Alterations in OxygenCarbon Dioxide Exchange

1
Alterations in Oxygen-Carbon Dioxide Exchange

• Chapters 31, 32

2
Respiratory Assessment

• Respirations
• Retractions
• Nasal flaring
• Head bobbing
• Grunting
• Color changes
• Chest pain
• Cough

3
Pediatric Differences

• Shorter distance between structures in young
  children
• Lumen of the young childs respiratory tract is
  smaller
• Fewer alveoli at birth
• Eustachian tubes are shorter

4
Pediatric Differences

• Neonates are nose-breathers
• Narrower airways increase airway resistance
• Infants airway walls have less cartilage
• Newborns have less respiratory mucus
• Increased respiratory and metabolic rates
  increase the need for oxygen

5
Diagnostic Procedures

• Pulmonary function tests
• Radiology
• Blood Gas
• Pulse Oximetry
• Bronchoscopy

6
Respiratory Therapy

• Oxygen therapy
• Aerosol Therapy
• Bronchial (Postural) Drainage
• Chest Physiotherapy (CPT)
• Artificial Ventilation

7
Tracheostomy

• Tracheostomy Care
• Suctioning
• Routine Care
• Emergency Care
• Decannulation
• Home Care

8
General Nursing Care

• Ease respiratory efforts
• Promote rest
• Promote comfort
• Prevent spread of infection

• Reduce temperature
• Promote hydration
• Provide nutrition
• Family support and home care

9
Acute Nasopharyngitis (Common Cold)

• Is an acute viral infection of the upper
  respiratory tract with potential involvement of
  nasal passages, sinuses, eustachian tubes, middle
  ears, conjuctiva and nasopharynx
• Etiology, Signs and Symptoms, Management,
  Prevention
• Children average 5 to 8 infections/year

10
Acute Streptococcal Pharyngitis

• Acute inflammation and infection of the throat
• S/S Sudden or gradual onset of symptoms, sore
  throat, fever, h/s, anorexia, malaise
• Treat if strep test is positive

11
Tonsillitis

• Viral tonsillitis saline gargles, throat
  lozenges analgesics for fever/pain encourage
  fluid to maintain hydration
• Surgical treatment

12
Infectious Mononucleosis

• -an acute disease characterized by fever,
  exudative pharymgitis, lymphadenopathy,
  hepatosplenomegally
• -caused by Epstein-Barr virus
• -S/S- fever, malaise, fatigue, severe sore
  throat, tender lymph nodes
• -Antibiotics if strep test and throat culture is
  positive

13
Influenza

• Is a highly contagious, viral illness
  characterized by sudden onset of fever, chills,
  malaise, headache, and dry cough
• Highest infectivity is 24 hours prior to onset of
  symptoms

14
Acute Otitis Media

• -is an inflammation of the middle ear with fluid
  and associated signs and symptoms of ear
  infections
• -caused by fluid/pathogen accumulation in middle
  ear due to eustacian tube malfunction secondary
  to obstruction caused by allergies, viral
  infections, decreased patency and/or other
  mechanical factors.

15
Acute Otitis Media

• Physiologic considerations
• Possible hereditary factors
• Common occurrence with/following upper
  respiratory infection
• Bottle feeding in supine position

• Craniofacial abnormality (cleft lip)
• Allergic rhinitis
• Tobacco smoke exposure
• Children in group day care centers at higher risk
  than those in home care

16
Acute Otitis Media

• S/S- fever (50) c/o ear fullness, pain (50 of
  the time), poor appetite and irritability,
  nausea/vomiting, runny nose, tugging on ears

17
External Otitis Media

• -acute ear infection and/or inflammation of
  external auditory canal swimmers ear
• S/S itching of ear canal (early symptom), acute
  and possibly severe ear pain upon manipulation of
  pinna or performance of otoscopic exam, fullness
  in ear
• Tx- irrigate debris in external canal, topical
  antibiotic drops, systemic analgesic, treat
  fungal infection

18
Acute Epiglottitis

• a severe, rapidly developing inflammation and
  swelling of the supraglottic structures leading
  to life threatening upper airway obstruction
• TRUE, MEDICAL EMERGENCY

