The Child with Respiratory Alterations - Lecture Notes

Question 1

One of the most common illnesses in children

Answer 1

Respiratory

Question 2

Nasopharynx

Answer 2

smaller, easily occluded during infection

Question 3

Lymph tissue (tonsils, adenoids)

Answer 3

grows rapidly in early childhood; atrophies after age 12

Question 4

Small oral cavity and large tongue

Answer 4

increases risk of obstruction
- especially in unconscious child

Question 5

Smaller nares

Answer 5

easily occluded

Question 6

Long, floppy epiglottis

Answer 6

vulnerable to swelling which results in obstruction

Question 7

Larynx and glottis

Answer 7

higher in neck, increasing risk of aspiration

Question 8

Immature thyroid, cricoid, and tracheal cartilages

Answer 8

may easily collapse when neck is flexed

Question 9

Fewer muscles are functional in airway

Answer 9

less able to compensate for edema, spasm, and trauma

Question 10

Large amounts of soft tissue and loosely anchored mucous membranes lining airway

Answer 10

increase risk of edema and obstruction

Question 11

smaller lung capacity and underdeveloped intercostal muscles

Answer 11

give children less pulmonary reserve

Question 12

Higher respiratory rates and demands for O2 in young children

Answer 12

makes hypoxia easy to occur

Question 13

where is the airway the smallest?

Answer 13

airway is smallest at the cricoid for children younger than 8 years - can be occluded very easily.

Question 14

what gender is more susceptible to airway obstruction and respiratory distress?

Answer 14

male children

Question 15

Infant and Toddler breathing

Answer 15

• barrel-chested
• rely heavily on the diaphragm for breathing
• lack the firm bony structure to ribs/chest makes child more prone to retractions when in respiratory distress

Question 16

CREBS

Answer 16

Cough
Rate/regularity
Effort (work of breathing)
Breath sounds
Saturation

Question 17

Quality of Respirations

Answer 17

Rate, regularity, symmetry, effort, accessory muscles, breath sounds, ability to speak (not able to speak is a big sign of respiratory distress)

Question 18

Respiratory Distress Associated Observations

Answer 18

Retractions, nasal flaring, head bobbing, snoring, grunting, colour, chest pain, clubbing, cough

Question 19

Respiratory Assessment (QQAPBS)

Answer 19

Quality of Respirations
Associated Observations
Quality of pulse
Position of the child
Behaviour change
Signs of dehydration

Question 20

Respiratory Distress

Answer 20

what you see initially, showing signs that this child is having difficulty breathing

Question 21

Respiratory Failure

Answer 21

when the child can no longer maintain effective gas exchange. there is either functional or structural failure of the mechanisms of respiration

Question 22

Clinical Manifestations of Respiratory Distress (3)

Answer 22

Hypoxemia: lack of oxygen in the blood
Hypercapnia: too much carbon dioxide
Alveolar hypoventilation: not enough gas exchange is taking place at the alveoli that are not being ventilated properly

Question 23

3 things that can cause alveolar hypoventilation

Answer 23

1. O2 need exceeds O2 intake. Mismatch between supply and demand
2. Airway partially occluded: foreign body, edema, swelling, mucus production
3. Transfer of O2 and CO2 in the alveoli is disrupted: between alveoli and capillary Ventilation perfusion mismatch

Question 24

Progression of Respiratory Failure/Arrest: Cardinal Signs (DTTR)

Answer 24

• Restlessness
• Tachypnea
• Tachycardia
• Diaphoresis
  Subtle, not that particular to any one condition. See there if a child was frightened. Important to notice and take into consideration the entire history of the child

Question 25

Early Decompensation (less obvious): they were managing ok and now they are starting to not manage as well

Answer 25

• mood changes
• headache
• increased WOB
• hypertension
• exertional dyspnea
• anorexia
• increased cardiac output & urinary output
• CNS symptoms (anxiety, confusion, restlessness, irritability, depressed LOC)
• nasal flaring
• retractions
• expiratory grunting
• wheezing/prolonged expiration

Question 26

Severe Hypoxia

Answer 26

• hypotension
• depressed respiration
• dyspnea
• bradycardia
• cyanosis
• stupor and coma

Question 27

Early Recognition is the Goal

Answer 27

important to watch for early signs and intervene early so the child doesn’t go into respiratory arrest. Children’s hearts are usually pretty healthy - most don’t have cardiac arrest, they would have respiratory arrest which if not corrected will eventually cause their heart to fail as well. And if they go into cardiac arrest they have a really poor prognosis

Question 28

Continuum of Respiratory Failure: Initial Signs (DTTRP)

Answer 28

Physiology: the child is attempting to compensate for an oxygen deficit and airway blockage. The oxygen supply is inadequate; behaviour and vital signs reflect compensation and beginning hypoxia
- restlessness
- tachycardia
- tachypnea
- diaphoresis
- pale

Question 29

Continuum of Respiratory Failure: Early Decompensation (CNGHHHAMW)

Answer 29

Physiology: the child uses accessory muscles to assist oxygen intake; hypoxia persists and efforts now waste more oxygen than is obtained
- Confusion
- nasal flaring
- grunting
- head bobbing
- headache
- hypertension
- anxiety & irritability
- mood changes
- seesaw respirations
- Wheezing

Question 30

Continuum of Respiratory Failure: Imminent Resp Arrestd (CNNDBS)

Answer 30

Physiology: the oxygen deficit is overwhelming and beyond spontaneous recovery. Cerebral oxygenation is dramatically affected; central nervous system changes are ominous
- Dyspnea/bradypnea
- bradycardia
- seesaw respiration’s
- cyanosis
- no air movement
- no wheezing