peds exam 2

process where oxygen is transported to the cells and carbon dioxide is transported from the cells

gas exchange

what kind of breathers are newborns

preferential nose breathers; they cannot open their mouths to breathe

why are newborns more susceptible to infections

they produce very little mucus (upper resp mucus serves as a cleansing agent)

why are newborns more prone to obstruction

have very small nasal passages

what happens as newborns sinuses are not developed

they are less prone to sinus infection

what can the placement of toddler’s tongue (relative to oropharynx larger) do

lead to airway obstruction

what can children’s enlarged tonsillar and adenoid lead to

airway obstruction

what does larynx funnel shaped until 10 lead to

secretions accumulate in retropharangeal space

what are traits of trachea

highly compliant, susceptible to collapse in presence of obstruction

what is the difference of bifurcation of trachea compared to the sixth in adults

occurs at level of the third thoracic vertebra in children

what to inspect for resp color

pallor, cyanosis, acrocyanosis

what to inspect resp for rate and depth of respirations

tachypnea

what cavities to inspect for resp

nose for mucus and congestion and oral for hydration

what does the slowing of RR in tachypneic infant/child show

not necessarily improvement, but often a slow RR is an indication of tiring / resp death

what to palpate resp in older child

sinuses for tenderness

palpable (feelable) vibration transmitted through the body

fremitus

what does decreased peripheral pulses say when assessing resp

poor perfusion and significant resp distress

what does a flat or dull percussion mean for resp

partially consolidated lung tissue

what does a tympanic percussion for resp mean

pneumothorax

what does a hyperresonance percussion for resp mean

asthma

process of air entering and inflating the lung to enable gas exchange (good, mod, poor); how well you hear resp sounds

aeration

obstruction in the lower trachea or bronchioles

wheezing

what is connected to wheezing

asthma, bronchiolitis, chronic lung disease, and cystic fibrosis

what does stridor sound like

rubbing

crackling sounds and fluid-filled alveoli

rales

might reveal hyperinflation and patchy areas of atelectasis or infiltration

chest radiograph

might show carbon dioxide retention and hypoexemia

blood gases

positive identification of rsv or other viral illness. rapid strep testing via throat swab culture

nasal-pharyngeal washings

may be useful in determining causative bacteria in older children and adolescents

white blood cell count

what may a pulmonary function test reveal

a decrease in forced vital capacity and forced expiratory volume, with increases in residual volume

what meds for resp

mucolytic agents, bronchodilators, steroids

what are common med treatments for resp

oxygen (flow and %); high humidity; suctioning; chest physiotherapy and postural drainage; saline gargles or lavage; chest tubes; bronchoscopy

what are examples of acute infectious disorders

common cold, sinusitis; flu; pharyngitis, tonsillitis, and laryngitis; croup syndromes; resp syncytial virus; pneumonia and bronchitis

risk factors for acute infectious disorders

prematurity; chronic illness; developmental disorders (cerebral palsy); passive exposure to cigarette smoke; immune deficiency; crowded living conditions or lower socioeconomic status; daycare attendance

how tp prevent rsv

handwashing and synagis (palivzumab)

prevent severe RSV disease in those most susceptible

synagis (palvizumab)

what are qualifying factors for synagis (palivizumab)

prematurity, chronic lung disease (BPD), certain congenital heart diseases, certain neuromuscular disorders

what are acute non-infectious disorders

epistaxis; foreign body aspiration; respiratory distress syndrome; acute respiratory distress syndrome

most frequently occurs in children 6m-3yrs & may require surgical removement; choking hazard

foreign body aspiration

specific to neonates - usually occurs within hours of birth, very infrequently term infant, and directly related to deficiency of pulmonary surfactant

respiratory distress syndrome

why are neonates more likely to experience respiratory distress syndrome

lung immaturity and deficiency in surfactant

what does lack of surfactant in lungs result in

stiff, poorly compliant lungs w poor gas exchange

how to treat respiratory distress syndrome

intensive respiratory care ; admin. of surfactant via endotracheal tube

what are s/s of respiratory distress syndrome

grunting respirations, use of accessory muscles, and nasal flaring appearing within hours after birth

what may respiratory distress syndrome need

mechanical ventilation which may cause long-term complications like bronchopulmonary dysplasia

what is pediatric acute respiratory distress caused by

obstruction, tension pneumothorax, pulmonary embolism, cardiac tamponade, resp illness, or many other processes

tx for pediatric acute respiratory distress

treating underlying cause and proving supportive care

what does nursing care for pediatric acute resp distress include

astute assessment (RR, breath sounds, work of breathing), patient positioning, and med admin

what are examples of chronic resp disorders

cystic fibrosis; allergic rhinitis; asthma; chronic lung disease; apnea

generalized dysfunction of the exocrine glands

cystic fibrosis

what are the traits of cystic fibrosis

thickened, tenacious secretions in the sweat glands, GI tract, pancreas, resp tract, and other exocrine tissues

