Children

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Childrens Respiratory Disorders

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• Epiglottis - RSV/Bronchitis - Pneumonia - Asthma
  - Cystic Fibrosis

Marydelle Polk, Ph.D., ARNP-CS Florida Gulf Coast
University
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Objectives

• Describe factors that influence the etiology and
  course of respiratory infections in children.
• Differentiate among Epiglottis, RSV/Bronchitis,
  Pneumonia, Asthma, and Cystic Fibrosis in terms
  of etiology, defining characteristics, and
  nursing management.

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Respiratory System
The respiratory system permits ventilation
through the process of inspiration and expiration
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Respiratory Infections

• Influencing factors Age Anatomical Size
  Resistance Seasonal Variations
• Etiology H. influenza, Group A ?-Hemolytic
  Streptococcus, Staphylococci, Chlamydia
  trachomatis, Mycoplasma, pneumoccoci

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Epiglotitis

• Definition A severe bacterial infection which
  causes inflammation of the epiglottis and
  surrounding areas.
• Incidence Usually occurs between the ages of
  2 5 years of age, but can occur from 7 mos.
  11 years rarely to adulthood.

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Epiglottitis

• History Abrupt onset History of
  pharyngitis. Clinical Signs Symptoms Wakes
  up looking very ill, fever, sore throat,
  dysphagia, drooling, dyspnea, dog position.

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Epiglotitis

• Clinical Signs Symptoms Anxious/apprehensiv
  e Muffled, froglike croaking Quiet
  inspiratory stridor
• Always observe for the absence of cough, drooling
  and agitation hallmarks of epiglottis.

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REMEMBER !!!

1. Never examine the pharynx.
2. Leave the child in a sitting position
   preferably in parents lap.
3. Child is anxious Do not cause further distress
   and never leave the child alone.
4. Cyanosis is a late sign of hypoxia (PO2 lt 50).

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Nursing Diagnoses

• Ineffective breathing pattern r/t inflammatory
  process.
• Fear/anxiety r/t difficult breathing and
  unfamiliar place/procedures.

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Nursing Coventions

• Observe for progressive worsening ofrespiratory
  status.
• Prepare for tracheostomy.
• Be prepared for administration of O2,IV
  antibiotics, sedation.
• Monitor VS, LOC, O2 levels, fluid status.
• Provide calm reassuring support to child and
  parents.
• Prevention is via the H. influenza B vaccine.

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Nursing Coventions

• Administer antipyretic medication, tepid sponge
  baths, or cooling mattress if indicated.
• If needed, provide cool mist for humidifying air.
• Ensure adequate rest and provide a less stressful
  environment.
• Organize nursing care to give adequate rest
  periods.

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Early Epiglottitis
Note the tripod
(dog-like) position
and the leaning forward
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Progressive Epiglottitis
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Bronchiolitis

• Definition An acute viral infection primarily
  occurring at the level of the bronchioles.
• Etiology Respiratory Syncytial Virus (RSV).
  Subgroup A gt B in children developing
  bronchiolitis and pneumonia.

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Incidence and Transmission
URI of the infant 2-5 mos. Rare in
children over 2 years. Considered to be the
most important pathogen in the infant.
Usually preceded by a viral URII (RSV).
Increased incidence due to (1) direct contact
hands, eyes, nose, mucous membranes and
(2) the virus has a long life span.
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Clinical Manifestations

• Mild (Initial phase) Rhinorrhea
• Pharyngitis Coughing and sneezing
• May present with ear or eye
  infection History of intermittent fever

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Clinical Manifestations

• Moderate (Progressive) ? coughing and
  wheezing Air hunger and ? WOB Tachypnea and
  retraction Cyanosis

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Sternal Retractions
When an infant/child is retracting like
this what else would you observe?
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Clinical Manifestations

• Severe Tachypnea gt 70 breaths/minute
  Listlessness Apnea spells Poor air
  exchange ? breath sounds

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Nursing Diagnoses

• Ineffective breathing r/t poor gas exchange.
• Altered activity level r/t ?work of breathing.
• Potential of fluid volume deficit r/t poorfluid
  intake.

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Nursing Coventions

• Provide ? humidity cool, moist oxygen
• Adequate fluid intake
• Ongoing assessment and monitoring of O2 status,
  VS, activity level
• Possible administration of antiviral agents
  (RespiGam used more for prophylactic value)

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Nursing Coventions

• Conserve childs energy
• Observe for signs of dehydration Sunken
  fontanel Poor skin turgor Dry
  mucous membranes Decreased and
  concentrated urinary output

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Remember
As this infection is due to a virus standard Rx
may not prove to be effective in non-complicated
situations, including antibiotics
bronchodilators corticosteroids cough
suppressants
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Pneumonia
Inflammation of the alveoli caused by bacteria,
virus, Mycoplasma organisms, aspiration, or
inhalation.
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Types of Pneumonia

• Lobar Large areas (segments) of
  one or both lungs are
  involved.
• Broncho bronchioles become clogged
  with thick mucopurulent
  mucus ? consolidates into
  patches in nearby lobes.

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Types of Pneumonia cont.

• Interstitial Primarily occurs within the
  alveolar walls and interlobular tissues.

