15 Alterations in Oxygenation

ALTERATIONS IN OXYGENATION
Rhealeen Viray Vicedo, MAN, RN

TOPIC OUTLINE
I. Review of the Respiratory System
II. Assessment of Respiratory Illness in Children
III. Laboratory Tests
IV. Diagnostic Procedures
V. Therapeutic Techniques
VI. Disorders of the Upper Respiratory Tract
VII.Disorders of the Lower Respiratory Tract
REVIEW OF THE
RESPIRATORY SYSTEM
• Two divisions:
– upper respiratory tract, composed of the nose,
paranasal sinuses, pharynx, larynx, and
epiglottis;
– lower tract composed of the bronchi,
bronchioles, and alveoli
• inspiration (breathing in)
• expiration (breathing out)
ASSESSING RESPIRATORY ILLNESS IN
CHILDREN
• Cough
• Tachypnea
• Retractions
• Restlessness
• Cyanosis
• Clubbing of fingers
• Chest Diameter
LABORATORY TESTS
• ARTERIAL BLOOD GASES (ABGs)
– Oxygenation
– Ventilation
– Acid-base Balance
– Pulse Oximetry- a noninvasive technique

for measuring oxygen saturation.
LABORATORY TESTS
• Nasopharyngeal Culture
• Respiratory Syncytial Virus Nasal Washings
– obtained to diagnose an infection by the respiratory syncytial
virus (RSV)
– supine position, and 1 to 2 ml of sterile normal saline is
dropped with a sterile needleless syringe into one nostril then
aspirated using a small, sterile bulb syringe
• Sputum Analysis
DIAGNOSTIC PROCEDURES
• Chest Radiography
– Xray
– CT Scan
• Pulmonary Function Test
– Vital Capacity
– Tidal Volume
– Residual Volume
THERAPEUTIC TECHNIQUES USED IN THE
TREATMENT OF RESPIRATORY ILLNESS IN
CHILDREN
• EXPECTORANT THERAPY
– Vaporizers – humidification via warm
mist
– Nebulizers - mechanical devices that
provide a stream of moistened air
directly into the respiratory tract
CHILDREN
• EXPECTORANT THERAPY
– Coughing / Deep breathing Technique
– Chest Physiotherapy
• Postural Drainage
• Percussion
• Vibration
CHILDREN
• THERAPY TO IMPROVE OXYGENATION
– Oxygen Administration
• elevates the arterial oxygen saturation
• flooding an incubator (infants)
• Cannula/ Nasal Prongs (50% O2 : 4 L/min)
• Mask (100% O2)
CHILDREN
• THERAPY TO IMPROVE
OXYGENATION
– Pharmacologic Therapy
• Nasal Sprays • Expectorants
• Antihistamines • Bronchodilators
• Corticosteroids – Metered Dose Inhalers
• Decongestants
CHILDREN
OXYGENATION
– Incentive Spirometry
• devices that encourage children to
inhale deeply to aerate the lungs fully or
to move mucus.
CHILDREN
– Endotracheal Intubation
• nasal or oral intubation) is the preferred means of bypassing
upper airway obstruction and allowing free entry of air to the
trachea
CHILDREN
OXYGENATION
– Tracheostomy
• an opening into the trachea to create an
artificial airway to relieve respiratory
obstruction that has occurred above that
point
CHILDREN
– Suctioning Technique
• to keep their airway free of mucus
• Hyperoxygenate 5mins prior to suctioning
DISORDERS OF THE UPPER
RESPIRATORY TRACT
CHOANAL ATREASIA
• congenital obstruction of the posterior nares by an
obstructing membrane or bony growth
– prevents a newborn from drawing air through the nose and
down into the nasopharynx
CHOANAL ATREASIA
ASSESSMENT:
• air hunger when their mouth is
closed but color improves when
they open their mouth to cry
• struggle and become cyanotic
at feedings
CHOANAL ATREASIA
MANAGEMENT:
• local piercing of the obstructing membrane
• surgical removal of the bony growth
• intravenous fluid to maintain their glucose and fluid level
until surgery can be performed
ACUTE NASOPHARYNGITIS
(COMMON COLD)
• most frequent infectious disease in children
• incubation period is typically 2 to 3 days
• Caused by:
– Rhinovirus
– Coxsackievirus
– RSV
– adenovirus
