NURSING CARE MANAGEMENT 109 h h h
NURSING CARE OFA CHILD W RESPI DISORDER
h h ,f h h h
Clinical Instructor: RaquelAnn Batayola-Jugasan
h h h
,f A&P RESPIRATORY SYSTEM
,f ,f
,f DIFFERENCES IN ADULT AND CHILD ,f ,f ,f ,f
Smallerlungcapacityand underdeveloped
intercostal muscles, poor chest musculature
Lesspulmonaryreserve,
Childrenrelyondiaphragm breathing
High risk for resp. failure if the diaphragm is
unable tocontract
,f
ASSESSING RESPIRATORY ILLNESS IN CHILDREN
,f ,f ,f ,f
● History
,f
RESPIRATORY TRACT DIFFERENCES IN CHILDREN
,f ,f ,f ,f ○ Chief concern: Cough, rapid respirations,
h h h h
noisy breathing, rhinitis, reddened sore
h h h h h
● Changes until - Child respiratory
, f , f h h
throat, lethargy, cyanosis, difficulty, sucking,
h h h h h
12illness risk greater than adults
h h ,f h h
fever. h
● Upper airway more prone to -
● Past Medical History
,f ,f ,f ,f ,f
Smallerairway = greater resistance
obstruction h h h
h h
● Less alveolar surface
, f - Reduced area , f ,f h h
○ Poor weight gain, difficulty
h h h h with
area for h
respirations at birth, prematurity
h h h h
gasexchange ● Physical Examination
h
● More diaphragmatic breathing - Flexible
, f , f h
chest reduces air intake
,f h h
RESPI ● Respiratory structures grow in h h h
DEVEL
,f hsize and distance from each other.
h h h h h
O PME,f ● Immature infant respiratory and h h h
NT h hneurologic system
offers
hless efficient response to hypoxia
,f h h h
hand elevated partial pressure of
h h h h
hcarbon dioxide (PCO2) h h
● Chest wall stiffens with age h h h h
○ Less retraction with h h
distress h
● Inspection
Chest
■ Size, symmetry movement
■ Infancy shapeisalmost circular
■ <6-7 years respiratory
movement primarily
abdominal or diaphragmatic
,f
Respirations
,CHEST/ ● Obligate nasal breathers until 4 – 6
h h h h h h
RESPI
,f hwks
SYSTE
,f ● Short neck
h
M ● Tongue is larger in proportion to
h h h h h
hthe mouth
h
○ More likely to obstruct the
h h h h
airway in an unconscious
h h h h
child.
h
● Smaller, shorter, narrower airways
h h h
hmore susceptible
h to airway h h
CHEST/ hobstruction and resp. Distress
,f h h
RESPI
,f
SYSTE
,f
M
, 6) Pulmonary FunctionTest
Rate, rhythm, depth, quality, effort ,f
>60/min in small children These laboratory tests can be used to confirm or rule
h h h h h h h h h
=s ignificant respiratory distress
,f
out the presence of respiratory disorders to help
h h h h h h h h
Auscultation identify the cause and severity of the problem.
h h h h ,f h h h
Listen comparing one areas to the other
Equality of breath sounds BLOOD GAS ANALYSIS OR ,f ,f ,f
Diminished ,f ARTERIAL BLOOD GAS (ABG) ,f ,f ,f
Poor air exchange
Abnormal breath sounds Blood Gas Analysis / Arterial Blood Gas (ABG) -
h h h h h h h h
Fine crackles - High pitched;Heard during ,f ,f
an ,f h h ,f ,f ,f ,f
invasive method for determining the effectiveness of
h h h h h h
hventilationand acid-base status. h h
cleared by cough ● Measures the amount of oxygen and carbon h h h h h h
(Discontinuous dioxidein the blood.
h h h
Wheezes - Musical noise during ○ Provides important
inspiration/expiration; Usually louder information
during expiration (Continuous) about oxygenation of the blood as h ,f h h h h
Rhonchi (coarse crackles) - values may indicate not only whether h h h h h h
Rumbling; Course sounds; Like a the arterial partial pressure of oxygen h h h h h h
snore; May clear with coughing or PO2 is adequate, but also whether the h h h h h h h
Suctioning (Continuous) oxygen saturation of hemoglobin is h h h h h
adequate. h
● An arterial blood is drawn.
h h h h
○ Rather than the venous blood since h h h h h
arterial blood will reflect how well the h h h h h h h
lungs are oxygenating the blood h h h h h
whereas venous blood will reflect only h h h h h h
the oxygenation of the particular extremity h h h h h h
from which the blood was drawn. h h h h h h
● In young infants, the temporal artery may be used.
h ,f h h h h h h
● In newborn, an umbilical artery can be used
h h h h h h h
○ Umbilical artery catheter can be used h h h h h
because for young infants and h h h h h
newborn, their radial and brachial h h h h h
arteries are not clearly seen. h h h h h
○ Cough ● In older children, the radial artery is the site of
h,f h,f h h h h h h h
● Color choice.
h
○ Mucous ○ Because of the collateral circulation h h h h
○ membranesNail present at the wrist. If clotting should h h h h h h h
○ beds occurin the radial artery, the hand will h h h h h h h
Skin still be well nourished by collateral h h h h h h
Temperature circulation. h
Febrilestateincreases ● Specimen is withdrawn into a h h h h
oxygenconsumption heparinized syringe
h h
Retractions (to prevent clotting).
h h
A sign of respiratory distress
,f
● After any arterial puncture, always firmly h h h h h
compress the site.
h h h
○ Otherwise, blood from the punctured h h h h
vessel can seep into subcutaneous h h h h h
tissue possibly causing a large h h h h h
hematoma and obscuring the site for h h h h h h
further assessment. h h
● Note the use of oxygen and its liter flow in the
h h h h h h h h h h
lab request.
h h
○ Applicable if the px has an O2 attached to h h h h h h h h
it. h
● Note the site where the specimen was obtained
h h h h h h h
○ Whether radial, brachial artery, etc. h h h h
● While being transported to the lab, ABG h h h h h h
specimens should be kept on ice to ensure
h h h h h h h h
accurate results.
h h
,f ABG COMPONENTS ,f
Measure Definition Normal , Clinical
Value f Significanc
,f
e
PaO2 Partial 80-100 Decreased
Pressure of mmHg ifchild
O2 in ,f cannot
arterial blood ,f inspire
VIDEO 2 h adequatel
COMMON LABORATORY & DIAGNOSTIC TEST
,f ,f ,f ,f
y
OF RESPIRATORY ILLNESS IN CHILDREN PaCO2 Partial 35-45 Increased
,f ,f ,f ,f ,f
1) Blood GasAnalysis (Respiratory ,f
Pressure mmHg ifchild
2) Allen Test determinant) of CO2 in cannot ex ,f
arterial blo pir
,f
3) Pulse Oximetry
,f
od e
, GOALS OF ABG ANALYSI ,f ,f ,f
blood With the given lab values, we need to
h h h h h h h
determine if the interpretation is:
HCO3
h h h h
The 22-26 Increased in
,f
1) Acidosis orAlkalosis h
(metabolic bicarbonat mEq/L respiratory - By looking at the pH value
e alkalosis,
h h h h h
determinant
,f
,f
2) Metabolic or Respiratory
concentrati decreased
h h
) - Through the PaCO2 for
o n in inrespiratory
h h h
respiratory andHCO3 for
,f
blood acidosis
h h h
metabolic h
O2 The 95%-100 Decreased if 3) Full Compensated, Partially Compensated,
h h h
orUncompensated
,f
saturation percentag % O2 cannot ,f
h
e of ,f
reach RBC, if
hemoglob unoxygenate 8 STEPS IN ABG ANALYSIS USING THE TIC-TAC-
i
,f ,f ,f ,f ,f ,f ,f
d cells are TOE METHOD
ncarrying
,f
being mixed
oxygen with 1 Memorize the normal values. ,f ,f ,f
oxygenated
ones
● PaO2 = indicates the amount of oxygen h h h h h h
available to bind with haemoglobin
h h h h h
○ pH: plays a role in the combining h h h h h h
power of oxygen with haemoglobin. h h h h h
■ Low pH = less O2 in the h h h h h h
haemoglobin. h
● PaCO2 = shows adequacy of gas exchange h h h h h h
between alveoli and external environment or
h h h h h h
the alveolar ventilation.
