Pediatric Respiratory Anatomy: Course Tak 5 Dula Stephanie P

COURSE TAK 5
DULA STEPHANIE P.
1. Submit an essay describing the unique characteristics of the pediatric respiratory system
anatomy and physiology and apply that information to the care of children with respiratory
conditions. (300-500 words)
Pediatric Respiratory Anatomy

Larynx composed of hyoid bone and a series of cartilages
Single: thyroid, cricoid, epiglottis
Paired: arytenoids, corniculates, and cuneiform
Laryngeal folds consist of:
 Paired aryepiglottic folds extend from epiglottis posteriorly to superior surface of arytenoids.
 Paired vestibular folds (false vocal cords) extend from thyroid cartilage posteriorly to superior
surface of arytenoids.
 Paired vocal folds (true vocal cords) extend from posterior surface of thyroid plate to anterior
part of arytenoids.
 Interarytenoid fold bridging the arytenoid cartilages.
 Thyrohyoid fold extend from hyoid bone to thyroid cartilage
Sensory Innervation:
 Recurrent Laryngeal Nerve-supraglottic larynx

 Internal Branch of Superior Laryngeal Nerve-infraglottic larynx
Motor Innervation:
 External branch of Superior Laryngeal Nerve-cricothyroid muscle.

 Recurrent Laryngeal Nerve-all other laryngeal muscles.
Blood Supply
 Laryngeal branches of the superior and inferior thyroid arteries.
Pediatric Respiratory Physiology

 Extrauterine life not possible until 24-25 weeks of gestation.
 Two types of pulmonary epithelial cells: Type I and Type II pneumocytes .
-Type I pneumocytes are flat and form tight junctions that interconnect the interstitium.
-Type II pneumocytes are more numerous, resistant to oxygen toxicity, and are capable of cell
division to produce Type I pneumocytes.
 Pulmonary surfactant produced by Type II pneumocystis at 24 wks. GA .

 Sufficient pulmonary surfactant present after 35 wks. GA.
 Premature infants prone to respiratory distress syndrome (RDS) because of insufficient
surfactant.
 Betamethasone can be given to pregnant mothers at 24-35wks GA to accelerate fetal surfactant
production.
 Work of breathing for each kilogram of body weight is similar in infants and adult.
 Oxygen consumption of infant (6 ml/kg/min) is twice that of an adult (3 ml/kg/min) Greater
oxygen consumption = increased respiratory rate.
 Tidal volume is relatively fixed due to an atomic structure.
 Minute alveolar ventilation is more dependent on increased respiratory rate than on tidal volume
Lack Type I muscle fibers, fatigue more easily.
 FRC of an awake infant is similar to an adult when normalized to body weight.
 Ratio of alveolar minute ventilation to FRC is doubled, under circumstances of hypoxia, apnea or
under anesthesia, the infant’s FRC is diminished and desaturation occurs more precipitously
2. Develop a school-based nursing care plan for a 9-year old child with asthma.
Asthma is a chronic inflammatory lung disease that causes airway

hyperresponsiveness, mucus production, and mucosal edema resulting in
reversible airflow obstruction. Allergens, air pollutants, cold weather, physical
exertion, strong odors, and medications are common predisposing factors for
asthma. When an individual is exposed to a trigger, an immediate inflammatory
response with bronchospasm happens.
The nursing care plan goals for asthma focuses on preventing the hypersensitivity
reaction, controlling the allergens, maintaining airway patency and preventing
the occurrence of reversible complications.
Here are eight (8) nursing care plans and nursing diagnosis for asthma:
1. Ineffective Breathing Pattern

2. Ineffective Airway Clearance
3. Deficient Knowledge
4. Anxiety
5. Activity Intolerance
6. Health-Seeking Behaviors: Prevention of Asthma Attack
7. Interrupted Family Processes
8. Fatigue
 Nursing Interventions and Rationales

 Here are the nursing assessment and interventions for this asthma nursing
care plan.
Nursing Interventions Rationale
Nursing Assessment
Increased BP, RR, and HR occur during the initial

