Caring for the Child with a Respiratory Condition

1
Chapter 24

• Caring for the Child with a Respiratory Condition

2
The Childs Respiratory System

• Differences between the child and adult
• Nares
• Epiglottis
• Thyroid, cricoid, and tracheal cartilage
• Neck muscles
• Soft tissue
• Trachea
• Lung tissue
• Abdominal versus thoracic breathing

3
Congenital Respiratory Conditions and Structural
Anomalies
4
Choanal Atresia

• Signs and symptoms
• Difficulty with nasal breathing
• Nursing care
• Insert oral airway
• Gavage feeding
• Teach parents
• Feed in a semi-upright position
• Maintain aspiration precautions

5
Respiratory Distress Syndrome

• Signs and symptoms
• Rapid, shallow respiration
• Audible grunting
• Retractions
• Nasal flaring
• Cyanosis

• Nursing care
• Assist in the administration of surfactant
• Place in an incubator
• Use warm humidified oxygen
• Analyze laboratory values
• Monitor vital signs
• Provide adequate amount of calories and fluids

6
Esophageal Atresia and Tracheoesophageal Fistula

• Signs and symptoms
• Frothing and bubbling at mouth/nose
• Excessive drooling/salivation
• Coughing, cyanosis, and respiratory distress
• Nursing care
• Maintain patent airway
• Prevent aspiration (no oral feedings)
• After corrective surgery
• Monitor vital signs
• Maintain chest tubes/intubation
• Provide parental nutrition, then oral feedings
• Prevent infection

7
Congenital Diaphragmatic Hernia

• Signs symptoms
• Severe respiratory distress
• Nursing care
• Discuss surgery
• Stabilize (oxygen and prevent further trauma)
• Assist with endotracheal intubation
• Insert orogastric or nasogastric tube
• Administer surfactant
• ECMO (full-term infants)
• Monitor pulmonary and cardiac status
• Provide postoperative care

8
Bronchopulmonary Dysplasia

• Signs symptoms
• Tachypnea
• Wheezing, rales, retractions,
• and cyanosis
• Increased respiratory rate

• Nursing care
• Give oxygen
• Administer bronchodilators and corticosteroids
• Use pulse oximetry
• Evaluate blood test/x-ray results
• Administer diuretics (replace electrolytes)
• Monitor and maintain fluids
• Ensure proper nutrition

9
Cystic Fibrosis

• Signs and symptoms
• Wide range severity varies
• Multisystem
• Nursing care
• Ensure respiratory function (aerosol therapy,
  chest physiotherapy, and antibiotic therapy)
• Promote good nutrition (replace pancreatic
  enzymes)
• Find resources for parents
• Teach parents
• See Chapter 24 Care Plan

10
Upper Airway Disorders
11
Sinusitis

• Signs and symptoms
• Cold (thick, yellow-green discharge)
• Postnasal drip
• Headache
• Irritability and fatigue
• Swelling around the eyes
• Nursing care
• Give antibiotics
• Give nasal spray/decongestant
• Teach parents

12
Nasopharyngitis

• Signs and symptoms
• Dryness and stuffiness
• Clear, watery nasal secretions and lacrimation
• sore throat, headache, and malaise
• Nursing care
• Promote symptomatic care (antipyretics and rest)
• Give antihistamines/decongestants
• Elevate head of bed
• Promote adequate fluid intake (avoid milk
  products)
• Teach hand washing and proper disposal of tissue
  paper into waste receptacle
• Discuss prevention strategies

13
Pharngitis

• Signs and symptoms
• Abrupt illness
• Headache, fever and abdominal pain
• Tonsils and pharynx (inflamed, large, red covered
  with yellow exudate)
• Lymph nodes enlarged and tender
• Pain on swallowing
• Nursing care
• Give antibiotics (teach parents to give full dose
  for prescribed duration)
• Encourage bed rest
• Apply cold or warm compress to neck
• Encourage warm saline gargle
• Give foods and liquids that can be tolerated
• Teach about proper hand washing

14
Tonsillitis

• Signs and symptoms (acute)
• Fever and chills
• Foul breath
• Dry throat, dysphagia, otaliga, headache,
  malaise, muscular pain, enlarged cervical nodes,
  and mouth breathing
• Nursing care
• Follow medical management (antibiotics,
  antipyretics, analgesics)
• Tonsillectomy (postoperative care)
• Assess for postoperative bleeding

15
Croup

• Signs and symptoms
• Hoarseness
• Barking cough
• Respiratory distress (varying degrees)
• Respiratory infection
• Nursing care
• Maintain airway/adequate respiratory exchange
• Use a cool mist vaporizer
• Give nebulized racemic epinephrine
• Give corticosteriods
• Monitor respiratory and cardiac systems
• Never assess childs throat with tongue blade if
  epiglottis or bacterial tracheitis is suspected

