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RESPIRATORY
DISEASES in
pediatrics
BY,
BHAVYA N KELAVADIYA
NURSING TUTOR
RESPIRATORY DISEASES by bhavya kelavadiya
Introduction:
Respiratory diseases are very often found in
children, especially the respiratory infections.
It is one of the leading cause of morbidity and
mortality among young children.
The important risk factors associated with
respiratory disease include mal-nutrition, LBW,
climatic variation especially in winter and rainy
season, overcrowding houses, poor
ventilation, air pollution, lack of ENV sanitation
and poor socioeconomic condition.
 The common C/F related to respiratory diseases are
cough, dyspnea, expectoration, chest indrawing, chest
pain, cyanosis and respiratory sound like wheezing,
stridor, grunting and snoring.
 Apnea, air hunger and flaring of alae nasi may also
present.
 In chronic cases hemoptysis, clubbing and associated
cardiac or neurological symptoms may be found.
 Special diagnostic procedures in the patients with
respiratory diseases can be done to confirm the
diagnosis.
 They include ABG analysis, blood examination,
examination of body secretion, radiology, MRI, USG,
direct laryngoscopy, pulmonary function test,
bronchoscopy, lung biopsy, sweat chloride in cystic
fibrosis etc.
RESPIRATORY DISEASES by bhavya kelavadiya
RESPIRATORY DISEASES by bhavya kelavadiya
Acute Respiratory Infections
 ARI and its complications are most frequent conditions
of acute illness in infants and children.
 In india , ARI is one of the major cause of childhood
death.
 It is also one of the major reason for which children are
brought to the hospitals and health facilities.
 About 13% of inpatient death in pediatric wards is due to
ARI.
 The proportion of death due to ARI in community is much
higher as many children die at home.
 Most children have 3-5 attacks of ARI in each year.
 Many of these infections run their natural course without
specific treatment and without complication.
DEFINITION:
ARI are an acute infection of any part of the respiratory
tract and related structures including para-nasal sinuses,
middle ear and pleural cavity.
It may cause inflammation of respiratory tract anywhere
from nose to alveoli with wide range of combination of
symptoms and signs.
It include all infections of less than 30 days duration, except
the infection of ear lasting less than 14 days.
The incidence of ARI is highest in young children,
especially below 5 yr of age and decreases with the
increasing age.
Classification:
 Depending upon the site of infection:
A. Acute upper respiratory infections: These include
common cold, rhinitis, nasopharyngitis, pharyngitis and
otitis media.
B. Acute lower respiratory infections: these include
epiglottitis, laryngitis, bronchitis, bronchiolitis and
pneumonia.
 Depending upon the anatomical involvement:
A. Broncho pneumonia: patchy involvement of lungs
B. Lobar pneumonia: one or more lobes of lungs involved
C. Pneumonitis or interstitial pneumonia : alveoli or
interstitial tissue between them affected.
 Depending upon the severity of infection( WHO
recommendation):
a) For the infant below 2 month:
 No pneumonia
 Severe pneumonia
 Very severe disease
b) For the child aged 2 month upto 5 years:
 No pneumonia
 Pneumonia(not severe)
 Severe pneumonia
 Very severe disease
Etiological factors
 Bacterial: pneumococcus, staphylococcus,
streptococcus. , Klebsiella, E-coli, M.tuberculie
 Viral: influenza, measels, chickenpox
 Mycoplasma: mycoplasma pneumoniae
 Fungal: candidiasis, blastomiosis
 Protozoal: pneumocystis carinii, toxoplasma gondi
 Rickettsial: typhus
 Miscellaneous:
 There are several different causes of
acute respiratory infection.
a) Causes of upper respiratory infection:
acute pharyngitis
acute ear infection
common cold
b)Causes of lower respiratory infection:
bronchitis
pneumonia
bronchiolitis
Clinical manifestations:
WHO recommendation, the features of lower
respiratory infections can be grouped as follows:
 Only cough and cold indicates no pneumonia.
 Fast breathing: increased RR with the presence of cough
and cold
40 b/m or more- 1-5yr
50 b/m or more- 2- 12 month
60b/m or more – less than 2 month
 Chest indrawing with or without fast breathing indicates
severe pneumonia.
(other sign with severe pneumonia include nasal flaring,
cyanosis, grunting or wheezing sound)
 Very severe disease is indicated by the presence of danger
sign like inability to drink, excessive drowsiness, stridor in
calm child, apnea, fever, convulsion.
Diagnostic evaluation:
 Examination of clinical features
 Detailed history taking
 Auscultation of chest sound
 X-rays
 Spirometry
 ABG analysis
 Blood analysis
 Sputum test
Complications:
 Pleural effusion
 Emphysema
 Atelectasis
 Empyema
 Lung abscess
 Bronchiectasis
 pneumothorax
Management:
Rx depends upon type of illness, severity of infections
and associated complications. The standard treatment
for childhood ARI is recommended by National ARI
Control Program especially for primary health care
setting.
 The child with NO PNUEMONIA can be treated at
home with home remedies for symptomatic treatment
and does not require antibiotic therapy.
