The document discusses the management of respiratory disorders in children. It begins with the anatomy and functions of the respiratory system. It then discusses diagnostic procedures for respiratory disorders and various respiratory therapies. The document further discusses disorders of the upper respiratory tract including common cold, tonsillitis, laryngitis, and croup. It also discusses disorders of the lower respiratory tract such as bronchitis. Treatment options for various respiratory conditions are provided.

1. MANAGEMENT OF CHILD WITH A
RESPIRATORY DISORDER
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Presented By: Mr. Arvind Joshi
B.V.C.O.N. Pune.

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3. ANATOMY OF THE RESPIRATORY SYSTEM
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Respiratory system Composed of the :
Nasal Cavity,
Pharynx
Trachea
Bronchi
Lungs
Keeps blood supplied with oxygen and
removes carbon dioxide

4. Pediatric Airway Differences
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5. FUNCTION OF RESPIRATORY SYSTEM
 Respiratory movements are first evident at 20 week
of gestation
 In neonate respiratory rate is higher to meet the
need of high metabolism.
 The volume of air inhaled increases with the growth
of the lungs.
 Ventilation
 Exchange of gases.
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6. DIAGNOSTIC PROCEDURE
 Pulmonary function test.: - pneumotechograph, spiorometry.
 Radiology : - bronchography, ct scan, usg, mri, chest x-ray
 Blood gas analysis: - pH, Pco2, HCO3, base excess, Po2
 Lung puncture
 Lung biopsy
 Oximeter
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3- Investigations To Find Out The Causative
Agents Or Organisms
 Throat swab examination
 Nasopharyngeal aspirate examination
 Sputum examination
 Gastric lavage examination
4- Mantoux Test/Accelerated BCG Reaction (to
rule out pulmonary tuberculosis)
5- Ultrasonography
6- Thoracocentesis (pleural tap)
7- Endoscopic Studies— fiberoptic Bronchoscopy
With Bronchoalveolar Lavage (BAL)
8- CT scan if needed

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9- Lung Function Tests (Help to assess the
severity and the improvement)
 Tidal volume (TV)—the volume of air either inspired
or expired during tidal respiration
10- Miscellaneous
 Sweat chloride test for cystic fibrosis
 Evaluate for gastro-oesophageal reflex
(oesophageal pH, radionucleotide scans) in a case
of recurrent/persistent pneumonia
 Evaluate for swallowing (barium swallow will show
palato-pharyngeal in-coordination which will cause
aspiration of feeds)

9. RESPIRATORY THERAPY
 Oxygen therapy: - the administration of oxygen is
hypoxemia .
 Oxygen is delivered by mask, nasal cannula, tent, hood,
face tent or ventilator
 The mode of delivery is selected on the basis of
concentration needed and childs ability to cooperate.
 Aerosol therapy: -
 Bronchial drainage: - indicated when excessive fluid or
mucus in bronchi
 Chest physical therapy: - to enhance the clearance of
mucus from the airway, by manual percussion, vibration
and squeezing of chest.
 Mechanical ventilation.
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DISORDERS OF
UPPER
RESPIRATORY
TRACT

11. DISORDERS OF THE UPPER RESPIRATORY
TRACT
Upper Respiratory Tract Disorders Causes By:
 Foreign organisms, including pathogens.
 Congenital malformation of respiratory structures.
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13. ACUTE NASOPHARNGITIS(COMMON
COLD)
 The common cold most frequent infectious
disease in children
 The incubation period is typically 2-3 days. Most
occur in the winter months.
 Acute Nasopharngitis (Common cold) is
caused most predominately by rhinovirus,
influenza viruses, adenovirus. Children are
exposed to common colds at school from sick
children .
 Children who have low immune system.
 Stress factors also appear to play a role.
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14. SIGNS & SYMPTOMS
1. Nasal congestion.
2. A watery rhinitis and low – grade fever.
1. The mucous membrane of the nose becomes
edematous and inflamed.
2. Difficulty breathing due to edema congestion.
3. Draining pharyngeal secretions may lead to cough.
4. Cervical lymph nodes may be swollen and
palpable.