– parainfluenza and influenza viruses.
(COMMON COLD)
ASSESSMENT:
• nasal congestion
• runny nose
• low-grade fever
• nasal congestion
• Posterior rhinitis, plus local irritation,
leads to pharyngitis (sore throat).
(COMMON COLD)
MANAGEMENT:
• Antipyretics for fever
• saline nose drops or nasal spray as
prescribed
• removing nasal mucus via a bulb
syringe before feedings
• cool mist vaporizer
TONSILITIS
• infection and inflammation of the palatine
tonsils, which are located on both sides of
the pharynx
• Waldeyer Ring
– Palatine tonsils
– Adenoid (pharyngeal) tonsils
– Tubal tonsils at the entrance of the eustachian
tubes
– Lingual tonsils
TONSILITIS
ASSESSMENT:
• Severe pharyngitis
• Drooling
• Dysphagia
• High grade fever
• Lethargy
• Bright red and enlarged tonsillar
tissues that may meet in midline
TONSILITIS
MANAGEMENT:
• Antipyretic
• Analgesic
• Antibiotic therapy (7-10 days)
• Tonsillectomy is removal of the palatine tonsils
• Adenoidectomy is removal of the pharyngeal tonsils
TONSILITIS
MANAGEMENT (Post Tonsillectomy/ Adenoidectomy):
• Side lying or Prone position
• WOF hemorrhage:
– Tachypnea
– Frequent swallowing/ throat clearing
– Anxiety / restlessness
• ice cream is not a food of choice
• frequent sips of clear liquid
• Popsicles, or ice chips
EPISTAXIS
• “Nosebleed”
Causes:
• trauma, such as picking at the nose, from falling, or from
being hit on the nose by another child
• hot, dry environment causes mucous membranes to dry
• strenuous exercise, with hemolytic disorders
EPISTAXIS
ASSESSMENT:
• Sudden visible nasal bleeding
• choking sensation of blood running
down the back of the nasopharynx
• Fear
EPISTAXIS
MANAGEMENT:
• upright position
• head tilted slightly forward
• Apply pressure to the cartilage on the sides of the nose with your
fingers for about 10 minutes
• Make every effort to quiet the child and to help stop crying
• Epinephrine may be applied to the bleeding site
• A cotton or gauze nasal pack may be necessary to provide
continued pressure
CONGENITAL LARYNGOMALACIA/
TRACHEOMALACIA
• an infant’s laryngeal structure is weaker than normal and
collapses more than usual on inspiration
TRACHEOMALACIA
ASSESSMENT:
• stridor (a high-pitched crowing
sound on inspiration)
• sternum and intercostal
spaces may retract on
inspiration
TRACHEOMALACIA
MANAGEMENT:
• feed them slowly and provide rest periods as needed
• Assess if parents are receiving enough sleep and are
not becoming too exhausted to be able to continue
ADLs
• WOF: signs of an URTI
CROUP (LARYNGOTRACHEOBRONCHITIS)
• inflammation of the larynx, trachea, and major bronchi
• In children between 6 months and 3 years of age, the
cause of croup is usually a viral infection such as
parainfuenza virus
ASSESSMENT:
• At night time:
– barking cough (croupy cough)
– inspiratory stridor
– marked retractions
• They wake in extreme respiratory distress
MANAGEMENT:
• run the shower or hot water tap in a bathroom until the room fills
with steam, then keep the child in this warm, moist environment →
relaxes the airway → widens the bronchi lumens
• bring the child to an emergency department
• Nebulizer with corticosteroids
• IV therapy
DISORDERS OF THE LOWER
RESPIRATORY TRACT
BRONCHITIS
• inflammation of the major bronchi and trachea
• Causative agents include the influenza viruses,
adenovirus, and Mycoplasma pneumoniae ,
BRONCHITIS
ASSESSMENT:
• mild upper respiratory tract infection for 1 or 2 days
• fever
• dry hacking cough
• coarse crackles
BRONCHITIS
MANAGEMENT:
• Maintain adequate hydration
• Antipyretics
• Antibiotic therapy
• Expectorants
ASTHMA
