WEEKLY ASSIGNMENT 4 – PRACTICAL RESPIRATORY SYSTEM
(PAEDIATRICS)
Name: Ruth Mwanza
SIN: 20157653
A. INSPECTION OF THE RESPIRATORY SYSTEM IN PAEDIATRICS
1. 1. Key aspects to observe during inspection
• General appearance: alertness, posture
• Respiratory rate and rhythm
• Pattern of breathing
• Work of breathing: nasal flaring, retractions, tracheal tug
• Symmetry of chest movement
• Accessory muscle use
• Audible sounds: stridor, wheeze
• Color: cyanosis
• Cough: quality and frequency
• Chest shape or deformities
2. 2. Asymmetrical chest movement
• Indicates unequal ventilation
Causes: consolidation, collapse, effusion, pneumothorax
• Diaphragmatic paralysis
• Post-surgical changes or airway obstruction
3. 3. Significance of nasal flaring
• Sign of increased work of breathing
• Reduces nasal airway resistance
• Early marker of hypoxemia and respiratory distress in infants
4. 4. Intercostal and subcostal retractions
• Inward movement of chest wall during inspiration
• Due to negative intrathoracic pressure
• Signify severe respiratory distress
• Common in asthma, pneumonia, bronchiolitis
5. 5. Cyanosis during inspection
• Bluish discoloration of lips, tongue, nail beds
• Central cyanosis: hypoxemia
• Peripheral cyanosis: poor circulation
• Indicates severe respiratory or cardiac disease
6. 6. Importance of observing chest shape
• Barrel chest: chronic asthma, hyperinflation
• Pectus excavatum/carinatum: congenital deformities
• Harrison sulcus: rickets
• Scoliosis/kyphosis: restrictive lung disease
7. 7. Audible stridor during inspection
• Indicates upper airway obstruction
• Inspiratory: laryngomalacia, epiglottitis
• Biphasic: subglottic stenosis, foreign body
• Expiratory: intrathoracic tracheal obstruction
B. PALPATION OF THE RESPIRATORY SYSTEM IN PAEDIATRICS
8. 1. Purpose of palpation
• Assess chest expansion
Evaluate tactile fremitus
• Identify tracheal position
• Check for tenderness or subcutaneous emphysema
• Confirm inspection findings
9. 2. Chest expansion assessment
• Hands placed symmetrically on chest wall
• Thumbs at midline
• Observe equal movement during deep breaths
• Reduced expansion = collapse, effusion, pneumothorax
10. 3. Tactile fremitus assessment
• Palpable vibrations during phonation/cry
• Assessed with ulnar side of hand
• Compare both sides at same level
11. 4. Reduced/absent tactile fremitus
• Pleural effusion
• Pneumothorax
• Airway obstruction
• Thick chest wall/obesity
12. 5. Tracheal deviation
• Palpate at suprasternal notch
• Deviation away: pneumothorax, effusion
• Deviation toward: collapse, fibrosis
13. 6. Differences in palpation between adults and children
• Gentler pressure required
• Smaller chest surface area
• Less cooperation
• Modify hand placement
• Short repeated assessments
14. 7. Assessing for tenderness
• May indicate rib fracture, costochondritis
• Suggests pleuritic pain in pneumonia
• Helps differentiate chest wall pain vs lung disease
C. PERCUSSION OF THE RESPIRATORY SYSTEM IN PAEDIATRICS
15. 1. Purpose of percussion
• Assess lung density and air content
• Detect consolidation, effusion, pneumothorax
• Outline diaphragm level
16. 2. Percussion technique
• Tap middle finger on finger placed in intercostal space
• Compare side to side
• Gentle taps in children
• Move from apex to base
17. 3. Key percussion notes
• Resonant – normal lung
• Dull – consolidation, collapse
• Stony dull – pleural effusion
• Hyperresonant – pneumothorax
18. 4. Challenges of percussion in children
• Small chest size
• Thin chest wall – sound transmits widely
• Poor cooperation
• Crying distorts findings
19. 5. Pneumonia vs pneumothorax percussion findings
• Pneumonia: dull note
• Pneumothorax: hyperresonant note
20. 6. Percussion in pleural effusion
Stony dull note over effusion
Upper level may form meniscus
Helps localize effusion
21. 7. Precautions in percussion
Gentle tapping
Avoid bony areas
Compare bilaterally
Keep child comfortable
D. AUSCULTATION OF THE RESPIRATORY SYSTEM IN PAEDIATRICS
22. 1. Importance of auscultation
Assess air entry
Detect abnormal breath sounds
Differentiate upper vs lower airway disease
Monitor disease progression
23. 2. Normal breath sounds in children
Vesicular breath sounds which are
Louder and harsher than adults
• Symmetrical air entry
• Inspiration longer than expiration
24. 3. Wheezes in children
Continuous, musical sound
Caused by narrowed airways
Seen in asthma, bronchiolitis, viral infections
25. 4. Fine vs coarse crackles
• Fine crackles: high-pitched, end-inspiratory seen in pneumonia/interstitial disease
• Coarse crackles: low-pitched, bubbling, Seen in bronchitis/bronchiectasis
26. 5. Stridor in children
• Harsh inspiratory sound
• Indicates upper airway obstruction
• Seen in croup, epiglottitis, foreign body
27. 6. Differentiate URTI vs LRTI on auscultation
• URTI: normal lung sounds with transmitted noises, stridor possible
• LRTI: crackles, wheezes, bronchial breathing, reduced air entry
28. 7. Precautions in auscultation
• Warm stethoscope
• Quiet environment
• Auscultate on bare skin
• Use paediatric chest piece
• Do a Systematic approach
E. INVESTIGATIONS OF THE RESPIRATORY SYSTEM IN PAEDIATRICS
29. 1. Role of chest X-ray
• Identifies pneumonia, collapse, effusion, pneumothorax
• Detects congenital anomalies
30. 2. Importance of pulse oximetry
• Non-invasive oxygen saturation monitoring
• Detects hypoxemia
• Guides oxygen therapy
31. 3. Full blood count in respiratory infections
• Neutrophilia: bacterial infection
• Lymphocytosis: viral infection
• Eosinophilia: allergy/asthma
32. 4. Sputum analysis in children
• Used in older children
• Helps diagnose TB, chronic infections
33. 5. Significance of ABG analysis
• Assesses oxygenation (PaO2)
• Assesses ventilation (PaCO2)
• Assesses acid-base balance
34. 6. Nasopharyngeal aspirate use
• Detects viral infections (RSV, influenza)
• PCR/antigen tests
35. 7. Role of CT scan
• Detailed chest imaging
• Bronchiectasis
• Congenital malformations
• Tumors
36. 8. Why bronchoscopy is performed
• Foreign body removal
• Assess airway abnormalities
• Diagnostic lavage
37. 9. Mantoux test use
• Detects TB infection
• Indicates latent or active infection
38. 10. Lung function testing in children
• Not reliable <5 years
• Older children: spirometry, peak flow
• Used to monitor asthma