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Pediatric Nursing

Pediatric Nursing. Module 2 Caring for Children with Alterations in Oxygenation Chapters 19, 20. Differences between Children and Adults. Chest/Respiratory System Obligate nasal breathers >6wks Short neck Smaller, narrower airways

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Pediatric Nursing

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  1. Pediatric Nursing Module 2 Caring for Children with Alterations in Oxygenation Chapters 19, 20

  2. Differences between Children and Adults • Chest/Respiratory System • Obligate nasal breathers >6wks • Short neck • Smaller, narrower airways • = more susceptible to airway obstruction and resp. distress • Tongue is larger in proportion to the mouth • = more likely to obstruct airway in unconscious child

  3. Differences between Children and Adults • Chest/Respiratory System • Smaller lung capacity and underdeveloped intercostal muscles, poor chest musculature • = less pulmonary reserve, lung damage w/o fx • Children rely on diaphragm breathing • = high risk for resp. failure if the diaphragm unable to contract

  4. Adjunct Assessments • Temperature • Febrile state increases oxygen consumption • Fluid Needs • Vomiting/diarrhea are commonly associated with respiratory illness • Increase respiratory efforts, increased fluid losses with decreased po intake requires an increase in fluid needs

  5. Respiratory System • Inspection • Chest • Size, symmetry movement • Infancy shape is almost circular • < 6-7 years respiratory movement primarily abdominal or diaphragmatic • Respirations • Rate, rhythm, depth, quality, effort • >60 /min in small children = significant respiratory distress

  6. Respiratory Assessment • Retractions • Substernal • Subcostal • Intercostal • Suprasternal • Supraclavicular • Effort • Grunting • Nasal flaring

  7. Respiratory Assessment • Color • Mucous membranes • Nailbeds • Skin • Cyanosis

  8. Respiratory Assessment • Auscultation • Listen comparing one areas to the other • Equality of breath sounds • Diminished • Poor air exchange • Abnormal breath sounds • Rales • Rhonchi • Wheezing • Grunting • Present on inspiration or expiration

  9. Upper Respiratory Tract Infections Tonsillitis • Tonsils • Lymphoid tissues • Abundance in children especially tonsils • Tonsillectomy • Pre-op • Bleeding time • Loose teeth

  10. Tonsillectomy • Post-op • T & A position • Semi prone with head turned to the side • Monitor for bleeding • Frequent swallowing • Persistent pulse of 120 or greater at rest • Restlessness • Pallor • Vomiting bright red blood • May bleed for 5-10 days post-op • Home care • Diet

  11. Otitis Media Acute infection of the middle ear • Generally bacterial • H. influenza • S. pneumoniae • Signs/Symptoms • Fever (maybe) • Pulling, tugging on ears • GI upset – vomit/diarrhea, poor appetite

  12. Otitis Media • Irritability • URTI • Treatment • Antibiotics Ampicillin, amoxicillin Nursing Concerns - compliance - chronic or recurrent otitis media - hearing loss can lead to speech impediments

  13. Croup -Acute Laryngotracheal Bronchitis • Upper airway problem • Edema, swelling of the larynx • Viral 3 months to 3 years • Bacterial 3 to 7 years • Signs/Symptoms • Croupy cough • Inspiratory stridor • Hoarseness • Fever • Drool

  14. Croup • Primary concern • Obstruction of the airway • Sedatives are contraindicated • Treatment – racemic epinephrine, cool mist

  15. Infections of the Lower AirwaysBroncholitis / RSV -Respiratory Syncytial Virus • Common cause of bronchiolitis or the common cold in infants • Signs/Symptoms • Pharyngitis • Fever • Otitis media • Tachypnea • Apnea spells • Poor air exchange • Secretions

  16. RSV • Treatment • Aerosol respiratory treatments • Supplemental 02 • Vaccine for high risk infants

  17. Pneumonia • Classified according to etiology • viral, bacterial, fungal, aspiration • Signs and Symptoms • Respiratory • rhonchi, rales • dull to percussion • retractions, nasal flaring • cough

  18. Pneumonia • Systemic • high fever • Neurological • irritable, restless, lethargic • pain • Gastrointestinal • a/v/d • abdominal pain

  19. Chest X-ray Pneumonia

  20. Long Term Respiratory DysfunctionAsthma • Chronic inflammatory disease of airways • airway inflammation • bronchospasm • obstruction • Triggers • environmental, chemical, tobacco, exercise, cold air, infection, medication, foods, emotions

  21. Asthma • Signs and Symptoms • Respiratory • cough • auscultation - prolonged expiration, wheeze, diminished breath sound • shortness of breath • short panting phrases • Other • restlessness, apprehension, cyanosis, sweating

  22. Cystic Fibrosis

  23. Cystic Fibrosis • Hereditary disease of the exocrine glands thick, tenacious secretions of the mucous-producing glands especially of the bronchi and pancreatic ducts • Lungs • Chronic lung disease • Bronchial obstruction • pulmonary hypertension • Over inflation of the lungs • Repeated lung infections

  24. Cystic Fibrosis • G.I System • Pancreatic ducts • Blockage of enzymes needed for digestion • Sweat glands • Secretions contain excessive amount of salt

  25. Cystic Fibrosis • Signs/symptoms • Newborn meconium ileus • Tastes salty when kissed • Recurrent respiratory illnesses • Failure to gain weight with a good appetite • Malasbsorption of fats and proteins • Stools are foul smelling, frothy and bulky • Pot belly with wasted buttocks

  26. Cystic Fibrosis • Diagnosis • Family history of CF • Repeated illnesses/hospitalization with respiratory problems or failure to thrive • Absence of pancreatic enzyme or stool studies • + sweat chloride tests • Concentration of Cl > 60mEq/L

  27. Cystic Fibrosis • Treatment • Nutritional • Pancreatic enzymes with meals and snacks • Vitamin replacement – A,D,E,K • High protein, high calorie diet • Pulmonary • Thin the secretions, keep them mobile • CPT • Aerosol Treatment • bronchodilators, D-nase

  28. Cystic Fibrosis • 02 when needed • Antibiotics for resp. infections • Pulmonary complications • Atelectasis • Lung abscesses • Pneumothorax • Emphysema • Prognosis • Life expectancy teen years to early 20s

  29. Respiratory – Nursing Diagnosis • Impaired gas exchange • Ineffective airway clearance • Ineffective breathing pattern • High risk fluid volume deficit • Altered tissue perfusion • Anxiety • Activity Intolerance • Altered growth/development • Knowledge deficit

  30. Respiratory – Nursing Diagnosis • PC: Atelectasis/Pneumonia • PC: Electrolyte Imbalance • PC: Hemorrhage • PC: Hypoxia

  31. Nursing Interventions • Assess respiratory status • Tachypnea, labored breathing, shallow breathing • Effort • Retractions • Nasal flaring • Head bobbing • Grunting • Apnea • Poor air exchange • 02 saturation

  32. Nursing Interventions • Oxygenation/ventilation needs • Administer O2 • Incubator/oxygen hood • Nasal prongs • Mist tent • Tracheotomy – croup • Decrease respiratory efforts • Infant car seat • Knee-chest position

  33. Nursing Interventions • Maintain airway • Head tilt – do not hyper extend neck • Aerosol treatment • CPT • Suction bulb syringe, BBG or tracheal bronchial • Fluids • IV or po

  34. Nursing Interventions • Labs • Medications • Conserve energy • Organize care • Monitor vital signs • Teaching

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