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Admitting the Pediatric Patient Assessment of the Respiratory System

Admitting the Pediatric Patient Assessment of the Respiratory System. History: Vital for Proper Treatment. Admitting the Pediatric Patient Assessment of the Respiratory System. Now What?. Admitting the Pediatric Patient Assessment of the Respiratory System. Gain Trust Parent Present

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Admitting the Pediatric Patient Assessment of the Respiratory System

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  1. Admitting the Pediatric PatientAssessment of the Respiratory System History: Vital for Proper Treatment

  2. Admitting the Pediatric PatientAssessment of the Respiratory System Now What?

  3. Admitting the Pediatric PatientAssessment of the Respiratory System • Gain Trust • Parent Present • Avoid Being Faceless (Isolation Masks) • Ease Fear • Sit or Kneel instead of Stand • Soft Calm Voice • Age Appropriate Words • Stickers, Coloring Books, Bubbles or Toys • Assess from a Distance • Listen for audible airway sounds • Observe Position • Observe Work of Breathing

  4. Admitting the Pediatric PatientAssessment of the Respiratory System • Retractions • Intercostal • Suprasternal • Clavicular • Substernal • Subcostal

  5. Admitting the Pediatric PatientAssessment of the Respiratory System • Respiratory Rate/Pattern • Do not rely on monitor to obtain accurate RR • Count for 1 full minute • Observe pattern (periods of apnea, paradoxical, rapid and deep) • Breath Sounds…Can be very tricky! • The infant or toddler will not remain motionless or quiet. • The infant or toddler will not take a deep breath upon command. • The room may be noisy. • The child or infant may become frightened and begin crying. ------------------------------------------------------------ • Listen during Insp. and Exp. Phase (2 cycles ideal) • Systematic Assessment; comparing segments from side to side

  6. Hr 120-140 SpO2 85% RR 60 bpm Insp/Exp. Wheezing Inspiratory Crackles Paroxysmal cough Parents report periods of apnea Copious thick secretions Intercostal & Suprasternal Retractions Rhinitis Afebrile Normal WBC Crackles Wheezes Pulmonary Disorders in ChildrenCase #13 month old infant presents to pediatrics with:

  7. Pulmonary Disorders in Children • CXR: Air trapping, atelectasis and infiltrates.

  8. Pulmonary Disorders in ChildrenBronchiolitis • Most common cause of wintertime pediatric hospitalizations • Leading cause of respiratory failure among infants in the US • Primarily affects infants < 2 years of age • Infants < 6 wks of age, with prematurity, congenital heart disease, chronic lung disease, and immunodeficiency are at increased risk

  9. Pulmonary Disorders in ChildrenBronchiolitis • Management • Oxygen • Suction • IV hydration • Racemic Epinephrine Nebs • Bronchodilators • Antibiotics • Monitoring • Bronchiolitis Protocol (if ordered)

  10. Pulmonary Disorders in ChildrenCase #2 • 10 month old presents to the ED. Mom states when she picked her son up from the daycare after work he was breathing harder and had trouble drinking his bottle. MD office sent her home with rx. For MDI and oral steroid. Mom states she is very worried; feels something is very wrong. • HR 180 • RR 80 • SpO2 90% on 5 lpm HFHH • Grunting • Nasal Flaring • Suprasternal retractions • Frequent Coughing • Tight exp. wheezing despite 1 hour continuous neb. • RUL atelectasis • Febrile • WBC increased

  11. Case #2Foreign Body Aspiration • Bronchoscopy revealed a small acorn in the Rt. Mainstem Bronchus. • Foreign Body removed; infant WOB improved dramatically. • Was sent home on antibiotics.

  12. Pulmonary Disorders in ChildrenCase #3 • 10 year old presents to the ER with the following symptoms after returning from camping: • Coughing (night), Sneezing • Fatigue (poor sleep, unable to perform usual activities) • Increased WOB (tachypnea, retractions, nasal flaring, tripod position) • Wheezing • CXR with hyper inflated lungs and flattened diaphragms

  13. Pulmonary Disorders in ChildrenAsthma Treatment • Oxygen • Nebs: Intermittent/Continuous (Mask vs. Blow-by) • Consider Peak Flows before and after tx. • Steroid Administration • IV Hydration • Frequent reassessment by RN/RT • Volume expansion • Walk, blow bubbles, sing songs • Rest • Allow child to assume position of comfort

  14. Pulmonary Disorders in ChildrenCase #4 • Tripoding • Grunting • Substernal Retractions • Nasal Flaring • Hypoxemia (no reserve) • Bradycardia • Paroxysmal cough (can be life threatening) • RR 60 decreases to 24 • Paradoxical/Seesaw breathing pattern • Decreased LOC

  15. Pulmonary Disorders in ChildrenCase #4 • Impending Respiratory Failure • Immediate emergency action must be taken • Peds Rapid Response Team • Call 1-1110 • Transfer to PICU

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