Ball Ch25 Lecture

CHILD HEALTH NURSING
Partnering with Children and Families

THIRD EDITION
CHAPTER
25
Alterations in
Respiratory Function
Copyright 2014, 2010, 2006 by Pearson Education, Inc.

All Rights Reserved
LEARNING OUTCOME 1
Describe unique characteristics of the pediatric respiratory
system's anatomy and physiology and apply that information
to the care of children with respiratory conditions.
Child Health Nursing: Partnering with Familes and Children, Third Edition
Jane W. Ball | Ruth C. Bindler | Kay J. Cowen
Pediatric vs. Adult Respiratory

System Anatomy and Physiology
Anatomy of airway
Comparison of airway structures
Figure 25-1 It is easy to see that a child's airway is smaller and less developed than an adult's airway, but why
is this important? The infant and child are more vulnerable to the consequences of an upper respiratory tract
infection, enlarged tonsils and adenoids, an allergic reaction, positioning of the head and neck during sleep, and
small objects that can be aspirated. All can cause an airway obstruction that results in respiratory distress.

Upper airway differences
Airway diameter
Figure 25-3 The diameter of an infant's airway is approximately 4 mm, in contrast to an adult's airway
diameter of 20 mm. An inflammatory process in the airway causes swelling that narrows the airway, and airway
resistance increases. Note that swelling of 1 mm reduces the infant's airway diameter to 2 mm, but the adult's
airway diameter is only narrowed to 18 mm. Air must move more quickly in the infant's narrowed airway to
get the same amount of air to the lungs. The friction of the quickly moving air against the side of the airway
increases airway resistance. The infant must use more effort to breathe and breathe faster to get adequate
oxygen.

Position of trachea
Figure 25-2 In children, the trachea is shorter and the angle of the right bronchus at bifurcation is more
acute than in the adult. Where is an aspirated foreign body likely to land? When you are resuscitating or
suctioning, you must allow for the differences in the length of the trachea because it is easier to slip into the right
bronchus with an endotracheal tube or suction catheter.

Position of right mainstem bronchus
Airway resistance

Lower airway differences
Growth of alveoli
Diaphragm use for respirations

Use of accessory muscles
Immaturity of respiratory system
LEARNING OUTCOME 2
Contrast respiratory conditions and injuries
that can cause respiratory distress in infants
and children.
Respiratory Conditions and

Injuries
Airway obstruction
Blockage of airway passages by
different causes
Foreign-body aspiration
Figure 25-5 An aspirated screw is clearly visible in the child's left mainstem bronchus on this chest radiograph.
Source: Courtesy of Evelyn Anthony, MD, Department of Radiology, Brenner Children's Hospital, Wake Forest
University Health Sciences.

Injuries
Acute respiratory distress syndrome
(ARDS)
FIGURE 257 A ventilation-perfusion mismatch can occur when an infant or child has an abnormal distribution
of ventilation or perfusion. A, Children with normal lung function and circulation have a ventilation-perfusion ratio
of 0.8 to 0.9 because perfusion is greater than ventilation (air exchange) in the lung bases. B, When ventilation is
inadequate to well-perfused areas of the lungs, the ventilation-perfusion ratio is low or mismatched, resulting in
shunting. Blood passing through the pulmonary capillaries gets less oxygen exchange than normal, and
hypoxemia occurs. This is the case in asthma due to bronchoconstriction and in pneumonia because alveoli are
filled with fluid. C, In the case of neonatal acute respiratory distress syndrome, ventilation does not occur because
the alveoli are collapsed, so blood passes through the alveolar capillaries and no oxygenation occurs. The
ventilation-perfusion ratio is very low with significant shunting that does not respond to oxygen therapy because
the capillary bed never gets exposed to the supplemental oxygen (Brashers, 2010a).

Injuries
Multiple factors may cause ARDS
Sepsis
Pneumonia
Meconium aspiration
Gastric content aspiration
Smoke inhalation
Near drowning
Apnea in Infants and Children

Cessation of respirations for longer
than 20 seconds
Obstructive apnea
Central apnea
Mixed apnea
Apnea of prematurity
Apparent life-threatening events
Apnea Monitors
Polysomnography
Sudden Infant Death Syndrome

The sudden death during sleep of an
infant under 1 year of age that remains
unexplained after a thorough
investigation
Most SIDS deaths occur in infants
between 2 and 4 months of age.
Sudden Infant Death Syndrome

Parent education related to prevention
Back to Sleep
Avoid loose bedding, toys, pillows
Discourage co-sleeping
Use of pacifier during sleep
Smoking increases risk
LEARNING OUTCOME 3
Distinguish between mild, moderate, and severe
respiratory distress, and plan the appropriate nursing
care for each level of respiratory distress severity.
Table 25-1
Assessment Guidelines for the Child with

a Respiratory Condition*
Clinical Manifestations of
Respiratory Distress
Dyspnea
Tachypnea
Grunting
Nasal flaring
Retractions
Figure 25-4 The chest wall is flexible in infants and young children because the chest muscles are immature
and the ribs are cartilaginous. With respiratory distress, the negative pressure created by the downward
movement of the diaphragm to draw in air is increased, and the chest wall is pulled inward causing retractions.
Intercostal retractions are seen in mild respiratory distress. As the severity of respiratory distress increases,
retractions can be seen in the substernal and subcostal areas. In cases of severe distress, accessory muscles
(sternocleidomastoid and trapezius muscles) are used, and retractions are seen in the supraclavicular
and suprasternal areas.
Assessment of Respiratory Status
Quality of pulse
Quality of respirations
Color
Cough
Behavior changes
Signs of dehydration
Clinical Manifestations Respiratory Failure and

