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UPPER AND LOWER
AIRWAY
OBSTRUCTIONS
BY-
RAMYA DEEPTHI PULI
ASST PROFESSOR
VIJAY MARIE COLLEGE OF NURSING
HYDERABAD.
INTRODUCTION
• Almost all of the pediatric codes are due to
respiratory distress in origin
• 80% of pediatric cardiopulmon...
Normal pediatric airway anatomy
• Larynx composed of hyoid bone and a series of cartilages
• Single: thyroid, cricoids, ep...
OBSTRUCTED AIRWAYS
UPPER AIRWAY
OBSTRUCTIO
NS
Introduction
• Acute upper airway obstruction from
any cause can be a life-threatening
emergency.
• Complete obstruction w...
• Upper airway includes
• Nose
• Nasopharynx
• Oropharynx
• Larynx (supraglottis, subglottis)
• Trachea (extrathoracic)
• Respiratory distress is one of the
most common chief complaints for
which children seek medical care.
• It accounts for ...
E
T
I
O
L
O
G
Y
• Factors that contribute to rapid respiratory
compromise in children include-
 smaller airways,
 increa...
LOCATION OF OBSRTUCTION
Noisy
Breathing
Noise during INSPIRATION Noise during EXPIRATION
Difficulty breathing OUT
Distal t...
Difficulty breathing IN
Awake/Crying
IMPROVES
Awake/Crying
DETERIORATES
LarynxNose / Pharynx
POSITION OF OBSRTUCTION
Snoring Stridor Wheeze
Naso
pharynx
+ + -
Larynx ±
Small babies
+ +
Severe
obstruction
Trachea &
b...
Causes of upper airway obstruction
• Common cause of UAO in outpatient practice is CROUP.
• The term croup refers to “ a c...
Other causes-
• Extrathoracic foreign body obstruction
• Bacterial tracheitis
• Retropharyngeal abscess
• Epiglottitis (ba...
Assessment of upper airway obstruction
• UAO is a life threatening medical emergency because of
underlying progressive hyp...
Contd..
• Children with croup presents with viral prodrome along with
croupy cough, cough inspiratory stridor, hoarseness ...
Clinical manifestations
• Barking cough
• Respiratory distress
• Tachypnea
• Inspiratory stridor
• Hoarseness
• Elevated t...
Diagnostic evaluation
• In addition to complete medical history and
physical examination, diagnostic
procedures for croup ...
Croup score
0 1 2
Stridor None Inspiratory Inspiratory
and expiratory
Air entry Normal Decreased Minimal
absent
Retraction...
Management
1. Monitor and facilitate respiration-
• Monitor respirations for rate and depth
• Observe for signs of respira...
ii. Administer prescribed medications
• In case of bacterial croup, administer antibiotics as prescribed
by physician
• Co...
iii. Maintain hydration and nutritional requirements
• Assess the hydration status of child
• If the child is unable to ta...
iv. Promote rest
If the child is apprehensive and crying, his
oxygen demand will increase, so, to
avoid this and conserve ...
v. Support and educate parents
• Keep the parents informed about the condition, progress and
treatment
• Allow parents to ...
FOREIGN
BODY
ASPIRATION
SWALLOWED OR INHALED FOREIGN
BODIES
• Anyone can swallow a foreign object.
• However, infants and toddlers are more likely...
• Toddlers and infants often explore items by
putting them in their nose and mouth.
• A child’s risk of swallowing somethi...
Identification of foreign body
• Foreign body can lodge either In nose or in airway leading to
partial or complete obstruc...
Signs and symptoms
• Usually, the symptoms of a swallowed foreign
object are hard to miss.
• They often appear immediately...
Diagnosis
• Physical examination
• X-ray
• If patient was not able to breath properly,
bronchoscopy is used to have detail...
Management
• If coughing effectively, just encourage the child to cough, and
monitor continuously.
• If coughing is, or is...
Management cont--
• Establishing a secure and patent airway is
the most important goal in the
resuscitation of a patient w...