what does the sweat glands in cystic fibrosis do

produce larger amount of chloride, leading to salty taste of skin and alterations in electrolyte balance and dehydration

what does CF loss of pancreatic enzyme activity, malabsorption of fats, proteins, carbs lead to

poor growth and large frothy stools

what is therapeutic management aimed at CF for

minimizing pulmonary complications, maximizing lung function, preventing infection, and facilitating growth

what is pulmonary hygiene

chest physiotherapy; pulmozyme - mucolytic ; inhaled antibiotics

chronic inflammatory disease of airways with acute bronchoconstriction (wheezing); airway edema; increased mucous production; airway injurt and repair leading to remodeling of the airway

asthma

what is the core of asthma management

control or prevention of inflammation

characterized by airway hyperresponsiveness, airway edema, and mucus production

chronic inflammatory airway disorder

what are children w asthma prescribed w

daily control med (low dose inhaled corticosteroid - aimed at preventing inflammation) and a rescue medication (short acting bronchodilators for acute bronchoconstriction - typically albuterol)

what are asthma control plan

peak flow meter; MDI, nebulizers, steroids; CLOSE follow up; step approach; collaboration

what is stepwise approach to asthma management

tiered system of therapy w fast acting short acting B2 agonist (SABA) later adding inhaled corticosteroid (ICS) and/or long acting B2 agonist (LABA) if symptoms persist

no or minor interference in normal activity, FEV > 80% of predicted

mild asthma

some limitation of activity, FEV 60% to 80% of predicted

mod asthma

extremely limited, FEV < 60% of predicted

severe asthma

absence of breathing for longer than 20 seconds; may or may not be accompanies by bradycardia

apnea

what does the sequence of ABC to CAB focus on

circulating remaining oxygen first then providing breaths

how to do CPR on infants

check brachial pulse; two-finger technique (single rescuer) or two-thumb encircling technique (two rescuer); compressions warranted for heart rate less than 60

sudden unexpected death of an infant in which death remains unexplained after performance of adequate post-mortem investigation

sudden infant death syndrome

what are maternal risk factors for SIDs

age; smoking; lack of prenatal care; drug use; short inter-pregnancy intervals

what are infant risk factors for SIDs

age; prematurity; twin or triplet; low body weight; previous acute life altering event; gender; siblings

what are sids prevention risk factors

prevent teen pregnancy; avoid substance abuse; stop smoking; protective factors; immunizations; pacifier; breast feeding; sleep practices

how to prevent SIDS

sleep in non-prone position; avoid soft surfaces and gas trapping objects; provide tummy time

when is the fetal heart rate present

about post conceptual day 17

when are the four chambers of the heart and arteries formed

gestational weeks 2-8

how does oxygenation occur in fetus during fetal development

via the placenta

what is the lung not able to do depsite being perfused

oxygenation nor ventilation

an opening between the atria that allows blood flow from right to left atrium

foramen ovale

allows blood flow between pulmonary artery and aorta, shutting blood away from pulmonary circulation

ductus arteriosus

what are the 2 major events that initiate transition

establishment of respirations and separation of the placenta

what happens to cord and placenta during tranistion

cord is clamped ; placenta is separated

what happens to blood pressure during transition

systemic BP increases

what happens to systemic vascular resistance in transition

becomes greater than pulmonary vascular resistance

drives the fluid into interstitium

transpulmonary pressure

what happens to fluid during transition

absorbed through lymphatics and pulmonary circulation

respond to elevated PO2 by vasodilation

pulmonary vessels

what is pulmonary vascular resistance inversely related to

PO2 and pH

how is the pulmonary vascular resistance decreasing

progressively until it reaches adult levels at 2-3 weeks

what happens when ductus arteriosus is closed

lungs now provide oxygenation and the PO2 rises

most potent stimulus for constriction of the ductus arteriosus

rise in PO2

what also causes the ductus arteriosus to constrict

drop in prostaglandin previously received from placenta

when does ductus arteriosus close

15-24 hrs after birth

when is the ductus arteriosus anatomically obliterated

by 3-4 weeks

what may occur intermittently until ductus arteriosus closes

functional murmur

what does the fall in pulmonary vascular resistance in foramen ovale do

results in a drop in RA and RV pressure

what does the increased systemic vascular resistance in foramen ovale do

causes an increase in the LA and LV pressure

what does the shift in pressure cause

foramen ovale to close

what happens to foramen ovale in first month of life

sealed by fibrin and cell products

what happens to foramen ovale until first month of life

anything that causes a significant increase in RA pressure can re-open the foramen ovale and cause right-to-left shunt

what does absent umbilical blood flow lead to

closure

when is ductus venosus functionally closed

with 2-3 days