NURSING3fCARE3fMANAGEMENT3f109
NURSING3fCARE3fOFACHILD3fW3fRESPI3fDISORDER ,f
Clinical3fInstructor:3fRaquelAnn3fBatayola-Jugasan
,f
● Smaller lung capacity
and3funderdeveloped
intercostal
3fmuscles,3fpoor3fchest3fmusculatu
,f
re
○ Less pulmonary reserve,
Children rely on
diaphragm3fbreathing
High3frisk3ffor3 f resp.3ffailure
3fif3fthe3fdiaphragm3fis3funab
le3ftocontract
,f
● History
○ Chief3fconcern:3fCough,3frapid3frespiration
,f
s,3fnoisy3fbreathing,3frhinitis,3freddened3fsor
e3fthroat,3flethargy,3fcyanosis,3fdifficulty,3fsu
● Changes3f3f 3f until - , f
cking,3ffever.
3 f Child
3f3f 3f 12 3 f respiratory3 f illness3frisk greater3ftha ,f
n3fadults
Upper 3f3f 3f, 3f 3fmore3f3f 3fprone3f3f 3fto
f f , f , f
● Past3fMedical3fHistory
● 3f3f 3fobstruction - ○ Poor3fweight3fgain,3fdifficulty3fwith3frespiration
Smallerairway3f=3fgreater3fresistance s3fat3fbirth,3fprematurity
● Less3f3f 3f alveolar3f3f 3 f surfa -
, f , f
● Physical3fExamination
ce3f3f3farea 3 f Reduced3 f area3 f
for
gasexchange
● More3f 3 f 3 f diaphragmatic3f 3 f 3 f b -3 f Flexible
, f , f
chestreduces3fair3fintake
reathing
,f
RESPI ● Respiratory3fstructures3fgrow3fin3fsize
DEVEL
,f 3fand3fdistance3ffrom3feach3fother.
OPMEN,f ● Immature3finfant3frespiratory3fand3f
3fT neurologic system
offers3flessefficient3 ,f
fresponse3fto3fhypoxia3fand3felevate
d3fpartial3fpressure3fof3fcarbon3fdi
oxide3f(PCO2)
● Chest3fwall3fstiffens3fwith3fage
○ Less3fretraction3fwith3fdistress
● Inspection
○ Chest
Size,3fsymmetry3fmovement3fIn
fancy3fshapeisalmost3fcircular
<6-7 years respiratory
movement3 f primarily
diaphragmatic
○ Respirations
,CHEST/ ● Obligate3fnasal3fbreathers3funtil3f43f
RESPI
,f –3f63fwks
SYSTE
,f ● Short3fneck
M ● Tongue3fis3flarger3fin3fproportion3fto
3fthe3fmouth
○ More3flikely3fto3fobstruct3fthe
3fairway3fin3fan3funconsciou
s3fchild.
● Smaller,3fshorter,3fnarrower3fairway
s3fmore3fsusceptible3fto3fairway3fobst
CHEST/ ructionand3fresp.3fDistress
,f
RESPI
,f
SYSTE
,f
M
, 6) Pulmonary3fFunctionTest
Rate,3 f rhythm,3 f dept
h,3f
These3flaboratory3ftests3fcan3fbe3fused3fto3fconfirm3for3frule3fo
>60/min3 f in3 f small3 f children
ut3fthe3fpresence3fof3frespiratory3fdisorders3fto3fhelp3fidentify3
3 f
fthe3fcause3fand severity3fof3fthe3fproblem.
,f
● Auscultation
Listen3fcomparing3fone3fareas3fto3fthe3foth
er
■ Equality3fof3fbreath3fsounds Blood3 f Gas3 f Analysis3 f /3 f Arterial3 f Blood3 f Gas3 f (AB
■ Diminished G)3 f - ,f ,f ,f
an ,f ,f
3f3 f
■ Poor3fair3fexchange
,f ,f
Abnormal3fbreath3fsounds invasive3fmethod3ffor3fdetermining3fthe3feffectiveness3fof3fven
cleared
■ Fine 3f(Disco by
crackles - cough tilationand3facid-base3fstatus.
ntinuous ● Measures3fthe3famount3 f of3foxygen3fand3fcarbon3 f
■ Wheezes3f- dioxidein3fthe3fblood.
