Peds Respiratory Flashcards
(34 cards)
Upper vs. Lower Disorders
Upper (neck and above) - croup, epiglottitis
- Nasal cavity
- Pharynx
- Larynx
Lower (the majority of disorders)
- Trachea
- Primary bronchi
- Lungs
Lung Resistance vs. Lung Compliance
Lung Resistance = determined by airway size
- If small airway = more resistance; if bigger airway = less resistance
Lung Compliance = ease to breathe; measurement of the ease of chest expression
Describe what respiratory distress looks like in the peds population
- As a child’s body starts working harder to breathe, the body will automatically start breathing faster.
- Under 2 months > 60 breaths/min
- 2 months - 12 months > 50 breaths/min
- 1-5 years > 40 breaths/min
- 6-12 years > 30 breaths/min
- 12 years > 20 breaths/min
- Abnormal breathing patterns
- Abnormal sounds: grunting (signs of distress in babies)
- Abnormal blood values to include ABG
- Tachycardia, tachypnea, nasal flaring, retractions, head bobbing
- Once distress has started if we can’t correct it in a timely manner, signs of failure begin.
- Distress -> Failure -> Arrest
Early Signs of Respiratory Failure
Interventions
Pallor, anxious behavior, restlessness
Treatment – Raise HOB, give O2 (nasal cannula - babies are obligatory nose breathers), neck roll underneath them, suction if there is a mucus issue
Late Signs of Respiratory Failure
Interventions
Hypotension, cyanosis, apnea
Call Dr. - time to intubate
Managing Respiratory Failure
- Recognition of prolonged periods of apnea
- Maximize ventilation and oxygen delivery
- Correct hypoxia and hypercapnia
- Treat Underlying cause
- Restrictive: Pneumothorax, Scoliosis (not a lot in pediatrics) - they can’t inhale well
- Obstructive: Laryngospasm, Asthma, COPD - they can’t exhale well
- Apply therapy to control oxygen demands
- Anticipate complications
- Identification of Compensatory Mechanisms
- Decrease in retractions, RR, cough, etc
Failure = decline in adequate oxygenation.
Pediatric Assessment Triangle
*Appearance
- Tone
- Interactiveness
- Consolability
- Look/Gaze
- Speech/cry
*Work of Breathing
- Abnormal breath sounds
- Abnormal position
- Head bobbing
- Retractions
- Gasping
- Nasal flaring
*Circulation to Skin
- Pallor
- Mottling
- Cyanosis
- Absent or Weak Pulses
- Abnormal BP
- Obvious signs of bleeding
Developmental and Biological Variances in Pediatric Population - Blood volume and shock
- Total blood volume is smaller = small blood loss may lead to hypovolemia and impaired perfusion
- Compensation: healthy children in shock can maintain their BP up until they lose 25% of their blood volume
- Tachycardia and Delayed Capillary Refill = Early signs of shock
- Cap refill looked at a lot in peds - it’s not affected by children being afraid
- Decreased Blood Pressure = Late sign
Pediatric Cardiac Arrest Algorithm
Doses of Epi - 0.01 mg per kg repeat every 3-5 min
One person: 30 to 2. Two people: 15 to 2
Describe Cystic Fibrosis and effects of the disease
- Genetic disorder regarding the production of mucus throughout the body.
- Increase in mucus production often leads to secondary bacterial infections. = chronic damage overtime leading to respiratory failure
- Can cause sterility due to mucus blocking the vans deferens and ovarian ducts
- “Salty” skin reported by caregivers due to
Metabolic system producing excess sodium chloride - Delayed growth/poor weight gain
- Meconium ileus at birth is common to see
- Lung transplant
- Affects the lungs primarily as well as the pancreas
- Digestive Impact
- Thick mucus in pancreatic ducts = decrease in absorption of digestive enzymes = failure to absorb fat, proteins, and carbs.
- Secondary DM1 “CF related Diabetes” – 20% adolescents
Cystic Fibrosis Management
Pulmonary Toileting
Chest physiotherapy
- Postural drainage: sitting upright, HOB up; gravity moves secretions from periphery to bronchi to be coughed out
- Controlled cough: get secretions out, sputum culture is usually obtained
- Percussion: cupped hands clap the chest
- Vibration: with hands or vest
- Vest: vibrates and percusses
- Usually done before bedtime, 1-2 hours AFTER meals
Expectorants: Guaifenesin (Mucinex)
Cystic Fibrosis Management
Nutrition
- Need 1.5-2x the caloric intake recommended for an individual their age
- 40% of meals should be from fat
- Every meal/snack: take digestive enzymes within 30 minutes of eating
Cystic Fibrosis Management
Psychosocial considerations
Self Image
- Adolescent age group
- “Relentless cough”
- Medical devices
- Nutritional limitations
- Medication management
Independence
- Vulnerability
- Life-shortening disease
- Interaction with peers
- “Loss of power”
- “No cure”
Metabolic
- Delayed puberty
- Delayed menarche
- Infertility
- Delayed weight gain
- Height
Common CF Medications
Bronchodilators
albuterol (Ventolin, ProAir, Proventil), levalbuterol hydrochloride (Xopenex)
- Open airways and relaxes muscles
- Inhaled MDI with Spacer
Common CF Medications
Mucolytic
Dornase alfa (Pulmozyme), hypertonic saline
- Thins/breaks-up mucus, allowing patients to cough it out!
- Inhaled
Common CF Medications
Antibiotics
Varies, likely an oral penicillin
- Prophylaxis; oral
- Also used in treating breakthrough infections (can be IV, Oral, or inhaled)
Common CF Medications
NSAIDs
Ibuprofen, Piroxicam
Recent evidence shows NSAID use in children may decreased pulmonary deterioration, improve FEV1, and decrease lung infection recurrence
Common CF Medications
Contraceptives
Oral, IUD, IM, ring, etc.
- Pregnancy can reduce lung function, decrease quality/quantity of life without proper planning.
- All women with CF of childbearing age should use contraceptives (and many consider sterilization).
Common CF Medications
Pancreatic Enzyme Replacement Therapy
Oral capsule
- To replace the pancreatic enzymes that are blocked from the pancreas to digestion due to mucus blockages
- Take with each meal and snack (within 30 minutes)
Common CF Medications
Vitamins
Multivitamins (in particular: vitamins A, D, E, K)
- Difficult to absorb fats
Common CF Medications
Proton-pump inhibitors/ H2 blockers
Used to treat GER(D); those with CF are more likely to have GER(D) secondary to excessive coughing
Common CF Medications
Stool softeners
Often used to help regulate BM.
Thick mucus and not adequate fluids in the bowel can lead to constipation = encourage fluid intake!
Common CF Medications
Corticosteroids
Corticosteroids are used to help decrease inflammation, typically during infection.
Bronchopulmonary Dysplasia
Chronic respiratory disorder in premature infants “CLD”
Characterized by stiff lung tissue = difficult delivery of oxygen
NICU admission, born prematurely = can’t fully oxygenate the lungs
Immature lungs have fewer alveoli
Hyperinflation of immature lungs produces inflammation and scarring in lungs
As they grow older - “Chronic Lung Disease”, always get respiratory illness, “junky”
