respiratory disorder

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  1. Anatomic and physiologic differences in the pediatric respiratory tract
    • Newborn & young child
    • easier to get respiratory infection

    • Thorax: rounded with horizontal ribs which are soft and pilable- harder to cough to get mucous out
    • Diaphragmatic or abdominal breathing- to help move air in and out- puts them at risk
    • chest wall thin with little musculature- harder to move air in and out
    • upper airway smaller & less firm
    •    - larynx and glottis higher in neck, nose, throat etc.-
    • glottis can swell if infected and cause obstruction
    • airway is pilable therefore susceptible to collapse- airway can collapse on itself
    • infants have fewer alveoli- babies have increase metabolic needs...they need more oxygen so they will breath more
    • breath sounds are large and harsh
  2. Adult v child
    • child has smaller nasal pharynx- this area can occuld very easily- upper respiratory infection easy blocked
    • tonsil and adnoids- grow rapidly- if this grow too fast the child will snore. too large can cause obstructive sleep apnea 
    • smaller nares- easily occulded 
    • oral cavity- large tongue
    • epiglottis is vunerable to swollen
  3. Risk factors for more severe respiratory illness
    • pediatric anatomic and physiological differences
    • premature- lung structure is not the same as baby born full term. 
    • 37 weeks- 37% more at risk for respiratory infection
    • 34-36 weeks- 70% risk of worsen respiratory infection
    • smoking in the house or around a child (pregnancy) put them at risk for immunosuppressants (infection)
    • maternal smoking
    • ill contacts- daycare risk for developing more infection
    • chronic disorders
    • - asthma, cystic fibrosis, dm, congential heart disorder, sickle cell anemia, cerebral palsy, muscular
  4. Respiratory disorder: commons signs and symptoms
    • Fever;103-105
    • newborn baby- hypothermic (low temp)- may indicate infection
    • listless, lethargic, irritable
    • headache
    • anorexia 
    • vomiting maybe the first sign of illness esp if coughing
    • diarrhea: transient, causes dehydration
    • abdominal pain- spasm from vomiting
    • nasal discharge/blockage/congestion: incr mucous production thin to thick (thin: rhinorrhea, thick purulent)
    • cough: common, may persist x months (noctunal cough) 
    • respiratory sounds: cough, hoarse, grunt (trying to get air in and out), stridor, wheeze, crackles
    • sore throat: viral or bacterial cause (throat culture)
    • respiratory sounds: cough, hoarse, grunt
  5. anatomy of respiratory system
    upper airway- nasal cavity, upper trachea, epiglottis, pharynx

    disease spread from the nose to the lower airways...
  6. Lungs
    • right has three lobes
    • left has two lobes
  7. Nursing process: assessment
    collect health hx, perform PE, monitor lab or dx testing

    • Possible finding include
    • symptoms of hypoxemia, pallor, cyanosis, tachypnea, tachycardia (bc body compesate for the loss of o2), anxiety, confusion (lack of o2 to the brain)
    • poor feedings- when they are feeding they breath thru their nose which is difficult if snuffy
    • cardiac arrhythmias- if we have decr o2 that means will have too much CO2 which creates an acid enviroment makes cardiac changes
  8. assessment cont interview or subjective data
    • onset of symptoms
    • key s/s cough, noisy breathing etc
    • progression of symptoms
    • associated symptoms
    • sick contacts
    • similar illness in past
    • treatments or medications
    • enviroment factors
    • PMH
  9. Physical Assessment
    • Vital signs: temp, BP, RR, HR, O2 stat, pain, 
    •   - incr RR: lower respiratory tract disorder**
    •   - incr HR compensatory mechanism

    • General Appearance 
    • anxiety, position for comfort, affect, color, nasal flaring, grunt, retractions
  10. Physical assessment: Inspection
    • Inspect 1st sign of respiratory illness: tachypnea
    • color: pallor, cyanosis 
    • rate and depth of respiration
    • work of breathing
    • nose and oral cavity
    • cough and airway noises
    • retractions
    • anxiety and restlessness
    • clubbing
    • hydration
  11. Physical assessment: palpate and ausculate
    • Palpate: 
    • - maxillary (born with this) and frontal (developed 6-8 yrs of age) sinuses- infection, for tenderness long term finding 7-10 days 
    • - lymph nodes of head and neck
    • - pulses: central and peripheral
    • - pulse

