Lecture 4 Respiratory Disorders PDF

Nursing care of Children and their Families NUR411 Nursing care of Children with Respiratory Disorders 9/5/2024 Outline Upper respiratory tract infection: - Naso-pharyngitis - Tonsillitis - Otit...

Nursing care of Children and their Families NUR411 Nursing care of Children with Respiratory Disorders 9/5/2024 Outline Upper respiratory tract infection: - Naso-pharyngitis - Tonsillitis - Otitis media - Croup syndrome Lower respiratory tract infection: - Bronchitis - Bronchiolitis - Pneumonia Long term respiratory dysfunction - Asthma  Objectives By the end of this lecture the students will be able to: Recognize the etiology & characteristics of acute upper & lower respiratory infections. Describe the postoperative nursing care of a child with a tonsillectomy. Describe priorities of nursing care for a child with acute otitis media ,croup Syndrome, respiratory syncytial virus bronchiolitis. List the major signs of pneumonia in infants and children. Identify priorities of nursing care for an infant with pneumonias. Describe the various therapeutic measures to relieve the symptoms of asthma. Demonstrate nursing process for long-term respiratory (asthma).  Anatomy Upper respiratory tract Lower respiratory tract -Nose -lungs -Nasal cavity -Bronchi -Ethmoidal air cells - Alveoli -Frontal sinuses -Maxillary sinus -Larynx -Trachea  Anatomical different in Respiratory system children adults In neonates and in infants respiratory tract is not Well developed tissues. produce mucus.(older children produce mucus) Eustachian tube is short and straight. Long. Tonsils and adenoids are large during childhood , Smaller tonsils. involved in the production of antibodies. Respiratory tract obstruction occurs commonly in Less chances of obstruction. children because of short airway. Respiratory rate higher RR lower than chidren Respiratory System physiology Respiration is the act of breathing: inhaling (inspiration) - taking in oxygen exhaling (expiration) - giving off carbon dioxide  Upper Respiratory Tract 1.Acute Nasopharyngitis Naso-pharyngitis = Common cold. “Viral infection of ‫العلوي‬ the‫التنفسي‬ nose‫الجهاز‬ & throat. ‫ التهاب البلعوم األنفي الحاد‬.1 Common cause is Rhinovirus..‫ "عدوى فيروسية في األنف والحنجرة‬.‫ التهاب األنف والبلعوم = نزالت البرد الشائعة‬.‫السبب الشائع هو فيروس الراينو‬ Risk factors including: :‫ عوامل الخطر بما في ذلك‬.‫التعرض لشخص مصاب بنزلة البرد‬ Exposure to someone with the common cold (‫العمر )الرضع واألطفال الصغار‬ Age (infants and young children).‫ضعف جهاز املناعة أو تناول أدوية تضعف جهاز املناعة‬ ‫املوسم )نزالت البرد أكثر شيوعاً خالل فصل الخريف والشتاء‬ A weakened immune system or taking drugs that weaken the immune system Season (colds are more common during the fall and winter).  Clinical manifestations Younger child: ‫حراره‬ Fever Sneezing Irritability Vomiting & diarrhea Older child: Dryness & irritation of nose & throat. Sneezing. Muscular aches. These symptoms usually peak within 2-3 days but can last for up to 10-14 days. Diagnostic Evaluation History of Illness & Physical Examination. Chest X-ray if suspect for bacterial infection. Treatment Cough syrups. Vitamin C and zinc. Acetaminophen: fever, sore throat, and headache. Saline nasal drops or clean humidifier or cool-mist vaporizer to relieved from nasal congestions. Nursing care management Administer analgesics, as prescribed. Facilitate the regular physical exercise. Monitor body temperature within a normal range. Maintain airway patency. Minimizing the transmission of infectious..‫ إعطاء املسكنات حسب الوصفة الطبية‬.