PEDS Modules 2: Oxygenation

What type of breathers are infants?

Nose breathers

Do infants produce a lot of mucus?

No, they produce very little mucus

Why are infants more susceptible to respiratory infections?

Because they produce little mucus and have underdeveloped sinuses

Are the sinuses in infants fully developed?

No, sinuses are not developed

What is a key feature of a newborn’s nasal passages?

They are very small and prone to obstruction

Why are infants at increased risk for airway obstruction in the throat?

Because they have a larger tongue in relation to the oropharynx

What tissue is often enlarged in infants, contributing to airway obstruction?

Tonsillar and adenoid tissue

Where is the bifurcation of the trachea in children?

At the level of the third thoracic vertebra (T3)

Why is the location of the tracheal bifurcation in children important?

It's important for suctioning and intubation procedures

How do the bronchi and bronchioles in children differ from adults?

They are narrower, increasing the risk of lower airway obstruction

Do infants have more or fewer alveoli compared to adults?

Fewer alveoli

What risk is increased due to fewer alveoli in infants?

Higher risk of hypoxemia

What is hypoxemia?

Low levels of oxygen in the blood

What is hypoxia?

Low levels of oxygen in the tissues

: How is the tracheal bifurcation in children different from adults?

It is positioned higher and more symmetrical

Does aspiration in children favor one lung over the other like in adults?

No, it may not favor the right lung as strongly as in adults

What emotional signs may indicate respiratory distress?

Anxiety and restlessness

What skin colors may indicate poor oxygenation?

Pallor and cyanosis

What physical sign on the fingers can indicate chronic hypoxia?

Clubbing

What breath sound is commonly associated with asthma or viral infections?

Wheezing

What breath sound is commonly heard with pneumonia?

Rales

What parts of the body should be inspected for respiratory effort?

Nose and oral cavity

What is a common respiratory sign in children indicating increased respiratory rate?

Tachypnea

What nasal sign may suggest respiratory distress in infants?

Nasal flaring

What airway noise may suggest upper airway obstruction?

Stridor

What is a key factor to observe when assessing respiratory effort?

Rate and depth of respirations

What is the normal urine output for a child?

0.5 mL/kg/hr

How should urine output be monitored in infants and young children?

By tracking diaper changes or wet diaper frequency

Why is thin, movable mucus important in the respiratory tract?

It helps clear airways effectively

Why is adequate hydration critical for gas exchange in the lungs?

It maintains the thin fluid layer needed to keep alveoli open

What conditions can proper hydration help manage in children?

Fever and rapid breathing

Why is fluid monitoring especially important in children?

Because they dehydrate faster than adults

What does clubbing indicate in a child?

Chronic hypoxia (low oxygen levels in the blood)

What are common causes of clubbing in children?

• Cystic Fibrosis (CF)

• Congenital Heart Disease

• Bronchiectasis

• Interstitial lung disease

• Chronic pneumonia (PNA)

What body system disorders commonly lead to clubbing?

Long-term respiratory or cardiovascular conditions

Why is cool, humidified oxygen used?

To provide oxygen while soothing airways and reducing irritation

What does cool humidity do for respiratory care?

Adds moisture to inspired air, helping to loosen secretions

What is the purpose of suctioning in respiratory care?

To remove mucus or secretions and maintain a clear airway

What is chest physiotherapy and postural drainage used for?

To mobilize secretions in the lungs and improve breathing

What is the purpose of saline gargles or lavage?

To soothe the throat and loosen secretions

What do mucolytic agents do?

Break down mucus, making it easier to cough up

What is the function of a chest tube?

To drain air, blood, or fluid from the pleural space

Why is bronchoscopy performed?

To visualize and sometimes treat airway abnormalities or remove obstructions

What is the Peak Expiratory Flow (PEF) test used for?

What is the Peak Expiratory Flow (PEF) test used for?

What does pulse oximetry measure and what might it indicate in respiratory illness?

Measures oxygen saturation; may show significantly decreased levels in respiratory disorders.

