maternal child chapter 36: The child with a respiratory disorder

what causes croup

can come on after a runny nose (coryza)

treatment of asthma

bronchodilators, corticosteroids, leukotriene inhibitors, mast cell stabilizers, and chest physiotherapy

how is tonsillitis and adenoiditis diagnosed?

with throat cultures

what age are tonsillectomies postponed to?

4 or 5 years old, unless in the rare instance that it appears to be urgently needed

You should teach family members that if they notice any signs of hemorrhage at any time to notify the healthcare provider, but especially if it is between the ___ and ___ day

5th and 7th

clinical manifestations of allergic rhinitis (hay fever)

a watery nasal discharge, postnasal drips, sneezing and allergic conjunctivitis are the usual symptoms. --continued sniffing, itching of the nose and palate and the "allergic salute", as the child wiggles the nose around in an attempt to relieve itching. ---because of the congestion in the nose, there is backpressure to the blood circulation around the eyes and dark circles are visible under the eyes. Headaches are common in the older children

clinical manifestations of bacterial pneumonia

abrupt high fever, resp distress, tachycardia, and tachypnea

what does the dietary treatment for CF consists of

adjusting the amount of pancreatic enzymes--the come in capsules that can be opened and sprinkled on food, a powdered preparation is used on infants

treatment/nursing care for tonsillitis/adenoiditis

analgesics for pain, antipyretics for fever, and an antibiotic in the case of streptococcal infection

what is the treatment and nursing care for allergic rhinitis

anti-histamines, decongestants, hyposensitization can be implemented if the anti-histamines are not working, and be sure to teach the parents the importance of avoiding allergens and administering antihistamines to decrease symptoms

clinical manifestations of acute nasopharyngitis

children older than 3 months usually develop a fever and younger babies do not, the child sneezes and becomes irritable and restless, The child might have vomiting and diarrhea----vomiting, diarrhea and sneezing is common in babies with a common cold

how is bacterial pneumonia diagnosed

clinical observation, chest radiography, and secretion culture

clinical manifestations of cystic fibrosis

meconium ileus is the presenting symptom in 5-10% of newborns who later develop additional manifestationsbile stained emesis, distended abdomen, and an absence of stool.---cystic fibrosis includes: pulmonary, pancreatic and other organ involvement

what is the treatment for pulmonary tuberculosis

medication (Rifampin or isoniazid) for 9-18 months

implementation for the child with bacterial pneumonia includes:

monitoring airway clearance, monitoring resp function, promoting adequate fluid intake, maintaining body temp, promoting energy conservation, preventing additional infections, reducing the child's anxiety, promoting family coping and providing family teaching

implementation for the child with asthma includes:

monitoring resp. function, monitoring/improving fluid intake, promoting energy conservation, reducing anxiety of the parent and the child, and providing family teaching

nursing diagnsoses for the child undergoing a tonsillectomy

risk for aspiration postoperatively r/t impaired swallowing and bleeding at the operative site, acute pain r/t surgical procedure, deficient fluid volume r/t inadequate oral intake secondary to painful swallowing and deficient knowledge r/t caregivers' understanding of post care and s/s of possible complications

what needs to be done with severe symptoms of croup

intubation

how is cystic fibrosis diagnosed

it is based on family history, elevated sodium chloride levels in the sweat, analysis of duodenal secretions, history of failure to thrive, recurrent resp infections, and radiologic findings of hyperinflation and bronchial wall thickening---the principle diagnostic testing for CF is a sweat chloride test using the pilocarpine iontophoresis method.

what is the goal with croup

maintain airway and adequate air exchanges

what is cystic fibrosis

major dysfunctionof all exocrine glands

what is it with infants and young children that can lead to airway obstruction, especially if there is edema/swelling or increased mucus in the airway?

they have larger tongues in proportion to their mouths, shorter necks, narrower airways, and the structures are closer together

clinical manifestations of asthma

dry hacking cough, wheezing and difficulty breathing

clinical manifestations of acute bronchiolitis

dyspnea, dry and persistent cough, extremely shallow respirations, air hunger, cyanosis, anxiety and restlessness

what is one of the major interventions with a child who has had a tonsillectomy?

