Respiratory Care & Diseases .pdf

Common Abnormal Respiratory assessments in childrens the respiratory assessment of pediatric clients includes both close visual observation and auscultation. Below are some abnormal findings that are common with the pediatric population. nasal flaring: enlargement of the nostrils to reduce resistanc...

Common Abnormal Respiratory assessments in childrens the respiratory assessment of pediatric clients includes both close visual observation and auscultation. Below are some abnormal findings that are common with the pediatric population. nasal flaring: enlargement of the nostrils to reduce resistance and maintain airway patency; sign of respiratory distress head bobbing: head bobs forward with each inspiration; sign of dyspnea stridor: high-pitched, noisy respiration; indication of narrowing of the upper airway due to edema, inflammation, or obstruction; associated with epiglottitis, foreign body, and tracheitis barking cough: caused by swelling of the trachea and bronchi; noise sounds similar to a seal barking; associated with croup syndromes grunting: sign of pain or respiratory distress; body’s attempt to improve efficiency of respirations Children will also display the abnormal respiratory findings associated with other age groups, including: tachypnea, retractions, wheezing, skin color changes, finger clubbing (chronic respiratory diseases, such as cystic fibrosis), coughing, and sputum. Manifestations of Respiratiory issues In addition to respiratory clinical manifestations, infants and young children often have generalized symptoms associated with respiratory illnesses such as: fever anorexia vomiting diarrhea abdominal pain nasal blockage nasal discharge sore throat Common Respiratory diagnoistic tests Several types of procedures and monitoring are available to assess respiratory function and to help diagnose respiratory disease. pulmonary function tests noninvasive test using spirometry useful to evaluate severity of disease and effectiveness of treatment peak flow meter x-rays blood gas pulse oximetry for infants, sensor placed on the toe or around foot transcutaneous monitoring continuous monitoring of oxygen in blood end-tidal carbon dioxide monitoring exhaled carbon dioxide Factors that impact illness Most acute illnesses in children involve the respiratory system. Differences in age, size, and susceptibility impact how respiratory illnesses present in infants and smaller children versus older children and adults. Age Infants and young children between 6 months and 3 years react more severely to acute respiratory tract infection and experience more generalized signs and symptoms than older children. Maternal antibodies often protect infants younger than 3 months against respiratory infections. Infants between 3 and 6 months are developing their own antibodies. Some illnesses such as respiratory syncytial virus present as severe in infants and mild in older children. Size Infants and younger children have smaller airway diameters and shorter distances between structures in the respiratory tract can make illnesses that cause edema and increased secretions more severe than in older children. Small nasal passages of infants are easily blocked by mucosal swelling and exudation, which can interfere with feeding. Respiratory illnesses may contribute to the development of otitis media and sinusitis. Susceptibility Conditions that predispose a child to infection include allergies (e.g., allergic rhinitis), bronchopulmonary dysplasia, asthma, history of respiratory syncytial virus infection, cardiac anomalies, and cystic fibrosis. Day care attendance and exposure to secondhand smoke also increase the likelihood of infection. Common Respiratory illness Respiratory Illness Upper or Lower Airway Most Common Age Group Affected Acute Viral Nasopharyngitis (Common Cold) upper all age groups symptoms more severe in infants Bronchitis lower all age groups frequently associated with an upper respiratory infection Influenza upper all age groups symptoms more severe in infants or clients with chronic medical conditions Bacterial Pneumonia lower all age groups Viral Pneumonia lower all age groups often associated with viral upper respiratory infections most can be prevented with immunization Acute Laryngotracheobronchitis upper children 6 months to 3 years ASTHMA Asthma is a chronic inflammatory disorder of the airways characterized by recurring symptoms, airway obstruction, and bronchial hyperresponsiveness. Asthma is the most common chronic disease of childhood which significantly contributes to childhood school absences and hospitalizations. Clinical Manifestations recurrent episodes of wheezing, shortness of breath, chest tightness, and cough symptoms may be worse at night or during exercise Diagnostic Evaluation pulmonary function tests peak expiratory flow rate Therapeutic Management treatment plans include a stepwise approach to balance medications with symptoms and are based on the severity of disease: intermittent, mild persistent, moderate persistent, and severe persistent prevention of exacerbations includes avoiding triggers, avoiding allergens, and adherence to prescribed treatment regimen the American