‫ تسهيل ممارسة التمارين الرياضية بانتظام‬.‫ مراقبة درجة حرارة الجسم لتكون ضمن املعدل الطبيعي‬.‫ الحفاظ على سالكية مجرى الهواء‬ ‫ تقليل انتقال األمراض املعدية‬ 2-Tonsillitis Inflammation of the tonsils ,tonsils are masses of lymphoid tissue located in the pharengeal cavity. In the first six months of life tonsils provide a useful defense against Tonsillitis is one of the most common disease in pre-school children, but it can also occur at any age. It is spread by close contact with other individuals and occurs more during winter periods. Causes Group-A Beta-hemolytic streptococcus is the most common bacterial cause. May be virus. S and s Sore throat Dysphasia Child do not want to eat or drink Fever Breath odor Diagnostic Evaluation ENT examination (ears, nose and throat) Cultures to determine presence and source of infection. Blood studies to determine risk of bleeding  ‫إدارة‬ Management.‫الراحة في الفراش‬.‫توفير كمية كافية من السوائل والنظام الغذائي اللني‬.(‫إعطاء األدوية )املسكنات واملضادات الحيوية‬ ‫ فإن اإلجراء البديل الذي يمكن‬،‫إذا لم يكن هناك أي تقدم‬.‫القيام به هو الجراحة‬ Bed rest. Provision of adequate fluids and soft diet. Administration of medications (analgesics and antibiotics). If there is no progress, then the alternative actions that can be done is surgery. Tonsillectomy Tonsillectomy is the surgical removal of the palatine tonsils Nursing care management Preoperative Interventions ‫التدخالت قبل الجراحة‬ Assess for signs of active infection. ‫تقييم عالمات العدوى‬.‫النشطة‬ Assess bleeding and clotting studies. ‫تقييم دراسات النزيف‬ ‫والتخثر‬ ‫قم بتقييم أي أسنان‬ Assess for any loose teeth to decrease ‫فضفاضة لتقليل خطر‬ ‫الطموح أثناء الجراحة‬ the risk of aspiration during surgery.  Post operative nursing care ❑Analgesic as prescribe ❑Apply cold compression on the operative side or Ice collar ❑Give the child sips of clear liquid or ice. ❑If bleeding does occur , elevating the child head and turning him/her on the side. ❑Place the child on Sims’ position ❑Remove the secretion. ❑Avoid suctioning and coughing to prevent hemorrhage ❑Do not go to school between 4-7 days to observe the child for any abnormality from operation and to avoid trauma to surgical site  ‫ التهاب األذن الوسطى‬.3 3. Otitis Media.‫ التهاب األذن الوسطى‬ ‫ يتميز بـ‬ Inflammation of the middle ear. ‫ تراكم السوائل املصابة في األذن‬.‫الوسطى‬ characterized by.‫انتفاخ طبلة األذن‬ ‫ وفي حالة ثقب طبلة‬،‫ألم في األذن‬ ‫األذن تسرب مادة قيحية )قيح( إلى‬ The accumulation of infected fluid in the ‫قناة األذن‬ middle ear. Bulging of the eardrum. Pain in the ear and, if eardrum is perforated drainage of purulent material (pus) into the ear canal. S and s Young child: :‫طفل صغير‬ Otalgia ,irritability, vigrous crying ,rubbing ear , fever, ،‫ألم األذن‬ ،‫والتهيج‬ ‫والبكاء‬ otorrhea. ‫ وفرك‬،‫الشديد‬ ،‫األذن‬ Older child: ،‫والحمى‬ ‫وسيالن‬ Sharp pain due to pressure on mastoid area..‫األذن‬ :‫الطفل األكبر‬ On otoscopic findings of the tympanic membrane the ‫ألم حاد‬ ‫بسبب الضغط‬ following appear: ‫على منطقة‬.‫الخشاء‬ - Opacity ‫في النتائج‬ - Bulging ‫املنظارية‬ ‫لغشاء الطبلة‬ :‫يظهر ما يلي‬ - Erythema ‫ العتامة‬- - Middle ear effusion (MEE) ‫ انتفاخ‬- ‫ احمرار‬- ‫الجلد‬ ‫ انصباب‬- ‫األذن‬ ‫الوسطى‬ Diagnostic Evaluation Physical examination by otoscopy. Culture of the ear drainage identifies the causative organisms.  Medication Decongestants (nasal spray, nose drops) Anti-histamines to promote drainage of fluid. Analgesic drugs such as acetaminophen and ibuprofen treat mild pain. Oral corticosteroids. Myringotomy and aspiration of middle ear fluid.  