Respiratory Disorders - Pediatric PDF

Respiratory disorders DOMINIKA KARPIŃSKA References  https://www.youtube.com/watch?v=d-oXzSaz81s&list=PLj9YgcGzj QqzQoIGSqM-D-z_gLhtdyO55&index=21&ab_channel=LevelUpRN  https://www.youtube.com/watch?v=GoNuWWAcTXk&list=PLj9Ygc GzjQqzQoIGSqM-D-z_gLhtdyO55&index=22&ab_channel=Level...

Respiratory disorders DOMINIKA KARPIŃSKA References  https://www.youtube.com/watch?v=d-oXzSaz81s&list=PLj9YgcGzj QqzQoIGSqM-D-z_gLhtdyO55&index=21&ab_channel=LevelUpRN  https://www.youtube.com/watch?v=GoNuWWAcTXk&list=PLj9Ygc GzjQqzQoIGSqM-D-z_gLhtdyO55&index=22&ab_channel=LevelUp RN Acute otitis media  it is an inflammation of the middle ear, most commonly in children between ages 6 months and 3 years and is uncommon after age 8. The incidence is higher during the winter months.  Cause bacteria (Haemophilus influenzae, Moraxella catarrhalis, and Streptococ cus pneumoniae), Viruses (respiratory syncytial virus (RSV), rhinoviruses, influenza viruses, and adenoviruses) AOM - symptoms  ear pain that may present as pulling at the ears in younger children or difficulty eating or lying down due to ear pressure and pain,  Fever,  Irritability,  loss of appetite,  purulent drainage in the external ear canal,  nasal congestion and cough,  vomiting and diarrhea AOT Treatment  using analgesics Complications  in children aged 6 to 23 months with nonsevere  Effusion, unilateral otitis media, giving parents the option of  allowing their child’s immune system to fight the hearing infection for 48 to 72 hours, then only starting impairment, antibiotics if the child’s condition doesn’t improve  spontaneous after that time, rupture of  myringotomy, which is an incision in the posterior the tympanic inferior aspect of the tympanic membrane and may membrane, be necessary to pro mote drainage of exudate and  mastoiditis release pressure  tympanoplasty ventilating tubes, or pressure- equalizing tubes, which may be surgically inserted into the middle ear to create an artificial auditory canal that equalizes pressure on both sides of the Asthma  It is a long-lasting, inflammatory condition of the airways that leads to periodic blockages and an exaggerated response of the airways to various triggers. This condition is caused by bronchial spasms, excess mucus production, and swelling of the airway lining.  Asthma attacks happen when the lungs become inflamed, causing mucus buildup, swelling, and tightening of the airway muscles. The lungs react strongly to triggers, which can increase anxiety and make the body react physically. This also causes the release of chemicals like histamine, leading to tightened airways. This creates a cycle where anxiety and the body’s reactions to it keep affecting each other. Symptomes Asthma triggers  recurrent cough ,  Exercise,  Wheezing,  viral or bacterial agents,  shortness of breath,  allergens, such as mold,  reduced expiratory flow, dust, and pollen,  Pollutants,  exercise intolerance,  changes in weather,  respiratory distress  food additives,  animal dander Asthma - types Extrinsic (atopic)  Atopic asthma usually starts in childhood. People with this type of asthma are often allergic to certain external triggers (extrinsic allergens) and typically have a family history of asthma or other allergies. Common allergens that can provoke an asthma attack include pollen, pet dander, dust mites, mold, feather pillows, food additives with sulfites, and other substances that cause allergic reactions. Children with extrinsic asthma often also experience other inherited allergies, like eczema and hay fever. Asthma - types Intrinsic (nonatopic)  People with intrinsic, or nonatopic, asthma respond to internal, non-allergic factors. These factors can include irritants, emotional stress, fatigue, hormonal changes, temperature and humidity fluctuations, exposure to harmful fumes, anxiety, coughing, laughing, and genetic predisposition. Most attacks are triggered by a severe respiratory infection, particularly in adults.  Exercise-induced asthma is a condition where the airways constrict, making it harder to exhale air from the lungs. Symptoms include coughing, wheezing, chest tightness, and sudden shortness of breath that lasts for several minutes after physical activity, typically 5 to 20 minutes. These symptoms are often worse in cold, dry air. Complications  Status asthmaticus is a condition characterized by severe and persistent respiratory distress and bronchospasm, which may persist even with medical treatment and supportive care. In cases of respiratory failure, mechanical ventilation might be required. If a child experiencing an acute asthma exacerbation is not treated quickly and progresses to respiratory failure without being intubated, it can lead to death.  