Peds week 6

Alteration in Gas Exchange/Respiratory Disorder

Respiratory disorders are the most common causes of illness and hospitalization in children and account for the majority of acute illnesses in children Newborns are obligatory nose breathers until at least 4 weeks of age and cannot automatically open their mouths to breathe if the nose is obstructed Anatomy of the nose and throat differs in infants, making them more prone to acquire infections

Respiratory Structures Differences

Airway lumen is smaller in infants and children than in adults and when edema, mucus, or bronchospasm is present, the capacity for air passage is greatly diminished. Small reduction in the diameter of a child's airway will result in an exponential increase in resistance to airflow, causing increased work or breathing Congenital laryngomalacia due to the funnel shape and location of the larynx, increases the chance of aspiration of foreign material into the lower airways Child's airway is highly compliant, making it quite susceptible to dynamic collapse during airway obstruction Location of the trachea at the third thoracic vertebra in children as opposed to the sixth in adults and how this difference is important when suctioning children and assessing for risk for aspiration Children have a significantly higher metabolic rate than adults and how this affects normal oxygen transport Diaphragm -Flatter -Muscle fibers more vulnerable to fatigue

Chronic Respiratory Disorders

Allergic rhinitis Asthma Chronic lung disease (bronchopulmonary dysplasia) Cystic fibrosis

Severe Influenza Infection

Chronic heart or lung disease (such as asthma) Diabetes Chronic renal disease Immune deficiency Children with cancer receiving chemotherapy

Inspection and Observation of the Respiratory System

Color: pallor, cyanosis, acrocyanosis, diaphoresis Rate and depth of respirations: tachypnea Nose and oral cavity Cough and other airway noises: atelectasis, stridor Respiratory effort Anxiety and restlessness Clubbing Hydration status

Acute Infectious Disorders

Common cold, sinusitis Influenza Pharyngitis, tonsillitis, and laryngitis Croup syndromes Respiratory syncytial virus (RSV) Pneumonia and bronchitis

Sinusitis

Cough Fever Halitosis: Facial pain Eyelid edema Irritability Poor appetite Persistent

Nursing Management of Epiglotitis

Do not attempt to visualize the throat. Do not leave the child unattended. Do not place the child in a supine position. Provide 100% oxygen in the least invasive manner. If complete airway occlusion occurs, tracheostomy may be necessary. Ensure emergency equipment is available.

Acute Noninfectious Respiratory Disorders

Epistaxis (bloody nose) Foreign body aspiration Respiratory distress syndrome Acute respiratory distress syndrome Pneumothorax Allergic rhinitis

Pneumonia

Inflammation of the lung parenchyma caused by a virus, bacteria, Mycoplasma, or fungus Most common cause of pneumonia in younger children and the least common cause in older children Diagnosis Interventions Pt education Viral or bacterial?

Anatomy and Physiology of the Child's Nose and Throat

Nose: Infants are obligate nose breathers; newborns produce very little mucus, making them more susceptible to infections. Newborns have very small nasal passages, making them more prone to obstruction; sinuses are not developed, making them less prone to sinus infection. Throat: Infants' tongues relative to oropharynx are larger; placement of tongue can lead to airway obstruction. Children have enlarged tonsillar and adenoid tissue, which can lead to airway obstruction.

Signs and Symptoms of Bronchiolitis (RSV)

Onset of illness with a clear runny nose (sometimes profuse) Pharyngitis Low-grade fever Development of cough 1 to 3 days into the illness, followed by a wheeze shortly thereafter Poor feeding Lots of mucous and secretions

Cystic Fibrosis

Over production of secretions Most common debilitating disease of childhood among those of European descent Signs and symptoms Risk factors

Common Medical Treatments for Respiratory Disorders

Oxygen High humidity Suctioning Chest physiotherapy and postural drainage Saline gargles Saline lavage Chest tubes Bronchoscopy

Nursing Care Posttonsillectomy

Promoting airway clearance Place child in side-lying or prone position Maintaining fluid volume Discourage coughing Encourage fluids; avoid citrus, brown, or red fluids Relieving pain Ice collar and analgesics with or without narcotics

Interventions to Minimize Psychosocial Impact of Chronic Respiratory Conditions

Promoting child's self-esteem through education and support Allowing school-age child to take control of management of the disease Promoting family coping through education and encouragement Providing culturally sensitive education and interventions

Laboratory and Diagnostic Tests Ordered for Bronchiolitis (RSV)

Pulse oximetry: oxygen saturation might be decreased significantly Chest radiograph: might reveal hyperinflation and patchy areas of atelectasis or infiltration Blood gases: might show carbon dioxide retention and hypoxemia Nasal-pharyngeal swab: positive identification of RSV can be made via enzyme-linked immunosorbent assay (ELISA) or immunofluorescent antibody (IFA) testing

Laboratory and Diagnostic Tests Ordered for Pneumonia

Pulse oximetry: oxygen saturation might be decreased significantly or within normal range Chest x-ray: varies according to child age and causative agent Sputum culture: may be useful in determining causative bacteria in older children and adolescents White blood cell count: might be elevated in the case of bacterial pneumonia

Pharyngitis, tonsillitis, and laryngitis

Quite abrupt History Fever Sore throat Difficulty swallowing Headache Abdominal pain

Acute Respiratory Distress Syndrome (ARDS)

Sepsis Viral pneumonia Smoke inhalation Drowning Note that respiratory distress and hypoxemia occur acutely within 72 hours of the insult in infants and children with previously healthy lungs

Croup

Significant stridor at rest Severe retractions after a several hour period of observation Edema of the larynx, trachea and bronchi Occurs at night Self limiting Steroids

Signs and Symptoms and Risk Factors for a Pneumothorax

Signs and symptoms Chest pain might be present as well as signs of respiratory distress such as tachypnea, retractions, nasal flaring, or grunting Risk factors Chest trauma or surgery, intubation and mechanical ventilation, or a history of chronic lung disease such as cystic fibrosis

Laboratory and Diagnostic Tests Ordered for Cystic Fibrosis

Sweat chloride test: considered suspicious if the level of chloride in collected sweat is above 50 mEq/L and diagnostic if the level is above 60 mEq/L Pulse oximetry: oxygen saturation might be decreased, particularly during a pulmonary exacerbation Chest radiograph: might reveal hyperinflation, bronchial wall thickening, atelectasis, or infiltration Pulmonary function tests: might reveal a decrease in forced vital capacity and forced expiratory volume, with increase in residual volume

Nursing Management Common Cold

Symptom relief Promote comfort Provide family education Prevent spread of cold Hand hygiene Lab test for common cold

Adventitious Breath Sounds

Wheezing High-pitched sound on expiration May occur with obstruction in lower trachea or bronchioles Rales (crackles) Crackling sounds heard when alveoli become fluid filled May occur with pneumonia Stridor Stridor is noisy breathing that occurs due to obstructed air flow through a narrowed airway. The specific type of stridor depends on the location of the obstruction

Laryngomalacia

floppy airway