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OXYGENATION AND RESPIRATIONS

Adjustment of Positioning
  • Before applying oxygen, first adjust the positioning of the patient.
Oxygen Delivery Methods

  1. Nasal Cannula

    • Delivers 24-35% oxygen.
    • Flow rate: 0.25-6L/min.
    • Newborns starting from 3-4 months require nasal cannula due to mouth breathing.

  2. Simple Oxygen Mask

    • Delivers 35-50% oxygen.
    • Flow rate: 5-10L/min.

  3. Non-Rebreather Mask

    • Delivers 70-100% oxygen.
    • Flow rate: 10-15L/min.
Respiratory Rates by Age
  • Newborn: 30-55 breaths/min
  • 1 year old: 25-40 breaths/min
  • 3 years old: 20-30 breaths/min
  • 7 years old: 16-22 breaths/min
  • 10 years old: 16-20 breaths/min
  • 17 years old: 12-20 breaths/min

RESPIRATORY DISTRESS AND FAILURE

Progression from Distress to Failure

  • Respiratory Distress: Compensatory mechanisms may show signs such as:

    • Grunting (indicates serious problem).
    • Retractions (expected during distress).
    • Head bobbing (assist with positioning).
    • Nasal flaring.
    • Hyperextension of head/neck.

  • When compensatory mechanisms fail, respiratory distress evolves into respiratory failure.

Signs of Respiratory Distress
  • Indicators of the body attempting to compensate:
    • Restlessness.
    • Tachycardia.
    • Tachypnea.
    • Diaphoresis.
Signs of Respiratory Failure
  • Indicators of the body giving up:
    • Cyanosis or a gray color (late sign).
    • Tachypnea followed by bradypnea.
    • Severe retractions and apnea.
    • Altered mental status.
    • Extreme tachycardia followed by bradycardia, indicating respiratory arrest.
    • Inability to maintain oxygen levels.
    • Development of respiratory acidosis.
Distress vs. Failure
  • Signs of Respiratory Distress: The body is actively fighting against the problem.
  • Signs of Respiratory Failure: Physiological processes slow down significantly; the body's compensatory mechanisms are failing.

LARYNGOTRACHEOBRONCHITIS (CROUP)

Overview
  • Affects children aged 6 months to 6 years.
  • Characterized as an upper airway infection with gradual onset and slow progression.
Signs and Symptoms
  • Brassy cough (often referred to as a 'croup bark').
  • Dyspnea.
  • Stridor (if breathing suddenly decreases, this indicates potential airway blockage).
  • Low-grade fever.
  • Cold air can temporarily reduce respiratory symptoms by decreasing swelling.
Nursing Management and Treatment
  • Monitor pulse oximetry (POX).
  • Auscultate the neck for stridor.
  • Monitor cardiac activity.
  • Administer racemic epinephrine (a bronchodilator - first line treatment if symptoms are severe).
  • Provide steroids (oral, never IV) with dexamethasone as the first line of treatment for mild cases to decrease inflammation and improve airway openness; steroids may have hypertensive effects.

EPIGLOTTITIS

Definition/Overview
  • Inflammation and swelling of the epiglottis; constitutes a medical emergency due to the risk of airway constriction.
  • Characterized by a rapid onset (airway obstruction can occur within 2-6 hours).
Signs and Symptoms
  • Toxic appearance of the patient.
  • Tripod positioning (leaning forward to ease breathing).
  • Drooling (indicates supraglottic obstruction).
  • Stridor or a croaking sound (often termed as ‘frog-like’).
  • High fever.
  • Cherry red epiglottis observed.
  • 'Thumb's sign' visible on x-ray indicates swelling.
Nursing Management and Treatment
  • Keep an intubation kit at bedside for emergencies.
  • Do not use bag-mask ventilation; the patient needs an endotracheal tube (ETT) instead.
  • Keep the patient calm to avoid crying, which can exacerbate airway restriction.
  • Insert an ETT for maintaining airway patency.
  • Administer antibiotics (ABX) after securing the airway.
  • Avoid placing anything in the mouth if epiglottitis is suspected and allow the provider to inspect the oral cavity first.
  • Allow the patient to remain in a comfortable position.
  • Monitor for inability to swallow, absence of voice, and increased drooling as concerning signs.

TRACHEITIS

Definition/Overview
  • Bacterial infection resembling epiglottitis, but without drooling.
Signs and Symptoms
  • Toxic appearance.
  • Croupy cough.
  • Dysphonia (hoarseness).
  • High fever.
  • Stridor that does not improve with positioning.
  • Thick or purulent secretions (cultures required for diagnosis).
Nursing Management and Treatment
  • Administer antibiotics (ABX).
  • Provide fluid therapy for rehydration.
  • Ensure airway maintenance and adequate oxygenation.
  • Administer mucolytics to help clear secretions.
  • Possible intubation may be needed; often care is required in an Intensive Care Unit (ICU).

BRONCHIOLITIS/RSV

Overview
  • Primarily affects premature infants who are more at risk.
  • Impairs gas exchange.
Signs and Symptoms
  • Mild cough.
  • Rhinorrhea (nasal discharge).
  • Nasal congestion.
  • Symptoms tend to worsen after 2 days.
  • Decreased oxygen saturation levels (POX).
Nursing Management and Treatment
  • Symptomatic treatment is provided.
  • Administer palivizumab (IM injection recommended for high-risk premature infants).

BRONCHITIS

Definition/Overview
  • Inflammation of the trachea, bronchi, and bronchioles, often resulting from allergies or irritants.
Signs and Symptoms
  • Coarse barking cough persisting for 2-3 weeks.
  • Chest pain.
  • Thick sputum.
  • Possible vomiting due to mucous.
  • Increased work of breathing (WOB) with accompanying retractions.
Nursing Management and Treatment
  • Symptomatic treatment is administered, including humidification.

CYSTIC FIBROSIS

Definition/Overview
  • A recessive genetic disorder that can have asymptomatic carriers.
Signs and Symptoms
  • Steatorrhea (fatty stools).
  • Failure to thrive.
  • Tachypnea and wheezing.
  • Retractions observed.
  • Recurrent pneumonia episodes.
  • Very salty sweat indicative of the condition.
Complications
  • Systemic effects include the build-up of thick and sticky mucous in the lungs, liver, pancreas, intestines, and reproductive organs.
Nursing Management and Treatment
  • Sweat chloride testing: >60 mmol/L is diagnostic for cystic fibrosis.
  • Pancreatic enzyme replacement therapy prior to every snack and meal.
  • Techniques such as percussion and drainage (CPT), and the use of an Adaptive Breathing Intervention (ABI) vest.
  • Administer mucolytics to help loosen secretions.
  • Promote a high protein, calorie-rich, and fat-inclusive diet.

BRONCHOPULMONARY DYSPLASIA

Definition/Overview
  • Primarily occurs in premature infants (<32 weeks gestation) whose lungs are not fully developed.
  • It can result from prolonged use of supplemental oxygen and positive pressure ventilation following premature birth.
Signs and Symptoms
  • Tachypnea.
  • Tachycardia.
  • Grunting.
  • Retractions.
  • Wheezing and crackles.
  • Failure to thrive.
  • Increased oxygen demands.
Nursing Management and Treatment
  • Positioning of the patient is crucial.
  • Provide humidified supplemental oxygen.
  • Utilize chest percussion techniques.
  • Administer bronchodilators as appropriate.
  • Implement suctioning as needed.
  • Organize and cluster nursing care to minimize disruption.
  • Diuretics may be utilized to prevent fluid overload.
  • In some cases, tracheostomy may be necessary for airway management.