admitting the pediatric patient assessment of the respiratory system
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Admitting the Pediatric Patient Assessment of the Respiratory System. History: Vital for Proper Treatment. Admitting the Pediatric Patient Assessment of the Respiratory System. Now What?. Admitting the Pediatric Patient Assessment of the Respiratory System. Gain Trust Parent Present - PowerPoint PPT PresentationTRANSCRIPT
History: Vital for Proper Treatment
Admitting the Pediatric PatientAssessment of the Respiratory System
Admitting the Pediatric PatientAssessment of the Respiratory System
Now What?
Admitting the Pediatric PatientAssessment of the Respiratory System
Gain Trust
Parent Present
Avoid Being Faceless (Isolation Masks)
Ease Fear
Sit or Kneel instead of Stand
Soft Calm Voice
Age Appropriate Words
Stickers, Coloring Books, Bubbles or Toys
Assess from a Distance
Listen for audible airway sounds
Observe Position
Observe Work of Breathing
Retractions
Intercostal
Suprasternal
Clavicular
Substernal
Subcostal
Admitting the Pediatric PatientAssessment of the Respiratory System
Admitting the Pediatric PatientAssessment of the Respiratory System
Respiratory Rate/Pattern
Do not rely on monitor to obtain accurate RR
Count for 1 full minute
Observe pattern (periods of apnea, paradoxical, rapid and deep)
Breath Sounds…Can be very tricky!
The infant or toddler will not remain motionless or quiet.
The infant or toddler will not take a deep breath upon command.
The room may be noisy.
The child or infant may become frightened and begin crying.
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Listen during Insp. and Exp. Phase (2 cycles ideal)
Systematic Assessment; comparing segments from side to side
Pulmonary Disorders in ChildrenCase #1
3 month old infant presents to pediatrics with:
Hr 120-140 SpO2 85% RR 60 bpm Insp/Exp. Wheezing Inspiratory Crackles Paroxysmal cough Parents report periods of
apnea Copious thick secretions Intercostal & Suprasternal
Retractions Rhinitis Afebrile Normal WBC
Crackles
Wheezes
Pulmonary Disorders in Children
• CXR: Air trapping, atelectasis and infiltrates.
Pulmonary Disorders in ChildrenBronchiolitis
• Most common cause of wintertime pediatric hospitalizations
• Leading cause of respiratory failure among infants in the US
• Primarily affects infants < 2 years of age
• Infants < 6 wks of age, with prematurity, congenital heart disease, chronic lung disease, and immunodeficiency are at increased risk
Pulmonary Disorders in ChildrenBronchiolitis
• Management
Oxygen
Suction
IV hydration
Racemic Epinephrine Nebs
Bronchodilators
Antibiotics
Monitoring
Bronchiolitis Protocol (if ordered)
Pulmonary Disorders in ChildrenCase #2
• 10 month old presents to the ED. Mom states when she picked her son up from the daycare after work he was breathing harder and had trouble drinking his bottle. MD office sent her home with rx. For MDI and oral steroid. Mom states she is very worried; feels something is very wrong. HR 180 RR 80 SpO2 90% on 5 lpm HFHH Grunting Nasal Flaring Suprasternal retractions Frequent Coughing Tight exp. wheezing despite 1 hour continuous neb. RUL atelectasis Febrile WBC increased
Case #2Foreign Body Aspiration
• Bronchoscopy revealed a small acorn in the Rt. Mainstem Bronchus.
• Foreign Body removed; infant WOB improved dramatically.
• Was sent home on antibiotics.
Pulmonary Disorders in ChildrenCase #3
• 10 year old presents to the ER with the following symptoms after returning from camping:
Coughing (night), Sneezing
Fatigue (poor sleep, unable to perform usual activities)
Increased WOB (tachypnea, retractions, nasal flaring, tripod position)
Wheezing
CXR with hyper inflated lungs and flattened diaphragms
Pulmonary Disorders in ChildrenAsthma
Treatment Oxygen Nebs: Intermittent/Continuous (Mask vs. Blow-by)
Consider Peak Flows before and after tx.
Steroid Administration IV Hydration Frequent reassessment by RN/RT Volume expansion
Walk, blow bubbles, sing songs
RestAllow child to assume position of comfort
Pulmonary Disorders in ChildrenCase #4
• Tripoding• Grunting• Substernal Retractions• Nasal Flaring• Hypoxemia (no reserve)• Bradycardia• Paroxysmal cough (can
be life threatening)• RR 60 decreases to 24• Paradoxical/Seesaw
breathing pattern• Decreased LOC
Pulmonary Disorders in ChildrenCase #4
• Impending Respiratory Failure Immediate emergency action must be taken
Peds Rapid Response Team– Call 1-1110
Transfer to PICU