Respiratory Disorders Book PDF

Unit (6) Nursing Management of Children With Respiratory Disorders General objective By the end of this lecture, the student nurse should be able to understand the common respiratory diseases and apply nursing care for each of them. Specific objectives By the end of this lecture each stude...

Unit (6) Nursing Management of Children With Respiratory Disorders General objective By the end of this lecture, the student nurse should be able to understand the common respiratory diseases and apply nursing care for each of them. Specific objectives By the end of this lecture each student will be able 1) Illustrate the anatomy of respiratory system. 2) Recognize factors affecting the type of illness. 3) Describe the etiology and clinical presentations of acute upper & lower respiratory infections. 4) Explain nursing management of common types of acute upper respiratory infections e.g.: tonsillitis & otitis media. 5) Explain nursing management of common types of acute lower respiratory infections e.g.: pneumonia. 90  Nursing Management of Children With Respiratory Disorders Introduction Infants and children have smaller airway structures than those of adults; thus obstruction of the airway can occur rapidly. In addition, the cartilage of the young pediatric airway and reactive bronchial smooth muscle places the pediatric client at risk for obstruction due to bronchial constriction. Respiratory tract infections are described according to the areas of involvement. The respiratory tract consists of upper and lower airway structures. Upper airway structures  Begin with the oronasopharynx, the passage way connecting the nasal airway to the trachea.  Because the oral area is a shared passageway to the esophagus as well as the pharynx and larynx, inflammation in the area can impact swallowing as well as breathing.  The pharynx and upper trachea, which contains the glottis or vocal cords and epiglottis of the larynx, have an impact on speech as well as breathing. Lower airway structures  Include the lower trachea, bronchi, bronchioles, and alveoli of the lungs.  The lungs are divided into a two-lobed lung on the left and a three- lobed lung on the right side of the chest. 91  Anatomy of the respiratory system Factors affecting type of illness in acute respiratory infections  Age of child: children of preschool and school age are more often exposed to infectious agents (generally after 6 months of age infants have less resistance to infection).  Frequency of exposure: the more frequent the exposure, the greater the likelihood of a significant infection.  Size of airway: the smaller the size in young children, the worsening of condition due to considerable narrowing from edema.  Ability to resist invading organism: school age children have more mature immune system, so they have greater ability to resist the infectious agent than infants and young children. 92   Presence of greater conditions: e.g., malnutrition, congenital heart diseases, anemia, or immune deficiencies leading to decrease normal resistance to infection.  Presence of respiratory disorders, such as allergy worsening the condition.  Season: epidemic appearance of respiratory pathogens occurs in winter and spring months. Etiologies and characteristics  Viruses cause the largest number of respiratory infections.  Other organisms that may be involved in primary or secondary invasion are group A beta-hemolytic streptococcus, homophiles influenza, & pneumococci.  Infections are seldom localized to a single anatomic structure; it tends to spread to available extent as a result of the continuous nature of the mucous membrane lining the respiratory tract. Respiratory tract infections in children (RTIs) Acute respiratory tract infections are the most common illnesses in childhood, it represents 50% of all illnesses in children less than 5 years old and 30% in children aged 5– 12 years.  It has two types: 1. Acute upper respiratory tract infections (URTIs) 2. Acute lower respiratory tract infections (LRTIs) Acute Upper Respiratory Tract Infections (URTIs) Acute Upper Respiratory Tract Infections (URTIs) are illnesses caused by an acute infection which involves the upper respiratory tract including the nose, sinuses, pharynx or larynx. This commonly includes nasal obstruction, sore throat, tonsillitis, pharyngitis, laryngitis, sinusitis, otitis 93 media and the common cold. Most infections are viral in nature and in other instances the cause is bacterial. 1) Tonsillitis Introduction  The tonsils are two small rounded masses of tissue that can be seen in the back of the throat.  They are composed of tissue similar to the lymph nodes or glands and are part of the immune system.  The tonsils are thought to help protect the body from infection during the first year of life. Definition  Tonsillitis is a common viral infection in children; however, 20% of acute tonsillitis is caused by group A b-hemolytic streptococci (GABHS) and can lead to significant health problems.  It is spread by close contact with other individuals and occurs more during winter periods Incidence  Tonsillitis can occur at any age, however it most common at pre- school children, when they start nursery or school and come into 94  contact with many new infections, but rarely in children less than two years of age. Tonsillitis Nasal area Nursing considerations  Encourage bed rest.  Introduce soft liquid diet according to the child's preferences.  Provide cool mist atmosphere to keep the mucous membranes moist during periods of mouth breathing.  Warm saline gargles &paracetamol are useful to promote comfort.  If antibiotics are prescribed, counsel the child's parents regarding the necessity of completing the treatment period. Management The controversy of tonsillectomy  Surgical removal of chronic tonsillitis (tonsillectomy) is controversial. Generally, tonsils should not remove before 3 or 4 yrs. of age, because of the problem of excessive blood loss & the possibility of re- growth or hypertrophy of lymphoid tissue, in young children. 95   If a child has severe tonsillitis that is recurrent, persistent and troublesome, i.e.; in cases where the child is subjected to around 4 attacks a year for two years or more, then surgery should be considered as an option.  Surgery might also be considered if the tonsils were so large that they are causing breathing problems at night. Postoperative nursing care (after tonsillectomy)  Abdomen or side lying position to facilitate drainage of secretions.  