Pediatric Respiratory System: Anatomy and Infections

A&P Differences in Pediatrics

• Nasal passages, glottis, and trachea are narrow, paired with a large tongue.
• There are fewer functional airway muscles.
• Soft tissue is abundant, and the mucus gland ratio increases (50x more than adults).
• Thyroid, cricoid, and tracheal cartilages are immature.
• Intercostal and accessory muscles are poorly developed.
• The abdomen is large.
• Children up to age 2 are mainly sensory learners and tend to put everything in their mouths.

Influences on Infection

• Age is a factor.
• Size matters.
• Decreased resistance increases risk.
• Infections & respiratory issues are more prevalent in cold seasons.
• Humidity can create favourable conditions for asthma patients.

Clinical Manifestations of Respiratory Dysfunction

• It is more difficult to assess respiratory distress in babies.
• Respiratory distress manifests as grunting, nasal flaring, retractions, cyanosis, and tachypnea, varying by age group.
• Fever might be absent in newborns and is not a reliable sign.
• Anorexia is very common, so encourage fluids like Pedialyte.
• Small children tend to vomit more readily with illness.only aspiration risk is a concern.
• Nasal blockage or discharge can occur.

Nursing Management

• Anxiety and pain can increase breathing rate
• Anxiety and pain should be assessed and managed to keep the child calm using toys that can promote cognitive development
• Easing respiratory effort is a priority
• Promote overall rest.
• Ensure the child is comfortable.
• Prevent the spread of infection through handwashing.
• Reduce temperature with Tylenol. A tepid bath with warm water is also helpful.
• Promote proper hydration and nutrition.
• Provide family support through early explanations of condition.
• Make parents knowledgeable so that they can make informed decisions. Ask if the child is up to date on vaccines.

Nasopharyngitis

• Nasopharyngitis, also known as the common cold, is usually caused by numerous viruses.
• Common viruses are RSV, rhinovirus, adenovirus, influenza, and parainfluenza viruses.
• Nasopharyngitis symptoms vary with age and may include fever, nasal mucus, and sneezing.
• There is no cure, only efforts to manage symptoms.
• Nursing care involves providing fluids, rest, elevating the head of the bed, and suctioning but most importantly involves prevention.
• Prevention is key: Hand washing & cough etiquette. *Fluids help rid of mucus & helps increase appetite. *Elevating HOB provides comfort and eases respiratory efforts (treat symptoms as they come out)

Pharyngitis

• 80-90% of pharyngitis cases are viral, while the rest are caused by Group A Beta-Hemolytic Streptococci (Strep throat).
• S/S: Sore throat, headache, fever, possible body rash(trunk area), and abdominal pain(esp in small kids.
• Diagnosis is confirmed with throat culture test(swab), rapid strep test for presence of Group A Strep (viral or bacterial). -Penicillin used to treat Strep
• Children should not return to school until they have had 24 hours w/o fever (contagious).
• Give Tylenol or Motrin for pain.
• Educate parents: Finishing the full course of antibiotics is essential. Waiting could cause bacteria to go dormant (test neg), but still spread to the heart and kidneys.
• Follow up with strep test (1-3 wks later) to confirm no active bacteria. *Throw away old tooth brushes.

Tonsillitis

• Often occurs with pharyngitis, either viral or bacterial.
• Clinical signs: edema, enlarged tonsils, difficulty swallowing, mouth breathing w/ struggle.
• Tx: Penicillin; tonsillectomy if tonsillitis is chronic.
• Nursing management: pain management.
• Loud Stridor means more airway blockage = Removal.

Tonsillectomy & Adenoidectomy

• To treat frequent strep throat infections and/or airway obstructions (sleep apnea).
• Post-op care: watch for hemorraging.
• Frequent swallowing=Bright red blood in saliva= notify PCP STAT!
• Vomiting bright red blood= call PCP STAT!
• NPO, ONLY Cool, clear liquids (Water, AJ & Pedialite only).
• Avoid coughing, crying, and screaming.
• Pain Meds : Tylenol/ Motrin + water constant 24hrs.

