~RESPIRATORY SYSTEM~

PRODUCED BY: •Walaa qadora•Haneen shaqora•Nabawiya el daour

•Jafraa nasser•Manar aoda•Azesa awad•Heba awad•Nada saleh

IN THE NAME OF ALLA

Today our group will talk about care of respiratory system in children.

:firstly I will produce a short introduction about anatomy of respiratory system in childAnd the differences between the child respiratory system and adult respiratory system

What are the differences

between adult respiratory system

and children respiratory system

?

The diameter of an infant’s airway is approximately 4 mm, in contrast to an adult’s airway diameter of 20 mm. An inflammatory process in the airway causes swelling that narrows the airway, and airway resistance increases.

Note that :

swelling of 1 mm reduces the infant’s airway diameter to 2 mm, but the adult’s airway diameter is only narrowed to 18 mm. Air must move more quickly in the infant’s narrowed airway to get the same amount of air to the lungs. The friction of the quickly moving air against the side of the airway increases airway resistance. The infant must use more effort to breathe and breathe faster to get

"Respiratory infections are the first leading cause of infant mortality in palestine; Conditions in the prenatal period form major cause of deaths among children under five years Based on Ministry of Health data for 2011, the leading cause of infant mortality in the West Bank was respiratory tract infections with 39.7%: 42.0% for male children and 37.0% for female. This was followed by infant mortality caused by premature and low birth weight with 16.2%: 17.0% for male children and 15.2% for female children.

Incidence:

PEDIATRIC RESPIRATORY

ASSESSMENT

Nose: Key Points

• Exam nose & mouth after ears • Observe shape & structural deviations• Nares: (check patency, mucous membranes,

discharge, turbinates, bleeding)• Septum: (check for deviation)• Infants are obligate nose breathers• Nasal flaring is associated with respiratory

distress

Nose and Throat

Sinusitis:

• Fever• Purulent rhinorrhea• Facial Pain – cheeks, forehead• Breath odor• Chronic cough – could be day and night

Mouth & Pharynx: Key Points

• Lips: color, symmetry, moisture, swelling, sores, fissures

• Buccal mucosa, gingivae, tongue & palate for moisture, color, intactness, bleeding, lesions.

• Tongue & frenulum - movement, size & texture

• Teeth - caries, malocclusion and loose teeth.• Uvula: symmetrical movement or bifid uvula • Voice quality, Speech• Breath - halitosis

Neck: Key Points

• √ position, lymph nodes, masses, fistulas, clefts• Suppleness & Range of Motion (ROM)• Check clavicle in newborn• Head control in infant• Trachea & thyroid in midline• Carotid arteries (bruits)• Torticollis• Webbing• Meningeal irritation

Chest Assessment

• All 4 quadrants• Front and back• Take the time to listen• Be sure about “lungs CTAB” (clear to auscultation bilaterally)

Auscultation-All 4 quadrants-Front and back

-Take the time to listen-Be sure about “lungs CTAB”

( clear to auscultation bilaterally)

Lungs & Respiratory: Key Points• Quality of Respirations: – Symmetry, Expansion, Effort, Dyspnea

• S & S Respiratory Distress:– Color: cyanosis, pallor, circumoral cyanosis, mottling– Tachypnea– Retractions

• Nasal flaring• Grunting (expiratory)• Stridor - inspiratory: croup• Adventitious sounds:

• Crackles / Rales• Rhonchi - course breath sounds• Wheeze – inspiratory vs. expiratory

Lungs & Respiratory: Key Points

• Clubbing• Snoring (expiratory): upper airway obstruction,

allergy, • Fremitus: – Increased in pneumonia, atelectasis, mass– Decreased in asthma, pneumothorax or FB

• Dullness to percussion: fluid or mass

Work of Breathing

*Increased or Decreased Respirations*Stridor*Wheezing

Chest Assessment

• Auscultation • Wheezing• Retractions

– Subcostal– Intercostal– Sub-sternal– Supra-clavicular– Red Flags: – grunting – nasal flaring

stridor

All that Wheezes isn’t always Asthma

Think:*Infection

*Foreign body aspiration*Anaphylaxis

• Insect bites/stings, medications, food allergies

And all Asthma doesn’t always Wheeze!