Provide comfort and minimizing activities that precipitate bleeding.  Discourage from coughing, clearing their throat, blowing their nose that may aggravate the operation site.  Analgesics may be given rectally or intravenously to avoid the oral route.  Food and fluids are restricted until children are fully alert and there are no signs of bleeding.  Cool water, crushed ice, diluted fruit juice is given.  Soft foods, cooked fruits, mashed potatoes are started on the first or second postoperative day.  All secretions and vomitus are inspected for evidence of fresh bleeding.  The nurse observes the throat directly for evidence of bleeding. Signs and symptoms of bleeding after tonsillectomy  A classic sign of bleeding after tonsillectomy is frequent swallowing, this occurs because blood drips down the back of the throat, irritating it.  Other signs include frequent clearing of the throat and vomiting of bright red blood. 96  2) Otitis Media Definition Otitis media (OM) is the second most common disease of childhood, after upper respiratory infection (URI). It is defined as an inflammation of the middle ear. Otitis media can be classified into many variants on the basis of etiology, duration, symptomatology, and physical findings as the following: 1) Acute Otitis Media (AOM) It implies rapid onset of disease associated with one or more of the following symptoms:  Irritability, vigorous crying, rolling head, rubbing ear (in young child).  Plus, sharp pain due to pressure on mastoid area.  Otalgia (pain), Fever, otorrhea, recent onset of anorexia, vomiting, & diarrhea (in older child). 2) Otitis Media with Effusion (OME) Is middle ear effusion (MEE) of any duration that lacks the associated signs and symptoms of infection (e.g., fever, otalgia, irritability). OME usually follows an episode of AOM. 3) Chronic Otitis Media (COM) Is a chronic inflammation of the middle ear that persists at least 6 weeks and is associated with otorrhea through a perforated TM, an indwelling tympanostomy tube (TT) 97 Chronic otitis media with effusion Ear discharge Tympanostomy tube in place. Acute Otitis media with purulent effusion behind a bulging tympanic membrane. Predisposing factors of developing otitis media in children  In children, developmental alterations of the Eustachian tube (short, wide, & straight), an immature immune system, and frequent infections of the upper respiratory mucosa, all play major roles in AOM development.  Furthermore, the usual lying-down position of infants favors the pooling of fluids, such as formula. Anatomic position of Eustachian tube 98 Therapeutic management of otitis media  Administration of antibiotic (Ambicillin or Amoxicillin).  Anti-inflammatory (analgesic & antipyretic). Nursing care  Apply hot water bag over the ear with the child lying on the affected side may reduce the discomfort (applied during the attack of pain).  Put ice bag over the affected ear may also be beneficial to reduce edema (between pain attacks).  For drained ear; the external canal may be frequently cleaned using sterile cotton swabs (dry or soaked in hydrogen peroxide).  Excoriation of the outer ear should be prevented by frequent cleansing & application of zinc oxide to the area of oxidate.  Give special attention to the tympanostomy tube i.e., avoid water entering the middle ear and introducing bacteria.  Educate family about care of child, & keep them aware with the potential complications of acute otitis media e.g., conductive hearing loss.  Provide emotional support to the child & his family.  Prevention of recurrence through:  Education regarding antibiotic therapy.  Sitting or holding an infant upright during bottle feeding.  Aware of potential complications as (loss of hearing). 99  Lower Respiratory Tract Infections in Children Pneumonia Definition Pneumonia is an inflammation with consolidation of the lung tissue, where air in the lung replaced by exudate materials that increase lung density. Consolidation of the lung tissue leads to increase sound heard on auscultation & dullness of the lung area on percussion. Anatomical forms of pneumonia 1. Lobar pneumonia: This affects one or more sections (lobes) of the lungs. 2. Bronchopneumonia: This affects patches throughout both lungs. 3. Interstitial pneumonia: it is one of lung disease characterized by progressive scarring of both lungs involves the supporting framework (interstitium) of the lung 100 Causative organism  Bacterial: In bacterial pneumonia, the onset is abrupt and caused by pneumococci, staphylococcus, streptococcus, & H. influenza.  Viral: in viral pneumonia: It is more common pediatric problem than  bacterial pneumonia. Respiratory syncytial virus (RSV) is the most common causative organism. Manifestations  General Signs of bacterial pneumonia: Fever, headache, not feeling well and fussiness and fatigue.  Gastrointestinal manifestation: Vomiting or diarrhea, abdominal pain and loss of appetite, and stomach pain.  Respiratory symptoms as: Productive cough, pain in the chest, hard / rapid fast breathing &chest pain Nursing assessment 1) Pneumonia: Fever, malaise, cough, chills, rapid & shallow respiration 2) Severe pneumonia: The previous signs + chest in drawing 3) Very severe pneumonia: The previous signs + Grunting, inability to drink, sleep difficulties, severe dehydration & malnutrition. Treatment and nursing management  Treatment depends up on the child’s age, overall health, and medical history.  Is primarily supportive & symptomatic as:  Antipyretic for fever and discomfort  Antitussive for cough.  Antibiotics for bacterial pneumonia.  Bed rest. 101   Appropriate diet: small frequent high caloric diet, increased fluid intake. In severe cases; IV infusion if the child unable to drink.  Oxygen therapy * Suction  Chest physiotherapy Unit (7) Nursing Management of Children with Cardiovascular Diseases General objective By the end of this chapter the student nurse will be able to explain the most common cardiovascular diseases among children and their management. Specific objectives By the end of this chapter the student nurse will be able to 1- Explain the essential concepts in fetal heart development. 2- Differentiate between fetal and post-natal circulation. 3- Define the most common heart diseases either a cyanotic or cyanotic one. 4- Explain the pathophysiology and nursing assessment in each disorder. 5- List the methods used in diagnosis of heart diseases. 6- Identify the etiology, criteria used in diagnosis and management of rheumatic fever as an acquired heart disease. 102