Respiratory DisordersNursing IIILinda Speranza PhD, ARNP-C
Respiratory Assessment Count  respiration for 1 full minute  Infants– obligatory   nose breathers Identify signs of  re...
Respiratory Assessment Quality of respirations Quality of pulse Color- pale, cyanotic, mottling Cough- croupy- loose, ...
Respiratory AssessmentNasal Flaring Widening of the nares during inspiration Represents an increased effort by the infan...
Retractions Depth and location of retractions indicate the severity of distress    Intercostal retractions- mild    Sub...
Anatomy is Different!•   Development•   Airways – shorter and more narrower•   Increase in airway resistance in children• ...
A Child’s Respiratory Anatomy
Respiratory Distress Syndrome Resultof a primary absence, deficiency, or alteration in the production of pulmonary surfac...
Signs & Symptoms of RDS   Shortness of breath   Grunting   Nasal flaring   Cyanosis   Apneic spells   Increased work...
Management/Treatment of RDS Support adequate ventilation Surfactant replacement therapy Monitor        for Complications
Nursing Interventions Risk   for ineffective breathing pattern     Check prenatal meds     Monitor vitals and skin    ...
 Altered    nutrition: less     If there is respiratory distress do not give oral      fluids. Start parenteral nutritio...
Croup Syndrome Broad   classification of upper airway illnesses that  result from swelling of the epiglottis and larynx ...
Laryngotracheobronchitis (LTB) LTB,most common form of croup Usually caused by virus;     Adenovirus,     Respiratory ...
Clinical Manifestations of LTB Upper   respiratory infection (URI) symptoms  that gradually progress to signs of distress...
Treatment/Management ofLTB   Lateral neck x-ray    confirms diagnosis   Maintain Airway    Patency       Supplemental  ...
Treatment/Management ofLTB Medication  Racemic epinephrine  Bronchodilators – Albuterol    Side   tachycardia  Steroi...
Epiglottitis•   An inflammation of the epiglottis, the long    narrow structure that closes off the glottis    during swal...
Clinical Manifestation ofEpiglottitis Sudden onset CARDINAL SIGNS-     intense sore  throat/difficulty swallowing/ drool...
Diagnosis of Epiglottitis Diagnosis confirmed by lateral neck films High Oxygenation to reverse hypoxemia Cool mist oxy...
Treatment/ ManagementEpiglottitis Closely       Monitor Respiratory status. Do not attempt to examine the throat. Axillar...
Bronchitis                Lower airway disorder                    Inflammation of the                     trachea and b...
Bronchiolitis   Caused when a virus    or bacterium causes    inflammation and    obstruction (mucus)    of the small air...
Bronchiolitis Pathophysiology    Cell debris- death virus after bursting to     invade    Irritation= Swelling/mucus  ...
Clinical Manifestation ofBronchiolitis Illness        may have been occurring for a few  days- upper respiratory Lower  ...
Clinical Therapy ForBronchiolitis   History and Physical   Chest x-ray       Hyperinflation, atelectasis and inflammati...
Treatment/ManagementBronchiolitis Rest& elevate HOB to 30 Clear fluids (NPO if resp rate >60)     I& O x 8 h & daily we...
Bronchopulmonary Dysplasia(BPD) Chronic    Lung Disease     Results from an acute respiratory disorder that begins      ...
Clinical Manifestation of BPD Persistent   signs of respiratory distress     Tachypnea     Wheezing     Crackles     ...
Tracheostomy Keep  small toys, dust away from child Careful when bathing! No showers Observe and clean skin daily Suct...
BPD Diagnoses    Chest x-ray shows hyperexpansion,     atelectasis, and interstitial thickening    Air trapping can cau...
Otitis Media Inflammation   of the  middle ear Occurrence- 6-36 m  (winter) Risk Factors Causative  organisms  Strept...
Otitis Media Etiology         – Eustachian tube dysfunction Pathophysiology     Preceding upper respiratory infection  ...
Otitis Media S   & Sx   Pulling   at the ear   Diarrhea, vomiting, & fever   Irritability, awakens at night crying  D...
Tonsillitis   Infection or    inflammation of the    palatine tonsils   Clinical Manifestations       Frequent throat  ...
Tonsillectomy Before     surgery    H&P      Are tonsils simply large or inflamed w       exudate?      Past tonsillar...
