CH36: The Child With a Respiratory Disorder

How is tonsillitis treated?

- Treatment consists of administration of analgesics for pain, antipyretics for fever, and an antibiotic in the case of streptococcal infection. A standard 10-day course of antibiotics is often recommended for the treatment of tonsillitis. Stress the importance of completing the full prescription of antibiotic to ensure that the streptococcal infection is eliminated.

What are clinical manifestations of Acute Nasopharyngitis?

- The infant usually develops a fever early in the course of the infection, often as high as 102 to 104 F, - Nasal congestion, which can interfere with feeding, increasing the infants irritability and fussiness. - In older children nasal congestion, and discharge with sneezing and coughing is present. - Nasal congestion is not a concern in an older child as it is in infants because the older child can mouth breathe. - Fever is less common in the older child but headache, decreased appetite and difficulty sleeping may occur

How is tonsillitis diagnosed?

- Throat cultures are performed to determine the causative organism. Frequently the cause of tonsillitis is viral, although B-hemolytic streptococcal infection may also be the cause.

What are common clinical manifestations a child with tonsillitis may have?

- A fever of 101F or more - Sore throat often with dysphagia - Hypertrophied tonsils - halitosis - Erythema of the soft palate Exudate may also be visible on the tonsils.

What are some implementation for providing comfort and relieving pain for a tonsillectomy?

- Apply ice color postoperative if child allows it - Administer pain medication as ordered, such as liquid acetaminophen. - Opioid analgesic medications may be used for pain unrelieved by other analgesic medications.

When is performing a tonsillectomy appropriate for a child with tonsillitis?

- Are generally not performed unless other measures are ineffective or the tonsils are so hypertrophied that breathing and eating are difficult. - If the child has obstructive sleep apnea, a tonsillectomy and adenoids to my are often the treatment. - Tonsillectomies are not performed when the tonsils are infected.

What observing a child with Acute laryngotracheobronchitis, what assessments should be done?

- Checking pulse, respirations, and color. - Listening for hoarseness and stridor - Noting any restlessness, because this can indicate an impending respiratory crisis. - Pulse OX to determine the degree of hypoxia.

What are clinical manifestations of Acute laryngotracheobronchitis ?

Child develops hoarseness and barking cough with fever that may reach 102.2F (39C). - As the disease progresses, marked laryngeal edema and inspiratory stridor occurs, and the child's breathing becomes difficult, the pulse is rapid, and cyanosis may appear. - Acute respiratory distress can result.

What risk arises when a child is postoperative for a tonsillectomy?

Dehydration risk related to inadequate oral intake secondary to painful swallowing.

When does the lymphoid tissue normally enlarge in a child?

Enrages progressively in childhood between the ages of 2 and 10 years and shrinks during preadolescents.

What implementations would be put into place to prevent postoperative aspiration?

Immediately after a tonsillectomy, place the child in a partially prone position with head turned to one side until the child is completely awake. - Keeping the head slightly lower than the chest and abdomen, which may hamper respiration. - Encourage child to expectorate all secretions, and place an ample supply of tissues and a waste container near the child. - Check vital signs every 10-15 minutes until the child is fully awake, and then check every 30 minutes to an hour. Observation of the pharynx with a flashlight should be down each time vitals are checked.

Why is there an increased possibility for respiratory obstruction in infants and younger children?

Infants and younger children have larger tongues in proportion to their mouths, shorter necks, and narrower airways, and the structures are closer together. - This will lead to the possibility of respiratory obstruction especially of there is edema, or swelling, or increased mucus in the airways.

What is croup syndrome?

Is not a disease, but a group disorder typically involving a barking cough, hoarseness, inspirations strider (shrill, harsh, respiratory sound). The disorders are names for the respiratory structure involved. Acute laryngotracheobronchitis, for instance, affects the larynx, the trachea, and the major bronchi. - This condition is not serious but can frighten both child and family.

What is the respiratory system made up of?

Nose, pharynx, larynx, trachea, epiglottis, bronchi, bronchioles, and the lungs

What is Spasmodic laryngitis?

