Paediatric Nursing PDF - Child with Respiratory Conditions

MDJ 3272 Paediatric Nursing Child with Respiratory Conditions Chan KG, FPSK, UNIMAS, 8.4.24  Learning outcomes at the end of the session: 1. Describe the clinical manifestation of children with various respiratory conditions. 2. Relate the pathophysiologic pro...

MDJ 3272 Paediatric Nursing Child with Respiratory Conditions Chan KG, FPSK, UNIMAS, 8.4.24  Learning outcomes at the end of the session: 1. Describe the clinical manifestation of children with various respiratory conditions. 2. Relate the pathophysiologic process of children with various respiratory conditions. 3. Describe the management for children with various respiratory conditions. 4. Formulate nursing care plan to meet the health needs of hospitalized children with various respiratory conditions. 2  Laryngotracheobronchitis/Croup; Bronchiolitis; Bronchopneumonia; Asthma oDefinition oAetiology & Epidemiology oPathophysiology oClinical manifestations oDiagnostic evaluation oTherapeutic management oNursing management  Differences to consider in children: 1)Anatomical Airway Breathing 2)Physiological Respiratory Immune function Anatomical differences (i) Anatomical differences (ii) Physiological differences (i) Physiological differences (ii)  Laryngotracheobronchitis/Croup Pathophysiology  Pathophysiology Upper respiratory tract infection Infection descends to adjacent structures Inflammation of mucosa lining of larynx and trachea; Narrowing of airway, Child struggles to inhale air past the obstruction and into the lungs, Resulting in inspiratory stridor and recessions.  Clinical features: Fever, Cough, Running nose Barking cough & hoarseness; https://youtu.be/sZrrtC7Pj6I?si=INy82kzfmXSW4oEe Inspiratory stridor, Respiratory distress* Respiratory distress: CHEST RECESSIONS at the following locations: Respiratory distress: chest recessions:  Other possible respiratory distress signs could be: Nasal flaring* refers to the widening of the nostrils during during respiratory distress; a physical sign that indicates increased effort in breathing. in an efforts to maximize the airflow into the lungs, commonly observed in infants and young children during respiratory distress.  Diagnostic assessment: Clinical assessment Visualization by ENT team using scopes; Pulse oximetry; Therapeutic management: Bronchiolitis: Aetiology Commonest: respiratory syncytial virus (RSV); Transmitted via direct contact with respiratory secretions. Common age group: infants: 1-6 months old.  Bronchiolitis: Pathophysiology:  Bronchiolitits: clinical features: Running nose, Mild fever, Coughing Tachypnoea Chest wall recession Wheezing sound Rhonchi/crepitation (auscultation) Wheezing sound: https://www.youtube.com/watch?v=QNrsjDzD0QM 4/8/2024 27  Rhonchi sound: https://www.youtube.com/watch?v=YgDiMpCZo0w 4/8/2024 28  Diagnostic evaluation: Arterial blood gas (assessment and monitoring) Pharmacotherapy: 3 % saline nebulisation. (increase mucus clearance); Inhaled short-acting beta-2 –agonist (salbutamol/Ventolin) – act on beta2 adrenergic receptors in the smooth muscles of the airways; leading to relaxation of these muscles and dilation of the bronchioles (small airways). Inhaled Ipratropium/Atrovent) - an anticholinergic bronchodilator; works by blocking the action of acetylcholine, a neurotransmitter that causes smooth muscle contraction in the airways; helps to relax the muscles around the airway.  Pathophysiology - Causative agent introduced into lungs through inhalation or from bloodstream; - Inflammation begins in terminal bronchioles; bronchioles clogged with mucopurulent exudate. Bronchopneumonia: Clinical manifestations *Tachypnoea: < 2 months: > 60/min 2 -12 months: > 50/min 12 months- 5 years: >40/min  Diagnostic evaluation 1) Chest X-ray 2) White blood cell count Increased with predominance of polymorphonuclear cells (bacterial) Leucopenia (viral or severe infection) 3) Blood culture 4) Pleural fluid analysis 5) Pulse oximetry (to determine severity)  Therapeutic management (i) Antibiotics: Therapeutic management (ii)  Asthma: Asthma is a chronic inflammatory disorder of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning.  