 The child with PNUEMONIA can be treated in OPD
with antibiotics and other symptomatic Rx like
antipyretic and bronchodilators.
 The child with SEVERE PNEUMONIA should be
hospitalized urgently and requires parenteral
antibiotics with symptomatic treatment.
 The child with VERY SEVERE PNEUMONIA needs
immediate hospitalization , antibiotic theraphy and O2
therapy.
Nursing management
 ASSESSMENT
Assessment of respiratory dysfunction in children
includes health history, physical examination, and
laboratory or diagnostic testing.
 Health History
 Physical Examination
Physical examination of the respiratory system includes
inspection and observation, auscultation, percussion,
and palpation.
 Inspection and Observation
Color. Observe the child’s color, noting pallor or
cyanosis (circumoral or central). Pallor (pale
appearance) occurs as a result of peripheral
vasoconstriction in an effort to conserve oxygen for
vital functions. Cyanosis (a bluish tinge to the skin)
occurs as a result of hypoxia
Note the rate and depth of respiration as well as work of
breathing. Often the first sign of respiratory illness in
infants and children is tachypnea .
 Auscultation
Assess lung sounds via auscultation. Evaluate breath
sounds over the anterior and posterior chest, as well as
in the axillary areas. Breath sounds should be equal
bilaterally. The intensity and pitch should be equal
throughout the lungs. Prolonged expiration is a sign of
bronchial or bron- chiolar obstruction.
Wheezing, a high-pitched sound that usually occurs on
expiration, results from obstruction in the lower trachea
or bronchioles. Wheezing that clears with coughing is
most likely a result of secretions in the lower trachea.
Wheezing resulting from obstruction of the
bronchioles, as in bronchiolitis, asthma,
chronic lung disease, or cystic fibro- sis, that
does not clear with coughing. Rales
(crackling sounds) result when the alveoli
become fluid-filled, such as in pneumonia.
 Interventions:
Position with airway open (sniffing position if
supine): open airway allows adequate
ventilation.
Humidify oxygen or room air and ensure
adequate fluid intake (intravenous or oral) to
help liquefy secretions for ease in clearance.
Suction with bulb syringe or via nasopharyngeal
catheter as needed, particularly prior to bottle-
feeding to promote clearance of secretions.
If tachypneic, maintain NPO status to avoid risk of
aspiration.
In older child, encourage expectoration of sputum
with coughing to promote airway clearance.
Perform chest physiotherapy if ordered to
mobilize secretions.
Ensure emergency equipment is readily availa ble
to avoid delay should airway become
unmaintainable
SINUSITIS
Sinusitis is an infection
of the sinuses.
The infection usually
occurs after a cold or
after allergic
inflammation.
Nasopharyngitis
 It is also known as
common cold or
rhinosinusitis.
 it is an inflammation of
nasopharynx.
 It is usually caused by
virus that inflammes
the membrane lining of
nose and throat.
Stridor
 It is high pitched
sound that usually
heard when a
child breathes in.
 It usually cause
by obstruction or
narrowing of
child’s upper
respiratory path.
Pharyngitis and Tonsillitis
 Pharyngitis and tonsillitis are common
co-morbidities that occurs due to
infection and inflammation of the throat.
 If the throat is primarily affected, it is
called PHARYNGITIS and if mainly the
tonsils are affected, it is known as
TONSILITIS.
 If both throat and tonsils are infected
and inflammed, the condition is known
as PHARYNGOTONSILITIS.
RESPIRATORY DISEASES by bhavya kelavadiya
RESPIRATORY DISEASES by bhavya kelavadiya
RESPIRATORY DISEASES by bhavya kelavadiya
Croup
Croup is the syndrome
characterized by
BARKING COUGH,
inspiratory stridor,
horseness and sign
of respiratory
distress which
occurs due to
varying degree of
laryngeal
obstruction.
Acute Bronchitis
 Inflammation of the
lining of bronchial
tubes, which carry
air to and from the
lungs.
 Acute bronchitis is
often caused by a
viral respiratory
infection and
improves by itself.
 In children less
than 4 yr of age
Etiology
Clinical features
• Runny nose( before the cough starts)
• Malaise
• Chills
• Fever
• Back and muscle pain
• Sore throat
• Wheezing
• In earlier stages of condition, the child may
experiences a dry non-productive cough which
progresses to excessive mucous filled cough.
Diagnostic evaluation
 History
 Physical examination
 X-ray
 Ct- scan
 Sputum test
Management
It include administration of:
 Antibiotics
 Cough expectorants
 Antipyretic medicines
 Steam inhalation
Bronchiolitis
 Bronchiolitis is a
serious illness
characterized by
inflammation of
bronchioles, causing
severe dyspnea.
 Bronchiolitis is
almost always
caused by a virus.
Typically, the peak
time for bronchiolitis
is during the winter
months
Incidences and Etiology
 Bronchiolitis is common in infant under the age
of 6 month.
 It is common in winter and early spring days.
 The exact etiology is not clear.
