Nursing 211

N211: Health Differences Across the Lifespan I

2.7 Respiratory Failure in Children Respiratory Failure in children causes can include congenital heart disease, respiratory distress syndrome, infection, sepsis, neuromuscular disorders, trauma and burns, aspiration, fluid overload and dehydration, anesthetic and narcotic overdose. Nursing Assessment Includes “bad looking” child, tachypnea, dyspnea, apnea, gasping, tachycardia, cyanosis, pallor, mottled color, irritability and later lethargy, retractions, nasal flaring, poor air movement, hypoxemia, hypercapnia, respiratory acidosis. If the pCO2 is >45 or PO2 <60 on 50% oxygen this signifies respiratory failure. A child in severe distress should be on 100% oxygen. Nursing Diagnosis • Ineffective airway clearance related to… • Ineffective breathing pattern related to… • Impaired gas exchange related to… • Activity intolerance related to… 2.8 Chronic Airflow Limitation Chronic Airflow Limitation (CAL) is a group of diseases that includes chronic bronchitis, asthma and pulmonary emphysema. Emphysema and chronic bronchitis are chronic obstructive pulmonary disease (COPD) and are characterized by bronchospasm and dyspnea. The damage to the lung is irreversible and will increase in severity with time. Chronic Bronchitis is a form of COPD. It results from irritants and infections that increase mucus production, impair airway clearance, and cause irreversible narrowing of the small airways leading to hypoxemia and CO2 retention. Clients will have chronic sputum with cough production daily for a minimum of three months per year; chronic hypoxemia, cor pulmonale; increase in mucus, increase in bronchial wall thickness which and obstructs airflow and a reduced responsiveness of the respiratory center to hypoxemic stimuli. Chronic bronchitis has a higher incidence in clients who smoke. Nursing Assessment Includes generalized cyanosis, “blue bloaters”, right sided heart failure, distended neck veins, crackles and expiratory wheezes. Chest x-ray will show hyperinflation and increased bronchovesicular markings. Pulmonary function tests may reveal increased residual volume,


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