What might a chest radiograph reveal in a child with respiratory issues?

Hyperinflation, patchy areas of atelectasis, or infiltration.

What do blood gases help detect in respiratory conditions?

Carbon dioxide retention and hypoxemia.

What is the purpose of nasal-pharyngeal washings?

To identify RSV or other viruses via ELISA or IFA testing.

What does rapid strep testing involve?

A throat swab to detect Streptococcus bacteria.

When is a sputum culture useful in children?

In older children and adolescents to identify causative bacteria.

What can an elevated white blood cell count indicate in pediatric respiratory cases?

Bacterial pneumonia.

What is asthma?

An obstructive inflammatory disorder with airway hyperresponsiveness, edema, narrowing, and inflammation.

How is asthma classified?

Mild, Moderate, or Severe

Name common asthma triggers.

Cold air, smoke, viral infections, stress, pet dander, exercise, pollution, fragrances, mold, chlorine.

What is a common short-acting beta 2 adrenergic agonist (SABA) for asthma?

Albuterol or Levalbuterol.

What is the role of SABA in asthma management?

Used alone to control intermittent asthma; provides quick relief.

hat are side effects of albuterol?

Tachycardia, tremors, dizziness.

Name long-acting beta 2 adrenergic agonists (LABAs).

Formoterol and Salmeterol.

When are LABAs used in asthma?

For long-term control, NOT for acute exacerbations.

Name inhaled corticosteroids used for asthma.

Fluticasone, Beclomethasone, Budesonide, Mometasone.

What should patients do after using a dry powder inhaler (DPI) corticosteroid?

Rinse and spit to reduce risk of oral candidiasis.

Side effects of inhaled corticosteroids?

Weight gain, insomnia, decreased immune function, hyperglycemia, oral candidiasis, muscle and bone degeneration.

Name corticosteroids used orally or systemically in asthma.

Methylprednisolone, Prednisone, Prednisolone

Name leukotriene modifiers used in asthma.

Montelukast and Zafirlukast.

What causes cystic fibrosis?

A mutation in the CFTR (cystic fibrosis transmembrane conductance regulator) gene.

What chromosome is the CFTR gene located on?

Chromosome 7.

What does the CFTR protein do?

Moves chloride ions (Cl⁻) in and out of cells to regulate salt and water balance.

What happens when CFTR protein is defective in CF?

Chloride can't leave the cells → water doesn’t follow → mucus becomes thick and sticky.

Which organs are affected by thick mucus in CF?

Pancreas, bile ducts, intestinal glands, gallbladder, submaxillary glands.

What does pancreatic enzyme loss cause in CF?

Malabsorption of fats, proteins, and carbohydrates → poor growth, large malodorous stools.

What medications are given to manage nutrient absorption in CF?

Pancreatic enzymes and fat-soluble vitamins (A, D, E, K).

When should pancreatic enzymes be taken?

During meals.

What respiratory therapy helps mobilize lung secretions in CF?

Chest physiotherapy (CPT) with postural drainage

What is bronchiolitis?

An acute inflammatory process affecting the bronchioles and small bronchi.

What is the most common cause of bronchiolitis?

Respiratory Syncytial Virus (RSV).

What are early symptoms of bronchiolitis?

Clear, profuse runny nose and pharyngitis.

What respiratory symptoms follow the initial phase of bronchiolitis?

Cough, wheezing, tachypnea, retractions, and grunting.

What other symptoms may appear in severe bronchiolitis?

Poor feeding and periods of apnea.

What is the main approach to treating bronchiolitis?

Supportive care, including oxygen, suctioning, and hydration.

What oxygen therapy is used in bronchiolitis?

Supplemental oxygen with cool humidification.

What types of suctioning may be used in bronchiolitis?

Nasal and/or nasopharyngeal suctioning.

What bronchodilator therapies may be used for bronchiolitis?

Inhaled racemic epinephrine or albuterol/levalbuterol.

Why is racemic epinephrine preferred over l-epinephrine?

It reduces tracheal edema with fewer side effects like tachycardia and tremor.