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Respiratory Tract Infection ( RI ). Prepared by Dr. Hoda Abdel Azim. Learning Objectives. Identify the general aspect of respiratory infections. State the etiology and factors leading to RI in the infant or young child. Discus common condition of the upper respiratory infection.
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Respiratory Tract Infection ( RI ) Prepared by Dr. Hoda Abdel Azim
Learning Objectives • Identify the general aspect of respiratory infections. • State the etiology and factors leading to RI in the infant or young child. • Discus common condition of the upper respiratory infection. • Contrast the effects of various respiratory infections observed in infants and children. • Describe postoperative nursing care for the child with a tonsillectomy. • Discus common condition of the lower respiratory infection.
Respiratory Infection Infections of the respiratory tract are described according to anatomical area of involvement. • The upper respiratory tract consist of: Pharynx, larynx, and upper part of the trachea. • The lower respiratory tract consist of: Lower trachea, bronchi, bronchioles, and the alveoli.
Nasal Cavity Throat (pharynx) Nose Mouth Windpipe (Trachea) Bronchus Left lungs Bronchiole Ribs Alveolus Diaphragm Respiratory System
Etiology and factors leading to RI 1. Infectious Agents • Virus • Streptococci, Staphylococci, Haemophilus Influenza, Chlamydia Trachomatis, Pneumococci.
2. Age • Infant younger than age 3 months have lower infectious rate (protected from maternal antibodies). • The infection rate increases from 3 to 6 months of age. • The viral infection rate increase during (toddler, and preschool years).
3. Size The diameter of the airway is smaller in young children, the organism may move rapidly. 4. Resistance The ability to resist depending on several factors: • Deficiency of immune system • Malnutrition Anemia • Fatigue Allergies • Asthma Cardiac anomalies 5. Seasonal variations.
Upper Respiratory Infections 1. Pharyngitis Hemolytic streptococci infection of the upper air way (throat). Clinical manifestations • Headache Fever • Abdominal pain Swallowing difficult • Anorexia • The tonsils and pharynx may be inflamed and covered with exudates.
Therapeutic Management • Antibiotics (penicillin, oral erythromycin ….etc. • Analgesic Nursing Considerations: • The nurse often obtains a throat swab for culture. • Instruct the parents about administering penicillin and analgesic as prescribed. • Cold or warm compresses to the neck may provide relief. • Warm saline gargles offer relief of throat discomfort.
Pain may interfere with oral intake , and children should not be forced to eat. • Cool liquids are usually accepted. • Completing the course of antibiotic therapy. • Children not return to school until they have been taking antibiotics for a full 24 hour period.
2. Tonsillitis Tonsils are masses of lymphoid tissue located in the pharyngeal cavity. Etiology • Tonsillitis often occurs with Pharyngitis. • Viral or bacterial
Clinical manifestations • Difficulty swallowing and breathing. • The child breathes through the mouth. Therapeutic management • Tonsillectomy • Adenoidectomy
Nursing considerations • Provide comfort and minimizing activities that interventions that precipitate bleeding. • A soft to liquid diet is preferred. • Warm salt water gargles, analgesic and antipyretic drugs. Postoperative nursing care • Abdomen or side lying position to facilitate drainage of secretions.
Discourage from coughing, clearing their throat, blowing their nose that may aggravate the operation site. • All secretions and vomitus are inspected for evidence of fresh bleeding. • Analgesics may be given rectally or intravenously to avoid the oral route.
Food and fluids are restricted until children are fully alert and there are no signs of bleeding. • Cool water, crushed ice, diluted fruit juice is given. • Soft foods, cooked fruits, mashed potatoes are started on the first or second postoperative day. • The nurse observe the throat directly for evidence of bleeding.
3. Otitis Media An inflammation of the middle ear without reference to etiology. Etiology • Bacteria • A relationship between the incidence of OM and infant feeding methods.
Clinical manifestation • Fever • Acute ear pain • Pulling or rubbing in the ear. • Bulging yellow or red tympanic membrane. • Rhinitis, cough , diarrhea. • Purulent discharge
Nursing considerations Nursing objectives • Relieving pain • Facilitating drainage. • Preventing complications or recurrence. • Educating the family in care of the child. • Providing emotional support to the child.