h h h
○ CO2 can’t escape when there is damage h h h h h h
Familiarize the normal and abnormal ABG
in the alveoli so if there is excess CO2, h h h h h h h h h
values when you review the lab results. The
it combines w/ water to form carbonic h h h h h h h recommended way of memorizing it is by
acid causing an h h h drawing the diagram of normal values, write it
acidotic state, to makebicarbonate. ,f ,f h h
down together with the arrows indicating
■ Bicarbonate - a buffer h h h h h h
acidosis and alkalosis. Note that PaCO2 is
system because it is the body’s h h h h h h
intentionally inverted for the purpose of the tic-
compensatory mechanism if there h h h h
tac-toe method.
will be an increase of CO2 in h h h h h h h
the alveoli. h h 2 Create your tic-tac-toe grid. ,f ,f ,f
● pH = also determines the acidity/alkalinity of
h h h h h h
the bodyfluids; will also be used as we analyze
h h h h h h h h h
● Create a blank in your
acid-base imbalances
h h
tic- tac-toe grid and label the top
● HCO3 = alkaline substance that comprises over
h h h h h h
row as acidosis, normal, and
half of the total buffer base in the blood.
h h h
alkalosis.
● Based on their values,
h h h h h h
○ Metabolic acidosis - a deficit of h h h h h
bicarbonateand other bases h h h
there is a need to determine in
○ Metabolic alkalosis - increase in which column we will place the
bicarbonate pH, PaCO2, and HC3 (the
● O2 saturation = basically the amount of oxygen in
,f
h h h h h h
determinants → iplot ra
theblood that combines with hemoglobin h h h h nimo sa grid)
3 Determine if pH is under NORMAL, ACIDOSIS,
ABG NORMAL VALUES
, f , f , f , f , f , f
or ALKALOSIS.
,f ,f ,f
,f ,f
To determine acid-base imbalance, you h h h h
h need to know and memorize these values to
h h h h h h h
h recognize what deviates from normal. The normal
h h h h h h
h range for ABGs is used as a guide, andthe
h h h h h h h h
h determination of disorders is often based h h h h h
on blood pH. If the blood is basic, HCO
h h the3 level is h h h h h h , f
considered because the kidneys regulate bicarbonate
h h h h h
h ion levels (meaning there is aproblem in the kidneys). If
h h h h h h h h h
h the blood is acidic, the PaCO2 or partial pressure of
h h h h h,f h,f h h h
h carbon dioxide in arterial blood is assessed because the
h h h h h h h h
h lungs regulate the majority of acid. ThenormalABG
h h h h h h
h values are the following:
h h h
● pH = 7.35 to 7.45 h h h h
● PaCO2 = 35 to 45 mmHg (respiratory determinant) h h h h h h h
● HCO3 = 22 to 26 mEq/L (metabolic determinant) h h h h h h h
● The normal pH range is 7.35 - 7.45.
,f ,f ,f
● If the blood pH is between 7.35 to 7.39,
ABG NORMAL INTERPRETATION
the interpretation is normal but slightly
,f ,f ,f
acidosis, place it under the normal
Interpreting ABG imbalances is used to detect
column but butangi siyag arrow padung
h h h h h h
respiratory acidosis/alkalosis or metabolic
acidosis.
h h h h
acidosis/alkalosis during an acute illness. To determine
● If blood pH is between 7.41 - 7.45, that is
h h h h h h h
the type of arterial blood gas, the key components are
still within the normal range but slightly
h h h h h h h h h h
checked. Also, we have 3 goals of ABG analysis that
alkalosis, so put it under normal but with
h h h h h h h h h h
h will serve as a guide as we interpret the ABG values.