Treatment  The most effective way to treat asthma is by preventing flare-ups. Treatment involves using medications, managing environmental triggers, and providing education and support to both the child and their parents. The goal is to choose medications that ensure optimal respiratory function. Anti-inflammatory medications  Anti-inflammatory medications, like inhaled corticosteroids (e.g., fluticasone [Flovent] and budesonide [Pulmicort]), help reduce swelling in the airways. These drugs are typically used on a daily basis to prevent the release of inflammatory chemicals like histamine. However, corticosteroids can have side effects, including changes in glucose metabolism, increased appetite, fluid retention, weight gain, a round face, mood changes, growth suppression, and high blood pressure. These side effects can be severe if the medication is used daily over a long period. Bronchodilators  Bronchodilators are medications that help relax the smooth muscles in the airways, providing quick relief for moderate to severe symptoms by widening the airways within 5 to 10 minutes. Short- acting beta-agonists (SABAs) are typically used for fast relief of acute symptoms and to prevent exercise-induced bronchospasm. Common examples include albuterol (Proventil), metaproterenol (Alupent), levalbuterol (Xopenex), and pirbuterol (Maxair).  These medications work by relaxing the muscle groups that constrict the airways, allowing them to open up. Bronchodilators can be used for immediate relief, as well as for daily management, nighttime symptoms, and exercise-induced bronchospasm. For long-term use, they are most effective when a consistent level is maintained in the bloodstream, which may require regular blood tests and adjustments in dosage. Side effects can include increased heart rate, nervousness, Leukotriene modifiers  Leukotriene modifiers, like montelukast (Singulair), can be used alongside steroids to help prevent bronchospasm. These medications improve lung function and boost the effectiveness of corticosteroids, which allows for lower doses of steroids. Possible side effects include diarrhea, inflammation of the throat or voice box (laryngitis), sore throat (pharyngitis), nausea, ear infections (otitis media), sinus infections (sinusitis), and headaches. Taking leukotriene modifiers daily, preferably at bedtime, can help improve adherence to the treatment. CROUP (acute laryngotracheobronchitis)  croup - a group of infectious diseases whose common feature is laryngeal obstruction,  Diseases classified as CROUP: - acute laryngitis, - epiglottitis, - acute laryngotracheitis, - laryngitis, - tracheobronchitis; CROUP - symptoms  rhinitis,  sore throat,  fever,  typical symptoms:  stridor,  barking cough,  hoarseness,  dyspnoea CROUP - treatment Acute bronchitis  Bronchitis is an infectious disease affecting the large, medium-sized bronchi, manifested by cough lasting up to 3 weeks. Classification:  acute  chronic bacterial bronchitis,  chronic bronchitis Reasons:  90% viruses (RS viruses, rhinoviruses, parainfluenza viruses, influenza, adenoviruses, coronaviruses, bocaviruses)  bacterial etiology (Mycoplasma pneumonie, Chlamydophilia pneuminiae) Acute bronchitis Symptoms:  runny nose (3-4 days)  cough - initially dry, then productive,  high fever,  deep, rapid breathing Treatment:  baby hydration,  proper temperature and air humidity,  antipyretics  mucolytic drugs  Cystic fibrosis  Cystic fibrosis (CF) is a genetic condition that affects a protein in the body. Cystic fibrosis causes mucus to become thick and sticky. As mucus builds up, it can cause blockages, damage, or infections in affected organs. Classification  cystic fibrosis with systemic symptoms:  respiratory,  digestive tract,  other organs,  undefined Symptoms:  bronchitis and pneumonia,  pancreatic exocrine insufficiency,  infertility in men  https://www.youtube.com/watch?v=GoNuWWAcTXk&list=PLj9YgcGzjQqzQoIGSqM-D-z_gLhtdyO55&index=22&ab_channel=LevelUpRN CF - treatment  non-pharmacological treatment - physiotherapy aimed at clearing the respiratory tract of residual secretions,  nutritional treatment - maintaining proper body weight, preventing malnutrition,  drug treatment:  Antibiotics to treat and prevent lung infections  Anti-inflammatory medications to lessen swelling in the airways in your lungs  Mucus-thinning drugs, such as hypertonic saline, to help you cough up the mucus, which can improve lung function  Inhaled medications called bronchodilators that can help keep your airways open by relaxing the muscles around your bronchial tubes  Oral pancreatic enzymes to help your digestive tract absorb nutrients  Stool softeners to prevent constipation or bowel obstruction  Acid-reducing medications to help pancreatic enzymes work better.  Specific drugs for diabetes or liver disease, when appropriate  Medications that target genes - The newest combination medication containing elexacaftor, ivacaftor and tezacaftor (Trikafta) is approved for people age 12 years and older and considered a breakthrough by many experts. - The combination medication containing tezacaftor and ivacaftor (Symdeko) is approved for people age 6 years and older. - The combination medication containing lumacaftor and ivacaftor (Orkambi) is approved for people who are age 2 years and older. - Ivacaftor (Kalydeco) has been approved for people who are 6 months and older. Epiglottitis  Epiglottitis is a severe inflammation of the epiglottis that typically affects children aged 2 to 5 years. This condition can block the airway and requires immediate medical attention.  