Early signs of respiratory distress in pediatrics

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Hi all,

I'm hoping for some guidance on the following question:

The nurse is caring for a 12-year-old child with pneumonia. Which of the following signs or symptoms would indicate early respiratory distress?

A. Restlessness

B. Substernal retractions

C. Heart rate 88, respiratory rate 20

D. Inspiratory and expiratory wheezing

I ruled out B as that would be a late sign, not an early one.

I ruled out C because HR and RR would be elevated. A child that age has similar normal vitals to an adult so this would not be correct.

That leaves A and D.

I know that an early sign in very young children, such as infants and toddlers, is restlessness. However, I'm not sure about a child that age.

I wasn't sure about D because while you would suspect inspiratory wheezing, I thought expiratory wheezing was a more later sign (because it takes more effort to exhale...and when you have to exert all that effort, it's later).

However, every resource I've found has listed both restlessness/changes in mental status and wheezing as early signs. But there is no definitive answer about which one would come earlier.

Any help would be greatly appreciated! Thank you!

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I would be careful about wheezing since someone could be wheezing and NOT be in respiratory distress --- wheezing comes from constriction and the amount of constriction could be mild enough to allow for adequate gas exchange and still generate the wheezing.. However, restlessness is always an early stage of hypoxia.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

The key to this question is...EARLY respiratory distress

Look at the options

A. Restlessness

B. Substernal retractions

C. Heart rate 88, respiratory rate 20

D. Inspiratory and expiratory wheezing

Picture this ...you are in the peds unit....you have this 12 year old that suddenly can't sit still. They can't seem to get comfortable. They become whiny and demanding. They suddenly can't get comfortable. You known the were admitted because of pneumonia that was bad enough to need IV antibiotics.

What is your first thought at this change of behavior?

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Specializes in PICU, Sedation/Radiology, PACU.

I want you to try something... Set your timer on your phone for 90 seconds. Hold your breath. Hold your breath as long as you can, or until the timer reaches 0. Note how you feel as your drive to exhale becomes stronger and stronger and your brain is yelling at your lungs to pull in more oxygen.

How are you feeling? A little anxious? Panicked? Frantic? All normal reactions. As the levels of CO2 build in your lungs, it send a signal to your brain to exhale and exchange the CO2 for oxygen. When you ignore that stimulus, it upsets your body and your brain, and it makes you want to do something to change it. it doesn't matter what age you are.

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Thank you all so much! My first inclination was toward restlessness...this is why I shouldn't listen to other people and go with my gut. You guys rock!

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Specializes in Complex pedi to LTC/SA & now a manager.

Good for you. It's refreshing to see a student post their thoughts rather than just request the answer. Remember restlessness as you move forth in your career. It is true for pedi through adult

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