 Etiologic agent may be viruses such as
respiratory syncytial virus, adenovirus and
influenza virus.
 Certain bacteria- pneumococcus, streptococcus
Clinical features
 Respiratory: fast breathing,
shortness of breath,
wheezing, difficulty
breathing, or shallow
breathing
 Whole body: dehydration,
fever, loss of appetite, or
malaise
Also common: coughing or
nasal congestion
Diagnostic evaluation
X-ray
x-ray of chest shows
emphysema, prominent
broncho-vascular
markings and small
areas of collaps.
Lungs are characteristically
overinflated and
intercostal space are
wide.
Management
 O2 administration
 Maintaining atmosphere more
saturated with water vapour
 Mild sedation and postural
drainage
 IV therapy
 Antibiotics
 Aerosol therapy
Bronchiectasis
• Bronchiectasis is a
chronic and permanent
dilation of the bronchi
and bronchioles.
• It develops due to
complete obstruction
by inflammation ,
infection or inhalation
of foreign body.
• Incomplete obstruction
of bronchi may result in
obstructive
emphysema.
• Obstruction may develop due to collection
of thick mucus in case of chronic bronchitis,
bronchial asthma and cystic fibrosis.
• Infection and obstruction lead to damage of the
bronchial wall as formation of cultivation and tissue
destruction.
• It causes segmental areas of collapse, which exert
negative pressure on the damaged bronchi leading
them to dilation.
• Collapse, emphysema and pneumonia usually
accompany bronchiectasis.
• The most common site of dilation is left lower lobe.
• Right lower lobe may be affected due to foreign body
and middle lobe due to tuberculosis.
• History of bronchial occlusion and inflammation for a
prolonged period leads to the development of the
condition.
Clinical Features
Diagnosis
History taking
Physical examination
X-ray= honeycomb appearance of affected part
Bronchoscopy
Broncho-graphy
CT-scan
Bacteriological study
Sputum analysis
Management
 Appropriate systematic
antibiotic therapy especially
in acute exacerbation
 Clearing secretion and
exudates from air passage
with postural drainage
 Bronchodilators
 Expectorants
 Breathing exercise
Nursing intervention
 Assessing respiratory status,
signs of complications,
general health and ABG
analysis
 Providing rest, comfort and
warm comfortable env.
 O2 therapy
 Removal of secretion
 Oral care
Pneumonia
 Pneumonia is
defined as an
acute
inflammation
and
consolidation of
lung
parenchyma.
 It is 2nd leading
cause of death
in children under
5yr of age.
Classification
It can be classified on anatomical and etiologic basis.
A) Classification on ANATOMICAL BASIS:
• Lobar/lobular pneumonia: 1 or more lobes of lungs
are involved
• Interstitial pneumonia: interstitial tissues of lungs are
affected
• Bronchopneumonia: patchy consolidation of lungs
RESPIRATORY DISEASES by bhavya kelavadiya
B) Classification on an etiological basis:
 Bacterial pneumonia: it may be
cause by pneumococcus,
streptococcus, staphylococcus
 Viral pneumonia: it is caused by
viruses like influenza, measles,
respiratory syncytial virus
 Fungal pneumonia: it may be
caused by histoplasmosis and
coccidiomycosis
 Protozoal pneumonia: it is caused
by pneumocystis carnii, toxoplasma
gondii
C) Miscellaneous types:
• Aspiration pneumonia: it is caused by
aspiration of food, nasal drops, amniotic fluid by
newborn, water(drowning), and chemicals like
kerosene oil etc.
• Loffler’s pneumonia: it is condition in which
eosinophils accumulate in lungs, in to parasitic
infection.
• Hypersensitivity pneumonitis: it is an
inflammation of alveoli within lungs caused by
hypersensitivity to inhaled dust.
• Hypostatic pneumonia: it results from
collection of fluid in dorsal region of lungs and
occurs especially in those confined to bed for
long time( bedridden)
Clinical features:
• Sudden onset
• High fever with chills
• Cough with thick sputum
• Increased respiratory
rate
• Grunting respiration
• Nasal flaring
• Runny nose
• Irritability
• Malaise
• Sore throat
• Anorexia
Late symptoms include:
• Convulsion
• Drowsiness
• Inability to drink from
mouth
• Chest indrowing
• Wheezing
• Horseness of voice
• Cyanosis
• Pleural pain which may
be increased by deep
breathing and referred
to shoulder or abdomen
Pathogenesis
Infectious agent foreign
substances aspiration of
gastric contents
Inflammatory reaction of
pulmonary tissues
Edema of
alveolar
membrane
Alveoli fill
with exudate
from
inflammation
Gases cannot
cross edematous
alveolar
membrane
Air cannot enter
fluid-filled alveolar
Hypoxia, Shortness of
breathing
Fatigue
Diagnosis evaluation
• History taking
• Chest X-ray= X-ray finding
suggesting
bronchopneumonia include
diffuse patchy consolidation
in lungs. Consolidation is
seen as homogenous
opacity occupying the
anatomic area of a lobe,
usually in one lungs.
