Respiratory Assessment by Brienne Leary

Introduction

• Importance of adhering to WHO guidelines on hand hygiene and barrier precautions.
• Brienne Leary, a nurse in the pediatric ICU at Boston Children's Hospital.
• Focus on comprehensive respiratory system assessment and safe monitoring in pediatric ICU.

Importance of Respiratory Assessment

• Critical for critical care nurses in the ICU.
• Essential to obtain baseline and continuous monitoring.
• Two main components: Physical exam and non-invasive monitoring.

Comprehensive Respiratory Exam

• Three Key Parts: Look, Listen, and Feel.

Basic Terms

• Tachypnea: Fast breathing rate.
• Bradypnea: Slow breathing rate.
• Apnea: No breathing.
• Dyspnea: Difficulty in breathing.

Physical Exam

• Look:

  • General appearance and position of comfort.
  • Facial expressions indicating distress.
  • Skin color for signs of cyanosis.
  • Midline position of trachea.
  • Respiratory rate and pattern.
  • Signs of respiratory distress: Nasal flaring, head bobbing, retractions.
  • Chest and abdominal movements.
  • I to E ratio (inspiratory to expiratory ratio).

• Listen:

  • Without stethoscope: Stridor, congestion, type of cough.
  • With stethoscope: Compare right to left lung, check for wheeze, coarse breath sounds, crackles.

• Feel:

  • Tactile fremitus and crepitus.

Considerations for Intubated Patients

• Ensure endotracheal tube is secured and in the correct position.
• Check for patient comfort and synchrony with ventilator.
• Monitor for air leaks.

Emergency Preparedness

• Keep available: Oxygen source, emergency airway bag, appropriately sized mask, suction equipment.

Reassessment and Monitoring

• Continually reassess pediatric patients.
• Use continuous monitoring for breathing rate, effort, and distress.

Safe and Effective Monitoring

• Use appropriate lead placement for accurate readings.
• Monitor respiratory rate and oxygen saturation.
• Set alarm limits based on patient-specific parameters.
• Troubleshoot monitors for artifacts or dislodged leads.

Summary

• Utilize look, listen, and feel model for comprehensive assessment.
• Continuous monitoring is critical for patient safety and progression.

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