Care of the patient with alteration is respiratory health. Care of the patient with alteration is respiratory health.

Airway Diameter Inverse relationship between airway diameter and airway resistance Upper Airway: Newborns Until 4 weeks of age, obligatory nose breathers Nasal patency is critical Lower Airway Alveoli change size and shape, increase in number Smooth muscles of bronchi and bronchioles Lower Airway Intercostal muscles immature - diaphragm primary muscle used to breathe Ribs are primarily cartilage and are very flexible - retractions seen, especially during respiratory distress Acid-Base Balance Normal pH Varies by Age Slightly basic Infants: 7.36 to 7.42 Children: 7.37 to 7.43 Adolescents: 7.35 to 7.41 Types of Acids in the Body Carbonic acid

Metabolic (noncarbonic) acids Buffers Binds hydrogen ions when there are too many Releases hydrogen ions when there are not enough Types of buffers

Once buffers are saturated, kidney excretes acids Role of the Lungs Chemoreceptors monitor PCO2 and pH of the blood - respiratory rate is adjusted to compensate Role of the Kidneys Excrete metabolic acids in two ways Blood Gases Evaluate acid-base status Four Types of Acid-Base Imbalance Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis

Metabolic Alkalosis Conditions Causing Respiratory Distress Acute Chronic Acute Disorders of the Respiratory System Foreign-body aspiration (FBA) Apnea Apparent Life-Threatening Event (ALTE) Apnea plus Most common in infants younger than 4 months ALTE: Is It SIDS? There is different pathophysiology ALTE may or may not have a cause Gastroesophageal reflux Seizures Cardiac arrhythmias Metabolic or endocrine problems Upper airway complications Question #1 A child presents to the emergency department in acute respiratory distress caused by an asthmatic episode. Which of the following drugs would the nurse plan to administer first? Prednisone Epinephrine Terbutaline Cromolyn sodium Question #2 Which of the following might a child with asthma be advised to avoid? Swimming Gymnastics Snow skiing Playgrounds Question #3 Which statement by an 8-year-old child with asthma indicates that she understands the use of a peak expiratory flow meter? Question #3 "My peak flow meter can tell me if an asthma episode might be coming, even though I might still be feeling okay." "When I do my peak flow, it works best if I do three breaths without pausing in between breaths." "I always start with the meter reading about halfway up. That way I don't waste any breath." "If I use my peak flow meter every day, I will not have an asthma attack." Question #4 An adolescent with asthma says she heard her doctor say smoking was her trigger. The adolescent asks the nurse what that means. The nurse explains to the adolescent that a trigger is: Question #4

A substance or condition that initiates an asthmatic episode. The term for narrowing of the airways during an asthmatic episode. Another way to describe asthma. The rapid breathing associated with an asthma attack. Question #5 A child in respiratory distress requires intubation. The nurse would estimate the endotracheal tube size based on: _____His little finger, or Bradley tape_______ Upon admission of a patient with suspected acidosis the nurse should expect which diagnostic test to be performed? Pulse oximetry Arterial blood gases Acid-fast smear Culture and sensitivity pH 7.31 PaO2 88 PaCO2 58 H2O3 28 This blood gas would be considered Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis pH 7.28 PaO2 98 PaCO2 33 H2O3 14 This blood gas would be considered Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis pH 7.48 PaO2 99 PaCO2 30 H2O3 22 This blood gas would be considered Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis pH 7.46 PaO2 90 PaCO2 46 H2O3 28 This blood gas would be considered Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis Obstructive Sleep Apnea (OSA) Airway obstruction (partial or complete) during sleep Peaks between 2 to 6 years of age due to enlarged tonsils and adenoids - may be associated with obesity Diagnosis Treatments Sudden Infant Death Syndrome (SIDS) Unexpected death of child younger than 1 year Diagnosed Croup

Broad term of upper airway illnesses examples Affect large numbers of children Laryngotracheobronchitis (LTB) Type of croup illness LTB Usually viral cause Most common: 3months to 4 years of age Signs: Treatment A child is brought to the Emergency Department with suspected epiglottitis. Which nursing intervention would be considered unsafe? Allowing the child to remain in the position of choice Placing intubation equipment at the bedside Encouraging parents to comfort the child Examining the throat Epiglottitis Usually caused by H. influenzae type B (Hib) - Hib vaccination now required for children Signs and symptoms: Epiglottitis: Interventions Avoid inspecting mouth or throat Treatment Bacterial Tracheitis S. aureus (most common) Signs and symptoms: Treatment The mother of an infant diagnosed with bronchiolitis asks the nurse what causes this disease. The nurse's response would be based on the knowledge that the majority of infections that cause bronchiolitis are a result of: Ribavirin. Mycoplasma pneumoniae. Respiratory syncytial virus (RSV). Hemophilus influenzae. Bronchiolitis Pathophysiology Symptoms: Treatment Bronchitis Unusual in childhood