Guidance for management – foreign body
obstruction
Heimlich maneuver
Back blows
Chest thrusts
note : none of these
shou...
• Heimlich maneuver is recommended for relief of the airway
obstruction in adults and children one to eight years of age
• Most important management is
medical management which
includes-
• Endotracheal intubation (transnasally
or orally)
• Cor...
• Surgical intervention which forms the most
important part of treatment in severe
emergency-
• Fiberoptic intubation
• Cr...
QUICK MANAGEMENT ALGORITHM FOR UAO
last
DIPTHERIA
• Diptheria is one of the acute infectious disease
of childhood characterized by local
inflammation of epithelia...
Epidemiology
• Agent: diptheria is caused by
corynebacterium diptheriae
• Source of infection: secretions and
discharges f...
Clinical features
• Sites affected were- nasal mucosa,
tonsils, pharynx, trachea, conjunctiva and
vagina
• Signs and sympt...
Nasal Diptheria
• It initially resembles cold, may be unilateral or
bilateral, more often unilateral.
• There may be mild ...
Tonsillar and Pharyngeal Diphtheria
• It is most common clinical variety
• Initially anorexia, malaise, low grade fever, s...
Laryngeal diphtheria
• It is usually due to extension
of membrane from tonsils and
pharynx
Common symptoms are-
• Noisy di...
Respiratory diphtheria
• Breathing difficulty
• Husky voice
• Stridor
• Enlarged lymph nodes
• Heart rate
• Nasal discharg...
Diagnostic evaluation
• Based on clinical examination
• Confirmed with isolation of bacteria- Albert’s
stain
• Other lab i...
Treatment
• Diptheria is a serious illness which needs
immediate management
• The first step is to give antitoxin
• This i...
Prevention
• With the use of antibiotics and vaccines,
diphtheria is not only treatable, but
preventable as well.
• DPT va...
LARYNGITIS
Introduction
• Laryngitis is when the voice box or vocal
cords become inflamed from overuse,
irritation, or infection.
• T...
Etiology
Causes of acute laryngitis include:
• viral infections
• straining vocal cords by yelling/talking more than norma...
Symptoms
The most common symptoms of laryngitis
include:
• weakened voice
• loss of voice
• hoarse, dry throat
• constant ...
Diagnosis
Laryngoscope is used to visualize the
larynx for diagnosis
Following were the findings for
laryingitis-
• irrita...
Treatment
• If it of viral cause, symptoms will disappear
• If it of bacterial cause treatment of choice is antibiotics
Ho...
LOWER AIRWAY
OBSTRUCTION
LAO-
• Lower airway obstruction is mainly caused
by increased resistance in
the bronchioles (usually from a decreased
radi...
COPD
INTRODUCTION
• Chronic obstructive lung disease (COPD)
describes a group of lung conditions
(diseases) that make it diffic...
ETIOLOGY
• Passive smoking
• Exposure to chemical, air pollution
• Inhalation of smoke
• Hereditary factors
SYMPTOMS
Symptoms of COPD include:
• Constant coughing
• Shortness of breath while doing activities
• Excess sputum produc...
DIAGNOSIS
• spirometry can detect COPD before
symptoms become severe.
• It is a simple, non-invasive breathing test
that m...
Treatment
• Bronchodilators to relax the muscles
around airways, to help open them and
make it easier to breathe.
• Inhale...
ASTHMA
INTRODUCTION
• Many children with asthma develop symptoms
before age 5.
• There are a number of conditions that can
cause ...
WHAT IS ASTHMA
• Asthma is a condition of chronic swelling of the airways.
• These airways are sensitive to stimulation by...
Definition
• Asthma is a reversible, episodic,
obstructive airway disease caused by
hyperactivity of the bronchial tree to...
Types
• Intrinsic asthma: refers to triggering factors
from environment
• Extrinsic asthma: also called as allergic
asthma
ASSESSMENT
Some children have few day-to-day symptoms, but have severe
asthma attacks now and then. Other children have pe...