Otitis Media

• OM involves having both inflammation and fluid in the middle ear, along with symptoms of an allergic illness.
• If fluid behind the ear drum w/o inflammation, it's OME (Otitis Media Effusion)
• It follows respiratory infection, and frequently occurs in winter.
• It is most common in those <24 months, and uncommon amongst kids >7 years
• OM is caused bacterial respiratory infecctions like RSV
• Non-infectious otitis media is due to blockage of euthachian tube
• Fever and cough will be present, along with swelling, tugging, or pulling on ear
• Treatment of OM is antibiotics
• Proper breast feeding and not propping bottles, not exposing children to smokers can help prevent otitis media

Croup Syndrome

• Syndromes are hoarseness, with "barking" cough and inspiratory stridor may cause breathing problems
• Affects larynx, trachea, and bronchi
• Epiglottitis is Croup getting worse
• LTB and laryngitis are types
• Monitor cases, especially in children

Acute Epiglottitis

• Obstructive inflammatory process is a: MEDICAL EMERGENCY
• It is commonly stemmed *H. infleunzae
• Manifestions: abrupt onset and Tripod
• Treated with antibioitcs
• There are no visualization of throat or tongue

Laryngitis

• Caused by URI, colds; overuse of voice(yelling, singing); and smoke.
• Hoarseness, throat discomfort & loss of speech.
• Voice should be rested with use of humidified air.

Acute Laryngotracheobronchitis

• This stems from acute Croup
• Slow onset
• There will nighttime barking cough, and low grade temperature
• O2 can treat this

Bronchiolitis/RSV

• Bronchiolitis is primarily caused by RSV, but adenovirus and parainfluenza can be linked.
• Illness causes inflammation and obstruction of bronchiole tubes.
• RSV causes: increased nasal discharge, low-grade fever, cough, intercostal retractions, wheezing, tachypnea, and diminished breath sounds.
• RSV is primarily supportive.
• Synagis reduces severity, hand washing is essential

Pertussis

• Bacterial, Bordetella pertussis
• Treatment is antibiotics
• The Nursing Management: Highly contagious; remain isolated for 5 days after antibiotics started

Foreign Body Aspiration

• Small toys and food aspiration.
• Dyspnea diagnosis; xray confirmation.
• Abdominal thrusts should be performed.

Asthma

• Inflammatory disorder of the airways, causing reversible obstruction.
• Allergic related w grow out of, wheezing
• Step 1: mild, nighttime symptoms less than 2x
• Spet IV: severe systems

Asthma causes

• Exposure to allergens
• Dx eval is PFT and PEFR
• Tx is drug therapy
• Albuterol is short-acting beta blocker broncodialator
• Side effects are energy an restlessness

Acute Asthma Attack

• Abuterol is used
• Effects are rapid heart rate (1st)
• Teach not to take before bed
• Check if effective

Asthma pharmacological therapy

• SABA albuterol is used
• Inhaled corticosteroids are used
• Wash out mouth after

Cystic Fibrosis

• A genetic dysfunction
• Life expectancey is 30s
• Respiratory issues are
• Stagnation of mucous
• Dx Testing
• Basis of most reliable diagnostic procedure
• C-ray

GI Symptoms in Cystic Fibrosis

• Failure to Thrive
• Enzyme prior to eatting
• Steatorrhea

Cystic Fibrosis

Parents report children tast salty Hyponatremix

Cystic Fibrosis T

CPT chert physiotherapy- cupping Aerosolized antibiotics

Prognosis C in Cytstic Fibrosis

• P: hand washing
• Increase nutrients intake

Overview of the anatomical and physiological differences in the pediatric respiratory system that make them more vulnerable to infections. Factors such as age, size, decreased resistance, seasonal humidity, and conditions like asthma influence the risk of infection. Clinical manifestations of respiratory dysfunction.