Peds CHAP 18 Ppt - Respiratory

Nursing Care of the Child with an Alteration in Gas Exchange/Respiratory Disorder

Chapter Outline and Concepts

  • Focus on the nursing care of children suffering from alterations in gas exchange due to respiratory disorders

Anatomy of the Respiratory System

  • Structures Involved:
    • Nasal cavity
    • Trachea
    • Bronchial tubes
    • Pulmonary artery (blood from the heart)
    • Pulmonary vein (blood to the heart)
    • Bronchiole
    • Alveoli (site of gas exchange)
    • Capillary network surrounding alveoli
  • Gas Exchange Mechanism:
    • Oxygen (O₂) enters the bloodstream, while carbon dioxide (CO₂) exits via diffusion in alveoli

Pediatric Considerations

Differences in Anatomy and Physiology
  • Infants:
    • Obligatory nasal breathers
    • Produce very little mucus
    • More susceptible to infections
    • Sinuses not fully developed.
  • Newborns:
    • Very small nasal passages, increasing risk for airway obstruction
    • Larger tongues in relation to oropharynx, promoting airway compromise.
  • Children:
    • Enlarged tonsillar and adenoid tissues, impacting airflow.
    • Bifurcation of trachea at the level of the third thoracic vertebrae is clinically significant for suctioning or intubation.
    • Narrower bronchi and bronchioles lead to increased risk for lower airway obstruction.
    • Fewer alveoli than adults, resulting in higher risk of hypoxemia.

Risk Factors for Respiratory Disorders

  • Prematurity
  • Chronic Illnesses:
    • Diabetes
    • Sickle cell anemia
    • Cystic fibrosis
    • Congenital heart disease
    • Chronic lung diseases
  • Developmental Disorders:
    • Cerebral palsy
  • Environmental Factors:
    • Passive exposure to cigarette smoke
    • Crowded living conditions or lower socioeconomic status
    • Daycare attendance increases exposure to infections.

Laboratory and Diagnostic Tests

Pulse Oximetry
  • Different sensors available: adult, infant, neonatal, pediatric.
Blood Gas Analysis
  • Buffer System:
    • Kidneys and lungs maintain acid-base balance.
  • Normal Values:
    • pH: 7.35-7.45
    • HCO₃: 22-26 mEq/L
    • PCO₂: 35-45 mmHg
    • PO₂: 80-120 mmHg

Understanding Respiratory Acidosis

  • Definition:
    • pH is lower than 7.35 due to accumulation of PCO₂.
  • Management:
    • Focus on improving ventilation and oxygenation.

Oxygen Delivery Methods

General Methods and Characteristics
  • Nasal Cannula:
    • Flow Rates from 1-6 L/min with FIO₂ ranging from approximately 24\