ASTHMA EMERGENCIES
For some children, severe asthma attacks can
be life-threatening and require emergency
room treatment. ...
DIAGNOSIS
• Diagnosing asthma can be tricky in young
children.
• Wheezing, coughing and other asthma-like
symptoms can occ...
Contd..
• For older children and adults, doctors can
use breathing tests (lung function tests)
such as spirometry or peak ...
Contd..
• doctor may be able to check for
inflammation in child's airways with a test
that measures levels of nitric oxide...
Medical Management
• The goal of treatment for childhood
asthma are prevention of acute episodes,
maximum control of sympt...
Pharmacological therapy
• Medications are used in the preventive
management of asthma as well as in the
treatment of acute...
Contd..
• Theophilline, aminophilline and its
derivatives are effective bronchodilators
frequently used in the management ...
Contd..
• Antibiotics are indicated for those with
secondary infections
• Antihistamines are not advised due to their
seda...
Nursing management
• The nursing care of children with asthma
involves comprehensive knowledge of disease
process, medical...
Acute care
1. Providing emotional support and
education:
• Child who is experiencing an acute attack
will be frightened, f...
2. Positioning
• The child in respiratory distress is better
able to breathe in sitting position.
• The child's bed should...
3. Evaluating respiratory status
• Nursing assessment of respirations should
be ongoing and documented.
• Frequent assessm...
4. Administering Oxygen therapy
• Oxygen therapy - humidified
• Younger children are usually advised to keep
in mist tent
...
5. Monitoring intravenous medication
• When intravenous medication therapy is
required, the child must be closely monitore...
Supporting family members
• Parents and other family members needs
to be allowed in promoting child’s care.
• Parents shou...
Summary-
• Upper respiratory obstructions-
1. Croup
2. Foreign body obstruction
3. Diptheria
4. laryngitis
• Lower respira...
upper & lower airway obstruction
upper & lower airway obstruction
upper & lower airway obstruction
upper & lower airway obstruction
upper & lower airway obstruction
upper & lower airway obstruction
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disorders of upper and lower airway obstruction

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upper & lower airway obstruction

  1. 1. UPPER AND LOWER AIRWAY OBSTRUCTIONS BY- RAMYA DEEPTHI PULI ASST PROFESSOR VIJAY MARIE COLLEGE OF NURSING HYDERABAD.
  2. 2. INTRODUCTION • Almost all of the pediatric codes are due to respiratory distress in origin • 80% of pediatric cardiopulmonary arrest are primarily due to respiratory distress • Majority of cardiopulmonary arrest occurs at less than 1 year of age.
  3. 3. Normal pediatric airway anatomy • Larynx composed of hyoid bone and a series of cartilages • Single: thyroid, cricoids, epiglottis • Paired: arytenoids, corniculates, and cuneiform
  4. 4. OBSTRUCTED AIRWAYS
  5. 5. UPPER AIRWAY OBSTRUCTIO NS
  6. 6. Introduction • Acute upper airway obstruction from any cause can be a life-threatening emergency. • Complete obstruction will result in respiratory failure followed by cardiac arrest in a matter of minutes. • This situation requires an immediate, aggressive response.
