STUDY - Technical - New Dacian's Medicine
Retractions
(Classical / Allopathic Medicine)
A
cardinal sign of respiratory distress in infants and
children, costal and sternal retractions are visible
indentations of the soft tissue covering the chest wall.
They may be suprasternal (directly above the sternum and
clavicles), intercostal (between the ribs), subcostal
(below the lower costal margin of the rib cage), or
substernal (just below the xiphoid process). Retractions
may be mild or severe, producing barely visible to deep
indentations.
Normally,
infants and young children use abdominal muscles for
breathing, unlike older children and adults, who use the
diaphragm. When breathing requires extra effort, accessory
muscles assist respiration, especially inspiration.
Retractions typically accompany accessory muscle use.
ALERT:
If you detect retractions in a child:
- check quickly for other signs of respiratory distress, such as cyanosis, tachypnea, and tachycardia
- observe the retractions, noting their location, rate, depth, and quality
- look for accessory muscle use, nasal flaring during inspiration, or grunting during expiration
- institute emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
If you detect retractions in a child:
- check quickly for other signs of respiratory distress, such as cyanosis, tachypnea, and tachycardia
- observe the retractions, noting their location, rate, depth, and quality
- look for accessory muscle use, nasal flaring during inspiration, or grunting during expiration
- institute emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
Observing
retractions
When you observe retractions in infants and children, be sure to note their exact location — an important clue to the cause and severity of respiratory distress. For example, subcostal and substernal retractions usually result from lower respiratory tract disorders, whereas suprasternal retractions usually result from upper respiratory tract disorders.
Mild intercostal retractions alone may be normal. However, intercostal retractions accompanied by subcostal and substernal retractions may indicate moderate respiratory distress. Deep suprasternal retractions typically indicate severe distress.
HISTORY:
Review the patient's medical history for premature birth or complicated delivery.
Ask the child's parents if he has shown recent signs of an upper respiratory tract infection, such as a runny nose, cough, or a low-grade fever. How often has the child had respiratory problems over the past year?
Ask the parents if the child has been in contact with anyone who has had a cold, the flu, or other respiratory ailments.
Ask the parents about a family history of allergies or asthma.
When you observe retractions in infants and children, be sure to note their exact location — an important clue to the cause and severity of respiratory distress. For example, subcostal and substernal retractions usually result from lower respiratory tract disorders, whereas suprasternal retractions usually result from upper respiratory tract disorders.
Mild intercostal retractions alone may be normal. However, intercostal retractions accompanied by subcostal and substernal retractions may indicate moderate respiratory distress. Deep suprasternal retractions typically indicate severe distress.
HISTORY:
Review the patient's medical history for premature birth or complicated delivery.
Ask the child's parents if he has shown recent signs of an upper respiratory tract infection, such as a runny nose, cough, or a low-grade fever. How often has the child had respiratory problems over the past year?
Ask the parents if the child has been in contact with anyone who has had a cold, the flu, or other respiratory ailments.
Ask the parents about a family history of allergies or asthma.
PHYSICAL
ASSESSMENT:
Check for other signs of respiratory distress, such as cyanosis, tachypnea, and tachycardia.
Observe the retractions, noting their location, rate, depth, and quality. (See Observing retractions.)
Look for accessory muscle use, nasal flaring during inspiration, or grunting during expiration.
If the child has a cough, record the color, consistency, and odor of sputum, if present.
Note whether the child appears restless or lethargic.
Auscultate the lungs to detect abnormal breath sounds.
Check for other signs of respiratory distress, such as cyanosis, tachypnea, and tachycardia.
Observe the retractions, noting their location, rate, depth, and quality. (See Observing retractions.)
Look for accessory muscle use, nasal flaring during inspiration, or grunting during expiration.
If the child has a cough, record the color, consistency, and odor of sputum, if present.
Note whether the child appears restless or lethargic.
Auscultate the lungs to detect abnormal breath sounds.
SPECIAL
CONSIDERATIONS:
Perform chest physical therapy with postural drainage to help mobilize and drain excess lung secretions.
Perform chest physical therapy with postural drainage to help mobilize and drain excess lung secretions.
PEDIATRIC
POINTERS:
When examining a child for retractions, know that crying may accentuate the retractions.
When examining a child for retractions, know that crying may accentuate the retractions.
AGING
ISSUES:
Although retractions may occur at any age, they're more difficult to assess in an older patient who's obese or in a patient who has chronic chest wall stiffness or deformity.
Although retractions may occur at any age, they're more difficult to assess in an older patient who's obese or in a patient who has chronic chest wall stiffness or deformity.
PATIENT
COUNSELING:
Instruct the parents on what to expect from diagnostic testing, which may include chest X-rays and arterial blood gas analysis.
Instruct the parents on what to expect from diagnostic testing, which may include chest X-rays and arterial blood gas analysis.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.