Respiratory Assessment

Jan Bazner-ChandlerCPNP, CNS, MSN, RN

Respiratory

Bifurcation of trachea Change in chest wall shape

Upper Airway Characteristics Narrow tracheo-bronchial lumen until age 5 Tonsils, adenoids, epiglottis proportionately

larger in children Tracheo-bronchial cartilaginous rings collapse

easily Infants up to 4-6 weeks are obligate nose

breathers Tongue is large in proportion to the mouth

Lower Airway Characteristics Lack of firm bony structure to ribs/chest make

child more prone to retractions when in respiratory distress

Fewer alveoli in the neonate Poor quality of alveoli until age 8 Lack of surfactant that lines the alveoli in the

premature infant Inhibits alveolar collapse at end of expiration

Focused Health History Reason for the visit Include questions about the environment

What makes condition worse – triggers Allergies

Past medical history: birth history, previous health problems, childhood illness, immunizations

Family medial history: respiratory illness – genetic link

Focused Physical Assessment Types of breathing:

Less than 7 years abdominal breathing

Greater than 7 years abdominal breathing can indicate problems

Respiratory Rate Inspiratory phase slightly longer or equal to

expiratory phase Prolonged expiratory phase = asthma Prolonged inspiratory phase = upper airway

obstruction Croup Foreign body

Color Observe color of face, trunk, and nail beds

Cyanosis = inadequate oxygenation

Clubbing of nails = chronic hypoxemia

Respiratory Distress Grunting = impending respiratory failure Severe retractions Diminished or absent breath sounds Apnea or gasping respirations Poor systemic perfusion / mottling Tachycardia to bradycardia Decrease oxygen saturations

Chest Muscle Retraction

Chest Retractions Retractions suggest an obstruction to

inspiration at any point in the respiratory tract.

As intrapleural pressure becomes increasingly negative, the musculature “pulls back” in an effort to overcome the blockage.

The degree and level of retraction depend on the extent and level of the obstruction.

Diagnostic Tests Detects abnormalities of chest or lungs

Chest x-ray Sweat chloride Test MRI Laryngoscope / bronchoscopy CT Scan

White Patchy Infiltrates

X-ray Hyperinflation of Lung

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Pleural Effusion

Pleural Effusion X-Ray

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Foreign Body Aspiration

A foreign body in oneor the other of the bronchicauses unilateral retractions.

*usually the right due tobroader bore and more vertical placement.

Sweat Test for Cystic Fibrosis

Gold Standard testfor Cystic Fibrosis

Oxygen Therapy: Nursing Interventions Proper concentration

Adequate humidity: make sure there is fluid in the bottle

Make sure prongs are in nose and that the nares are patent – suction out nares to increase oxygen flow

Monitor oxygen SATS: if alarm keeps on going off but the infant / child looks good, check the device

Monitor activity level or infant / child

Aerosol Therapy Respiratory Therapist will do the treatment Communicate with therapist – eliminated

needless paging for treatments Treatment should be done before the infant

eats When you make your morning rounds assess

if there is any infant / child that needs an immediate treatment

Home Teaching Inhaled Medications Correct dosage Prescribed time Proper use of inhaler No OTC drugs Encourage fluids When to call physician

Aerosol Therapy

Medicationadministeredby oxygen or compressedair.

Outpatient Aerosol Treatment

Postural Drainage and Percussion In the small child you can position on

your lap Do first thing in the AM Do before meals or one hour after Do after the aerosol treatment since the

treatment will help open the airways and loosen the mucous

Suction the infant after treatment – teach parents to do bulb suction

Percussion and postural drainage

Mechanical Ventilation

Alterations in Respiratory Function

Severe Respiratory Distress• Nasal flaring and grunting• Severe retractions• Diminished breath sounds• Hypotonia• Decreased oxygen saturations

What to do if infant / child in respiratory distress! Stimulate the infant / child - remember crying

or activity will help mobilize secretions and expand lungs

Have the older child sit up take deep breaths and cough

Chest percussion to loosen secretions Give oxygen Assess if interventions work Call for help if you need it – pull the

emergency cord – yell for help