Nursing Care of Children with Upper and Lower Respiratory Infections PDF

 Introduction According to world health organization (WHO) estimates, even more than 150 million episodes of community-acquired pneumonia and 2 million pneumonia-related deaths took place amongst children under five years of age in creating countries. Of all pneumoni...

 Introduction According to world health organization (WHO) estimates, even more than 150 million episodes of community-acquired pneumonia and 2 million pneumonia-related deaths took place amongst children under five years of age in creating countries. Of all pneumonia instances, 7-13% were sever enough to be life- threatening and necessary hospitalization. Acute lower respiratory infections considers The first common leading causes of infant mortality in developing countries Respiratory tract infections account for the majority of acute illnesses in children. The etiology and course of these infections are influenced by the age of the child, the season, living conditions, and preexisting medical problems.  Developmental variances of the children’s respiratory system The respiratory tract is shorter as such, the trachea, bronchi and lower respiratory structures are in very close proximity. Transmission of infectious agents is much more efficient Respiratory efforts in infants are largely abdominal Poor immunoglobulin A (IgA) production in pulmonary mucosa combined with a narrower tracheal lumen and lower respiratory structures causes infant to be more prone to respiratory difficulties from edema, mucus or foreign body aspiration Less alveolar surface for gaseous exchange Eustachian tube is short and broad and in close proximity to the middle ear (The Eustachian tubes of this age group are more horizontal than amongst older children and, therefore, they do not have the potential benefit of gravity to assist drainage.  Common infections of upper respiratory tract in children:  Tonsillitis.  Otitis media. Laryngotracheobronchitis(Spasmodic Croup )  Tonsillitis: The tonsils are masses of lymphoid tissue located in the pharyngeal cavity. Functions of tonsils:  To filter and protect the respiratory and alimentary tracts for invasion by pathogenic organisms.  They also may have a role in antibody formation. Types of tonsils:  Palatine: located on each side of the oropharynx. Pharyngeal: adenoids Lingual: located at the base of the tongue. Tubal: found near the posterior nasopharyngeal opening of the eustachian tube. Tonsillitis is a swelling of the tonsils, which are areas of lymphoid tissue on either side of the throat. Tonsils can become swollen when they are infected by bacteria or a virus. This is a common occurrence in children. Tonsillitis  Symptoms of tonsillitis include: Sore throat. Difficult swallowing Fever. Headache. White patches in the throat or tonsils. Red, swollen tonsils. Pain when swallowing. Vomiting. Sore glands in the throat or jaw.  Therapeutic Management Therapeutic management 1- Medical Throat cultures positive ----antibiotic if bacterial infection. Antibiotics should be given for the minimum duration of 7 to 10 days in proper doses to reduce the complications of tonsillitis. The most common antibiotics used are penicillin  Analgesic/antipyretic drugs as are useful to promote comfort (given rectally or IV.).   Nursing considerations with tonsillitis: Rest and providing comfort.  Drink adequate fluids to keep the throat moist and prevent dehydration.  Drink warm liquids Soft liquid diet is generally preferred.  cool mist.  Warm salt gargles, throat lozenges. when they are 6 years old 2- Surgical Tonsillectomy-removal of the palatine tonsils if massive hypertrophy, difficulty breathing or eating was present. Adenoidectomy----(under 3 years of age) If there is obstruction of nasal breathing.  Contraindications to either tonsillectomy or adenoidectomy  Cleft palate.  Acute infections at the time of surgery. Local inflamed tissues increase the risk of bleeding.  Uncontrolled systemic disease. Nursing diagnoses with a tonsillectomy : Ineffective airway clearance related to discomfort.  Impaired swallowing related to inflammation and discomfort.  Pain related to surgery.  Altered oral mucous membranes related to operative site.  High risk for injury. Anxiety/fear related to unfamiliar event, discomfort.  Altered family processes related to hospitalization of child.  If surgery is needed: Care after tonsillectomy: Children are placed on the abdomen or side lying (recovery position) to facilitate drainage of secretions.  * If the child need suctioning must be performed carefully to avoid trauma to the oropharynx. * Alert child to bed rest for the remainder of day. * Discourage child from coughing frequently and blowing their nose, clear their throat and activities that may aggravate the operative site. The throat is very sore ---- Ice collar may provide relief. Pain medication for at least the first 24 hours.  Cool water, crushed ice, fluids, diluted fruit juices is given first. * Avoid red or brown color fluids. * Citrus fluids or juices may cause discomfort.  Minimizing activities or interventions may precipitate bleeding. Soft foods are started on the first or second post operative day.  Observe post operative bleeding and other signs of Hage.  