h h h h h h h h h h
NURSING CARE OFA CHILD W RESPI DISORDER
h h ,f h h h
Clinical Instructor: RaquelAnn Batayola-Jugasan
h h h
,f A&P RESPIRATORY SYSTEM
,f ,f
,f DIFFERENCES IN ADULT AND CHILD ,f ,f ,f ,f
Smallerlungcapacityand underdeveloped
intercostal muscles, poor chest musculature
Lesspulmonaryreserve,
Childrenrelyondiaphragm breathing
High risk for resp. failure if the diaphragm is
unable tocontract
,f
ASSESSING RESPIRATORY ILLNESS IN CHILDREN
,f ,f ,f ,f
● History
,f
RESPIRATORY TRACT DIFFERENCES IN CHILDREN
,f ,f ,f ,f ○ Chief concern: Cough, rapid respirations,
h h h h
noisy breathing, rhinitis, reddened sore
h h h h h
● Changes until - Child respiratory
, f , f h h
throat, lethargy, cyanosis, difficulty, sucking,
h h h h h
12illness risk greater than adults
h h ,f h h
fever. h
● Upper airway more prone to -
● Past Medical History
,f ,f ,f ,f ,f
Smallerairway = greater resistance
obstruction h h h
h h
● Less alveolar surface
, f - Reduced area , f ,f h h
○ Poor weight gain, difficulty
h h h h with
area for h
respirations at birth, prematurity
h h h h
gasexchange ● Physical Examination
h
● More diaphragmatic breathing - Flexible
, f , f h
chest reduces air intake
,f h h
RESPI ● Respiratory structures grow in h h h
DEVEL
,f hsize and distance from each other.
h h h h h
O PME,f ● Immature infant respiratory and h h h
NT h hneurologic system
offers
hless efficient response to hypoxia
,f h h h
hand elevated partial pressure of
h h h h
hcarbon dioxide (PCO2) h h
● Chest wall stiffens with age h h h h
○ Less retraction with h h
distress h
● Inspection
Chest
■ Size, symmetry movement
■ Infancy shapeisalmost circular
■ <6-7 years respiratory
movement primarily
abdominal or diaphragmatic
,f
Respirations
,CHEST/ ● Obligate nasal breathers until 4 – 6
h h h h h h
RESPI
,f hwks
SYSTE
,f ● Short neck
h
M ● Tongue is larger in proportion to
h h h h h
hthe mouth
h
○ More likely to obstruct the
h h h h
airway in an unconscious
h h h h
child.
h
● Smaller, shorter, narrower airways
h h h
hmore susceptible
h to airway h h
CHEST/ hobstruction and resp. Distress
,f h h
RESPI
,f
SYSTE
,f
M
, 6) Pulmonary FunctionTest
Rate, rhythm, depth, quality, effort ,f
>60/min in small children These laboratory tests can be used to confirm or rule
h h h h h h h h h
=s ignificant respiratory distress
,f
out the presence of respiratory disorders to help
h h h h h h h h
Auscultation identify the cause and severity of the problem.
h h h h ,f h h h
Listen comparing one areas to the other
Equality of breath sounds BLOOD GAS ANALYSIS OR ,f ,f ,f
Diminished ,f ARTERIAL BLOOD GAS (ABG) ,f ,f ,f
Poor air exchange
Abnormal breath sounds Blood Gas Analysis / Arterial Blood Gas (ABG) -
h h h h h h h h
Fine crackles - High pitched;Heard during ,f ,f
an ,f h h ,f ,f ,f ,f
invasive method for determining the effectiveness of
h h h h h h
hventilationand acid-base status. h h
cleared by cough ● Measures the amount of oxygen and carbon h h h h h h
(Discontinuous dioxidein the blood.
h h h
Wheezes - Musical noise during ○ Provides important
inspiration/expiration; Usually louder information
during expiration (Continuous) about oxygenation of the blood as h ,f h h h h
Rhonchi (coarse crackles) - values may indicate not only whether h h h h h h
Rumbling; Course sounds; Like a the arterial partial pressure of oxygen h h h h h h
snore; May clear with coughing or PO2 is adequate, but also whether the h h h h h h h
Suctioning (Continuous) oxygen saturation of hemoglobin is h h h h h
adequate. h
● An arterial blood is drawn.