3fMusical3fnoise3fduring3finspirati ○ Provides important
on/expiration;3fUsually3flouder3f information3faboutoxygenati ,f
during3fexpiration3f(Continuous) on3fof3fthe3fblood3fas3fvalues3fmay3findicate3fn
■ Rhonchi3f(coarse3fcrackles)3f- ot3fonly3fwhether3fthe3farterial3fpartial3fpres
3fRumbling;3 f Course3 f sounds;3
sure3fof3foxygen3fPO23fis3fadequate,3fbut3falso
3fwhether3fthe3foxygen3fsaturation3fof3fhemog
f Like3fa3fsnore;3fMay3fclear3 f wit
h3 f coughing3for3fSuctioning3f(Co lobin3fis3fadequate.
ntinuous) ● An3farterial3fblood3fis3fdrawn.
○ Rather3fthan3fthe3fvenous3fblood3fsince3farte
rial3fblood3fwill3freflect3fhow3fwell3fthe3flung
s3fare3foxygenating3fthe3fblood3fwhereas3fv
enous3fblood3fwill3freflect3fonly3fthe3foxyge
nation3fof3fthe3fparticular3fextremity3ffrom3fw
hich3fthe3 f blood3fwas3fdrawn.
● In3fyoung infants,3fthe3ftemporal3f artery3fmay3fbe3fuse
,f
d.
● In3fnewborn,3fan3fumbilical3fartery3fcan3fbe3fused
○ Umbilical3fartery3fcatheter3fcan3fbe3fused3fbe
cause3ffor3fyoung3finfants3fand3 f newborn,3f
their3fradial3fand3fbrachial3farteries3fare3fnot
○ Cough
3fclearly3fseen.
● 3fCol
● In3f older3f children,3fthe3fradial3fartery3fis3fthe3fsite
memb
,f ,f
or
3fof3fchoice.
ranesNail3f
○ Because3fof3fthe3fcollateral3fcirculation3 f p
resent3fat3fthe3fwrist.3fIf3fclotting3fshould3fo
● Temperature ccurin3fthe3fradial3fartery,3fthe3fhand3fwill3fstil
Febrile state increases l3fbe3fwell3fnourished3fby3fcollateral3fcirculati
oxygenconsumption on.
Retractions ● Specimen3 f is3 f withdrawn3 f into3 f a3 f hepariniz
ed3 f syringe
(to3fprevent3fclotting).
● After3fany3farterial3fpuncture,3falways3ffirmly3fcompr
ess3fthe3fsite.
○ Otherwise,3fblood3ffrom3fthe3fpunctured3fves
sel3fcan3fseep3finto3fsubcutaneous3ftissue3fp
ossibly3fcausing3fa3flarge3 f hematoma3fand
3fobscuring3fthe3fsite3ffor3ffurther3fassessme
nt.
● Note3fthe3fuse3fof3foxygen3fand3fits3fliter3fflow3fin3f
the3flab3frequest.
○ Applicable3fif3fthe3fpx3fhas3fan3fO23fattached3fto3fit.
● Note3fthe3fsite3fwhere3fthe3fspecimen3fwas3fobtained
○ Whether3fradial,3fbrachial3fartery,3fetc.
● While3fbeing3ftransported3fto3fthe3flab,3fABG3fspecim
ens3fshould3fbe3fkept3fon3fice3fto3fensure3faccurate3
fresults.
