Pediatric Respiratory Disorders

Topics: Pulmonology, Respiratory physiology, Cystic fibrosis Pages: 13 (4669 words) Published: October 30, 2014

Pediatric Respiratory Assessment
General History
General History Questions to Ask
-Ask about gestational age
-Any past medical history, including onset of current s/s.
****recurrent sore throats, eczema, resp problems at birth
-Detailed family hx****chronic resp conditions-asthma
-Exposures to enviormental irritants
****pets, smoke
-Feeding and sleeping patterns
-Growth
-Milestones for age
-International travel
Things to Remember Before Assessment of Child
-Childs airway is shorter than adults
-Newborns=nose breathers
-Child's airway can easily spasm
-Pronounced abd wall mvmt is normal until age 6
-Higher O2 demand
-Anterior-Posterior diameter of the chest is equal at birth and decreases with age Auscultation: 
~ Anterior and posterior chest, and bilateral mid-axillary for aretion       {Respiratory rate -- varies based on child's age} ~Heart rate depends on age; increased with fever, dehydration. ~Adventitious breath sounds

       {Crackles (rales) are fine crackling noises heard on inspiration}             -Results as air moves through fluid-filled alveoli, as in pneumonia             -May not change after coughing
            -Sound can be stimulated by rolling hair b/w fingers        {Rhonchi are low-pitched sounds heard throught out respiration}             -Air passes through thick secretions throughout respiration             -May clear after coughing

       {Stridor is a high-pitched sound on inspiration}
             -Heard when child has croup
       {Wheezing is a high-pitched musical sound; heard throughout respiration}              -Results from air passing through constricted bronchioles/ narrowed airways [Asthma] AUSCULTATION:
Respiratory rate varies based on the child's age. Auscultate anterior & posterior chest, and bilateral mid-axillary for aeration. Heart rate depends on age; increased with fever and dehydration. Adventitious Breath Sounds:

Crackles: (rales) are fine crackling noises heard on inspiration. Result as air moves through fluid-filled alveoli, as in pneumonia. May not change after coughing. The sound can be simulated by rolling hair b/w your fingers. Rhonchi: are low-pitched sounds heard throughout respiration. Air passess through thick secretions throughout respiration. May clear after coughing. Stridor: is a high-pitched sound heard on inspiration. This is often heard when a child has croup. Wheezing: is a high-pitched musical sound that can be heard throughout respiration. Results from air passing through constricted bronchioles or narrowed smaller airways, as in asthma. Brief periods of apnea, the absence of respiration, of up to 15 seconds are NORMAL in the newborn period. A child's metabolic rate is higher than an adult's, and therefore newborns have a higher oxygen demand; newborns use 4 to 8 liters of oxygen per minute and adults use 3 to 4 liters per minute. A child's respiratory rate is FASTER, with an IRREGULAR pattern. Percussion

Lungs should resonate when percussed
-you will have flat or dull sounds in a consolidated area
-tympany will be heard with a pneumothorax
-hyperresonance may be heard in the presence of asthma
 Diagnostic Tests
ABG - invasive and anxiety provoking for child and parent-PaO2 is decreased with hypoventilation or shunting -PaCO2 will increase with hypoventilation and decrease with increased alveolar ventilation -pH will cahnge due to respiratory or metabolic dysfunction

Chest X-ray- used with judgment duet o radiation exposure
-identifies thoracic structures
-takes different views; AP, lateral or oblique
-use lead protection over gonads
CT
-more sensitive and more radiatioon used than CXR
-3D picture
-contrast used; NPO for 4-6 hrs; child may need sedation
MRI-identifies structures and obstructions
-powerful magnet; no metal in or on body
-child may need sedation
Bronchoscopy-allows direct visualization of trachea and upper parts of bronchi -collect secretion samples, in brush or lesion biopsy, and to remove...
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