h h h h
○ Rather than the venous blood since h h h h h
arterial blood will reflect how well the h h h h h h h
lungs are oxygenating the blood h h h h h
whereas venous blood will reflect only h h h h h h
the oxygenation of the particular extremity h h h h h h
from which the blood was drawn. h h h h h h
● In young infants, the temporal artery may be used.
h ,f h h h h h h
● In newborn, an umbilical artery can be used
h h h h h h h
○ Umbilical artery catheter can be used h h h h h
because for young infants and h h h h h
newborn, their radial and brachial h h h h h
arteries are not clearly seen. h h h h h
○ Cough ● In older children, the radial artery is the site of
h,f h,f h h h h h h h
● Color choice.
h
○ Mucous ○ Because of the collateral circulation h h h h
○ membranesNail present at the wrist. If clotting should h h h h h h h
○ beds occurin the radial artery, the hand will h h h h h h h
Skin still be well nourished by collateral h h h h h h
Temperature circulation. h
Febrilestateincreases ● Specimen is withdrawn into a h h h h
oxygenconsumption heparinized syringe
h h
Retractions (to prevent clotting).
h h
A sign of respiratory distress
,f
● After any arterial puncture, always firmly h h h h h
compress the site.
h h h
○ Otherwise, blood from the punctured h h h h
vessel can seep into subcutaneous h h h h h
tissue possibly causing a large h h h h h
hematoma and obscuring the site for h h h h h h
further assessment. h h
● Note the use of oxygen and its liter flow in the
h h h h h h h h h h
lab request.
h h
○ Applicable if the px has an O2 attached to h h h h h h h h
it. h
● Note the site where the specimen was obtained
h h h h h h h
○ Whether radial, brachial artery, etc. h h h h
● While being transported to the lab, ABG h h h h h h
specimens should be kept on ice to ensure
h h h h h h h h
accurate results.
h h
,f ABG COMPONENTS ,f
Measure Definition Normal , Clinical
Value f Significanc
,f
e
PaO2 Partial 80-100 Decreased
Pressure of mmHg ifchild
O2 in ,f cannot
arterial blood ,f inspire
VIDEO 2 h adequatel
COMMON LABORATORY & DIAGNOSTIC TEST
,f ,f ,f ,f
y
OF RESPIRATORY ILLNESS IN CHILDREN PaCO2 Partial 35-45 Increased
,f ,f ,f ,f ,f
1) Blood GasAnalysis (Respiratory ,f
Pressure mmHg ifchild
2) Allen Test determinant) of CO2 in cannot ex ,f
arterial blo pir
,f
3) Pulse Oximetry
,f
od e
, GOALS OF ABG ANALYSI ,f ,f ,f
blood With the given lab values, we need to
h h h h h h h
determine if the interpretation is:
HCO3
h h h h
The 22-26 Increased in
,f
1) Acidosis orAlkalosis h
(metabolic bicarbonat mEq/L respiratory - By looking at the pH value
e alkalosis,
h h h h h
determinant
,f
,f
2) Metabolic or Respiratory
concentrati decreased
h h
) - Through the PaCO2 for
o n in inrespiratory
h h h
respiratory andHCO3 for
,f
blood acidosis
h h h
metabolic h
O2 The 95%-100 Decreased if 3) Full Compensated, Partially Compensated,
h h h
orUncompensated
,f
saturation percentag % O2 cannot ,f
h
e of ,f
reach RBC, if
hemoglob unoxygenate 8 STEPS IN ABG ANALYSIS USING THE TIC-TAC-
i
,f ,f ,f ,f ,f ,f ,f
d cells are TOE METHOD
ncarrying
,f
being mixed
oxygen with 1 Memorize the normal values. ,f ,f ,f
oxygenated
ones
● PaO2 = indicates the amount of oxygen h h h h h h
available to bind with haemoglobin
h h h h h
○ pH: plays a role in the combining h h h h h h
power of oxygen with haemoglobin. h h h h h
■ Low pH = less O2 in the h h h h h h
haemoglobin. h
● PaCO2 = shows adequacy of gas exchange h h h h h h
between alveoli and external environment or
h h h h h h
the alveolar ventilation.
