Apnea of Infants, Apparent Life-Threatening Event, Respiratory Failure

7/29/2019 Apnea of Infants, Apparent Life-Threatening Event, Respiratory Failure

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APNEA OF INFANCY

Reported by:

Agripo, Kenje Kate T.


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> Generally refers to pathologic apnea in

infants of more than 37 weeks of gestation.

> Temporary absence or cessation of breathing

for 20 sec. or more

APNEA OF INFANCY


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Causes:

Direct depression of the central nervous system'scontrol of respiration

- hypoglycemia, meningitis, drugs, hemorrhage, seizures

Disturbances in oxygen delivery

- shock, sepsis, anemia

Ventilation defects-pneumonia, RDS , PPHN, muscle weakness

APNEA OF INFANCY


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Diagnostic test:1) Cardiopneumogram

- continuous recording of cardiorespiratory patterns

2) Four-channel pneumocardiograms- monitor heart rate, respirations, nasal airflow & oxygensaturation

3) Polysomnography

- sleep study,records brain waves, eye & body movements,

esophageal manometry

APNEA OF INFANCY


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Diagnostic test:1) Cardiopneumogram

- continuous recording of cardiorespiratory patterns

2) Four-channel pneumocardiograms- monitor heart rate, respirations, nasal airflow & oxygensaturation

3) Polysomnography

- sleep study,records brain waves, eye & body movements,

esophageal manometry

APNEA OF INFANCY


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Types of Apnea:1) Obstructive Apnea

- is charac. by absent airflow but persistent chest wall motion

- is caused by an obstruction of the airway (such as enlarged

tonsils and adenoids).

- The respiratory efforts are absent

TREATMENT:

-Keep the throat open to aid air flow such as withadenotonsillectomy

-continuous positive airway pressure (CPAP), which isdelivered by having the child wear a nose mask while sleeping.

APNEA OF INFANCY


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Therapeutic Management:

Continuous home monitoring of cardiorespiratory

rhythms

Use of Methylxantines

Infant is apneic, stimulate the trunk by patting or

rubbing it. Infant is prone position, turn to the back and flick the

feet

APNEA OF INFANCY


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ADPIE


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ASSESSMENT-Cessation respirations longer than 20 secs.

-Cyanosis

-Nasal Flaring

-Pallor

-Fatigue

-Bradycardia-Hypoxia

-Low Oxygen level detected

-Low Respiratory movement

DIAGNOSISo Ineffective breathing pattern; Cyanosis related

to immaturity mechanisms secondary to apnea


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PLANNING

o After 4 hours of nursing intervention the patient will be able to:

Attain normal respiration as evidenced by absence of cyanosis

INTERVENTIONS

Gently flick the sole of the foot

Maintain a neutral thermal environment

Do suctioning and always suction gently Prepare rescusitive equipment

Administer indwelling nasogastric tubes as ordered

Administration of Methylxantines as prescribed by the

doctor

EVALUATION

o After 4 hours of nursing intervention the patient was able to:

Attain normal respiration as evidenced by absence of cyanosis


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Reported by:


Apparent Life-Threatening

Events

(ALTEs)


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Apparent Life-Threatening Events

- The clinical presentation with a combination of

apnea and change in color, change in muscle

tone, choking, or gagging.

- Cardiomyopathy incidence but child looks

normal


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Apparent Life-Threatening Events

Factors:Seizures

Sepsis

High-risk infants

Respiratory tract infection

Causes:Viral infection

Airway blockage

Diagnostic Test: Physical Examination


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ADPIE


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ASSESSMENT-Apnea

-Nasal Flaring

-Cyanosis

-Pallor

-Poor muscle tone

DIAGNOSISoAltered breathing pattern; Apnea related to

respiratory muscle fatigue

PLANNINGAfter 4 hours of nursing intervention the patient will be

able to:

Maintain normal breathing pattern as evidenced

by no use accessory muscles in breathing.


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INTERVENTIONS

Maintain a neutral thermal environment

Position patient with proper alignment

Do suctioning and always suction gently

Elevate the head of bed

Perform CPR in emergency casesMonitor pulse oximetry

EVALUATION

o After 4 hours of nursing intervention the patientwas able to:

Maintain normal breathing pattern as evidenced

by no use accessory muscles in breathing.


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Reported by:


RESPIRATORY FAILURE


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Respiratory Failure

- The inability of the respiratory apparatus tomaintain adequate oxygenation of the blood, withor without carbon dioxide retention

- This process involves pulmonary dysfunction thatgenerally results in impaired alveolar gas exchange,which can lead to hypoxemia or hypercapnia

- Clinical manifestations are nonspecific and areaffected by variations among individual patientsand differences in the severity.


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Respiratory Failure

Clinical Manifestations of Respiratory Failure:Cardinal Signs:

-Restlessness -Tachypnea

-Tachycardia -Diaphoresis

Early but less obvious signs:

- Headache -Wheezing

- Hypertension - Exertional dyspnea

- Anorexia - Increase cardiac output

- Nasal flaring - Chest wall retractions

- Expiratory grunting


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Respiratory FailureClinical Manifestations of Respiratory Failure:

Signs of more severe hypoxia

-Hypotension or hypertension - Bradycardia

-Depressed respirations - Coma

-Dimness of vision -Dyspnea

Types:

1) Type I (Hypoxemic Respiratory Failure)-Decrease oxygen

2) Type II (Hypercornic Respiratory Failure)

-Decrease carbon dioxide


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Respiratory Failure Treatment:

Specific Therapy

- Directed toward reversal of the causative factors

Non-Specific Therapy

- Non-specific measure needed to maintain oxygenation and

enhance carbon dioxide removal until specific methods take

effect

- Major reasons for implementing Non- Specific Treatment:

1)Unknown etiology

2) Lack of specific treatment for a known cause

3) Lack of time for specific methods to take effect

4) . Need for specialized personnel or equipment for

specific treatment


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ADPIE


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ASSESSMENT- Nasal Flaring - Restlessness

- Cyanosis - Tachypnea

- Dyspnea - Tachycardia

- Diaphoresis - Wheezing

DIAGNOSIS

o Impaired gas exchange; Dyspnea related topulmonary dysfunction secondary to distress

PLANNING

After 4 hours of nursing intervention the patient will

be able to:

Maintain Normal breathing pattern as evidenced

by normal skin color and absence of cyanosis.


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INTERVENTIONS

Provide a neutral environment

Administer Oxygen Therapy as ordered

Proper positioning of the patient

Do suctioning and always suction gently

Monitor arterial blood gas appropriately

EVALUATION

o After 4 hours of nursing intervention the patient wasable to:

Maintain Normal breathing pattern as evidenced

by normal skin color and absence of cyanosis.

Apnea of Infants, Apparent Life-Threatening Event, Respiratory Failure

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