•Cough•Fatigue•Reduced exercise tolerance

Coughs

• Allergies• Asthma • Infections – pneumonia, bronchitis, bronchiolitis • Sinusitis – Post-nasal drip • GERD • Cigarette smoking • Exposure to secondhand smoke, • Other pollutants

Cough - Characteristics

• Dry, non-productive• Mucousy – productive• Croupy • Acute – less than 2-3 weeks• Chronic – more than 2-3 weeks• Associating Symptoms

• if severe, acute, unremitting – needs immediate attention - very rare

• Non-cardiac – most common– Musculoskeletal: costochondritis– Pulmonary– Gastrointestinal e.g. GERD– Psychogenic– Often no significant physical findings

• Must rule out Cardiac origin – refer to PCP or pedicardiologist

Chest Pain

How to control your child asthma

When you have asthma?

House dust mites• Washing the bed pillow ,sheet And cover every weak.• Use special allergy mattress and Bed cover• if possible , get rid of carpets, extra Pillow, and upholstered furniture.• Limit stuffed animals in children Room .• Dust and vacuum often.• Use dehumidifier in damp area.

Animal and molds

• Don’t have furry pets in your home

• Repair leaks and clean with fungi-Side or bleach and water when visible• Use dehumidifier in damp area

Outdoor triggertree , pollens, grass , air pollution , smoke , car

exhaust

• Keep your door and window shut• Avoid outdoor activity during high pollens • Shower and shampoo after being Out side

Strong smells

• Stay out side the house or apartment when these chemical and spray being used.

smoker

• Smoker in families with asthma

Should quite.• Should never smoke indoor.

Infection

• Get your flu shot every year• Sea your provider for proper treatment• Ask your provider for asthma medecin prior to

flu season to prevent asthma attackIf your child have the virus every year

Common cold and sinusitis

• Don’t ignore a drippy nose• Washed hand frequently• Don’t share toothbrush or toothpaste when

you have cold

Weather change

• Avoid doing much out door when the weather very hot or cold.

Exercise

-If your exercise is one of your trigger,Your provider can give you medicine10 to 15 mint before exercising to prevent asthma attack.-Do warm –up exercise 6 to10 mint prior exercise.-Make a plane to be active and do regular exercise.

Peak flow meter

• A peak flow meter is simple to use for tracking asthma

• Here's what to teach: Stand up or sit up straight. Make sure the indicator is at the bottom of the meter

(zero). Take a deep breath in, filling the lungs completely. Place the mouthpiece in the mouth and blast the air out as • hard and as fast as possible in a single blow. Remove the meter from the mouth and record the number • that appears on the meter. Repeat three times

Interpreting Peak Expiratory Flow Rates

• Green: (80-100% of personal best) signals all clear and asthma is under reasonably good control

• Yellow (50-79% of personal best) signals caution; asthma not well controlled; call dr. if child stays in this zone

• Red (below 50% of personal best) signals a medical alert. Severe airway narrowing is occurring; short acting bronchodilator is indicated

Aerosol therapy

• Aerosol therapy is used for respiratory care in the treatment of some disease such as Asthma and Cystic Fibrosis .

• The purpose of Aerosol therapy is to deliver a fine mist medications into the lungs whether to relieve the spasm or to liquefy bronchial secretions to be removed easily.

Aerosol therapy

• The most common medications prescribed for CF. is Albuterol, a bronchodilator that helps open the airways and relax the airways muscles.

