Pediatric Respiratory Assessment Part 6

Skin temp and color

·         Should be consistent over the trunk and extremities

·         As perfusion deteriorates, cyanosis in the extremities develops

·         Cool ambient may a factor

·         Assess skin temperature with the back of the hand

Skin Color:  Pallor

·         Lack of normal color to the skin or mucus membranes

·         Decreased blood supply to the skin

·         Decreased number of circulating RBCs

·         Decreased skin pigmentation

Note:  Family members can tell you if a child’s skin color looks different

Skin Color:  Mottling

·         Caused by an irregular supply of oxygenated blood to the skin

·         Irregular or patchy discoloration of the skin

·         Areas may appear as uneven combination of pink, blue, gray, or pale skin tones

Skin Color: Cyanosis

·         Blue discoloration of the skin and mucus membranes

·         Acrocyanosis:  bluish discoloration of the hands and feet; common in newborns

·         Peripheral cyanosis:  bluish discoloration of the hands in feet beyond newborn period

·         Central cyanosis:  bluish discoloration of the lips and mucus membranes

Note:  Cyanosis may be more obvious in the mucus membranes and nail beds than in the skin, particularly if the skin is dark. 

Pulse Oximetry

·         Monitors percent of hemoglobin that is saturated with oxygen

·         Interpret pulse oximetry readings in conjunction with other clinical signs

·         Unreliable if the heart rate displayed on the pulse oximeter is not the same as the child’s heart rate determined by ECG monitoring

·         Pulse oximetry waveform may be poor or irregular if the child had poor peripheral circulation%

Note:  If a child has a pulse oximetry reading of < 94% then oxygen should be applied.  If the pulse oximetry reading is < 90% despite receiving 100% oxygen, then further intervention is needed. 

Source:

Pediatric Advanced Life Support Provider Manual by Leon, M.D. Chameides, Ricardo A., M.D. Samson, Stephen M., M.D. Schexnayder and Mary Fran, RN Hazinski (Oct 12, 2011)