Respiratory Distress vs. Respiratory Failure (Pediatric Nursing)

00:01 Now we're going to compare respiratory distress versus respiratory failure.

00:04 In respiratory distress, your child is able to maintain their oxygenation by increasing their work of breathing.

00:12 In respiratory failure, the child can no longer compensate for the inadequate oxygenation despite their increased respiratory rate and effort.

00:20 This child is at risk for circulatory and respiratory system collapse.

00:25 Signs and symptoms of respiratory distress include tachypnea, so an increased respiratory rate.

00:31 The child does this to compensate.

00:34 The child may have the nasal flaring and pursed lips, and this is an attempt to move more air into the system.

00:40 The child may have stridor or wheezing as the airway is beginning to tighten.

00:45 They may have an altered mental status, and they may be agitated.

00:49 These children are getting air hungry.

00:52 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.

01:03 When a child progresses to respiratory failure, you're going to see their respiratory rate significantly increase.

01:09 And this number says 60, but remember, that's going to vary based on the patient's age.

01:13 The patient will begin retracting, and we saw that this can progress from mild to moderate to severe, based on the locations.

01:21 The child may start grunting, and their skin may look mottled.

01:23 Remember, this is the vasoactivity that's beginning.

01:29 The child may have some head bobbing, and this is as their state of alertness begins to suffer.

01:34 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.

01:43 If there's not an immediate intervention, your patient can progress to respiratory arrest.

01:48 This is where the patient's respiratory rate will decrease.

01:51 They will have inefficient respirations, and the patient may become cyanotic and grey.

01:59 The patient will stop moving air.

02:03 Here's an example of a respiratory status scoring tool.

02:06 Now, wherever you work, there's going to be different models that you can use, and you will assign points based on your patient.

02:12 This gives the clinician an objective way to see if their patient's improving or declining.

02:16 It's also good to use at the end of shift report to see if your patient's doing better or worse.

02:21 Here's an example on the right of points assigned based on respiratory rate.

02:25 This will give the child either 1, 2 or 3 points.

02:29 Next, there will be a chart based on the presence and location of retractions, and the child will also get points based on this.

02:36 Next, you'll check for the presence of dyspnea and assign points accordingly.

02:40 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.