• Necessary equipment includes a compressor , which blows air into a nebulizer or cup changing liquid medicine into a mist

Aerosol therapy

Home Teaching Inhaled Medications

• Teach how to use medication• Correct dosage • Prescribed time• Proper use of inhaler

Device for Inhalation Therapy

• Selective of device include:

1-Nebulizer

2-Metered dose inhaler MDI

3-Dry powder inhaler DPI

Metered-Dose Inhaler with spacer

• A spacer is a chamber that can be attached to a metered-dose inhaler (MDI). The spacer chamber allows the medication to be held in the chamber before it is inhaled so the child can inhale the medicine in one or many breaths, depending on ability.

• A spacer: Helps prevent getting a yeast infection in the mouth

(candidiasis) Increases the amount of medicine delivered directly to

airwaysReduces the amount of medicine swallowed, which

• minimizes side effects.

How to use a Metered _Dose Inhaler with spacer

1. Remove the cap from the inhaler.2. Remove the cap from the spacer.3. Shake the inhaler well for 4 seconds.4. Insert the inhaler into the open end of the

chamber.5. Insure that the inhaler fits properly.6. Stand up and turn your head back slightly.

How to use a Metered _Dose Inhaler with spacer(cot..)

7. Before starting to inhale , breathe out completely away from the spacer.

8. Place the mouthpiece between your teeth and close your lips tightly around the mouthpiece.

9. Press the inhaler once and breathe slowly and deeply.

10. Hold your breath for 10 seconds.

How to use a Metered _Dose Inhaler with spacer(cot..

11. Remove the inhaler and breathe out slowly.12. Repeat the steps from 3 to 10 after 30

seconds, if another dose is required.

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Using nebulizer

• If using a face mask, the mask must fit probably and tightly over the nose and mouth.

• If using a mouthpiece, it must be between the teeth and lips close tightly around it.

• Waving the mouthpiece around the mouth will not get the medicine in to lung .

• Rinse mouth after nebulizing budesonide.• Give infant a drink of water.

continue

• Cup , mouthpiece and mask should be wash daily with mild soup and water.

• Rise in a vinegar and water solution , and dried. Never wash the tube.

• Change filter of the nebulizer as manufacture recommendation

Know your sings and symptom

• Coughing , sneezing ,and itchy throat.• Tight chest and wheeze.• Shortness of breath.• Wake up at night.• Fast heart beat and breathing.• Headache.

Take action

• Work with your provider to make an action plan.

• Learn your child wearing sings .When you feel an attack coming:-• Get away from trigger factor.• Give the child quick – relief medicine.• If he stile have shortness of breath and

wheezing , get emergency help

HOME HEALTH CARE OF CYSTIC FIBROSIS

Cystic Fibrosis Care

• Keep airway clearance• by doing Chest Physiotherapy at least twice a day to

increase sputum expectoration .

• CPT (chest physical therapy) works in combination with postural drainage

• Postural drainage means placing patients in a various positions using gravity to help move mucus upwards toward the large airways.

Postural drainage

chest physical therapy

• then clapping firmly over chest and back on part of the lung segment to shake the mucus loose. Once loosened, the mucus will fall to the large airways, then can be coughed out

Exercise of cystic fibrosis

• Exercise should be encouraged in children and with cystic fibrosis as regular exercise will help clear mucus from the lungs, build up respiratory muscles, and improve ability to breathe.

• Just remember to drink plenty of fluid to prevent dehydration and boost calories to prevent weight loss

Choking and Foreign Body Airway Obstruction(FBAO)

What is Choking?

• Choking is the physiological response to sudden airways obstruction.

Choking……

• A foreign object that is stuck at the back of the throat may block the throat or cause muscular spasm.

• Young children especially are prone to choking. A child may choke on food, or may put Small objects into their mouth and cause a blockage of the airway

Foreign body airway obstruction (FBAO)

• Foreign body airway obstruction (FBAO) causes asphyxia and is a terrifying condition, occurring very acutely, with the patient often unable to explain what is happening to them. If severe, it can result in rapid loss of consciousness and death if first aid is not undertaken quickly and successfully. Immediate recognition and response are of the utmost importance.