Tonsillectomy
Tonsillectomy After   Surgery     May have sore throat for 7-10 days     Drink cool fluid and chew gum     Give Acetam...
 Sore throat: cool fluids, chew gum, ice  collar, gargle ½ tsp. of each baking soda  and salt in water, rinse w viscous l...
Asthma Chronicinflammatory disorder of the airway  Airway obstruction  Increased airway responsiveness  Acute exacerba...
Pathophysiology of Asthma After   exposure to various “triggers”     Bronchospasm     Inflammation and edema of the bro...
Pathophysiology of Asthma Reactive   airway responses Antigen binds to the specific  immunoglobulin E surface on the muc...
Clinical Manifestations of Asthma   Airway       Inflammation       Obstruction (narrowing)       Hyperreactivity   “...
Clinical Manifestations of Asthma     Respirations     Appears tired     Nasal flaring- 4 wks     Intercostal retracti...
Diagnosis of Asthma   4   key elements       Symptoms of episodic airflow obstruction       Partial reversal of broncho...
Evaluation of Asthma Spirometry    Shows how much a person can exhale-     evidence of episodic airflow obstruction     ...
Evaluation of Asthma Peak   flow meter (expiratory flow meter)     Blow into it every morning to see if you need      tr...
Medications Used for Asthma Short-acting   bronchodilators  Albuterol/ventolin/proventil-                              d...
Status Asthmaticus Severe respiratory distress & bronchospasm in  an asthmatic Itpersists in spite of pharmacologic and ...
 Meds     Continuous nebulized albuterol     Inhaled inpratropium, iv corticosteroids,      magnesium, aminophylline C...
Cystic Fibrosis  CysticFibrosis is an autosomal recessive  multisystem disorder with dysfunction of  the exocrine glands ...
Cystic Fibrosis  Abnormal  secretion of thick, tenacious mucus   causes obstruction and dysfunction of all body   organs ...
Clinical Manifestations    Production   of thick sticky mucus    Meconium ileus    Constipation    Chronic moist produ...
Clubbing of Fingers
Diagnostic & Evaluation of CF3    presentations     Meconium ileus     Malabsorption- steatorrhea     Chronic recurren...
Treatment & Management Chest  physiotherapy (CPT): Can use  percussion to help move secretions  downward so they can coug...
Treatment & Management of CF   Antibiotics (oral, IV, & inhalation)   Pancreatic enzymes with meals,    Pancrease or Cre...
Allergic Reactions Allergy-   abnormal or altered reaction to an  antigen Allergens – antigens that cause allergy
 Allergic         reaction - antigen-antibody reaction that can manifest as anaphylaxis, atopic dermatitis, serum sicknes...
Allergy Assessment   Physical  exam- history of exposure to    allergens, itching, tearing, burning of eyes    and skin, ...
Treatment of Allergies Avoidance Desensitization For   skin allergies Allergy   alert bracelet Teaching     about all...
Skin Allergy Testing
Question One: Which of the following respiratory conditions is always considered a medical emergency?    A. Asthma    B...
Question Two: In a child with asthma, albuterol is  administered primarily to do which of the  following?      A. Dilate...
Question Three: When  developing a care plan for a child diagnosed with cystic fibrosis, which of the following must the ...