    Auscultate: for normal/abnormal breath sounds both anterior, posterior and lateral 

    on children- anteriorly, lateral, posterior
  12. Adventitious breath sounds
    • crackles (fine): continous, high pitched, short crackling popping sounds
    • - heard during inspiration not cleared with cough

    • crackles coarse
    • loud, low pitched, bubbling gurgling sounds

    • wheezing (high pitched)
    • - musical squeaking sounds, predominate on expiration but possible in inspiration

    • Rhonchi (low pitched)
    • - musical snoring or moaning sounds heard throughout respiration, may clear with cough

    • Stridor
    • - high pitched inspiratory crowing sound, louder in neck than over chest wall
  13. other respiratory assessment findings
    • restlessness/anxiety
    • cyanosis
    • clubbing- hypoxemia
    • anatomic differences
    • chest diameter changes- barrel chest
  14. deformities of thorax
    • Pectus excavatum- funnel chest indented in
    • petuc carinatum- pigeon breast- v shape
    • barrel chest
    • scolosis > 45 can compromise breathing
  15. average respiratory rates
    • Newborn 30-60
    • infant/toddler: 20-40
    • preschool: 20-30
    • school age: 16-22
    • adolescent: 15-20

    nursing documenttion: rate, activity of child (what are the doing), any deviation from normal and any intervention of actions taken
  16. Alarming Respiratory rates
    note: respiratory parameters which indicate respiratory illness/distress. count full minute

    • infants less than 2mos: resting RR > 60
    • infants 2-12 mos: resting RR > 50 mins
    • children 1-5 yrs: resting RR > 40
    • older than 5 yrs: resting RR > 30

    tachypnea or incr RR often first indicator of airway obstruction in young children
  17. General Aspects of respiratory tract infections
    • respiratory tract infections: 
    • involve upper and or lower respiratory tract
    • can spread from one structure: ex nose- throat- lungs
    • cause majority of acute infections in children
    • influencing factors: age, size, (smaller the person the smaller the airways) season (babies can have bronchilitis), preexisting, medical conditions
  18. Symptoms and complication URI upper part of trachea, mouth nose
    • Symptoms:
    • cough
    • nasal congestion, watery eyes
    • low grade fever
    • sore throat/pharyngitis
    • cervical adenopathy
    • infants poor feeding
    • - high temp (babies can have low temp)
    • - vomiting/diarrhea
    • - dehydration

    • Complications
    • Lower respiratory tract infections
    • bronchial hyper reactivity
    • otitis media
    • acute sinusitis
    • pneumonia 

    cardiopulmonary arrest- for children is respiratory but for adults is usually cardiac
  19. Symptoms: lower airway obstruction
    • incr RR, HR, dec O2 stat
    • wheeze
    • dyspnea
    • cyanosis
    • retractions- sites- supra
    • repetitive hacking cough- non productive
    • prolonged expiratory phase
    • diminished chest expansion
    • barrel chest
  20. sites for retraction
    left up the kids clothing

    Supraclavicular or suprasternal: retractions of upper chest muscles suggest upper airway obstruction

    Intercostal, substernal, or subcostal muscles- retractions suggest lower airway obstruction

    document severity: mild, moderate, severe

    tripod position, use of accessory muscle
  21. Dx Pulse Oximetry (O2 stat)
    • assess oxygenation > 95% standard
    • accuracy decreases: dark nail polish, low cardiac output status, motion and overhead heating lamps

    • Nursing
    • place probe on finger foot or toe
    • Explain procedure to child
    • rotate site when using attached probed
    • ensure accurate reading- (if baby is on a cardiopulmonary monitor)by comparing hr on pulse oximetry to childs hr on monitor 
    • assess skin for breakdown
  22. Dx ABG
    Purpose: assess gas exchange, changes in pH, metabolic and respiratory dysfunction

    Asthma, kids with pulmonary problem (CF), kids who are looking ill

    PO2- level of oxygen in arteries 80-100mmHg- it will go down if the child can't breath in adequately

    PCO2- partial pressure CO2- 35-45mmHg- if the child is not putting out air- then this means that the child is holding on to too much CO2- which will happen u will create too much acid