Imminent Respiratory Arrest
Nursing Care
ABCairway, breathing, circulation
Determine if cause can be alleviated
Foreign body
Supportive care
Supplemental oxygen
Pulmonary Function for

Chronic Conditions
Force vital capacity (FVC)
Peak expiratory flow rate (PEFR)
Partnering with Families: Using a Peak Expiratory

Flow Meter
Pulmonary Function for

Chronic Conditions
Forced expiratory volume in 1 second
(FEVI)
LEARNING OUTCOME 4
Assess the child's respiratory status and
analyze the need for oxygen
supplementation.
Diagnostic Tests to Determine

Oxygen Saturation
Pulse oximetry
Arterial blood gases
Box 25-1
Guidelines for Increasing the Accuracy of

Pulse Oximetry Readings
Supplemental Oxygen
Indicated when SPO2 level < 92%
Monitor with pulse oximetry and blood
gases
Humidified oxygen may be needed
LEARNING OUTCOME 5
Differentiate between the signs and
symptoms of a child with an upper airway
and lower airway respiratory condition.
Upper Airway Disorders
Croup syndromes
Laryngotracheobronchitis
Epiglottitis
Bacterial tracheitis
Upper Airway Disorders

Characterized by inflammation and
swelling of pharynx, surrounding
tissues
Clinical manifestations vary according
to severity
Table 25-4 Summary of Acute Infectious Upper

Airway Obstructive Disorders
Lower Airway Disorders

Neonatal respiratory distress syndrome
Meconium aspiration syndrome
Transient tachypnea of the newborn
Bronchitis
Bronchiolitis and respiratory syncytial
virus
Pneumonia
Tuberculosis

Common clinical manifestations
infants
Nasal flaring
Retractions
Grunting
Irritability
Tachypnea

Common clinical manifestations
Crackles
Labored breathing, dyspnea
Wheezing
Cyanosis (with increased severity)
Cough (bronchitis, pneumonia,
tuberculosis)

Respiratory distress uncommon with TB
LEARNING OUTCOME 6
Create a nursing care plan for a child with
a common acute respiratory condition.
Respiratory Assessment
Determine baseline status of child
Provide pulmonary therapies as needed
Maintain oxygenation
Increased Metabolic Activity

Increased need for calories/nutrition
Increased need for fluid
Anxiety and Fear Common

Psychosocial support for parent
Psychosocial support for child
Discharge Planning
Education about duration of illness
Need for follow-up
When to seek emergency care
Home-Care Planning
Education of parents/child about home
therapies
LEARNING OUTCOME 7
Plan the nursing care for a child with a
chronic respiratory condition.
Chronic Lung Diseases

Asthma
Bronchopulmonary dysplasia
Cystic fibrosis
Nursing Considerations for Chronic

Respiratory Conditions
Oxygenation
Activity intolerance
Fluid and nutrition
Growth and development
Treatment management
Social interactions
Psychosocial support
Oxygenation
Most important consideration
Assess and reassess
Hypoxia leads to chronic changes
Permanent changes in body systems
Figure 25-18
Digital clubbing.
Oxygenation
Activity intolerance
Stress and coping
Fluid management as necessary
Growth and Development

Nutritional concerns
Need increased calories to meet body
requirements
Developmental
Appropriate activities and interactions
Social Interactions
Lack of peers for some
Decreased activity tolerance
Decreased age activities
Treatment Management
Family collaboration required
Plan around family, if possible
Family education
Prevention of exacerbations
When to call healthcare provider, 911
Medication administration
LEARNING OUTCOME 8
Demonstrate the nursing assessment
for a child with an acute lung injury.
Assessing Acute Lung Injury

Smoke inhalation
Vital signs
Pulse oximetry
Auscultation
Level of consciousness
Behavioral changes

Blunt chest trauma
Observation
Dyspnea, wheezes, crackles
Decreased breath sounds
Hemoptysis
Transient temperature elevation
Level of consciousness
Agitation, lethargy

Blunt chest trauma
Careful monitoring
Inspect thorax
Cyanosis is a late sign of respiratory
distress.

Pneumothorax
Airway management
Monitoring lung inflation
Careful monitoring of vital signs and
respiratory function
Monitor chest tube, related
complications

Ball Ch25 Lecture

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Ball Ch25 Lecture

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CHILD HEALTH NURSING

Partnering with Children and Families

Copyright 2014, 2010, 2006 by Pearson Education, Inc.

Pediatric vs. Adult Respiratory

Pediatric vs. Adult Respiratory

Pediatric vs. Adult Respiratory

Pediatric vs. Adult Respiratory

Pediatric vs. Adult Respiratory

Diaphragm use for respirations

Immaturity of respiratory system

Respiratory Conditions and

Respiratory Conditions and

Respiratory Conditions and

Apnea in Infants and Children

Sudden Infant Death Syndrome

Sudden Infant Death Syndrome

Assessment Guidelines for the Child with

Assessment of Respiratory Status

Clinical Manifestations Respiratory Failure and

Pulmonary Function for

Partnering with Families: Using a Peak Expiratory

Pulmonary Function for

Diagnostic Tests to Determine

Guidelines for Increasing the Accuracy of

Upper Airway Disorders

Upper Airway Disorders

Table 25-4 Summary of Acute Infectious Upper

Lower Airway Disorders

Lower Airway Disorders

Lower Airway Disorders

Lower Airway Disorders

Increased Metabolic Activity

Anxiety and Fear Common

Chronic Lung Diseases

Nursing Considerations for Chronic

Growth and Development

Assessing Acute Lung Injury

Assessing Acute Lung Injury

Assessing Acute Lung Injury

Assessing Acute Lung Injury

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