Assess the client’s vital signs as needed while in hypoxia and hypercapnia. And when it becomes
distress. severe, BP and HR drops and respiratory failure
may result.
Changes in the respiratory rate and rhythm may

Assess the respiratory rate, depth, and rhythm. indicate an early sign of impending respiratory
distress.
Anxiety may result from the struggle of not being

Assess the client’s level of anxiety
able to breathe properly.
Adventitious sounds may indicate a worsening

condition or additional developing complications
such as pneumonia. Wheezing happens as a
Assess breath sounds and adventitious sounds
result of bronchospasm. Diminishing wheezing
such as wheezes and stridor.
and indistinct breath sounds are
suggestive findings and indicate impending
respiratory failure.
Reactive airways allow air to move into the lungs
Assess the relationship of inspiration to more easily than out of the lungs. If the client is
expiration. gasping for air, instruction for effective breathing
is needed.
These indicate respiratory distress. Once the

Assess for signs of dyspnea (flaring of nostrils, movement of air into and out of the lungs
chest retractions, and use of accessory muscle). becomes challenging, the breathing pattern
changes.
Dyspnea during a normal conversation is a sign

Assess for conversational dyspnea.
of respiratory distress.
Fatigue may indicate distress, leading to

Assess for fatigue
respiratory failure.
Paradoxical pulse is an abnormally large decrease

in systolic blood pressure and pulses wave
Assess the presence of paradoxical pulse of 12 amplitude during inspiration. The normal fall in
mm Hg or greater. pressure is less than 10 mm Hg. A paradoxical
pulse of 12 mm Hg or greater indicates a severe
airflow obstruction.
Oxygen saturation is a term referring to the

fraction of oxygen-saturated hemoglobin relative
Monitor oxygen saturation.
to the total hemoglobin in the blood. Normal
oxygen saturation levels are considered 95-100%.
Monitor arterial blood gasses (ABG). During a mild to moderate asthma attack, clients
may develop respiratory alkalosis. Hypoxemia
leads to increased respiratory rate and depth,
and carbon dioxide is blown off. An ominous
finding is a respiratory acidosis, which usually
indicates that respiratory failure is pending and
that mechanical ventilation may be necessary.
THERAPEUTIC INTERVENTIONS
Fatigue is common with the increased work of

breathing from the ineffective breathing pattern.
Plan for periods of rest between activities.
Activity increases metabolic rate and oxygen
requirements.
This promotes maximum lung expansion and assists in

Maintain head of bed elevated.
breathing.
Pursed lip breathing improves breathing patterns by

Encourage client to use pursed-lip
moving old air out of the lungs and allowing for new air
breathing for exhalation.
to enter the lungs.
Common goals and expected outcomes:
 Patient will maintain optimal breathing pattern, as evidenced by

relaxed breathing, normal respiratory rate or pattern, and absence of
dyspnea.
Reference: https://nurseslabs.com/asthma-nursing-care-plans/

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COURSE TAK 5

Pediatric Respiratory Anatomy

 Recurrent Laryngeal Nerve-supraglottic larynx

 External branch of Superior Laryngeal Nerve-cricothyroid muscle.

 Laryngeal branches of the superior and inferior thyroid arteries.

Pediatric Respiratory Physiology

 Pulmonary surfactant produced by Type II pneumocystis at 24 wks. GA .

Asthma is a chronic inflammatory lung disease that causes airway

1. Ineffective Breathing Pattern

 Nursing Interventions and Rationales

Nursing Interventions Rationale

Increased BP, RR, and HR occur during the initial

Changes in the respiratory rate and rhythm may

Anxiety may result from the struggle of not being

Adventitious sounds may indicate a worsening

These indicate respiratory distress. Once the

Dyspnea during a normal conversation is a sign

Fatigue may indicate distress, leading to

Paradoxical pulse is an abnormally large decrease

Oxygen saturation is a term referring to the

Fatigue is common with the increased work of

This promotes maximum lung expansion and assists in

Pursed lip breathing improves breathing patterns by

Common goals and expected outcomes:

 Patient will maintain optimal breathing pattern, as evidenced by

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