Respiratory disorders peds
Respiratory disorders peds
Respiratory disorders peds
Respiratory disorders peds
Respiratory disorders peds
Respiratory disorders peds
Respiratory disorders peds
Respiratory disorders peds
Respiratory disorders peds
Respiratory disorders peds
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  • Naris expand Retractions Stridor: Thrill harsh sound Ronchi: Once you cough, rhonchi goes away. It’s the only one that goes away after coughing Rales- fine crackling sound. Associated with pneumonia- ab will help it go away; and CHF- Lasix will help it go away Make sure to listen to the lung bases
  • Check for this findings: Look for dyspnea, tachypnea, nasal flaring, retractions, child can’t pronounce P because of diminished expiratory effort, focus on breathing, anxious expression, upright position w neck extended, crying improves or worsens the color, low cap refill Quality of Respirations: 1. Depth 2. Clarity of breath sounds 3. Pain with breathing- dyspnea 4. Difficulty breathing – use of accessory muscles – sternocleidomastoid and intercostal muscles Quality of pulse: 0- absent pulse, -4-bounding Normal RR Newborn 30-35 1- 25-40 3- 20-30 6- 16-22 10- 16-20 17- 12-20 Cyanosis: check mucous membranes and tongue Valsalva maneuver or expiratory grunt: is a preventive mechanism to prevent atelectasis. Do not intubate Fixed heart rate indicates a decrease in vagal stimulation Displacement of point of maximal impulse could be due to hernia in diaphragm or pneumothorax Decreased muscle tone of unresponsiveness= deteriorating CNS
  • Tachycardia and tachypnea go together
  • Retractions- due to moving muscles to get more air in Intercostal- under the ribs. Seen in mild distress Substernal, and subcostal- severity increases Supraclavicular, and suprasternal- due to use of accessory muscles
  • Airway resistance: effort needed to move oxygen through the trachea to the lungs. Can intubate to help child
  • Atelectasis- bronchioles filled with fluid
  • Surfactant: reduces surface tension throughout the lung, thereby contributing to its general compliance. It gives alveolar stability by decreasing the alveoli’s surface tension and tendency to collapse. It gives better lung compliance and permits breathing w less work Leads to: atelectasis, hypoxia, acidosis (lack of gas exchange), and respiratory failure Collapsed alveoli= harder & harder to breath Hypoxia leads to Low pulmonary blood flow= fetal circulation= blood flow is moved around lungs Impaired response to cold Anaerobic metabolism Low perfusion to other organs Respiratory acidosis: Alveolar hypoventilation Metabolic acidosis Due to the anaerobic metabolism Atelectasis is the collapse of part or (much less commonly) all of a lung. Endotracheal tube pic RDS is only found in preterm babies
  • Grunting: abnormal, short, deep, hoarse sounds in exhalation that often accompany severe chest pain. Slow expiratory flow that prevents alveolar collapse during expiration Apneic- respirations lasting longer than 20 sec Respiratory failure: Early signs- restlessness, tachypnea, tachycardia Imminent RF: dyspnea, bradycardia, cyanosis Tachypnea: more than 60 respirations See-saw respirations: flat chest during inspiration and abd bulging out. Use ventilation bc there is more O2 need and more workload
  • Treat RDS Surfactant replacement with endotracheal tube + gas checkups + fix acid-base imbalance + regulate temperature + good nutrition + protection from infection. Treatment modalities: Increased humidified oxygen Continuous positive airway pressure (CPAP) Ventilation from a respirator High frequency ventilation (HFV) Treat cause of Resp failure Reverse hypoxemia w O2 Mechanical ventilation & Positive end expiratory pressure If decreased LOC: Endotracheal tube (ET) intubation Monitor vitals, respiratory status, O2 sat, LOC & changes in behavior Keep in upright position- elevate HOB Give O2 and keep emergency equipment at hand Pneumothorax- collapsed lung Intraventicular hemorrhage- bleeding in the brain?
  • Croup= barking of a seal
  • Symptoms worse at night. Progresses to retractions, increasing stridor and cyanosis Airway obstruction= intubation and ICU
  • Throat cultures and visual inspection of the inner mouth and throat= laryngospasm= complete airway obstruction. My note: Use XR instead! Cool, noncarbonated nonacidic drinks: rehydration fluids or fruit flavored drinks, gelatin, and popsicles
  • Beta agonist and betaadrenergics: albuterol, racemic w face mask? Temp relief in half an hour, side: tachycardia, HTN Corticosteroids: dexamethasone: decrease edema & stridor resolves faster, side: HTN Bronchodialator- xanapex? Quiet parent= quiet kid Once on steroids, wheezing should minimize O2 Sats should be above 92% Start with a quarter of a liter when giving O2 to a baby
  • Sudden illness that starts with sore throat and can’t swallow own spit Keep airway open + ab.
  • Epiglottis becomes cherry red, swollen and extremely edematous Use tripod position to breath in- also used with COPD Can’t swallow, no voice sounds (before intubation), acute onset of drooling, quiet child= CONCERN!
