RESPIRATORY DISORDERS

• The major function of the respiratory system is to deliver O2 to arterial blood and remove CO2 from the venous blood known as gas exchange.
• Ventilation - movement of gases from the atmosphere into and out of the lungs. This is accomplished through the mechanical acts of INSPIRATION & EXPIRATION.
• Diffusion – movement of inhaled gases in the alveoli & across the alveolar CAPILLARY MEMBRANE
• Perfusion – movement of oxygenated blood from the lungs to the tissues
• Inspiration- deliver warm and moistened air to the alveoli transport O2 across the alveolar membrane to hgb – laden RBC allow CO2 to diffuse from RBC back to alveoli thru expiration, CO2 filled air is discharged to outsid
• Cough- a reflex initiated by stimulation of nerve of respiratory tract mucosa by the presence of dust ,chemicals, mucus or inflammation
• Cough - useful procedure to clear excess mucus
• paroxysmal cough - refers to series of expiratory cough after deep expiration (seen in whooping cough, aspiration )
• tachypnea - 1 st indicator of airway obstruction in young children
• Retraction - inward drawing of the chest
• Retraction - commonly seen in infants and newborns because intercostal tissue is weaker and less developed
• Supraclavicular/ Suprasternal retraction - suggest upper airway obstruction
• intercostal retraction- suggest lower airway obstruction
• Restlessness - when infant or children have decreased O2 they become anxious and restless
• Cyanosis – blue tinged to the skin
• Cyanosis – become apparent when PO2 is < 40mmhg result in inc. RR
• Clubbing of fingers - change in the angle between the fingernail and nail bed because of increase capillary growth in the fingertips
• Adventitious sounds - extra or abnormal breathing sounds
• Adventitious sounds - I/E ratio is reversed (bronchial or tubular breathing)
• Rhonchi - obstruction at the level of nose or pharynx
• Rhonchi - obstruction at the level of nose or pharynx
• Wheezing – obstruction is in the lower trachea or bronchioles (expiration)
• Rales – when alveoli are filled with fluids, fine crackling sounds
• Stridor - obstruction at the level of larynx (best heard when placed in supine position)
• in children with COPD unable to exhale completely air trapped in lung alveoli (hyperinflation), produce elongated A-P diameter of the chest (pigeon chest)
• blood gas analysis - an invasive method for determining the effectiveness of ventilation acid-base status
• blood gas analysis - Provide information about oxygenation of the blood as well as O2 saturation of Hgb
• Increase PCO2 - seen in children who are hyperventilating (breathing deeply)- blowing off too much PCO2
• decrease PCO2- seen in children who are hypoventilating (breathing very shallow) - can’t blow the CO2
• Respiratory syncytial virus nasal washing - pt is placed in supine position and 1-2 ml of sterile saline is dropped with sterile needle less syringe into one nose, then nose is aspirated using small, sterile bulb syringe
• Sputum analysis - rare in children younger than school age
• pulmonary function test - measure the forces of inertia, elasticity, and flow resistance measure by the use of spirometry (device that record the force of air exchange )
• Chest physiotherapy

  3 technique are involved:

  1. postural drainage
  2. percussion
  3. vibration
• Expectorant therapy

  1. Coughing
  2. Chest physiotherapy
  3. Mucus clearing devices
• Incentive spirometry - device that encourage children to inhale deeply to aerate the lung
• decongestant – causes vasoconstriction leading to shrinkage of mucous membrane
• Expectorant - help raise mucus
• Antitussive – cough suppressant
• Bronchodilator - use to open lower airway
• Breathing technique - blowing ball, blowing out with purse lips