neonatal / peds assessment and lung function monitoring w3

Generalizations for peds

Fewer alveoli

 Smaller airways

 Decreased cartilage in airways

 Increased chest wall compliance

 Increased metabolic rate

 Increased O2 consumption

Obligate nose breathers until 6 months

Auscultation of lungs peds

Best with quiet infant; warm diaphragm or bell

 Normal breath sounds are bronchovesicular and

harsher than in adults

Cardiopulmonary Symptoms

Cough

 Sputum production

 Hemoptysis

 Shortness of breath (SOB, dyspnea)

 Chest pain

Cough

Acute: sudden onset, usually severe with a short course, self-limited

 Viral infection

 Chronic: persistent and troublesome for more

than 3 weeks

 Post nasal drip, acute asthma, COPD, allergic

rhinitis, GERD, chronic bronchitis, chronic

bronchiectasis

 Paroxysmal: periodic, prolonged, and forceful

episodes

cough descriptions

Descriptions:

 Effective (strong enough to clear the airway vs inadequate (audible, but too weak to

mobilize secretions)

 Productive vs dry and nonproductive

 Quality

 Barking, brassy (harsh dry), hoarse, wheezy,

hacking

Sputum Production

The substance expelled from the airways, mouth, sinuses, and nose by coughing or clearing the throat

 Phlegm is from lungs and tracheobronchial tree

 Caused by inflammation of mucous glands

Sputum descriptions

Color

 White, clear, black, brownish, pink, yellow, green, red, blood-

streaked

 Consistency

 Thin, thick, viscous (gelatinous), tenacious (extremely sticky),

frothy

 Odor

 Foul-smelling, fetid

 Quantity

 Small amount, large amount

 Time of day

 morning, throughout the day, at night

Hemoptysis

Expectoration of sputum containing blood

 Ranges from slight streaking to frank blood

 Causes

 Acute bronchitis with sever coughing

 Bronchogenic carcinoma

 Bronchiectasis

 Chronic bronchitis

 tuberculosis

Shortness of Breath (SOB)

Also known as dyspnea

 Difficulty breathing as perceived by the

patient

 Most distressing symptom of respiratory

disease

 Cardinal symptom of cardiac disease

 May be associated with metabolic

diseases, hematologic disorders, toxic

ingestion, or psychiatric conditions.

Dyspnea scoring systems

Method to help quantify dyspnea at a single point

in time or to help track changes

 Visual analog scales (0-10)

 Modified Borg scale (0-10 and descriptive terms)

 Modified Medical Research Council (MMRC) dyspnea

scale (0-4, 0 is only breathless with strenuous exercise

and 4 is too breathless to leave the house.

Chest Pain

Can occur from musculoskeletal disorders, trauma, drugs therapy,

indigestions, anxiety

 Characteristics range from sharp or stabbing to a feeling of heaviness or discomfort

 May be steady or intermittent, mild or acute

 Pulmonary causes

 Chest wall or parietal pleura

 Mediastinitis

Assessing Oxygenation

Arterial Blood Gases

 Obtained at the following sites

 Radial

 Most common

 Brachial

 Femoral

 Only during codes

 Advantages of ABG:

 Tests many analytes which give valuable information about ventilation and oxygenation which help guide mechanical ventilation

 Oxygen level

 PaO2

 Normal level 80-100mmHg

 <80mmHg = hypoxemic

Oxygenation disadvantages

Invasive

 They hurt!

 Can give a small injection of lidocaine

 Can be difficult to obtain

 Hypovolemia, poor perfusion

 Atherosclerosis

 Can’t see where the vessel is

 Have to palpate it

Pulse oximetry

One of the most widely used pieces of equipment an RT uses

 Advantages

 Quick and easy reading, Non-invasive, Painless, Portable

Disadvantages

 Can be subject to motion, Skin temp can affect readings, Nail polish/length can affect readings'

Treatment

 Oxygen therapy, Nasal cannula, non-rebreather mask, venturi mask

Tidal Volume

Amount of air taken with each normal breath

 Varies greatly from person to person

 400ml to 750mL

Minute Volume

Respiratory Rate x Tidal Volume

 Total amount of air the patient breathes in one

minute

 Normal adult range: 6L/min-10L/min

 500mL x 12 breaths per minute

Muscle Strength

Negative Inspiratory Force

 Pressure generated by drawing in against a closed

valve

 Used to assess respiratory muscle strength during weaning from a vent

 Should be < -20mmHg

 Can also be used in pulmonary function testing

Peak Expiratory Flow Rate (PEFR)

Maximum flow rate a patient can exhale on a forced exhalation

 Parameter used in

 Pulmonary Function Testing

 Home monitoring for asthmatics

 Based on patient’s

 Age

 Height

 Gender

 Weight is not a factor!

Peak Flow Meters

Commonly used to measure PEFR

 Stable patients at home

 Pediatric population

 Typically calibrated in liters per minute (L/min)

 Proper technique is essential

 Poor technique = erroneous results

 Wide range of quality

Asthma facts

1 in 11 children have it

 1 in 12 adults have it

 Associated costs = $56 billion per year

 In 2013, asthma caused 13.8 million missed days of school,14.2 million missed days of work

 In 2020, 4,145 people died from asthma

Asthma Action Plan

green zone - perf 80% or greater no symptoms

yellow zone - perf 79%- 50% patient is symptomatic

red zone - Perf 50% or less experiencing severe asthma symptoms or an asthma flare-up got to hospital