Ncm109 Respiratory Rate

Newborn 35 (30-80)
HIB Vaccine (Haemophilus Influenzae type B) 1 30 (20-40)
- Part of the 5-in-1 or the Pentavalent Vaccine 5-8 20 (15-25)
DPT – Diphtheria, Tetanus, and Pertussis Vaccine 10 19 (15-25)
Adult (16-20)
A. Upper Respiratory System
- Nose - Paranasal Assessment
- Pharynx - Sinuses  Interview (onset, depth, duration)
- Larynx - Epiglottis  Physical examination
B. Lower Respiratory System  Lab testing
- Bronchi
- Bronchioles Physical Assessment
- Alveoli 1. Cough – initiated by simulation of the nerve of
RT mucosa by the presence of dust, chemicals,
Inspiration – delivers, warms, moistens the air to mucus, or inflammation.
the alveoli Function: to clear excess mucus or foreign
respiratory system transports oxygen across bodies
alveolar membrane to RBC Harmful: coughing no mucus or debris; if it
becomes exhausting.
Allows carbon dioxide to diffuse from RBC back
 Paroxysmal coughing – continues cough;
to alveoli.
series of expiratory cough after a deep
Expiration – carbon dioxide discharged outside
inspiration.
2. Rate and Depth of Respirations
RESPIRATORY TRACT IN CHILDREN
 Increase RR (tachypnea) – the 1st
1. The ethmoidal and maxillary sinuses are present
indicator of airway obstruction in child or
at birth.
infant
 Both are lined with cells that makes
 Depth – reveals anoxia (absence of
mucus to keep the nose from drying out.
oxygen in cells)
2. The frontal sinuses and sphenoidal sinuses do
3. Retractions – inspire forcefully = inflate lungs
not develop until 6-8 years old.
 Frontal sinuses traps bacteria
 Sphenoidal sinuses filters and cleans air Decreases or inflates intrapleural space
breathed
 Decreased respiratory mucus =
Non-rigid parts of chest draws inward
respiratory infection
Sites of Retraction:
3. Right bronchus is shorter, wider, vertical than
 Suprasternal
the left bronchus
 Supraclavicular
 Inhaled foreign bodies are dislodged at
 Subcoastal
right bronchus
 Substernal
4. Infant’s chest is not fully developed. They are
 Intercoastal
using abdominal muscles to assist inhalation.
4. Restlessness – decreased oxygen (hypoxia)
 Thoracic breathing: 2-3 years old
5. Cyanosis – blue tinge of skin
 Completes at 7 years old
 Normal SPO2 = 95% - 100%
 They use their accessory muscles that
6. Clubbing of fingers
causes weakness.
7. Adventitious Sounds
5. Walls of the airway have less cartilage.
 Ronchi – “snoring sound” (nose,
 There is an increase chances of collapse
pharynx)
after respiration.

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  Wheezing – “whistle sound” (lower
trachea, bronchioles)
 Rales – “crackling sound” (alveoli filled Causes:
with water) - Infectious droplet
 Stridor – “high pitch sound” - Haemophilus Influenza Type B

Most Common: Streptococcus Pneumoniae

LAB TEST
1. Sputum Test – TB Prevention: HIB Vaccine
 Gene expert
2. ABG – analysis of the amount of oxygen & Signs & Symptoms:
carbon dioxide in the blood - Abnormal position –TRIPOD
3. Pulse oximetry – oxygen saturation  Mouth – open
 Non invasive  Tongue – protrude
4. Nasopharyngeal culture – nose, throat - Dysphagia
- Drooling of saliva
DIAGNOSTIC TEST - Increased temperature = fever
1. Chest X-ray – areas of infiltration - Rapid onset
 Difficult to obtain in infants (they can’t - Nasal flaring
hold their breath) - Chest retractions
2. Pulmonary Function Test – elasticity & flow - Stridor
resistance, inertia - Enlarged epiglottis (X-Ray)

THERAPEUTIC TECHNIQUES Nursing Intervention:

1. Expectorants – guaifenesin 1. Never insert anything in patient’s mouth to
2. Liquefying agents – saline nose drops, nasal assess (tongue depressor or throat culture),
spray because it will completely block the airway
 Contains salt (PNSS) and create spasm.
3. Vaporizers – it is warm to help open the 2. Assess for O2 status (respiratory rate and
airways breath sound)
4. O2 administration 3. Color of the skin
5. Nebulizers 4. Increase HR
6. MOI (Metered Dose Inhaler) 5. Keep the child in calm environment
6. Intubation set
*Bacterial – green Collaborative:
* Viral – white 1. NPO
* Allergy – Makati, white 2. Medications (Antibiotics and Corticosteroids)