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Incidence and Etiology
Incidence10-20 of the cases of pneumonia are
bacterial10 are mixed both viral and
bacterial.70 80 are viral.EtiologyMycopla
sma pneumoniae most common inchildren 5 12
years-of-age.
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Chest x-rays - Pneumonia
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Clinical Manifestations

• ? fever
• Cough (productive or nonproductive)
• Tachypnea
• Fine crackles and rhonchi
• Chest pain
• Retractions and nasal flaring
• Pallor to cyanosis
• Irritability restless lethargic
• GI disturbances (nausea, diarrhea, pain,
  anorexia).

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Nursing Diagnoses

• Ineffective airway clearance r/t inflammation.
• Pain r/t inflammatory process pneumonia

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Nursing Coventions

• Administer and monitor antibiotic therapy
  (bacterial).
• Monitor fluid intake, VS (especially
  thetemperature give antipyretics in needed
  (fever/irritability), bed rest, cool mist
  humidifier.
• In-hospital monitor O2 if child develops
  respiratory distress.
• Avoid cough suppressants.
• Teach parents s/s of respiratory distress and
  dehydration.
• Conserve childs energy.

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Reactive Airway Disease - Asthma

• Definition inflammatory process of the large
  airways, which results in heightened airway
  reactivity.
• An obstructive disorder due to the inflammation
  and edema of the mucous membranes, ? in thick,
  tenacious secretions, spasms of the bronchial
  smooth muscle ? a ? diameter of bronchioles.

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Types of Asthma

• Mild Intermittent Asthma S/S ? 2 times per
  week Exacerbations are brief Nighttime s/s
  ? 2 times per month Asymptomatic between
  episodes Does not require chronic drug
  therapy Teach and encourage parents to ?
  exposure to allergens

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Types of Asthma

• Mild Persistent AsthmaS/S gt 2 times per week - lt
  1/dayExacerbations may/may not affect
  exerciseNighttime s/s gt 2 times per monthTx
  with a nonsteroidal Rx - Cromolyn Sodium, a low
  dose inhaled cortico- steroid or a leukotriene
  inhibitor.

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Types of Asthma

• Moderate Persistent Asthma
• Daily s/sDaily use of short-acting
  ?2-agonist or a low dose long-acting
  bronchodilator
• Exacerbations affect exerciseExacerbations
  ? 2 times per week and may last for
  daysNighttime s/s gt 1 time per weekMay see
  Nedocromil (Tilade) given in children 5 years
  or younger in place of long-acting
  bronchodilator

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Types of Asthma

• Severe Persistent Asthma Continual s/s
  Frequent exacerbations frequent nighttime s/s
  PEFR and/or FEV1 gt 1 second and ? 60 of
  predicted value Tx - high dose inhaled
  corticosteroids (Vanceril, Flovent) plus oral
  steroids as needed to control s/s

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Asthma

• Educate child and family about the disease -
  assist them to identify the triggers - help them
  in developing an asthma action plan AND teach
  and encourage child to use a peak flow meter
  regularly as part of his/her action plan to
  determine management of their s/s.

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Asthma

• Guidelines for child? 80 of childs baseline
  is acceptable.50 - 80 of childs baseline
  indicates obstruction.? 50 of childs baseline
  indicates an acute attack.

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Nursing Diagnoses

• Ineffective airway clearance r/t allergenic
  response and inflammatoryprocess in bronchial
  airways.
• Risk for suffocation r/t bronchospasm,edema and
  ?? tenacious mucus.

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Nursing Coventions

• Allergy control
• Drug therapy
• Chest PT
• Hydration
• Exercise
• Keeping up with immunizations/flu vaccine
• Desensitization therapy

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O2 Delivery Devices
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Metered Dose Inhaler-Spacer
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Remember

• Assessment - Teaching - Monitoring are hallmarks
  of effective care for the asthmatic child -
  whether in an acute care facility or community
  health center.

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Cystic Fibrosis

• DefinitionAn inherited, autosomal recessive
  disorder, which affects the exocrine glands and
  results in multisystem involvement.Most
  significant factor - The ? viscosity of mucus
  gland secretions obstruction

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Cystic Fibrosis

• Areas of involvement Respiratory system
  Integumentary system GI system Reproductive
  system

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Cystic Fibrosis

• Major signs and symptoms due to Lack of
  sufficient pancreatic enzymes. Gradual
  obstructive lung disease ? sweat gland
  function.

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Nursing Diagnoses

• Ineffective airway clearance r/t increased mucus
  production.
• Alteration in nutrition - ? body requirements r/t
  malabsorption.

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Nursing Coventions

• Administer and monitor effects of antibiotic,
  bronchodilator, and nutritional management.
• Teach chest PT - MAINSTAY of therapy!
• Teach proper postural drainage technique.
• Promote exercise, deep breathing and directed
  coughing.
• Teach parents/child s/s of infection and
  complications i.e. pneumothorax

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Nursing Coventions

• Administer and/or monitor pancreatic enzyme
  replacement therapy. Always administer with
  meals and snacks - amount given relates to degree
  of insufficiency and the childs response to the
  enzyme therapy. Goal is to prevent FTT and to ?
  number of stools.
• Teach parents/child about s/s of Na depletion
  and rectal prolapse

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The End...