,f
Measure Definition Clinical
3 f Val
ue e
PaO2 Partial3fPressu 80-100 Decreased3f
re3fof3f 3f mmHg ifchild3fcan
not
inspire3fade
VIDEO3f2 quately
PaCO2 Partial3fPress 35-45 Increased3fi
ure3fof3fCO23 mmHg fchild3f
3 f determinan fin3f
t) adequate
, Blood3fGasAnalysis
Pulse3f Oximetry
NURSING3fCARE3fOFACHILD3fW3fRESPI3fDISORDER ,f
Clinical3fInstructor:3fRaquelAnn3fBatayola-Jugasan
,f
● Smaller lung capacity
and3funderdeveloped
intercostal
3fmuscles,3fpoor3fchest3fmusculatu
,f
re
○ Less pulmonary reserve,
Children rely on
diaphragm3fbreathing
High3frisk3ffor3 f resp.3ffailure
3fif3fthe3fdiaphragm3fis3funab
le3ftocontract
,f
● History
○ Chief3fconcern:3fCough,3frapid3frespiration
,f
s,3fnoisy3fbreathing,3frhinitis,3freddened3fsor
e3fthroat,3flethargy,3fcyanosis,3fdifficulty,3fsu
● Changes3f3f 3f until - , f
cking,3ffever.
3 f Child
3f3f 3f 12 3 f respiratory3 f illness3frisk greater3ftha ,f
n3fadults
Upper 3f3f 3f, 3f 3fmore3f3f 3fprone3f3f 3fto
f f , f , f
● Past3fMedical3fHistory
● 3f3f 3fobstruction - ○ Poor3fweight3fgain,3fdifficulty3fwith3frespiration
Smallerairway3f=3fgreater3fresistance s3fat3fbirth,3fprematurity
● Less3f3f 3f alveolar3f3f 3 f surfa -
, f , f
● Physical3fExamination
ce3f3f3farea 3 f Reduced3 f area3 f
for
gasexchange
● More3f 3 f 3 f diaphragmatic3f 3 f 3 f b -3 f Flexible
, f , f
chestreduces3fair3fintake
reathing
,f
RESPI ● Respiratory3fstructures3fgrow3fin3fsize
DEVEL
,f 3fand3fdistance3ffrom3feach3fother.
OPMEN,f ● Immature3finfant3frespiratory3fand3f
3fT neurologic system
offers3flessefficient3 ,f
fresponse3fto3fhypoxia3fand3felevate
d3fpartial3fpressure3fof3fcarbon3fdi
oxide3f(PCO2)
● Chest3fwall3fstiffens3fwith3fage
○ Less3fretraction3fwith3fdistress
● Inspection
○ Chest
Size,3fsymmetry3fmovement3fIn
fancy3fshapeisalmost3fcircular
<6-7 years respiratory
movement3 f primarily
diaphragmatic
○ Respirations
,CHEST/ ● Obligate3fnasal3fbreathers3funtil3f43f
RESPI
,f –3f63fwks
SYSTE
,f ● Short3fneck
M ● Tongue3fis3flarger3fin3fproportion3fto
3fthe3fmouth
○ More3flikely3fto3fobstruct3fthe
3fairway3fin3fan3funconsciou
s3fchild.
● Smaller,3fshorter,3fnarrower3fairway
s3fmore3fsusceptible3fto3fairway3fobst
CHEST/ ructionand3fresp.3fDistress
,f
RESPI
,f
SYSTE
,f
M
, 6) Pulmonary3fFunctionTest
Rate,3 f rhythm,3 f dept
h,3f
These3flaboratory3ftests3fcan3fbe3fused3fto3fconfirm3for3frule3fo
>60/min3 f in3 f small3 f children
ut3fthe3fpresence3fof3frespiratory3fdisorders3fto3fhelp3fidentify3
3 f
fthe3fcause3fand severity3fof3fthe3fproblem.
,f
● Auscultation
Listen3fcomparing3fone3fareas3fto3fthe3foth
er
■ Equality3fof3fbreath3fsounds Blood3 f Gas3 f Analysis3 f /3 f Arterial3 f Blood3 f Gas3 f (AB
■ Diminished G)3 f - ,f ,f ,f
an ,f ,f
3f3 f
■ Poor3fair3fexchange
,f ,f
Abnormal3fbreath3fsounds invasive3fmethod3ffor3fdetermining3fthe3feffectiveness3fof3fven
cleared
■ Fine 3f(Disco by
crackles - cough tilationand3facid-base3fstatus.
ntinuous ● Measures3fthe3famount3 f of3foxygen3fand3fcarbon3 f
■ Wheezes3f- dioxidein3fthe3fblood.