Occurs in children between ages 6 months and 3 years. Cause is undetermined but may still be infectious or allergic origin, but certain children seem to develop severe laryngospasms with little, if any, apparent cause.

What should be done next if a child with acute nasopharyngitis has symptoms that have prolonged?

The child must be seen by a healthcare provider to rule our complications, such as otitis media.

What is the viral origin of Acute nasopharyngitis?

The illness is of viral origin such as rhinoviruses, coronaviruses, coxsackievirus, respiratory syncytial virus (RSV), influenza virus, parainfluenza virus.

What is the "allergic salute"?

When a child pushes their nose upward and backward to relieve itching and open the air passages in the nose. This is usually done by the child when there is continued sniffing, itching of the nose and palate.

What are treatments that can be done for a child with allergic rhinitis?

When possible, offending allergens should be avoided or removed from the environment. Antihistamines and decongestants can be helpful for some children also. Hyposensitization can also be implemented, if antihistamines are not helpful or are needed chronically

What is the major goal of treatment for acute laryngotracheobronchitis?

To maintain an airway and adaquate air exchange. - Corticosteroids are administered to decrease airway edema and inflammation. - The child is placed on a humidified air atmosphere and oxygen may be administered to maintain oxygen a saturation levels at 92% or above. - To activate bronchodialiation, RECEMIC or NEBULIZER EPINEPHRINE may be administered by respiratory therapist. Be aware that a child requires carful observation for reappearance of symptoms.

allergic rhinitis

an allergic reaction to airborne allergens that causes an increased flow of mucus

What are symptoms common in older children with allergic rhinitis?

Headaches are common in older children

A 2 year old child inhales a foreign body, what bronchus is this foreign body likely to be drawn?

More likely to be drawn into the right bronchus rather than the left. Rational: In children older than 2 years, the right bronchus is shorter, wider, and more vertical than the left, making it more likely for a foreign body inhaled by the child to be drawn into.

What are some symptoms of Allergic Rhinitis?

A watery nasal discharge, post nasal drip, sneezing, and allergic conjunctivitis are the usual symptoms.

What would cause dark circles and inflammation around the eyes in a child with allergic rhinitis ?

Congestion in the nose, causing back pressure to the blood circulation around the yes is the cause.

What are treatments for Spasmodic Laryngitis?

- Cool-mist or humidifiers produce mist at room temperature may be used in the hills bedroom to provide humidity. Must be cleaned regularly to prevent growth of undesirable organisms. - Spasms can also be relived by exposure to cold air.

What is one way the infants and child's respiratory system differs from the adults system?

- Differ because of their immature body defenses and small underdeveloped anatomical structures The diameter of. The infants and child's trachea is about the size of the child's little finger. The small diameter makes it extremely important to be aware that something can easily lodge in this small passageway and obstruct the child's airway.

What implementations would be in place for encouraging fluid intake after a child has had a tonsillectomy?

- Offer clear fluids or ice chips - Decrease discomfort by administering pain medications to encourage the child to increase fluid intake - Offer carbonated beverages that are flat, and frozen juice popsicles. - Avoid irritating fluids such as orange juice and lemonade - Avoid milk and ice cream because it tends to cling to the surgical site and make swallowing more difficult, despite the old tradition of offering ice cream after a tonsillectomy.

What are clinical manifestations of epiglottitis?

- Onset of severe sore throat, dysphagia, and a high fever of 102.2F to 104F. - Dysphagia will cause drooling, which is a sign of significant concern. - The child is very anxious, restless, and prefers to breath by sitting up and leaning forward with mouth open and tongue out (tripod condition). Immediate emergency attention is necessary.

What are clinical manifestations of Spasmodic laryngitis?

- Proceeds by Cory a (runny nose) and hoarseness or by no apparent signs of respiratory irregularity during the evening. - It is common for a child to be woken up with bark like cough, increasing respiratory difficulty, and strider. - The child will become anxious, restless, and markedly hoarse. - A low grade fever and mild upper respiratory infection may also be present

What is Tonsillitis and Adenoiditis?

