Help identifying lung sounds of vent baby

caliotter3 · May 2, 2011

I would have a talk with your nursing supervisor. S/he listens to the lungs at their sup visits and can give you guidance about what to chart.

JaredRN · May 13, 2011

Hi n315,lpn,

I am a pediatric ICU nurse, and I know exactly the kind of baby you're dealing with. Best advice I can tell you, don't worry about the sounds. I'm not telling you not to worry about anything, you sound like you just lack a little experience and maybe some confidence. Let me tell you what exactly a baby like this has gone through.

To give you an idea, because premature babies are born with underdeveloped lungs, and the variety of things that go wrong, like respiratory failure. They mec aspirate, or born to early, or develop an infection. They have acute respiratory failure, their lungs fill up with fluid get edematous and no longer have adequate gas exchange. Maybe a little pulmonary hypertension on top of that to give a little multisystem organ failure and you should of seen this kid when he was 2 or 3 days old on a ventilator, probably either jet ventilator or high frequency occillator, maybe a little nitric therapy and all these lines and tubes in side of him. A UA catheter here, an L cath there. These kids unfortunately sometimes get better but not completely healthy or even normal, and they almost always develop chronic lung disease. So you're probably looking at a very delayed child, probably with multiple medical problems, maybe a little syndromy (PICU nurses make up their own words sometimes). You know chromosomal deletion, maybe a really low one. Probably very delayed or mentally retarded, maybe spastic cerebral palsy. Just an all around train wreck.

CLD can be irreversible, sometimes the babies will grow back viable lung tissue but this isn't the case most of the time because of the repeated exposure to therapies to keep the buggers alive, namely chronic ventilator support and the resulting barotrauma, also the effects that free radicals have destroying lung tissue being on oxygen so long.

So these kids end up with having jacked up lungs in general. The kid sounds like he breathes really hard, thats because he doesnt have as much (if any) viable lung tissue a healthy infant does for gas exchange, and why he needs to be on a ventilator. I once took care of an infant who made it to 13 months of age with only a little bit of his right lower lung left. Well what happened to him was he got pneumonia in that little bit of lung and died within a few hours, just to tell you how fragile these kids are. Can't live without lungs, and putting this kid on ecmo is just crazy stupid.

If he sounds coorifice all the time, his lungs are also producing a lot of mucous which you probably suction all time from this kids trach. If he sounds wheezy his airways are constricted, from mucous or bronchospasming, so he needs bronchodilators constantly.

Don't focus on the lung sounds too much, pay attention to how the kids looks like his overall work of breathing. You should also have a pulse oximeter. Also keep in mind these kids should be on palliative care and dont live for much longer, which is why you're there as skilled nursing care. Because the parent's are idiots and didn't want to withdraw care, and probably wanted everything done, and now you have a train wreck in front of you.

Document what you see, what people say, what you do, and you'll be just fine. Just pay attention, make sure he gets the therapies he needs, and when he gets a pneumonia watch out, hes probably on his last leg. But don't worry too much about it, cause the outcomes for these kids aren't very good anyway (I don't see too many make it to 2 years). I tend to focus my interventions on the parent's if they're even around, thing's like supportive care and dying and not prolonging suffering. In these cases I bet they look at you as the only respite they have, leave you babysitting while probably getting drunk somewhere to escape their troubles.

ventmommy · May 13, 2011

Also keep in mind these kids should be on palliative care and dont live for much longer, which is why you're there as skilled nursing care. Because the parent's are idiots and didn't want to withdraw care, and probably wanted everything done, and now you have a train wreck in front of you.
Document what you see, what people say, what you do, and you'll be just fine. Just pay attention, make sure he gets the therapies he needs, and when he gets a pneumonia watch out, hes probably on his last leg. But don't worry too much about it, cause the outcomes for these kids aren't very good anyway (I don't see too many make it to 2 years). I tend to focus my interventions on the parent's if they're even around, thing's like supportive care and dying and not prolonging suffering. In these cases I bet they look at you as the only respite they have, leave you babysitting while probably getting drunk somewhere to escape their troubles.

