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Respiratory Assessment - Coggle Diagram
Respiratory Assessment
Airway - The physiological differences in the respiratory system in childhood
Birth/infancy - Larynx high in the neck with cricoid roughly at the level of C3/C4, epiglottis long, rests against soft palate prone to collapse because of this less head tilt to open the airway as all we need to do is make the airway straight.
Large tongue concerning jaw size which is likely to cause obstruction when a child is unconscious.
Funnel-shaped airway- narrowest at carotid cartilage for young children and narrowest at vocal cords for older children/adults.
The small diameter of the airway can be easily blocked by secretions or blood. This is especially heightened for toddlers as they are more prone to choking.
Breathing - Physiological differences in the respiratory system in childhood
Children when developing the alveoli tend to have 20 million at term then 300 - 400 million at 18/12.
Small children are dependent on the contraction of the diaphragm to breathe. Being easily fatigued means fewer twitch fibres. The ribs are more horizontally inserted and contribute less to chest expansion.
The ribcage and sternum are cartilaginous and compliant (elastic) therefore are prone to recession.
A child's primary response to respiratory distress is to increase the rate and effort of breathing. This leads to hypoxia which equals tachypnoea.
Babies only breathe through their noses. That's why the common cold is serious.
Implication of physiological differences
Smaller upper and lower airways
Compliant chest wall
Relatively inefficient respiratory muscles
Susceptibility to infection
Requires significant energy to function effectively
Position of other organs - heart, stomach and liver
What to look for if a child has physiological differences in a health care setting
A consideration of the upper thoracic differences - nose to trachea.
Intrathoracic consideration - trachea to lungs and carina to alveoli.
What does respirtory compise look like - this happens when you exert too much enegry and all exert is drained.
Tachypnoea and tachycardia
Colour
Nasal flaring, tracheal tug, grunting, head bobbing, recession (0-6yrs), accessory muscle use, position, facial expression, behaviour
Audible noises - wheezing or stridor or no noise.
The efficiency of breathing - chest expansion and air entry bilaterally. Look for the 3 E’s - Effort, efficacy and effect of breathing.
Structure of the respiratory system - part of the ABCDE
Consider all elements of the respiratory system - Nose to the diaphragm and consider links to other systems
Documentation - Trends allow for detection
How do we assess: Observe, Hear, Feel, Count
Consider - Inspection, Palpation, Percussion, Auscultation.
Exploring the structured assessment
Observe - Colour, position, behaviour, work of breathing.
Hear - Airway and breathing sounds, Frequency, pitch, sound
Feel - Chest, Skin temperature, hydration, Lumps, altered shape, pain/tenderness
Count - Respiratory Rate - Age appropriate ranges - Normal for child
Respiratory Rate - Observe the chest and count for 1 full minute. Babies have periodic breathing. Try and count respirations before you touch the child
Breathing Effort (WOB) - Normally breathing is a relaxed, regular subconscious activity.
Head injuries, pain, metabolic disorders, Diabetic ketoacidosis (DKA)
Breathing Efficacy
Air Entry - Auscultation will indicate the amount of air entry and exit. Locate areas of reduced entry or exit. Additional sounds such as crackles
Pulse oximetry - Measures saturation of haemoglobin with oxygen
Breathing Effects - Colour, rate, pattern
Breathlessness - Talking, feeding, sleeping
Hypoxia - tachycardia initially – bradycardia - pre-terminal. Reduce the level of consciousness.
Progression of respiratory comprmise
Children in distress will exert greater effort to breath
Tachypnoea and tachycardia
Increased work on breathing
Use of accessory muscles
Alter position
Coughing
Outcome if not recognised or managed
Reduced respiratory effort
Hypoxia
Apnoea and bradycardia
Auscultations
Normal Breath Sounds:
Vesicular, Soft, quiet, low pitched: ‘wind in the trees’
Abnormal Breath Sounds:
Increased Sounds - Bronchial (Harsh sounds) where you expect vesicular sounds
Diminished Sounds - Less audible breath sounds or absent (due to impaired sound transmission)
Comman respiratory conditions
Upper Airway
Croup (laryngotracheobronchitis)
Epiglottitis
Foreign Body Inhalation/obstruction
Indicators: Stridor
Lower Airway
Bronchiolitis - viral infection
Asthma
Pneumonia
Indicators: Wheeze
Oxygen delivery
All patient who requires supplemental oxygen receive therapy that is appropriate to their clinical condition
It should be monitored closely and make sure to check the fit of the mask and what their saturations are throughout.
Make sure they are kept within the target saturation range.
In emergency prescriptions of oxygen are not required.
Planning Care
A plan of care must consider the physiological status and age of the child
Instigate interventions as required
Priorities of Care - Immediate needs, Intermediate needs and in some cases long term needs
Include the parents/carers as partners in the process where appropriate
Any case study with respiratory the 3 E’S should be metioned