Risk factors: Environmental: air pollutions, dust mites, pollens, animal furs, Tobacco smoke exposure; Food (e.g. nuts) Exercise-induced; Cold air; Hereditary/family history; *Atopy/eczema; Gender: > boys than girls till adolescence *Atopy - a predisposition to developing certain allergic hypersensitivity reactions; tend to produce higher levels of immunoglobulin E (IgE) antibodies in response to allergens.  Pathophysiology: Inflammation of airways - involves various immune cells, including mast cells, eosinophils; release mediators, e.g. histamine; leads to: - Inflamed/thickened airway walls; - Broncho-constriction: due to contraction of the smooth muscle surrounding the airways; - Mucus secretions: due to mediators effects; These lead to narrowed airway and air flow resistance. Pathophysiology involved Clinical features: Breathlessness: unable to finish a sentence (bigger child); feeding difficulties (infants), Irritable, agitated, inconsolable, Chest wall recessions, Crackles, rhonchi (auscultation), *Silent chest (pre-terminal sign) Emergency management Therapeutic management Allergen /personal trigger control; Drug therapy:  Relieving drugs: e.g. Beta 2-agonists: salbutamol (via MDI/dry powder inhaler) Ipratropium bromide (via MDI)  Preventive drugs: e.g. Corticosteroids: oral Prednisolone, MDI fluticasone, Budesonide; Oral Montelukast: anti-leukotrienes  Prioritized nursing diagnosis: Based on: Urgency: ABC, Major concern… (……) related to (……) secondary to (……) as evidenced by (……) 1) Ineffective airway clearance related to… …inflammation of larynx and trachea secondary to croup…as evidenced by inspiratory stridor. …inflammation of bronchiolar wall and accumulation of mucus secondary to bronchiolitis……as evidenced by wheeze/rhonchi/fine crepitus on auscultation. …inflammation of the airway, bronchoconstriction and build-up of excessive mucus secondary to asthma…as evidenced by audible wheeze, rhonchi/crackles on auscultation. 1) Ineffective airway clearance related to…inflammation of larynx and trachea secondary to croup…as evidenced by inspiratory stridor. Interventions: 1) Assess the child’s airway patency (as a baseline data). 2) Administer saline nebulization as prescribed (to loosen the secretions). 3) Perform naso/oropharyngeal suctioning (to remove excessive secretions that obstruct the airway). 4) Perform chest physiotherapy using percussion or vibration (to mobilize the secretions). 5) Encourage feeding if not contraindicated (for hydration, and to loosen the tenacious secretions for easier mobilization and expulsion). 6) Administer atrovent:ventolin: saline 3% (AVN) nebulization at 250mcg (2mls):2.5mg(0.5mls):1.5mls (to dilate the airway). Oxygen.. Monitor, Inform.. Document..  2) Altered breathing pattern related to… …narrowing of the airway secondary to inflammation of larynx and trachea.. …as evidenced by chest recession, dyspnea and inspiratory stridor. …inflammation of bronchiolar wall and accumulation of mucus secondary to bronchiolitis …as evidenced by a respiratory rate of 70 breaths/min (tachypnea), dyspnea, chest recession and hyperinflated lung on chest x-ray. 3) Ineffective gaseous exchange related to accumulation of mucopurulent exudate within the alveoli secondary to inflammation of the terminal bronchioles and lung parenchyma as evidenced by the SpO2 of 89%. Altered body temperature (hyperthermia) related to inflammatory process at …. as evidenced by the body temperature of …. Anxiety related to …. as evidenced by …. Parental anxiety related to …. as evidenced by …. 4/8/2024 52 Bronchopneumonia - Pathogens based on age-group; - Generalized patchy infiltrates (vs. lobar pneumonia: affecting lobe); - Management: Antibiotics  Asthma Chronic, Episodic Management: Presence of risk factors Personal triggers/allergen control Personal triggers/allergies Strict drug compliance Inflammation of the airway, (preventer, reliever) bronchoconstriction, excessive mucus Correct techniques in drug Classic presentation (at night or early administration morning): Asthma diary Wheeze Chesty cough Chest tightness Dyspnoea  Bibliography Hockenberry , M.J. and Wilson, D. (2011). Wong’s Nursing Care of Infants and Children (9th ed.). Canada: Elsevier, Mosby. Hussain Imam Hj Muhammad Ismail, Hishamshah Mohd Ibrahim, Ng, H.P. and Thomas, T. (2019). Paediatric Protocols for Malaysian Hospitals (4th ed.). Malaysia: Ministry of Health of Malaysia.