Nursing Care of the Child with Respiratory Disorder PDF

Nursing Care of the Child with Respiratory Disorder Elizabeth Bennett-Garguilo, MSN, FNP-BC, RN Variations in Pediatric Anatomy and Physiology Nose Throat Trachea Lower Metabolic Rate Respiratory Chest Wall and Oxygen Structures...

Nursing Care of the Child with Respiratory Disorder Elizabeth Bennett-Garguilo, MSN, FNP-BC, RN Variations in Pediatric Anatomy and Physiology Nose Throat Trachea Lower Metabolic Rate Respiratory Chest Wall and Oxygen Structures Needs Epidemiology 30% of ED visits are pediatric Characteristics of a pediatric life-threatening injury/illness Rapid in onset Frequently involves respiratory or CNS Requires rapid interventions Differences in pediatrics Infants have smaller upper and lower airways Infants are obligate nose breaths –keep secretions clear The tongue is larger proportionally – obstruction Cartilage of larynx is softer – support is less Children 60 = high risk for aspiration) o IV fluids o Oxygen as need to keep oxygen saturation above 95% o CPT o Suctioning if needed o Acetaminophen for fever / antibiotics o Antibiotic therapy, fluids, o Administer antitussives (cough medicines) as ordered if cough is keeping child/family up all night. o I&O, o Plan nursing care so child can rest. o Child may lie in any position, usually most comfortable in low Fowler’s, or lying on affected side of chest which helps splint chest when coughing oAlthough bacterial pneumonia takes longer to resolve, prognosis is generally good, 7-10 days. oTeach parents importance of vaccination available to prevent pneumococcal disease: (Prevnar) one of the most common types of bacterial pneumonia, especially if child is in day care. Tonsillitis An inflammation (with infection) of the tonsils which can cause significant edema of the tonsils occluding airway making the passage of food (eating) and breathing difficult Etiology : caused by a bacteria or virus. o Most common bacterial agent is Group A beta hemolytic streptococcus. (GABHS). “KISSING TONSILS” NURSING ASSESSMENT o Causative agent diagnosed by throat culture. o Strep infection can be diagnosed in minutes using a “rapid strep” test. o Enlarged, reddened tonsils with or without exudates o Sore throat, difficulty swallowing due to sever sore throat o Drooling caused by the inability to swallow secretions o Lymphadenopathy o Mouth breathing o With strep child can have very distinct foul odor in their mouth (not always but very frequent) o Fever (can be quite high with strep) TREATMENT If viral:, supportive care only: promote comfort, gargling with warm salt water, Tylenol/Motrin for pain, antiseptic throat sprays, and throat lozenges. If Group A beta hemolytic strep: antibiotic therapy. First choice of treatment is penicillin o If PCN allergic: erythromycin, azithromycin, clairthromycin o In addition to antibiotic therapy use supportive measures for comfort. NURSING INTERVENTIONS oParent/ Patient teaching o If bacterial infection stress importance of finishing prescription, a complete course of prescribed antibiotics is the only treatment for GABHS. o Inadequate treatment of GABHS can lead to rheumatic fever. o Patients ( and parents have a tendency to stop RX once the patient is feeling better) Tonsillectomy oSurgical removal of the tonsils oDone when a child has a history of recurrent tonsillitis (usually 6 or more GABHS infections within 1 calendar year) peritonsillar abscess or respiratory compromise from airway obstruction (sleep apnea from very large tonsils). oCan be done in ambulatory day surgery unit or overnight (23) hour stay in hospital. oChildren must be free of infection 1 week prior to surgery POST-OP NURSING INTERVENTIONS AIRWAY There is a potential for post operative edema/swelling/bleeding o Monitor for s/s of bleeding o Frequent or continual swallowing (child is trying swallow blood from operative site) o Hemorrhage from surgical site, frank bleeding from nose, mouth, between teeth. o Strict I &O o NPO until awake & alert, then offer clear fluid (H20), apple/white grape juice, yellow/green/orange Jell-O), popsicles. o Avoid all RED colored liquids if child vomits it could be mistaken for blood. Advance diet as tolerate to soft bland diet mashed potatoes, macaroni & cheese, pudding, ice cream, oatmeal, farina etc… o When tolerating full po & has voided, IV is heplocked. o Pain Medication o NO po/pr Tylenol with codeine. Guidelines changed! Child can be discharged the next morning. These procedures are frequently done as a 23 hour stay (admitted 9-10 am day 1, go to OR 12noon, return to floor 2pm, discharged 6-7am day 2 (to avoid a Full day hospitalization, it is a way to get insurance companies to pay for an overnight admission for observation but it is less than 1 full day so it is cheaper) Patient /Parent Teaching/Home care 1. Monitor for s/s bleeding 2. HYDRATION at home- stress this to parents Child’s Ear vs. Adult’s Ear + Three major differences between the infant’s or young child’s ear and the adult ear + A child’s tympanic membrane slants horizontally, rather than vertically + A child’s external canal slants upward + A child’s Eustachian tube slants horizontally, this causes fluid to stagnate and act as a medium for bacteria Otitis Media Infection of the middle ear cavity most common in 6 months – 2 years. 85-90% of all children has at least one episode before school age. + Incidence increases in winter months, boys>girls, higher in families with smokers, day care attendance + Often proceeded by a URI or allergy, which results in edema and congestion of the mucosa of nasopharynx, eustachian tubes and middle ear leading to eustachian tube dysfunction. OTITIS MEDIA Can be bacterial or viral. § In children, eustachian tubes are short, wide and straight, lying relatively horizontal. Abundant pharyngeal lymphoid tissue obstructs tube Usual lying down position favors pooling of fluids in pharyngeal cavity Most common organisms are: strep pneumoniae, haemophilus influenza and viruses Organism gains access when normal patency of tube is blocked. Air trapped in middle ear is reabsorbed, creating negative pressure allowing reflux of bacteria, viruses. Bacteria, viruses + obstruction of flow of secretions leads to middle ear effusion (fluid). CLINICAL MANIFESTATIONS Rhinorrhea, malaise, irritability, restlessness, pain in the ear, pulling or tugging at the ear, purulent discharge, diarrhea or vomiting, fever 102° or higher , vertigo, loss of appetite, enlarged post auricular and cervical lymph nodes. Tympanic membrane is normally translucent, pearly, pin/gray. With OM, TM Þintense erythema, bulging toward examiner, immobile landmarks However, redness of TM also occurs from crying, fever. Discharge from ear = perforation of TM with acute relief of pain TREATMENT AND NURSING CONSIDERATIONS If suspected bacterial infection: Amoxicillin for 10 days, reexamine TMs. If no improvement in 48 hrs. dosage may be increased, or different abxs tried. Auralgan otic solution if TM is not perforated for comfort.. Do not use antihistamines in young children thicken secretions and may cause systemic complications. Children’s Tylenol or Ibuprofen for fever >102° Teach parents need for follow up care, repeated or incompletely treated OM can & WILL lead to hearing deficits. HEALTH TM ACUTE OM PERFORATED TM BULGING TM OM WITH EFFUSIONS LONG TERM COMPLICATIONS Long term complications of AOM – conductive hearing loss. AOM with effusion – sensorineural hearing loss Recurrent infections (3 episodes in 6 months or 2 episodes in