Week 12 - chpt.40 - respiratory - up to slide 9 - RECORDING

🫁 Pediatric Respiratory System Notes

🚨 MOST IMPORTANT CONCEPT

• #1 cause of cardiac arrest in pediatrics = respiratory failure

• Sequence:

  • Respiratory distress → Respiratory failure → Cardiac arrest

• Unlike adults:

  • Adults → cardiac issues (MI, HTN, cholesterol)

  • Kids → respiratory problems FIRST

👉 Always prioritize respiratory assessment

🧠 Key Nursing Focus

Ask yourself:

• What is the respiratory status?

• Could respiratory issues be causing other symptoms?

👶 Pediatric Airway Differences

👃 Nose

• Infants (< ~12 months) = obligate nose breathers

• Cannot switch to mouth breathing easily

• Problems:

  • Mucus → obstruction → distress

• Nursing:

  • Suction frequently

  • Keep nasal passages clear

👅 Mouth/Throat Anatomy

• Larger:

  • Tongue

  • Tonsils

  • Adenoids
    ➡ Increased risk of airway obstruction

🫁 Airway Structure

• Funnel-shaped (narrower than adults)

• Easier for:

  • Foreign body obstruction

  • Swelling → blockage

🫁 Bronchioles

• Already small

• With illness (e.g., RSV):

  • Inflammation + mucus → severe narrowing

🫁 Chest & Breathing

• Flexible chest wall

• Diaphragm-dependent (belly breathers)

• Less efficient → fatigue faster

🍃 Epiglottis

• Large + floppy

• Risks:

  • Can block airway accidentally

  • Can fail to protect airway

• Inflammation → near total obstruction

🌬 Gas Exchange Differences

• Smaller alveoli → ↓ gas exchange

• ↑ Oxygen demand

Result:

• Faster breathing (30–60 breaths/min)

• Higher O₂ intake needed

🦠 Infection Risk

• Immature immune system (<5 years)

• More prone to:

  • Upper respiratory infections

  • RSV, flu, allergies

⚠ Compensation & Deterioration

• Prone to acidosis

• Body response:

  • ↑ RR to blow off CO₂

• Leads to:

  • Fatigue → respiratory failure

🚨 Key point:

• Kids deteriorate FAST

• Can go from stable → ICU in minutes

🫁 Common Condition: Laryngomalacia

📌 What it is:

• Floppy laryngeal tissue

• Partial airway collapse

🔊 Symptoms:

• Stridor (high-pitched sound)

• Worse with:

  • Crying

  • Feeding

  • Activity

⚠ Risks:

• Aspiration

🩺 Management:

• Mild:

  • Monitor

  • Educate caregivers

• Moderate:

  • Nebulizers, meds

• Severe:

  • Surgery

• Often resolves by 1 year

🔍 Stridor vs Wheezing

• Stridor = upper airway

• Wheezing = lower airway

🏥 Interventions for Pediatric Respiratory Distress

🎯 Goal:

Prevent:
➡ Respiratory distress → failure

🫁 Oxygen Therapy

• ALWAYS use humidified oxygen

• Kids need moisture more than adults

🧽 Secretion Management

1. Suctioning

• For kids who cannot:

  • Cough

  • Blow nose

2. Saline

• Loosens thick mucus

3. Chest Physiotherapy (CPT)

• Helps mobilize mucus

Methods:

• Chest percussion (manual tapping)

• Vibration devices (vest for older kids)

4. Pulmonary Hygiene (NEW TERM)

(Previously “pulmonary toileting”)

Includes:

• Nebulizers

• CPT

• Suctioning

⏱ May be needed every 2 hours in severe cases

🤧 Advanced Support

🫁 Chest Tubes

• For:

  • Effusion

  • Pneumothorax

• Nursing concern:

  • High risk of dislodgement (active kids)

🔍 Bronchoscopy

Used for:

• Foreign body removal (toys, etc.)

• Airway assessment

• Airway widening

🤖 Cough Assist Device

• For weak muscle tone patients

• Simulates cough to remove secretions

🚨 KEY TAKEAWAYS (EXAM GOLD)

• Pediatric cardiac arrest = respiratory origin

• Infants = nose breathers

• Airway = small + easily obstructed

• Kids:

  • Desaturate quickly

  • Fatigue quickly

  • Deteriorate rapidly

• Stridor = upper airway emergency sign

• Humidified oxygen ALWAYS

• Pulmonary hygiene is critical