RESPIRATORY
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School
Holy Family University *
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Course
433
Subject
Anatomy
Date
Jan 9, 2024
Type
docx
Pages
11
Uploaded by dgraff1926 on coursehero.com
1
Alterations in Respiratory Functions
2
Pediatric versus Adult Respiratory System Anatomy and Physiology
Anatomy of upper airway
•
A smaller nasopharynx is easily occluded during infections.
•
A small oral cavity and a large tongue increase the risk of
obstruction
•
The large amounts of soft tissue and loosely anchored
mucous membranes increase the risk of edema and
obstruction.
•
Cartilage around trachea flexible
•
Airway diameter
–
Trachea shorter and narrower
→
increased airway
resistance
→
increased respiratory effort
3
Pediatric versus Adult Respiratory System
Anatomy and Physiology
•
Position of trachea
–
Right bronchus acute angle at
bifurcation
→
increased foreign body aspiration
4
Pediatric versus Adult Respiratory System
Anatomy and Physiology
Anatomy of lower airway
•
Use diaphragm to breathe until 6 years of age
•
Immature chest muscles and ribs
→
retractions
•
Suprasternal and intercostal
•
https://youtu.be/n66CTtQRf60
•
Subcostal and intercostal
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https://youtu.be/FOsxPhJsZrE
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Substernal
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https://youtu.be/TUWk4t_RTq4
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Respiratory Distress and Respiratory Failure
•
Respiratory failure
–
Partially occluded airway
NUFT 433- PEDS- ALTERATION IN RESPIRATORY FUNCTIONS
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–
Malfunction of the respiratory center
–
Fatigued muscles of respiration
–
Body can no longer maintain effective gas exchange.
–
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Respiratory Distress and Respiratory Failure
Mild Respiratory Distress: Attempting to Compensate
–
Restlessness
–
Tachypnea
–
Tachycardia
–
Diaphoresis
Moderate Respiratory Distress: Early Decompensation
–
Nasal flaring
–
Retractions
–
Grunting
, wheezing
–
Anxiety, irritability, mood changes, confusion
Severe Respiratory Distress: Respiratory Failure/Imminent Arrest
–
Dyspnea
–
Bradycardia
–
Cyanosis (note that cyanosis is a late sign)
–
Stupor, coma
7
Pediatric Emergencies
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Brief resolved unexplained event (B R U E)
•
Frightening episode of one of the following: apnea, decreased breathing, cyanosis
or pallor, change in muscle tone, and altered level of responsiveness in a child less
than 1 year of age.
•
Lasts less than 1 minute
•
Common causes
•
Gastroesophageal reflux
•
Seizures
•
Lower respiratory disorders
•
Cardiac arrhythmias
9
Brief resolved unexplained event (B R U E)
Diagnostics
•
CBC, electrolytes
•
Blood and urine cultures
•
EKG
•
EEG
•
pH study
•
MRI
Management
NUFT 433- PEDS- ALTERATION IN RESPIRATORY FUNCTIONS
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•
Treatment is targeted at the underlying condition
Nursing
Care
•
Monitor cardiorespiratory status
•
Emergency resuscitation
•
Provide emotional support
•
Teaching
10
Sudden Infant Death Syndrome (S I D S)
•
The sudden death during sleep of an infant under 1 year of age that remains
unexplained after a thorough investigation
•
Most S I D S deaths occur in infants between 2 and 4 months of age.
•
Risk factors
–
Maternal smoking during pregnancy
–
Secondhand smoke
–
Co-sleeping
–
Premature, low birth weight
–
Prone or side-lying position
–
Viral illness
–
Soft bedding, pillows
–
Low apgar scores
11
Sudden Infant Death Syndrome (S I D S)
•
Parent education related to prevention
–
Back to sleep
–
Avoid loose bedding, toys, pillows
–
Use a firm, tight mattress in crib
–
Discourage co-sleeping
–
Use of pacifier during sleep
–
Smoking increases risk
–
Keep immunizations up to date
12
Pediatric Airway Disorders
13
Croup syndromes
•
Upper airway illnesses that result from inflammation and swelling of the epiglottis and
larynx
•
Broad classification of upper airway illnesses
•
Viral syndromes
–
Acute spasmodic laryngitis
–
Laryngotracheobronchitis (LTB)
•
Bacterial syndromes
–
Bacterial tracheitis
–
Epiglottitis
NUFT 433- PEDS- ALTERATION IN RESPIRATORY FUNCTIONS
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14
Laryngotracheobronchitis (LTB)
Causes
Parainfluenza RSV
Influenza Adenoviruses
Enteroviruses
Who?
Children 3 months- 3 years old
Manifestations
Early
Fever Barking-seal
Stridor
Restlessness, irritable
Later
Retractions
Increased stridor
Cyanosis
15
Laryngotracheobronchitis (LTB)
•
Monitor for airway obstruction
•
Cool mist
•
Administer O2 if needed
•
Administer corticosteroids (oral dexamethasone) as ordered
•
Administer nebulized racemic epinephrine
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Epiglottitis
•
Usually caused by
Haemophilus Influenzae
•
MEDICAL EMERGENCY
•
Progresses rapidly
→
complete airway
obstruction
•
Absence of cough, drooling
•
Tripod position
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Epiglottitis
Management
•
Immediate endotracheal intubation
•
Supplemental oxygen
•
IV antibiotics
Nursing Care
•
Protect airway- prepare for intubation
•
Monitor continuous oximetry
•
Droplet precautions for first 24 hours
•
Avoid throat culture
NUFT 433- PEDS- ALTERATION IN RESPIRATORY FUNCTIONS
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