respiratory infection in baby

[littlemissradiant]

I wonder what the clinical signs would look like for a nurse in a 4 month old baby with an increased respiratory effort in a 4 month old baby? If O2 was 94% and unable to breastfeed due to shortness of breath and being very sleepy and uninterested in surroundings with RR=48bpm, HR=162bpm febrile @ 38.6C. Baby is irritable and not feeding and parents haven't supplied the data of when and how much baby last breastfed.

Temperature affects heart rate and respiratory rate and then oxygen saturations. I suspect upper respiratory tract infection and dehydration due to not feeding. Is this reasonable?

[Double-Helix, BSN, RN]

I'm not entirely sure what you're asking? The assessment you have is consistent with respiratory distress, but you're missing some important information: what does the breathing look like? Are their retractions, accessory muscle use, see saw breathing? What do the lungs sound like? Is there a cough? Secretions? Hydration in an infant is also assessed by capillary refill, urine output, skin turgor, the fontanel, moisture of mucous membranes and tear production. Any lab results to consider?

What does the upper airway sound like? Drainage, secretions, requiring suctioning? Babies are strongly preferential nose breathers, but if the nose is congested they can breath through their mouth. But they need their mouth for eating. If the baby can't breathe through his nose and you put a bottle in his mouth, he can't suck and swallow because he can't breathe. Therefore he won't eat.

Fever would affect heart rate and respiratory rate, but not oxygen saturation. If the infant were able to adequately oxygenate, the saturations would increase with tachypnea. That sats are low because the baby can't get in adequate oxygen. If the child has a URI, as you suspect, it's preventing adequate air entry, which is decreasing the oxygen saturation. What could you do to help this child?

[littlemissradiant]

Ok Here is a case study I have contemplated....

Baby G is 4 months old, born full-term weighing 7ks. Parents present to ED as Baby G is irratible, not feeding well (breast-fed infant) and has nasal discharge. (No colour or consistency described). Baby G appears very sleepy and is not interested in her surroundings. Temperature is 38.6C, pulse 162 bpm and respiratory rate 48bpm with oxygen 94%.

a) Abnormal vital signs and symptoms that Baby G is exhibiting are:

Temperature 38.6°C, Pulse = 162bpm, Respirations = 48bpm with symptoms of nasal discharge, not feeding well (breast fed infant) and is irritable in mood and very sleepy not interested in her surroundings.

As Baby G's T of 38.6C may not always correlate with a serious underlying condition it would signal to a nurse to do further investigations to determine why the T would be that. A pausity of literature states that once a Temp is over 38.3C it may indicate an underlying infection or illness but the human body being a remarkable thing it could be that the body is working hard to fight the cause of the fever such as a viral infection.

Then the Baby G was described by the triage nurse as having increased respiratory rate. What physical signs from limited data above could indicate this as a clinical finding? Not much I sus[ect other than O2 94%, increased RR, HR and Temp. What does anyone think?