NURSING CARE OF THE CHILD WITH A RESPIRATORY ALTERATIONCHAPTER 45

ASSESSING RESPIRATORY ILLNESS IN CHILDREN

• Physical assessment– cough– rate & depth of respirations– retractions – restlessness– cyanosis– clubbing of fingers– adventitious sounds– chest diameters

ASSESSING RESPIRATORY ILLNESS IN CHILDREN

• Laboratory tests– blood gas studies

• pulse oximetry

• transcutaneous oxygen monitoring

– nasopharyngeal culture– respiratory syncytial virus nasal washings– sputum analysis

ASSESSING RESPIRATORY ILLNESS IN CHILDREN

• Diagnostic procedures– chest x-ray– bronchography– pulmonary function studies

THERAPEUTIC TECHNIQUES USED IN THE TREATMENT OF RESPIRATORY

ILLNESS IN CHILDREN

• Expectorant therapy– oral fluid– liquefying agents– humidification– coughing– chest physiotherapy– mucus-clearing device

THERAPEUTIC TECHNIQUES USED IN THE TREATMENT OF RESPIRATORY

ILLNESS IN CHILDREN

• Therapy to improve oxygenation– oxygen administration– pharmacologic therapy– incentive spirometry– breathing techniques– tracheostomy– endotracheal intubation– assisted ventilation

DISORDERS OF THE UPPER RESPIRATORY TRACT

• Acute nasopharyngitis ( common cold)– Viral and DOES NOT need an antibiotic– Fever and green mucus do not necessarily

mean bacterial infection– Treat the symptoms but suppressing a

productive cough is not good– Using a humidifier is good but a vaporizer

can be dangerous

Allergic Rhinitis• S/S

– Sneezing, nasal engorgement, watery nasal d/c

– Allergic salute leading to an allergic crease– Allergic shiners– Headaches

• Therapeutic management– Avoidance of allergens– Antihistamines, leukotriene inhibitors,

intranasal corticosteroids– immunotherapy

DISORDERS OF THE UPPER RESPIRATORY TRACT

• Pharyngitis– viral pharyngitis

• Usually milder with “cold” symptoms

• Treat the symptoms

– streptococcal pharyngitis• Assessed with a throat culture or a rapid strept

• May be accompanied by a sandpaper rash, petechiae, abdominal pain, vomiting

• Rarely accompanied by “cold” symptoms

• If untreated, may result in Rheumatic fever

• Treated or not, some children will develop acute glomerulonephritis

DISORDERS OF THE UPPER RESPIRATORY TRACT

• Tonsillitis– Infection and inflammation of the palatine tonsils– S/S

• Sore throat• Drooling• Fever

– Management• Most common cause is group A beta-hemolytic streptoccus, treated with Amoxil• If strept negative, assumed to be viral and treated with comfort measures

• Tonsillectomy– Less common today– Usually done for three or more cases of Strept throat in six months, mouth

breathing, sleep apnea– Risk for hemorrhage is greater because site is cauterized and not sutured– Observe closely for frequent swallowing, changes in BP– Don’t allow red foods, drinks to be consumed

DISORDERS OF THE UPPER RESPIRATORY TRACT

• Epistaxis– Usually comes from “picking” but may come

from lack of humidity, resp. illness, or systemic illness

– Keep children in an upright position with head tilted forward applying pressure to the sides of the nose

• Croup (Laryngotracheobronchitis)– Characterized by “barking” cough, stridor,

and retractions– Danger from laryngeal inflammation closing

off airway– Emergency measures include putting child in

a hot, steamy bathroom or receiving racemic epi via nebulizer in the ER

DISORDERS OF THE UPPER RESPIRATORY TRACT

• Epiglottitis– Airway emergency– S/S

• Severe inspiratory stridor with a very sore throat

• High fever, hoarseness

• If this is suspected, never attempt to visualize epiglottis with a tongue blade or obtain a throat culture