Teach the family about home care because Hage may occur up to 10 days.  Otitis media Incidence Highest in children 6mos.- 2yrs Gender Boys are affected more frequently than girls in children less than school age Months/year Common in winter mos. Predisposing factors Crowdedness, household smokers and familial history and method of feeding.  Infectious Streptococcus pneumoniae. causative agents Haemophilus influenzae. Staphylococcus aureus. Non infectious Unknown. Result of blocked eustachian tubes from the edema of URIs, allergic rhinitis or hypertrophic adenoids Pathophysiology Normally: Eustachian tube connect between middle ear and nasopharynx. Eustachian tube----- closed and flat preventing organisms from the pharyngeal cavity from entering the middle ear. Opens: - To allow drainage of secretions produced by middle ear mucosa and to equalize air pressure. Impaired drainage negative pressure cause retention of fluids in middle ear. If the tube opens: difference of the pressure causes bacteria to be swept into middle ear organisms quickly proliferate ( multiply and grow) and invade the mucosa Diagnosis: Otoscopy normal findings Intact membrane, bright red and bulging. Abnormal findings : Slightly inflamed dull-gray membrane, visible fluid level. Acute Otitis media The tympanic membrane as it appears in child with acute otitis media Manifestations of otitis media: Follows an upper respiratory infection Earache (otalgia), pain that is more severe and continuous. Fever of 39 °C. Purulent otorrhea. Perforation of the ear drum. Infection of the mastoid space (the posterior (back) part of the temporal bone, one of the bones of the skull. ). Infant or very young child: Crying. Fussy, restless, irritable. Tendency to rub, hold, or pull affected ear Rolls head side to side. Difficulty comforting child. Older child: Crying and/or verbalizes feelings of discomfort. Irritability. Lethargy. Loss of appetite. Chronic Otitis Media (complications ): Feeling of fullness, tinnitus, vertigo (dizziness) may be present Hearing loss. Difficulty communicating. Therapeutic management: Administration of antibiotics child must improved within 48-72 h. Analgesic/ antipyretic are used to alleviate discomfort and reduce an elevated temperature. Myringotomy (surgical incision of the eardrum) to relieve symptoms in some children.   Tympanostomy tubes (pressure equalizer tubes or facilitate continued drainage of fluid and allow ventilation of the middle ear). Trans-tympanic drainage  After antibiotics child should be assessed for effectiveness of Tympanostomy tubes (TT) and to identify potential complications: -Effusion or hearing impairment. Nursing diagnosis:  Discomfort related to pressure caused by inflammatory process.  High risk for impaired skin integrity related to drainage.  Altered family processes related to ill child.  Nursing interventions:  Analgesics/ antipyretics.  The application of heat with a heating pad on low setting -----may reduce the discomfort, local heat over the ear with child lying on the affected side.  This position facilitates drainage.  An ice bag placed over the affected ear may also be beneficial ( reduces edema and pressure).   External ear canal may be cleaned with sterile cotton swabs soaked in hydrogen peroxide (antiseptic liquid ). The skin around the ear become excoriated from the exudates------this is prevented by frequent cleansing and application of zinc oxide. Teach the parent for temporary hearing loss.  Complete use of antibiotics.  Avoid supine position during infant feeding.  Laryngo tracheo Bronchitis Croup syndrome in children Children who are risky:  Who have allergy.  Psychogenic factors. Characteristics:  Mild respiratory symptoms.  Barking cough.  Hoarseness.  Noisy inspirations and restlessness. Child appears:  Anxious.  Frightened  Dyspnea is aggravated by excitement.  The child has a barking cough that is worse at night and may have low-grade fever  Therapeutic Management Children with spasmodic croup are managed at home.  Cool mist humidifier is recommended for child home.   Children with moderately to severe symptoms may be hospitalized for observation  Cool mist  Racemic epinephrine.  Corticosteroid therapy to decrease airway edema  Nursing care &home care Humidified air. Cool mist from a humidifier and/or sitting with the child in a bathroom (not in the shower) filled with steam generated by running hot water from the shower, help minimize symptoms. Antipyretics. Treat fever with an antipyretic such as acetaminophen or ibuprofen. Fluid intake. Encourage oral intake Avoid smoking in the home; smoke can worsen a child’s cough. Decreasing anxiety.* avoiding unnecessary painful interventions that may cause agitation, respiratory distress, and lead to increased oxygen requirements. Vital signs monitoring. heart rate ,respiratory rate, and pulse oximetry are important. Cool mist administration. mist moistens airway secretions, decreases their viscosity, and soothes the inflamed mucosa. Lower respiratory tract infection  Lower respiratory tract infection  Bronchiolitis  Asthma  Pneumonia  Bronchiolitis Bronchiolitis is an acute cause of respiratory distress and wheezing in infants, due to obstruction of the small airways (bronchioles). A viral infection causes the airways to narrow, which makes breathing difficult Age: