week 5 module 14 peds resp Flashcards
primary muscles of respiration
diaphragm
- primary
- contracts during inspiration
external intercostal muscles
- inc. the anteroposterior chest diameter during inspiration
interior intercostal muscles
- dec. the transverse chest diameter during expiration
accessory muscles of respiration
sternocleidomastoid and trapezius
- associated with pulmonary problems and compromise
peds and lung compliance
inc. compliance of chest wall
-> inc. risk collapse
less fatigue resistant muscles: tire easy
infant lung growth and development
derives from foregut during 4th week gestation
bronchial tree by 16th week
alveoli develop from latter 3rd of gestation through first months of life
- alveoli inc. in number throughout childhood
chest in infant
rounded
circumference equal to head until about age 2
infants anatomical risk for respiratory compromise
upper airway smaller and less firm than adults
more compliance in chest wall -> collapse when stressed
fewer fatigue resistant diaphragm muscles: tire easy
retractions
chest wall seems to cave
- suggests obstruction to inspiration
paradoxic breathing
on inspiration, the lower thorax is drawn in, and on expiration, the opposite occurs
- chest wall collapses as the abdomen distends on inspiration
periodic breathing
sequence of relatively vigorous respirations followed by apnea of as long as 10-15 seconds
- common in newborn and infant
persisting round chest
indication of a pulmonary problem after 2 y/o
stidor
high-pitched, piercing sound most often heard during inspiration
result of an obstruction high in the respiratory tree
grunting
mechanism by which the infant tries to expel trapped air or lung fluid while trying to retain air and increase oxygen levels
nasal flaring
indicator of respiratory distress
asthma
chronic inflammatory condition of the lung airways resulting in episodic outflow obstruction
asthma and genetics
more than 22 loci on 15 autosomal chromosomes linked
- IL-4 gene cluster on chromosome 5
- proallergic, proinflammatory
clinical manifestations of asthma
intermittent dry cough expiratory wheezing prolonged expiratory phase SOB chest tightness or pain resp. symptoms worsen at night self-imposed limitation of physical activities generalized fatigue
PFT
help confirm the dx of asthma and determine severity
- >6y/o
bronchiolitis patho
acute viral infection of the smaller airways
- > hyperinflation of lungs
- primarily caused by RSV
croup
results from infection with a variety of viral agents - particularly parainfluenza - common from 1.5-3yrs Inflammation of upper airway - larynx, trachea, bronchi
croup characterized by
bark like cough possible hoarseness high-pitched resp. sound inspiratory stridor resp. distres worse at night
resp. distress syndrome
preterm infant has great difficulty breathing
-dec. surfactant
Cystic fibrosis patho
autosomal recessive disorder of exocrine glands involving lungs
pancreas
sweat glands
- single gene on the long arm of chromosome 7
Thick mucus plugs clog the bronchi and bronchioles
clinical manifestations of CF subjective
viscous meconium in newborn wt loss despite large appetite recurrent resp. infections liquid, large, bulky foul-smelling stools recurrent or persistent wheezing salty skin frequent flatulence of abd. pain chronic cough retractions dyspnea on exertion
newborn RR
30-80
1 year RR
20-40
3 year RR
20-30
6 year RR
16-22
10 year RR
16-20
17 year RR
12-16
diaphragmatic hernia patho
result of an imperfectly structured diaphragm
- 90% of the time the liver is not there to get in the way
diaphragmatic hernia subjective
degree of resp. distress can be slight or severe depending on extent of bowel invading the chest through the defect
diaphragmatic hernia objective
bowel sounds heard in the chest flat of scaphoid abdomen heart displaced to the right tachypnea retractions grunting
CF objective
bronchiectasis barrel chest nasal polyps low body mass clubbing pulmonary hypertension cor pulmonale
croup subjective
URI s/s
- mild fever
awakens suddenly after going to bed, often frightened, with harsh, barking cough
croup objective
labored breathing retractions hoars barking cough stridor restless irritable
tracheomalacia patho
lack of rigidity of the trachea or airway
trachomalacia subjective
noisy breathing or wheezing in infancy
inspiratory stridor
tracheomalacia objective
stridor
wheezing
bronchiolitis subjective
begins with URI poor feeding vomiting diarrhea lethargy expiration becomes difficult infant appears anxious
bronchiolitis objective
breaths rapid and short generalized retractions perioral cyanosis wheezing, grunting diminished breath sounds altered mental status hyperinflation -> inc. AP diameter hyperresonant percussion
