The Child with Respiratory Disorder PDF

2/15/2024 The Child with Respiratory Disorder Introduction to Maternity and Pediatric Nursing, pp. 593-622 NP03L009 ELO A · Version 2.0 1 Terminal Learning Objective Given a scenario of a pediatric patient with a respiratory disorder,...

2/15/2024 The Child with Respiratory Disorder Introduction to Maternity and Pediatric Nursing, pp. 593-622 NP03L009 ELO A · Version 2.0 1 Terminal Learning Objective Given a scenario of a pediatric patient with a respiratory disorder, provide safe and effective care by correctly responding to written, oral and experiential assessment measures. 2 Respiratory System 3 1  2/15/2024 Anatomic Differences Uses abdominal Alveoli continue to muscles to divide breathe Small airway diameter Uses accessory Less respiratory muscles mucus Diaphragm, Less smooth muscle larynx, & trachea Respiratory rate is attached higher higher Nose breathers 4 Respiratory Procedures Bronchoscopy Lung biopsy ABG Pulse oximetry Pulmonary function tests CXR CT Radioisotope scan Bronchogram Angiogram 5 Upper Respiratory Disorders 6 2  2/15/2024 Nasopharyngitis Pathophysiology Cold (acute coryza) Rhinovirus kpprx.com ebmedicine.net pbs.org 7 Nasopharyngitis Manifestations Inflammation and edema of mucus membranes Fever of 104 F (40 C) Nasal drainage Irritability Sore throat Cough General Discomfort Loss of fluids through nausea and diarrhea 8 Nasopharygitis Treatment No cure Rest Clear airways Adequate fluid intake Prevention of fever Skin care Antibiotics are NOT effective 9 3  2/15/2024 Acute Pharyngitis Pathophysiology Inflammation of structures of the throat Children 5-10 years Group A beta-hemolytic streptococcus or Haemophilus influenzae 10 Acute Pharyngitis Manifestations Fever of 104 F (40 C) Malaise Dysphagia Anorexia Positive throat culture 11 Acute Pharyngitis Treatment Acetaminophen Penicillin for 10 days 12 4  2/15/2024 Croup Syndromes Pathophysiology “Barking” cough Varying degrees of inspiratory stridor Benign vs. Acute 13 Croup symptoms 14 Congenital Laryngeal Stridor Benign croup Weakness of the airway wall and floppy epiglottis Symptoms improve with prone position or propped in side-lying position Condition improves with growth and muscle strengthening Provide reassurance Suggest slow, small feedings, and positioning 15 5  2/15/2024 Spasmodic Laryngitis Benign Caused by: Virus Allergy Psychological trigger GERD Sudden onset, at night with barking, brassy cough Attacks last a few hours Treatment Increased humidity and providing fluids 16 Laryngotracheobronchitis Acute croup Viral cause Mild upper respiratory infection followed by brassy or barking cough Manifestations Edema Destruction of respiratory cilia Exudate Obstruction 17 18 6  2/15/2024 Laryngotracheobronchitis Treatment Increase humidity If hospitalized Mist Tent Croupette IV fluids Cluster care Nebulized epi 19 Epiglotitis Pathophysiology Caused by H. influenzae type B Children 3 -6 years Life threatening emergency Manifestations Abrupt onset Orthopnea Wide-eyed, anxious, restless Froglike croak on inspiration Cough absent 20 Epiglotitis Treatment Never use a tongue blade to examine throat Primary nursing responsibility Tracheostomy set at bedside Oxygen Antibiotics H. influenzae type B vaccine recommended 21 7  2/15/2024 Check on Learning What is another name for nasopharyngitis? Why aren't antibiotics given for nasopharyngitis? 22 Check on Learning Which are signs/symptoms of epiglottitis? (Select all that apply.) A Child insists on sitting up B Drooling because of difficulty in swallowing C Anxious with croaking on respiration D Edematous tongue and swollen lips E Child leans forward with the mouth open 23 Check on Learning A health care provider is preparing to examine the throat of a child diagnosed with acute epiglottitis. A priority nursing responsibility would be to a) have a tracheotomy set at the bedside b) immobilize the child’s head c) restrain the child’s arms d) have oxygen available 24 8  2/15/2024 Bronchitis Pathophysiology Infection of the bronchial tree Seldom occurs as a primary infection Predisposing factors Poor nutrition Allergy Chronic respiratory infections 25 Bronchitis Manifestations Gradual onset Unproductive hacking cough May become productive with purulent sputum Treatment Cough Suppressants Not useful Antihistamines Expectorations