Respiratory Tract Infection ( RI )

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Respiratory Tract Infection ( RI )

• Prepared by
• Dr. Hoda Abdel Azim

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Learning Objectives

• Identify the general aspect of respiratory
  infections.
• State the etiology and factors leading to RI in
  the infant or young child.
• Discus common condition of the upper respiratory
  infection.
• Contrast the effects of various respiratory
  infections observed in infants and children.
• Describe postoperative nursing care for the child
  with a tonsillectomy.
• Discus common condition of the lower respiratory
  infection.

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Respiratory Infection

• Infections of the respiratory tract are described
  according to anatomical area of involvement.
• The upper respiratory tract consist of
• Pharynx, larynx, and upper part of the trachea.
• The lower respiratory tract consist of
• Lower trachea, bronchi, bronchioles,
• and the alveoli.

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Respiratory System
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Etiology and factors leading to RI

• 1. Infectious Agents
• Virus
• Streptococci, Staphylococci, Haemophilus
  Influenza, Chlamydia Trachomatis, Pneumococci.

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• 2. Age
• Infant younger than age 3 months have lower
  infectious rate (protected from maternal
  antibodies).
• The infection rate increases from 3 to 6 months
  of age.
• The viral infection rate increase during
  (toddler, and preschool years).

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• 3. Size
• The diameter of the airway is smaller in young
  children, the organism may move rapidly.
• 4. Resistance
• The ability to resist depending on several
  factors
• Deficiency of immune system
• Malnutrition Anemia
• Fatigue Allergies
• Asthma Cardiac anomalies
• 5. Seasonal variations.

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Upper Respiratory Infections 1. Pharyngitis

• Hemolytic streptococci infection of the upper air
  way (throat).
• Clinical manifestations
• Headache Fever
• Abdominal pain Swallowing difficult
• Anorexia
• The tonsils and pharynx may be inflamed and
  covered with exudates.

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Pharyngitis
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• Therapeutic Management
• Antibiotics (penicillin, oral erythromycin .etc.
• Analgesic
• Nursing Considerations
• The nurse often obtains a throat swab for
  culture.
• Instruct the parents about administering
  penicillin and analgesic as prescribed.
• Cold or warm compresses to the neck may provide
  relief.
• Warm saline gargles offer relief of throat
  discomfort.

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• Pain may interfere with oral intake , and
  children should not be forced to eat.
• Cool liquids are usually accepted.
• Completing the course of antibiotic therapy.
• Children not return to school until they have
  been taking antibiotics for a full 24 hour
  period.

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2. Tonsillitis

• Tonsils are masses of lymphoid tissue located in
  the pharyngeal cavity.
• Etiology
• Tonsillitis often occurs
• with Pharyngitis.
• Viral or bacterial

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• Clinical manifestations
• Difficulty swallowing and breathing.
• The child breathes through the mouth.
• Therapeutic management
• Tonsillectomy
• Adenoidectomy

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Nursing considerations

• Provide comfort and minimizing activities that
  interventions that precipitate bleeding.
• A soft to liquid diet is preferred.
• Warm salt water gargles, analgesic and
  antipyretic drugs.
• Postoperative nursing care
• Abdomen or side lying position to facilitate
  drainage of secretions.

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• Discourage from coughing, clearing their throat,
  blowing their nose that may aggravate the
  operation site.
• All secretions and vomitus are inspected for
  evidence of fresh bleeding.
• Analgesics may be given rectally or intravenously
  to avoid the oral route.

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• Food and fluids are restricted until children are
  fully alert and there are no signs of bleeding.
• Cool water, crushed ice, diluted fruit juice is
  given.
• Soft foods, cooked fruits, mashed potatoes are
  started on the first or second postoperative day.
• The nurse observe the throat directly for
  evidence of bleeding.

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3. Otitis Media

• An inflammation of the middle ear without
  reference to etiology.
• Etiology
• Bacteria
• A relationship
• between the incidence of OM and infant feeding
  methods.

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Clinical manifestation

• Fever
• Acute ear pain
• Pulling or rubbing
• in the ear.
• Bulging yellow or red tympanic membrane.
• Rhinitis, cough , diarrhea.
• Purulent discharge

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Nursing considerations

• Nursing objectives
• Relieving pain
• Facilitating drainage.
• Preventing complications or recurrence.
• Educating the family in care of the child.
• Providing emotional support to the child.

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• Analgesic drugs (ibuprofen).
• An ice compress placed over the affected ear may
  also provide comfort and reduce edema.
• If the ear drainage , the external canal cleaned
  with sterile cotton swabs.
• Prevention of recurrence through
• Education regarding antibiotic therapy.
• Sitting or holding an infant upright during
  bottle feeding.
• Aware of potential complications as (loss of
  hearing).