  7. 7. • Upper airway includes • Nose • Nasopharynx • Oropharynx • Larynx (supraglottis, subglottis) • Trachea (extrathoracic)
  8. 8. • Respiratory distress is one of the most common chief complaints for which children seek medical care. • It accounts for nearly 10 percent of pediatric emergency department visits and 20 percent of hospitalizations • Respiratory distress in children, particularly neonates and infants, must be promptly recognized and aggressively treated because they may decompensate quickly. I N C I D E N C E
  9. 9. E T I O L O G Y • Factors that contribute to rapid respiratory compromise in children include-  smaller airways,  increased metabolic demands,  decreased respiratory reserves, and  inadequate compensatory mechanisms as compared to adults. COMMON FACTORS INCLUDE-  swallowed or inhaled foreign objects  Diphtheria  Laryngitis  Epiglottitis  Peritonsellar abscess  Anaphylaxis  Chemical burns
  10. 10. LOCATION OF OBSRTUCTION Noisy Breathing Noise during INSPIRATION Noise during EXPIRATION Difficulty breathing OUT Distal to Thoracic Inlet Trachea, bronchi, peripheral airways Difficulty breathing IN Proximal to Thoracic Inlet Nose, pharynx, larynx
  11. 11. Difficulty breathing IN Awake/Crying IMPROVES Awake/Crying DETERIORATES LarynxNose / Pharynx
  12. 12. POSITION OF OBSRTUCTION Snoring Stridor Wheeze Naso pharynx + + - Larynx ± Small babies + + Severe obstruction Trachea & bronchi + + Small airways +
  13. 13. Causes of upper airway obstruction • Common cause of UAO in outpatient practice is CROUP. • The term croup refers to “ a clinical syndrome characterized by barking cough, inspiratory stridor and hoarseness of voice. • Most cases of croup are of viral etiology and 65% of viral croup is caused by three types of parainfluenza virus • Since the viral infection is seen on larynx, trachea and bronchi the viral croup is immediately referred as acute laryngo- trache-brohchitis • Usually the term croup referres to viral croup.
  14. 14. Other causes- • Extrathoracic foreign body obstruction • Bacterial tracheitis • Retropharyngeal abscess • Epiglottitis (bacterial croup) • diptheria
  15. 15. Assessment of upper airway obstruction • UAO is a life threatening medical emergency because of underlying progressive hypoxemia • Clinical examination is the most important aspect that helps in both the diagnosis and in the assessment of severity of disease. • Investigations add little in the initial workup • As viral croup is the commonest cause of UAO, attempts to identify other causes is also very important to confirm the diagnosis.
  16. 16. Contd.. • Children with croup presents with viral prodrome along with croupy cough, cough inspiratory stridor, hoarseness and respiratory distress. • Viral croup occurs between ages 3months and 5years • Croup of bacterial cause occurs in older children 3-7 years. • As the obstruction increases, stridor becomes continuous associated with worsening of cough, nasal flaring, supra- sternal, intra-sternal and inter-coastal retractions. • Children with progressive stridor, severe retractions, hypoxia, cyanosis, depressed sensorium needs hospitalization. • Application of croup score may be useful in the management of protocol.
  17. 17. Clinical manifestations • Barking cough • Respiratory distress • Tachypnea • Inspiratory stridor • Hoarseness • Elevated temperature • Rapid pulse • Irritability • Dysphagia • In severe cases, manifestations may progress to shock, cyanosis, impaired consciousness
  18. 18. Diagnostic evaluation • In addition to complete medical history and physical examination, diagnostic procedures for croup may include- • Neck and chest X-ray • Blood tests, cultures done to rule out diphtheria • Bronchoscope • Pulse oxymetry to find out oxygen saturation.
  19. 19. Croup score 0 1 2 Stridor None Inspiratory Inspiratory and expiratory Air entry Normal Decreased Minimal absent Retractions None Suprasternal minimal Suprasternal, sternal, subcoastal Color Normal Cyanosis in room air Cyanosis with 40% of oxygen Consciousne ss Alert Irritable consolable by parents drowsy
  20. 20. Management 1. Monitor and facilitate respiration- • Monitor respirations for rate and depth • Observe for signs of respiratory distress • Keep the child in humid atmosphere to liquefy secretions • Provide steam inhalation • Nebulize the child with epinephrine and corticosteroids. Epinephrine is a short acting bronchodilator which helps in relieving respiratory congestion and tissue edema. Corticosteroids nebulization has anti inflammatory action in reducing inflammation • Cool mist therapy may be provided as it tends to reduce mucosal edema • Provide oxygen inhalation for respiratory distress • Encourage the child to cough and breathe deeply • Chest physiotherapy and suctioning can be done as advised by physician.
