retained secretions and infection
- Widespread lung involvement
- Chronic disease with acute exacerbations
- Deterioration with age

Neonates present with abdominal distension, vomiting and failure to pass meconium

31
Q

Person vs family centred approach

A

Person centred
- Listening to what they want
- Respecting their autonomy
- Centre of decision making

Family centred
- Considering the family when treating a child
- Strain can be placed on families when child has high treatment needs
- Empowers the patient and their families and fosters independence
- Allows them to make decisions respecting their values, beliefs and cultural backgrounds

32
Q

Communicating with children

A
  • Engaging through play, also acts as a good distraction
  • Approach your interactions with children with the same level of enthusiasm that the child displays and children will generally co-operate
  • Crying can be a normal response
  • Your direct interaction with the child will shape their perceptions of their environment and the people around them as a whole
  • Have a calm approach and address child by their name
  • Build rapport to make them feel comfortable
  • Assume a position at eye level
  • Using age appropriate language
  • Clear simple explanation of what you are going to do
  • Try and give them a special job or a choice that really isn’t a choice (red or blue PEP device?)
  • Ensure environment is calming and non-intimidating
  • Be aware of the developmental stage of the child
  • Allow children to express concerns and fears and to ask questions
  • Older children can talk without parents present if that makes them more comfortable
  • Encourage participation from caregivers
33
Q

Physio intervention strategies with children with cognitive challenges

A
  • Some kids will not want to be examined so when this is the case it is best for you to work quickly and save your conversation for after physical exam
  • Distraction can help intervention go more smoothly and encourage participation in treatment
  • Using visual cues like happy or sad faces for children who cannot communicate well
  • Ask parents how they learn what their child is thinking and feeling and work from the same cues and nonverbal approaches they use for communication
34
Q

Consent and Gillick’s competence

A
  • In general, a minor (less than 18 years) requires consent from a parent or guardian before treatment can commence, with the exception of an emergency or where treatment is of a minor nature.
  • However, in Australia, there are legislative provisions and common law principles that recognise the developing competency of adolescents to make decisions regarding their own medical treatment - Gillick competent child
  • Judgment about a minor’s competence involves consideration of…
    1. their ability to understand the issues and circumstances
    2. their maturity and degree of autonomy
    3. the type and sensitivity of the information to be disclosed
    4. the age of the minor
    5. the complexity and nature of the treatment (e.g. elective, therapeutic or emergency).
  • If a child is consider a mature minor they consent to their medical procedures and are entitled to the same confidentiality as adults.

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