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4. Croup(acute spasmodic laryngitis)

• Definition
• A severe inflammation and obstruction of the
  upper airway (larynx).
• Causes
• Viral (RSV, Influenza virus,
• Bacteria (pertussis, diphtheria, mycoplasma).
• Complications
• Respiratory insufficiency

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Signs and symptoms

• Barking cough or hoarseness.
• Worse at night and can last 5 to 6 days.
• Decrease breath sounds.
• Dyspnea
• Fever
• Diagnostic test
• Throat cultures
• Laryngoscopy
• Neck Xray

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Nursing interventions

• Exposure of child to cool water.
• Cool humidification during sleep with cool mist
  tent or room humidifier.
• Encourage clear liquid intake to keep mucus thin.
• Monitor vital signs and pulse oximetry.
• Administer medication (Antipyretic, antibiotics,
  corticosteroids.
• Oxygen administration if necessary.
• IV fluid to prevent dehydration.
• Care of tracheostomy if indicated.

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Lower respiratory infections 1. Bronchitis

• Is an inflammation of the large airways (trachea
  and bronchi) which is frequently associated with
  a URI.
• Common in children under the age of 2 3 years.
• Mycplasma pneumoniae is a common cause in
  children older than 6 years f age.

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Sign Symptoms

• Fever
• Dyspnea
• Nonproductive cough
• that worsens at night
• and become productive
• in 2 to 3 days .

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• Bronchitis is a mild self limited disease that
  required only symptomatic treatment including
• Analgesics
• Antipyretics
• Humidity
• Cough suppressants to allow rest
• Temperature of the home must be moderate (inhale
  steam).
• Recover 5 to 10 days

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Respiratory Syncytial Virus
(RSV)and 2.Bronchiolitis

• Is an acute viral infection with maximum effect
  at the bronchiolar level.
• Occur in infancy and early childhood (first 2
  years).
• Clinical manifestations
• Rhino rhea (nasal discharge)
• Fever
• Dyspnea
• Otitis media and conjunctivitis may also be
  present.
• Cough and convert to productive cough .
• Apnea in very young infants

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• Therapeutic Management
• Bronchiolitis is treated symptomatically
• A adequate fluid intake and rest.
• IV fluids are preferred if the child cannot take
  enough by mouth.
• Bronchodilators, corticosteroids, cough
  suppressants and antibiotics are not effective
  alone.
• Ribavirin antiviral activity.
• Hospitalization is recommended for children with
  underlying lung or heart disease.

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Bronchiolitis
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Nursing Considerations

• Separate room or grouped with other infected
  children.
• Place the child in o2 tent to provide him with
  oxygen high humidity.
• Consistent hand washing and use of contact
  precautions (gloves, gowns, masks ).
• Nurses who assigned to infected children do not
  take care of other patients who are considered
  high risk.

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3.Pneumonias

• Inflammation of the pulmonary parenchyma, is
  common in childhood but occurs more frequently in
  infancy and early childhood.
• Pneumonia may occur either as a primary disease
  or as a complication of another illness.

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Types of Pneumonia

• Lobar pneumonia all or a large segment of one or
  more pulmonary lobes is involved.
• Bronchopneumonia begins in the terminal
  bronchioles which become clogged with
  mucopurulent exudates to form consolidated
  patches in nearby lobules.
• Interstitial pneumonia the inflammatory process
  in the alveolar walls and per bronchial

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Bacterial Pneumonia

• Causative organism
• Streptococcus pneumoniae
• Other bacteria that cause pneumonia in children (
  a staphylococcus,
• aureus, and Haemophilus influenza).

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Streptococcus pneumoniae
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General Signs of Pneumonia

• Fever
• Malaise
• Rapid and shallow
• respirations
• Cough
• Chest pain
• Anorexia , vomiting, diarrhea and abdominal pain

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• Therapeutic Measures
• Antibiotics therapy
• Bed rest
• Oral intake of fluid
• Antipyretic
• IV fluid and oxygen is required if the child is
  in respiratory distress.

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• Complications
• Necrosis
• Empyema
• Neumothorax
• Pneumonic (pleural ) effusion
• Lung abcess

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Chest X-ray of Pneumococcal Pneumonia
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Nursing Considerations

• Isolation
• Encourage rest and conservation of energy.
• Encourage the child to regular sleep.
• To prevent dehydration fluid are frequently
  administered intravenous.
• Oral fluids if allowed to decrease cough.
• Children may be placed in a mist tent.

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• Fever controlled by administration of antipyretic
  drugs as prescribed.
• Vital signs and breath sounds are monitored to
  assess the progress of disease.
• Children with ineffective cough require
  suctioning to maintain patent airway.

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Thank You