3fMusical3fnoise3fduring3finspirati ○ Provides important
on/expiration;3fUsually3flouder3f information3faboutoxygenati ,f
during3fexpiration3f(Continuous) on3fof3fthe3fblood3fas3fvalues3fmay3findicate3fn
■ Rhonchi3f(coarse3fcrackles)3f- ot3fonly3fwhether3fthe3farterial3fpartial3fpres
3fRumbling;3 f Course3 f sounds;3
sure3fof3foxygen3fPO23fis3fadequate,3fbut3falso
3fwhether3fthe3foxygen3fsaturation3fof3fhemog
f Like3fa3fsnore;3fMay3fclear3 f wit
h3 f coughing3for3fSuctioning3f(Co lobin3fis3fadequate.
ntinuous) ● An3farterial3fblood3fis3fdrawn.
○ Rather3fthan3fthe3fvenous3fblood3fsince3farte
rial3fblood3fwill3freflect3fhow3fwell3fthe3flung
s3fare3foxygenating3fthe3fblood3fwhereas3fv
enous3fblood3fwill3freflect3fonly3fthe3foxyge
nation3fof3fthe3fparticular3fextremity3ffrom3fw
hich3fthe3 f blood3fwas3fdrawn.
● In3fyoung infants,3fthe3ftemporal3f artery3fmay3fbe3fuse
,f
d.
● In3fnewborn,3fan3fumbilical3fartery3fcan3fbe3fused
○ Umbilical3fartery3fcatheter3fcan3fbe3fused3fbe
cause3ffor3fyoung3finfants3fand3 f newborn,3f
their3fradial3fand3fbrachial3farteries3fare3fnot
○ Cough
3fclearly3fseen.
● 3fCol
● In3f older3f children,3fthe3fradial3fartery3fis3fthe3fsite
memb
,f ,f
or
3fof3fchoice.
ranesNail3f
○ Because3fof3fthe3fcollateral3fcirculation3 f p
resent3fat3fthe3fwrist.3fIf3fclotting3fshould3fo
● Temperature ccurin3fthe3fradial3fartery,3fthe3fhand3fwill3fstil
Febrile state increases l3fbe3fwell3fnourished3fby3fcollateral3fcirculati
oxygenconsumption on.
Retractions ● Specimen3 f is3 f withdrawn3 f into3 f a3 f hepariniz
ed3 f syringe
(to3fprevent3fclotting).
● After3fany3farterial3fpuncture,3falways3ffirmly3fcompr
ess3fthe3fsite.
○ Otherwise,3fblood3ffrom3fthe3fpunctured3fves
sel3fcan3fseep3finto3fsubcutaneous3ftissue3fp
ossibly3fcausing3fa3flarge3 f hematoma3fand
3fobscuring3fthe3fsite3ffor3ffurther3fassessme
nt.
● Note3fthe3fuse3fof3foxygen3fand3fits3fliter3fflow3fin3f
the3flab3frequest.
○ Applicable3fif3fthe3fpx3fhas3fan3fO23fattached3fto3fit.
● Note3fthe3fsite3fwhere3fthe3fspecimen3fwas3fobtained
○ Whether3fradial,3fbrachial3fartery,3fetc.
● While3fbeing3ftransported3fto3fthe3flab,3fABG3fspecim
ens3fshould3fbe3fkept3fon3fice3fto3fensure3faccurate3
fresults.
,f
Measure Definition Clinical
3 f Val
ue e
PaO2 Partial3fPressu 80-100 Decreased3f
re3fof3f 3f mmHg ifchild3fcan
not
inspire3fade
VIDEO3f2 quately
PaCO2 Partial3fPress 35-45 Increased3fi
ure3fof3fCO23 mmHg fchild3f
3 f determinan fin3f
t) adequate
, Blood3fGasAnalysis
Pulse3f Oximetry