A common illness in children resulting from pharyngitis (inflammation of pharynx) leading to inflammation of the tonsils and adenoids

An older child has nasal congestion and discharge with coughing and sneezing? What is most likely the infectious condition associated with these symptoms? A: Acute Nasopharyngitis (Common Cold) B: Allergic Rhinitis

A: Acute Nasopharyngitis - Rational: The nasal secretions associated with allergic rhinitis are clear and watery with no discharge.

What analgesics would be used for a child with acute nasopharyngitis?

Acetaminophen or ibuprofen may be administered as an analgesic and antipyretic

What is epiglottis?

Acute inflammation of the epiglottis

What is Acute Laryngotracheobronchitis?

Acute laryngotracheobronchitis (croup) is acute inflammation of the larynx, trachea, and epiglot- tis that is potentially life-threatening in infants. It is most often caused by viral infection. Characteristics include a harsh cough and inspiratory stridor.

What is Acute Nasopharyngitis?

Also known as the common cold - The young infant is as susceptible as the older child but generally is not exposed as frequently

What are major postoperative goals for a child who has had a tonsillectomy?

Aspiration risk related to impaired swallowing and bleeding at the operative site. - Preventing aspiration; reliving pain, especially while swallowing; and improving fluid intake.

At what age does the infant stop using the diaphragm and abdominal muscles to breath?

At about age 2 to 3 years, the child starts using the thoracic muscles to breath. The change from using abdominal to using thoracic muscle for respiration is completed by the age of 7 years.

If a child with acute Nasopharyngitis has irritation ion the nares or upper lip what intervention can be done?

Cold cream or petrolatum (Vaseline) can be used.

What are complications that may arise from the common cold?

Complications that may arise from acute Nasopharyngitis (common cold) are Otitis media: inflammation or infection located in the middle ear. Sinusitis: a condition in which the cavities around the nasal passages become inflamed.

Which clinical manifestations of spasmodic laryngitis would need attention from health care provider?

Continuous stridor, use of accessory muscles, labored breathing, lower rib retractions, restlessness, pallor, and rapid respirations. The family must be aware that recurrence of these conditions may occur.

A child was taken during the night to go to the emergency department because he was experiencing episodes of Spasmodic Laryngitis, but when they arrived there was little evidence for the healthcare provide when assessing. Why did this occur?

Episodes subside after a few hours and can be relived by exposure to cold air, when, for instance, this child was taken out in the night to go to the emergency department or to see the healthcare provider the spasms were relieved and the episode had subsided.

What is the most common complication of a tonsillectomy?

Hemorrhage is most common. Bleeding is most often a concern within the first 24hours after surgery and the fifth to seventh postoperative day. - During the first 24 hours after surgery, observe, document, and report any unusual restlessness or anxiety, frequent swallowing, or rapid pulse that may indicate bleeding. - Vomiting dark, old blood may be expected, but bright, red flecked emesis or oozing indicates fresh bleeding. - Bleeding can occur when the clots dissolve between the fifth and seventh postoperative days if new tissue is not yet present.

Which clinical manifestations of spasmodic laryngitis can be treated at home?

Hoarseness, croup cough, and inspiratory strider.

Why are some nursing interventions that would be done for a child with acute nasopharyngitits?

If uncomplicated the child may not need any treatment in addition to: - Rest - Increased fluids - Adequate nutrition - Normal Saline drops - Bulb syringe suction - Cool-mist humidified environment.

What can occur if the lymphoid tissue becomes a site of acute or chronic infection?

It may become hypertrophied and can interfere with breathing and swallowing, cause partial deafness, or become a source of infection in itself.

What may frequent swallowing after a tonsillectomy indicate?

May indicate bleeding

What is the most common cause of epiglottitis?

Use to be caused by Haemophilus influenza type B, but since the Hib conjugate vaccine is now given routinely, more often it is caused by other bacterium. This causes inflammation and swelling with edema of the epiglotis, resulting in blockage of the airway and creates an emergency.

If epiglottis is suspected, why should you not put anything in the child's mouth in an attempt to visualize the throat?

You should not put anything in the child's throat an attempt to visualize possible inflammation of epiglottitis because of the concern of causing complete airway obstruction.