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Respiratory Disorders

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Respiratory Disorders Jan Bazner-Chandler CPNP, CNS, MSN, RN Typical X-ray Symptoms High fever Thick green, yellow, or blood tinged secretions Grunting respirations ... – PowerPoint PPT presentation

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Title: Respiratory Disorders


1
Respiratory Disorders
  • Jan Bazner-Chandler
  • CPNP, CNS, MSN, RN

2
Respiratory
Bifurcation of trachea
Change in chest wall shape
3
Upper Airway Characteristics
  • Narrow tracheo-bronchial lumen until age 5
  • Tonsils, adenoids, epiglottis proportionately
    larger in children
  • Tracheo-bronchial cartilaginous rings collapse
    easily

4
Lower Airway Characteristics
  • Fewer alveoli in the neonate
  • Poor quality of alveoli until age 8
  • Lack of surfactant that lines the alveoli in the
    premature infant
  • Inhibits alveolar collapse at end of expiration

5
Respiratory Characteristics
  • Basal metabolic rate is greater thus greater
    oxygen consumption
  • Immunoglobulin G (IgG) levels reach low point
    around 5 months of age

6
Focused Physical Assessment
  • Types of breathing
  • Less than 7 years abdominal breathing
  • Greater than 7 years abdominal breathing can
    indicate problems

7
Respiratory Rate
  • Inspiratory phase slightly longer or equal to
    expiratory phase
  • Prolonged expiratory phase asthma
  • Prolonged inspiratory phase upper airway
    obstruction
  • Croup
  • Foreign body

8
Color
  • Observe color of face, trunk, and nail beds
  • Cyanosis inadequate oxygenation
  • Clubbing of nails chronic hypoxemia

9
Respiratory Distress
  • Grunting impending respiratory failure
  • Severe retractions
  • Diminished or absent breath sounds
  • Apnea or gasping respirations
  • Poor systemic perfusion / mottling
  • Tachycardia to bradycardia late sign
  • Decrease oxygen saturations

10
Chest Muscle Retraction
11
Chest Retractions
  • Retractions suggest an obstruction to inspiration
    at any point in the respiratory tract.
  • As intrapleural pressure becomes increasingly
    negative, the musculature pulls back in an
    effort to overcome the blockage.
  • The degree and level of retraction depend on the
    extent and level of the obstruction.

12
Diagnostic Tests
  • Detects abnormalities of chest or lungs
  • Chest x-ray
  • Sweat chloride Test
  • MRI
  • Laryngoscope / bronchoscopy
  • CT Scan

13
White Patchy Infiltrates
14
X-ray Hyperinflation of Lung
Vh.org
15
Pleural Effusion
16
Pleural Effusion X-Ray
vh.org
17
Sweat Chloride Test
  • Analysis of sodium and chloride
  • Contents in sweat
  • Gold Standard for diagnosis
  • May do genetic screening earlier
  • if positive family history

Ball Bindler
18
Foreign Body Aspiration
A foreign body in one or the other of the
bronchi causes unilateral retractions. usually
the right due to broader bore and more vertical
placement.
19
Oxygen Therapy Nursing Interventions
  • Proper concentration
  • Adequate humidity make sure there is fluid in
    the bottle
  • Make sure prongs are in nose and that the nares
    are patent suction out nares to increase oxygen
    flow
  • Monitor oxygen SATS if alarm keeps on going off
    but the infant / child looks good, check the
    device
  • Monitor activity level or infant / child

20
Aerosol Therapy
  • Respiratory Therapist will do the treatment
  • Communicate with therapist eliminated needless
    paging for treatments
  • Treatment should be done before the infant eats
  • When you make your morning rounds assess if there
    is any infant / child that needs an immediate
    treatment

21
Home Teaching Inhaled Medications
  • Correct dosage
  • Prescribed time
  • Proper use of inhaler
  • No OTC drugs
  • Encourage fluids
  • When to call physician

22
Aerosol Therapy
Medication administered by oxygen or
compressed air.
Ball Bindler
23
Nebulizer - infant
24
Outpatient Aerosol Treatment
25
CPT
26
CPT
  • In the small child you can position on your lap
  • Do first thing in the AM
  • Do before meals or one hour after
  • Do after the aerosol treatment since the
    treatment will help open the airways and loosen
    the mucous
  • Suction the infant after treatment teach
    parents to do bulb suction RN, LVN or RT to
    deep suction prn