Cause: - infection with Haemophilus influenzae type B (Hib), but other bacteria such as Streptococcus pneumoniae and group A, B, and C streptococci can also be responsible Symptoms  Sore throat, pain when swallowing, and refusal to eat or drink due to difficulty swallowing (dysphagia)  A "frog in the throat" feeling  A muffled, thick voice, wheezing inspiratory stridor, and a snoring sound when exhaling, with a croaking noise during inhalation (not the hoarseness seen with croup)  The child typically sits upright, leaning forward with their chin jutting out, mouth open, and tongue sticking out (the tripod position)  Drooling due to difficulty or pain when swallowing, accompanied by a high fever and a toxic appearance  Irritability, restlessness, and an anxious, frightened look  Retractions in the chest area above and below the sternum  Rapid heart rate (tachycardia) and weak pulse. Treatment  The best treatment for epiglottitis is prevention, and it’s recommended that all children receive the Hib conjugate vaccine beginning at age 2 months.  Children with epiglottitis are treated with antibiotics, initially through an intravenous (IV) line and then orally, for a 7- to 10-day course. In some cases, corticosteroids are given to reduce swelling during the early phase of treatment. Children who are intubated typically receive corticosteroids for 24 hours before being extubated.  The child requires close monitoring for the first 24 hours of antibiotic treatment, after which the swelling of the epiglottis typically begins to decrease. By the third day, the epiglottis often returns to normal, and most children can be safely extubated at that point. Pneumonia  Pneumonia is an acute infection or inflammation affecting the respiratory bronchioles, alveolar ducts, sacs, and alveoli (the lung tissue), which disrupts normal gas exchange. It affects around 4% of children under age 4, with the incidence decreasing as children get older. Causes:  Pneumonia can be caused by various factors including viruses, bacteria, mycoplasma, or the inhalation of foreign substances. Viral pneumonia is the most common form, with respiratory syncytial virus (RSV) being the leading cause. Other viral agents include influenza, parainfluenza, rhinovirus, and adenovirus.  For bacterial pneumonia, common culprits include pneumococci, streptococci, and staphylococci. Children with bacterial pneumonia typically appear sicker than those with viral pneumonia and may show more specific physical signs.  Symptomes: Older children typically Infants may also show experience: symptoms such as:  Headache  Vomiting   Chest or abdominal pain Seizures  Poor feeding  High fever with chills  Irritability  Periods of drowsiness or restlessness  Fever  Tachycardia and tachypnea  Stiff neck  Dry, nonproductive cough  Bulging fontanel  Expiratory grunting  Cyanosis around the mouth  Cyanosis around the mouth (circumoral cyanosis)  Respiratory distress  Reduced breath sounds and loss of crackles  Diminished breath sounds, crackles, (suggesting lung consolidation) and pleural friction rub.  Moist crackles and a cough that produces a lot of blood-tinged mucus as the condition Types Types of pneumonia Pneumonia is classified according to location and extent of involvement:  Lobar pneumonia involves a large segment of one or more lung lobes; if it involves both lungs it’s known as bilateral or double pneumonia.  Bronchopneumonia begins in the terminal bronchioles and involves nearby lobules, which become clogged to form consolidated patches.  Interstitial pneumonia is confined to the alveolar walls and peribronchial and interlobular tissues.  Aspiration pneumonia is caused by aspiration of fluid or food substance in a child who has difficulty swallowing; who’s unable to swallow due to paralysis, weakness, congenital anomalies; or who has an absent cough reflex. It can also occur if the child is fed while crying or breathing rapidly. Treatment  The treatment for pneumonia of all types primarily focuses on managing symptoms, such as controlling pain and fever, providing supportive care for the airway and hydration, and encouraging rest.  Bacterial pneumonia is treated with antibiotics targeted to the specific organism, while mycoplasma pneumonia may also require antibiotics to prevent secondary bacterial infections.  Some children might also be given anti-inflammatory medications as part of their treatment.  To help prevent pneumonia, the pneumococcal conjugate vaccine (PCV-13) is recommended for all children at 2 months of age. In addition, the pneumococcal polysaccharide vaccine (PPSV or PPV-23) is recommended for children over 2 years old who are immunocompromised or have chronic conditions, such as asthma or sickle cell disease. Sourses 1. M. Meadows-Oliver, Pediatric Nursing made Incredibly Easy, Wolters Kluwer, Philadelphia 2015 2. https://www.mayoclinic.org/diseases-conditions/cystic-fibrosis/di agnosis-treatment/drc-20353706 3. https://www.rch.org.au/clinicalguide/guideline_index/croup_laryn gotracheobronchitis/ 4. https://www.ncbi.nlm.nih.gov/books/NBK448067/