Respiratory Dysfunction and Infections

• Leading factors in respiratory dysfunction include location(upper or lower), infectious agents, the child's age and resistance and croup syndrome.
• The upper respiratory tract includes the nose, pharynx, larynx, and upper trachea.
• The lower respiratory tract includes the lower trachea, bronchi, bronchioles, and alveoli.
• Croup syndromes involve infections of the epiglottis and larynx.
• Clinical manifestations of respiratory infections vary with age.
• Generalized signs and symptoms and local manifestations of respiratory infections differ in young children: fever, anorexia, vomiting, diarrhea, abdominal pain, cough, sore throat, nasal blockage or discharge and respiratory sounds.
• Nursing interventions for respiratory infections include assessment, easing respiratory effort, fever management, promoting rest and comfort, infection control, promoting hydration and nutrition, family support, and teaching.

Upper Respiratory Tract Infections

• Acute Viral Nasopharyngitis is the "common cold".
• It is caused by viruses such as RSV, rhinovirus, adenovirus, influenza, and parainfluenza viruses.
• Fever and home management vary with the child's age.
• Nursing care management involves nursing care for babies with nasopharyngitis, prevention, and family support.
• Acute Streptococcal Pharyngitis (GABHS) is caused by Group A beta-hemolytic strep (strep throat), which carries risks for rheumatic fever and acute glomerulonephritis.
• Clinical manifestations vary with symptoms; onset is abrupt, characterized by pharyngitis, headache, fever, and abdominal pain.
• A child with GABHS Pharyngitis may have a fine sandpaper rash on the trunk, axillae, elbows, and groin; the uvula is edematous and red, and pain can range from mild to severe.
• Diagnostics for GABHS Pharyngitis include throat culture or rapid antigen testing.
• Therapeutic management for streptococcal infection involves oral penicillin or erythromycin for children allergic to PCN.
• If GABHS is not treated it can lead to Rheumatic Fever or Acute glomerulonephritis.
• Nursing considerations should be taken into account

Tonsillitis

• Indications for tonsillectomy and adenoidectomy should be taken into consideration
• Nursing care includes placing the patient in a side-lying position or sitting up, avoiding coughing, blowing the nose, and clearing the throat, inspecting for fresh bleeding, using an ice collar/analgesics, and providing hydration.

Otitis Media (OM)

• OM is one of the most prevalent diseases of early childhood, with the highest incidence in the winter months.
• The Etiology and Pathophysiology is Streptococcus pneumoniae, H. influenzae, moraxella catarrhalis.
• Predisposing factors include malfunctioning Eustachian tubes.
• Diagnosis includes visual inspection and assessment of clinical symptoms, such as acute onset of ear pain, fever, and a bulging yellow or red tympanic membrane.
• Therapeutic management involves pharmacologic interventions (antibiotics, amoxicillin) and surgical interventions(Myringotomy and Tympanostomy tubes
• Nursing considerations include relieving pain with heat/cold packs and administering ibuprofen/Tylenol.
• Prevention of recurrence involves holding the child upright during feedings, immunizations, exclusive breastfeeding for the first 6 months, avoiding propping bottles, abstaining from smoking, and reducing pacifier use as a night soothing method.

Croup Syndromes

• Croup Syndromes are characterized by hoarseness, a “barking” cough, inspiratory stridor, and varying degrees of respiratory distress
• Affect the larynx, trachea, and bronchi.
• Croup syndromes include epiglottitis, laryngitis, laryngotracheobronchitis (LTB), and tracheitis.
• Acute Epiglottitis involves abrupt onset, progressing to severe respiratory distress.
• Manifestations include the absence of spontaneous cough, agitation, drooling, sore throat, pain, tripod positioning, retractions, muffled voice, frog-like stridor, inspiratory stridor, mild hypoxia, and distress.
• Therapeutic management focuses on potential respiratory obstruction.
• Prevention includes the Hib vaccine.
• Acute Laryngitis is more common in older children and adolescents and is usually caused by a virus
• The chief complaint is hoarseness, it is generally self-limiting and without long-term sequelae
• Treatment is symptomatic
• Acute laryngotracheobronchitis (LTB) is the most common of the croup syndromes, generally affects children <5 years.
• LTB is caused by organisms such as RSV, parainfluenza virus, Mycoplasma pneumoniae, influenza A and B.
• Manifestations of LTB include low-grade fever, barking or seal-like cough, inspiratory stridor, suprasternal retractions, increasing respiratory distress and hypoxia, and can progress to respiratory acidosis, respiratory failure, and death.
• Therapeutic management for LTB involves airway management, maintaining hydration (PO or IV), high humidity with cool mist, and administering nebulizer treatments with epinephrine or steroids.