16
Otitis Media/Externa

• Signs and symptoms
• severe ear pain
• itching drainage
• erythema edema
• Nursing care
• Give antibiotic ear drops
• Give corticosteroids and analgesics
• Teach parents to have child avoid getting ears wet

17
Otitis Media

• Signs and symptoms
• Pain
• Irritable and pulls on affected ear
• Febrile (104F 40C)
• Lymph gland enlargement
• Rhinorrhea, vomiting, diarrhea, and loss of
  appetite
• Nursing care
• Administer antibiotics used judiciously
• Give analgesics
• Teach parents about prevention strategies

18
Lower Airway Disorders
19
Bronchitis

• Signs and symptoms
• Cough (dry to productive and worsens at night)
• Rhinorrhea
• Nursing care
• Give symptomatic care (antipyretics, analgesics,
  humidity)
• Give adequate oxygen
• Administer bronchodilators
• Use cool-mist vaporizer
• Give fluids
• Promote bed rest
• Teach parents to avoid secondhand smoke
• Promote adequate nutrition

20
Pneumonia

• Nursing care
• Give symptomatic care
• Administer antibiotics (bacterial)
• Give oxygen with cool mist
• Give chest physiotherapy
• Promote postural drainage
• Give bronchodilators
• Encourage fluid intake
• Give antitussive medication at
• bedtime
• Position on affected side
• Monitor vital signs and breath sounds
• Teach parents

• Signs and symptoms
• High fever
• Cough
• Rapid respirations
• Chest pain
• Retractions
• Nasal flaring
• Malaise
• Rhonchi or fine crackles

21
Infectious Conditions
22
Pertussis

• Signs and symptoms
• Catarrhal, paroxysmal, convalescent
• Nursing care
• Limit paroxysms (observe severity of cough,
  nutrition, rest, and recovery)
• Give antibiotic therapy
• Promote adequate nutrition
• Discuss vaccination (DTaP)
• Teach parents about hospitalization
• Droplet precaution
• Vital signs and oxygen saturation
• Hydration, nutrition, and fluids

23
Tuberculosis

• Signs and symptoms
• Asymptomatic early
• Low-grade fever, mild cough, and flu-like
  symptoms
• Anorexia and weight loss
• Nursing care
• Promote proper nutrition
• Give anti-TB drugs
• Give supportive care
• Prevent reinfection

24
Influenza

• Signs and symptoms
• Sudden fever and chills
• Flushed face
• Photophobia, myalgia, hyperesthesia, and
  exhaustion
• Nursing care
• Promote rest and fluids (electrolyte solution)
• Give medication for fever and pain
• Give antiviral drugs
• Give antibiotics only if evidence of bacterial
  infection
• Discuss influenza vaccine for prevention

25
Pulmonary Noninfectious Irritation
26
Foreign Body Aspiration

• Signs and symptoms
• Choking, gagging, wheezing, and coughing
• Obstruction dyspnea, cough, stridor,
  hoarseness, inability to speak and breathe
• Nursing care
• Laryngoscopy or bronchoscopy to remove
  obstruction
• Monitor vital signs and assess LOC
• Explain procedures
• Ensure NPO, cool-mist vaporizer, and antibiotic
  therapy
• Heimlich maneuver

27
Smoke Inhalation

• Signs and symptoms
• Heat (edema of the upper airway)
• Chemical (airway erythema, edema, ulceration)
• Systemic (headache, malaise, nausea, dizziness,
  andalterations in mental status)
• Nursing care
• Provide immediate administration of oxygen
• Monitor respiration and circulation
• Nutrition
• Maintain normal development

28
Passive Smoking

• Signs and symptoms
• Stuffy, runny nose watery eyes sneezing
  coughing wheezing headache and nausea
• Nursing care
• Control passive smoking
• Provide health education
• Teach parents about a smoke-free environment

29
Respiratory Conditions Related to Allergens
30
Allergic Rhinitis

• Signs and symptoms
• Sneezing, itching, rhinorrhea, postnasal drip,
  congestion, headache, earache, tearing, red eyes,
  eye swelling, fatigue, drowsiness, and malaise
• Nursing care
• Administer antihistamines, nasal corticosteroid
  sprays, decongestants, and leukotriene inhibitors
• Identify triggers
• Educate parents about allergy shots

31
Asthma

• Signs and symptoms
• Wheezing, prolonged expiratory phase
• Tachypnea
• Retractions and nasal flaring
• Chronic cough at night, barrel chest, elevated
  shoulders
• Nursing care
• Administer drug therapy
• Quick relief
• Long-term control
• Asthma Action Plan
• Instruct about the use of apeak flow meter
• Understand symptom relief
• Educate parents
• Status asthmaticus is persistent intractable
  asthma in which the child does to respond to
  therapy and a medical emergency ensures