RESPIRATORY

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 • https://youtu.be/FOsxPhJsZrE • Substernal • https://youtu.be/TUWk4t_RTq4 5 Respiratory Distress and Respiratory Failure • Respiratory failure – Partially occluded airway NUFT 433- PEDS- ALTERATION IN RESPIRATORY FUNCTIONS 1

– Malfunction of the respiratory center – Fatigued muscles of respiration – Body can no longer maintain effective gas exchange. – 6 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 8 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 2

• 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 3