• Nasopharynx or throat
culture
• Blood test
Management
• Antibiotics- penicillin, amoxicillin and
clavulanic acid and macrolides including
erythromycin, azythromycin and
clorithromycin.
• Antiviral therapy
• Antifungal- fluconazole
Nursing management
• Make continuing assessment:
- respiratory rate/patterns
- observe the sign for distress
• Facilitate respiratory effort
- maintain airway and provide high humidity
atmosphere
- place child in semi-fowlers position
- change the positions frequently to prevent
pooling of secretion into the lungs
- adm. Cough suppressants and bronchodilators
• Control fever
• Maintain fluid electrolyte balance along with
nutritional status of the child
• Promote rest and sleep
Emphysema
Emphysema
results from
distension and
rupture of the
alveoli due to the
loss of elasticity
of the lungs
tissue with
resultant air
trapping.
Risk factors/ causes
Babies with a greater risk of are those with
the following conditions:
• Preterm birth, which often leads to
respiratory disease
• The lungs don't develop correctly
(pulmonary hypoplasia)
• Breathing in the first intestinal discharge
(meconium) at birth
• A lung infection (pneumonia)
• Very fast breathing right after birth
(transient tachypnea of the newborn)
Classification
• Obstructive emphysema: it occurs due to partial
occlusion of bronchus or a bronchiole in case of
atelectasis, bronchial asthma, lung infection etc
• Compensatory emphysema: it occurs when normal
lung tissue expands to fill up the areas of collapsed
lung segments.
• Congenital lobar emphysema: it is found in
neonates and young children resulting from severe
RD
• Familial emphysema: it is found especially in female
young child as progressive dyspnea, which is
inherited as autosomal recessive trait.
Clinical manifestation:
Common features are:
• Dyspnea
• Tachypnea
• Cough
• Wheeze
• Chest retraction
• cyanosis
Management
Rx is depends upon the cause of the condition.
Symptomatic Rx is important with,
O2 adm
Bronchodilators
Mucolytic agents and antibiotics.
Conservative treatment
Lobectomy
Empyema
• Empyema is the collection of thick pus in the
pleural cavity.
• Empyema is the medical term for pockets of
pus that have collected inside a body
cavity.
• It also termed as PYOTHORAX.
• It developed directly from lungs or from
neighboring structure or through blood.
• It is fair common in infancy.
Etiological factors
• infections
• Pneumococcus
• Streptococcus
• H. Influenza, etc
• It may develop following pneumonia, lung
abscess, pulmonary tuberculosis, chest
injury, suppurative lung disease, septicemia
and due to metastatic spread of suppurative
foci from distant lesions such as osteomyelitis
Clinical feature
Many children do not have any symptoms of empyema, but they may
have growth failure and some nonspecific symptoms like,
Fever
Cough
Respiratory distress
Chest pain
Diarrhea
Weight loss
Clubbing
Anemia
Other feature malnutrition
Chest signs are found as diminished movement of the affected side,
mediastinal shift to opposite healthy side, widening and dullness of
the intercostal spaces, dull percussion note and diminished air
entry.
Diagnostic
evaluation
• History taking
• Physical examination
• Pleural aspiration for
biochemical and
bacteriological
examination.
Complications:
• Bronchopleural fistulas
• Pyopneumothorax
• Lung abscess
• Purulent pericarditis
• Osteomyelitis of rib
• Septicemia
• Meningitis
• arthiritis
RESPIRATORY DISEASES by bhavya kelavadiya
Management
• Management of empyema should be done with
appropriate antibiotic therapy, inter-coastal drainage
and symptomatic measures.
• Antibiotic therapy should be started as early as
possible and to be continued for 3-4 weeks.
• Commonly used antibiotics are penicillin, cloxacillin,
ampicillin, chloramphenicol, cephalexin etc.
• Continuous closed intercoastal drainage is strongly
recommended for management of empyema rather
than the multiple aspiration of the pleural cavity.
• Surgical drainage after thoracotomy may be needed
to remove the collection, in case of severe
respiratory difficulty.
• Antipyretic
• Analgesics
• Nutritional supplementation
RESPIRATORY DISEASES by bhavya kelavadiya
Bronchial asthma
• The word “asthma” means Struggling For
Breath.
• Asthma is a chronic inflammatory disease,
characterized by airway obstruction( which
is reversible either spontaneously or with
medication), airway inflammation and an
increased responsiveness of trachea and
bronchi due to various stimuli.
• It is chronic inflammatory disorder of lower
airway due to temporary narrowing of
bronchi by bronchospasm, mucosal edema
and thick secretion.
Etiological factors
Bronchial asthma is the multifactorial.
There are some predisposing and excitatory factors.
