The child with Respiratory Alteration

1. The child with Respiratory Alteration Lecture 4 Part Two

2. TUBERCULOSIS • Tuberculosis is a highly contagious disease caused by inhalation of droplets of Mycobacterium tuberculosis or Mycobacterium bovis. • Annually about 1,000 U.S. children contract active tuberculosis disease. • Non white children and children with chronic illness or malnutrition are more susceptible to infection. • The incubation period is 2 to 10 weeks.

3. Types • Latent TB. In this condition, you have a TB infection, but the bacteria remain in body in an inactive state and cause no symptoms. It can turn into active TB, • Active TB. This condition makes patient sick and can spread to others. It can occur in the first few weeks after infection with the TB bacteria, or it might occur years later.

4. Signs and symptoms • Coughing that lasts three or more weeks • Coughing with blood • Chest pain, or pain with breathing or coughing • Unintentional weight loss • Fatigue • Fever • Night sweats • Chills • Loss of appetite

5. Diagnostic test • Skin test : A small amount of a substance called PPD tuberculin is injected Within 48 to 72 hours, a health care professional will check arm for swelling at the injection site. • Chest X-ray or a CT scan. • Sputum tests

6. Drug Therapy • The American Academy of Pediatrics recommends: • a 6-month course of oral therapy. The first two months consist of isoniazid, rifampin, and pyrazinamide given daily. • This is followed by twice-weekly isoniazid and rifampin. • Ethambutol or streptomycin is given via intramuscular injection

7. Nursing Management • Hospitalization of children with tuberculosis is necessary only for the most serious cases. • Nursing management is aimed at providing supportive care and encouraging adherence to the treatment regimen. • Supportive care includes ensuring adequate nutrition and adequate rest, providing comfort measures such as fever reduction, preventing exposure to other infectious diseases, and preventing reinfection.

8. Preventing Infection • Tuberculosis infection is prevented by avoiding contact with the tubercle bacillus. • hospitalized children with tuberculosis must be isolated according to hospital policy to prevent nosocomial spread of tuberculosis infection. • Promotion of natural resistance through nutrition, rest, and avoidance of serious infections does not prevent infection. • Pasteurization of milk has helped to decrease the transmission of Mycobacterium bovis. Administration of bacilleCalmette-Guérin (BCG) vaccine can provide incomplete protection against tuberculosis

9. EPISTAXIS • Epistaxis (a nosebleed) occurs most frequently in children younger than adolescent age. Bleeding of the nasal mucosa occurs most often from the anterior portion of the septum. • Epistaxis may be recurrent and idiopathic

10. Nursing Management • The child should sit up and lean forward (lying down may allow aspiration of the blood). • Apply continuous pressure to the anterior portion of the nose by pinching it closed. • Encourage the child to breathe through the mouth during this portion of the treatment. • Ice or a cold cloth applied to the bridge of the nose may also be helpful. • The bleeding usually stops within 10 to 15 minutes. • Apply petroleum jelly or water-soluble gel to the nasal mucosa with a cotton-tipped applicator to moisten the mucosa and prevent recurrence.

11. Neonatal respiratory distress syndrome (NRDS) • It results from lung immaturity and a deficiency in surfactant, so it is seen most often in premature infants. • Diabetic mothers, cesarean section deliveries without preceding labor, and those experiencing perinatal asphyxia. It is believed that each of these conditions has an impact on surfactant production

12. Other Names for Respiratory Distress Syndrome • Hyaline membrane disease • Respiratory distress syndrome • Infant respiratory distress syndrome • Surfactant deficiency

13. The administration of surfactant via endotracheal tube shortly after delivery helps to decrease the incidence and severity of NRDS. • Management of NRDS focuses on intensive respiratory care, usually with mechanical ventilation.

14. Signs and Symptoms of Respiratory Distress Syndrome • Rapid, shallow breathing • Sharp pulling in of the chest below and between the ribs with each breath • Grunting sounds • Flaring of the nostrils

15. Complications • Air leak syndrome (pneumothorax) . • Bronchopulmonary dysplasia(atelectasis). • Patent ductusarteriosus. • congestive heart failure • Intraventricular hemorrhage, • Retinopathy of prematurity. • Necrotizing enterocolitis. • Complications resulting from intravenous catheter use (infection, thrombus formation), and developmental delay or disability

16. Diagnostic test • Chest x ray. A chest x ray creates a picture of the structures inside the chest, such as the heart and lungs. • Blood tests. Blood tests are used to see whether an infant has enough oxygen in his or her blood. • Echocardiography (echo). This test uses sound waves to create a moving picture of the heart.