  • Remind parents that ET tube can be removed in 1- 2 days, and that child may be unable to make sounds temporarily
  • Assess breath sounds, nasal flaring, accessory muscle use, retractions, stridor, Axillary temp (Not the oral route!), pulse ox Keep NPO IV ab and antipyretics, corticosteroids, nebulized epinephrine (racemic epi)- vasoconstriction =lowers edema, Hib vaccine Do not leave child unattended until he is intubated, keep NPO, never supine, have resuscitation equipment av, prepare for endotracheal intubation, or tracheostomy, keep a relaxed athmosphere (crying= laryngospasm) Can insert ET tube to maintain the airway. Then take a culture of the epiglottis
  • Cough is worse at night. Some cracking & wheezing, sore chest & ribs
  • Greater incidence in Winter & Spring- keep supplies to treat condition at hand Bronchitis- large airways involved, bronchiolitis- small airways involved
  • Initial: rhinorrhea, ear drainage, coughing, sneezing, wheezing Progresses: More coughing and wheezing, air hunger, tachypnea, retractions, cyanosis Severe: tachypnea (more than 70), increased adventitious sounds, listlessness, apneic episodes
  • Viral- resolves by itself
  • Use cardiorespiratory monitor and place a pulse ox w alarm Small freq feedings. IV if risk of aspiration Encourage parents to hold child to reduce anx
  • Barrel chest
  • Wean off assisted ventilation
  • Bad nutrition bc of high metabolic needs and fatigue when feeding Meds: diuretics, bronchodilators, antiinflammatory, mehylxantines, Palivizumab to prevent RSV
  • Most common childhood disease RF: enlarged adenoids, allergic rhinitis, pacifiers alters function of eustachian tube, parents that smoke, day care centers
  • Tube becomes blocked due to edema from upper resp. inf.
  • Why is ab treatment delayed for 2-3 days in children of 6 m to 2 years? Pg 1291 Myringotomy- allow draninage, equalize pressure & allow ventillation Ab- amoxicillin, keflex, tetracycline, etc PE- pressure equalizing tube. Cover ear if going into water, careful if swimming. Drops for pain relief.
  • Drug of choice- penicillin Strep- sand paper rash, fever. Use saline gargles, ibuprofen x 8 h and tylenol x 6h alternating for inflammation, popsicles. Prevention, change tooth brush frequently
  • Mast cell releases histamine= pouring out of fluid
  • Smaller airway for gas exchange= wheezing
  • Tripod position used for breathing better Nasal flaring, H RR, intercostal retractions, productive cough, expiratory wheezing, respiratory fatigue, chest tightness. Wheezing might not be heard if lack of airflow! 
  • Use bronchodilator before exercising Cta- abbreviation used for “clear to auscultation” Ronchi- clears with coughing, wheezes and rales don’t
  • Peak flow meter- the one I have
  • Short acting: Use bf inhaled steroid and wait 15 min. Hold breath 10 sec after inspiring. Rinse mouth. Side- tachycardia, headache, nervousness, n&v Long acting: not for acute asthma attack!. Pre exercise 30-60 min bf Mast cell inh- Up to 4 x d. Therapeutic in 2 wks. Careful w anaphylaxis, bronchospasm…  Corticosteroids- decreases inflammation and obstruction, enhances effect of bronchodialators. Used for short courses until 80% of peak expiratory flow is achieved or no sx. Give w food in the AM. Side- decreased growth, unstable blood sugar, immunosuppresion Methylxantines: theophylline relaxes muscle bundles that constrict airway Pediapred- PO steroid, liquid? Use albuterol first and then steroid- Dilate vessels so that med can go into body Rinse mouth after using steroids
  • Sx: Accessory muscles, restlessness, anxiety, altered loc, diaphoresis, cyanosis, can’t talk too much, hypercarbia, hypoxemia
  • Exocrine- glands that excrete mucus
  • Tenacious- thick secretions. May need tracheostomy because of the secretions
  • Males are usually sterile & women may not be able to carry out pregnancy Meconium ileus- Unable to pass first meconium stool Sweat test-salty skin (Na in sweat) Steatorrhea- malabsorption due to cloggled pancreatic ducts + small intestine can’t absorb properly fats and proteins (short stature)
  • CPT- abbreviation means “child protection team” or “chest physiotherapy”
  • Vitamins A, D, E, K Don’t sprinkle enzymes on warm meals because heat will destroy the enzyme. Don’t put it in the baby‘s bottle either, can put a little amount of milk separate w the med and make sure the baby takes all of the milk.
