NURS 225 Lecture Notes - Lecture 3: Respiratory Acidosis, Salbutamol, Electronvolt
University of Pennsylvania School of Nursing
N 225 Pediatric Nursing
Helene Fuld Pavilion for Innovative Learning and Simulation
MODULE: Nursing care of the pediatric patient with alterations in respiratory function
As with any activity you must consult the policy and procedure manual of the healthcare
facility you are working at before commencing patient care to determine the specific
requirements of that setting.
Point values for each response to the objectives are in parenthesis
Total number of points: 100
LEARNING OBJECTIVES AND CRITICAL THINKING QUESTIONS
1. List the airway differences that put the child at risk for upper airway obstruction
for the following clinical presentations (Chapter 20)?
(4 points)
A child shows increased work of
breathing and the breathing is noisy.
The child’s head is leaned forward and
to one side.
(refer to question # 1 to answer this)
The trachea is shorter and the angle of the
right bronchus at bifurcation is more acute
than in the adult.
A 15 day old newborn presents with an
upper respiratory infection. The O2
saturation is low, 90%, on arrival to the
ED. The patient has copious amounts of
cloudy secretions from the nose.
(refer to question # 1 to answer this)
Newborns are obligatory nose breathers,
breathing only through the mouth while
crying. The newborn is unable to
adequately oxygenate his tissues because
he cannot inhale enough oxygen due to his
copious nasal secretions.
2. Why do children under 6 years of age exhibit retractions with respiratory distress
and partial airway obstruction? (Chapter 20) (2 points).
Children under 6 use the diaphragm to breathe because the intercostal muscles are immature. The
ribs and primary cartilage are also very flexible. During respiratory distress, the negative
pressure caused by the diaphragm movement causes retractions.
3. Explain the physiology of retractions in children < 6 years old (Chapter 20) (4
points).
Children under 6 use their diaphragm to breathe because the intercostal muscles are still
too immature. The ribs are also extremely flexible because they are made of mainly
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cartilage. The negative pressure created by the downward motion of the diaphragm
during respiratory distress pulls the chest wall inward, causing retractions.
4. What is stridor? (Chapter 20) (2 point)
An audible crow-like inspiratory and expiratory breath sound
5. List 1 condition of the respiratory system that will present with stridor in the
pediatric population (Chapter 20). 2 points
Laryngotracheobronchitis
6. Define respiratory failure (2 point)
Define respiratory
failure
Define
Occurs when the body can no longer maintain effective gas
exchange.
Begins with poor ventilation of the alveoli and then
hypoventilation occurs when the airway is partially occluded or
when the transfer of oxygen and carbon dioxide in the alveoli is
disrupted. Hypoxemia and hypercapnia occur, which leads to
hypoxia and then to the beginning of respiratory failure.
7. Describe epiglottitis. What are 2 causative organisms? (Chapter 20)? (3 points)
Epiglottitis is an inflammation of the epiglottis, the long narrow
structure that closes off the glottis during swallowing. Swelling in
this area can rapidly obstruct the airway by occluding the trachea.
This can be caused by bacterial invasion of the soft tissue of the
larynx by streptococcus or by Haemophilus influenza type B (Hib)
in unimmunized children.
8. What is the vaccination that has significantly decreased the incidence of epiglottis
(Chapter 20)? 2 points
Hib vaccination
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9. Your patient was diagnosed with Epiglottis. What are 3 “classic” signs/symptoms of
supraglottic obstruction- epiglottis (Chapter 20)?
(3 points)
Dyspohnia (muffled, hoarse voice and pain with talking)
Dysphagia (difficulty in swallowing)
Drooling
10. The nurse observes an 18-month-old who has been admitted with a respiratory tract
infection who is drooling (see figure). The nurse should FIRST (list 2 priority
nursing interventions). 4 points
Until the child is intubated, the nurse should not leave the patient’s side.
1. Observe the child’s respiratory and airway status continuously
2. Note any change in the child’s LOC-if LOC is decreasing, then the child requires
medical attention
________________________________________
11. What is the hallmark symptom of Laryngotracheobronchitis (aka Croup) (Chapter
20)? (2 points)
Symmetric subglottic narrowing called a “steeple sign”
12. Why would a patient with Croup receive PO Dexamethasone? What is the oral
dosage for a 2-year-old child, that weighs 26 lbs. Please note: this is not a single
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Document Summary
Helene fuld pavilion for innovative learning and simulation. Module: nursing care of the pediatric patient with alterations in respiratory function. As with any activity you must consult the policy and procedure manual of the healthcare facility you are working at before commencing patient care to determine the specific requirements of that setting. Point values for each response to the objectives are in parenthesis. Learning objectives and critical thinking questions: list the airway differences that put the child at risk for upper airway obstruction for the following clinical presentations (chapter 20)? (4 points) A child shows increased work of breathing and the breathing is noisy. The child"s head is leaned forward and to one side. (refer to question # 1 to answer this) A 15 day old newborn presents with an upper respiratory infection. The o2 saturation is low, 90%, on arrival to the.
