RESP 4106 Neonatal And Pediatric Pathophysiology For The Critical Care Therapist

RESP 4106 Neonatal and Pediatric Pathophysiology for the Critical Care Therapist

The concept of \”Early Goal-Directed Therapy\” for the management of septic shock took off with an article in 2001 by Rivers et al in the New England Journal. It was quickly adopted and led to the Surviving Sepsis Campaign and became a mainstay of Sepsis management in the ICU and ER. I have posted River\’s article link below. I have also posted an article related to pharmacologic management of pediatric patients with Sepsis. Please discuss the management of septic shock from either the neonatal or pediatric perspective.

Management of Pediatric Septic shock.

Septic shock is defined as the presence of hypotension despite fluid resuscitation in the presence of sepsis. Patients with septic shock can present with tachycardia, cold extremities, hypovolemia, weak pulses, lactic acidosis, tachypnea, and cardiovascular pressure (Armstrong et al., 2017). Furthermore, multiple organ failure may presume if left untreated leading to death.

Management is done in a stepwise manner to alleviate symptoms, restoration of intravascular volume, clearance of infectious agents, and prevention of complications. Central venous access and intraosseous are the preferred routes in shock. Notably, the first-line treatment is fluid, antibiotics, and vasopressors.

In fluid resuscitation, crystalloids are the preferred fluids. An initial bolus of 20mls/kg is given over 10 minutes (Kim et al., 2018). Vitals including capillary refill, urine output, blood pressure, and peripheral pulses are monitored for improvement. However, colloids such as albumin may be used for initial fluid resuscitation. Moreover, oxygen therapy should be initiated to improve tissue oxygen concentration.

Secondly, the infectious agent must be addressed. A broad-spectrum antibiotic is started empirically to cover the infectious agent while blood cultures are taken for confirming the causative organism. When gram-negative bacteria are suspected, combination therapy may be initiated. Nonetheless, aminoglycosides, beta-lactams, vancomycin, and fluoroquinolones are preferred first-line treatments (Kim et al., 2018). Also, antifungals may be given in fungi infection. Intravenous medications are preferred for the first three days while monitoring the patient.

In addition, inotropes and vasopressors are used to stabilize cardiac function and prevent hypoperfusion to major organs. Examples include epinephrine, vasopressin, norepinephrine, and dobutamine (Marroyln et al., 2012). Vasopressors increase blood pressure, improve perfusion, increase cardiac output, and augment venous return. On the other hand, inotropes increase oxygen delivery while improving cardiac output.

Steroids such as hydrocortisone are used in septic shock to suppress cytokine production and improve cardiac sensitivity to catecholamines essential in improving cardiac output and urine output. Steroids are also useful in correcting adrenal insufficiency that comes with septic shock. Finally, hyperglycemia that follows septic shock should be treated with insulin while monitoring glucose levels.

References

Armstrong, B. A., Betzold, R. D., & May, A. K. (2017). Sepsis and septic shock strategies. The Surgical Clinics of North America, 97(6), 1339–1379. https://doi.org/10.1016/j.suc.2017.07.003
Kim, K., Choi, H. S., Chung, S. P., & Kwon, W. Y. (2018). Septic Shock. In Essentials of Shock Management (pp. 55–79). Springer Singapore.
Marroyln L. Simmons, PharmD, MS, BCPS Spencer H. Durham, PharmD, BCPS Chenita W. Carter, Phar. (2012). Pharmacological Management of Pediatric Patients With Sepsis. Accessed from https://zdocs.tips/doc/jurnal-antibiotik-sepsis-pada-anak-j1jn8ygykmpe

RESP: 4106 Case Study

Please read the following case study and answer the questions following each part of the case study.
You are required to provide an additional reference besides your textbook to answer these questions. Please answer the questions thoroughly in a 1-page double-spaced word document. Please cite references using APA format.

RESP: 4106 Flowchart

Your second flowchart should describe important pathophysiological changes in the disease process you have chosen. For the second flowchart, you should work to describe key pathology changes associated with your chosen condition; emphasis should include breakdown that occurs in the system/organ as it progresses to the diseased state down to the cellular level.

please make this a professional flow chart. I am attaching the 1st part that I did with my team. I need the second part done according to the 1st. they do not have to be combined as these are two different assignments.

RESP: 4106 Neonatal Pediatric Patients

This Discussion Forum will address neonatal or pediatric patients who are difficult to wean from mechanical ventilation. The student will post a comment on some aspect of this problem with support from personal or institutional experience or a citation from the literature to substantiate their statement.

This is a multifaceted problem, so any aspect is fair game. Topics might include but are not limited to psychologic preparation, pharmacologic support, respiratory muscle training, ventilatory modes, nutrition, the role of tracheostomy, and pitfalls of any kind.

Weaning Pediatric Patient from Mechanical Ventilation Example

Mechanical ventilation is a critical and lifesaving intervention for the management of respiratory failure in pediatric patients. However, mechanical ventilation has been linked with menacing complications such as ventilator-induced lung injury and nosocomial infections (Newth et al., 2020). Similarly, endotracheal tubes (ETT) are intolerable to pediatric patients necessitating the need for sedatives. Positive pressure ventilation further contributes significantly to cardiovascular instability due to heart-lung interactions (Saeed & Lasrado, 2021). The challenges necessitate prompt discontinuation of mechanical ventilation as soon as the patient is capable of sustaining spontaneous ventilation.

Nevertheless, weaning pediatric patients from mechanical ventilation is often a challenge due to limited guidelines on weaning and extubation from pediatric literature. According to Newth et al. (2020), premature extubation resulting in emergent reintubation is correlated with increased morbidity and mortality.

Successful extubation is followed suit by several supportive interventions. This piece of writing focuses on ventilatory modes and nutritional support after extubation. Immediately after extubation, spontaneous breathing on continuous positive airway pressure (CPAP) should be considered. CPAP increases functional residual capacity and maintains the small airways (Saeed & Lasrado, 2021). Adequate oxygenation should be ensured throughout and if feasible, the child should be in a sitting position.

On the other hand, most of these patients are usually on parenteral feeding or enteral feeding on a nasogastric tube. Transitioning to oral feeds should be careful and smooth from liquids to solids. In high-risk patients, enteral feeding via a nasogastric tube can be continued until the child can swallow or tolerate oral feeds. In conclusion, weaning a pediatric patient from mechanical ventilation is a multifactorial process that requires attention from multiple patient care team members and careful assessment to avoid weaning and extubation failures.