  21. 21. ii. Administer prescribed medications • In case of bacterial croup, administer antibiotics as prescribed by physician • Corticosteriods (50-75mg/kg ) can be given for reducing edema and spasms of croup
  22. 22. iii. Maintain hydration and nutritional requirements • Assess the hydration status of child • If the child is unable to take oral feeds and is in shock, intravenous fluids are given to prevent dehydration • Clear and high calorie liquids are given orally, as tolerated by child • Maintain strict input and output chart
  23. 23. iv. Promote rest If the child is apprehensive and crying, his oxygen demand will increase, so, to avoid this and conserve child’s energy following measure are to be taken- • Provide rest to child in fowlers position, as this position facilitates better respirations • Familiar toys should be provided to the child • Mild sedation may be given if the child is very restless to promote rest and sleep • Provide quite and restful environment to the child
  24. 24. v. Support and educate parents • Keep the parents informed about the condition, progress and treatment • Allow parents to be with the child • Reassure parents and involve them in child’s care. last
  25. 25. FOREIGN BODY ASPIRATION
  26. 26. SWALLOWED OR INHALED FOREIGN BODIES • Anyone can swallow a foreign object. • However, infants and toddlers are more likely to do so than adults because of their natural curiosity and tendency to put things into their mouths. • In many cases, the swallowed object will be processed by the digestive tract and exit body naturally. • In other cases, though, the object may get stuck or cause injuries on the way down. • If this happens, healthcare provider should be consulted immediately for treatment—surgery may be needed.
  27. 27. • Toddlers and infants often explore items by putting them in their nose and mouth. • A child’s risk of swallowing something potentially dangerous increases when he or she is left with little to no supervision. • Also occurs when children are in reach of  coins  small batteries  buttons  marbles  rocks  nails  screws  pins  small magnets
  28. 28. Identification of foreign body • Foreign body can lodge either In nose or in airway leading to partial or complete obstruction • Nasal obstruction-
  29. 29. Signs and symptoms • Usually, the symptoms of a swallowed foreign object are hard to miss. • They often appear immediately, since the item is blocking the airway. • The most common symptoms include:  choking  difficulty breathing  coughing  wheezing
  30. 30. Diagnosis • Physical examination • X-ray • If patient was not able to breath properly, bronchoscopy is used to have detailed view of airway.
  31. 31. Management • If coughing effectively, just encourage the child to cough, and monitor continuously. • If coughing is, or is becoming, ineffective, shout for help and assess the child's conscious level. • If the child is conscious, give up to five back blows, followed by five chest thrusts to infants or five abdominal thrusts to children (repeat the sequence until the obstruction is relieved or the patient becomes unconscious).
  32. 32. Management cont-- • Establishing a secure and patent airway is the most important goal in the resuscitation of a patient with acute UAO. • Quick history and clinical examination can help in determining the site of obstruction. • In the outpatient setting the most common cause of UAO is obstruction of the larynx with a foreign body
  33. 33. Guidance for management – foreign body obstruction Heimlich maneuver Back blows Chest thrusts note : none of these should be applied if patient is able to speak or cough Finger sweep / grasp should be done only if object is visible and will
  34. 34. • Heimlich maneuver is recommended for relief of the airway obstruction in adults and children one to eight years of age
  35. 35. • Most important management is medical management which includes- • Endotracheal intubation (transnasally or orally) • Corticosteroids • Helium–oxygen mixture
  36. 36. • Surgical intervention which forms the most important part of treatment in severe emergency- • Fiberoptic intubation • Cricothyroidotomy • Tracheostomy
  37. 37. QUICK MANAGEMENT ALGORITHM FOR UAO last
  38. 38. DIPTHERIA • Diptheria is one of the acute infectious disease of childhood characterized by local inflammation of epithelial surface, formation of membrane and severe toxemia.