EPIGLOTTITS LARYNGEOTRACHEOBRONCHITIS
- Inflammation of the epiglottis - Also known as Croup
Epiglottis – hinge pinge of cartilage found at the - Inflammation of larynx, trachea, and major
back of the tongue bronchi
- Often worse at night time
Found: inside thyroid cartilage - 6 mos. – 3 yo
Fx: Cause: Viral Infection – Parainfluenza Virus
- closes the entry way to trachea during
swallowing Most Common: H. Influenzae
- helps in preventing aspiration Vaccine: HIB Vaccine
If informed:
- leads to airway issues (blocking) Signs & Symptoms:
- difficulty of swallowing and talking - Cold
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- “barking cough” ASPIRATION
- Anxiety, agitated - Inhalation of a foreign object into the airway
- Hoarse voice - Occurs most frequently in infants and toddlers
- Fever (mild) Assessment:
- Labored breathing - After aspirating a small foreign body, the child
generally coughs violently and may become
Management:
dyspneic.
- Suob (facilitates breathing properly)
- If the article is not expelled, hemoptysis, fever,
- Go to the hospital
purulent sputum, and leukocytosis will generally
- Corticosteroids (reduce inflammation;
result as infection develops.
bronchodilator)
- Localized wheezing may occur
- IVF (well-hydrated)
Management:
- Sub diaphragmatic abdominal maneuver (may
ASSESSMENT CROUP EPIGLOTTITIS
cause a child to vomit as well as expel an
Causative Usually viral Usually pneumococci
aspirated object.)
organism or streptococci
- Back blows and chest thrusts to relieve complete
foreign body airway obstruction in an infant.
Usual age of 6 mo – 3 3 – 6 years
child years
Seasonal Late fall and None BRONCHIOLITIS
occurrence winter - inflammation of the fine bronchioles and small
Onset pattern Preceded by Preceded by upper bronchi.
upper respiratory infection; - the most common lower respiratory illness in
respiratory suddenly very ill children younger than 2 years, peaking in
infection; incidence at 6 months of age.
cough - occurs most often in the winter and spring.
becomes
worse at Age Group: 2 years and below
night Cause: adenovirus, parainfluenza virus, and RSV
Presence of Low grade Elevated to about
fever 103° F Vaccine: RSV and Flu vaccine
Appearance Retractions Drooling; very ill-
S/Sx:
and stridor; appearing; neck
prolonged hyperextended to - low grade fever
inspiratory breathe. (do not - paroxysmal, dry cough
phase of attempt to view large - barely audible breath sounds, rales, expiratory
respirations; epiglottitis, or wheezing
not very ill- immediate airway - nasal flaring
appearing obstruction can - intercostal and subcostal retractions on
occur. inspiration
Cough Sharp, Muffled cough - increased respiratory rate
barking
Radiographic Lateral neck Lateral neck Management:
findings radiographic radiograph showing - If symptoms are severe, children need
showing enlarged epiglottis humidified oxygen to counteract hypoxemia and
subglottal adequate hydration to keep respiratory
narrowing
membranes moist
Possible Asphyxia Asphyxia because of
- Nebulized bronchodilators, epinephrine, and
complications because of supraglottic
anti-inflammatory medications such as nebulized
subglottic obstruction
budesonide (a glucocorticoid steroid) may be
obstruction
used

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- All infants with bronchiolitis need to be carefully PNEUMONIA
observed because if RSV is the cause, apnea may - infection and inflammation of alveoli
occur. - It is the most common pulmonary cause of death in
- In some infants, extracorporeal membrane infants younger than 48 hours of age.
oxygenation (the same as that used for heart - It occurs most often in late winter and early spring.
surgery) is necessary to maintain adequate Age group: All age group
oxygenation.
- Intravenous fluids may be given for the first 1 or Types:
2 days of illness to eliminate the need for oral 1. Hospital acquired (pneumococcal or
feeding. streptococcal pneumonia)
2. Community acquired (chlamydia, viral
ASTHMA pneumonias)
- a chronic lung disease that affects the airway of
the body mainly the major bronchi at the Cause: Pneumococcal or H. Influenzae
bronchioles.
- the most common chronic illness in children Prevention: ORS (Oral Rehydration Solution)

Age group: 1-5 years’ old Vaccine: PCV (Pneumococcal Conjugate Vaccine)

Cause: Hypersensitivity type 1 immune response S/Sx:

- Productive, harsh cough
Causative Agent:
- Fatigue
1. Extrinsic Agent - caused by dusts, smoke, mold
- Shallow respirations
and even chemicals and pet dander
- Elevated fever
2. Intrinsic Agent - there is an underlying respiratory
- Decreased breath sounds, rales
infection, emotional stress or fatigue
- Nasal flaring

S/Sx
Management:
- Wheezing upon expiration or exhalation - Administer antibiotics such as ampicillin, 3rd gen
- paroxysmal cough with thick mucus production cephalosporin
- Shortness of breath or; - Provide rest to prevent exhaustion
- Difficulty of breathing - antipyretic such as acetaminophen to reduce
- Tightness of Chest fever
- Humidified oxygen may be necessary to alleviate
Management: labored breathing and prevent hypoxemia
- Check for oxygen status or O2 sat - Assess oxygen saturation levels frequently
- Listen and assess lungs
- Assess for respiratory distress CYSTIC FIBROSIS
- Position the patient in an upright or sitting position - a genetic condition that affects a protein in the
(high-fowler's position) body.
- Administer medications prescribed by the Physician - Inherited disorder
(Albuterol, Salbutamol or Corticosteroid) - Basta
- Health teach the patient about non-
pharmacological treatment such as avoiding
allergens and exercising
- Heath teach about the proper way of using MDI or
Metered Dose Inhaler

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