  • Mold, pollen, house dust, pet dander Cow’s milk, eggs, wheat, chocolate, citrus fruits, peanuts, pepper, etc- document on chart Oral and injectables, animal serum/venom and insect stings Plants, dyes, chemicals
  • Allergic rhinitis, asthma, serous otitis media, allergic croup, eczema, urticaria, diarrhea, constipation, colic, headache, fatigue, dysuria, enuresis, anaphylaxis
  • Answer: B
  • Answer: A
  • Answer: B Autosomal recessive Exocrine glands
  • Respiratory disorders peds

    1. 1. Respiratory DisordersNursing IIILinda Speranza PhD, ARNP-C
    2. 2. Respiratory Assessment Count respiration for 1 full minute  Infants– obligatory nose breathers Identify signs of respiratory distress Listen to breath sounds 1st!  Stridor- thrill harsh sound  Rhonchi  Wheezing
    3. 3. Respiratory Assessment Quality of respirations Quality of pulse Color- pale, cyanotic, mottling Cough- croupy- loose, wet, dry Behavior change- tired of breathing fast?, restless?, lethargic?, change in LOC Signs of dehydration- low I&O, L skin turgor- check in abd or sternum, lack of tears in older children,
    4. 4. Respiratory AssessmentNasal Flaring Widening of the nares during inspiration Represents an increased effort by the infant to breathe
    5. 5. Retractions Depth and location of retractions indicate the severity of distress  Intercostal retractions- mild  Subcostal - moderate  Suprasternal – moderate  Supraclavicular- severe  Use of accessory muscles- severe
    6. 6. Anatomy is Different!• Development• Airways – shorter and more narrower• Increase in airway resistance in children• Flexible larynx• Tongue is proportionally larger – can cause obstruction• Obligate nose breathers – plugging can cause respiratory distress
    7. 7. A Child’s Respiratory Anatomy
    8. 8. Respiratory Distress Syndrome Resultof a primary absence, deficiency, or alteration in the production of pulmonary surfactant Prematurity Surfactant deficiency disease
    9. 9. Signs & Symptoms of RDS Shortness of breath Grunting Nasal flaring Cyanosis Apneic spells Increased work of breathing – tachypnea  1st sign of respiratory distress Retractions
    10. 10. Management/Treatment of RDS Support adequate ventilation Surfactant replacement therapy Monitor for Complications
    11. 11. Nursing Interventions Risk for ineffective breathing pattern  Check prenatal meds  Monitor vitals and skin  Clear airway prn with bulb syringe  Give warm humidified O2 Ineffective thermoregulation  Warm all inspired gases. Cold air= more need of O2 and high metabolic rate  Respiratory distress can lead to metabolic acidosis. Check for acrocyanosis, bradycardia, apnea, etc
    12. 12.  Altered nutrition: less  If there is respiratory distress do not give oral fluids. Start parenteral nutrition per MD  Give calories to prevent metabolic acidosis due to starvation. TPN is an alternative Risk for fluid vol deficit  Record I& O hourly and daily weights. Circulatory overload= pulmonary edema  Check signs of dehydration: poor skin turgor, pale mucous memb, sunken anterior fontanelle. Specific gravity, etc  Check IV sites for infiltration, infection (edema, and erythema)
    13. 13. Croup Syndrome Broad classification of upper airway illnesses that result from swelling of the epiglottis and larynx Viral  Spasmodic laryngitis  Laryngotracheitis  Laryngotracheobronchitis (LTB) Bacterial  Bacterial trachitis  Epiglottitis
    14. 14. Laryngotracheobronchitis (LTB) LTB,most common form of croup Usually caused by virus;  Adenovirus,  Respiratory Syncytial Virus (RSV)  Influenza Virus Inflammation and narrowing of the laryngeal and tracheal areas.