Antibiotics 26 Bronchiolitis Pathophysiology Viral Infection of small airways Inflammation of small diameters of bronchioles Obstruction leads to atelectasis Manifestations URI with mild fever Serous nasal discharge Wheezing cough with signs of respiratory distress Increased respiratory rate 27 9  2/15/2024 Bronchiolitis Treatment Symptomatic Similar treatments as croup Semi-Fowlers with slightly hyperextended neck Oral feeding with supplemental IV fluids Bronchodilating aerosol therapy Frequent VS Monitor oxygen saturation 28 Influenza Pathophysiology Leading cause of death of children with underlying medical conditions Spread through droplet infection Seasonal occurring between October and March Annual vaccines Manifestations Like other viral infections Point of care testing 29 Influenza Treatment Started within 48 hours of first signs and symptoms Drugs oseltamivir (Tamiflu) Inhaled zanamivir (Relenza) Intravenous peramivir (Rapivab) Neurominidase inhibitors Prevention Annual vaccine 30 10  2/15/2024 Respiratory Syncytial Virus (RSV) tutorvista.com 31 RSV Pathophysiology 50% of bronchiolitis cases Most common cause of viral pneumonia Occurs before 2 years old and reinfection is common Infants between 2-7 month can become seriously ill Older children and adults don’t become seriously ill 32 RSV Low grade fever Cough Rhinorrhea Gradually progress to respiratory distress CXR normal Nasopharyngeal washing show RSV antigens 33 11  2/15/2024 Transmission Contact respiratory secretions RSV easily spread Incubation period is 2-8 days Survive for more than 6 hours on fomites and on hands for 30 minutes 34 RSV Prevention Infants with underlying medical conditions Monoclonal antibody palivizumab (Synagis) 35 RSV Assign to personnel not caring for other patients at high risk Treatment Assess for “quiet chest” Oxygen – maintain 90 – 95% saturations Suctioning – maintain airway IV fluids I&O – Urine output = 1-2 mL/kg/hr Pedialyte or Ricelyte Weigh daily Bronchodilators 36 12  2/15/2024 Pneumonia stanford.edu 37 Pneumonia Manifestations Preceded by URI Cough begins dry and gradually becomes productive Fever rises 103 – 104 F (39.5 – 40 C) Tachypnea Shallow respirations Listlessness Poor appetite Lies on affected side CXR confirms diagnosis 38 Pneumonia Treatment Depends on causative organism Antipyretics Ibuprofen or acetaminophen Oxygen Rest Fluids Cough suppressant Good hygiene Avoid tobacco use H. Influenzae type B vaccine recommended 39 13  2/15/2024 Pneumonia Nursing Care Pneumonia Pathway helps with plan of care Assess for respiratory distress Increased respiratory rate Retractions Nasal flaring Home care teaching Suction MDI Medications VS, I&O, daily weight, Monitor the progression of disease 40 Inhalation Injury / CO Poisoning Pathophysiology Smoke inhalation Poisonous substances Three stages of inhalation injury Pulmonary insufficiency Pulmonary edema Bronchopneumonia Evidence of inhalation injury Carbon monoxide combines with hemoglobin Carboxyhemoglobin (COHb) 41 Inhalation Injury / CO Poisoning Treatment Oxygen administration I & O Frequent ABGs Hyperbaric oxygenation Have intubation tray readily available Respiratory arrest Prevention Working smoke and CO detectors in the home 42 14  2/15/2024 Tonsillitis / Adenoiditis Pathophysiology Part of the body’s defense mechanism Manifestations Tonsillitis Difficulty swallowing Adenoiditis Blocked nasal passages Mouth breathing Symptoms similar to nasopharyngitis 43 Tonsillitis / Adenoiditis Treatment Self correcting as the child grows Surgery is not performed during acute infectious episode Tonsillectomy Persistent airway obstruction Repeated infections Difficulty breathing therabreath.com 44 Tonsillitis / Adenoiditis Post-operative Care Position on the side and partly on the abdomen Watch for bleeding Frequent swallowing while asleep Increased pulse & respirations Restlessness Vomiting bright red blood 45 15  2/15/2024 Tonsillitis / Adenoiditis Post-operative Care Ice collar or ice-pops Small amounts of clear liquids No red or brown colored juices No milk or milk products Pain relief Acetaminophen Watch for hemorrhage Keep quiet for a few days Avoid gargling, clearing throat, blowing nose, or spicy foods 46 Rhinitis Pathophysiology Inflammation of nasal mucosa due to allergic response Seasonal allergies Occurs I 10% of children Mast