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15. SIGNS & SYMPTOMS
7. Temp. as high as 38.8 to 40 C
8. Infants also may develop secondary symptoms
(vomiting and diarrhea).
9. Because they cannot suck and breathe through
their mouth at the same time, they refuse
feedings, this can lead to dehydration.
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16. THERAPEUTIC MANAGEMENT
 There is no specific treatment for a common cold.
Antibiotics are not effective unless a secondary
bacterial invasion has occurred.
 If children have fever, it should be controlled by
antipyretic drugs
 If infants have nasals congestion, saline nose drops
or nasal spray may be use to liquefy nasal secretion
and help them drain.
 Parents may use a cool mist vaporize to help
loosen nasal secretions.
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17. CHOANAL ATRESIA
 Choanal atresia is a narrowing or blockage of
the nasal airway by tissue. It is a congenital
condition.
Incidences
 The condition is the most common nasal
abnormality in newborn infants, affecting
about 1 in 7,000 live births. Females get this
condition about twice as often as males.
More than half of affected infants also have
other congenital problems.
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18. Causes
 The cause of choanal atresia is unknown. It is thought
to occur when the thin tissue separating the nose and
mouth area during fetal development remains after
birth.
Symptoms include:
 Chest retracts unless the child is breathing through
mouth or crying
 Difficulty breathing following birth, which may result in
cyanosis (bluish discoloration), unless infant is crying
 Inability to pass a catheter through each side of the
nose into the throat.
 Persistent one-sided nasal blockage or discharge.
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19. TREATMENT
In some cases, intubation or tracheostomy may be
needed. An infant can learn to mouth breathe,
which can delay the need for immediate surgery.
Surgery to remove the obstruction cures the
problem. Surgery may be delayed if the infant can
tolerate mouth breathing. The surgery may be
done through the nose (transnasal) or through the
mouth (transpalatal).
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20. PHARYNGITIS
 Pharyngitis is infection and inflammation of the
throat.
 It may be caused either bacterial or viral in origin.
 It occurs as a result of a chronic allergy in which
there is constant postnasal discharge
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TONSILLITIS

23. TONSILLITIS
 Tonsillitis is inflammation of the palatine tonsils most
commonly caused by a viral or bacterial infection.
 Adenitis refers to infection and inflammation of the
adenoid ( pharyngeal ) tonsils.
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24. ADENITIS
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25. CAUSES
 Viral: Adenovirus, Rhinovirus, Influenza,
Coronavirus, and Respiratory Syncytial Virus
(RSV).
 Bacterial: Group A β-hemolytic streptococcus
(GABHS),
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26. SIGNS & SYMPTOMS
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Red and/or swollen
tonsils
White or yellow
patches on the tonsils
Tender, stiff, and/or
swollen neck
Swollen lymph nodes
Sore throat
Cough
Headache
Sore eyes
Body aches
Earache
Fever
Chills
Nasal congestions
Ulceration

27. SIGNS AND SYMPTOMS OF BACTERIAL TONSILLITIS
 Sudden pain in throat and pain with swallowing
 Fever and bad breath
 Red, swollen throat and snoring
 Sleep apnea
 Whitish-yellow patches on the back of his throat
 Nausea, vomiting and stomach pain
 Painful, swollen lumps on the sides of his neck
 Rash that looks like sunburn with little bumps
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28. SIGNS & SYMPTOMS (PHY. T.)
11. Children drool because their throat is too sore for them to
swallow saliva.
12. Pharyngeal pain and edema.
13. Nasal quality of speech
14. Mouth breathing
15. Difficulty hearing (post pharyngeal obstruction by the
enlarged tissue).
16. Acute otitis media.
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29. THERAPEUTIC MANAGEMENT
Therapy for bacterial tonsilliar:
1- Antipyretic for fever an analgesic for pain,
2- Full 10 days course of an antibiotic such as penicillin.
3- Tonsillectomy is removal of the palatine tonsils.
 Adenoidectomy
Tonsillectomy and adenoidectomy is never done while
the organs are infected because an operation at such
A time might speared pathogenic organisms into blood
stream, causing septicemia.
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30. AFTER TONSILLECTOMY
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31. TONSILLECTOMY
Management before surgery:
Complete history , physical examination and
laboratory tests (bleeding and clotting
times, complete blood count, and
urinalysis).