Infections of the Lower Airways

• The bronchi and bronchioles are the “reactive” portion of the lower respiratory tract.

• Cartilaginous support is not fully developed until adolescence.

• Smooth muscle in these structures plays a major role in the constriction of airways.

• RSV and Bronchiolitis is a common, acute viral infection with maximum effect at the bronchiolar level.

• RSV (respiratory syncytial virus) is the common cause of bronchiolitis.

• Symptoms can be treated with: cool humidified oxygen, adequate fluid intake, airway maintenance, medication

• Nursing considerations: droplet precautions, suction before feeds and at bedtime, maintain hydration

• A vaccine (palivizumab (synagis)) is available for high-risk groups.

• Pulmonary dysfunction can be caused by noninfectious irritants.

• Foreign Body Aspiration is most common in children aged 1 to 3 years.

• Diagnosis is suspected based on history and physical signs

• For children >1, abdominal thrusts should be administered; for children <1, back blows and chest thrusts should be administered

• Recognize signs and implement measures to relieve obstruction, educate parents on prevention

• Asthma is a chronic inflammatory disorder of the airways with recurring episodic symptoms (wheezing, breathlessness, chest tightness, cough(especially at night).

• Limited airflow or obstruction reverses spontaneously or with treatment, with bronchial hyperresponsiveness.

• Clinical and Diagnostic should be evaluated

• Interpreting Peak Expiratory Flow Rates (the person's maximum speed of expiration)

  • Green (80-100% of personal best) → best-good to go
  • Yellow (50-79% of personal best) → reduce activity
  • Red (<50% of personal best) → limit activity and use short acting bronchodilator/contact HCP

• Therapeutic Management, maintain activity, pulmonary function, prevent chronic symptoms, provide drug therapy, and live life normally.

• Drug Therapy include long-term, preventive, and bronchodilators as well as quick-relief medication that have albuterol or inhaled/oral/IV Corticosteroids

• Asthma interventions include allergen control and breathing exercises.

• Acute Asthma Care involves a calm nursing presence, monitoring pulse oximetry, allowing older children to sit up if they are more comfortable, and allowing parents to remain with children.

• Status Asthmaticus is when respiratory distress continues despite vigorous therapeutic measures which could require 3 treatment of β2-agonist 20-30 mins apart, IV magnesium sulfate, concurrent infection, and therapeutic intervention.

• Cystic Fibrosis (CF) is an exocrine gland dysfunction that produces multisystem involvement and is the most common lethal genetic illness among Caucasian children.

  • The gene responsible for CF is located on the long arm of chromosome 7.
  • Approximately 3% of the U.S. Caucasian population are symptom-free carriers
  • inherited defective gene from both parents, with an overall incidence of 1:4

• Pathophysiology of CF increases the viscosity of mucus gland, sweat electrolytes, and organic and enzymatic constituents of saliva, as well abnormalities of the autonomic nervous system.

• Diagnostic Evaluation of CF: Quantitative sweat chloride test, Chest x-ray, Pulmonary function tests (PFTs), Stool fat/enzyme analysis, Barium enema

• Increased Sweat Electrolytes: Basis of the most reliable diagnostic procedure: sweat chloride test

• Normal sweat chloride is <40 mEq/L

  • 60 mEq/L in a child 6 months or older diagnostic of CF

  • 40 mEq/L highly suggestive of CF (requires a repeat test in 1-2 months)

• Treatment Goals include preventing/minimizing pulmonary complications, adequate nutrition for growth, activity, family life.

• Respiratory Manifestations of CF are present in nearly all the patients. Tenacious secretion hard to take out, obstructed bronchi and bronchioles.

