Respiratory Assessment of the Pediatric

Question 1

Respiratory Assessment

Answer 1

Normal breathing in children is evidence by quiet inspiration and passive expiration at age appropriate rates

Normal heart rate is higher in younger children and decreases with age

Question 2

Overserve movement of chest or abdomen

Answer 2

Chest or abdomen movement without breath sounds can indicate total airway obstruction and basic life support maneuvers are indicated

Question 3

Stridor

Answer 3

• High pitched sounds heard on inspiration (stridor) often indicated of upper airway conditions whereas expiratory noises are more often associated with lower airway obstruction
• Causes of stridor can include
  
  • Croup
  • Foreign body aspiration
  • Congenital or acquired airway abnormalities
  • Allergic reaction
  • Edema after a procedure

Question 4

treatment fo Stridor

Answer 4

Inhaled epinephrinevia a nebulizer and intravenous steroids are common used t otreat stridor

Question 5

Common Causes of Lower Airway Obstruction

Answer 5

Bronchiolitis and Asthma

Question 6

Wheezing

Answer 6

When wheezing is noted inhaled bronchodilators are indicated

If the patient is able to use a metered dose inhaler (MDI) repeated inhalation can act quickly to imprve aeration

When a patient is unable to use a MDI appropriately or sever symptons are present deliver bronchodilators with a nebulizer

Question 7

Nebulizer Treatment

Answer 7

More than one nebulizer treatment is needed to relieve airway inflatmmation. A common approach is to deliver 3 consectutive treatments

If a patient continues to be symptomatic continuous bronchodilators therapy may be delvered with a nebulizer attached to an infusion pump set to administer a bronchodilator continuously

Frequent reassessment of any patient reciveing continuous bronchodilator therapy is essential

Question 8

Inhaled Bronchodilator Side Effects

Answer 8

Tachypnea secondary to beta 1 effect of inhaled bronchodiltos may occur

Question 9

Heliox

Answer 9

Heliox an inhaled mixture of helium and O2is beneficial in case of some airway conditions in children

Question 10

Head Bobbing

Answer 10

Head bobbing is noted by the chin up and neck extended during inspiration with chin falling during expiration and seesaw respiration indicted by chest retraction and abdomen expanding during inspiration is a sign of impending respirtory failure

Question 11

Child Alertness

Answer 11

It is important to assess child’s level of alertness which can range from fully awake, agitated, minimally responsive, to unresponse

Whena child is minimally responsive or unresponsive children we nened to question their ability to protect their airway

Question 12

Adolsecent (16-22 yr)

Normal RR and HR

Answer 12

16-22 breath/min

60-80 b/min

Question 13

School Age (6-12 yr)

Normal RR and HR

Answer 13

18-30 breath/min

70-90 b/min

Question 14

School Age (6-12 yr)

Normal RR and HR

Answer 14

18-30 breath/min

70-90 b/min

Question 15

Preschooler (4-5 yr)

Normal RR and HR

Answer 15

22-34 breath/min

70-90 b/min

Question 16

Toddler (1-3 yr)

Normal RR and HR

Answer 16

24-40 breath/min

80-100 b/min

Question 17

Infants (<1 yr)

Normal RR and HR

Answer 17

30-60 breath/min

90-120 b/min

Question 18

Goal of Oxygen Therapy

Answer 18

The goa of oxygen therapy is to provide adequate tissue oxygenation

Oxygen therapy is most frequently adjusted according to O2 saturataion levels

Question 19

Oxygen Therapy and Oxygen Saturations

Answer 19

Infants and children recieveing O2 therapy will have variable o2 saturatio target ranges depending on age and underlying condition

Lower saturation levels are targeted in infants <32 weeks gestation as exposure to supplemental O2 in premature infants is a risk factor for the development of retinopathy of prematurity (ROP) which is cause through abnormal vascularization which in the most severe cases will lead to retinal detahemnt, babies <1500g are most susceptible

Question 20

Oxygen Therapy and PPHN

Answer 20

Infants with PPHN should have a higher targetd saturation level in order to advoid pulmonary constrction associated with hypoxemia

Pre ductal saturation should be measure in order to get an indication in saturated blood beign delivered to the brain

Question 21

Oxygen Therapy and Cardiac Anomalities

Answer 21

Newborns wil certain cardiac anomlaies are dpendant on intracardiac shunts and an increased saturation in newborns will promote the constriction of the ductus arteriosus

Hyperoxia can increase aortic pressure and systemic vascular resistance decreasing the cardiac index and O2 transport in children with acyanotic congenital heart disease

Question 22

Air Entrainment Mask

Answer 22

Age: >/= 3

FiO2: High Flow 0.24-1

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