A. Predisposing factors:
• Heredity, with a family history of asthma and some
other allergic disorders
• Labile and over conscientious nature
B. Excitatory factors:
• Allergy to foreign substance produces allergic or
extrinsic asthma
- Inhalation of pollen, wool, feather, animal hair,
smoke, dust
- Ingestion of food, like egg, chocolate, some
vegetables
- Drugs
• Respiratory infections
• Worm infestation
• Change in climate
• Emotional disturbance due to anxiety, tension,
fear and conflict
• Excessive fatigue, exhaustion
Classification
Allergic or
extrinsic asthma
Non- allergic or
intrinsic asthma
It is produced by a
hyper-immune (IgE)
response to inhalation of
specific allergen.
The children usually
have positive skin test to
the offending allergen
and positive family
history of allergy.
It is produced in
response to unidentified
or nonspecific factors of
the environment.
No hyper-immune
response is produced.
Inhalation of irritants like
cigarette, odor, air
pollution
RESPIRATORY DISEASES by bhavya kelavadiya
Pathophysiology
Exposure to allergens or triggers(dust, pollen, smoke)
Inflammatory response ( increased IgE)
Bronchoconstriction
Airway edema and increased mucous production
Airway obstruction
Hypoxia, wheezing, dyspnea, hyperventilation
Clinical features:
• The clinical feature of asthma have sudden onset and
often occur at night.
• Occasionally, asthma attack is preceded by asthmatic
aura which is characterized by feeling of tightness in
chest, restlessness, polyuria or coughing spell.
• A typical asthmatic attack is manifested by:
- Severe dyspnea
- Bouts of cough
- Wheezing
- Cyanosis
- Pallor
- Sweating
- Restlessness
- Excessive use of accessory muscle of respiration
- Extreme fatigue
• Severe attack of asthma results in hypoxia,
cyanosis and cardiac arrhythmias
• In chronic cases the chest of the child
becomes barrel shaped.
RESPIRATORY DISEASES by bhavya kelavadiya
Diagnostic evaluation
• History
• Physical examination
• Pulmonary function test
• Blood examination
• Chest X-ray
• Allergy test
Management
During acute attack, management aims at controlling
bronchospasm and relieve inflammation.
The medical management include:
• Fast acting drugs:
Salbutamol are 1st line Rx for bronchial asthma.
Anticholinergic medications, such as Ipratropium bromide.
• Long term control:
Fluticasone oral inhalation is used to prevent difficulty breathing,
chest tightness, wheezing, and coughing caused by asthma in
adults and children. It is in a class of medications called
corticosteroids. Fluticasone works by decreasing swelling and
irritation in the airways to allow for easier breathing.
• Other drugs:
O2 therapy
Magnesium sulfate- in severe asthma attack
HOLIX, a mixture of helium and O2 may also be considered in
severe unresponsive case.
RESPIRATORY DISEASES by bhavya kelavadiya
Nursing management
• Providing emotional support and
education
• Administering adequate fluids
• Provide rest and comfortable
• Evaluate respiratory status and
facilitate breathing
Pneumothorax
A pneumothorax is an abnormal collection of
air in the pleural space between the lung and
the chest wall.
It may be develop due to rupture of sub-pleural
or mediastinal nodes through the parietal
pleura.
 Pneumothorax usually occurs with fluid- Hydro
pneumothorax
 With blood- Hemo pneumothorax
 With purulent material- pyo pneumothorax
It may occur spontaneously as spontaneous
pneumothorax (due to trauma or pathological
process) or be introduced deliberately as
artificial pneumothorax.
Etiological factors:
• The causes of pneumothorax in neonates are mainly
the vigorous resuscitative procedures and
staphylococcal infections.
• In infancy, the common causes are infections
(staphylococcal, pertussis) and iatrogenic problems
(thoracocentesis, tracheostomy).
• In older children, the common causes of pneumothorax
are tuberculosis, empyema and foreign bodies.
Clinical manifestations
Dyspnea
Cyanosis
Chest pain
Mediastinal shift to healthy
side
Hyper-resonant percussion
note
Flat percussion indicate
presence of fluid
Management
Management of pneumothorax should be
done promptly after the confirmation of
diagnosis.
Symptomatic and supportive care should be
provided
Pleural effusion
• Pleural effusion
is the collection
of fluid in the
thoracic cavity,
between
visceral and
perietal pleura.
• It is less
common in
children below 5
years.
• Small effusion rarely produces symptoms or
definite physical signs and usually detected
by X-ray.
• Large effusion may cause respiratory
distress, chest pain and fever.
• The fluid accumulates in pleural cavity may
be transudate, exudate, serous, sanguineous,
sterile, purulent or chylous.
• Serous pleural effusion is commonly
developed due to tuberculosis.
• Hemothorax may result from trauma,
malignancy or hemorrhagic diseases.
• Chylothorax usually rare, it may occur due to
injury of thoracic duct.
Clinical manifestation
• High fever
• Cough
• Chest pain on affected side that worsen on
deep breathing and coughing
• Abdominal pain
• Weight loss
• On examination, decreased chest movement
on affected side, mediastinal shift to the
opposite side, fullness of inter-coastal space,
pleural rub, decreased breath sound, dull
percussion note, decreased vocal resonance
are usually found.
Diagnostic evaluation
History of illness
Physical examination
Chest X-ray
X- ray = it shows a
uniform opacity with
curved upper border of
fluid line.
