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Children’s Respiratory Disorders

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Children s Respiratory Disorders Epiglottis - RSV/Bronchitis - Pneumonia - Asthma - Cystic Fibrosis Marydelle Polk, Ph.D., ARNP-CS Florida Gulf Coast University – PowerPoint PPT presentation

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Title: Children’s Respiratory Disorders


1
Childrens Respiratory Disorders




  • Epiglottis - RSV/Bronchitis - Pneumonia - Asthma
    - Cystic Fibrosis

Marydelle Polk, Ph.D., ARNP-CS Florida Gulf Coast
University
2
Objectives
  • Describe factors that influence the etiology and
    course of respiratory infections in children.
  • Differentiate among Epiglottis, RSV/Bronchitis,
    Pneumonia, Asthma, and Cystic Fibrosis in terms
    of etiology, defining characteristics, and
    nursing management.

3
Respiratory System
The respiratory system permits ventilation
through the process of inspiration and expiration
4
Respiratory Infections
  • Influencing factors Age Anatomical Size
    Resistance Seasonal Variations
  • Etiology H. influenza, Group A ?-Hemolytic
    Streptococcus, Staphylococci, Chlamydia
    trachomatis, Mycoplasma, pneumoccoci

5
Epiglotitis
  • Definition A severe bacterial infection which
    causes inflammation of the epiglottis and
    surrounding areas.
  • Incidence Usually occurs between the ages of
    2 5 years of age, but can occur from 7 mos.
    11 years rarely to adulthood.

6
Epiglottitis
  • History Abrupt onset History of
    pharyngitis. Clinical Signs Symptoms Wakes
    up looking very ill, fever, sore throat,
    dysphagia, drooling, dyspnea, dog position.

7
Epiglotitis
  • Clinical Signs Symptoms Anxious/apprehensiv
    e Muffled, froglike croaking Quiet
    inspiratory stridor
  • Always observe for the absence of cough, drooling
    and agitation hallmarks of epiglottis.

8
REMEMBER !!!
  • Never examine the pharynx.
  • Leave the child in a sitting position
    preferably in parents lap.
  • Child is anxious Do not cause further distress
    and never leave the child alone.
  • Cyanosis is a late sign of hypoxia (PO2 lt 50).

9
Nursing Diagnoses
  • Ineffective breathing pattern r/t inflammatory
    process.
  • Fear/anxiety r/t difficult breathing and
    unfamiliar place/procedures.

10
Nursing Coventions
  • Observe for progressive worsening ofrespiratory
    status.
  • Prepare for tracheostomy.
  • Be prepared for administration of O2,IV
    antibiotics, sedation.
  • Monitor VS, LOC, O2 levels, fluid status.
  • Provide calm reassuring support to child and
    parents.
  • Prevention is via the H. influenza B vaccine.

11
Nursing Coventions
  • Administer antipyretic medication, tepid sponge
    baths, or cooling mattress if indicated.
  • If needed, provide cool mist for humidifying air.
  • Ensure adequate rest and provide a less stressful
    environment.
  • Organize nursing care to give adequate rest
    periods.

12
Early Epiglottitis
Note the tripod
(dog-like) position
and the leaning forward
13
Progressive Epiglottitis
14
Bronchiolitis
  • Definition An acute viral infection primarily
    occurring at the level of the bronchioles.
  • Etiology Respiratory Syncytial Virus (RSV).
    Subgroup A gt B in children developing
    bronchiolitis and pneumonia.

15
Incidence and Transmission
URI of the infant 2-5 mos. Rare in
children over 2 years. Considered to be the
most important pathogen in the infant.
Usually preceded by a viral URII (RSV).
Increased incidence due to (1) direct contact
hands, eyes, nose, mucous membranes and
(2) the virus has a long life span.
16
Clinical Manifestations
  • Mild (Initial phase) Rhinorrhea
  • Pharyngitis Coughing and sneezing
  • May present with ear or eye
    infection History of intermittent fever

17
Clinical Manifestations
  • Moderate (Progressive) ? coughing and
    wheezing Air hunger and ? WOB Tachypnea and
    retraction Cyanosis

18
Sternal Retractions
When an infant/child is retracting like
this what else would you observe?
19
Clinical Manifestations
  • Severe Tachypnea gt 70 breaths/minute
    Listlessness Apnea spells Poor air
    exchange ? breath sounds

20
Nursing Diagnoses
  • Ineffective breathing r/t poor gas exchange.
  • Altered activity level r/t ?work of breathing.
  • Potential of fluid volume deficit r/t poorfluid
    intake.

21
Nursing Coventions
  • Provide ? humidity cool, moist oxygen
  • Adequate fluid intake
  • Ongoing assessment and monitoring of O2 status,
    VS, activity level
  • Possible administration of antiviral agents
    (RespiGam used more for prophylactic value)

22
Nursing Coventions
  • Conserve childs energy
  • Observe for signs of dehydration Sunken
    fontanel Poor skin turgor Dry
    mucous membranes Decreased and
    concentrated urinary output

23
Remember
As this infection is due to a virus standard Rx
may not prove to be effective in non-complicated
situations, including antibiotics
bronchodilators corticosteroids cough
suppressants
24
Pneumonia
Inflammation of the alveoli caused by bacteria,
virus, Mycoplasma organisms, aspiration, or
inhalation.
25
Types of Pneumonia
  • Lobar Large areas (segments) of
    one or both lungs are
    involved.
  • Broncho bronchioles become clogged
    with thick mucopurulent
    mucus ? consolidates into
    patches in nearby lobes.