– Management• Possible tacheostomy, antibiotics

DISORDERS OF THE EAR

• Otitis Externa– Swimmer’s ear

– Pain upon manipulation of the pinna

– Treatment…Floxin Otic Gtts

• Impacted cerumen– Wax seldom needs removing, serves to cleanse the

outer ear

– Using Qtips can push wax further into the canal

– Cerumex will remove hard wax if necessary

DISORDERS OF THE EAR

• Acute otitis media– Common childhood disorder– Occurs most often following a “cold” and in homes

with smoking– S/S

• Pulling on ears• Fever• On inspection, TM appears inflamed and light reflex is

absent, fluid may be present causing bulging of TM (serous)

– Probably overtreated

DISORDERS OF THE EAR• Otitis Media with Effusion

– Results from chronic Otitis Media– s/s

• Pressure in the ear• Muffled hearing• On inspection

– Level of fluid behind TM– distorted light reflex– TM immobile

– Treatment• Myringotomy tubes

– Tubes come out on their own within 6-12 months– Water shouldn’t enter the ears while tubes are in place– Will have hearing impairment with tubes

DISORDERS OF THE LOWER RESPIRATORY TRACT

• Bronchiolitis– Most common causative agent, RSV– Usually in children younger than 2– S/S

• Resp distress with exp wheezing

– Management• Humidified oxygen, albuterol, steroids

• Possibly Ribavirin if RSV positive

DISORDERS OF THE LOWER RESPIRATORY TRACT

• Asthma– Hypersensitivity response connected to other atopic

conditions (i.e. eczema and allergic rhinitis)– Characterized by exp wheezing and coughing– Treated according to how many times they must use their

rescue inhaler (short acting beta2agonist) weekly and how often they are awakened at night with symptoms

– All but the mildest stage require an inhaled steroid to minimize chronic lung changes according to the NIH

• Pneumonia– Many different types– Clinical presentations

• Chlamydial…wheezes, hx of conjunctivitis in first 2 weeks of life

• Viral…rhinorrhea, low-grade fever, non-productive cough

• Bacterial…acute onset of fever, productive cough, pleural pain, toxic appearance, poor feeding, lethargy

• Mycoplasma (community acquired)…staccato cough

– Management• Depends on type

Foreign Body Aspiration

• Children will put anything into their mouth!– The usual-hot dogs, grapes– The unusual-Barbie shoes, Christmas ornaments

• Suspect aspiration when…– Choking, coughing, wheezing unilaterally occurs

• Treatment– Bronchoscopy, laryngoscopy

Apnea

• Defined as the cessation of breathing for 20 seconds or longer

• When combined with color change or a change in muscle tone, is referred to as an apparent life-threatening event

• Infants are sent home with apnea monitors, parents trained in CPR, and resuscitation equipment.

Sudden Infant Death Syndrome

• Characterized by the sudden, unexplained death of an infant

• Etiology is unknown but several theories exist

• Most victims are boys, under 6 mos, lower socioeconomic status, and in winter months.

• At present, putting healthy infants to sleep on their back has reduced the SIDS rate in the US drastically.

DISORDERS OF THE LOWER RESPIRATORY TRACT

• Cystic fibrosis– Autosomal recessive inheritance– Disorder of the exocrine glands where secretions have

difficulty flowing through gland ducts– pancreas involvement

• Inability of child to digest fat, protein, and some sugars cause stools to be large, bulky, greasy, and foul (steatorrhea)

• Children appear malnourished because of poor absorption

• Suspect CF with an infant with a meconium plug

DISORDERS OF THE LOWER RESPIRATORY TRACT

• Cystic fibrosis– lung involvement

• Thick secretions provide a medium for infection

• Symptoms of emphysema occur

– sweat gland involvement• Skin has salty taste, test is called “sweat test”

– Management• High calorie, high protein, moderate fat diet

• Synthetic pancreatic enzyme at meals

• Chest physiotherapy