17. Treatments • Surfactant replacement therapy. • Breathing support from a ventilator or nasal continuous positive airway pressure (NCPAP) machine. • Oxygen therapy.

18. Prevention • Seeing your doctor regularly during your pregnancy • Following a healthy diet • Avoiding tobacco smoke, alcohol, and illegal drugs • Managing any medical conditions • Preventing infections. • Some cases can be prevented or at least made less sever by treating the mother with a medication called betamethasone before birth

19. Nursing Management • Nursing care of the child with NRDS is mainly supportive and occurs in the intensive care unit. • Closely monitor respiratory and cardiovascular status. • Comfort measures such as hygiene and positioning as well as pain and anxiety management. • Maintenance of nutrition, and prevention of infection are also key nursing interventions. • Psychological support of the family as well as education

20. ASTHMA • Asthma is a chronic inflammatory airway disorder characterized by airway hyper responsiveness, airway edema, and mucus production. Airway obstruction resulting from • asthma might be partially or completely reversed

21. ASTHMA

22. Symptoms of Asthma • Wheezing • Coughing: Cough may be the only symptom of asthma, especially in cases of exercise-induced or nocturnal asthma. • Chest tightness: The child may feel like the chest is tight or won't expand when breathing in. • Other symptoms: Infants or young children may have a history of cough or lung infections (bronchitis) or pneumonia

23. Causes of Asthma • Respiratory infections: These are usually viral infections. In some patients, other infections with fungi, bacteria, or parasites might be responsible. • Allergens: An allergen is anything in a child's environment that causes an allergic reaction. Allergens can be foods, fungi, or dust mites. • Irritants: Tobacco smoke, cold air, chemicals, perfumes, paint odors. • Weather changes. • Emotional factors. • Gastroesophageal reflux disease (GERD).

24. The Five Parts to an Asthma Treatment Plan • Step 1: Identifying and controlling asthma triggers • Step 2: Anticipating and preventing asthma flares. • Step 3: Taking medications as prescribed. • Step 4: Controlling flares by following the doctor's written step-by-step plan. • Step 5: Learning more about asthma, new medications, and treatments.

25. Laboratory and diagnostic studies • Pulse oximetry: oxygen saturation may be significantly decreased or normal during a mild exacerbation • Chest x-ray: usually reveals hyperinflation • Blood gases: might show carbon dioxide retention and hypoxemia • Pulmonary function tests (PFTs): can be very useful in determining the degree of disease. • Allergy testing: skin test or RAST can determine allergic triggers for the asthmatic child

26. Nursing care • Ineffective airway clearance RT bronchoconstriction, increased mucus production • Keep the patient adequately hydrated • Instruct patient or parents  to avoid bronchial irritants such as cigarette smoke, extremes of temperature. • Teach early signs of infection for parents. • Administer nebulization as ordered • Administer medications as ordered

27. Nursing care • Ineffective breathing pattern r/t presence of secretions AEB productive cough • Assess patient’s respiratory rate, depth, and rhythm. Obtain pulse oximetry. • Monitor and record vital signs. • Auscultate breath sounds and assess airway pattern • Elevate head of the bed and change position of the pt • Encourage deep breathing and coughing exercises. • Encourage increase in fluid intake • rest and limit physical activities.

28. Tracheostomy • A tracheostomy is an artificial opening in the airway, usually a plastic tracheostomy tube is in place to form a patent airway. • Thetracheostomy facilitates secretion removal, reduces work of breathing, and increases patient comfort. • In some cases the tracheostomy facilitates mechanical ventilation weaning.

29. It may be permanent or temporary depending on the condition that leads to the tracheostomy.

30. Complications • Hemorrhage, air entry, pulmonary edema and respiratory arrest. • Tube occluded and ventilation compromised. • Complications of chronic tracheostomy include infection, cellulitis, and formation of granulation tissue around the insertion site.

31. Nursing Management • In the immediate postoperative period the infant or child may require restraints to avoid accidental dislodgment of the tracheostomy tube. • Provide humidity to either room air or oxygen. • Tracheostomies require frequent suctioning to maintain patency. • Perform tracheostomy care every 8 hours or per institution protocol.

32. References • http://nurseslabs.com/bronchial-asthma-nursing-care-plans/ • http://www.nhs.uk/Conditions/Respiratory-distress-syndrome/Pages/Introduction.aspx • http://www.mayoclinic.org/diseases-conditions/tuberculosis/basics/treatment/con-20021761

33. Homework 3 Nursing care: • Child with status asthmaticus • Cystic fibrosis