    15. 15. Clinical Manifestations of LTB Upper respiratory infection (URI) symptoms that gradually progress to signs of distress. Hoarseness, barky cough Inspiratory stridor Retractions Restlessness and irritability Pallor and cyanosis Sometimes a low grade fever Potential complication: airway obstruction  Difficulty swallowing or drooling= epiglotitis
    16. 16. Treatment/Management ofLTB Lateral neck x-ray confirms diagnosis Maintain Airway Patency  Supplemental oxygen with humidity  Cool mist tent Meet fluid and nutritional needs
    17. 17. Treatment/Management ofLTB Medication  Racemic epinephrine  Bronchodilators – Albuterol  Side tachycardia  Steroid therapy- IV or inhaled Keep calm and comfortable NO Throat cultures or visual inspections of the mouth Continue to monitor- Respiratory effort, responsiveness, signs of respiratory distress Constant attendance
    18. 18. Epiglottitis• An inflammation of the epiglottis, the long narrow structure that closes off the glottis during swallowing• A life-threatening condition!!! This is a Medical Emergency• Bacterial- Caused by strep, staph, and haemophilus influenzae type B • Hib vaccine reduces risk for epiglottitis
    19. 19. Clinical Manifestation ofEpiglottitis Sudden onset CARDINAL SIGNS- intense sore throat/difficulty swallowing/ drooling Cherry red, edematous epiglottis High fever- 102 Dysphonia Dysphagia Inspiratory stridor Respiratory distress Tripod position
    20. 20. Diagnosis of Epiglottitis Diagnosis confirmed by lateral neck films High Oxygenation to reverse hypoxemia Cool mist oxygen  Cools airway and lowers swelling! Antipyretics, ab, & steroids to decrease inflammation May use a tracheostomy to bypass the problem
    21. 21. Treatment/ ManagementEpiglottitis Closely Monitor Respiratory status. Do not attempt to examine the throat. Axillary temp only! Medications include antibiotics and steroids to decrease inflammation Minimize fear and anxiety to decrease oxygen consumption
    22. 22. Bronchitis  Lower airway disorder  Inflammation of the trachea and bronchi  Cause- mainly viral  Symptoms  Fever, dry hacking cough non productive. Productive in a couple of days  Management  Cool, humid air, increase fluids, antipyretics, cough suppressants
    23. 23. Bronchiolitis Caused when a virus or bacterium causes inflammation and obstruction (mucus) of the small airways Occurrence- First 2 years  Peak: 6 months Cause – Respiratory Syncytial Virus (RSV)
    24. 24. Bronchiolitis Pathophysiology  Cell debris- death virus after bursting to invade  Irritation= Swelling/mucus  Bronchospasm  Inhalation, poor exhalation  Wheezing, hypoxemia, respiratory failure
    25. 25. Clinical Manifestation ofBronchiolitis Illness may have been occurring for a few days- upper respiratory Lower respiratory Severerespiratory distress. Thick mucus occludes bronchioles  Initial: Rhinitis, cough, low fever, tachypnea, poor feeding, v & d, dehydration, less playful
    26. 26. Clinical Therapy ForBronchiolitis History and Physical Chest x-ray  Hyperinflation, atelectasis and inflammation Nasal swab- to find bacteria Ribavirin – antiviral for RSV. Used for immunocompromised Bulb syringe & Saline Isolation Risk Factors – lung disease, low weight, siblings that go to school, passive smoke, premmie
    27. 27. Treatment/ManagementBronchiolitis Rest& elevate HOB to 30 Clear fluids (NPO if resp rate >60)  I& O x 8 h & daily weights, mucous memb Maintain respiratory functions. Use suctioning- Also before feeding Cool, humidified oxygen Albuterol updrafts Steroids Infants often hospitalized due to feeding difficulties, increased respirations Hand washing!- RSV is recurrent
    28. 28. Bronchopulmonary Dysplasia(BPD) Chronic Lung Disease  Results from an acute respiratory disorder that begins during infancy Risk Factors  Prematurity  Lung immaturity  High inspired oxygenation concentrations,  Positive pressure ventilation  Patent ductus arteriosus  Vitamin A deficiency
    29. 29. Clinical Manifestation of BPD Persistent signs of respiratory distress  Tachypnea  Wheezing  Crackles  Irritability  Nasal flaring  Grunting  Retractions  Pulmonary edema  FTT- Failure to Thrive- O2 demands ↑ + fatigue  Intermittent bronchospasm & mucous plugs
