583 composed of lecithin and sphingomyelin and prevents alveoli from collapsing during respirations after birth.
584 Process of breathing air into and out of lungs, affected by several elements and their interaction w/each other:
Intercostal muscles, diaphragm, ribs:
These allow chest expansion and contraction. Expansion of chest lowers pressure in chest cavity, and air flows from higher pressure of atmosphere into lower pressure of chest cavity. Diaphragm and actual rib structure
Vagus nerve and respiratory centers in medulla of brain regulate rhythmic respiratory movements. Signals sent to respiratory center will increase or decrease respiratory rates. 584
These sensors respond to changes in O2 saturation of blood by sendin a signal to pons in brainstem, which is stimulated to increase respirations when O2 sat is low.
Last to form are alveoli
Form 24 wks. gestation; alveolar cells begin to produce surfactant, which prevents the alveoli from collapsing during respirations after birth (phospolipid-helps alveoli to stay open)583 Acts like soap to keep alveoli open, decreases surface tension.
Summary of Respiratory Tract in Children
584 Ribs and diaphragm allow for inspiration of air. Air enters body through the nares, or nostrils. Use more oxygen. Airway smaller than in adult-smaller than pinky. Mucous membranes of airways are highly vascular and are susceptible to trauma, edema, and spasm.
Accessory muscles of respiration are not as strong in children, particulary in infants.
Trachesophageal (TE) Fistula
Intestines go into upper cavity; usually on L side; can be in severe distress or back to NICU - put NG TUBE in-stomach acids out and air; don't want air to go into intestine-will take up room where heart and lungs are
Allows abdominal contents (intestines, spleen, and stomach ) to enter chest cavity and prevents lungs from expanding fully.
Occurs 6-7th week of gestation.
More flexible-hyper/hypoextension problem
Used for respirations rather than chest/costal muscles/diaphragm
Not completely developed amount at birth, that's why some infants can recover from some damage at birth. Continues to add more alveoli till prior to puberty
Cartilage/bony growth that blocks nasal passage. Newborns are nasal breathers-can't get air through there. Block one nare and then block other nare to determine if breathing through. Airway breather-keeps mouth open; surgery next-break or remove cartilage.
Types of retractions
Suprasternal-ones around collar bone/indicative of more respiratory distress
Substernal-breastbone; below xiphoid process
Intercostal-muscles around ribs-see whole chest pulling in
Subcostal-fall along bottom line of ribcage
PROCEDURES THAT CAN BE DONE
THROAT AND NASOPHARYNGEAL CULTURES-which organism
BRONCHOSCOPY-CHILD sedated; flexible tube-look down bronchi
LUNG BIOPSY-testing piece of tissure to pathology
ARTERIAL BLOOD GAS-CO2, pH, O2, metabolic blood levels; ventilation and where we stand; can cause apnea if u try to keep O2 levels down
pH ANALYSIS-acid base balance
PULSE OXIMETRY-O2 saturation in hemoglobin
PULMONARY FUNCTION TESTS-vital lung capacity; how much air getting in
BRONCOGRAM-how dilated are bronchi;find places of obstruction
ANGIOGRAPHY-looks at vessel around lungs; dye study; make sure kids have good kidney function; BUN-Creatinine
Cold; coryza, most common infection of respiratory tract
Principle cause is rhinovirus, which is spread from person to person by sneezing, coughing, or direct contact
Hand hygiene will help prevent spread of virus
Nasal discharge, irritability, sore throat, cough, and general discomfort
Moist air soothes inflamed nose and throat
Avoid nosedrops w/an oily base
Adequate fluid intake-fluids s/be encouraged to prevent dehydration
Prevention of fever - tylenol-dosage and concentration , easy to overdose kids- what strenghth and dose; motrin 586
Skin care - petroleum ointment to nares and upper lip to prevent skin irritation
Inflammation of structures of throat
Comon in children 5-15 years
Virus most common cause
Haemophilus influenzae most common in children under 3 years
Symptoms: fever, malaise, dysphagia, and anorexia, conjunctivitis, rhinitis, cough, and hoarseness w/gradual onset, lasts no longer than 5 days. 586
Sinusitis in Children
Frontal sinuses are present around 8 years of age but not fuly mature until around age 18 yrs.