27
Mechanical Ventilation
28
Alterations in Respiratory Function
29
Severe Respiratory Distress
  • Nasal flaring and grunting
  • Severe retractions
  • Diminished breath sounds
  • Hypotonia
  • Decreased oxygen saturations

30
What to do if infant / child in respiratory
distress!
  • Stimulate the infant / child - remember crying or
    activity will help mobilize secretions and expand
    lungs
  • Have the older child sit up take deep breaths and
    cough
  • CPT to loosen secretions and suction! suction!
    suction!
  • Give oxygen
  • Assess if interventions work
  • Call for help if you need it pull the emergency
    cord yell for help

31
Allergic Rhinitis
32
Symptoms
  • Itching of nose, eyes, and throat
  • Sneezing and stuffiness
  • Watery nasal discharge / post nasal drip
  • Watery eyes
  • Swelling around the eyes

33
Rhinitis Treatment
  • Antihistamines
  • Competitive inhibitors for histamine at the mast
    cell receptor sites
  • Benadryl OTC medication
  • Prescription Cromolyn or steroid nasal spray
  • Environmental changes - avoidance of allergens
  • Do not use combination OTC medications especially
    those that contain pseudoephedrine

34
Sinusitis
Sinuses not fully developed until age 12.
Adam.com
Sinuses are hollow cavities within the facial
bones.
35
Sinusitis Symptoms
  • Fever
  • Purulent rhinorrhea
  • Pain in facial area
  • Malodorous breath
  • Chronic night-time cough

Children more prone to sinusitis children with
asthma and cystic fibrosis.
36
Treatment
  • Normal saline nose drops
  • Warm pack to face
  • Acetaminophen for pain
  • Increase po fluid intake
  • Antibiotics
  • Recent studies question their effectiveness

37
Tonsillitis
Kissing tonsils occur when the tonsils are so
enlarged they touch each other.
38
Tonsillitis
  • Inflammation of the tonsils.
  • Part of the immune system to trap and kill
    bacteria and viruses traveling through the body.

39
Tonsillitis
  • Child may refuse to drink
  • Night snoring enlarged tonsils or adenoids
  • Size of tonsils are obstructing airway

40
Treatment
  • Antibiotics x ten days if positive for beta strep
  • Acetaminophen for pain
  • Cool fluids
  • Saline gargles
  • Antiseptic sprays
  • Viral throat infections will not get better
    faster with antibiotics.

41
Tonsillectomy
  • Done if childs respiratory status is compromised
  • Post operative care
  • Side lying position
  • Ice collar
  • Watch for swallowing
  • Cool fluids / soft diet

42
Croup
  • Laryngotracheobronchitis or Acute spasmotic croup
  • Infants from 3 months to about 3 years
  • Respiratory symptoms are caused by inflammation
    of the larynx and upper airway, with resultant
    narrowing of the airway.

43
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44
Symptoms
  • Symptoms
  • Hoarseness
  • Inspiratory stridor
  • Barking cough
  • Afebrile
  • Often worsens at night

45
Management
  • Home care
  • Cool mist
  • Fluids
  • Hospital care
  • Racemic epinephrine inhalant
  • Mist tent not used much anymore
  • Dexamethasone IV over 1 to several minutes

46
Pertussis or whooping cough
  • Agent Bordetella Pertussis
  • Source respiratory
  • Transmission droplet
  • Incubation 10 days
  • Period of communicability before onset of
    paroxysms to 4 weeks after onset

47
Management
  • Respiratory support as needed
  • Suctioning
  • Oxygen to keep oxygen saturation at gt 98
  • Nutritional support
  • IV fluids
  • Erythromycin, Zithromax or Biaxin for child and
    all exposed family members

48
Isolation Precautions
  • Transmission through direct contact with
    discharges from respiratory mucous of infected
    persons.
  • Highly contagious with up to 90 of household
    contacts developing disease after contact.
  • Respiratory and contact isolation for 3-4 days
    after the initiation of antibiotic therapy.

49
Epiglottitis
Bowden Greenberg
Tripod position
50
Epiglottitis Symptoms
  • Acute inflammation of supra-glottic structures.
  • Medical Emergency
  • Sudden onset
  • High fever
  • Dysphasia and drooling
  • Epiglottis is cherry red and swollen

51
Epiglottitis
  • Has decreased dramatically since introduction of
    the Haemophilus influenzae type b or Hib vaccine
    in 1985.
  • Incidence as of 2003 32 cases in children under
    5 years of age.
  • Incidence in the adult population has increased
    from 0.8 to 3.1 per 100,000 adults

52
Management
  • Diagnosis made on presenting symptoms
  • No tongue blade in mouth
  • Emergency tracheostomy set
  • No procedures until in the operating room
  • Keep quiet
  • Ceftriaxone third-generation cephalosporin for
    7 to 10 days.