    30. 30. Tracheostomy Keep small toys, dust away from child Careful when bathing! No showers Observe and clean skin daily Suction prn  Only 5 sec, sterile gloves, intermittent suction when withdrawing cath Notifyif secretions increase or turn purulent, or fever Have an emergency bag w extra cath and tubes No smoking O2 away from heat
    31. 31. BPD Diagnoses  Chest x-ray shows hyperexpansion, atelectasis, and interstitial thickening  Air trapping can cause “Barrel Shape” Chest Treatment  Support respiratory function- supplemental O2 w humidity. Chest physiotherapy + meds  Medications  Nutrition Prognosis
    32. 32. Otitis Media Inflammation of the middle ear Occurrence- 6-36 m (winter) Risk Factors Causative organisms  Streptococcus pneumoniae  H. flu.  Moraxella catarrhalis
    33. 33. Otitis Media Etiology – Eustachian tube dysfunction Pathophysiology  Preceding upper respiratory infection  Edema  Blocked air  Air reabsorbed to bloodstream  Fluid is pulled from mucosal lining  Tympanic membrane becomes infected
    34. 34. Otitis Media S & Sx  Pulling at the ear  Diarrhea, vomiting, & fever  Irritability, awakens at night crying  Diagnosis  Otoscopic examination- Shows a red, bulging, non-mobile tympanic membrane  Treatment  Antibiotics  Myringotomy/Tympanostomy (PE tubes)  Pain relief – Tylenol/Ibuprofen, anesthetic ear drops- verify integrity of tympanic membrane
    35. 35. Tonsillitis Infection or inflammation of the palatine tonsils Clinical Manifestations  Frequent throat infection  Breathing and swallowing difficulties  Persistent redness  Enlargement of cervical lymph nodes
    36. 36. Tonsillectomy Before surgery  H&P  Are tonsils simply large or inflamed w exudate?  Past tonsillar infections and lengh of present discomfort  Free from sore throat, fever, respiratory infection for week before surgery  No aspirin or ibuprofen for 2 weeks  Check other home medication
    37. 37. Tonsillectomy
    38. 38. Tonsillectomy After Surgery  May have sore throat for 7-10 days  Drink cool fluid and chew gum  Give Acetaminophen elixir  Apply ice collar around child’s neck  Side-lying position- difficult to swallow
    39. 39.  Sore throat: cool fluids, chew gum, ice collar, gargle ½ tsp. of each baking soda and salt in water, rinse w viscous lidocaine and swallow. No citrus liquids Report bright red blood or increased swallowing immediately  Avoid red, purple or brown liquids= difficult to assess for bleeding Normal: white, and odor on back of throat in the first wk. Report fever 102 F
    40. 40. Asthma Chronicinflammatory disorder of the airway  Airway obstruction  Increased airway responsiveness  Acute exacerbations or persistent symptoms Onset-before age 5 Causes of asthma & respiratory problems in children  Smoking, pet dander
    41. 41. Pathophysiology of Asthma After exposure to various “triggers”  Bronchospasm  Inflammation and edema of the bronchial mucosa  Production of thick mucus Asthma triggers- perfume
    42. 42. Pathophysiology of Asthma Reactive airway responses Antigen binds to the specific immunoglobulin E surface on the mucosal mast cell Histamine is released Intercellular chemical mediators are released- histamines, prostaglandins, leukotrienes  Release cytokines that make permanent airway remodeling- thickening Result: bronchospasm, mucosal edema, & mucus secretion
    43. 43. Clinical Manifestations of Asthma  Airway  Inflammation  Obstruction (narrowing)  Hyperreactivity  “Asthma Attack”- sudden cough, wheeze, or SOB  “Silent” asthma- frequent coughing, especially at night (airway is very sensitive)
    44. 44. Clinical Manifestations of Asthma  Respirations  Appears tired  Nasal flaring- 4 wks  Intercostal retractions  Productive cough  Expiratory wheezing  Decreased air movement  Respiratory fatigue  In severe obstruction
    45. 45. Diagnosis of Asthma 4 key elements  Symptoms of episodic airflow obstruction  Partial reversal of bronchospasm with bronchodilator treatment  Exclusion of alternative  Diagnosis confirmation by spirometry
    46. 46. Evaluation of Asthma Spirometry  Shows how much a person can exhale- evidence of episodic airflow obstruction and airway hyper-responsiveness. Place mouth covering entire mouth piece… Breathe out as hard as possible and then breathe in deeply