  39. 39. Epidemiology • Agent: diptheria is caused by corynebacterium diptheriae • Source of infection: secretions and discharges from an infected person • Mode of infection: contact with droplets of infected secretions • Portal of entry: respiratory tract, conjuctiva or open wound • Preschoolers are at higher risk
  40. 40. Clinical features • Sites affected were- nasal mucosa, tonsils, pharynx, trachea, conjunctiva and vagina • Signs and symptoms depends on the site involved-
  41. 41. Nasal Diptheria • It initially resembles cold, may be unilateral or bilateral, more often unilateral. • There may be mild fever, nasal discharge • Careful inspection may reveal a white membrane on nasal septum • The affected nostril gets obstructed and leads to difficulty in breathing
  42. 42. Tonsillar and Pharyngeal Diphtheria • It is most common clinical variety • Initially anorexia, malaise, low grade fever, sore throat and difficulty in swallowing occur • With in 1-2 days, a white membrane appears on tonsils and covers pharyngeal walls or progress down into larynx and trachea • Cervical lymph nodes are enlarged giving an appearance of BULL neck • In severe cases there will be respiratory obstruction, circulatory collapse
  43. 43. Laryngeal diphtheria • It is usually due to extension of membrane from tonsils and pharynx Common symptoms are- • Noisy difficulty breathing • Barking cough • Hoarseness of voice • Progressive stridor • If obstruction is not relieved, child may develop suffocation and heart failure
  44. 44. Respiratory diphtheria • Breathing difficulty • Husky voice • Stridor • Enlarged lymph nodes • Heart rate • Nasal discharge • Swelling of palate
  45. 45. Diagnostic evaluation • Based on clinical examination • Confirmed with isolation of bacteria- Albert’s stain • Other lab investigations- WBC count, raised proteins and cells in CSF
  46. 46. Treatment • Diptheria is a serious illness which needs immediate management • The first step is to give antitoxin • This is followed by antibiotics like penicillin, erythromycin
  47. 47. Prevention • With the use of antibiotics and vaccines, diphtheria is not only treatable, but preventable as well. • DPT vaccine at 6, 10, 14 weeks for infants and at 18 months booster dose is given last
  48. 48. LARYNGITIS
  49. 49. Introduction • Laryngitis is when the voice box or vocal cords become inflamed from overuse, irritation, or infection. • There are two main types of laryngitis: chronic (long-term) and acute (short-term). • The inflammation that causes laryngitis can be tied to a variety of conditions. These include viral infections, environmental factors, and in rare cases, bacterial infections.
  50. 50. Etiology Causes of acute laryngitis include: • viral infections • straining vocal cords by yelling/talking more than normal • bacterial infections (rare) Causes of chronic laryngitis include: • frequent exposure to harmful chemicals or allergens • acid reflux • frequent sinus infections • smoking or being around smokers • overusing of voice • low-grade yeast infections caused by frequent use of an asthma inhaler
  51. 51. Symptoms The most common symptoms of laryngitis include: • weakened voice • loss of voice • hoarse, dry throat • constant tickling or minor irritation of throat • dry cough
  52. 52. Diagnosis Laryngoscope is used to visualize the larynx for diagnosis Following were the findings for laryingitis- • irritation • redness • lesions on the voice box • widespread swelling—a sign of environmental factors behind laryngitis • vocal cord swelling only—a sign of overuse of vocal cords
  53. 53. Treatment • If it of viral cause, symptoms will disappear • If it of bacterial cause treatment of choice is antibiotics Home remedies for management are- • drinking lots of fluids • gargling with salt water • resting voice • avoiding screaming or talking loud for long periods of time • avoiding decongestants (medicines to help clear stuffy noses by drying out nasal passages), which can dry throat • sucking on lozenges to keep throat lubricated • refraining from whispering, which can strain the voice last
  54. 54. LOWER AIRWAY OBSTRUCTION
  55. 55. LAO- • Lower airway obstruction is mainly caused by increased resistance in the bronchioles (usually from a decreased radius of the bronchioles) that reduces the amount of air inhaled in each breath and the oxygen that reaches the pulmonary arteries. • It is different from airway restriction (which prevents air from diffusing into the pulmonary arteries because of some kind of blockage in the lungs). Diseases that cause lower airway obstruction are termed obstructive lung diseases. (COLD) OR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
  56. 56. COPD
  57. 57. INTRODUCTION • Chronic obstructive lung disease (COPD) describes a group of lung conditions (diseases) that make it difficult to empty the air out of the lungs. • This difficulty can lead to shortness of breath (also called breathlessness) or the feeling of being tired. • COPD is a word that can be used to describe a person with chronic bronchitis, emphysema or a combination of these. • COPD is a different condition from asthma, but it can be difficult to distinguish between COPD and chronic asthma.