    O2 stat- 95-100 this goes down if air cant reach the blood

    Ph- 7.35-7.45 balance between acid and alkaline (basic)
  23. ABG Nursing consideration
    • provide explanation only small amount of blood
    • this is an invasive procedure
    • be honest this is a painful procedure- provide coping mechanism. praise child
    • if child is crying CO2 could increase (false reading)
    • follow lab procedure for collecting sample
    • hold pressure on site x several minutes, assess for bleeding. since arteries is puncture
    • comfort the child (coping mechanism) and apply bandage right after to assure the child
    • transport sample on ice and bring to lab right away
    • air bubbles can changes results
  24. Dx radiography
    • chest x-ray- radiation exposure
    • protect gonads (reproductive system) lead shield
    • r/o foriegn body aspiration, hyperinflation, abnormal heart or lung size
    • sinus x-ray

    • CT (protect gonads as well) more radiation
    • use of contrast medium, check for allergies, keep NPO 4-6 hrs, may need sedation

    • MRI: ID's structures and any obstruction of blood flow in vessels and tissues
    • may show sinus involvement. may need sedation
    • nurse will have to go with child to monitor during sedation
  25. Peak flow rates
    Pulmonary function test
    • Peak flow: uses calculated expiratory flow rates to assess respiratory impairment and effectiveness of therapy. this essentially is the amount of air person can blow out- lung volume amount of air taking in and out (asthma- use everyday to help with treatment and keep kids out of hosp)
    • - measures max amount of air forcefully exhaled in 1 sec
    • - established a personal best: pt when well use the peak flow meter two times a day for two weeks and then we would average number. then we would use this number to evaluate the type of treatment pt needs.  

    • PFT
    • purpose measure lung volume, flow rates, lung compliance mostly for asthma. not useful for kids bc u have to follow direction. < 5 yrs dont use
    • blow forcefully into this...
  26. Collecting cultures/washings
    • Nose and throat cultures: identify upper respiratory tract pathogens
    • not useful for lower respiratory tract
    • most children are fearful- quickly hit tonsils back of larngynx and to other tonsils. if exudate is present get that too..get in and out
    • RSV nasal washing- dx rsv
    • lay supine
    • couple of drops saline into one nostril
    • aspirate washing with sterile bulb syringe
    • place secretions in a sterile container. send to lab 
  27. Nursing Therapeutic techniques
    • encourage cough: effective method to raise and expel mucus
    • - change position
    • - encourage deep breathing

    • To initiate cough reflex: demonstrate proper techinque
    • - take breath blow out take another deep breath blow out then take a 3rd deep breath then u should cough
    • almost always produces spontaneous cough
  28. Humidfication
    • Provide moisture to the airways
    • - important to add water pack to oxygen. cause O2 is very dry- extra moisture in the airways

    Vaporizer at home- cool mist is best bc it could burn the child

    • Nebulizer- provides stream of moistened air directly into the airways
    • - delivers minucule droplets that reach the bronchioles
    • - delivery method for respiratory tract medications such as albuterol, steriods, antibiotics (CF- only these kids)
  29. Chest Physiotherapy (PT)
    • helps moves mucus
    • initiates cough reflex
    • expel excess mucous

    Use hand or suction to move that mucus 

    • three techniques
    • postural drainage- have child bend over
    • percussion
    • vibration
    • chest vest for children with CF
  30. Administering Oxygen
    • provide O2 helps relieves hypoxemia and respiratory distress
    • elevates PaO2 arterial oxygen stat levels
    • Infants: incubator or plastic hood, mask or nasal cannula, blow by (not on face but child able to breath in)
    • Older children
    • - nasal cannula
    • - provides approx 50% O2 concentration at 4L/min
  31. Nursing consideration Oxygen
    • assess nostrils frequently esp if using nasal cannula can cause necrosis 
    • can cause skin breakdown
    • snug fitting o2 mask in emergency situation
    • o2 is combustible no fire smoke
  32. spirometry
    make this a game for kids..blowing party favors, blowing cotton across the room 

    • device used to encourage deep breathing fully openning the lungs and move mucus
    • pt needs instruction to perform accurately
    • breathing techniques helps to expand and empty alveoli
Card Set:
respiratory disorder
2014-12-05 03:08:49

breath and let it go...
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