NURSING CARE OF THE CHILD WITH A RESPIRATORY ALTERATION CHAPTER 45

1. NURSING CARE OF THE CHILD WITH A RESPIRATORY ALTERATIONCHAPTER 45

2. ASSESSING RESPIRATORY ILLNESS IN CHILDREN • Physical assessment • cough • rate & depth of respirations • retractions • restlessness • cyanosis • clubbing of fingers • adventitious sounds • chest diameters

3. ASSESSING RESPIRATORY ILLNESS IN CHILDREN • Laboratory tests • blood gas studies • pulse oximetry • transcutaneous oxygen monitoring • nasopharyngeal culture • respiratory syncytial virus nasal washings • sputum analysis

4. ASSESSING RESPIRATORY ILLNESS IN CHILDREN • Diagnostic procedures • chest x-ray • bronchography • pulmonary function studies

5. THERAPEUTIC TECHNIQUES USED IN THE TREATMENT OF RESPIRATORY ILLNESS IN CHILDREN • Expectorant therapy • oral fluid • liquefying agents • humidification • coughing • chest physiotherapy • mucus-clearing device

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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.

21. 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.

22. 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

23. 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