Assess severity

*Mild obstruction:

• Children are fully responsive, crying or verbally respond to questions, may have loud cough (and able to take a breath before coughing).[

Sever obstruction :

*Is indicated by:• Person is unable to speak, cry, cough or

breathe.• If the person doesn’t receive assistance, they

will eventually become unconscious.

ManagementFor infant:1-Call for help.2-Approach the infant and grab his jaw.3-Support the infant face down on your forearm and keep his

head lower than the trunk by using your thigh to support your forearm.

For infant(cont…)

4-Deliver 5 back blows between the shoulder blades.(make sure you do not hit him in the head,then deliver 5 slow

and deep chest thrusts.

For infant(cont…)

5-If the infant becom unresponsive ,call for an ambulance.

6-Check his mouth.7- Provide 5 breaths(mouth-to-mouth-and-nose)

For infant(cont…)

8-Deliver 30 chest compressions and 2 mouth-to-mouth-and-nose breath.

(Repeat 3 times)

9-Continue until help arrives.

Management

• For Children:

1-Partial obstruction: Approach the child and encourage him to cough.2-Complete obstruction: -call for help and stay with the child.3-Grab the childs jaw and position him over your bent knee.4-Deliver 5 back blows between the shoulder blades and 5

abdominal thrusts.5-If the child becoms unresponsive,call for an ambulance.

Management(cont..)

6-Chek his mouth.7-provide 5 breaths(mouth-to-mouth)8-Deliver 30 chest compression and 2 mouth-to-

mouth breaths(Repeat 3 times)

9-continue until help arrives

prevention•Children, in particular mobile babies and toddlers

who orally explore their environments, are at risk from FBAO. Carers need to maintain vigilance for objects such as coins, balloons, marbles. Risky foods in childhood tend to be round in shape and include sweets, nuts, grapes and improperly chewed other food

Meconium Aspiration

• Meconium aspiration syndrome (MAS) occurs when a neonate inhales thick, particulate meconium.

• This is usually secondary to fetal hypoxia which causes increased peristalsis, relaxation of anal sphincters and reflex gasping.

Meconium aspiration syndrome (MAS)

• Significant aspiration of thick meconium, however, can induce 4 major pulmonary effects:

1-airway obstruction2- Surfactant dysfunction 3-chemical pneumonitis4-Pulmonary hypertention.

Presentation

• Obvious presence of meconium or dark green staining of the amniotic fluid.

• Green or blue staining of the skin at birth.• Baby appears limp, with a low Apgar score.• Breathing is rapid, laboured, or absent.• Signs of postmaturity (eg peeling skin) are

present.• Fetal monitor may show bradycardia.

*Management

-Suction- Oxygen:- depending on the degree of respiratory distress, respiratory

support should be provided with oxygen via a nasal cannula, continuous positive pressure ventilation or conventional mechanical ventilation.

- Antibiotics: (eg gentamicin)

Management(cont…)

- Surfactant :meconium flowing into the lung deactivates the activity of surfactant,

causes a rise in surface tension and presaging the onset of respiratory distress.

- Inhaled nitric oxide :- this is useful in the management of pulmonary hypertension

associated with meconium aspiration syndrome (MAS). It is thought to act by relaxing smooth muscles in the pulmonary vessels causing vasodilatation, as well as promoting bronchodilation.

- Steroids - inhaled or systemic - have been used to good effect in some studies.[

Prevention -More frequent diagnosis of abnormal fetal heart rate

patterns and the avoidance of post-mature delivery by elective Caesarean section have both been shown to reduce the incidence of meconium aspiration syndrome (MAS).

- The use of uterine stimulants such as misoprostol is associated with meconium staining of amniotic fluid and amniotomy during labour may be a risk factor for MAS.