cells respond to an antigen releasing histamine Nasal edema and increased mucus production Genetic predisposition 47 Rhinitis Manifestations Allergic Salute Darkened circles under eyes Crease on nose Nasal congestion Clear, watery nasal drainage Sneezing Itchy eyes Lab and skin test 48 16  2/15/2024 Rhinitis Treatment Symptomatic Nonsedating antihistamines Decongestants Prophylactic Therapy Cromolyn inhalants Glucocorticoid nasal sprays carbinoxamine maleate (Karbinal ER) – H-1 blocker Leukotriene antagonists 49 Rhinitis Treatment Main goals Understand the difference between allergies and cold Provide referral for medical care Support during long-term allergy testing and immunotherapy process Teaching Controlling the environment exposure Dust control Prevention of contact with animal dander Use of AC and HEPA filters 50 Asthma 51 17  2/15/2024 Asthma Pathophysiology 52 Asthma 53 Asthma Diagnosis History Physical examination Response to bronchodilator therapy Elevated eosinophils Allergy skin testing Radioallergosorbent test (RAST) Exhaled nitrous oxide Rarely diagnosed in infants 54 18  2/15/2024 Asthma Manifestations Slow or abrupt episodes Obstruction is most severe during expiration Hyperinflation results in increase effort of breathing Often happen at night Allergic shiners Slight eyelid eczema Mouth breathing 55 Asthma Treatment Management Assessment Monitoring Education Environment Medication Reduction of exacerbations while maintaining normal growth and development 56 Asthma Main goals 57 19  2/15/2024 Asthma 58 Asthma 59 Asthma Nursing Care Control environment Avoid dander, mold, smoking, dust Humidity controlled 25 - 50% Remove dust collectors Kill mites with benzyl benzoate (Acarosan) Do not exclude children from physical activity Identify triggers of asthma Monitor lung function with PFM Self-care aids to improve control of asthma 60 20  2/15/2024 Asthma Nursing Care Diet Encourage oral fluids Room temperature beverages Avoid milk products Well-balanced diet Timing of meals to prevent aspiration risk 61 Asthma Nursing Care Self-Care Importance of exercise to strengthen lungs Pursed-lip breathing Biofeedback Teaching the child about triggers Teach use of peak flow meter Self testing Peak flow meter diary Spirometry MDI, powder inhalers 62 Status Asthmaticus Pathophysiology Severe respiratory distress not responsive to treatment This is a medical emergency Child admitted to the ICU 63 21  2/15/2024 Status Asthmaticus Treatment VS IV medications Oxygen via nasal cannula Comply with prescribed medical regimen Teach family and child Seek prompt medical care Minimize exposure to known allergens Medical alert bracelet Use your written plan for crisis management 64 Cystic Fibrosis 65 Cystic Fibrosis Pathophysiology Inherited recessive trait Defect on gene chromosome number 7 Newborn screening Sweat chloride test Exocrine gland dysfunction Increased viscosity of mucus gland Loss of electrolytes in sweat 66 22  2/15/2024 Cystic Fibrosis Pathophysiology Multisystem disease Respiratory Airways obstructed by thick secretions Creates medium for growth of organisms Thick secretions and infections cause hypoxia leading to heart failure Emphysema, wheezes and respiratory distress 67 Cystic Fibrosis Pathophysiology Multisystem disease Digestive System Thick secretion prevent digestive enzymes leading to poor absorption Bulky, foul-smelling stools Thick, impacted feces cause rectal prolapse Pancreatic, liver and biliary obstruction 68 Cystic Fibrosis Pathophysiology Multisystem disease Skin Loss of electrolytes Sodium Chloride Electrolyte imbalances Reproductive System Infertility 69 23  2/15/2024 Cystic Fibrosis Manifestations Salty tears Salty saliva Salty sweat Heat prostration Distended abdomen Rectal prolapse Sinusitis Chronic cough 70 Cystic Fibrosis Manifestations Lung involvement Clogged airway passages with mucus Widespread obstruction of bronchioles Obstructive emphysema Atelectasis Barrel chest, clubbed fingers Compensatory response to chronic hypoxemia Dyspnea, wheezing, cyanosis 71 Cystic Fibrosis Treatment and Nursing Care Intermittent aerosol therapy Inhaler that acts as mucus clearance device Bronchodilators Recombinant human deoxyribonuclease dornase alfa (Pulmozyme) decreasing thickness of secretions Postural drainage Pursed-lip breathing 72 24  2/15/2024 Cystic Fibrosis 