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Mechanisms of Gas Exchange
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The process by which oxygen is transported to cells
and carbon dioxide is transported from the cells
The first thing an infant does once it comes out is
breath
For effective gas exchange to occur 3 things must
happen
1. Ventilation
2. Transportation
3. Perfusion
Age Related Variations
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Babies that are born before 30 weeks
o Have insufficient surfactant to prevent alveoli
from collapsing
Infants under 3 months are --> Obligate nose
breathers
Differences in the Respiratory System
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Lack of or insufficient surfactant
Smaller airways and undeveloped cartilage
Obligatory nose breather (infant)
Less well-developed intercostal muscles
Brief periods of apnea common (newborn)
o Sometimes all you need to do is reposition the
child
o This is fine as long as their O2 sat doesn’t
decrease
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An infants heart rate decreases with their oxygen
level
Faster respiratory rate; increased metabolic needs
Eustachian tubes relatively horizontal
Tonsilar tissue enlargement
More flexible larynx, susceptible to spasm
Abdominal breathers
Anatomy of the Respiratory System
 Note that the sinus is right on the brain
Trasncutaneous Monitoring
 Strip used
Alterations in the Upper Airway
Allergic Rhinitis
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Clinical manifestations: dark circles
Sinusitis
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Oftern leads to
o Upper airway infections
Although not serious it can lead to life-threatening
complications if left untreated
Bacterial VS Viral Pharyngitis
 Bacterial
o Abrupt
o High fever
 Viral
o Gradual
o
o Vesicles
Tonsillitis
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Inflammation and infection of the two palatine tonsils
Adenoiditis- Infection and inflammation of the
pharyngeal tonsils or adenoids
o Incidence peaks during middle childhood
Must do patient teaching
Things to assess the child for postoperative
bleeding
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Excessive swallowing
Elevated pulse; decreasing blood pressure
Signs of fresh bleeding in back of throat
Vomiting bright red blood
Restlessness not associated with pain
Prone or side lying position
Clear, cool liquids- avoid citrus (acidic)
Laryngomalacia
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Congenital (born with it)
laryngeal stridor
o Noisy, crowing, respiratory sounds with or
without retractions in the neonatal period
Flaccidity of the epiglottis and supra-glottic aperture
and weakness of the airways
Caused by immature neuromuscular development of
the airway
Symptoms resolve by 18 to 24 months
Repositioning of the neck and head may absolve this
Floppy voice box
Bronchiolitis
 Inflammation of the bronchioles
 Caused by Respiratory syncytial virus (RSV)
 Significant cause of hospitalization in children
under 1 year of age common in winter and
spring
 Synagist vaccine is given to babies to prevent
RSV
 Only seen in infants (due to small airways)
 Highly communicable
 Contact isolation and hand hygiene!!
Croup
Often begins at night; may be preceded by several days of
symptoms of upper respiratory tract infection
 Sudden onset of harsh, metallic, barky cough; sore
throat; inspiratory stridor; hoarseness
 Parainfluenza virus cause most viral croup cases
 Laryngeotracheobronchitis- most common form leading
to hospitalizations (viral or bacterial)
 See page 1043, table 45.2 for comparison of types of
croup
 Use of accessory muscles to breathe Frightened
appearance Agitation Cyanosis
 Pathophysiology o croup
o Mucosal inflammation and edema narrow
airway
Epiglottis (supraglottitis)
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Infant Subcostal Retractions
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Expiratory grunt
Pneumonia
 Inflammation of the lung parenchyma
 Given fluid
Organism responsible is H. influenzae
Clinical Manifestations
o Drooling
o Tripod positioning
o Strident cough
o Irritability
o Dysphagia
DO NOT
o Leave the child unattended if this is suspected
o Examine or attempt to obtain culture
o Stimulate airway using a tough depressor or
anything else because it can trigger an airway
obstruction
Head bobbing
 Means lack of O2
 Bobbing is an effort to pull in more O2
Apnea
Foreign Body Aspiration
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Seen most frequently in children age 6 months to 5
years
Children’s curiosity, oral needs, and lack of supervision
all contribute to FBA.
o Latex balloons contribute to a significant
number of deaths.
Most foreign bodies become lodged in the right
bronchi
o Because its the shorter one
Common items of aspiration
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Cessation of breathing for 20 seconds or longer
During an episode of apnea it is important to
document the following:
o Time and duration of the episode
o Color change
o Bradycardia
o O2 saturation
o Action that stimulated breathing
We send them home with an apnea monitor to
monitor the baby
Asthma
Sudden Infant Death Syndrome
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Sudden and unexplained death of an infant younger
than 1 year
Exact cause is unknown.
Referred to as crib death by the public
Most common
o during sleep
o African American boys
o In low-birth-weight infants
o Most common in winter months
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A chronic reversible obstructive airway disease
characterized by
o Causes: Increased airway responsiveness to a
variety of stimuli (allergens)
o Bronchospasm resulting from constriction of
bronchial smooth muscle
 For treatment we give bronchodilators
 For long term treatment- steroids
o Inflammation and edema of the mucous
membranes that line the small airways and the
subsequent accumulation of thick secretions in
the airways
Emergency Asthma Management
o Worsening wheeze, cough, or shortness of
breath
o No improvement after bronchodilator use
o Difficulty breathing
o Trouble with walking or talking
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o Discontinuation of play
o Listlessness or weak cry
o Gray or blue lips or fingernails
Therapeutic Management
o Administration of medications and treatments
o Education for the child and family
o Avoidance of triggers
o Recognize early signs of an asthma episode
o Measures to prevent an asthma attack
o We must make sure our patients have access to
medications
Bronchopulmonary Dysplasia
 Chronic obstructive pulmonary disease
o Result of
 Basically Infant CHF
 Thickening of the alveolar walls
Cystic Fibrosis
 Inherited multisystem disorder categorized by
widespread dysfunction of exocrine glands
 Obstruction and dysfunction of
 More common in causasion males
 Cure: lung transplant
 Therapeutic Management
o
TB
 Seen commonly in jail
 PPD
o 48-72 hours
 Treatment- rest, increased protein
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