Exam (elaborations)
NSG 4421 CHAPTER 27 & 28 0VERVIEW OF OXGEN AND CARBON DIOXIDE EXCHANGE
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NSG 4421 CHAPTER 27 & 28 0VERVIEW OF OXGEN AND CARBON DIOXIDE EXCHANGE
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Peds exam 4NSG 4421 CHAPTER
Chapter 27 Overview
27 & 28 & 28 0VERVIEW OFand
of oxygen OXGEN AND
Carbon CARBON
Dioxide
DIOXIDEExchange
EXCHANGE
A. Airway of a child:
• Large amounts of soft tissue/loosely anchored mucous membranes lining the
airway (increase the risk of edema and obstruction)
B. ALL OF THIS @ RISK FOR: edema and obstruction
• Nasopharynx – smaller and easily occluded
• Lymph tissue (tonsils and adenoids) – grow rapidly in early
childhood and atrophies after age 12
i. Usually have bigger lymph nodes
• Nares – smaller and easily occluded
• Oral cavity- small with large tonsils = ^ risk of obstruction
i. Higher soft palate
ii. Large tongue- ^risk of obstruction
• Epiglottis – long and floppy; vulnerable to swelling
• Larynx and glottis- higher in neck = increased aspiration
• Thyroid, cricoid, tracheal cartilage- immature and easily
collapse when neck is flexed
• Airway
i. Fewer functional muscles which lesson the ability to
compensate when
1. Edema
2. Spasms
3. Trauma
ii. Loosely anchored mucous membranes lining in airway =
edema and obstruction
• Trachea- diameter smaller
i. Bifurcation @ T3
ii. Right bronchus having steeper slop = ^ risk
for aspiration
iii. measure with pinky finger
• chest
i. normally rounded
ii. chronic resp disorders (asthma, CF) = barrel chest
C. Physical exam
,Peds exam 4
• V/S
• Auscultate breath sounds
• Monitor
i. RR and effort (labored? accessory muscles?)
ii. Abdominal breaths?
iii. Color change
iv. Chest tightness
v. Nasal flare
• Resp symptoms –
i. Retraction
ii. Head bobbing
iii. Stridor
iv. Grunting
v. Wheezing
vi. Clubbing
vii. Cough
• Child behavior –
i. irritable, restless, change in responsiveness
• Family and Personal Hx-
i. Asthma and CF
D. Dx procedures
• Pulmonary function test
i. Forced vital capacity (FVC) –
1. max air expired after max inspiration
2. dec = obstructive disease and obesity
ii. Forced expiratory volume in 1 or 3
secs- (FEV1 or FEV3)
1. amount of air expired after max inspiration
2. single best measurement of airway
function
3. dec = obstructive disease
iii. Tidal volume- (TV or V1)
1. Amount of air inhaled and exhaled during resp
cycle
2. Determine the depth of mechanical ventilation
,Peds exam 4
iv. Functional residual volume and
functional respiratory capacity (FRV or
FRC)
1. Volume of air remaining in lung after passive
expiration
2. Allows aeration of alveoli
3. ^^ = hyper inflated lungs (obstructive disease)
v. Dynamic compliance-
1. Relationship b/w change in volume and pressure
difference
2. Reflects elastic recoil of lungs
3. Normal V but dec airflow (pressure)= obstructive disease
a. (asthma)
4. Normal flow but dec V = restrictive disease
a. (pulmonary fibrosis)
vi. Pulmonary resistance
1. Changes in pressure w/ changes in flow on
inspiration and expiration
vii. Work of breathing
1. Total work expended moving lung and chest
viii. Respiratory time constancy
1. Time for proximal and alveolar airway pressure to
equilibrate
ix. Transcutaneous oxygen or carbon dioxide
monitoring (TCM)
1. Skin electrodes heated and applied to well perfused areas
of trunk (mm Hg)
2. continuous and reliable trends in arterial O2 and
CO2
x. pulse ox
1. photometric measurement of (SaO2)
2. measures hemoglobin sat
xi. FEV1/FVC or FEV3/FVC = % of max inspiration
that is expired in 1-3 secs
, Peds exam 4
• Radiology
i. Table 27-5 (COME BACK and REVIEW)
ii. Kind of already know
• Blood gases
i. ABG – blood drawn form artery w/ needle and syringe
1. Measures: pH, bicarb, PaCo2, blood oxygenation
ii. HCO3 –
1. Buffers effect of acid in blood
2. Kidneys control
a. Acidosis
i. Diarrhea
ii. Lactic acidosis
iii. Shock
iv. Pancreatic juice leakage
v. DKA
b. Alkalosis
i. Fluid loss
ii. Diuretics
iii. Corticosteroids
iv. Upper GI – vomiting
iii. PCO2-
1. Pressure exerted by dissolved CO2 in blood
2. Lungs control
a. Acidosis
i. Hyperventilation
ii. Hypoxia
iii. PE
b. Alkalosis
i. Hypoventilation
ii. Obstructive lung disease
iv. PO2
1. Pressure exerted by dissolved oxygen
2. Effectiveness of lungs
E. Oxygen Delivery Devices
• Oxygen mask
i. A:
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