Oxygenation & Gas Exchange
A 2-year-old with bronchiolitis has nasal flaring and retractions. What is your priority nursing action?
Apply oxygen via nasal cannula.
Signs of increased work of breathing mean oxygen demand is not being met. Early oxygen prevents deterioration.
Why are infants more vulnerable to dehydration during respiratory illnesses?
They have higher metabolic rates and greater insensible fluid losses.
Small fluid reserves mean dehydration develops quickly with fever/tachypnea.
What is the correct way to use a spacer with an inhaler for a 6-year-old?
Shake, attach, breathe in slowly, hold for 10 sec.
Spacer improves medication delivery to lungs.
What position promotes best oxygenation in an infant with respiratory distress?
Semi-Fowler’s or upright.
Gravity expands lungs, improving ventilation.
Which child should the nurse see first?
A) 10-year-old with mild wheezing
B) 6-year-old with pneumonia and O₂ sat of 88%
C) 2-year-old with cough and nasal congestion
D) 4-year-old with asthma using albuterol MDI
B) 6-year-old with pneumonia and O₂ sat of 88%
Rationale: Severe hypoxemia (88%) is the most life-threatening.
Why do infants in respiratory distress tire more quickly than older children?
They rely on the diaphragm and have weaker accessory muscles.
Infants have underdeveloped intercostals; once fatigued, respiratory failure occurs rapidly.
A 3-year-old with pneumonia is receiving IV fluids. The nurse notes decreased urine output, edema, and crackles in the lungs. What is the most likely cause?
Fluid overload.
Children’s smaller fluid requirements mean IV fluids must be carefully titrated. Excess fluids in respiratory illness can worsen pulmonary edema and impair oxygenation.
How should a parent suction a baby’s nose at home with a bulb syringe before feeding?
Squeeze before inserting, release gently, clear one nostril at a time.
Prevents forcing mucus deeper or causing trauma.
Why should you never give cough syrup with codeine to a young child with pneumonia?
Risk of respiratory depression.
Opiates suppress breathing, worsening gas exchange.
A child with croup has inspiratory stridor, retractions, and is drooling. What is the priority action?
Call provider and prepare for airway management.
Drooling + stridor may indicate epiglottitis; airway must be secured immediately.
In an asthma attack, explain why wheezing may suddenly stop and what this means.
It indicates severe airway obstruction.
No air movement = silent chest, a life-threatening sign of impending respiratory failure.
An infant with bronchiolitis has been NPO due to respiratory distress. Labs show Na⁺ 128 mEq/L. What is the priority nursing action?
Notify the provider and anticipate IV sodium replacement.
Hyponatremia (<135) is dangerous in infants because it can cause seizures. Correction must be cautious but prompt.
Teach a parent how to identify early signs of respiratory distress in their toddler with asthma.
Increased RR, retractions, nasal flaring, wheezing.
Early recognition prevents status asthmaticus.
A child with croup develops stridor at rest. What is the safest immediate nursing intervention?
Administer racemic epinephrine.
Stridor at rest = severe airway obstruction; epinephrine reduces swelling.
You are caring for 3 patients. Who is at greatest risk for rapid deterioration?
A) RSV infant with nasal flaring
B) 7-year-old with pneumonia and fever 102°F
C) 9-year-old with asthma using inhaler before recess
A) RSV infant with nasal flaring
Infants deteriorate quickly due to small airway and fatigue risk.
A child with pneumonia has an SpO₂ of 86% on room air. What intervention should be done first?
Apply oxygen.
Airway/oxygenation always comes before antibiotics or fluids in acute hypoxemia.
In cystic fibrosis, why do patients often require salt supplementation?
They lose excessive sodium and chloride in sweat.
Defective chloride channels cause salty sweat, leading to hyponatremia risk.
What home safety change should parents make for a child with asthma who lives with smokers?
Eliminate all smoke exposure.
Smoke is a strong trigger and worsens outcomes.
You are preparing a toddler with RSV for suctioning. What safety equipment must be available at the bedside?
Suction setup and oxygen.
Children desaturate quickly; oxygen must be ready post-suction.
A child with asthma is receiving albuterol but continues to deteriorate. What is the next priority nursing action?
Notify provider; anticipate systemic corticosteroids.
If bronchodilator fails, steroids reduce inflammation and prevent respiratory failure.
Explain how cystic fibrosis alters gas exchange at the alveolar level.
Thick secretions obstruct airflow, trapping CO₂ and reducing O₂ exchange.
Mucus plugs prevent ventilation of alveoli, leading to V/Q mismatch and chronic hypoxemia.
How does excessive insensible fluid loss occur in respiratory distress?
Rapid breathing increases water loss through the lungs.
Tachypnea causes evaporation with each breath.
A parent says, “I don’t give my child vaccines because we never get sick.” How should you respond?
“I hear your concern. Can I share how vaccines protect children before they get sick?”
Therapeutic communication builds trust and opens space for education.
Why is it unsafe to administer excess oxygen to a child with chronic lung disease?
It may suppress their hypoxic drive to breathe.
Some rely on low O₂ as a stimulus; too much oxygen depresses respirations.
You enter a room and see a 1-year-old with grunting, nasal flaring, and head bobbing. What are your first three interventions in order?
(1) Apply oxygen, (2) Position upright, (3) Call provider/prepare for advanced airway.
Airway and oxygen are always first; escalation follows stabilization.