Page 840 - Saunders Comprehensive Review For NCLEX-RN

B. Assessment
1. Signs of mild airway obstruction include good air
exchange, ability to cough forcefully, and wheezing
between coughs.
2. Signs of severe airway obstruction include poor or no
air exchange, weak or ineffective cough or no cough,
a high-pitched noise while inhaling or no noise,
increased respiratory difficulty, cyanosis, and
inability to cry.

C. Interventions

1. For mild obstruction, do not interfere with the infant’s
own attempts to expel the object. Stay with them and
continue to monitor. If the obstruction persists,
activate the emergency response system and relieve
the obstruction.
2. Severe obstruction must be relieved as soon as
possible (see Priority Nursing Actions).

Priority Nursing Actions

Choking Infant
1. Sit or kneel with the infant in your lap.
2. Remove clothing from the infant’s chest if easily removed.
3. Hold the infant face down with the head lower than the chest
while resting on your forearm. The infant’s head and jaw
should be supported with the hand. The forearm is rested on
the thigh to support the infant (Fig. 27-8).
4. Deliver 5 back slaps between the infant’s shoulder blades using
the heel of the other hand with sufficient force. Place free hand
on infant’s back while supporting the back of the infant’s head
with the palm of the hand. Cradle the infant between the 2
forearms. Turn the infant as a unit while supporting the head
and neck.
5. Rest the forearm on the thigh while holding the infant face up.
Deliver 5 chest thrusts in the middle of the chest over the lower
half of the sternum at a rate of 1 per second with enough force
to dislodge the foreign body.
6. Repeat the sequence until the object is removed or the infant
becomes unresponsive.
7. If the infant becomes unresponsive, call for help and activate the
emergency response system.
8. Begin cardiopulmonary resuscitation (CPR) while checking for a
foreign body each time the airway is opened. Do not perform
blind finger sweeps.

Reference

American American Heart Association (2018). 2017 American
Heart Association Focused Update on Pediatric Basic Life
Support and Cardiopulmonary Resuscitation Quality: An
Update to the American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency Cardiovascular
Care. Circulation, 137(1), e1–e6.

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