  58. 58. ETIOLOGY • Passive smoking • Exposure to chemical, air pollution • Inhalation of smoke • Hereditary factors
  59. 59. SYMPTOMS Symptoms of COPD include: • Constant coughing • Shortness of breath while doing activities • Excess sputum production • Feeling like -can't breathe • Wheezing
  60. 60. DIAGNOSIS • spirometry can detect COPD before symptoms become severe. • It is a simple, non-invasive breathing test that measures the amount of air a person can blow out of the lungs (volume) and how fast he or she can blow it out (flow). • The spirometry reading can help doctor determine the best course of treatment.
  61. 61. Treatment • Bronchodilators to relax the muscles around airways, to help open them and make it easier to breathe. • Inhaled steroids to prevent the airways from getting inflamed. • Pulmonary Rehabilitation to help learn to exercise and manage disease with physical activity and counseling. • Oxygen therapy to help with shortness of breath. last
  62. 62. ASTHMA
  63. 63. INTRODUCTION • Many children with asthma develop symptoms before age 5. • There are a number of conditions that can cause asthma-like symptoms in young children. • But if child's symptoms are caused by asthma, early diagnosis is important. • Asthma treatment in children improves day-to- day breathing, reduces asthma flare-ups and helps reduce other problems caused by asthma.
  64. 64. WHAT IS ASTHMA • Asthma is a condition of chronic swelling of the airways. • These airways are sensitive to stimulation by a number of things, such as infection, cold air, exercise, pollens, etc. • The swelling may produce an obstruction of the airways, similar to COPD. • Some people with COPD also have asthma.
  65. 65. Definition • Asthma is a reversible, episodic, obstructive airway disease caused by hyperactivity of the bronchial tree to a variety of stimuli. • It is the leading cause for school absents in children under 17 yrs of age • Onset usually occurs during first five years of life. • Boys are affected twice as often as girls until adolescence
  66. 66. Types • Intrinsic asthma: refers to triggering factors from environment • Extrinsic asthma: also called as allergic asthma
  67. 67. ASSESSMENT Some children have few day-to-day symptoms, but have severe asthma attacks now and then. Other children have persistent mild symptoms or symptoms that get worse with activity or other triggers such as cigarette smoke or seasonal allergies. • If child is an infant, manifestations such as slow feeding or shortness of breath during feeding were observed. • If child is a toddler or older, a decreased desire to run and play due to breathlessness, fatigued easily and cough when exercising. • For many children under age 5, asthma attacks are triggered or worsened by colds and other respiratory infections. child's colds last longer than they do in other children, or that signs and symptoms include frequent coughing that may get worse at night.
  68. 68. ASTHMA EMERGENCIES For some children, severe asthma attacks can be life-threatening and require emergency room treatment. Signs and symptoms of an asthma emergency in children under 5 years old include: • Gasping for air • Breathing in so hard that the abdomen is sucked under the ribs • Trouble speaking because of restricted breathing
  69. 69. DIAGNOSIS • Diagnosing asthma can be tricky in young children. • Wheezing, coughing and other asthma-like symptoms can occur with conditions other than asthma, such as viral infections. • For this reason, it may not be possible to make a definite diagnosis of asthma until child is older.
