Week 2: Physiological Differences Flashcards
Should we treat paediatric patients as “little adults” ?
No
Differences in neurological system
-BBB not mature until 2
-Myelinization in first year of life
-Numerous reflexes present initially
-CNS immature; nerve fibres poorly developed
How much % of brain growth is achieved in an infant’s life?
50% by 1y, 75% by 3, 90% by 6
How much %BW does a brain weight at birth?
12%; doubles by 1y, 3X by 5-6
When does blood brain barrier develop?
1 month. This is why we’re worried if a baby has a fever
Fontanelle
Suture/separation between the bones of the skull that have not yet joined
What are fontanelles covered by?
Tough membranous tissue to protect brain
When does the posterior fontanelle close?
2-3m
When are anterior fornatelle and sutures palpable?
18 months and then they close
What do we think if a patient presents with depressed or sunken fontanelles?
dehydration
What do we think if a patient has a bulging fontanelle and a screaming cat cry?
Increase in intercranial pressure
Why do we have fontanelles?
To allow the brain space to grow- as this is a period of RAPID growth
You are an RN, and are told to do a COMPLETE neurological assessment on a pediatric patient. How would you proceed?
-Fontanelles
-Reflexes
-LOC/Glasgow
-PERRLA
-Behaviour appropriate
-Bilateral strength and coordination
-Crying-what type of crying?
-Are they inconsolable?
-orientation
-Strength and coordination of suck
How long is the respiratory tract growing and changing?
12y
Upper airway differences between children and adults?
Shorter neck
Shorter trachea
Obligatory nose breathers (newborns)
Larynx and glottis higher in neck
Tongue is large relative to small nasal and oral passage
What happens as a result of the shorter and more narrow trachea?
Creates risk for obstruction
Newborns are obligatory nose breathers, talk about it.
They won’t automatically open their mouth if the nose is obstructed. This emphasizes the important of nasal patency.
What increases the newborn’s risk of aspiration?
Larynx and glottis high in the neck
What are some of the lower airway differences?
-25 million alveoli (less)
-Less lung volume
-Depend on diaphragm to breath
-CO2 not expired with they are stressed
So, what are the concerns with fewer alveoli seen in children-when do they increase?
300mil by age 8. Smaller alveoli as they aren’t fully developed, predispose them to alveolar collapse
Why do infants have greater airway resistance?
It is smaller and narrower by 15X. If anything goes wrong (i.e. swelling) their risk is far greater than in an adult
What happens when a child can’t expire CO2 properly?
metabolic acidosis
You are an RN, and you are doing a complete respiratory assessment on a child. How would you proceed?
-Auscultate
-resp rate
-WOB
-SPO2
-Rhythm
What are some ways we can tell there is WOB?
grunting, can see ribs, trach, nasal flaring, head bobbing
