Respiratory Dysfunction in Children.pptfinal.ppt1 - Copy
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Transcript of Respiratory Dysfunction in Children.pptfinal.ppt1 - Copy
CHEST PT FOR NEONATES Aim to improve airway clearance Bronchial drainage- Increased diameter of airways through suction
mobilization- in creased ventilation- increased work of breathing
POSITIONAL ROTATION Frequent changing of position- prevents dependency of any one portion of
the lung Pooling of secretions can be limited/ avoided Improved ventilation (Menkes and Britt 1980) Should emphasize all lung areas Rt upper lobe, middle lower lobe common for Atelectasis
PREMATURE INFANTS TOLERATE AND BENEFIT PRONE POSITIONING○ Prone positioning in infants causes
Improved oxygenationTidal volumeDynamic lung complianceSynchrony of chest wall movement
Positional rotation done every two hours manually
Continuous positional oscillation in a chest physical therapy program decrease the duration of oxygen supplementation without adversely affecting the cardiopulmonary status of the neonates
POSITIONAL ROTATION
ESSENTIALS OF POSITIONAL ROTATION PROGRAM
Care should be taken to coordinate any change in the infants position with other nursing procedures to avoid unnecessary stimulation
Infants should never be left unattended when in a head down position
Vital signs should be monitored closely by respiration and heart rate monitors. the alarms should be turned on
The infants chest should be auscultated for adventitious breathe sounds after positioning
While the infant is in the drainage position, suctions will be more easily mobilized. the infant’s trachea or endotracheal tube should be suctioned as needed
Avoid placing the infant in a head down position for approximately one hour after eating to avoid aspiration of regurgitated food
Any change in the infants position should be done slowly to minimize stress on the cardiovascular system
Some infants might require modified drainage positions. infants with severe cardiovascular instability or suspected intracranial bleeding should not be placed in a head down position
SEQUENCE FOR POSITIONAL ROTATION POSITION 1: Segments that come off the left lower bronchus posteriorly are drained
by positioning the infant on the right side, three fourths prone with a head down angle
POSITION2: The post. segment of the Rt upper lobe is drained by positioning on the left side, three fourth,s prone with the bed flat
POSITION 3: The anterior segments of the upper lobe are drained by positioning supine with the head of the bed elevated or flat
POSITION 4: Segments that come of the right lower lobe bronchus posteriorly are drained by positioning on the left side, ¾ th prone with head down angle
POSITION 5: The posterior segment of the left upper lobe is drained by positioning on the right side, ¾ th prone with the head of the bed elevated
POSITION 6: Segments that come off the Tracheobronchial tree anteriorly will be drained in a supine position slightly head down angle
POSITION 7 AND 8: Segments such as the right middle lobe or Lingula that come off the tracheobronchial tree anterolaterally will be drained in a ¾ th spine position slightly head down
POSTURAL DRAINAGE Promote gravity assisted drainage of specific segmental airways Rule for modification- position close to the classical ( anatomically correct)
position for that segment Horizontal to slightly elevated position of the head may be best ( thoresan,
cowan,1998)
POSTURAL DRAINAGE
POSTURAL DRAINAGE
POSTURAL DRAINAGE
POSTURAL DRAINAGE
POSTURAL DRAINAGE
PRECAUTIONS FOR TRENDELENBERG POSITIONING
○ Abdominal distension○ Congestive heart failure○ Dysrhythmia’s○ Hydrocephalus○ Frequent episodes of apnea and bradycardia○ Acute resp. distress
CHEST PERCUSSION AND VIBRATION
Given together to augment effect of gravity removal of secretions For larger infants- cupped hand Smaller infants- some modification needed
↓ Use of tenting three fingers, four fingers or using
commercial available percussion devices made for neonates A small anaesthesia mask or palm cup can be used
PRECAUTIONS- Unstable cardiovascular oxygenation status, coagulability, subcutaneous emphysema, intraventricular haemorrhage
CONTRAINDICATIONS- Healing thoracotomy incision, child displays irritability, signs of resp. distress
VIBRATION- Manual vibratory motion of therapists fingers on the infants chest wall or using mechanical vibrator
Electric toothbrush adapted by padding bristle portion with foam ( Curran and Kachoyeanos, 1979)
PRECAUTION- Increased irritability with development of bradycardia and resp. distress
Use of chest percussion and vibration depend on medical condition of the infant, infants tolerance to handling