53
Apnea
  • Apnea is cessation of respiration lasting longer
    than 20 seconds.
  • Monitor in hospital for 48 hours for underlying
    problems.
  • Discharge home with monitor

54
Apnea Monitoring
55
Foreign Body
  • Severe inspiratory stridor
  • Symptoms depend on location
  • Unilateral chest movement
  • Chest x-ray
  • Bronchoscope to remove object


56
Coin in Trachea
57
Teaching
  • No small hard candies, raisins, popcorn or nuts
    until age 3 or 4 years
  • Cut food into small pieces
  • No running, jumping, or talking with food in
    mouth
  • Inspect toys for small parts
  • Keep coins, earring, balloons out of reach

58
Influenza
  • Associated with community epidemic
  • Febrile, URI, achy joints,
  • Management
  • Acetaminophen for fever
  • Fluids
  • Keep away from others
  • Watch for signs of pneumonia

59
Bronchiolitis
  • Acute obstruction and inflammation of the
    bronchioles.
  • Most common causative agent RSV
  • Respiratory syncytial virus
  • Bronchioles become narrowed or occluded as a
    result of inflammatory process, edema, mucus and
    cellular debris clog alveoli

60
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61
Symptoms
  • Harsh dry cough
  • Low grade fever
  • Feeding difficulties
  • Wheezing
  • Respiratory distress with apnea
  • Thick mucus

62
Management
  • Oxygen to maintain oxygen saturation gtthan 95
  • Pulse oximeter
  • Normal saline nose drops before suctioning
  • Deep suction especially before feeding
  • CPT to mobilize secretions
  • Inhalation therapy not sure it is beneficial
  • Mechanical ventilation as needed

63
RSV Positive - Isolation
  • RSV is spread from respiratory secretions through
    close contact with infected persons or contact
    with contaminated surfaces or objects.
  • Patient should be on contact and respiratory
    isolation
  • Can be placed with other RSV patients

64
Pneumonia
  • An inflammatory condition of the lungs
  • in which alveoli fill with fluid or blood
  • resulting in poor oxygenation and air
  • exchange.

65
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66
Typical X-ray
67
Symptoms
  • High fever
  • Thick green, yellow, or blood tinged secretions
  • Grunting respirations
  • Rales, crackles, diminished breath sounds
  • Cough and cyanosis
  • Infiltrate seen on x-ray

68
Management
  • Assess for respiratory distress
  • NPO (rr gt 60 high risk for aspiration)
  • IV fluids
  • Oxygen as need to keep oxygen saturation above
    95
  • CPT
  • Deep suctioning
  • Acetaminophen for fever / antibiotics

69
Pneumonia Isolation
  • Respiratory isolation
  • May be taken off isolation if RSV negative and on
    antibiotics for 24 hours.

70
Cystic Fibrosis
Inherited autosomal recessive disorder of the
exocrine glands.
71
Pathophysiology Cystic Fibrosis
  • A chronic, progressive, genetic illness involving
    the digestive system and lungs.
  • Abnormality of the exocrine glands
  • Sweat and mucous glands
  • Mucus of CF is thick and viscous
  • Causes scar tissue
  • Leads to irreversible lung damage

72
Exocrine Gland Dysfunction
  • Mucous secretions are thick and tenacious
  • Dysfunction of mucous producing glands leads to
    multiple gastrointestinal absorption problems.
  • Blocked pancreatic ducts
  • No secretion of digestive enzymes

73
Cystic Fibrosis
74
Cystic Fibrosis
75
Symptoms
  • Meconium ileus at birth
  • Failure to thrive
  • Steatorrhea stools / constipation
  • Voracious appetite with poor weight gain
  • Recurrent respiratory infections
  • Chronic cough
  • Malabsorption of intestines

76
Diagnosis
  • Positive sweat test
  • Genetic marker
  • Life long management
  • Enzyme replacement with eating
  • Daily CPT postural drainage
  • Inhaled bronchodilators
  • Control of lung infections
  • Nutritional supplements as needed