19
Croup - Acute Laryngotracheobronchitis

• -an acute upper airway obstruction typically
  caused by a viral infection of the larynx
• S/S low grade fever, general malaise, rhinitis
  for 3 to 4 days, rapid onset of barky cough and
  inspiratory stridor, symptoms worse at night
• Prevention hand washing and avoid touching face

20
Bacterial Tracheitis

• - an infection of the mucosa of the upper trachea
• -history of previous URI with croupy cough,
  stridor unaffected by position, toxicity, and
  high fever
• -production of thick, purulent tracheal secretions

21
Bronchitis

• -transient inflammation of the larger lower
  airways
• -S/Sdry, brassy cough (may become productive as
  illness progresses)

22
RSV (bronchiolitis)

• -an acute viral infection of the smaller
  airways
• -S/S initial rhinorrhea, congestion, cough,
  low-grade fever progresses to tachypnea,
  decreased appetite or poor suck, change in
  activity level or level of consciousness may
  present as apnea in very young infants

23
Pneumonia

• Infectious pneumonia infection which usually
  involves small airways in children, but may also
  infect larger airways and/or the alveoli
• Aspiration pneumonia casued by the ingestion of
  food, saliva, gastric contents or other
  substances into air passages

24
Pneumonia

• S/S Cough (occasionally productive or associated
  with emesis), fever, chest or abdominal pain, may
  have tachypnea, retractions, expiratory grunting,
  nasal flaring, cyanosis

25
Pertussis-Whooping Cough

• - highly contagious bacterial infection involving
  the respiratory tract characterized by prolonged
  coughing episodes ending in an inspiratory whoop

26
Pertussis-Whooping Cough

• Catarrhal stage mild URI symptoms with cough
  for approximately two weeks low-grade fever
• Paroxysmal stage severe coughing episodes with
  inspiratory whoops that may persist for weeks
  vomiting, sucking or crying precipitates coughing
  episodes poor feeding

27
Tuberculosis (TB)

• - a chronic, granulomatous infection
• TB rates for all ages in US are highest in urban,
  low-income areas

• S/S usually asymptomatic may have cough,
  wheezing, dyspnea, abdominal pain, anorexia,
  fever, lethargy

28
Foreign Body Aspiration

• Inhalation of a foreign body that lodges in the
  upper trachea or lower airways, resulting in
  total or partial airway obstruction with local
  injury and inflammation

29
Foreign Body in Nose

• Common items include food, crayons, small toys,
  erasers, paper wads, beads, stones, alkaline
  button batteries

30
Allergic Rhinitis

• -IgE mediated response to inhaled allergens or
  irritants producing nasal mucosa inflammation
• Types
• Seasonal- inhaled pollens (trees, grasses, more
  common after age 6)
• Perennial house dust mites, mold spores, animal
  dander may occur in children

31
Asthma

• Chronic lung disease charcterized by
• -Airway inflammation
• -Airway hyper-responsiveness to a variety of
  stimuli
• -Variable airway obstruction that is reversible

32
Asthma S/S

• Recurrent episodes of cough, wheezing, chest
  tightness, breathlessness and decreased endurance
• Some do not wheeze
• Symptoms often worse at night, early morning or
  after exercise

• Some patients may have severe, life-threatening
  exacerbations separated by long periods of normal
  lung function and no symptoms
• Chronic cough

33
Asthma Management

• Accurate diagnosis
• Classify severity
• Medication
• Identify and reduce child-specific triggers
• Provide clear written instructions to family
• Review care every 6 months

• Educate child/family to monitor and treat
  symptoms early
• Provide smoking cessation counseling as needed
• High risk for asthma related deaths

34
Cystic Fibrosis (CF)

• Defective epithelial chloride transport results
  in dehydrated, viscous secretions which obstruct
  the exocrine ducts (with subsequent destruction
  and scarring) in the respiratory, hepatobiliary,
  gastrointestinal, and reproductive tracts

35
Cystic Fibrosis (CF) S/S

• Extremely viscid meconium (newborns)
• Weight loss despite voracious appetite
• Recurrent respiratory infections
• Liquid, large, bulky, foul-smelling, greasy stools

• Frequent flatulence or abdominal pain
• Recurrent or persistent wheezing
• Salty-tasting skin
• Heat prostration