Nursing care of OM Position the child side-lying facilitating drainage. Preventing complications or recurrence. Educating the family in care of the child. Providing emotional support to the child and family. 4- Croup Syndrome Croup is not a disease, but a group of disorders (laryngotracheobronchitis) because inflammation and edema of the larynx, trachea, and bronchi Occur as a result of viral infection. Parainfluenza is responsible for most cases of croup. S$S Barking cough or hoarseness Stridor Crackles Dyspnea Diagnostic Evaluation Throat cultures Laryngoscopy Neck X-ray Treatment Tracheostomy & oxygen. Antipyretic: acetaminophen Inhaled racemic: epinephrine Corticosteroids: nebulizer Parenteral glucocorticoids Nursing care management Assess respiratory and cardiovascular status to detect indications of obstruction. Monitor vital signs and pulse oximetry Administers oxygen. Administer medications, as ordered. Provide emotional support to the parents to decrease anxiety. Provide age-appropriate activities for the child to ease anxiety. lower Respiratory Tract infection  1. Bronchitis Bronchitis is inflammation of the large airways (trachea and bronchi , and bronchioles). Usually occurs in association with URI. Primarily viral but may also arise from bacterial. Late infancy and early childhood. Clinical manifestations Cough, copious secretions Tachypnea Tachycardia Crackles wheezing Flaring Grunting Pallor cyanosis Diagnostic Evaluation ABG analysis Chest X-ray  ECG Sputum culture. Treatment and nursing care Bed rest Analgesics and Antipyretics Adequate hydration In chronic cases Bronchodilator Oral corticosteroids if there are wheezy form of bronchitis.  2.Bronchiolitis Bronchiolitis is an infection of the small air passages of the lungs called the bronchioles  Causative Agents Respiratory Synctial Virus (RSV), adenovirus, influenza virus, and mycoplasma pneumoniae. Most common in infants younger than 6 months old, may occur up to age 2 years.  S$S Tachypnea Tachycardia Intercostal and subcostal retractions Cyanosis Nasal Flaring Wheezing Irritability Poor Feeding Dehydration Treatment & Nursing care Bronchodilators Epinephrine Corticosteroids Hypertonic Saline Antibiotics Prevention of cross infection. Oxygen Chest physiotherapy  3.PNEUMONIA Inflammation of the lungs, is common in childhood but occurs more frequently in early childhood. Clinically, pneumonia may occur either as: Aprimary disease complication of another illness. Classification of pneumonia According to causes - Bacterial pneumonia Bacteria streptococcus pneumoniae -Viral pneumonia: Respiratory Syncytial Virus. Influenza, adenovirus, rhinovirus. Children under 5 -Fungal pneumonia Chemical pneumonia Ingestion of kerosene or inhalation of irritating substance Inhalation pneumonia (aspiration pneumonia) Classification of pneumonia According to areas involved Lobar pneumonia: if one or more lobe is involved. Broncho-pneumonia: the pneumonic process has originated in one or more bronchi and extends to the surrounding lung tissue. Interstitial – Primarily occurs within the alveolar walls and interlobular tissues. Clinical manifestations Shaking chills ,rapidly rising fever ( 39.5 to 40.5 degree). Stabbing chest pain aggravated by and coughing. RDS (tachypnea, nasal flaring , shortness of breath, retractions, pallor to cyanosis). Cough with purulent. low energy, and fatigue. GI disturbances (nausea, diarrhea, pain, anorexia). Diagnostic tests History taking Physical examination Chest x-ray Blood test Sputum culture Arterial Blood Gas (ABG) analysis indicates hypoxemia Nursing Management Separate room. Maintain a patent airway and adequate oxygenation. Use suction if needed Perform chest physiotherapy. Provide a high calorie, high protein diet of soft foods. CONT…. To prevent aspiration during nasogastric tube feedings: check the position of tube administer feedings slowly. To control the spread of infection: dispose secretions properly.  