family teaching

clinical manifestations of tonsillitis and adenoiditis

fever, sore throat, dysphagia, hypertrophied tonsils, erythema of the soft palate, and exudate may be visible on the tonsils.

treatment/nursing care of broncholitis

hospitalization with contact precautions, mist tent, rest and increased fluids

treatment for bacterial pneumonia

anti-infectives, O2 and fluids

treatment/nursing care fore epiglottitis

possible intubation, moist air, pulse ox and antibiotics

clinical manifestations of croup

post sleep barking cough, increasing resp. difficulty, stridor, anxiety, restlessness and hoarseness

what does implementation for a tonsillectomy include

preventing post-op aspiration, providing comfort and relieving pain, encouraging fluid intake and and providing family teaching

what is the treatment for acute nasopharyngitis?

rest, increased fluids, adequate nutrition, normal saline nose drops, suction nose with a bulb syringe and a humidified environment-tylenol or ibuprofen if needed

tell whether the statement is true or false: in the newborn, meconium ileus is the earliest s/s of CF. Meconium ileus is treated with gently adminsitered hyperosmolar enemas

true

prevention for TB

vaccination -used only in countries with a high incidence

what is the major goal of the treatment for a child with acute laryngotracheobronchitis

maintaining airway

what is the treatment for croup

antimicrobial therapy, supersaturated atmosphere, and nebulized epinephrine

nursing process for the child with asthma includes:

assessment, selected nursing diagnoses, and outcome identification and planning

how is asthma diagnosed

ausculation and pulmonary function tests

why do respiratory problems occur more often and with greater severity in infants and children than in adults

because of their immature body defenses and small, undeveloped anatomical structures.

why is it essential to keep the nasal passages clear to enable the infant to breathe and eat?

because they are nose breathers

how is acute bronchiolitis diagnosed?

by ELISA of mucus

is the cause of tonsillitis viral or bacterial

can be both, but it is usually viral

treatment/nursing care for the child with croup

cool mist humidifier and possible low dose emetic prescription (this medication induces vomiting, which can provide some relief by helping to reduce spasms of the larynx

clinical manifestations of pulmonary tuberculosis

cough with sputum, fever, weight loss, malaise, and night sweats

what is the treatment for CF

dietary treatment, pulmonary treatment, and home care

what does acute bronchiolitis present with?

difficult breathing upon exhalation--the bronchioles are are plugged with thick mucus , which traps air in the lungs

what can be potential complications of acute or chronic infection of the tonsils and adenoids

if the tissue itself becomes a frequent site for infection, it can become hypertrophied and can interfere with breathing, cause partial deafness, or become a source of infection itself

implementation of cystic fibrosis includes:

improving airway clearance, improving breathing, preventing infection, maintaining adequate nutrition, reducing the child's anxiety, providing family support, and providing family teaching

what is done during the assessment phase prior to a child having a tonsillectomy

much of the preoperative preparations are done on a preadmission outpatient basis (CBC, bleeding/clotting time, and urinalysis)--both the child and the caregiver should be included in the interview, ask about any bleeding tendencies, carefully explain all procedures to the child and be sensitive to their apprehension, take/record VS to establish a baseline--the temp is an important part of the data collection to determine that the child has no upper resp. infection, observe the child for loose teeth and document all findings

is epiglottitis a common condition

no

what is the controversy over tonsillectomies/adenoidectomies

no supported evidence has been found that a tonsillectomy improves a child's health by reducing the number of respiratory illnesses they have, increasing their appetite or improving general well-being. --they are currently only usually done if other measures are ineffective or the tonsils are so hypertrophied that they have breathing or eating problems.

is the ability to breathe through the mouth when the nose is blocked, automatic for infants and young children?

no, it develops as the child's neurological development increases

clinical manifestations of epiglottitis

sore throat, dysphagia, high fever, anxiety and the tripod position breathing

outcome/identification and planning for the child with the tonsillectomy

the major postoperative goals for the child: preventing aspiration, relieving pain, especially while swallowing and improving fluid intake --the major goal for the family is to increase knowledge and understanding of postdischarge care and possibel complications

how to diagnose the child with acute nasopharyngitis

the symptoms can often mimic other common childhood illnesses, such as the common cold, therefore the child should be carefully observed----parents should watch for the child to be pulling at their ears