Symptoms: Treatment Background Etiology: RSV, other viruses Pathophysiology Clinical manifestations Diagnosis: ELISA test on nasal wash specimen Treatment: Supportive Assessment Diagnosis Ineffective breathing pattern Activity Intolerance Risk for deficient fluid volume Anxiety (child and parent) Planning and Implementation Evaluation A child with cystic fibrosis is hospitalized for a respiratory infection. Which documentation in the chart would indicate the need for counseling regarding nutrition and gastrointestinal complications? Frothy, foul-smelling stools Weight unchanged from yesterday Weight unchanged from yesterday Eats three snacks every day An adolescent was diagnosed with cystic fibrosis as an infant. At this time, the adolescent will need additional teaching related to: Obtaining a sweat chloride test. The effect of pancreatic enzymes on the sex hormones. Weight reduction diet. Reproductive ability. The parents of a child with cystic fibrosis inform the nurse that they will be unable to perform postural drainage at home because their bed does not recline like the hospital bed. The nurse's response is based on an understanding that: Postural drainage is essential to mobilize secretions in the airways so they can be coughed out. Postural drainage is not necessary as long as the child takes his pulmozyme to decrease the viscosity of the mucus. Postural drainage does not influence the pulmonary status of a child with cystic fibrosis. The parents can be referred to The Cystic Fibrosis Foundation for a flexible bed. Background: Cystic Fibrosis (CF) Inherited autosomal recessive disorder Pathophysiology Clinical manifestations Cystic Fibrosis (CF) Pathophysiology

Symptoms: A child with a respiratory infection is scheduled to have a sweat test. The mother asks the purpose of this diagnostic test. The nurse's response would be based on the knowledge that the test: Determines if the child is dehydrated. Assesses if the sweat glands are functioning. Identifies the infectious organism. Establishes a diagnosis of cystic fibrosis. Cystic Fibrosis Evaluation Diagnosis: Sweat test - DNA Treatment Prevent infections Optimize nutrition Assessment Diagnosis Ineffective airway clearance Risk for infection Imbalanced nutrition: Less than body requirements Parental role conflict Planning and Implementation Evaluation Question An 18-month-old child is seen in the Emergency Department with respiratory distress and is admitted with a diagnosis of pneumonia. Following the initial workup, the baby is still short of breath but is rubbing his eyes as if he is sleepy. The mother wants to lay the baby down for his nap. The infant refuses to lie down. The nurse would suggest: The answer is? Rocking the baby until he is asleep and then lay him down. The mother hold him in her arms while he sleeps. The mother allow the baby to sleep in an upright position. A sleeping pill to help the baby rest. Pneumonia Symptoms: Treatment Tuberculosis (TB) Caused by M. tuberculosis Pathophysiology Symptoms: Treatment Question An 11-month-old child is being discharged home for the first time after being diagnosed with bronchopulmonary dysplasia (BPD). She will require home oxygen therapy. Which statement by the mother indicates that discharge teaching is incomplete?

The answer is ? "We will not allow any smoking at our home." "We have several fire extinguishers, and we know how to use them." "Her brother will blow out the birthday candles at her party." "We will return to the hospital if she seems irritable and won't play." Chronic Disorders of the Respiratory System Bronchopulmonary dysplasia (BPD) Triggers: Symptoms: Treatment The father of a premature infant asks why oxygen concentrations are not higher to help his son breathe better. The nurse's best response is based on an understanding of: Cystic fibrosis. Pneumonia. Bronchiolitis. Bronchopulmonary dysplasia. Asthma Most common chronic illness among children

Pathophysiology Asthma (contd) Symptoms:

Treatment Mechanisms of Injury Smoke Inhalation Blunt Chest Trauma Consequences of Respiratory Distress May lead to respiratory failure, which can be fatal if not treated promptly Respiratory Failure Body can no longer maintain effective gas exchange Process begins at alveoli Results in hypoxemia and hypercapnia Mild Respiratory Distress: Attempting to Compensate Signs and symptoms

Nursing interventions Moderate Respiratory Distress: Early Decompensation Signs and symptoms

Nursing interventions Severe Respiratory Distress: Respiratory Failure/Imminent Arrest Signs and symptoms

Nursing interventions The nurse is teaching home tracheostomy care to the parents of a toddler. What information is essential to include? The importance of changing the tracheostomy every day How to recognize signs of infection and obstruction How to remove the tracheostomy so the child can talk Teaching the child to keep large objects away from the tube