Alterations in Oxygen Transport Chapters 24-26 By Dr. Nataliya Haliyash, MD, BSN.
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Alterations in Alterations in Oxygen TransportOxygen Transport
Chapters 24-26
By Dr. Nataliya Haliyash, MD, BSN
Oxygen TransportOxygen Transport
Lecture ObjectivesUpon completion of this lecture, you will be better
able to: Explain differences in the anatomy, physiology, and
functioning of the respiratory system of children and adults.
Describe the pathophysiology, clinical manifestations, treatment, and nursing management of:* common acute respiratory alterations:
nasopharyngitis, pharyngitis, tonsillitis, otitis media, croup, bronchiolitis, and pneumonia.
* common chronic respiratory alterations: allergic rhinitis and asthma.
* less common respiratory alterations: cystic fibrosis, bronchopulmonary dysplasia, tuberculosis, and sinusitis.
* additional respiratory alterations: foreign body aspiration, smoke inhalation injury, acute respiratory distress syndrome, and apnea.
Lecture Objectives Explain differences in anatomy and physiology of
child's cardiovascular system as compared to adults. Perform an assessment of the child with heart
disease. Describe the clinical symptoms of congestive heart
failure and identify appropriate interventions. Identify two congenital heart lesions that increase
pulmonary blood flow. Identify two congenital heart lesions that decrease
pulmonary blood flow resulting in cyanosis. Describe the disorder and treatment for acute
rheumatic fever, Kawasaki disease, and infectious endocarditis.
Identify the three forms of shock.
Shock in ChildrenShock in Children
A clinical syndrome characterized by prostration and insufficient perfusion to meet the metabolic demands of tissues
Hypotension is not part of the definition in children
Shock vs. Hypotension
Shock – State of insufficient perfusion to meet the
metabolic demands of tissues Hypotension
– Physical sign characterized by a fall in systolic blood pressure (BP below normal values)
– Hypotension is a late sign of shock in children and it’s presence in children implies profound cardiovascular compromise
Pathophysiology Hypovolemic shock
– Hemorrhage– Dehydration
Distributive shock– Neurogenic / Spinal– SIRS / Sepsis– Anaphylaxis
Cardiogenic– Pump failure– Obstructive
Help!
Excuse me, I believe that my child is in a state of inadequate tissue perfusion!
Recognition of shock Early recognition is key
– The longer you wait, the higher the mortality!!!!
Key parameters to assess:– L.O.C.– Respiratory rate– Heart rate– Peripheral perfusion
• Skin color and temp.• Capillary refill
Heart Rate Tachycardia
– Above higher normal limit• (age x 5 minus 150)
– 4yr X 5 = 20 – 150 = 130• Too fast
– Infant > 220– Child > 180
• Too slow– < 60
– Sustained– Decompensated shock
• Slowing or Bradycardia
Level of Consciousness (L.O.C.) (Key)
Changes in L.O.C. occur early– Irritable– Does not interact with parents– Stares vacantly into space– Poor response to pain– Asleep/sleeping a lot
• Difficult to arouse
– Unresponsive
Peripheral Perfusion (Key)
Decreased or bounding pulses
Volume discrepancy– Central vs peripheral
pulses• Poor or brisk capillary
refill• Cool or mottled or red
and warm extremities• Decreased urine
output
Respiratory Rate
Compensated shock– Tachypnea
• Elevated for age• “Quiet respirations”
– Think of DKA or Hypovolemia
• Retractions
– Sepsis• Decompensated shock
– Bradypnea or apnea
Compensated (Early) Shock
Vital organ function is maintained by intrinsic compensatory mechanisms; blood flow is usually normal or increased but generally uneven or maldistributed in the microcirculation.
Compensated (Early) Shock
Normal level of consciousness– Agitated
Quiet tachypnea Tachycardia
– Sustained– Difference between central and peripheral pulses
Normal or delayed capillary refill Normal or elevated B/P
Decompensated Shock (with hypotension)
Efficiency of the CVS gradually diminishes, until perfusion in the microcirculation becomes marginal despite compensatory adjustments.
Decompensated Shock (with hypotension)
Altered level of consciousness– Painful stimulation or unresponsive
Delayed capillary refill– > 5 seconds
Hypotension Weak central pulses, absent peripheral
pulses Bradycardia
Hypotension
Blood Pressure– Lowest acceptable systolic blood pressure
• Birth – 1 month: 60 mmhg• 1 month – 1 year: 70 mmhg• 1 year – 10 year: 70 + (2 X age in years)• >10 years : 90 mmhg
Normal systolic– 80 + (2 x age in years) – or fiftieth percentile
Irreversible (terminal) shock
Damage to vital organs such as the heart or brain of such magnitude that the entire organism will be disrupted regardless of therapeutic intervention. Death occurs even if CV measurements return to normal levels with therapy.
Hypovolemic shock
Hypovolemia is the usual cause of shock in the out of hospital setting– Most common cause is blood loss
secondary to blunt force trauma– Vomiting and diarrhea is a second leading
cause
Septic Shock
Most common form of distributive shock
Infectious organism or their byproducts (endotoxins)
Triggers an immune response– Vasodilation– Increase capillary
permeability– Maldistribution of blood
Early stage– High cardiac output, low
vascular resistance• Tachycardia
– Bounding pulses• Flash capillary refill• Flush, warm skin
Later stage– Just like hypovolemic shock
Neurogenic
Usually the result of either head or high spinal cord injury (T6)– Disrupts sympathetic
nervous system innervention with blood vessels and heart
– Uncontrolled vasodilation
Signs and symptoms– Hypotension with
wide pulse pressure– Normal heart rate or
bradycardia– Increased respiratory
rate– Diaphragmatic
breathing
Cardiogenic Shock
Usually a problem with stroke volume– Rate is either:
• Too fast– Inadequate time for
ventricle filling– SVT, Atrial Fib
• Too slow– Bradycardia
• Or not at all– Asystole– PEA
Manifestations– Alteration in L.O.C.– Trouble breathing
• Crackles/rales
– Trouble feeding or not feeding well
– Large liver– S3 gallop
Anaphylactic
Acute multisystem allergic response
Can occur in seconds or minutes– Usually within 5 – 10
minutes of exposure
• Venodilation • Systemic vasodilation • Pulmonary
vasoconstriction
Signs & symptoms – Anxiety/agitation – Nausea and vomiting – Urticaria (hives) – Angioedema – Respiratory distress – Hypotension – Tachycardia
Nursing management
Dxs: – Ineffective breathing pattern R/T
diminished oxygen needed for impaired tissue perfusion
– Altered tissue perfusion R/T reduced blood flow, decreased blood volume, reduced vascular tone
– Altered family process R/T a child in a life-threatening condition
Nursing management
Goals: Inc O2 to lungs
– Adm O2 as prescribed, position to maintain open airway, monitor artificial airway
Promote venous return and cardiac output– Position flat with legs elevated– Adm. IV fluids and plasma expander, vasopressor
and cardiotonics– Maintain opt body tempr.
Neck in neutral Neck in neutral or “sniffing” or “sniffing”
positionposition
The end.The end.
Q & A ?Q & A ?
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