77
Medications
  • Enzymes to help digest food
  • Antibiotics to control infection
  • Bronchodilators to open airways
  • Vitamin C to improve absorption of other meds
  • Vitamins E, A, D, K / fat soluble vitamins

78
Long Term Complications
  • Nasal polyps
  • Sinusitis
  • Rectal polyps / prolapse
  • Hyperglycemia / diabetes
  • infertility

Life span approximately 30 years of age
79
Asthma
  • Asthma is a chronic, inflammatory lung disease
    involving recurrent breathing problems.
  • Caused by complex, multicellular reaction in the
    airway characterized by
  • Airway inflammation
  • Airway hyper-responsiveness to a variety of
    triggers

Asthma is the most common, chronic health
problem among children.
80
Symptoms
  • Wheezing
  • Cough
  • Tightness of chest
  • Prolonged expiratory phase
  • Hypoxemia
  • X-ray hyper-expansion of lungs

81
Medical Management
  • High fowlers position / bed rest
  • Pulse oximetry
  • Nebulized albuterol
  • CPT
  • Methylprednisone / Solu-medrol IV
  • IV fluids
  • Oxygen to keep oxygen sats gt 95

82
Home Management
  • Peak flow spirometer
  • Identify triggers
  • Maximize lung function
  • Optimal physical growth
  • Optimal psycho-social state
  • Maximum participation

83
Peak Flow Monitoring
  • Spirometry measures how
  • much and how fast air is
  • forcefully expelled from fully
  • inflated lungs.
  • Recommended standard of care
  • for management of asthma.

84
Home Medications
  • Rescue drugs short acting albuterol beta 2
    agonist used as a quick-relief agent for acute
    bronchospasm and for prevention of exercise
    induced bronchospasm.
  • Anti-inflammatory or preventative low-dose
    inhaled corticosteroid inhaled or oral
    prednisone
  • Allergy Singulair

85
Bronchodilators
  • Bronchodilators rapidly relax the airway smooth
    muscle cells, thus reversing the bronchospasm
    until anti-inflammatory effect of steroids is
    attained.
  • Aerosols
  • Via mouth piece 3 years and older
  • Via facial mask for less than 3 years

86
Corticosteroids
  • Steroids reduce the inflammatory component of
    bronchial obstruction, decrease mucus production
    and mediator release, as well as the late phase
    (cellular) inflammatory process.
  • Methyl prednisone IV in severe cases
  • May need histamine H2 receptor antagonists
    (cimetadine or ranitidine) if experiencing GI
    upset
  • PO prednisone always give with food to decrease
    GI upset

87
Anti-inflammatories
  • Oral prednisone (Pedia-pred, Prelone, Liquid
    pred) recommended for short course in moderate or
    severe exacerbation
  • Inhaled Pulmicort, AeroBid, Flovent
  • Infant mask should fit firmly cataracts
  • Older child rinse and spit after treatment to
    prevent thrush

88
Family Teaching
  • Teach how to use medication
  • When to use and how often
  • No OTC drugs
  • Increase fluid intake
  • Signs and symptoms of respiratory distress

89
Normal Lungs
http//galen.med.virginia.edu/smb4v/tutorials/ast
hma/asthma1.html
90
Asthma Attack
91
Bronchopulmonary Dysplasia
Pediatric Nursing January/February 1999
92
History
  • It occurs in newborns who are born prematurely
    and or have a variety of pulmonary disorders and
    who require ventilatory support with high
    pressure and oxygen in the first 2 weeks of life.

93
Pathophysiology
  • Fibrosis of airways and marked hyperplasia of the
    bronchial epithelium
  • Increased fluid in the lungs, as a result of
    disruption of the alveolar-capillary membrane
  • Over distention due to damage to alveolar
    supporting structures resulting in air trapping
  • Fibrosis, airway edema, and broncho-constriction

94
BPD Symptoms
  • Persistent respiratory distress
  • Dependent on supplemental oxygen
  • Failure to thrive
  • Gastro-esophageal reflux
  • Pulmonary hypertension

95
Long Term Management
  • Supplemental oxygen
  • CPT
  • Bronchodilators
  • Diuretics (pulmonary hypertension)
  • Anti-inflammatory medication
  • Nutritional support po formula NG supplement
  • Gastrostomy tube (GER)
  • Bicarbonate in formula due to chronic state of
    acidosis

96
Long-term Outcomes
  • Oxygen dependent
  • Visual problems
  • Feeding difficulties
  • Developmental delay
  • Learning difficulties
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