Management after surgery:
 Observe vital signs (bleeding)
 Place the child on the side of abdomen with
a pillow under the chest so the head is
lower than the chest.
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32. TONSILLECTOMY (CONT.)
 Acute hemorrhage after tonsillectomy may occur ,
but little blood is apparent, assess of signs for
hemorrhage ( plus or respiratory rate will increase,
frequent swallowing
 If bleeding occurs, elevating the child's head and
turning him on the side to reduces vascular
pressure on the operative side.
 If the child have no complication from surgery are
able to swallow fluids and have voided, he will
discharge to home .
 Family instruction: watch child at their first day at
home ; clearing the throat, and restrict their activity.
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33. LARYNGITIS
 Laryngitis is inflammation of the larynx.
 It may occur as a spread of pharyngitis or from
excessive use of voice.
 The most effective measure, for children is rest their
voice at least 24 hours.
 Drink plenty of warm fluid.
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36. CROUP (LARYNGOTRACHEOBRONCHITIS)
 Croup is the inflammation of the larynx, trachea,
and major bronchi
 It affect children between 6 month and 3 years of
age
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37. CAUSES
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Viral Croup Is Caused
By
Parainfluenza virus
Influenza A and B
Measles
Adenovirus
Respiratory Syncytial
Virus (RSV).
Bacterial Croup Is
Caused By
Corynebacterium
Diphtheria
Staphylococcus
Aureus
Streptococcus
Pneumoniae
Hemophilus Influenza
Moraxella Catarrhalis

38. SIGNS AND SYMPTOMS
 "Barking" cough
 Stridor (worsened by agitation or crying)
 Hoarseness
 Difficult breathing which usually worsens at night.
 Fever
 Coryza (symptoms typical of the common cold),
 Chest wall retractions
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39. THERAPEUTIC MANAGEMENT
 Keep the child in warm moist environment to revile the pain.
 Give nebulizer, to reduce inflammation.
 Steroid therapy (Corticosteroids, such as Dexamethasone
and Budesonide) are given routinely to reduce airway
edema.
 Epinephrine is used in severe cases
 I.V. fluid therapy to treat dehydration..
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40. Disorder of the lower
respiratory tract
It is infection by a pathogenic agent of trachea, bronchi,
bronchioles and lung tissues
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43. Bronchitis:
Is an inflammation of the air passages within the
lungs. It occurs when the trachea and the large and small
bronchi within the lungs become inflamed because of
infection.
It is one of he more common illness affecting
preschool and school children.
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44. Acute bronchitis:
is caused by infection of the bronchi by
viruses or bacteria (streptococci) and lasting
several days or weeks. It may be preceded by a
common cold or influenza.
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45. Symptoms include:
1. Coughing up extra mucus, sometimes with blood
2. Wheezing .
3. Difficulty breathing
4. Fever and tiredness.
5. Central chest pain aggravated with cough.
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46. THERAPEUTIC MANAGEMENT
 The aims of the therapy to reduce the symptoms of
illness, reducing fever and maintaining adequate
hydration.
 Antibiotic for treat infection.
 if considered to be bacterial is commonly treated with
an antibiotic called Amoxicillin.
 Inhalers for wheezing (bronchodilators) may be used like
Ventolin, (Salbutamol) or aminophyllin, is commonly used
for shortness of breath due to bronchospasm.
 Expectorants like solvodin.
 Cough syrups to suppress the cough.
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48. BRONCHIOLITIS
Bronchiolitis is inflammation of the fine bronchioles,
the smallest air passages of the lungs.
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49.  It occurs most often in a child younger than age
2 years. Peaking 6 months of age.
 Incidence is highest in the winter and spring
months.
 many children develop asthmas in future.
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50. Causative agents
This is most commonly caused by respiratory
syncytial virus (RSV).
Other viruses which may cause this illness include
metapneumovirus, influenza, parainfluenza,
coronavirus, adenovirus, and rhinovirus.
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51. ASSESSMENT OF BRONCHIOLITIS
 Children have 1 o 2 days of an upper respiratory tract
infection than suddenly begin to have nasal flaring .