  70. 70. Contd.. • For older children and adults, doctors can use breathing tests (lung function tests) such as spirometry or peak flow measurement. • As child gets older, these tests may be used to help pinpoint on asthma diagnosis and track how well treatment's working. • Generally, children under age 5 aren't able to do these tests.
  71. 71. Contd.. • doctor may be able to check for inflammation in child's airways with a test that measures levels of nitric oxide gas in the breath. • In general, higher levels of nitric oxide mean child's lungs aren't working as well as they should be, and asthma isn't under control
  72. 72. Medical Management • The goal of treatment for childhood asthma are prevention of acute episodes, maximum control of symptoms and maintenance of normal growth and development . • Medication and adjunct therapies, such as chest physical therapy, exercise and counselling are incorporated into the treatment plan, which is individualized and based on physiologic and developmental needs.
  73. 73. Pharmacological therapy • Medications are used in the preventive management of asthma as well as in the treatment of acute episodes. • Drug therapy is employed to – 1. Promote bronchodilation 2. Reduce inflammation 3. Remove secretions Medications may be necessary only when the child experiences an attack or on a continuous basis for control in more severely affected children.
  74. 74. Contd.. • Theophilline, aminophilline and its derivatives are effective bronchodilators frequently used in the management of childhood asthma • Certain adrenergics such as epinephrine, isoproteneraol are inactivated in GI hence they should be administered only through IV or inhalation. • Corticosteroids helps in relaxing bronchial smooth muscles and reduces inflammatory response such as mucosal edema. But these should be administered to children who fails to respond for other modalities of treatment due to their associated side effects.
  75. 75. Contd.. • Antibiotics are indicated for those with secondary infections • Antihistamines are not advised due to their sedative and drying effects. • Administration of humidifies oxygen through nasal cannula to treat hypoxia
  76. 76. Nursing management • The nursing care of children with asthma involves comprehensive knowledge of disease process, medical treatment modalities and expected outcomes. • Skillful assessment and innovative approaches to assist the child towards optimal respiratory functioning, growth and social development are essential elements of care planning.
  77. 77. Acute care 1. Providing emotional support and education: • Child who is experiencing an acute attack will be frightened, fatigued and uncomfortable. • The child should be addressed calmly and quietly. • External stimuli should be reduced to as much as possible • For elder children’s all procedure planned and performing should be explained well in age appropriate language
  78. 78. 2. Positioning • The child in respiratory distress is better able to breathe in sitting position. • The child's bed should be raised and back supported with pillows. • If the child is more comfortable leaning forward, a table to lean or a pillow to hug should be kept available.
  79. 79. 3. Evaluating respiratory status • Nursing assessment of respirations should be ongoing and documented. • Frequent assessment for presence of  cyanosis,  inspirational and expiration breath sounds,  use of accessory muscles for respiration,  the intensity or absence of wheezing should be checked.
  80. 80. 4. Administering Oxygen therapy • Oxygen therapy - humidified • Younger children are usually advised to keep in mist tent • Bed lines and dressing may required to be changed frequently, as the cool mist may gets saturated quickly and chills the child • Older children are kept on nasal cannula
  81. 81. 5. Monitoring intravenous medication • When intravenous medication therapy is required, the child must be closely monitored • A bolus of Theophilline is frequently given on admission. • The apical pulse, respiratory rate and blood pressures are taken and recorded every 5mins during the 20 minute bolus. • Continuous Theophilline therapy is then delivered by an infusion pump for safety. • Vital signs needs to be monitored every 2nd hourly and signs of toxicity needs to be informed immediately.
  82. 82. Supporting family members • Parents and other family members needs to be allowed in promoting child’s care. • Parents should be allowed to verbalize their feelings and supported with positive re-inforcement for their care giver abilities. last
  83. 83. Summary- • Upper respiratory obstructions- 1. Croup 2. Foreign body obstruction 3. Diptheria 4. laryngitis • Lower respiratory obstructions- 1. COPD 2. Asthma

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