Management
• Pleural effusion should be
done according to the
specific cause.
• Specific chemotherapy
along with symptomatic
and supportive measures
should be provided.
• Relief of respiratory
distress can be done by
therapeutic thoracentesis
for removal of collected
fluid.
Cystic fibrosis
 Cystic fibrosis is an inherited disease
characterized by an abnormality in the body’s
salt, water and mucous making cells.
 It is chronic, progressive and usually fatal
condition.
 Children with cystic fibrosis have an
abnormality in the function of a cell protein
called Cystic Fibrosis Transmembrane
Regulator (CFTR).
 This cell protein controls the flow of water and
certain salts in and out of body’s cells. As the
movement of salt and water in and out of cells
is altered, mucous becomes thickened.
 Thick mucous can affect many organs and body
system including:
Clinical features
• Each child may experience symptoms differently. Infants
born with cystic fibrosis usually show symptoms within
the first year. some children may not show symptoms
until later in life.
• The following symptoms may indicate cystic fibrosis-
• Abnormalities in the glands that produce sweat and
mucous
• Thick mucous that accumulates in the lungs and
intestines may lead to poor growth, frequent respiratory
infections
• Diarrhea may occur
• Frequent episode of wheezing/ pneumonia
• Persistent cough
• Skin tastes like salt
• Abdominal pain
• Gas in intestines
Other medical problems:
Sinusitis
Nasal polyps
Clubbing of finger and toes
Pneumothorax
Hemoptysis
Cor pulmonale
Rectal prolapse
Liver disease
Diabetes
Pancreatitis
gallstones
Diagnostic evaluation
Physical examination
History taking
Genetic test
Sweat (chloride) test
Chest X ray
Pulmonary function test
Sputum cultures
Stool evaluation
Management
At present there is no cure for cystic fibrosis.
However, researches in gene therapy are being
performed.
The gene that causes cystic fibrosis has been
identified and there is hope that will lead to an
increased understanding of the disease.
Also being researched are different drug
regimens, to help treat cystic fibrosis.
The goal of treatment are to ease severity of
symptoms and slow the progress of the
disease. Treatment may include:
• Management of respiratory problems:
 Chest physiotherapy ( to help loosen and
clear lung secretion, it may include postural
drainage and devices, such as a percussor
or flutter, which vibrate the chest wall and
loosen the secretion.)
 Exercise (it help to loosen mucous,
stimulate coughing and improve overall
physical condition)
 Medications (bronchodilators and anti-
inflammatory medication)
 Antibiotics ( to treat infection)
• Management of digestive problems:
 Appropriate diet
 Pancreatic enzymes to aid digestion
 Vitamin supplement
 Psychosocial support is required to help the
child and family to deal with issues such as
independence, health, quality of life,
finances and relationships.
 Newer therapies include lung transplantation
for patient with end-stage lung disease.
Lung abscess
• Lung abscess is a sever, localized
suppurative infection in the lung, associated
with necrotic cavity formation.
• The cavity is surrounded by a fibrous
reaction, forming the abscess wall.
• Multiple small abscess formation may occur
and sometimes referred to as “Necrotizing
pneumonia”.
• It may develop single abscess or multiple
abscesses.
Etiology and risk factors
• The most frequent cause of lung abscess is
aspiration of anaerobic organism from mouth, in
those predisposed to pulmonary aspiration and
having impaired immune defenses and cough reflex.
• A pneumonitis develops which progresses to abscess
formation over a period of days or weeks.
• Mechanisms precipitating abscess formation include:
 Inhalation of foreign body
 Bacterial colonization in the lungs
 Tricuspid endocarditis leading to septic pulmonary
embolus
 Extension of hepatic abscess
 Bronchial carcinoma
 Severe or incompletely treated pneumonia
 Penetrating pulmonary trauma
 Post general anesthesia
 Pneumonia
 Diabetes mellitus
 Choking/ near-drowning/ aspiration
 Severe periodontal disease
 Stroke/cerebral palsy/cognitive impairment
 Immunosuppression
 Congenital heart disease
 Chronic lung disease
 Bacteremia
Types of lung abscess
Diagnostic evaluation
• Blood and sputum cultures
• ESR and C-reactive protein, which
are usually elevated
• Chest-X-ray shows walled cavity,
usually with a fluid level. There may
also be presence of an empyema or
effusion.
• CT-scan
• Fibreoptic bronchoscopy
• Trans-thoracic biopsy
Management
The management of lung abscess
includes:
 IV antibiotics are given usually about 2-3
weeks, followed by oral antibiotics for a
further 4-8 weeks.
 Recommended first line therapy includes
beta-lactamase inhibitor or cephalosporin
plus clindamycin, an alternative regimen is
to begin with a broad spectrum
cephalosporin and flucloxacillin.
 If the condition fails to resolve,
bronchoscopy/ trans-thoracic
drainage/cardiothoracic surgical intervention
may be considered.
 Surgery may be necessary when reinfection
of large cavitary lesion occur or there is
evidence of underlying neoplasm.