 In a typical case, an infant under two years of age
develops cough, wheeze, and shortness of breath over
one or two days.
 Intercostals and subcostal retraction on inspiration and
increase respiratory rate .
 Mild fever, leukocytosis and an erythrocyte sedimentation
rate are increased.
 Infants develop tachycardia and cyanosis from hypoxia.
 Chest X-ray is useful .
 After the acute illness, it is common for the airways to
remain sensitive for several weeks, leading to recurrent
cough and wheeze.
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53. THERAPEUTIC MANAGEMENT OF BRONCHIOLITIS
 Therapy is principally supportive.
 Frequent small feeds are encouraged to maintain hydration
 Semi- fowlers poison to facilitate breathing.
 I.V fluid may be give for the 1 to 2 days of illness.
 Humidified and adequate Oxygenation therapy to keep
respiratory membranes moist and ventilation.
 Suction of the nasopharynx to maintain a clear airway.
 Monitoring vital signs and blood gas levels and ventilatory.
 Nebulizer bronchodilators and steroids may be used.
 Antibiotics are often given in case of a bacterial infection
complicating bronchiolitis, but have no effect on the
underlying viral infection.
 Reduce the stress due the hospitalization.
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54. Prevention of Bronchiolitis
In general, prevention of bronchiolitis relies on
measures to reduce the spread of the viruses that cause
respiratory infections (that is, hand washing, and avoiding
exposure to those symptomatic with respiratory
infections).
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55. ASTHMA
 Asthma means struggling for breath.
 It has been defined as a common chronic disorder of the
airways that is complex and characterized by, temporary
narrowing of bronchi by bronchospasm airflow obstruction,
and an underlying inflammation.
 It is the most common chronic illness in children .
 Asthma results in obstruction of airway.
 Its occur initially before age 5 years.
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56.  Sever bronchoconstriction can be induce by cold air or
irritating odors (smoke) inhalation of a known allergen.
 Air pollutants such as cigarette smoke.
 Most asthmatic child has sensitization to inhalation
antigens such as pollens, molds, or house dust.
 Food also may cause allergic.
 Seasonal factor may responsible for the child's
symptoms.
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57. ETIOLOGY OF ASTHMA
 Allergy
 Hereditory
 Respiratory infection
 Worm infestation
 Change in climate
 Emotional disturbance
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58. Common symptoms of asthma in a steady-state
include:
 Nighttime coughing,
 Shortness of breath with exertion,
 Complaints of a tight feeling in the chest.
 Severity often correlates to an increase in symptoms.
Symptoms can worsen gradually, up to the point of an
acute exacerbation of asthma.
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59. Signs of an asthmatic episode
include:
 wheezing,
 prolonged expiration,
 a rapid heart rate (tachycardia).
 During very severe attacks, an asthma sufferer can turn
blue from lack of oxygen and can experience chest pain or
even loss of consciousness.
 The person's feet may become icy cold.
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60. Therapeutic management
(Asthma)
 The most effective treatment for asthma is identifying
triggers, such as pets or aspirin, and limiting or
eliminating exposure to them.
 If trigger avoidance is insufficient, medical treatment is
available.
 Therapy for child with asthma involves planning for the
three goals of all allergy disorders:
1- Avoidance of the allergen by environmental control.
2- Skin testing and hypo sensitization to identified allergens
3- Relief of symptoms by use of pharmacologic agents.
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61. Medical management of asthma: -
A) If the child has only mild intermittent symptoms, no daily
medication is usually needed.
B) When symptoms occur, the child should take a short acting
inhaled beta 2- agonist bronchodilator.
C) If the child needs to do this more than twice a week, long
term control therapy is indicated.
D) For children who have moderate persistent symptoms,
inhaled anti – inflammation corticosteroid daily and a long-
acting bronchodilator at bedtime.
E) children who have severe persistent symptoms , taking a
high dose of an inhaled anti inflammation corticosteroid
daily and a long- acting bronchodilator at bedtime and oral
corticosteroid.
F) Children who have severe symptoms may admit to hospital
for given nebulizer or metered dose inhaler and I.V. fluid .
