Respiratory interventions and SIDS

Why are respiratory problems often more serious in children than adults?

Children have smaller airways, less alveoli, larger tonsils/adenoids → easily obstructed airway from edema, mucus, bronchospasm, less reserve

Newborn nose structure

Obligate nose breathers (4wk-6mo), ↓ mucus, maxillary and ethmoid sinuses

Sinus development in children

Sphenoid sinus starts developing at 2-3yo, then frontal sinus 6-8yo

How does infant’s tongue contribute to airway obstruction?

Tongue is proportionally larger, so posterior displacement can obstruct airway more easily

Common signs of pediatric respiratory distress

Tachypnea, accessory breathing, abnormal breath sounds, restlessness, cyanosis, eventually lethargy

Why is a slow respiratory rate concerning in an acutely ill child who was previously tachypneic?

May indicate respiratory fatigue and impending respiratory failure, not improvement

If a child’s pulse oximeter reads 89%, what should nurse do first?

Look at child first to assess overall condition first, not the monitor

What should you check if a pulse ox reading is unexpectedly low?

Child’s appearance positioning and respiratory status, probe placement, oxygen equipment/flow

Nebulizer

Delivers liquid medication into respiratory tract as an inhaled mist

What is albuterol used for?

Bronchodilation to treat wheezing and bronchospasm

What is racemic epinephrine used for?

Croup, it rapidly decreases airway edema

What is dornase alfa used for?

Cystic fibrosis; it helps thin respiratory mucus

What are inhaled corticosteroids used for?

Long-term control of airway inflammation, not immediate relief of acute wheezing

What should children do after using an inhaled corticosteroid?

Rinse their mouth to decerease oral candidiasis and hoarseness

What is chest physiotherapy (CPT)?

Percussion, vibration, and postural drainage used to thin respiratory secretions so they can be coughed up or suctioned

When is CPT indicated?

Cystic fibrosis, bronchiolitis, and pneumonia

When is CPT contraindicated?

Decreased cardiac reserve, severe dehydration, pulmonary embolism, increased ICP

When is CPT not useful?

Croup, epiglottitis, laryngitis, pleuritis, pneumonitis, asthma

Nasal cannula

Low-flow oxygen delivery (max is 4L) that allows eating, drinking, and talking; typically w/ humidification

Why is humidification used in pediatric oxygen therapy?

Prevents drying and irritation of the airway and helps prevent thick secretions

What flow rate is used for simple face mask?

6-10 L/min; below 6 → rebreathing exhaled CO2

Oxygen hood

Enclosure over infant’s head, providing 5-12 L/min without requiring a mask to avoid distress

Oxygen tent

Device that surrounds child’s body with 10-15 L/min w/ humidification

Nursing consideration with oxygen tent

Keep tent closed and secure to maintain concentration, change damp/wet linens frequently

What is a nonrebreather mask used for?

Emergency situations or very high oxygen needs, providing 80%-100% oxygen

Blow-by oxygen

Oxygen held near child’s nose/mouth (not face!) for children unable to tolerate mask

Nursing consideration for oxygen delivery methods

Always include humidification, titrate oxygen starting at the lowest flowrate, make delivery method feel safe

Why do pediatric tracheostomy tubes generally not have an inner cannula?

Inner cannula makes tube bulkier, further narrowing already small airway

What should a normal tracheostomy stoma look like?

Pink and free of bleeding or abnormal drainage

Why does a child with a tracheostomy need humidification?

Tracheostomy bypasses upper airway, which normally warms and humidifies inhaled air

What happens when humidification isn’t used when it needs to be?

Airway becomes dry → thick secretions → mucus plug → possible airway obstruction

When should a pediatric tracheostomy be suctioned?

PRN based on assessment findings not scheduled, such as audible secretions or ineffective airway clearance

What are complications of excessive/aggressive suctioning?

Mucosal trauma, hypoxia, and bradycardia

What emergency equipment should always be at the bedside of a child with a tracheostomy?

Two spare trach tubes (same size and one smaller), suction equipment, spare trach ties, lubricating jelly, and a bag-valve mask

What is SUID?

Broad category that describes SIDS, accidental suffocation/strangulation, and other explained causes

SIDS sleep environment and care practice risk factors

Prone/side sleeping, soft loose bedding or pillows/toys, bed sharing, sleeping in car seat at home

SIDS prenatal risk factors

Maternal smoking, alcohol, inadequate prenatal care/low maternal age

SIDS infant risk factors

Infants 2-3 months (<1yr is risky but less), low birth weight, born prematurely, african/native

What are the ABC’s of safe sleep?

Alone, Back, Crib

What should be kept out of an infant’s sleep area?

Pillows, loose blankets, stuffed animals, toys, and bumper pads

How can pacifier use affect SIDS risk?

May reduce SIDS risk by promoting arousal or keeping airway open during nap/bedtime