26
Types of Pneumonia cont.
  • Interstitial Primarily occurs within the
    alveolar walls and interlobular tissues.

27
Incidence and Etiology
Incidence10-20 of the cases of pneumonia are
bacterial10 are mixed both viral and
bacterial.70 80 are viral.EtiologyMycopla
sma pneumoniae most common inchildren 5 12
years-of-age.
28
Chest x-rays - Pneumonia
29
Clinical Manifestations
  • ? fever
  • Cough (productive or nonproductive)
  • Tachypnea
  • Fine crackles and rhonchi
  • Chest pain
  • Retractions and nasal flaring
  • Pallor to cyanosis
  • Irritability restless lethargic
  • GI disturbances (nausea, diarrhea, pain,
    anorexia).

30
Nursing Diagnoses
  • Ineffective airway clearance r/t inflammation.
  • Pain r/t inflammatory process pneumonia

31
Nursing Coventions
  • Administer and monitor antibiotic therapy
    (bacterial).
  • Monitor fluid intake, VS (especially
    thetemperature give antipyretics in needed
    (fever/irritability), bed rest, cool mist
    humidifier.
  • In-hospital monitor O2 if child develops
    respiratory distress.
  • Avoid cough suppressants.
  • Teach parents s/s of respiratory distress and
    dehydration.
  • Conserve childs energy.

32
Reactive Airway Disease - Asthma
  • Definition inflammatory process of the large
    airways, which results in heightened airway
    reactivity.
  • An obstructive disorder due to the inflammation
    and edema of the mucous membranes, ? in thick,
    tenacious secretions, spasms of the bronchial
    smooth muscle ? a ? diameter of bronchioles.

33
Types of Asthma
  • Mild Intermittent Asthma S/S ? 2 times per
    week Exacerbations are brief Nighttime s/s
    ? 2 times per month Asymptomatic between
    episodes Does not require chronic drug
    therapy Teach and encourage parents to ?
    exposure to allergens

34
Types of Asthma
  • Mild Persistent AsthmaS/S gt 2 times per week - lt
    1/dayExacerbations may/may not affect
    exerciseNighttime s/s gt 2 times per monthTx
    with a nonsteroidal Rx - Cromolyn Sodium, a low
    dose inhaled cortico- steroid or a leukotriene
    inhibitor.

35
Types of Asthma
  • Moderate Persistent Asthma
  • Daily s/sDaily use of short-acting
    ?2-agonist or a low dose long-acting
    bronchodilator
  • Exacerbations affect exerciseExacerbations
    ? 2 times per week and may last for
    daysNighttime s/s gt 1 time per weekMay see
    Nedocromil (Tilade) given in children 5 years
    or younger in place of long-acting
    bronchodilator

36
Types of Asthma
  • Severe Persistent Asthma Continual s/s
    Frequent exacerbations frequent nighttime s/s
    PEFR and/or FEV1 gt 1 second and ? 60 of
    predicted value Tx - high dose inhaled
    corticosteroids (Vanceril, Flovent) plus oral
    steroids as needed to control s/s

37
Asthma
  • Educate child and family about the disease -
    assist them to identify the triggers - help them
    in developing an asthma action plan AND teach
    and encourage child to use a peak flow meter
    regularly as part of his/her action plan to
    determine management of their s/s.

38
Asthma
  • Guidelines for child? 80 of childs baseline
    is acceptable.50 - 80 of childs baseline
    indicates obstruction.? 50 of childs baseline
    indicates an acute attack.

39
Nursing Diagnoses
  • Ineffective airway clearance r/t allergenic
    response and inflammatoryprocess in bronchial
    airways.
  • Risk for suffocation r/t bronchospasm,edema and
    ?? tenacious mucus.

40
Nursing Coventions
  • Allergy control
  • Drug therapy
  • Chest PT
  • Hydration
  • Exercise
  • Keeping up with immunizations/flu vaccine
  • Desensitization therapy

41
O2 Delivery Devices
42
Metered Dose Inhaler-Spacer
43
Remember
  • Assessment - Teaching - Monitoring are hallmarks
    of effective care for the asthmatic child -
    whether in an acute care facility or community
    health center.

44
Cystic Fibrosis
  • DefinitionAn inherited, autosomal recessive
    disorder, which affects the exocrine glands and
    results in multisystem involvement.Most
    significant factor - The ? viscosity of mucus
    gland secretions obstruction

45
Cystic Fibrosis
  • Areas of involvement Respiratory system
    Integumentary system GI system Reproductive
    system

46
Cystic Fibrosis
  • Major signs and symptoms due to Lack of
    sufficient pancreatic enzymes. Gradual
    obstructive lung disease ? sweat gland
    function.

47
Nursing Diagnoses
  • Ineffective airway clearance r/t increased mucus
    production.
  • Alteration in nutrition - ? body requirements r/t
    malabsorption.

48
Nursing Coventions
  • Administer and monitor effects of antibiotic,
    bronchodilator, and nutritional management.
  • Teach chest PT - MAINSTAY of therapy!
  • Teach proper postural drainage technique.
  • Promote exercise, deep breathing and directed
    coughing.
  • Teach parents/child s/s of infection and
    complications i.e. pneumothorax

49
Nursing Coventions
  • Administer and/or monitor pancreatic enzyme
    replacement therapy. Always administer with
    meals and snacks - amount given relates to degree
    of insufficiency and the childs response to the
    enzyme therapy. Goal is to prevent FTT and to ?
    number of stools.
  • Teach parents/child about s/s of Na depletion
    and rectal prolapse

50
The End...
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