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62. STATUS ASTHMATICUS
 This is a life threatening condition
 It is a severe form of asthma in which the airway
obstruction is unresponsive to usual drug therapy.
 It is medical emergency & should be treated with
intensive care
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63. SIGN & SYMPTOMS OF STATUS ASTHMATICUS
 Tachypnea
 Laboured respiration and use of accessory muscle
of respiration
 Suprasternal retraction
 Diminished breath sounds
 Irritability
 Fatigue
 Tachycardia
 High blood pressure
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64. MANAGEMENT OF STATUS ASTHMATICUS
 Bronchodilator- beta 2 adrenergic(salbutamol,
terbutaline, formoterol), theophylline &
 Steroid (beclomethasone, budesonide,
prednisolone, adrenaline.) along with additional
supportive and symptomatic measure
 Asthma preventers (kitotifen, cromoglycate, steroid)
to prevent exacerbation
 Antecholinergic- atropin derrivatives
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65. PNEUMONIA
 Pneumonia is inflammation or infection of the
bronchioles and alveoli in the lung. Most common in
infants and young children, the causative organism
is usually viral. In premature infants and older
children, the causative agent is more commonly
bacterial (Pneumococcus).
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67. PATHOPHYSIOLOGY OF PNEUMONIA
 The infecting organism causes inflammation and
swelling of the mucous membranes. Macrophages
move to the area and engulf the organisms by
phagocytosis. Thick mucus, dead cells, and other
debris accumulate in the alveoli and small air
passages where they block gas exchange. If the
mucus remains in the small airways, it will
consolidate and become more difficult to remove.
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68. CLINICAL MANIFESTATION
 Fever
 Malaise
 Cough
 Wheezing
 Tachypnea
 Diagnosis: -
Sputum cultures and chest x-rays are used to
diagnose pneumonia
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69. MEDICAL MANAGEMENT
 Antibiotics
 Iv fluids
 Cough suppressants
 Antipyratics
 Chest physiotherapy

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70. NURSING MANAGEMENT
 Maintain the airway
 Provide symptomatic treatment relief from pain and
fever.
 Bed rest, frequently changing position to avoid
pooling of recreation .
 Chest physiotherapy will encourage the movement
of mucus and prevent obstruction
 Constant attention
 Provide psychological support to the patient
 Age appropriate health education
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71. TUBERCULOSIS
 Tuberculosis (TB) is an infection of the respiratory
system by the acid-fast bacillus Mycobacterium
tuberculosis.
 When a child develops TB, it is most commonly due
to close association with a TB-infected adult. If left
untreated, the disease leads to lung damage and
central nervous system involvement, including
tuberculosis meningitis, coma, and death.
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72. PATHOPHYSIOLOGY OF TB
 The organism enters the body by droplets from an
infected individual. Once inside the lungs, the
organism rapidly divides and spreads throughout
the body via the lymphatic and circulatory systems.
Granulomas develop around the site of primary
exposure. The granulomas contain and destroy the
bacteria, eventually scarring the lung tissue.
Pockets of infection may survive the immune
response and lay dormant for some time. A change
in the body’s internal environment can cause the
disease to reactivate.
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73. DIAGNOSIS
 Diagnosis is based on a combination of physical
findings, positive purified protein derivative (PPD)
skin tests (Mantoux test), x-rays, and laboratory
isolation of M. tuberculosis in the sputum. In rare
cases, the skin test may give a false-positive
reading.
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74. MEDICAL MANAGEMENT
 Medical treatment includes the administration of
isoniazid, rifampin, and pyrazinamide for 2 months,
followed by 6 months of isoniazid or rifampin.
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75. NURSING MANAGEMENT
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76. FOREIGN OBJECTS
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77. FOREIGN OBJECT - INHALED OR SWALLOWED
 If you breathe a foreign object into your nose, mouth,
or respiratory tract, it may become stuck and cause
breathing problems. It can also lead to inflammation and
infection.
 If you swallow a foreign object, it can get stuck along
the gastrointestinal (GI) tract. This can lead to infection
or bleeding.
 Considerations
 Children age 1 to 3 are most like to swallow or breathe
in a foreign object, such as a coin, marble, pencil
eraser, buttons, beads, or other small items or foods.