CHEST PERCUSSION
CHEST PHYSICAL THERAPY FOR CHILDREN( 2YRS OR OLDER) Capable of following directions- deep breathing, coughing, active exercise Improving ventilation, improving breathing efficiency, increasing general
strength, endurance with emphasis on muscles of resp. , improving posture, addressing relaxation, breathing control and pacing
POSITIONAL ROTATION Goal- prevent accumulation of secretions and to aid their removal Especially for children inactive, receiving artificial ventilation, not
expanding chest adequately○ Needs positional rotation every 2 hours
YOUNG CHILDREN (18 MON. TO 3 YRS) Deep breathing- blowing bubbles, paper, balloons, whistling For maximal chest expansion- child positional sidelying on each side while
playing blowing games
For child with inadequate coughing- nasopharynx suctioning
OLDER CHILDREN
Breathing exercises- purselip breathing Segmental lateral costal breathing Relaxed deep breathing for control and pacing activity Paediatric incentive spirometers available with cheerful/ cool pictures to
make respiratory exercises more like a game Firm pressure over trachea in suprasternal notch
PREOPERATIVE AND POST OPERATIVE CARE Preoperative assessment, instruction and treatment
○ Decrease postoperative complications
Parent and family education
Level of preoperative teaching depends on childs age
Child less than 2 yrs- parents explained purpose of bronchial drainage treatment, potential airway clearance problems, possible complications
Explain to parents the procedures after surgery○ Positioning○ Chest percussion○ Vibration○ Airway suctioning
If child able to understand○ Breathing games○ Incentive spirometer○ General upper and lower extremity exercises
Children 8 yrs or older○ Explain procedures, deep breathing, coughing○ Child shown to splint incision using pillows or stuffed animal to
assist comfort○ Diaphragmatic, pursed lip breathing with inspiratory hold
maneovre, incentive spirometer
CHILDREN AT RISK Preexisting lung disease Thoracic or upper abdominal location of the incision Prolonged postoperative bedrest of restricted mobility Neuromuscular involvement
POSTOPERATIVE TREATMENTS Increasing ventilation Coughing Active mobility Specific bronchial drainage Arm, shoulder, trunk movement encouraged to prevent post operative
complications Young child- chest mobility encouraged by clapping hands overheads Child should be active
PAEDIATRIC PULMONARY REHABILITATION
MOST COMMON- ASTHMA, CYSTIC FIBROSIS
EXERCISE AND ASTHMA○ Improved chest and trunk mobility○ Control of breathing○ Strength○ Posture○ Increased tolerance to exercise ( magee, 1970)
Child’s participation in physical education
Running in a cool dry environment aggravates exercise induces asthma
Swimming excellent activity
Continuous or high burst exercise○ Bronchospasm○ Short periods of exercise ( less than 6 continuous minutes) – beneficial for
conditioning without bronchial aggravation ( magee, 1991)
May need pre exercise aerosol to participate in pe without pulmonary consequences
EXERCISE Exercise tolerance helps to mobilize secretions in children
Exercise programme designed on individual basis
Preexercise assessment done Assessment of ROM, Strength and Posture Complete chest evaluation Evaluation of ADL tolerance and limitation Improving muscle strength and endurance testing Exercise tolerance testing performed with ECG, blood pressure, O2 monitoring
Basic exercise activities for children with cystic fibrosis Activities to strengthen the back, shoulder extensors Elongate trunk flexors Address overall endurance
Older children:An aerobic exercise programme require careful monitoring of pulmonary support during exercise
MOTOR APPROACHES TO MAXIMIZE TRUNK AND VENTILATORY FUNCTION
pulmonary development is clearly interrelated with musculoskeletal, motor development of the trunk
Approach to motor therapy to children with trunk weakness, tightness, alterations in tone, general immobility can
NDT approach has a dual focus on movement quality and ventilation
PROPRIOCEPTIVE INPUT ON POST. THORAX
○ Reinforces active thoracic extension and ant. chest expansion○ The therapists hands can stabilize the rib cage to reinforce abdominal
oblique function during movement○ Activities requiring alternating extension rotation and flexion rotation
will recruit control of the abdominal oblique and maintain upper trunk extension
BUBBLE BLOWING, WHISTLE TOYS AND SINGINGExcellent means of monitoring ventilatory changes that occur with active use of increased upper chest expansion
Tidal volume increases- vocalisation should increase frequency, sound higher and become louder
Functional carryover
THANK YOU