Exam 3 Peds

Respiratory System Overview

  • Primary Function: Facilitate gas exchange.

Anatomy of the Respiratory System

  • Upper Airway Components:

    • Oronasopharynx

    • Pharynx

    • Larynx

    • Upper part of the trachea

  • Lower Airway Components:

    • Lower trachea

    • Bronchi

    • Bronchioles

    • Alveoli

  • Reactive Portion:

    • Bronchi and bronchioles are reactive due to smooth muscle content and ability to constrict.

Anatomical Differences in Infants vs Adults

  • Smaller Nasopharynx:

    • Easily occluded during infection.

  • Lymph Tissue Growth:

    • Tonsils and adenoids grow rapidly in early childhood, atrophying after age 12.

  • Nares Size:

    • Smaller nares are easily occluded.

  • Oral Cavity and Tongue Size:

    • Smaller oral cavity and larger tongue increase risk of obstruction.

  • Epiglottis:

    • Long, floppy, and vulnerable to swelling.

  • Larynx and Glottis Position:

    • Higher in the neck which increases aspiration risk.

  • Cartilage Maturity:

    • Thyroid, cricoid, and tracheal cartilages may collapse when neck is flexed.

  • Muscle Functionality:

    • Fewer functional muscles decrease compensation for edema, spasm, and trauma.

  • Soft Tissue and Mucous Membranes:

    • Large amounts increase risk of edema and obstruction.

Lower Respiratory Structures Details

  • Trachea Bifurcation:

    • Bifurcates at the level of the third thoracic vertebra; important during suctioning or intubating children.

  • Bronchi and Bronchioles:

    • Narrower in infants and children, increasing risk for lower airway obstruction.

  • Alveoli:

    • Smaller numbers lead to a higher risk of hypoxemia.

Airway Characteristics

  • Airway Diameter:

    • Air must move more quickly through the narrowed airway in infants, resulting in a faster respiratory rate.

    • Increased friction raises airway resistance, requiring more effort to breathe.

  • Diameter Comparisons:

    • Newborn: 4 mm

    • Infant: 2 mm

    • Adult: 18 mm

  • Swelling Impact:

    • Infant: 1 mm circumferential edema causes a 50% reduction of diameter, increasing pulmonary resistance by a factor of 16.

    • Adult: 1 mm circumferential edema causes a 20% reduction of diameter, increasing pulmonary resistance by a factor of 2.4.

Inflammatory Processes and Airway Resistance

  • Airway Inflammation: Causes swelling which narrows the airway.

  • Resistance Increase:

    • A 1 mm swelling reduces infant airway diameter to 2 mm, while in adults, it narrows to 18 mm.

Position of Trachea

  • Trachea in infants: Shorter, narrower, and positioned higher.

  • Right Bronchus Angle: More acute at bifurcation.

Differences in Lower Airways

  • Alveoli Growth:

    • Infants have the most limited alveolar surface for gas exchange in relation to height and weight.

  • Diaphragm Use: Immaturity can necessitate using accessory muscles for respiration.

Assessment Components

  • Vital Signs: Monitor rate, depth, ease, and rhythm of respiration.

  • Symptoms: Check for cough, abnormal breath sounds, cyanosis, and sputum presence.

Adventitious Breath Sounds

  • Wheezing: High-pitched sound; indicates obstruction in the lower trachea or bronchioles, common in asthma or viral infections.

  • Rales: Crackling sounds; indicating fluid-filled alveoli, common with pneumonia.

Risk Factors for Respiratory Disorders

  • Prematurity

  • Chronic Illnesses: Such as diabetes, sickle cell anemia, cystic fibrosis, congenital heart disease, and chronic lung disease.

  • Developmental Disorders: Example, cerebral palsy.

  • Passive Smoke Exposure

  • Immune Deficiency

  • Social Factors: Crowded living conditions or poorer socioeconomic status.

  • Day Care Attendance

Common Respiratory Conditions

  • Foreign Body Aspiration:

    • Characterized by severe distress (inability to speak, cyanosis, collapse).

    • Timing: Child’s life at risk within four minutes.

  • Apnea: Cessation of respirations for longer than 20 seconds; should be reported in neonates.

  • Croup: Viral illness causing swelling of the trachea, larynx, and large bronchi. Treatment includes Racemic Epinephrine and steroids.

