x Resp: Pediatrics (Ms. Ci) Flashcards
RESPIRATORY DISTRESS SYNDROME (RDS)
- Cause: DEC in surfectant
- Affects: Preterm, low birth weight infants
- Rare in full term babies
- big reason for mortality/morbidity in neonates
- lungs formed in last weeks of pregnancy (26 - 34wks)
- preemies don’t have fully formed lungs
- 10/100 infants premies
- more MALES
RDS: Risk Factors
- preterm
- Csec delivery
- Diabetes (mom)
- Asphyxia
- maternal hemorrhage
- abnormal genes for surfactant
Surfactant
- Site: Lining of alveoli (made by epithelium of alveoli)
- DEC surface tension of fluid
- uniform expansion + maintenance of lung expansion
- when infant lacks surfactant, they are unable to keep lungs inflated. they use lots of energy to keep lung inflated.
RDS: SS
- dev 24 hrs after birth
- hypoxic
- hypercapnia (retain CO2, acidosis)
- rapid shallow breath
- expiratory grunting
- nasal flaring
- apnea
- tachypnea
- retractions (chest looks caved in because accessory muscles being used)
- Mottling (red white spotty legs)
RDS: Complications
- Pneumothorax
- Bronchopulmonary dysplasia
- blindess/retinopathy
- necrotizing enterocolitis
RDS: Dx Tests
- clinical presentation
- CxR
- ABG
- Echo
RDS: Rx
- surfactant replacement therapy (ETT, thru endotracheal tube)
- breathing support (mech vent, cpap)
- Nutrition support (breast milk, TPN, PPN)
- Temp control (incubator)
RDS: NI
- NICU
- Frequent resp assess
- suctioning (never routine)
- skin care/oral hygiene
- emotional support
- if baby survive 96 hrs, prognosis UP
RDS: Prevention
- prevent pre-term birth (if they think mom is going to deliver early , they give steroids to UP surfactant production in fetus
- see MD prenatal
- Avoid Smoking, ETOH, Drugs
- control: ongoing med condition
- Prevent: Infection
BRONCHOPULMONARY DYSPLASIA (BPD)
Lung disorder affecting:
-Born 10 or more wks b4 due date
-
BPD: Risk Factors
- meconium aspiration
- RDS
- Pressure from mech vent or CPAP
- Lung infections
- UP O2 levels
BPD: SS
- Pulmonary arterial HTN
- Cor Pulmonale
and SS of RDS
- dev 24 hrs after birth
- hypoxic
- hypercapnia (retain CO2, acidosis)
- rapid shallow breath
- expiratory grunting
- nasal flaring
- apnea
- tachypnea
- retractions (chest looks caved in because accessory muscles being used)
- Mottling (red white spotty legs)
BPD: Dx
- clinical presentation - no improvement 14-30 days old (2-4wks)
- CxR, ABG, PFTs
- Echo (is it the heart?)
BPD: Rx
- Resp: Mech Vent/CPAP (lowest O2)
- MED: Bronchodilators
- Nutrition: Parental then gut (NGT, Gavage, Oral Feed)
TPN vs PPN
- Total Parenteral Nutrition (thru Central Line)
- Peripheral Parental Nutrition (can go in arm d/t LO Dextrose)
- If Dextrose is UP 10%, needs to go through central line
BPD: NI
- Rest
- small frequent oral feeds
- LO risk of resp infections (don’t expose to sick), Flu shot
- notify MD for SS resp infection
- educate parent, CPR instruction
PNEUMONIA (PNA)
Infection and inflammation of the pulmonary parenchyma, bronchioles and alveoli
-associated w URIs
PNA: Types
- Bacterial
- Viral
- Foreign body aspiration
PNA: SS
- cough
- wheeze
- crackles
- resp distress
- CP
- anorexia
- irritability
- lethargy
- HA
- F
- Myalgia
- Abd Pain
- Nasal Discharge
- Malaise
- newborns/infants may be asymptomatic. may first vomit
PNA: Dx
- CxR
- CBC (UP WBC)
- Sputum, Blood C/S
- Thoracentesis (if develops pleural effusion)
PNA: Rx
- O2
- Abx
- Chest PT
- Suctioning
- Fluids (to thin mucus)
- MED: Bronchodilators
- MED: antipyretics (tylenol)
PNA: NI
- frequent resp asst
- rest
- infection control, hand washing
- encourage pt participation in care
Respiratory Syncytial Virus (RSV)
causes PNA and Bronchitis
- affects all ages
- severe infection in infants, children, elderly
- causes: lower resp tract infection
RSV
Almost ALL children are infected w the virus by 2nd bday, but only small % develop severe disease
-3-10days duration
RSV: Transmission
- droplets
- direct/indirect contact
- (sneeze = 100,000 droplets, 90mph)
RSV: SS
- cough
- stuffy/runny nose
- mild sore throat
- earache
- F
- LO interest in surr
- listless/sleepy
- irritable/not sleeping
- poor feeding
- Apnea
RSV: Dx
- Viral detection test (nasal washing)
- CxR, ABGs, Pulse Ox
- CBC
Nasopharngeal Swab, Aspirate, Wash
have to restrain baby. uncomfortable
RSV: MM
- mist tent
- O2 therapy
- IV fluids
- MEDS: Bronchodilator
- MED: Ribavirin (Virazole) (admin in hospital, aerosol)