I can't remember the last time I have seen such an arrogant post from a PICU nurse (or any nurse really)! Maybe you are not aware of the hundreds of kids that are on vent support for a couple of years and learn to walk and talk and get decanned. Yes, some are delayed, some are not and there are plenty that lead happy lives even if they are never decanned. I know LOTS of parents of trach (some with vents) kids and none of them are sitting around drinking while you are helping to kill their child because YOU think that is what is right. The number one complaint of parents of SN kids isn't how hard it is to take care of their kids, it's how incompetent, inconsiderate and/or condescending that some of the nurses can be.

By the way, my son is almost 6 and has been on a vent since birth.

JaredRN · May 13, 2011

You know, every nurse has a bad day, just like every mom can. Sometimes you just get tired of the insanity of it all. And if that feels arrogant or uncaring, just remember there are no perfect nurses out there. The ones you got to watch out for, are the ones who think they are.

JeanettePNP, MSN, RN, NP · May 13, 2011

I can't remember the last time I have seen such an arrogant post from a PICU nurse (or any nurse really)! Maybe you are not aware of the hundreds of kids that are on vent support for a couple of years and learn to walk and talk and get decanned. Yes, some are delayed, some are not and there are plenty that lead happy lives even if they are never decanned. I know LOTS of parents of trach (some with vents) kids and none of them are sitting around drinking while you are helping to kill their child because YOU think that is what is right. The number one complaint of parents of SN kids isn't how hard it is to take care of their kids, it's how incompetent, inconsiderate and/or condescending that some of the nurses can be.
By the way, my son is almost 6 and has been on a vent since birth.

Thank you, ventmommy. I also take care of one of these "train wrecks" in pediatric homecare who wasn't expected to survive past a couple months. Well now she's 2 1/2 and while she's still on the vent, she's developing, she plays and interacts with her environment, is friendly, outgoing and just the sweetest little thing who is adored by her family. I certainly don't think they were "idiots" for giving her every chance they could, despite knowing what her prognosis was.

JeanettePNP, MSN, RN, NP · May 13, 2011

You know, every nurse has a bad day, just like every mom can. Sometimes you just get tired of the insanity of it all. And if that feels arrogant or uncaring, just remember there are no perfect nurses out there. The ones you got to watch out for, are the ones who think they are.

Nobody's forcing you to work in PICU if you can't handle it.

HisTreasure, BSN, RN · May 14, 2011

Dear heavens, this thread went downhill fast. :crying2: I would read the notes and see how others describe the lung sounds, to develop some consistency. Talk to your CM and the RT to see if they can point you in the right direction, as well. When I had a kiddo (who was vented as well and reminds me of the breath sounds you describe) I would document baseline- diminished breath sounds bilaterally (unless otherwise symptomatic) Retractions and nasal flaring noted; otherwise asymptomatic- O2 --%, no further s/sx of respiratory distress. :redpinkhe

tothepointeLVN, LVN · May 15, 2011

I have found that with most children on vents/with trachs seem to almost always have some level of "junkiness" when assessing lung sounds. If You asses adventious lung sounds without being specific as to whhezes/rhonchi/rales you will be ok charting wise. As you listen to more and more lungs you'll be able to pick out the difference.

With private duty kids the thing you really need to know is the pt's baseline and know when something is off or different. I didn't really become that skilled at assessment until I started doing hospice when you see/hear a variety of pathologies and are their for the decline.

If you just focus on everyday being a better nurse than the day before you'll be fine.

PerfectlyPlump, ADN, RN · May 25, 2011

Point LVN,

Well put. I notice that I am learning a lot in every job I have. I am just that way. Thank you!

tothepointeLVN, LVN · May 26, 2011

To want to do your best is the only thing anyone can really ask of you. Perfection doesn't come overnight. If it comes at all.

liveyourlife747 · Jun 1, 2011

I work in home care with the peds vent cases. The things I document frequently about lung sounds are rhonci, crackles, and wheezing. If they just sound congested or it doesn't quite sound like a crackle, I call it "wet" lung sounds. It is hard to pick up these things, especially in home care where you don't have another person to listen to what you hear and compare. You will learn what is abnormal for the child and when/if they would need a breathing tx or CPT or any other prescribed tx. hope that helps!