h h h
○ CO2 can’t escape when there is damage h h h h h h
Familiarize the normal and abnormal ABG
in the alveoli so if there is excess CO2, h h h h h h h h h
values when you review the lab results. The
it combines w/ water to form carbonic h h h h h h h recommended way of memorizing it is by
acid causing an h h h drawing the diagram of normal values, write it
acidotic state, to makebicarbonate. ,f ,f h h
down together with the arrows indicating
■ Bicarbonate - a buffer h h h h h h
acidosis and alkalosis. Note that PaCO2 is
system because it is the body’s h h h h h h
intentionally inverted for the purpose of the tic-
compensatory mechanism if there h h h h
tac-toe method.
will be an increase of CO2 in h h h h h h h
the alveoli. h h 2 Create your tic-tac-toe grid. ,f ,f ,f
● pH = also determines the acidity/alkalinity of
h h h h h h
the bodyfluids; will also be used as we analyze
h h h h h h h h h
● Create a blank in your
acid-base imbalances
h h
tic- tac-toe grid and label the top
● HCO3 = alkaline substance that comprises over
h h h h h h
row as acidosis, normal, and
half of the total buffer base in the blood.
h h h
alkalosis.
● Based on their values,
h h h h h h
○ Metabolic acidosis - a deficit of h h h h h
bicarbonateand other bases h h h
there is a need to determine in
○ Metabolic alkalosis - increase in which column we will place the
bicarbonate pH, PaCO2, and HC3 (the
● O2 saturation = basically the amount of oxygen in
,f
h h h h h h
determinants → iplot ra
theblood that combines with hemoglobin h h h h nimo sa grid)
3 Determine if pH is under NORMAL, ACIDOSIS,
ABG NORMAL VALUES
, f , f , f , f , f , f
or ALKALOSIS.
,f ,f ,f
,f ,f
To determine acid-base imbalance, you h h h h
h need to know and memorize these values to
h h h h h h h
h recognize what deviates from normal. The normal
h h h h h h
h range for ABGs is used as a guide, andthe
h h h h h h h h
h determination of disorders is often based h h h h h
on blood pH. If the blood is basic, HCO
h h the3 level is h h h h h h , f
considered because the kidneys regulate bicarbonate
h h h h h
h ion levels (meaning there is aproblem in the kidneys). If
h h h h h h h h h
h the blood is acidic, the PaCO2 or partial pressure of
h h h h h,f h,f h h h
h carbon dioxide in arterial blood is assessed because the
h h h h h h h h
h lungs regulate the majority of acid. ThenormalABG
h h h h h h
h values are the following:
h h h
● pH = 7.35 to 7.45 h h h h
● PaCO2 = 35 to 45 mmHg (respiratory determinant) h h h h h h h
● HCO3 = 22 to 26 mEq/L (metabolic determinant) h h h h h h h
● The normal pH range is 7.35 - 7.45.
,f ,f ,f
● If the blood pH is between 7.35 to 7.39,
ABG NORMAL INTERPRETATION
the interpretation is normal but slightly
,f ,f ,f
acidosis, place it under the normal
Interpreting ABG imbalances is used to detect
column but butangi siyag arrow padung
h h h h h h
respiratory acidosis/alkalosis or metabolic
acidosis.
h h h h
acidosis/alkalosis during an acute illness. To determine
● If blood pH is between 7.41 - 7.45, that is
h h h h h h h
the type of arterial blood gas, the key components are
still within the normal range but slightly
h h h h h h h h h h
checked. Also, we have 3 goals of ABG analysis that
alkalosis, so put it under normal but with
h h h h h h h h h h
h will serve as a guide as we interpret the ABG values.
h h h h h h h h h h