Proximity of sinus to tooth roots often results in tooth pain when a sinus infection occurs.
Maxillary and ethmoid sinuses often involved in childhood sinusitis - can get conjunctivitis
587 Restlessness-can't breathe ; and aprehension
Focus on trying to breathe
Accessory muscles of respiration-increasing use
Cyanosis of nail beds
Confused - late signs
Rale, bronchi, wheezing
Club fingers - overgrowth of nailbed
Tachypnea- school age - 20-25 - respiratory rate; 30 or 40-be concerned
Infant 60 - in distress
May or maynot have cough - barking cough
Nasal flaring - as much O2 in as they can
Grunting or stidor on expiration
Cold mist humidifier; cool mist in tents - make sure linens and clothing not wet - need to change
Below vocal cords; get the edema/ IVs started for hydration; antibiotic and medication therapy; O2 stat monitors 588
Don't give opiotes-respiratory depression - don't give sedatives - too relaxed
Nebulized form of epinephrine /corticosteroids
Acute spasmodic laryngitis is milder form
Acute laryngotracheobronchitis ost common
Also referred to as subglottic croup because edema occurs below vocal cords
Can lead to airway obstruction, acute respiratory failure, and hypoxia
Congenital laryngeal stridor (laryngomalacia)
Weakness in airway walls, floppy epiglottis that causes stridor on inspiration
Symptoms less when infant is placed prone or propped in side-lying position
Usually clears spontaneously as child grows and muscles strenghten
Spasmodic laryngitis Occurs in chilren 1-3 years of age
Causes: viral, allergic, psychologic
Trigger can be gastroesophageal feflux
Sudden onset, usually at night
Characterized by barking, brassy cough and respiratory distress; lasts few hours
Child insists on sitting up, leaning forward with mouth open, drools saliva because of difficulty in swallowing.
Cough is absent
Examining throat w/tongue blade could trigger laryngospasms, therefore, a tracheotomy set s/be at bedside before any exam. of throat takes place
Treatment: increasing humidity and providing fluids
Helps relieve respiratory distress and laryngeal spasm
If hospitalized, may be place in mist tent or croupette
Cool air saturated in microdroplets enter small airway of child, cooling and vaoconstriction occurs, relieving respiratory obstruction - avoid using opiates and sedatives
Viral condition manifested by
Edema, destruction of respiratory cilia, and exudate, resulting in respiratory obstruction
Mild URI followed by barking couggh, then stridor develops and leads to respiratory distress; crying and agitation worsen symptoms
Child prefers to be in upright (orthopnea)
RSV Respiratory Syncytial Virus
Responsible for 50% of cases of bronchiolitis in infants and young children
Synagis - has to be given every month; IM injection
Most common cause of viral pneumonia
Infants between 2 & 7 months of age can become seriously ill because of their small airways
Spread by direct contact w/respiratory secretions/use good hand hygiene
Survives for more than 6 hr. on countertops, tissues, and bars or soap
Incubation is approx. 4 days 591 Put in isolation
Cough suppresants at bedtime.
Antibiotics don't work because this is viral.
Can't feed well - dehydration follows; put on IV fluids
Caregivers who are pregnant or wear contact lenses s/not give direct care to infants who are receiving ribavirin aerosol therapy
Routine immunizations may have to be postponed for 9 months after Respi-GaM has been given
Inflammation of lungs in which alveoli become filed w/exudate and surfactant may be reduced.
Breathing shallow, resulting in decreased oxygenated blood
Dry cough, fever, increased respiratory rate
Respirations shallow to reduce chest pain typicaly caused from amount of coughing or from pleural irritation, nasal flaring
Child is listless, poor appetite, tends to lie on affected side-makes it easier to breathe. 591
Group B streptococci - killer in newborns
Chlamydia most common cause in infants 3 wks to 3 months
H. influenzae type B infection has been decreasing w/current immunization program.
RSV, rhinovirus, adenovirus, pneumococcus - infants and children
Pneumocystis jiroveci - gram-negative organism
Lipid pneumonia - infant inhales oil-based substance
Hypostatic pneumonia-poor circulation-remain in one position too long
Need to finish antibiotic therapy
Decrease tobacco in environment