Now we're going to compare respiratory
distress versus respiratory failure.
In respiratory distress, your child
is able to maintain their oxygenation
by increasing their work of breathing.
In respiratory failure,
the child can no longer compensate
for the inadequate oxygenation
despite their increased
respiratory rate and effort.
This child is at risk for circulatory
and respiratory system collapse.
Signs and symptoms of respiratory
distress include tachypnea,
so an increased respiratory rate.
The child does this to compensate.
The child may have the nasal
flaring and pursed lips,
and this is an attempt to move
more air into the system.
The child may have stridor or wheezing
as the airway is beginning to tighten.
They may have an altered mental
status, and they may be agitated.
These children are getting air hungry.
Their heart rate is going to increase
to spread the blood faster
throughout the body,
and they're going to start with
a delayed capillary refill
due to the distal vasoconstriction.
When a child progresses
to respiratory failure,
you're going to see their respiratory
rate significantly increase.
And this number says 60, but remember,
that's going to vary based
on the patient's age.
The patient will begin retracting,
and we saw that this can progress
from mild to moderate to severe,
based on the locations.
The child may start grunting, and
their skin may look mottled.
Remember, this is the
vasoactivity that's beginning.
The child may have some head bobbing,
and this is as their state of
alertness begins to suffer.
They're going to become even more air hungry,
and their heart rate is going to decrease,
and this shows that they're not
really compensating very well.
If there's not an immediate intervention,
your patient can progress
to respiratory arrest.
This is where the patient's
respiratory rate will decrease.
They will have inefficient respirations,
and the patient may become
cyanotic and grey.
The patient will stop moving air.
Here's an example of a
respiratory status scoring tool.
Now, wherever you work, there's going to
be different models that you can use,
and you will assign points
based on your patient.
This gives the clinician an objective way
to see if their patient's
improving or declining.
It's also good to use at
the end of shift report
to see if your patient's
doing better or worse.
Here's an example on the right of points
assigned based on respiratory rate.
This will give the child either
1, 2 or 3 points.
Next, there will be a chart based on the
presence and location of retractions,
and the child will also get
points based on this.
Next, you'll check for the presence of
dyspnea and assign points accordingly.
Finally, the points will be assigned
according to the findings on
the auscultation exam,
and the total will let the clinician know
the patient's respiratory status score.