 The usual procedure done is lobectomy or
pneumonectomy.
Supportive measure include:
 Analgesics
 O2 if required
 Rehydration, if indicated
 Postural drainage with chest physiotherapy

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RESPIRATORY DISEASES by bhavya kelavadiya

  • 3. Introduction: Respiratory diseases are very often found in children, especially the respiratory infections. It is one of the leading cause of morbidity and mortality among young children. The important risk factors associated with respiratory disease include mal-nutrition, LBW, climatic variation especially in winter and rainy season, overcrowding houses, poor ventilation, air pollution, lack of ENV sanitation and poor socioeconomic condition.
  • 4.  The common C/F related to respiratory diseases are cough, dyspnea, expectoration, chest indrawing, chest pain, cyanosis and respiratory sound like wheezing, stridor, grunting and snoring.  Apnea, air hunger and flaring of alae nasi may also present.  In chronic cases hemoptysis, clubbing and associated cardiac or neurological symptoms may be found.  Special diagnostic procedures in the patients with respiratory diseases can be done to confirm the diagnosis.  They include ABG analysis, blood examination, examination of body secretion, radiology, MRI, USG, direct laryngoscopy, pulmonary function test, bronchoscopy, lung biopsy, sweat chloride in cystic fibrosis etc.
  • 8.  ARI and its complications are most frequent conditions of acute illness in infants and children.  In india , ARI is one of the major cause of childhood death.  It is also one of the major reason for which children are brought to the hospitals and health facilities.  About 13% of inpatient death in pediatric wards is due to ARI.  The proportion of death due to ARI in community is much higher as many children die at home.  Most children have 3-5 attacks of ARI in each year.  Many of these infections run their natural course without specific treatment and without complication.
  • 9. DEFINITION: ARI are an acute infection of any part of the respiratory tract and related structures including para-nasal sinuses, middle ear and pleural cavity. It may cause inflammation of respiratory tract anywhere from nose to alveoli with wide range of combination of symptoms and signs. It include all infections of less than 30 days duration, except the infection of ear lasting less than 14 days. The incidence of ARI is highest in young children, especially below 5 yr of age and decreases with the increasing age.
  • 10. Classification:  Depending upon the site of infection: A. Acute upper respiratory infections: These include common cold, rhinitis, nasopharyngitis, pharyngitis and otitis media. B. Acute lower respiratory infections: these include epiglottitis, laryngitis, bronchitis, bronchiolitis and pneumonia.  Depending upon the anatomical involvement: A. Broncho pneumonia: patchy involvement of lungs B. Lobar pneumonia: one or more lobes of lungs involved C. Pneumonitis or interstitial pneumonia : alveoli or interstitial tissue between them affected.
  • 11.  Depending upon the severity of infection( WHO recommendation): a) For the infant below 2 month:  No pneumonia  Severe pneumonia  Very severe disease b) For the child aged 2 month upto 5 years:  No pneumonia  Pneumonia(not severe)  Severe pneumonia  Very severe disease
  • 12. Etiological factors  Bacterial: pneumococcus, staphylococcus, streptococcus. , Klebsiella, E-coli, M.tuberculie  Viral: influenza, measels, chickenpox  Mycoplasma: mycoplasma pneumoniae  Fungal: candidiasis, blastomiosis  Protozoal: pneumocystis carinii, toxoplasma gondi  Rickettsial: typhus  Miscellaneous:
  • 13.  There are several different causes of acute respiratory infection. a) Causes of upper respiratory infection: acute pharyngitis acute ear infection common cold b)Causes of lower respiratory infection: bronchitis pneumonia bronchiolitis
  • 15. WHO recommendation, the features of lower respiratory infections can be grouped as follows:  Only cough and cold indicates no pneumonia.  Fast breathing: increased RR with the presence of cough and cold 40 b/m or more- 1-5yr 50 b/m or more- 2- 12 month 60b/m or more – less than 2 month  Chest indrawing with or without fast breathing indicates severe pneumonia. (other sign with severe pneumonia include nasal flaring, cyanosis, grunting or wheezing sound)  Very severe disease is indicated by the presence of danger sign like inability to drink, excessive drowsiness, stridor in calm child, apnea, fever, convulsion.
  • 16. Diagnostic evaluation:  Examination of clinical features  Detailed history taking  Auscultation of chest sound  X-rays  Spirometry  ABG analysis  Blood analysis  Sputum test
  • 17. Complications:  Pleural effusion  Emphysema  Atelectasis  Empyema  Lung abscess  Bronchiectasis  pneumothorax
  • 18. Management: Rx depends upon type of illness, severity of infections and associated complications. The standard treatment for childhood ARI is recommended by National ARI Control Program especially for primary health care setting.  The child with NO PNUEMONIA can be treated at home with home remedies for symptomatic treatment and does not require antibiotic therapy.  The child with PNUEMONIA can be treated in OPD with antibiotics and other symptomatic Rx like antipyretic and bronchodilators.  The child with SEVERE PNEUMONIA should be hospitalized urgently and requires parenteral antibiotics with symptomatic treatment.  The child with VERY SEVERE PNEUMONIA needs immediate hospitalization , antibiotic theraphy and O2 therapy.
