Exam 1 Peds

What are some upper airway variations in pediatrics?

• Obligate nose breathers (first 3-4 months of life)

• Shorter and narrower upper airways

• Small oral cavities and larger tongues

• Long, floppy epiglottises 

• Larynx and glottis higher in the neck

• Cartilage in neck more flexible

• Increased airway resistance

What are some lower airway variations in pediatrics?

• Mainstem bronchi separates higher (T3 for children vs T6 for adults)

• Fewer immature alveoli

• Narrower bronchioles

• Diaphragm for inspiration in children younger than 6 years

• Smaller lungs 

• Immature intercostal muscles

What are the types of coughs and characteristics of each?

Dry — Nonproductive

Wet — productive with mucus

Brassy — noisy (musical)

Croup-like — brassy or seal-like

What are 5 compensatory mechanisms of Respiratory Distress?

Grunting

Retractions

Head bobbing

Nasal flaring

Hyperextension of head and neck

Why do pedis do the compensatory mechanisms?

• Grunting

  • Keep alveoli open, prevent end-expiratory alveolar collapse

    • Prolongs gas exchange

• Retractions

  • Assist with ventilation, using accessory muscles (chest and neck)

    • Flexible chest wall

  • Note where they are on the body, how fast are they breathing, and are they using any other compensatory mechanisms

• Head bobbing

  • Assist with ventilation, using sternocleidomastoid muscles

    • No intercostal muscle support

    • Going to want to give respiratory support

• Nasal flaring

  • Increase diameter of air passages

    • Decrease nasal resistance

  • Ask parent if their nose looks different than usual

• Hyperextension of head and neck 

  • Opens the airway, form of accessory muscle use

    • Can look like the tripod position

What are the 4 cardinal signs of respiratory distress in a child?

Restlessness

Tachycardia

Tachypnea

Diaphoresis

Compare and contrast the Pediatric vs Adult Neuro systems

Pedi Rapid Development Fontanelles and sutures in skull allow for brain growth Relatively large heads Rapid myelination during first 3 years

Adult Slower development Increased skull thickness Decreased pliability Relatively proportional heads Normal myelination

What are the safety interventions for patients with a seizure disorder?

Side rails up and padded

Do not let child ambulate alone

Assist with bedpan or commode

What are the nursing interventions for a child with a seizure disorder?

Safety (side rails up and padded, ambulate with patient, assist with toileting)

Administering meds (anti-inflammatories)

Record specifics about behavior

Coordinate services for collaborative care

Loosen restrictive clothing if patient is having a seizure

Educate child and family on seizure treatment and medication management

What are the signs of increased intracranial pressure in an infant?

Dilated scalp veins

Pale scalp skin and separation of cranial sutures

Macewen sign: tapping on the skull near the junction of the frontal, temporal, and parietal bones produces a resonant sound

Difficulty holding the head upright

Frontal bossing (an enlarged forehead)

Sunsetting eyes

Bulging fontanelle

Emesis and/or poor feeding

Irritability

Sixth nerve palsy

Periods of apnea

What are the signs of increased intracranial pressure in a child?

HA

N/V

Lethargy

Irritability

Decline in school performance

Gait disturbances

6th nerve palsy (Abducens)

Why are pediatric patients more prone to fractures?

Children’s bones are more porous, less dense, so they are more likely to buckle or bow under compression

Also, increased activity and decreased coordination (recipe for disaster) in toddlers

What are the principles of Traction?

• Positioning (straight and supine) 

• Countertraction (flat)

• Friction (free-weight, avoid skin breakdown)

• Continuous use (do not remove w/out MD order)

• Neurovascular status (frequent position changes, protect pressure points)

• Developmental interventions (provide toys & activities)