Overview
The Airway Problem
A 10 week old, after repair of oesophageal atresia and tracheo oesophageal fistula, is on the paediatric unit for noisy breathing.
NCLEX-RN
NCLEX-RN
A 10-week-old, after repair of oesophageal atresia and tracheo-oesophageal fistula, is on the paediatric unit for noisy breathing. During feeds and crying the nurse hears a harsh noise on breathing out that fades within a minute once the infant is calm. At rest the respiratory rate is 44 breaths/min and oxygen saturation is 97%; during a feed saturation falls to 91% with brief dusky colour around the mouth. A nebulized bronchodilator given yesterday made no audible difference. Clinical priority: a trigger-dependent expiratory noise with desaturation in this infant suggests dynamic airway collapse rather than asthma. Protect oxygenation first, then report the pattern so the airway team can confirm the cause. By the end of this lesson the nurse will be able to: - Explain why the airway narrows when pressure outside the trachea exceeds pressure inside it. - Recognize the trigger pattern of tracheomalacia and distinguish it from asthma. - Identify the findings that make an episode an emergency and state the first actions. - Describe how dynamic bronchoscopy and dynamic CT show the collapse, and why the percentage of...
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