    47. 47. Evaluation of Asthma Peak flow meter (expiratory flow meter)  Blow into it every morning to see if you need treatment like a nebulizer to open up the airway.  Warns of impending attack  Green- ok  Yellow  Red- less than 50%= Warning! Skin testing- to id triggers Medications
    48. 48. Medications Used for Asthma Short-acting bronchodilators  Albuterol/ventolin/proventil- drug of choice  Terbutaline- not very common Long & short acting beta agonists  Salmeterol- can use for exercise and night sx Mast cell inhibitor  Intal/cromolyn- Can be used in nebulizer  Ex Singulair- Minimizes allergies Corticosteroids  Prednisone or solumedrol
    49. 49. Status Asthmaticus Severe respiratory distress & bronchospasm in an asthmatic Itpersists in spite of pharmacologic and supportive interventions Considered a medical emergency Without immediate intervention, it will progress to respiratory failure & death
    50. 50.  Meds  Continuous nebulized albuterol  Inhaled inpratropium, iv corticosteroids, magnesium, aminophylline Check electrolytes Nonivasive positive pressure ventilation intubation
    51. 51. Cystic Fibrosis  CysticFibrosis is an autosomal recessive multisystem disorder with dysfunction of the exocrine glands  Genetic testing  Expected lifespan- 30 years (terminal disease)  Results in physiologic alterations in several systems
    52. 52. Cystic Fibrosis  Abnormal secretion of thick, tenacious mucus causes obstruction and dysfunction of all body organs with mucous ducts.  This includes the pancreas, lungs, salivary glands, sweat glands, and reproductive organs.
    53. 53. Clinical Manifestations  Production of thick sticky mucus  Meconium ileus  Constipation  Chronic moist productive cough  Frequent respiratory infections  Chronic sinus infections  Difficulty gaining & maintaining weight  Short stature  Clubbing of finger tips & toes
    54. 54. Clubbing of Fingers
    55. 55. Diagnostic & Evaluation of CF3 presentations  Meconium ileus  Malabsorption- steatorrhea  Chronic recurrent respiratory infections The Sweat test is the standard diagnostic test for CF Spirometer Sputum cultures
    56. 56. Treatment & Management Chest physiotherapy (CPT): Can use percussion to help move secretions downward so they can cough it up. Position: head of baby downward to use gravity 3-4 x day to prevent increase of hospitalizations and infections Do not perform immediately after eating Give bronchodilator to open bronchi for easier expectoration before therapy AM Exercise stimulates mucus expectoration Use forced expiratory technique to mobilize secretion- Huffing
    57. 57. Treatment & Management of CF  Antibiotics (oral, IV, & inhalation)  Pancreatic enzymes with meals, Pancrease or Creon. To help digest food  Aerosol bronchiodilators  Steroids  Diet- high calorie & protein, extra salt in hot weather, ADEK vitamins  Psychosocial concerns
    58. 58. Allergic Reactions Allergy- abnormal or altered reaction to an antigen Allergens – antigens that cause allergy
    59. 59.  Allergic reaction - antigen-antibody reaction that can manifest as anaphylaxis, atopic dermatitis, serum sickness or contact dermatitis Hypersensitivity response
    60. 60. Allergy Assessment  Physical exam- history of exposure to allergens, itching, tearing, burning of eyes and skin, rashes, nose twitching, stuffiness  Lab  X-ray  Pulmonary function studies  Nasal function  Skin testing
    61. 61. Treatment of Allergies Avoidance Desensitization For skin allergies Allergy alert bracelet Teaching about allergens in the home
    62. 62. Skin Allergy Testing
    63. 63. Question One: Which of the following respiratory conditions is always considered a medical emergency?  A. Asthma  B. Epiglottitis  C. Cystic Fibrosis  D. Laryngotracheobronchitis
    64. 64. Question Two: In a child with asthma, albuterol is administered primarily to do which of the following?  A. Dilate the bronchioles  B. Decrease postnasal drip  C. Reduce airway inflammation  D. Reduce secondary infections
    65. 65. Question Three: When developing a care plan for a child diagnosed with cystic fibrosis, which of the following must the nurse keep in mind?  A. CF is an autosomal dominant hereditary disorder  B. Pulmonary secretions are abnormally thick.  C. Obstruction of the endocrine glands occur  D. Elevated levels of K+
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