Lung Association (2020) recommends these general guidelines for clients: Nursing Care Management monitor respiratory status and response to treatment provide education regarding triggers, medication administration, symptom monitoring, and developing asthma action plans Types of Croup Syndromes Infants and young children are more prone to acute upper airway infections than older children. Infants and young children have airways that are smaller in diameter than those of older children, which makes it more dangerous when swelling occurs. Most types of croup, such as acute laryngotracheobronchitis, are benign and can be treated at home. However, acute epiglottitis is a medical emergency. Therefore, it is critical that the type of croup is identified quickly so it can be treated appropriately. Clinical Manifestations Acute Laryngotracheobronchitis Acute Laryngotracheobronchitis Acute laryngotracheobronchitis is the most common type of croup and primarily affects infants and children less than 5 years old. It is caused by viruses such as influenza types A and B, adenovirus, respiratory syncytial virus, and measles. Clinical manifestations include: low-grade fever barky, brassy cough inspiratory stridor respiratory distress, which may include retractions, nasal flaring, and tachypnea Acute Epiglottitis Acute epiglottitis is a serious obstructive inflammatory process that can rapidly progress to complete respiratory obstructio n, severe respiratory distress, and even sudden death. It typically affects children ages 2 to 5 years old and is often caused by haemophilus influenzae. The haemophilus influenza type B vaccine has dramatically reduced cases of acute epiglottitis in recent years. Clinical manifestations include: high fever sore throat sitting upright and leaning forward (“tripod” position) with mouth open drooling irritability cherry-red, edematous epiglottis Acute Laryngotracheobronchitis The child has a history of illness. progressive onset usually preceded by an upper respiratory infection and low-grade fever The child awakens in the night with a barking, brassy cough and at times inspiratory stridor. Symptoms are typically worse at night, and agitation and crying tend to exacerbate the symptoms. Acute Epiglottitis The child has a history of illness. rapid onset often preceded by a sore throat The child will often awaken in the middle of the night with a high fever and complain of a sore throat and painful swallowing. desire to sit upright and lean forward (“tripod” position) with mouth open drooling irritable and restless red and inflamed throat with cherry red, edematous epiglottis Three classic signs of epiglottitis are: absence of spontaneous cough presence of drooling agitation Therapeutic Management Acute Laryngotracheobronchitis Acute Laryngotracheobronchitis Children with mild croup (no stridor at rest) are managed at home. Cool mist constricts edematous blood vessels. In the home: Parents can take the child outside to breathe in cool night air, use a cold-water vaporizer or humidifier, stand in front of the open freezer, or take the child to a cool basement or garage. In the hospital: Cool mist will be administered by face mask or blow by. For moderate to severe cases, nebulized racemic epinephrine is administered as quickly as possible. Corticosteroids may be used to reduce edema early in treatment. Supplemental oxygen is administered as needed. Intubation is implemented if airway obstruction is severe. Fluid intake is encouraged for mild cases. NPO status is implemented for children with severe respiratory distress to prevent aspiration. Acute Epiglottitis Intensive observation of respiratory status is needed to ensure action is taken quickly. If the status deteriorates: For less severe distress, mask or blow-by humidified oxygen is administered as needed. For severe respiratory distress, children are intubated. Administer intravenous antibiotics for children with suspected bacterial epiglottitis, followed by oral administration to complete a 7to 10-day course. Corticosteroids may be used to reduce edema early in treatment. NPO status is implemented to prevent aspiration. Epiglottal swelling usually decreases after 24 hours of antibiotic therapy, and the epiglottis is near normal by the third day. Nursing Care Management There are several similarities between nursing care for children hospitalized with acute laryngotracheobronchitis or acute epiglottitis. Similarities include that the nurse should: Continuously monitor respiratory status, including pulse oximetry, so that impending respiratory failure is recognized quickly. Ensure resuscitation and suction equipment are available at the child’s bedside. Encourage the child to be held and comforted by parents to conserve energy and prevent exacerbation. Some nursing actions that are specific to caring for a child with acute epiglottitis include: Administer intravenous antibiotics. Follow droplet isolation precautions for the first 24 hours of antibiotic therapy. If epiglottitis is suspected, the child should be seen by the healthcare provider immediately. Do not attempt to visualize the epiglottis or take a throat culture, as this may cause complete airway obstruction.