• an immediate hypersensitivity (type I) response, is the
most common chronic illness in children
• may be intermittent, with symptom-free periods, or
chronic, with continuous symptom
• diffuse obstructive and restrictive changes in the airway
because of a triad of inflammation, bronchoconstriction,
and increased mucus production
ASTHMA
CAUSATIVE FACTORS:
• sensitization to inhalant antigens such as pollens, molds,
house dust, or peanuts.
• exposure to cold air, irritating odors such as turpentine or
smog, or air pollutants such as cigarette smoke
• seasonal factor
• Aspirin
ASTHMA
ASSESSMENT:
• “panting”
• An episode begins with a
dry cough
• Dyspnea
• Wheezing
• May cough out copious
mucus
ASTHMA
MANAGEMENT:
• avoidance of the allergen by environmental control
• skin testing and hyposensitization to identified allergens
• relief of symptoms by pharmacologic agents
PNEUMONIA
• infection and inflammation of alveoli
• Hospital / community acquired
Causative Factors:
• Bacteria (pneumococcal, streptococcal,
staphylococcal, or chlamydial)
• Virus (RSV)
• Aspiration
PNEUMONIA
ASSESSMENT: • Tachypnea
• high fever • Tachycardia
• nasal flaring • Crackles (rales)
• Retractions
• chest pain
• Chills
• Dyspnea
PNEUMONIA
MANAGEMENT:
• Antibiotics - Ampicillin and third-generation cephalosporins are
both effective against pneumococci
• plan nursing care carefully to conserve strength
• Turn and reposition a child frequently
• IV therapy
• O2 therapy
• CPT
TUBERCULOSIS
• causative agent is Mycobacterium tuberculosis
(tubercle bacillus)
• a highly contagious pulmonary disease
• mode of transmission is inhalation of infected
droplet
• incubation period is 2 to 10 weeks
• Children generally contract this disease from
someone in the immediate family
TUBERCULOSIS
ASSESSMENT:
• Cough
• Anorexia
• Weight loss/ loss of appetite
• Night sweats
• low-grade fever
TUBERCULOSIS
ASSESSMENT:
• Mantoux test, also called a purified protein derivative
(PPD) test
– units of protein derivative vaccine is injected intradermally,
usually on the left lower arm.
– A health care professional inspects the area in 72 hours and
notes the reaction.
– A positive reaction (the formation of a 5- to 15-mm reddened
induration)
TUBERCULOSIS
MANAGEMENT:
• Drug therapy
– Isoniazid (INH) is the drug of choice
– Rifampin is a secondary drug often used in combination with
INH
– Ethambutol – used with caution with infants because one side
effect is optic neuritis
• Diet high in protein, calcium, and pyridoxine
• Strict treatment compliance (6 months)
CYSTIC FIBROSIS
• generalized dysfunction of the exocrine glands
• Mucus secretions of the body, particularly in the pancreas
and the lungs, are so tenacious that they have difficulty
flowing through gland ducts.
• cause of the disorder is an abnormality of the long arm of
chromosome 7
CYSTIC FIBROSIS
ASSESSMENT:
• Thickened mucus pools in bronchiole → infection
• Secondary emphysema (overinflated alveoli) occurs because air
cannot be pushed past the thick mucus on expiration when all
bronchi are narrower than they are on inspiration
• Enlarged antero-posterior diameter of the chest
• Respiratory acidosis
• Atelectasis
• Clubbing of fingers
CYSTIC FIBROSIS
MANAGEMENT:
• measures to reduce the involvement of the pancreas,
lungs, and sweat glands
• Because so many organs are involved, care works best if
it is a collaborative process.

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ALTERATIONS IN OXYGENATION

Rhealeen Viray Vicedo, MAN, RN

– Pulse Oximetry- a noninvasive technique

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