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Respiratory Assessment

Respiratory Assessment. Jan Bazner-Chandler CPNP, CNS, MSN, RN. Respiratory . Bifurcation of trachea. Change in chest wall shape. Upper Airway Characteristics. Narrow tracheo-bronchial lumen until age 5 Tonsils, adenoids, epiglottis proportionately larger in children

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Respiratory Assessment

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  1. Respiratory Assessment Jan Bazner-Chandler CPNP, CNS, MSN, RN

  2. Respiratory Bifurcation of trachea Change in chest wall shape

  3. Upper Airway Characteristics • Narrow tracheo-bronchial lumen until age 5 • Tonsils, adenoids, epiglottis proportionately larger in children • Tracheo-bronchial cartilaginous rings collapse easily • Infants up to 4-6 weeks are obligate nose breathers • Tongue is large in proportion to the mouth

  4. Lower Airway Characteristics • Lack of firm bony structure to ribs/chest make child more prone to retractions when in respiratory distress • Fewer alveoli in the neonate • Poor quality of alveoli until age 8 • Lack of surfactant that lines the alveoli in the premature infant • Inhibits alveolar collapse at end of expiration

  5. Focused Health History • Reason for the visit • Include questions about the environment • What makes condition worse – triggers • Allergies • Past medical history: birth history, previous health problems, childhood illness, immunizations • Family medial history: respiratory illness – genetic link

  6. Focused Physical Assessment • Types of breathing: • Less than 7 years abdominal breathing • Greater than 7 years abdominal breathing can indicate problems

  7. Respiratory Rate • Inspiratory phase slightly longer or equal to expiratory phase • Prolonged expiratory phase = asthma • Prolonged inspiratory phase = upper airway obstruction • Croup • Foreign body

  8. Color • Observe color of face, trunk, and nail beds • Cyanosis = inadequate oxygenation • Clubbing of nails = chronic hypoxemia

  9. Respiratory Distress • Grunting = impending respiratory failure • Severe retractions • Diminished or absent breath sounds • Apnea or gasping respirations • Poor systemic perfusion / mottling • Tachycardia to bradycardia • Decrease oxygen saturations

  10. Chest Muscle Retraction

  11. Chest Retractions • Retractions suggest an obstruction to inspiration at any point in the respiratory tract. • As intrapleural pressure becomes increasingly negative, the musculature “pulls back” in an effort to overcome the blockage. • The degree and level of retraction depend on the extent and level of the obstruction.

  12. Diagnostic Tests • Detects abnormalities of chest or lungs • Chest x-ray • Sweat chloride Test • MRI • Laryngoscope / bronchoscopy • CT Scan

  13. White Patchy Infiltrates

  14. X-ray Hyperinflation of Lung Vh.org

  15. Pleural Effusion

  16. Pleural Effusion X-Ray vh.org

  17. Foreign Body Aspiration A foreign body in one or the other of the bronchi causes unilateral retractions. *usually the right due to broader bore and more vertical placement.

  18. Sweat Test for Cystic Fibrosis Gold Standard test for Cystic Fibrosis

  19. Oxygen Therapy: Nursing Interventions • Proper concentration • Adequate humidity: make sure there is fluid in the bottle • Make sure prongs are in nose and that the nares are patent – suction out nares to increase oxygen flow • Monitor oxygen SATS: if alarm keeps on going off but the infant / child looks good, check the device • Monitor activity level or infant / child

  20. Aerosol Therapy • Respiratory Therapist will do the treatment • Communicate with therapist – eliminated needless paging for treatments • Treatment should be done before the infant eats • When you make your morning rounds assess if there is any infant / child that needs an immediate treatment

  21. Home Teaching Inhaled Medications • Correct dosage • Prescribed time • Proper use of inhaler • No OTC drugs • Encourage fluids • When to call physician

  22. Aerosol Therapy Medication administered by oxygen or compressed air.

  23. Outpatient Aerosol Treatment

  24. Postural Drainage and Percussion • In the small child you can position on your lap • Do first thing in the AM • Do before meals or one hour after • Do after the aerosol treatment since the treatment will help open the airways and loosen the mucous • Suction the infant after treatment – teach parents to do bulb suction

  25. Percussion and postural drainage

  26. Mechanical Ventilation

  27. Alterations in Respiratory Function

  28. Severe Respiratory Distress • Nasal flaring and grunting • Severe retractions • Diminished breath sounds • Hypotonia • Decreased oxygen saturations

  29. What to do if infant / child in respiratory distress! • Stimulate the infant / child - remember crying or activity will help mobilize secretions and expand lungs • Have the older child sit up take deep breaths and cough • Chest percussion to loosen secretions • Give oxygen • Assess if interventions work • Call for help if you need it – pull the emergency cord – yell for help

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