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78. CAUSES
 Certain foods (nuts, seeds, popcorn) and small
objects (buttons, beads) are easily inhaled by young
children. Such objects may cause either partial or
total airway blockage.
 Coins, small toys, marbles, pins, screws, rocks, and
anything else small enough for infants or toddlers to
put in their mouths can be swallowed. If the object
passes through the esophagus and into the
stomach without getting stuck, it will probably pass
through the entire GI tract.
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79. SYMPTOMS
 Choking
 Coughing
 No breathing or breathing trouble
(respiratory distress)
 Wheezing
 However, in some cases, only minor
symptoms are seen at first, and the
object may be forgotten until later
symptoms (inflammation, infection)
develop.
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80. FIRST AID, FOR INHALED OBJECT
 Any child who may have inhaled an object should be
seen by a doctor. Children with obvious breathing
trouble may have a total airway blockage that requires
emergency medical attention.
 If choking or coughing goes away, and the child does
not have any other symptoms, he or she should be
watched for signs and symptoms of infection or
irritation. X-rays may be needed.
 Bronchoscopy may be necessary to make a definitive
diagnosis and to remove the object. Antibiotics and
respiratory therapy techniques may be used if infection
develops.
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81. FOR SWALLOWED OBJECT
 Any child who is believed to have swallowed a
foreign object should be watched for pain, fever,
vomiting, or local tenderness. Stools (bowel
movements) should be checked to see if the
object exited the body. This may sometimes
cause rectal or anal bleeding.
 Even sharp objects (such as pins and screws)
usually pass through the GI tract without
complications. X-rays are sometimes needed,
especially if the child has pain or the object does
not pass within 4 to 5 days.
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82. CYSTIC FIBROSIS
 Inherited autosomal recessive disorder of the exocrine
glands
 Gene responsible for CF is located on chromosome 7
 Life span is about 37 years
 Complex disease requiring a holistic approach
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83. CYSTIC FIBROSIS
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84. CYSTIC FIBROSIS
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85. ASSESSMENT
History of Meconium ileus at birth
 Foul smelling, greasy, bulky stools / constipation
 Voracious appetite with poor weight gain
 Recurrent respiratory infections
 Persistent chronic cough
 Salty tasting skin
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86. DIAGNOSIS
Positive sweat test – Gold standard
Genetic marker
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87. MEDICATIONS
 Pancreatic enzymes to help digest food
 Inhaled antibiotics – antimicrobial for lung treatment
 Aerosol bronchodilators to open airways
 Mucolytic enzyme – to thin mucus
 H2 blocker – alters gastrointestinal acidic environment
 Tagamet
 Prokinetic agents – enhances gastrointestinal motility
 Reglan
 Vitamin C to improve absorption of other meds
 Vitamins E, A, D, K / fat soluble vitamins
 Oral and IV antibiotics – S. aureus, H. influenzae, P
aeruginosa
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88. LONG TERM COMPLICATIONS
 Nasal polyps
 Sinusitis
 Rectal polyps / rectal prolapse
 Hyperglycemia / diabetes
 Infertility - male
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89. NURSING CARE OF CHILD WITH RESPIRATORY
DISORDER
 PRIORITIES IN NURSING CARE
The priorities of nursing care for children with
respiratory disorders are to:
■ Maintain patent airway
■ Prevent infection
■ Promote healing
■ Prevent further respiratory damage.
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90. NURSING ASSESSMENT
 lung sounds bilaterally,
 oxygen saturation
 elevated temperature, and stridor.
 If the throat is infected, the ears should be checked
for signs of infection
 signs of respiratory distress
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91. NURSING DIAGNOSIS
 The following nursing diagnoses are common
among pediatric clients with respiratory disorders
and their families:
 ■ Ineffective Airway Clearance
 ■ Risk for Infection
 ■ Deficient Fluid Volume
 ■ Fear/Anxiety
 ■ Deficient Knowledge.
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92. NURSING CARE OF THE CHILD WITH RESPIRATORY
DYSFUNCTION
 Ease respiratory efforts.
 Promote rest
 Promote comfort
 Prevent spread of infection
 Promote hydration
 Reduce temperature
 Provide nutrition
 Family support and home care
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