Produced by : • Walaaqadora • Haneenshaqora • Nabawiya el daour • Jafraanasser • Manaraoda • Azesaawad • Hebaawad • Nada saleh
In the name of alla Today our group will talk about care of respiratory system in children . :firstly I will produce a short introduction about anatomy of respiratory system in child And the differences between the child respiratory system and adult respiratory system
What are the differences between adult respiratory system and children respiratory system ?
The diameter of an infant’s airway is approximately 4 mm, in contrast to an adult’s airway diameter of 20 mm. An inflammatory process in the airway causes swelling that narrows the airway, and airway resistance increases. Note that : swelling of 1 mm reduces the infant’s airway diameter to 2 mm, but the adult’s airway diameter is only narrowed to 18 mm. Air must move more quickly in the infant’s narrowed airway to get the same amount of air to the lungs. The friction of the quickly moving air against the side of the airway increases airway resistance. The infant must use more effort to breathe and breathe faster to get
Incidence: "Respiratory infections are the first leading cause of infant mortality in palestine; Conditions in the prenatal period form major cause of deaths among children under five years Based on Ministry of Health data for 2011, the leading cause of infant mortality in the West Bank was respiratory tract infections with 39.7%: 42.0% for male children and 37.0% for female. This was followed by infant mortality caused by premature and low birth weight with 16.2%: 17.0% for male children and 15.2% for female children.
PEDIATRIC RESPIRATORY ASSESSMENT
Nose: Key Points • Exam nose & mouth after ears • Observe shape & structural deviations • Nares: (check patency, mucous membranes, discharge, turbinates, bleeding) • Septum: (check for deviation) • Infants are obligate nose breathers • Nasal flaring is associated with respiratory distress
Nose and Throat Sinusitis: • Fever • Purulent rhinorrhea • Facial Pain – cheeks, forehead • Breath odor • Chronic cough – could be day and night
Mouth & Pharynx: Key Points • Lips: color, symmetry, moisture, swelling, sores, fissures • Buccal mucosa, gingivae, tongue & palate for moisture, color, intactness, bleeding, lesions. • Tongue & frenulum - movement, size & texture • Teeth - caries, malocclusion and loose teeth. • Uvula: symmetrical movement or bifid uvula • Voice quality, Speech • Breath - halitosis
Neck: Key Points • √ position, lymph nodes, masses, fistulas, clefts • Suppleness & Range of Motion (ROM) • Check clavicle in newborn • Head control in infant • Trachea & thyroid in midline • Carotid arteries (bruits) • Torticollis • Webbing • Meningeal irritation
Chest Assessment • All 4 quadrants • Front and back • Take the time to listen • Be sure about “lungs CTAB” (clear to auscultation bilaterally) • Auscultation • -All 4 quadrants • -Front and back • -Take the time to listen • -Be sure about “lungs CTAB” (clear to auscultation bilaterally)
Lungs & Respiratory: Key Points • Quality of Respirations: • Symmetry, Expansion, Effort, Dyspnea • S & S Respiratory Distress: • Color: cyanosis, pallor, circumoral cyanosis, mottling • Tachypnea • Retractions • Nasal flaring • Grunting (expiratory) • Stridor - inspiratory: croup • Adventitious sounds: • Crackles / Rales • Rhonchi - course breath sounds • Wheeze – inspiratory vs. expiratory
Lungs & Respiratory: Key Points • Clubbing • Snoring (expiratory): upper airway obstruction, allergy, • Fremitus: • Increased in pneumonia, atelectasis, mass • Decreased in asthma, pneumothorax or FB • Dullness to percussion: fluid or mass
Work of Breathing *Increased or Decreased Respirations *Stridor *Wheezing
Chest Assessment • Auscultation • Wheezing • Retractions • Subcostal • Intercostal • Sub-sternal • Supra-clavicular • Red Flags: • grunting • nasal flaring stridor
All that Wheezes isn’t always Asthma Think: • *Infection • *Foreign body aspiration • *Anaphylaxis • Insect bites/stings, medications, food allergies
And all Asthma doesn’t always Wheeze! • Cough • Fatigue • Reduced exercise tolerance
Coughs • Allergies • Asthma • Infections – pneumonia, bronchitis, bronchiolitis • Sinusitis – Post-nasal drip • GERD • Cigarette smoking • Exposure to secondhand smoke, • Other pollutants
Cough - Characteristics • Dry, non-productive • Mucousy – productive • Croupy • Acute – less than 2-3 weeks • Chronic – more than 2-3 weeks • Associating Symptoms
Chest Pain • if severe, acute, unremitting – needs immediate attention - very rare • Non-cardiac – most common • Musculoskeletal: costochondritis • Pulmonary • Gastrointestinal e.g. GERD • Psychogenic • Often no significant physical findings • Must rule out Cardiac origin – refer to PCP or pedicardiologist
House dust mites • Washing the bed pillow ,sheet And cover every weak. • Use special allergy mattress and Bed cover • if possible , get rid of carpets, extra Pillow, and upholstered furniture. • Limit stuffed animals in children Room . • Dust and vacuum often. • Use dehumidifier in damp area.
