Week 2 - Aquantic/Cardiorespiratory

Question 1

When do children develop adult respiratory characteristics?

Answer 1

3 months - 12 years

Question 2

What are risks associated with children respiratory

Answer 2

Infants and children can develop respiratory distress very quickly with respiratory infection

Question 3

What are respiratory anatomic differences of children

Answer 3

1. Preferential nose breathers
2. larynx position
3. Trachea short and smaller
4. Large tongue, tonsils & adenoids
5. Airway diameters smaller
6. bronchial wall mostly cartilage, connective tissue, mucous glands
7. cilia poorly developed at birth
8. alveoli smaller
9. alveoli develop from 150 to 400 million by 8 years old
10. No collateral ventilation at birth
11. Pores of john develop 1-2 years
12. channels of Martin develop 2-3
13. canals of Lambert appear between 6-8 years
14. Horizontal ribs, rounded chest wall
15. bones of rib are soft so chest more compliant
16. Respiratory muscles poorly developed
17. Diaphragm inserted more horizontal and more prone to fatigue
18. lungs less compliant
19. Larger closing volume (CC>FRC)
20. Larger tidal volume (50% vs. 10%) with smaller inspiratory and expiratory reserve

Question 4

What are the differences in children’s diaphragm compared to adults?

Answer 4

Inserted horizontal and prone to fatigue

Question 5

What are lung differences in children/infant

Answer 5

1. lungs less compliant
2. Larger closing volume (CC>FRC)
3. Larger tidal volume (50% vs. 10%) with smaller inspiratory and expiratory reserve

Question 6

Physiological differences of infants and children

Answer 6

1. reversed distribution of ventilation (preferential ventilate non-dependent regions with perfusion remain distributed in the dependent lung)

Question 7

List the normal changes with development

Answer 7

1. Development of lungs parallels the motor development of baby
2. Reaching out develops upper limb and chest wall muscles
3. Chest wall becomes more rectangular
4. Develop antigravity muscles in sitting
5. Pulls ribs down from horizontal
6. Increase tidal volumes

Question 8

What happens if don’t develop normal respiratory changes?

Answer 8

Diaphragm remains their main respiratory muscle and should encourage upper limb movement, stretching and reaching

Question 9

Grey area of respiratory development?

Answer 9

9-12

Question 10

What age should there be fully adult respiratory development?

Answer 10

12 years

Question 11

What questions would you ask the carer during the respiratory assessment?

Answer 11

1. Stability over the last few hours
2. Tolerance of handling
3. Feeds (when, tolerance)

Question 12

What are differences in auscultation of children/infants? (5)

Answer 12

CDSWR

1. more complicated
2. no deep breath on command
3. small chest size allows easier transmission of sound
4. Wheeze
5. Rapid breaths

Question 13

What are the signs of respiratory distress?

Answer 13

Tachypnoea, Tachycardia (>200), bradycardia (<80)

Question 14

What are the normal RR of different stages of development? (4)

Answer 14

1. Newborn - 30-50
2. <2 years- 20-40
3. 2-6 - 20-40
4. > 6 years - 15-30

Question 15

What are the normal HR of different stages of development? (4)

Answer 15

Newborn - 140 (100-200)
<2 years - 130 (100-190)
2-6 - 80 (60-140)
> 6 years - 75 (60-90)

Question 16

What is an important factor for Infantile (primitive) reflexes and when should they be integrated? (2)

Answer 16

1. Reflexes become important if still demonstrating them when should no longer be a reflex but should be a controlled movement.
2. first year of life?

Question 17

List the signs of respiratory distress (8)

Answer 17

1. Recession of breathing pattern (intercostal, subcostal, substernal, tracheal tug)
2. Pallor
3. Sweating
4. Reduced activity/floppy/inability to feed or cry
   Infants
5. Head bobbing
6. Neck extension
7. Nasal flaring
8. Expiratory grunting