What's Different About Kids? Flashcards
What makes Kids Different?
Anatomic, physiologic, emotional
- Subtle signs
Growth & development
Unreliable historians
Change quickly
Family involvement
ABCDEF of Children
Airway
Breathing
Circulation
Disability (neuro, pain, LOC, response to people and environment, behaviour, and movement)
Exposure (temp, skin, bruising, rashes)
Family
Airway - Nursing implications
Airway positioning (allow child to maintain a position of comfort)
O2 therapy
Suction - with CAUTION!!
Patent
Maintainable with positioning or suction
Unmaintainable - requiring intervention
Head bobbing
Tracheal tug
Stridor
more intrathoracic pressure, more air into their lungs. Tracheal tugging: commonly seen in croup
Stridor: heard on inspirations (upper airway obstructions)
Upper airway
Nasal flaring
Stridor
Tracheal tugging
Stertor
Lower airway
wheezing
grunting
subcostal retractions
intercostal retractions
Lower airway
wheezing
grunting
subcostal retractions
intercostal retractions
Breathing (8)
Less O2 reserve
Higher RR
Fewer alveoli (until 8 years)
Anatomical dead space (spaces where air isn’t exchanged)
Thin chest wall
Poorly developed intercostal muscles & soft, pliable ribs (allows for retractions)
Diaphragmatic breathing
Retractions (hallmark sign for respiratory distress)
Trachea bifurcation
In children, the trachea is shorter and the angle of the right bronchus at bifurcation is more acute than in the adult. Aspirated foreign body is more likely to land in the right side.
Breathing - Nursing Implications
- Respiratory Effort
- Colour
Respiratory effort: low RR is sign of impending cardiovascular collapse. RR increases 4bpm for each 0.6 degree celsius change and HR increases 8-10 bpm
Retractions - note location
Stridor (indicates a narrowing or obstruction of upper airway)
Grunting
nasal flaring
Colour: central cyanosis - sign of late resp failure. shouldnt me mottled or discoloured
Auscultation
O2 therapy
Perfusion
Cough
Barky
Harsh
Congested
Paryoxysmal (pertussis)
Secretions
Frequency
Regularity (CREBS)
Inspiratory/expiratory ration
- inspiration slightly longer or = expiration
Increased inspiration
? upper respiratory problem (croup)
Prolonged expiration
? Asthma (air trapping)
Adventitious Breath Sounds
Air entry (bilateral/anterior/posterior)
Wheeze (bronchospasm)
Moist sounds (rales)
Coarse sounds (rhonchi)
Crackles (fluid, secretions, inflammation)
Stridor (upper airway, foreign body)
Saturation (oxygen)
94-100% on RA
Assess pre/post inhalation medication
Administration of O2
Assess and move probe every 4 hours/
Nasal cannula administer up to 4 L/min
Pulse Oximetry Tips: Assess patient for factors that could cause inaccurate SpO2 readings:
- presence of abnormal Hgbs
- Hypoperfusion
- severe anemia
- venous congestion
- Presence of nail polish
Pulse Ox: Ensure good signal & measurement by observing the following
Strong signal indicator
Correlating pulse rate with palpated pulse & auscultated HR
Correlating SpO2 measurements with clinical condition
Circulation
- Cardiac Output
- Blood pressure
CO:
- HR x SV
- CO is dependent until late school age or adolescence
Blood Pressure: hypotension is a late & ominous sign of cardiovascular collapse
Tachycardia: how children increase CO, 180-200bpm, children can tolerate tachycardia better than bradycardia