Asthma Asthma is a spasm of the bronchial tubes caused by hypersensitivity of the airways in the bronchial system. Inflammation that leads to mucosal edema and mucous hypersecretion. Causes Unknown but there is evidence that many factors play a part: Genetic factors Environmental factors Dietary changes Asthma triggers Certain foods such as chocolate, milk, eggs, nuts & grains. Exposure to cold weather. Irritants such as wood-burning stoves, dust, and pet dander. Infections, such as bronchitis and upper respiratory. Emotional stress or anxiety. Cigarette smoking, perfumes, sprays. Air pollution and toxins  Assessment Findings Rapid pulse Dypsnea Tachypnea Wheeze; in severe distress, may hear an inspiratory wheeze Exercise intolerance Diaphoresis Fatigue Restlessness Diagnostic tests Detailed history and physical exam Pulmonary function tests Chest x-ray ABGs analysis Allergy testing Sputum culture and sensitivity  Treatment and nursing care ❑The goal of treatment is to appropriately manage the condition so the child can maintain optimal life style and development. The treatment is focused on: ❑Reducing episodes ❑Minimizing the inflammatory process ❑Decreasing the frequency of hospitalization ❑Eliminate the allergic factor  Treatment and nursing care Medications are classified into two categories: ❑Long term medication (controllers)-oral ❑Short term medication (relievers )-inhaler ❑Preferred route of administration is inhalation via nebulizer or metered dose inhaler. ❑Acute attack of asthma treated with nebulized albuterol every 20 minute for 1 hour with oxygen. Nursing care ❑Place the child in a high fowler's position ❑Monitor oxygen saturation ❑Teach the patient and his family to avoid known allergens and irritants. ❑Teach the patient and his family important of Regular medical follow- up care ❑Remove pets from home permanently. ❑Teach the child to used metered dose inhale (MDI) at home Complications of asthma ❑Status asthmaticus ❑Respiratory failure. Test your self What is the primary physiological alteration in the development of asthma? A. Bronchiolar inflammation and dyspnea B. Hypersecretion of abnormally viscous mucus C. Infectious processes causing mucosal edema D. Spasm of bronchiolar smooth muscle Which of the following nursing actions according the priority for the child with acute asthma attack? A. Assess the air way patency and respiratory status B. Determining the cause of the attack C. Improving exercise tolerance D. Start I.V. fluid to prevent E. Dehydration Fred is a 12-year-old boy diagnosed with pneumococcal pneumonia. Which of the following would Nurse Nica expect to assess? A.Mild cough B. Slight fever C. Chest pain D.Bulging fontanel  References Springhouse review for NCLEX RN. Lippincott Williams and Wilkins Lippincott Manual of Nursing Practice. Lippincott Williams and Wilkins For images taken from https://www.google.com.sa http://www.who.int/mediacentre/factsheets/fs342/en/ Saunders Comprehensive Review for the NCLEX-RN https://www2.health.vic.gov.au/hospitals-and- healthservices/patient-care/perinatal- reproductive/neonatalehandbook/procedures/umbilical- cord-car.  A N K Y O U T H j o i n i n g.. fo r Dr. Samar 2024/1445 h