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Respiratory Assessment. Jan Bazner-Chandler CPNP, CNS, MSN, RN. Respiratory . Bifurcation of trachea. Change in chest wall shape. Upper Airway Characteristics. Narrow tracheo-bronchial lumen until age 5 Tonsils, adenoids, epiglottis proportionately larger in children

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respiratory assessment

Respiratory Assessment

Jan Bazner-Chandler



Bifurcation of trachea

Change in chest wall shape

upper airway characteristics
Upper Airway Characteristics
  • Narrow tracheo-bronchial lumen until age 5
  • Tonsils, adenoids, epiglottis proportionately larger in children
  • Tracheo-bronchial cartilaginous rings collapse easily
  • Infants up to 4-6 weeks are obligate nose breathers
  • Tongue is large in proportion to the mough
lower airway characteristics
Lower Airway Characteristics
  • Lack of firm bony structure to ribs/chest make child more prone to retractions when in respiratory distress
  • Fewer alveoli in the neonate
  • Poor quality of alveoli until age 8
  • Lack of surfactant that lines the alveoli in the premature infant
    • Inhibits alveolar collapse at end of expiration
focused health history
Focused Health History
  • Reason for the visit
  • Include questions about the environment
    • What makes condition worse – triggers
    • Allergies
  • Past medical history: birth history, previous health problems, childhood illness, immunizations
  • Family medial history: respiratory illness – genetic link
focused physical assessment
Focused Physical Assessment
  • Types of breathing:
    • Less than 7 years abdominal breathing
    • Greater than 7 years abdominal breathing can indicate problems
respiratory rate
Respiratory Rate
  • Inspiratory phase slightly longer or equal to expiratory phase
    • Prolonged expiratory phase = asthma
    • Prolonged inspiratory phase = upper airway obstruction
      • Croup
      • Foreign body
  • Observe color of face, trunk, and nail beds
    • Cyanosis = inadequate oxygenation
    • Clubbing of nails = chronic hypoxemia
respiratory distress
Respiratory Distress
  • Grunting = impending respiratory failure
  • Severe retractions
  • Diminished or absent breath sounds
  • Apnea or gasping respirations
  • Poor systemic perfusion / mottling
  • Tachycardia to bradycardia
  • Decrease oxygen saturations
chest retractions
Chest Retractions
  • Retractions suggest an obstruction to inspiration at any point in the respiratory tract.
  • As intrapleural pressure becomes increasingly negative, the musculature “pulls back” in an effort to overcome the blockage.
  • The degree and level of retraction depend on the extent and level of the obstruction.
diagnostic tests
Diagnostic Tests
  • Detects abnormalities of chest or lungs
    • Chest x-ray
    • Sweat chloride Test
    • MRI
    • Laryngoscope / bronchoscopy
    • CT Scan
foreign body aspiration
Foreign Body Aspiration

A foreign body in one

or the other of the bronchi

causes unilateral


*usually the right due to

broader bore and more

vertical placement.

sweat test for cystic fibrosis
Sweat Test for Cystic Fibrosis

Gold Standard test

for Cystic Fibrosis

oxygen therapy nursing interventions
Oxygen Therapy: Nursing Interventions
  • Proper concentration
  • Adequate humidity: make sure there is fluid in the bottle
  • Make sure prongs are in nose and that the nares are patent – suction out nares to increase oxygen flow
  • Monitor oxygen SATS: if alarm keeps on going off but the infant / child looks good, check the device
  • Monitor activity level or infant / child
aerosol therapy
Aerosol Therapy
  • Respiratory Therapist will do the treatment
  • Communicate with therapist – eliminated needless paging for treatments
  • Treatment should be done before the infant eats
  • When you make your morning rounds assess if there is any infant / child that needs an immediate treatment
home teaching inhaled medications
Home Teaching Inhaled Medications
  • Correct dosage
  • Prescribed time
  • Proper use of inhaler
  • No OTC drugs
  • Encourage fluids
  • When to call physician
aerosol therapy1
Aerosol Therapy



by oxygen or



postural drainage and percussion
Postural Drainage and Percussion
  • In the small child you can position on your lap
  • Do first thing in the AM
  • Do before meals or one hour after
  • Do after the aerosol treatment since the treatment will help open the airways and loosen the mucous
  • Suction the infant after treatment – teach parents to do bulb suction
severe respiratory distress
Severe Respiratory Distress
  • Nasal flaring and grunting
  • Severe retractions
  • Diminished breath sounds
  • Hypotonia
  • Decreased oxygen saturations
what to do if infant child in respiratory distress
What to do if infant / child in respiratory distress!
  • Stimulate the infant / child - remember crying or activity will help mobilize secretions and expand lungs
  • Have the older child sit up take deep breaths and cough
  • Chest percussion to loosen secretions
  • Give oxygen
  • Assess if interventions work
  • Call for help if you need it – pull the emergency cord – yell for help