Animal and molds • Don’t have furry pets in your home • Repair leaks and clean with fungi- Side or bleach and water when visible • Use dehumidifier in damp area
Outdoor triggertree , pollens, grass , air pollution , smoke , car exhaust • Keep your door and window shut • Avoid outdoor activity during high pollens • Shower and shampoo after being Out side
Strong smells • Stay out side the house or apartment when these chemical and spray being used.
smoker • Smoker in families with asthma Should quite. • Should never smoke indoor.
Infection • Get your flu shot every year • Sea your provider for proper treatment • Ask your provider for asthma medecin prior to flu season to prevent asthma attack If your child have the virus every year
Common cold and sinusitis • Don’t ignore a drippy nose • Washed hand frequently • Don’t share toothbrush or toothpaste when you have cold
Weather change • Avoid doing much out door when the weather very hot or cold.
Exercise -If your exercise is one of your trigger,Your provider can give you medicine10 to 15 mint before exercising to prevent asthma attack. -Do warm –up exercise 6 to10 mint prior exercise. -Make a plane to be active and do regular exercise.
Peak flow meter • A peak flow meter is simple to use for tracking asthma • Here's what to teach: • Stand up or sit up straight. • Make sure the indicator is at the bottom of the meter (zero). • Take a deep breath in, filling the lungs completely. • Place the mouthpiece in the mouth and blast the air out as • hard and as fast as possible in a single blow. • Remove the meter from the mouth and record the number • that appears on the meter. • Repeat three times
Interpreting Peak Expiratory Flow Rates • Green: (80-100% of personal best) signals all clear and asthma is under reasonably good control • Yellow (50-79% of personal best) signals caution; asthma not well controlled; call dr. if child stays in this zone • Red (below 50% of personal best) signals a medical alert. Severe airway narrowing is occurring; short acting bronchodilator is indicated
Aerosol therapy • Aerosol therapy is used for respiratory care in the treatment of some disease such as Asthma and Cystic Fibrosis . • The purpose of Aerosol therapy is to deliver a fine mist medications into the lungs whether to relieve the spasm or to liquefy bronchial secretions to be removed easily.
Aerosol therapy • The most common medications prescribed for CF. is Albuterol, a bronchodilator that helps open the airways and relax the airways muscles. • Necessary equipment includes a compressor , which blows air into a nebulizer or cup changing liquid medicine into a mist
Home Teaching Inhaled Medications • Teach how to use medication • Correct dosage • Prescribed time • Proper use of inhaler
Device for Inhalation Therapy • Selective of device include: 1-Nebulizer 2-Metered dose inhaler MDI 3-Dry powder inhaler DPI
Metered-Dose Inhaler with spacer • A spacer is a chamber that can be attached to a metered-dose inhaler (MDI). The spacer chamber allows the medication to be held in the chamber before it is inhaled so the child can inhale the medicine in one or many breaths, depending on ability. • A spacer: • Helps prevent getting a yeast infection in the mouth (candidiasis) • Increases the amount of medicine delivered directly to airways Reduces the amount of medicine swallowed, which • minimizes side effects.
How to use a Metered _Dose Inhaler with spacer • Remove the cap from the inhaler. • Remove the cap from the spacer. • Shake the inhaler well for 4 seconds. • Insert the inhaler into the open end of the chamber. • Insure that the inhaler fits properly. • Stand up and turn your head back slightly.
How to use a Metered _Dose Inhaler with spacer(cot..) 7. Before starting to inhale , breathe out completely away from the spacer. 8. Place the mouthpiece between your teeth and close your lips tightly around the mouthpiece. 9. Press the inhaler once and breathe slowly and deeply. 10. Hold your breath for 10 seconds.
How to use a Metered _Dose Inhaler with spacer(cot.. 11. Remove the inhaler and breathe out slowly. 12. Repeat the steps from 3 to 10 after 30 seconds, if another dose is required.
Using nebulizer • If using a face mask, the mask must fit probably and tightly over the nose and mouth. • If using a mouthpiece, it must be between the teeth and lips close tightly around it. • Waving the mouthpiece around the mouth will not get the medicine in to lung . • Rinse mouth after nebulizingbudesonide. • Give infant a drink of water.