73 Cystic Fibrosis Treatment and Nursing Care Oral pancreatic preparation pancrelipase (Pancreaze) Vitamins A, D, E, K, iron and zinc supplements Cystic fibrosis transmembrane conductance regulator kelydeco (ivacaftor) 74 Cystic Fibrosis Treatment and Nursing Care Diet high in protein and calories Monitor weight, and I & O Assess for dehydration and electrolyte imbalances Skin conditions Wear light clothing to avoid overheating 75 25  2/15/2024 Bronchopulmonary Dysplasia Pathophysiology Thickening of the alveolar walls and bronchiolar epithelium Premature infants with abnormal lung development Dependent on oxygen Edema Cilia paralyzed Lose of ability to clear mucus Respiratory obstruction 76 Bronchopulmonary Dysplasia Prevention Prevention of premature births Goal of treatment Administer only the amount of oxygen required to prevent hypoxia Prevent tissue trauma Administer surfactant 77 Bronchopulmonary Dysplasia Manifestations Wheezing Retractions Cyanosis on exertion Use of accessory muscles Clubbing of fingers Failure to thrive Irritability 78 26  2/15/2024 Bronchopulmonary Dysplasia Treatment Goal of therapy Reduce inflammation of airway Wean infant from mechanical ventilator Noninvasive positive pressure ventilation (CPAP) Fluid restriction Bronchodilators Diuretics Nutrition via NGT Education 79 Sudden Infant Death Syndrome Pathophysiology Unexpected death of an apparently healthy infant Peak incidence between 2 – 4 months Incidence has decreased with “Back to sleep” Campaign Risk factors Brain and lung Environmental issues Sleeping prone Intrauterine exposure Bed-sharing 80 Sudden Infant Death Syndrome Manifestations Death occurs during sleep Infant does not cry or sounds of distress 81 27  2/15/2024 Sudden Infant Death Syndrome Prevention Firm mattress with no loose bedding Use of pacifier and breast feeding Home apnea monitors for high-risk infants Teach CPR to parents Remove soft pillows and fluffy blankets “Safe to Sleep Campaign” Positioning in car seat Positioning in sling carrier 82 Sudden Infant Death Syndrome Nursing Care Convey that infant died of a disease process Parents are not responsible for the death Give time to say good-bye Encourage holding and rocking the infant Encourage tears and sharing emotions Misplaced guilt or blame 83 Check on Learning The nurse is reinforcing teaching concerning the use of a cromolyn sodium inhaler for a 10-year-old with asthma. Which would be an accurate concept to emphasize? a) You should use the inhaler whenever you have difficulty breathing b) You should use the inhaler between meals c) You should use the inhaler regularly every day even if you are symptom free d) You can discontinue using the inhaler when you are feeling stronger 84 28  2/15/2024 Check on Learning How long can RSV survive on countertops, tissues and soap bars? On hands? 85 Check on Learning What are the classic signs of asthma? What are the goals of asthma therapy? 86 Check on Learning Which sign or symptom observed in a sleeping 2- year-old child immediately after a tonsillectomy necessitates reporting and follow-up care? a) A pulse of 110 beats/min b) A blood pressure of 96/64 mm Hg c) Nausea d) Frequent swallowing 87 29  2/15/2024 Check on Learning Which is a priority nursing diagnosis in a child admitted with acute asthma? a) Risk for infection b) Imbalanced nutrition c) Ineffective breathing pattern d) Disturbed body image 88 Check on Learning An infant is admitted with a diagnosis of respiratory syncytial virus (RSV) infection. The type of transmission-based isolation precaution the nurse would set up would be (Select all that apply): a) Standard precautions b) Droplet precautions c) Contact precautions d) Airborne infection isolation precautions 89 Critical Thinking The father of a child diagnosed with cystic fibrosis visits his child in the hospital. He states that he thinks the hospital food does not agree with his child because he notices the child has a loose stool with a very bad odor. None of his other children have that type of stool. He brought some loperamide (Imodium) pills from the drugstore to give to the child. What is the best response of the nurse? 90 30  2/15/2024 Review of Main Points Respiratory infections Nasopharyngitis and acute pharyngitis Tonsillitis and adenoiditis Croup RSV Pneumonia Asthma Cystic fibrosis 91 Questions 92 31