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Page 1Pediatric Respiratory Assessment Obtain · Medical history · General Assessment o Determine current emotional state o How are they presenting themselves? · Respiratory Assessment o Inspection 1. Respiratory rate and pattern Normal Respiratory Rates in Children
2. Signs of WOB · Percussion and Palpation of the Chest · Palpation o Procedure o Place hands lightly on the patient’s chest with fingertips and palms in contact with the chest. o Have the patient take a slow, deep breaths if possible o Used to determine § Asymmetrical chest movement § Tactile fremitus § Tenderness and pain · Percussion o Diagnostic percussion o Procedure o Placing one or more fingers of one hand between the ribs of the child and then tapping the tips of those fingers with a finger from the other hand o The sound make is assessed with each area of one lung as compared to the other. o Useful in determining the presence of § Atelectasis § Consolidation § Air trapping § Pneumothorax · Auscultation of the Chest o The primary tool of assessment o Stethoscope § Adult size § Pediatric size o Upper airway congestion § Don’t confuse upper airway congestion for bronchial constriction o Little or no sound heard § A grave sign § A upper or lower airway obstruction
Cardiac Assessment · Normal heart rate will decrease with age Normal Heart Rate in Children
· Blood Pressure o Systolic formula 70 +(2 x age in years) o Pulse pressure § The difference between systolic and diastolic pressures § Pulses paradoxus o Capillary refill § If >3 seconds
Normal Blood Pressure in Children
Respiratory Modalities Oxygen Therapy
Respiratory Modalities · CPT · A techniques designed to aid in o The mobilization of bronchial secretions o The prevention of secretion accumulation o Improvement of gas exchange in the treatment of acute and chronic lung disease · Techniques o Positioning o Percussion o Vibration o Cough
Mechanical Ventilation · Overview o Pediatric patient’s are too often treated as small adults or large neonate’s · Indications o Same as any age group § Acute respiratory acidosis § Impending respiratory failure § Apnea § Neuromuscular § Pulmonary § Increased ICP § Resuscitation § Drug overdoses · Methods of Ventilation o Selected according to the patient’s size and weight o Special needs for patients o Volume vs. Pressure ventilator · Volume o Consistent Vt - increase risk of barotrauma o Vt · Pressure o Barotrauma is reduced - volumes vary as the lung compliance changes o Patient’s < 10 kg o PIP o Respiratory rate o Ti o Peep o Flow o Fi02 · Parameters o Ventilator rate § Used in combination with Vt for adequate alveolar ventilation o Fi02 § To maintain a saturation of 92% - 95% § Use an analyzer with limits § Effects should be to wean the FiO2 below 60% to prevent oxygen toxicity o PEEP § Titration study § The PEEP is increased in small amounts every 10 – 15 minutes o Inspiratory Time o Considerations § Patient’s age § Breathing pattern § Time constant o I:E ratio
o Peak Flow § Titrated to the spontaneous demands of patient § Maintain a selected set inspiratory pressure
Approximate sizes for ETT and suction
Ethics
· The study of rational processes for determining the most morally desirable courses of action with conflicting moral choices · Fundamental Ethical Principles o Autonomy § The patient has the right to make decisions regarding their medical care § Two basic requirements · The right to decide · Act without coercion § Paternalism o Beneficence § All medical decisions must be made so as to do good for the patient. § Challenges · When the patient, the family, and care givers cannot agree on a course of action. § Medical treatment is not mandated if · It is not medically indicated · Merely prolongs the process of dying · It’s futile and inhuman ·& |