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Key Pediatric Differences in the Respiratory System. Lack of /insufficient surfactant Alveoli developing Smaller airways Underdeveloped cartilage. F. Key Differences (cont). Obligatory nose breather (infant) Intercostal muscles less developed Faster respiratory rate
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Key Pediatric Differences in the Respiratory System Lack of /insufficient surfactant Alveoli developing Smaller airways Underdeveloped cartilage F
Key Differences (cont) Obligatory nose breather (infant) Intercostal muscles less developed Faster respiratory rate Eustachian tubes relatively horizontal
Respiratory Assessment RR first - full minute Breath sounds Quality Retractions Nasal flaring Color Cough
Signs Respiratory Distress Cough Hoarseness Grunting Stridor Wheezing Nasal flaring Retractions Vomiting Diarrhea Anorexia Tachypnea Tachycardia Restlessness Cyanosis
Potential Nursing Diagnoses Ineffective Airway Clearance Ineffective Breathing Patterns Impaired Gas Exchange Anxiety Activity Intolerance Risk for FVD Altered nutrition Altered comfort Knowledge deficit Ineffective coping – individual or family
Apnea Periodic breathing of newborn True apnea ALTE Parental teaching
Sudden Infant Death Syndrome The sudden and unexplained death of an infant less than 1 yr old. Usually occurs during sleep. “Back to Sleep” campaign AAP revised SIDS guidelines (Pediatrics, Vol. 116, No. 5, Nov. 2005)
Sepsis • Def: a systemic bacterial infection spread through bloodstream • Neonates high risk: unable to localize infection • High Risk: • Immunocompromised • Skin defects/injuries • Invasive devices
Assessment: Sepsis • Know high risk children & monitor • Hypo or hyperthermia • Lethargy; poor feeding • Jaundice, hepatosplenomegaly • Respiratory distress • Vomiting • Hyper or hypoglycemia
Otitis Media Description: inflammation middle ear Acute otitis media Otitis media w/effusion Bacterial
Risk Factors < 3 years Bottle-fed babies Passive smoke Groupchild care
Acute Otitis Media Definition Inflammation of middle ear Rapid onset Fever Otalgia Other Clinical Manifestations: F
Treatment: AOM Primary Prevention pneumococcal vaccine No passive smoke Hold bottle fed babies upright handwashing
AOM: Secondary Prevention Pain relief Rest Antibiotics after 48-72 hrs in selected patients 6 mo to 2 yrs. PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1451-1465
Nursing Dx: AOM Altered comfort r/t inflammation & pressure Knowledge deficit r/t incomplete understanding of disease Risk for Fluid Volume Deficit
Otitis Media w/Effusion Definition Fluid in middle ear No s/s acute infection Clinical Manifestations: F
Treatment: OME Antibiotics if > 3 mo. Assess for hearing loss *** Myringotomy w/placement tympanostomy tubes
Pharyngitis 80-90% sore throats viral in origin Gradual onset Bacterial Group A beta-hemolytic strep greatest concern. F
Therapeutic Management Primarily symptomatic Pain relief Rest Abx only if positive bacterial culture
Tonsillectomy/adenoidectomy Most common reason: OSA Monitor for post-op bleeding ***Excessive swallowing Elevated pulse, decreased BP Evidence of fresh bleeding Restlessness Pain meds – teach parents Fluids
Croup Croup • Broad classification of upper airway illness • Group of conditions with: • Inspiratory stridor • Harsh cough • Hoarseness • Degrees of respiratory distress • 4 different types Fig. 45-UF03, p. 1209 F
Laryngotracheobronchitis Def: inflammatory condition of larynx, trachea, bronchi viral Gradual onset harsh cough & insp. stridor Very important to differentiate from epiglottitis
LTB - treatment Racemic epinephrine via neb Corticosteroids Tylenol Cool mist Oxygen Observe for sudden silent respiration
Four D's of Epiglottitis Drooling Dysphagia Dysphonia Distressed respiratory efforts Tripod position Do not: examine throat or do throat culture! Do: reassure, keep calm, anticipate intubation F
Brochiolitis • Lower airway • 50% RSV (respiratory syncytial virus) • Contact and droplet precautions • Mycoplasma, parainfluenza, adenovirus • Usually young infants who need hospitalization.
Patho of Bronchiolitis Virus invades mucosal cells Cells die: debris Irritation increased mucus & bronchospasm Air trapping
BronchiolitisClinical Manifestation Tachypnea Wheezing, crackles, or rhonchi Retractions Fever- maybe Difficulty feeding Cyanosis
Changes to Bronchiolitis Management What You Will See What You Will Do Decrease in the amount of nasal swabs being ordered Decrease in orders for CPT by RT Decrease in continuous O2 saturation monitoring Decrease in use of albuterol treatments Discharge orders for patients with > 90% O2 saturations while asleep When cohorting patients, infection control may be consulted Teach parents CPT for comfort measures Increase amount of intermittent O2 sat checks (ex. Q4h) Increase use of Racemic Epi Accept O2 saturations as low as 88% when a patient is sleeping Continue suctioning as usual For patients placed on Isolation Precautions: Gowns, Gloves, & MASKS are encouraged
Bronchiolitis Nursing Interventions Facilitate gas exchange Monitor I & O (for DFV) IV prn Reduce fever Reduce anxiety
Asthma Reactive airway disease Bronchospasm Edema Increased mucus production Triggers Dusts, pollen, food, strenuous exercise, weather changes, smoke, viral infections F
AsthmaClinical Manifestations Wheezing Dyspnea w/prolonged expiration Nonproductive cough Tachypnea, orthopnea Tripod position Fatigue
Asthma treatment Short-acting bronchodilator Mast cell inhibitor Systemic corticosteroids Inhaled steroids Leukotriene receptor antagonist Peak expiratory flow rate Immunizations
Cystic Fibrosis Mechanical obstruction r/t increased viscosity of mucous secretions. Autosomal recessive disorder
Cystic Fibrosis: A Multisystem Disorder Respiratory system Digestive system Integumentary system Reproductive system Growth and development F
Assessment findings - CF Salty-tasting skin Profuse sweating Frequent infections Dry, non-productive cough Increased amt, thickness of secretions Wheezing Cyanosis
Assessment findings – CF (cont) Digital clubbing Increased A-P diameter of chest Steatorrhea Thin extremities Muscle wasting Failure to thrive Meconium ileus
Cystic Fibrosis: Interventionsstrengthen lines of resistance Facilitate airway clearance and gas exchange. CPT Pulmozyme Prevent infection Immunizations TOBI Azithromycin Promote increased exercise tolerance.
CF: Interventions Provide optimal nutrition for growth. High-calorie, high protein Pancreatic enzymes with every meal Creon, Pancrase Dosage adjusted to stool formation
CF interventions (cont) Strengthen FLD/extrapersonal environment Child's and family's emotional needs Prepare the family for home care