APNEA OF INFANCY

Reported by: Agripo, Kenje Kate T.

APNEA OF INFANCY
> Generally refers to pathologic apnea in infants of more than 37 weeks of gestation.
> Temporary absence or cessation of breathing for 20 sec. or more

APNEA OF INFANCY
Causes:
Direct depression of the central nervous system's

control of respiration
- hypoglycemia, meningitis, drugs, hemorrhage, seizures

Disturbances in oxygen delivery

- shock,

sepsis, anemia

Ventilation defects
-pneumonia, RDS , PPHN, muscle weakness

 Diagnostic test:

APNEA OF INFANCY
- continuous recording of cardiorespiratory patterns

1) Cardiopneumogram

2) Four-channel pneumocardiograms
- monitor heart rate, respirations, nasal airflow & oxygen
saturation

3) Polysomnography
- sleep study,records brain waves, eye & body movements, esophageal manometry

 Diagnostic test:

APNEA OF INFANCY
- continuous recording of cardiorespiratory patterns

1) Cardiopneumogram

2) Four-channel pneumocardiograms
- monitor heart rate, respirations, nasal airflow & oxygen
saturation

3) Polysomnography
- sleep study,records brain waves, eye & body movements, esophageal manometry

 Types of Apnea:

APNEA OF INFANCY

1) Obstructive Apnea - is charac. by absent airflow but persistent chest wall motion
- is caused by an obstruction of the airway (such as enlarged tonsils and adenoids). - The respiratory efforts are absent TREATMENT: -Keep the throat open to aid air flow such as with adenotonsillectomy -continuous positive airway pressure (CPAP), which is delivered by having the child wear a nose mask while sleeping.

 Types of Apnea:
2) Central Apnea

APNEA OF INFANCY

- Central apnea occurs when the part of the brain that controls
breathing doesn't properly maintain the breathing process. - is caused by decreased central nervous system (CNS) stimuli to respiratory muscles, airflow; chest wall motion are absent -The respiratory efforts are present

3) Mixed Apnea
- Mixed apnea is a combination of central and obstructive apnea and is seen particularly in infants or young children who have abnormal control of breathing. - may occur when a child is awake or asleep.

APNEA OF INFANCY
Therapeutic Management:
Continuous home monitoring of cardiorespiratory

rhythms Use of Methylxantines Infant is apneic, stimulate the trunk by patting or rubbing it. Infant is prone position, turn to the back and flick the feet

ADPIE

 ASSESSMENT
-Cessation respirations longer than 20 secs. -Cyanosis -Nasal Flaring -Pallor -Fatigue -Bradycardia -Hypoxia -Low Oxygen level detected -Low Respiratory movement

DIAGNOSIS
o Ineffective breathing pattern; Cyanosis related to immaturity mechanisms secondary to apnea

 PLANNING
o After 4 hours of nursing intervention the patient will be able to: Attain normal respiration as evidenced by absence of cyanosis

INTERVENTIONS
Gently flick the sole of the foot Maintain a neutral thermal environment Do suctioning and always suction gently Prepare rescusitive equipment Administer indwelling nasogastric tubes as ordered Administration of Methylxantines as prescribed by the doctor

EVALUATION
o After 4 hours of nursing intervention the patient was able to: Attain normal respiration as evidenced by absence of cyanosis

Apparent Life-Threatening Events (ALTEs)

Reported by: Agripo, Kenje Kate T.

Apparent Life-Threatening Events

- The clinical presentation with a combination of apnea and change in color, change in muscle tone, choking, or gagging.
- Cardiomyopathy incidence but child looks normal

Apparent Life-Threatening Events

Factors:
Seizures Sepsis High-risk infants Respiratory tract infection

Causes:
Viral infection Airway blockage

Diagnostic Test:
Physical Examination

ADPIE

 ASSESSMENT
-Apnea -Nasal Flaring -Cyanosis -Pallor -Poor muscle tone

DIAGNOSIS
o Altered breathing pattern; Apnea related to respiratory muscle fatigue

PLANNING
After 4 hours of nursing intervention the patient will be able to: Maintain normal breathing pattern as evidenced by no use accessory muscles in breathing.

 INTERVENTIONS
Maintain a neutral thermal environment Position patient with proper alignment Do suctioning and always suction gently Elevate the head of bed Perform CPR in emergency cases Monitor pulse oximetry

EVALUATION
o After 4 hours of nursing intervention the patient was able to: Maintain normal breathing pattern as evidenced by no use accessory muscles in breathing.

RESPIRATORY FAILURE

Reported by: Agripo, Kenje Kate T.

Respiratory Failure
- The inability of the respiratory apparatus to maintain adequate oxygenation of the blood, with or without carbon dioxide retention

- This process involves pulmonary dysfunction that

generally results in impaired alveolar gas exchange, which can lead to hypoxemia or hypercapnia

- Clinical manifestations are nonspecific and are affected by variations among individual patients and differences in the severity.

Respiratory Failure
Clinical Manifestations of Respiratory Failure:
Cardinal Signs:
-Restlessness -Tachycardia - Headache - Hypertension - Anorexia - Nasal flaring - Expiratory grunting -Tachypnea -Diaphoresis -Wheezing - Exertional dyspnea - Increase cardiac output - Chest wall retractions

Early but less obvious signs:

Respiratory Failure
Clinical Manifestations of Respiratory Failure:
Signs of more severe hypoxia
-Hypotension or hypertension -Depressed respirations
-Dimness of vision

- Bradycardia
- Coma

-Dyspnea

Types: 1) Type I (Hypoxemic Respiratory Failure) -Decrease oxygen 2) Type II (Hypercornic Respiratory Failure) -Decrease carbon dioxide

Respiratory Failure
Treatment:
Specific Therapy - Directed toward reversal of the causative factors Non-Specific Therapy - Non-specific measure needed to maintain oxygenation and enhance carbon dioxide removal until specific methods take effect - Major reasons for implementing Non- Specific Treatment: 1) Unknown etiology 2) Lack of specific treatment for a known cause 3) Lack of time for specific methods to take effect 4) . Need for specialized personnel or equipment for specific treatment

ADPIE

 ASSESSMENT
- Nasal Flaring - Cyanosis - Dyspnea - Diaphoresis - Restlessness - Tachypnea - Tachycardia - Wheezing

DIAGNOSIS o Impaired gas exchange; Dyspnea related to pulmonary dysfunction secondary to distress PLANNING
After 4 hours of nursing intervention the patient will be able to: Maintain Normal breathing pattern as evidenced by normal skin color and absence of cyanosis.

 INTERVENTIONS
Provide a neutral environment Administer Oxygen Therapy as ordered Proper positioning of the patient Do suctioning and always suction gently Monitor arterial blood gas appropriately

EVALUATION
o After 4 hours of nursing intervention the patient was able to: Maintain Normal breathing pattern as evidenced by normal skin color and absence of cyanosis.