  • Epiglottitis: Caused by Haemophilus influenzae type B (HIB). Key signs are absence of cough, drooling, and agitation. Precautions: Do not visualize throat, ensure oxygen supply, and have emergency equipment ready.

  • Bronchitis (Tracheobronchitis):

    • Inflammation of the trachea and bronchi, primarily viral. Symptoms include dry cough, chest pain, and resolution in 5-10 days or longer.

  • Bronchiolitis: Mainly caused by RSV. Symptoms include nasal symptoms, cough, fever, wheezing, tachypnea, retractions, decreased activity, and dehydration.

RSV Statistics

  • Over 57,000 hospitalizations and 2.1 million outpatient visits.

  • Viable RSV can survive for hours on surfaces and for 30 minutes on hands.

  • Severe RSV in infancy can be a risk factor for asthma.

Pneumonia

  • Inflammation or infection of bronchioles and alveoli; can stem from viral, mycoplasmal, bacterial sources, and aspiration risks.

Tuberculosis (TB)

  • Caused by Mycobacterium tuberculosis (acid-fast bacillus). Symptoms: cough, weight loss, fever, night sweats.

  • Anti-TB drug regimen includes ethambutol, isoniazid, pyrazinamide, rifampin for 6 months.

Chronic Lung Complications

  • Bronchopulmonary Dysplasia (BPD): Chronic lung disease of prematurity, requiring supplemental oxygen for over 28 days post-birth. Treatment with surfactant therapy at birth.

Asthma Overview

  • A chronic inflammatory disease affecting bronchi, leading to difficulty in breathing.

  • Risk Factors: Family history, allergies, exposure to environmental triggers (e.g., pets, plants), and high rates in boys until adolescence.

Asthma Medications

  • Categories include:

    • SABA (Short-Acting Beta Agonists)

    • LABA (Long-Acting Beta Agonists)

    • Corticosteroids

    • Methylxanthines

    • Mast Cell Stabilizers

    • Leukotriene Modifiers

    • Anticholinergics

    • Monoclonal Antibodies

Interventions for Asthma

  • Develop individualized health plans; administer quick relief medications; assess for exercise-induced asthma; coordinate education with teachers and support groups.

Critical Alerts for Respiratory Conditions

  • Sudden onset of breath sounds or absent breath sounds indicate ventilatory failure and imminent respiratory arrest.

Status Asthmaticus

  • Goals include improving ventilation, reducing airway resistance, relieving bronchospasm, correcting dehydration and acidosis.

Cystic Fibrosis

  • Common autosomal recessive disorder affecting exocrine glands and leading to alterations in multiple systems. Newborns can present with meconium ileus. Pancreatic enzyme supplements are required for digestion.

Indicators of Impending Airway Obstruction

  • Early signs include increased pulse and respiratory rates, retractions, flaring nares, and restlessness.

Smoke Inhalation Symptoms

  • Signs include burns around the face/neck, singed nasal hairs, soot around the mouth/nose, hoarseness, and respiratory distress. Carbon monoxide exposure can lead to headaches and confusion, with normal oxygen saturation readings despite poisoning.

Respiratory Distress Evaluation

  • Signs of Hypoxemia:

    • Early: Tachypnea, tachycardia, restlessness, pallor

    • Late: Confusion, stupor, cyanosis, bradycardia, low/high blood pressure.

Nursing Care for Surgical Intervention in Tonsillitis

  • Postoperative care includes managing bleeding risk, providing analgesics, ensuring appropriate dietary adaptations, and preventing stress on the surgical site (e.g., coughing, throat clearing).

Assessment and Treatment of Common Viral Infections

  • Common Cold (Nasopharyngitis): Self-limiting lasting 4-10 days; symptoms include nasal inflammation and restlessness.

  • Streptococcal Pharyngitis (Strep Throat): Characterized by abrupt onset, headache, abdominal pain, exudate, and requires throat culture/testing.

Otitis Media

  • Defined as fluid in the middle ear; prevalent in young children with guidelines on antibiotic use based on severity and age.

Nutrition and Preventative Measures for Respiratory Health

  • Monitor risk factors, including exposure to secondhand smoke and feeding practices (such as bottle-feeding at bedtime).