Analgesic drugs (ibuprofen). • An ice compress placed over the affected ear may also provide comfort and reduce edema. • If the ear drainage , the external canal cleaned with sterile cotton swabs. Prevention of recurrence through: • Education regarding antibiotic therapy. • Sitting or holding an infant upright during bottle feeding. • Aware of potential complications as (loss of hearing).
4. Croup(acute spasmodic laryngitis) Definition A severe inflammation and obstruction of the upper airway (larynx). Causes • Viral (RSV, Influenza virus, • Bacteria (pertussis, diphtheria, mycoplasma). Complications Respiratory insufficiency
Signs and symptoms • Barking cough or hoarseness. • Worse at night and can last 5 to 6 days. • Decrease breath sounds. • Dyspnea • Fever Diagnostic test • Throat cultures • Laryngoscopy • Neck Xray
Nursing interventions • Exposure of child to cool water. • Cool humidification during sleep with cool mist tent or room humidifier. • Encourage clear liquid intake to keep mucus thin. • Monitor vital signs and pulse oximetry. • Administer medication (Antipyretic, antibiotics, corticosteroids. • Oxygen administration if necessary. • IV fluid to prevent dehydration. • Care of tracheostomy if indicated.
Lower respiratory infections 1. Bronchitis Is an inflammation of the large airways (trachea and bronchi) which is frequently associated with a URI. Common in children under the age of 2 – 3 years. Mycplasma pneumoniae is a common cause in children older than 6 years f age.
Sign & Symptoms • Fever • Dyspnea • Nonproductive cough that worsens at night and become productive in 2 to 3 days .
Bronchitis is a mild self limited disease that required only symptomatic treatment including : • Analgesics • Antipyretics • Humidity • Cough suppressants to allow rest • Temperature of the home must be moderate (inhale steam). Recover 5 to 10 days
Respiratory Syncytial Virus (RSV)and 2.Bronchiolitis Is an acute viral infection with maximum effect at the bronchiolar level. • Occur in infancy and early childhood (first 2 years). Clinical manifestations • Rhino rhea (nasal discharge) • Fever • Dyspnea • Otitis media and conjunctivitis may also be present. • Cough and convert to productive cough . • Apnea in very young infants
Therapeutic Management Bronchiolitis is treated symptomatically • A adequate fluid intake and rest. • IV fluids are preferred if the child cannot take enough by mouth. • Bronchodilators, corticosteroids, cough suppressants and antibiotics are not effective alone. • Ribavirin antiviral activity. • Hospitalization is recommended for children with underlying lung or heart disease.
Nursing Considerations • Separate room or grouped with other infected children. • Place the child in o2 tent to provide him with oxygen high humidity. • Consistent hand washing and use of contact precautions (gloves, gowns, masks ). • Nurses who assigned to infected children do not take care of other patients who are considered high risk.
3.Pneumonias Inflammation of the pulmonary parenchyma, is common in childhood but occurs more frequently in infancy and early childhood. • Pneumonia may occur either as a primary disease or as a complication of another illness.
Types of Pneumonia • Lobar pneumonia all or a large segment of one or more pulmonary lobes is involved. • Bronchopneumoniabegins in the terminal bronchioles which become clogged with mucopurulent exudates to form consolidated patches in nearby lobules. • Interstitial pneumonia the inflammatory process in the alveolar walls and per bronchial
Bacterial Pneumonia Causative organism • Streptococcus pneumoniae • Other bacteria that cause pneumonia in children ( a staphylococcus, aureus, and Haemophilus influenza).
General Signs of Pneumonia • Fever • Malaise • Rapid and shallow respirations • Cough • Chest pain • Anorexia , vomiting, diarrhea and abdominal pain
Therapeutic Measures • Antibiotics therapy • Bed rest • Oral intake of fluid • Antipyretic • IV fluid and oxygen is required if the child is in respiratory distress.
Complications • Necrosis • Empyema • Neumothorax • Pneumonic (pleural ) effusion • Lung abcess
Nursing Considerations • Isolation • Encourage rest and conservation of energy. • Encourage the child to regular sleep. • To prevent dehydration fluid are frequently administered intravenous. • Oral fluids if allowed to decrease cough. • Children may be placed in a mist tent.
Fever controlled by administration of antipyretic drugs as prescribed. • Vital signs and breath sounds are monitored to assess the progress of disease. • Children with ineffective cough require suctioning to maintain patent airway.
