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Upper Respiratory Tract
- - Oronasopharynx
- - Pharynx
- - Larynx
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Lower Respiratory Tract
- Trachea
- ◦ Bronchi
- ◦ Bronchioles
- ◦ Alveoli
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Respiratory Infection most often caused by
- RSV
- ◦ β- hemolytic streptococci
- ◦ Staphylococci
- ◦ Haemophilus influenzae
- ◦ Chlamydia trachomatis
- ◦ Mycoplasma
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can be vaccinated against
- RSV - only those who qualify
- H Influenzae
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Pediactric Anatomy
- diameter of airway
- distance bewtween structures
- easy access to
- - smaller in children
- - is shorter
- - middle ear
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Predisposing Factors for Respiratory Infections
- Poor nutrition
- Anemia
- Fatigue
- Asthma
- Allergies
- Cardiac anomalies
- Cystic Fibrosis
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Chest and lungs
- inspection
Chest wall is thinner, infant chest is rounded,>2yrs becomes more oval, head and chestcircumference are about equal until 1 year ofage. Infants and young children are abdominalbreathers.
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chest and lungs
- palpation
- Used to evaluate chest movement, respiratory effort, deformities, tactile fremitus
- ◦ Increased fremitus?◦ Decreased fremitus?
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chest and lungs
- ausultation
- Use an infant or pediatric stethoscope
- ◦ Compare sounds between sides
- ◦ Listen to an entire inspiratory and expiratory phase
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Expected Findings
- no excessive
- nares
- nasal mucosa
- mucous membranes
- tonsils
- chest
- - drainage from the ears
- - patent w/out flaring
- - pink and moist, no excessive d/c
- -moist and pink
- - barely visible or prominent
- - more round, transverse to AP 2:1 by childhood
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Expected Findings
- chest movement
- breathing in infants
- children under 6 are what kind of breathers
- breath sounds in infant
- children and adolescents, vesicular sounds over
- - symetrical, no retractions
- - irregular is common
- - abdominal
- - harsher
- - lung fields
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Expected findings
- S1 and S2
- sinus arrhythmias associated with respirations
- infants pulses
- children and adolescents pulses
- - clear and crisp
- - common
- - brachial, temporal and femoral pulses full
- - pluse locations and finding same as adult
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Unexpected Findings - abnormal breath sounds
- absent or diminished suggests
- crackles suggest
- rhonchi suggest
- - pneumothorax or airway obstruction
- - air passing through watery secretions in small airways
- - air passing through thick secretions in bronchi and trachea
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unexpected findings - abnormal voice sounds
- stridor
- wheezing
- hoarsness
- - results from air moving throughnarrowed trachea and larynx
- - results from passage of airthrough mucus or fluids in a narrowedlower airway
- -suggests inflammation
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Early signs of REsp complications
- Earache
- Respirations > 50-60- (never a good sign)
- Fever > 101 degrees
- Listlessness
- confusion
- Irritability/ crying
- Persistent cough/ wheezing
- Refusal to take fluids
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basic interventions for resp complications
- Positioning
- Airway patency
- Oxygen administration
- Calm, quiet environment
- Coughing
- Incentive spirometry
- CPT
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Respiratory Distress
- Tachypnea/Inc HR
- ◦ Retractions
- ◦ Nasal Flaring
- ◦ Grunting
- Stridor◦
- Seesaw resp
- ◦ Diminished breathsounds
- ◦ PaO2 less than 50
- ◦ PCO2 above 60
- ◦ Restlessness
- ◦ Fatigue
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REspiratory Failure
- ◦ Cyanosis
- ◦ Bradycardia
- ◦ Bradypnea
- Low Blood pressure
- confusion
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prep for Dx procedure
- Recognize prior knowledge
- include the parents and the child
- Use concrete words
- Provide teaching to child based ondevelopmental age (when?)
- Explain what child will feel, see, hear, smell and touch
- be honest
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During the procedure or dx test
- Avoid delays, set the room up before childgets there
- not done in patient room
- Be confident that the child can besuccessful and do well
- Involve the child
- Provide distraction
- Allow expression of feelings
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after procedure
- Encourage expression of feelings
- Positive reinforcement- (whether theywere good or not!)
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Respiratory Diagnostics
- Respiratory secretion specimens–required for diagnosis of respiratoryinfections such as
- throat culture
- chest
- CT
- CBC
- - TB and RSV
- - swab tonsils and pharynx
- - xRay
- - of chest - with or without contrast
- - other lab test
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Albuterol
- admin how
- monitor what
- think
- SE
- - with nebulizer, sometimesliquid form used po
- - heart rate very closely
- - SBAR
- - palpitations, tremors, insomnia,nervousness, HA
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Racemic Epinephrine
- if given monitor for how long
- mucosal vasoconstriction decreases
- watch what in frequent dosing
- - at least three hours
- - subglottic edema
- - heart rate
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Prednisolone
- usually administered how
- reduces
- SE
- Taper...
- - as a syrup: Pediapredor Orapred
- - inflammation in lungs
- - mood changes, seizures, hyperglycemia,GI bleeding
- - slowly, watch for increased healing time, cushingoid effects
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Solumedrol
- given how
- decreases
- SE
- Taper...
- - IV
- - inflammation in lungs
- - HTN, hyperglycemia, Cushingsyndrome, GI bleeding
- - slowly, watch for increased healingtime, cushingoid effects
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Oxygen
- increases
- potent
- high levels contraindicated in
- evidence of toxicity
- if pt shows signs of confusion, diaphoresis always think about
- - amount of O2 in bloodstream
- - vasodilator
- - COPD, sickle cell anemia
- - convulsions, difficultybreathing, chest pain
- - effect of oxygen
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Xopenex
- relaxes
- treats
- administer how
- SE
- don't give with
- given less often than albuterol....
- - bronchial smooth muscle,
- - bronchospasms
- - nebulizer
- - dizziness, nervousness, tachycardia,increased cough
- - with other bronchodilators or epi
- - effect canlast up to 8 hours
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