Peds, part 21: Respiratory Disorders - Respiratory Distress, BRUE/ALTE, SIDS
by Cathy Parkes December 28, 2021 Updated: August 10, 2023 4 min read
Hi, I'm Cathy with Level Up RN. In this video, I'm going to wrap up our coverage of pediatric respiratory disorders. Specifically in this video, I will be talking about respiratory distress and failure, as well as a brief resolved, unexplained event, which was previously known as an apparent, life-threatening event. And then we will wrap up our coverage by talking about SIDS. At the end of the video. I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering in this video, so definitely stay tuned for that. And if you have our Level Up RN pediatric nursing flashcards, definitely pull those out, so you can follow along with me.
First up, let's talk about respiratory distress and failure. This is where we have inadequate ventilation or oxygenation such that we end up with hypoxemia, which is where we have inadequate oxygenation of the blood. And this can lead to hypoxia, which is where we have insufficient oxygenation of the body's tissues. Respiratory distress or failure can be caused due to a respiratory disorder or infection. It can also be caused due to a central nervous system issue as well. Early signs of respiratory distress include restlessness and agitation. It can also include signs and symptoms of dyspnea, so difficulty with breathing, which can include grunting, nasal flaring, retractions, and use of accessory muscles. In addition, early signs will include tachypnea, tachycardia, pallor, as well as diaphoresis. If the inadequate oxygenation continues, then we can end up with the late signs of respiratory distress, which are going to be the signs of respiratory failure. This includes decreased level of consciousness, bradypnea, bradycardia, as well as cyanosis. In terms of labs, ABGs will show a decrease in the partial pressure of oxygen and an increase in the partial pressure of carbon dioxide. In addition, the patient will have a decreased oxygen saturation, so under 95%. In terms of treatment, we're going to want to secure the airway, provide oxygen, apply a CPAP or BiPAP, and then mechanical ventilation or CPR may be necessary as well.
All right. Next, let's talk about a brief, resolved, unexplained event, which back in 2016, the American Academy of Pediatrics recommended replacing the term, apparent life-threatening event, with a brief, resolved, unexplained event to underscore the fact that this is a transient event that is not life threatening. So during a brief, resolved, unexplained event, the infant will have the sudden onset of breathing difficulty, or they may have color changes such as pallor or cyanosis. They may have changes in their muscle tone. They may also have a decreased level of responsiveness. So these are all possible symptoms that may occur with a brief, resolved, unexplained event, and this pertains to an infant under the age of 12 months. So risk factors for this type of an event include a previous brief, resolved, unexplained event. It's also more common with premature infants and infants under the age of two months. In terms of diagnosis for low risk infants, then the provider will likely just observe the infant with pulse oximetry. For high-risk infants, then a workup will likely be done with an EKG and various diagnostic tests. In terms of treatment, it really involves outpatient observation by the guardian and then close follow-up with the primary pediatrician. In terms of family teaching, we want to reinforce sleep safety guidelines, which I'm going to talk about more when we talk about SIDS next. In addition, we don't want to have the infant exposed to smoke, and we want to advise the parent or guardian to get CPR training in the event that they would need this.
Let's just talk about sudden infant death syndrome or SIDS. This is the unexplained and unexpected death of an infant under 12 months of age, and the pathophysiology behind this event is unknown. However, we do know best practices for prevention of SIDS, and one of those key things is sleep safety. So we have a cool chicken hint here on the card, which is the ABCs of safe sleep. So this includes placing the baby alone on their back in a crib. We also want to make sure the mattress is firm and we're not placing any toys or loose blankets in there with the baby. It's also been shown that pacifier use, as well as breastfeeding, are protective against SIDS. Smoke exposure is a risk factor for SIDS, so we want to make sure there's no smoke exposure during pregnancy and after birth of the baby. In addition, we want to make sure mom receives prenatal care during pregnancy, and after birth, the baby receives routine health checkups as well as their immunizations. That will be protective against SIDS as well. In terms of nursing care, we're going to, of course, use therapeutic communication when caring for the families who have lost their baby. And we also want to facilitate referrals to mental health services as well as support groups.
All right, it's time for a quiz. With this quiz, I'm going to do things a little differently. During round one, I'm going to give you a symptom, and I want you to tell me whether that symptom is an early or late sign of respiratory distress. You guys ready? First symptom is agitation. That's an early sign. Bradypnea. That is a late sign. Decreased level of consciousness. That's a late sign. Tachycardia. That's an early sign. Cyanosis. That is a late sign. Okay. I hope you did well there with round one. During round two, I'm going to give you an item or factor. I want you to tell me whether it increases or decreases the risk for SIDS or sudden infant death syndrome. You guys ready? The first is pacifier use. That decreases the risk of SIDS. Breastfeeding. That also decreases the risk of SIDS. Smoke exposure. That increases the risk for SIDS. And placing the baby on their back for sleep. That decreases the risk for SIDS. Okay. I hope this video was helpful. Hope you enjoyed that quiz too. Take care and good luck with studying. All right. It's quit [inaudible]. Sorry.
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