apnea of infants, apparent life-threatening event, respiratory failure
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APNEA OF INFANCY
Reported by:
Agripo, Kenje Kate T.
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> Generally refers to pathologic apnea in
infants of more than 37 weeks of gestation.
> Temporary absence or cessation of breathing
for 20 sec. or more
APNEA OF INFANCY
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Causes:
Direct depression of the central nervous system'scontrol of respiration
- hypoglycemia, meningitis, drugs, hemorrhage, seizures
Disturbances in oxygen delivery
- shock, sepsis, anemia
Ventilation defects-pneumonia, RDS , PPHN, muscle weakness
APNEA OF INFANCY
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Diagnostic test:1) Cardiopneumogram
- continuous recording of cardiorespiratory patterns
2) Four-channel pneumocardiograms- monitor heart rate, respirations, nasal airflow & oxygensaturation
3) Polysomnography
- sleep study,records brain waves, eye & body movements,
esophageal manometry
APNEA OF INFANCY
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Diagnostic test:1) Cardiopneumogram
- continuous recording of cardiorespiratory patterns
2) Four-channel pneumocardiograms- monitor heart rate, respirations, nasal airflow & oxygensaturation
3) Polysomnography
- sleep study,records brain waves, eye & body movements,
esophageal manometry
APNEA OF INFANCY
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Types of Apnea:1) Obstructive Apnea
- is charac. by absent airflow but persistent chest wall motion
- is caused by an obstruction of the airway (such as enlarged
tonsils and adenoids).
- The respiratory efforts are absent
TREATMENT:
-Keep the throat open to aid air flow such as withadenotonsillectomy
-continuous positive airway pressure (CPAP), which isdelivered by having the child wear a nose mask while sleeping.
APNEA OF INFANCY
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Therapeutic Management:
Continuous home monitoring of cardiorespiratory
rhythms
Use of Methylxantines
Infant is apneic, stimulate the trunk by patting or
rubbing it. Infant is prone position, turn to the back and flick the
feet
APNEA OF INFANCY
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ADPIE
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ASSESSMENT-Cessation respirations longer than 20 secs.
-Cyanosis
-Nasal Flaring
-Pallor
-Fatigue
-Bradycardia-Hypoxia
-Low Oxygen level detected
-Low Respiratory movement
DIAGNOSISo Ineffective breathing pattern; Cyanosis related
to immaturity mechanisms secondary to apnea
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PLANNING
o After 4 hours of nursing intervention the patient will be able to:
Attain normal respiration as evidenced by absence of cyanosis
INTERVENTIONS
Gently flick the sole of the foot
Maintain a neutral thermal environment
Do suctioning and always suction gently Prepare rescusitive equipment
Administer indwelling nasogastric tubes as ordered
Administration of Methylxantines as prescribed by the
doctor
EVALUATION
o After 4 hours of nursing intervention the patient was able to:
Attain normal respiration as evidenced by absence of cyanosis
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Reported by:
Agripo, Kenje Kate T.
Apparent Life-Threatening
Events
(ALTEs)
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Apparent Life-Threatening Events
- The clinical presentation with a combination of
apnea and change in color, change in muscle
tone, choking, or gagging.
- Cardiomyopathy incidence but child looks
normal
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Apparent Life-Threatening Events
Factors:Seizures
Sepsis
High-risk infants
Respiratory tract infection
Causes:Viral infection
Airway blockage
Diagnostic Test: Physical Examination
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ADPIE
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ASSESSMENT-Apnea
-Nasal Flaring
-Cyanosis
-Pallor
-Poor muscle tone
DIAGNOSISoAltered breathing pattern; Apnea related to
respiratory muscle fatigue
PLANNINGAfter 4 hours of nursing intervention the patient will be
able to:
Maintain normal breathing pattern as evidenced
by no use accessory muscles in breathing.
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INTERVENTIONS
Maintain a neutral thermal environment
Position patient with proper alignment
Do suctioning and always suction gently
Elevate the head of bed
Perform CPR in emergency casesMonitor pulse oximetry
EVALUATION
o After 4 hours of nursing intervention the patientwas able to:
Maintain normal breathing pattern as evidenced
by no use accessory muscles in breathing.
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Reported by:
Agripo, Kenje Kate T.
RESPIRATORY FAILURE
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Respiratory Failure
- The inability of the respiratory apparatus tomaintain adequate oxygenation of the blood, withor without carbon dioxide retention
- This process involves pulmonary dysfunction thatgenerally results in impaired alveolar gas exchange,which can lead to hypoxemia or hypercapnia
- Clinical manifestations are nonspecific and areaffected by variations among individual patientsand differences in the severity.
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Respiratory Failure
Clinical Manifestations of Respiratory Failure:Cardinal Signs:
-Restlessness -Tachypnea
-Tachycardia -Diaphoresis
Early but less obvious signs:
- Headache -Wheezing
- Hypertension - Exertional dyspnea
- Anorexia - Increase cardiac output
- Nasal flaring - Chest wall retractions
- Expiratory grunting
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Respiratory FailureClinical Manifestations of Respiratory Failure:
Signs of more severe hypoxia
-Hypotension or hypertension - Bradycardia
-Depressed respirations - Coma
-Dimness of vision -Dyspnea
Types:
1) Type I (Hypoxemic Respiratory Failure)-Decrease oxygen
2) Type II (Hypercornic Respiratory Failure)
-Decrease carbon dioxide
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Respiratory Failure Treatment:
Specific Therapy
- Directed toward reversal of the causative factors
Non-Specific Therapy
- Non-specific measure needed to maintain oxygenation and
enhance carbon dioxide removal until specific methods take
effect
- Major reasons for implementing Non- Specific Treatment:
1)Unknown etiology
2) Lack of specific treatment for a known cause
3) Lack of time for specific methods to take effect
4) . Need for specialized personnel or equipment for
specific treatment
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ADPIE
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ASSESSMENT- Nasal Flaring - Restlessness
- Cyanosis - Tachypnea
- Dyspnea - Tachycardia
- Diaphoresis - Wheezing
DIAGNOSIS
o Impaired gas exchange; Dyspnea related topulmonary dysfunction secondary to distress
PLANNING
After 4 hours of nursing intervention the patient will
be able to:
Maintain Normal breathing pattern as evidenced
by normal skin color and absence of cyanosis.
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INTERVENTIONS
Provide a neutral environment
Administer Oxygen Therapy as ordered
Proper positioning of the patient
Do suctioning and always suction gently
Monitor arterial blood gas appropriately
EVALUATION
o After 4 hours of nursing intervention the patient wasable to:
Maintain Normal breathing pattern as evidenced
by normal skin color and absence of cyanosis.