Nursing Management of Respiratory Infections

Nursing Management of Upper and Lower Respiratory Infections and Disorders

• Respiratory infections are a leading cause of infant mortality in developing countries.
• 150 million episodes of community-acquired pneumonia, and 2 million pneumonia-related deaths occur in children under 5 years old in developing countries.
• 7-13% of pneumonia cases are severe enough to be life-threatening.
• Respiratory tract infections are the most common acute illnesses in children.
• The cause and severity of infections are influenced by factors such as age, season, living conditions, and pre-existing medical problems.

Developmental Variations of the Respiratory System in Children

• The respiratory tract is shorter and the structures are closer together in children, making transmission of infectious pathogens more efficient.
• Infants primarily use abdominal muscles for breathing.
• Infants have a lower IgA (immunoglobulin A) production in the pulmonary mucosa, making them more prone to respiratory difficulties from mucus, edema, or foreign objects.
• Children have less alveolar surface area for gas exchange.

Eustachian Tube

• The Eustachian tube in young children is shorter and wider, and more horizontal than in older children.
• This position reduces the benefit of gravity for drainage, increasing the risk for issues like otitis media.

Upper Respiratory Infections (URIs) in Children

• Tonsillitis:
  • Tonsils are masses of lymphoid tissue in the throat.
  • Their main functions are to filter and protect the respiratory and alimentary tracts from pathogens.
  • They also aid in antibody formation.
  • Types of tonsils include Palatine, Pharyngeal (adenoids), Lingual, and Tubal.
  • Tonsillitis is characterized by tonsil swelling, caused by bacterial or viral infection.
• Otitis Media:
  • Inflammation and fluid accumulation in the middle ear.
  • The Eustachian tube is often narrower than in older children, which obstructs secretions and leads to middle ear infections.
  • More common in young children due to horizontal Eustachian tubes and frequent respiratory infections.
• Laryngotracheobronchitis (Croup):
  • A viral infection of the upper airway, causing inflammation.
  • Typically occurs in children 3 months to 5 years old, with a peak during the second year of life.

Bronchiolitis

• Acute respiratory distress and wheezing in infants.
• Caused by viral infections affecting the small airways (bronchioles), narrowing them and hindering breathing.
• More common during winter months.

Asthma

• Causes swelling and inflammation in airways leading to the lungs.
• Airway tightening and narrowing occurs during asthma attacks, hindering air passage and causing breathing difficulties.
• Causes include heredity, allergies, pollution (indoor/outdoor), foods, cold air, strong emotions and exercise.

Pneumonia

• A lung infection caused by bacteria, viruses, parasites, or other agents (like aspiration or ingestion of chemical agents).
• Infection causes fluid or mucus buildup in air sacs (alveoli) in the lungs, making breathing difficult and causing coughing.
• Common in winter months, with children under 2 years old at higher risk.

Nursing Considerations for Infections

• General care: rest and comfort, adequate hydration (warm liquids), soft liquid diet, cool mist, salt gargles, or throat lozenges.
• Medical interventions: antibiotics (when bacterial), pain/fever reducers.
• Surgical interventions: tonsillectomy (for severe cases) or adenoidectomy.
• Post-operative care: positioning to facilitate drainage, suctioning, observing for complications (bleeding), soft foods.
• Home care: Avoiding activities that could worsen bleeding. Monitoring for post-operative bleeding. teaching about home care.

Nursing Diagnoses

• Ineffective airway clearance
• Impaired swallowing
• Pain related to surgery
• Altered oral mucous membranes
• High risk for injury
• Anxiety/fear
• Altered family processes
• Discomfort (Pressure due to inflammation)
• High risk for impaired skin integrity (related to drainage)

Nursing Interventions and Management

• Specific to tonsillectomy: Position the child for drainage. Minimize activities that may cause bleeding.
• Specific to Otitis Media: Administer antibiotics. Position for drainage or use a heating pad. Administer antibiotics promptly.
• Specific to Bronchiolitis: Provide supplemental oxygen, encourage breast milk or fluids, monitor vital signs.
• Specific to Asthma: Administer inhaled corticosteroids and bronchodilators.
• Specific to pneumonia: Administer antibiotics, monitor for signs of dehydration.

Important Considerations for Respiratory Disorders in Infants/Children

• The severity and course of respiratory infections depend on various factors and may require medical or surgical interventions.
• It's vital to prioritize the child's airway, breathing, and circulation (ABCs).
• Early recognition and appropriate management are crucial for preventing complications and improving patient outcomes.