• Mucus backup, which causes bacterial destruct lung tissue.

• Airway clearance therapies: Percussion and postural drainage - Twice daily and PRN - Flutter mucus clearing device - Handheld plastic pipe, no assistance needed - Handheld percussors - High frequency chest compressions - Mechanical vest device, chest wall oscillation - Forced expiration of Huffing - Glottis partially closed move secretions from smaller airways - Autogenic drainage - Variety of breathing techniques - Move mucus from lower lobes to airway - Positive expiratory pressure mask

• Breathe into mask attached to one way valve creates resistance

• Management: Bronchodilator/Steroids/NSAIDs Hypertonic saline nebulization, Physical exercise, Aerosolized antibiotics, Antifungal medication, Intravenous antibiotics, Oxygen with caution, Management of pneumothorax/Hemoptysis, Transplantation

• Thick secretions in the GI tract block pancreatic ducts, which lead to pancreatic fibrosis which prevents pancreatic enzymes from reaching the duodenum. Which will create steatorrhea and azotorrhea

• Clinical Manifestations of CF consist of Meconium Ileus (abdominal distention, vomiting, failure to pass stools, dehydration) and Gastrointestinal Manifestations (steatorrhea and azotorrhea, voracious appetite (early in disease), loss of appetite (later in disease), weight loss, failure to grow, distended abdomen)

• Evidence of deficiency of fat-soluble vitamins

• GI Management of CF: Replacement of pancreatic enzymes, High-protein, high-calorie diet, as much as 150% RDA,Water miscible forms of vitamins, Multivitamins, Night time supplemental gastrostomy feedings, Intestinal obstruction, Reduction of rectal prolapse

• Management of endocrine problems helps with pancreatic function. Eventually pancreatic fibrosis may result in CFRD. Close monitoring of Blood glucose X 3 ,Administration of Insulin, Diet, Exercise, Quarterly glycosylated hemoglobin A1cMicrovascular complication in children

• Prognosis of CF is predicted to live long as 37.4 years. CR can be controlled but it is incurable with organ transplantation has increased the survival rate. Nutrition, Prevention ,and Pulmonary hygiene can improve.

  • Families should be supportive as well

• Respiratory Failure occurs when the respiratory can't give enough oxygen to the body.

• Management include recognizing the situation to help.

Chapter 28 – The Child with Endocrine Dysfunction

• The Endocrine System controls and regulates metabolic processes, with endocrine glands distributed throughout the body.

Precocious Puberty

• Defined as sexual development before age 9 years in boys; before age 7 years in Caucasian girls; or before 6 years in African-American girls
• Occurs more frequently in girls
• Categorized into 3 types: Central precocious puberty (CPP) (80%), Peripheral precocious puberty (PPP), Incomplete precocious puberty (IPP)
• Treating it by knowing the origin if Central variety is treated with leuprolide acetate (Lupron Depot) to slown growth back to normal.

Disorders of Adrenal Function

• Adrenal cortex secretes three groups of “steroids": Glucocorticoids (cortisol, corticosterone), Mineralocorticoids (aldosterone), and Seroids.
• Congenital Adrenal Hyperplasia (CAH) is a group of disorders caused by less cortisol in the adrenal cortex. Diagnosed through the presence of ambiguous genitalia, DNA testing to rule out other causes, and increased serum levels of cortisol precursor andpotassium and decreased serum sodium and chloride.
• Therapeutic Management of CAH includes Psychological support and gluccorticoids
• Diabetes Mellitus (DM) is when the is a total or partial inshiffiency of hormone.
• Most common endocrine disorder of childhood - Type 1:IDDM: Juvenile Diabetes - Type 2:NIDDM: Adult Onset Diabetes Type 1 Diabetes. It is a desctruction of cell that lead to abscence of insulin the body. it occur in child hood or adult good. Autoimune with person with genetic predisposition from a disease.
• Type 2 Diabetis happens beucase of insulin resitence it occurs after 45
• Long term are the macro and micro vascular damages the nerves as well.
• Clinical Manifestations are 3 Ps, skin and healing.
• Insulin in therapy use rapid acing and shore acting with injection. Nutrition and excecicr are very important.