  • 19. Nursing management  ASSESSMENT Assessment of respiratory dysfunction in children includes health history, physical examination, and laboratory or diagnostic testing.  Health History  Physical Examination Physical examination of the respiratory system includes inspection and observation, auscultation, percussion, and palpation.  Inspection and Observation Color. Observe the child’s color, noting pallor or cyanosis (circumoral or central). Pallor (pale appearance) occurs as a result of peripheral vasoconstriction in an effort to conserve oxygen for vital functions. Cyanosis (a bluish tinge to the skin) occurs as a result of hypoxia
  • 20. Note the rate and depth of respiration as well as work of breathing. Often the first sign of respiratory illness in infants and children is tachypnea .  Auscultation Assess lung sounds via auscultation. Evaluate breath sounds over the anterior and posterior chest, as well as in the axillary areas. Breath sounds should be equal bilaterally. The intensity and pitch should be equal throughout the lungs. Prolonged expiration is a sign of bronchial or bron- chiolar obstruction. Wheezing, a high-pitched sound that usually occurs on expiration, results from obstruction in the lower trachea or bronchioles. Wheezing that clears with coughing is most likely a result of secretions in the lower trachea.
  • 21. Wheezing resulting from obstruction of the bronchioles, as in bronchiolitis, asthma, chronic lung disease, or cystic fibro- sis, that does not clear with coughing. Rales (crackling sounds) result when the alveoli become fluid-filled, such as in pneumonia.  Interventions: Position with airway open (sniffing position if supine): open airway allows adequate ventilation. Humidify oxygen or room air and ensure adequate fluid intake (intravenous or oral) to help liquefy secretions for ease in clearance.
  • 22. Suction with bulb syringe or via nasopharyngeal catheter as needed, particularly prior to bottle- feeding to promote clearance of secretions. If tachypneic, maintain NPO status to avoid risk of aspiration. In older child, encourage expectoration of sputum with coughing to promote airway clearance. Perform chest physiotherapy if ordered to mobilize secretions. Ensure emergency equipment is readily availa ble to avoid delay should airway become unmaintainable
  • 23. SINUSITIS Sinusitis is an infection of the sinuses. The infection usually occurs after a cold or after allergic inflammation.
  • 24. Nasopharyngitis  It is also known as common cold or rhinosinusitis.  it is an inflammation of nasopharynx.  It is usually caused by virus that inflammes the membrane lining of nose and throat.
  • 25. Stridor  It is high pitched sound that usually heard when a child breathes in.  It usually cause by obstruction or narrowing of child’s upper respiratory path.
  • 26. Pharyngitis and Tonsillitis  Pharyngitis and tonsillitis are common co-morbidities that occurs due to infection and inflammation of the throat.  If the throat is primarily affected, it is called PHARYNGITIS and if mainly the tonsils are affected, it is known as TONSILITIS.  If both throat and tonsils are infected and inflammed, the condition is known as PHARYNGOTONSILITIS.
  • 30. Croup Croup is the syndrome characterized by BARKING COUGH, inspiratory stridor, horseness and sign of respiratory distress which occurs due to varying degree of laryngeal obstruction.
  • 31. Acute Bronchitis  Inflammation of the lining of bronchial tubes, which carry air to and from the lungs.  Acute bronchitis is often caused by a viral respiratory infection and improves by itself.  In children less than 4 yr of age
  • 33. Clinical features • Runny nose( before the cough starts) • Malaise • Chills • Fever • Back and muscle pain • Sore throat • Wheezing • In earlier stages of condition, the child may experiences a dry non-productive cough which progresses to excessive mucous filled cough.
  • 34. Diagnostic evaluation  History  Physical examination  X-ray  Ct- scan  Sputum test
  • 35. Management It include administration of:  Antibiotics  Cough expectorants  Antipyretic medicines  Steam inhalation
  • 36. Bronchiolitis  Bronchiolitis is a serious illness characterized by inflammation of bronchioles, causing severe dyspnea.  Bronchiolitis is almost always caused by a virus. Typically, the peak time for bronchiolitis is during the winter months
  • 37. Incidences and Etiology  Bronchiolitis is common in infant under the age of 6 month.  It is common in winter and early spring days.  The exact etiology is not clear.  Etiologic agent may be viruses such as respiratory syncytial virus, adenovirus and influenza virus.  Certain bacteria- pneumococcus, streptococcus
  • 38. Clinical features  Respiratory: fast breathing, shortness of breath, wheezing, difficulty breathing, or shallow breathing  Whole body: dehydration, fever, loss of appetite, or malaise Also common: coughing or nasal congestion
  • 39. Diagnostic evaluation X-ray x-ray of chest shows emphysema, prominent broncho-vascular markings and small areas of collaps. Lungs are characteristically overinflated and intercostal space are wide.
  • 40. Management  O2 administration  Maintaining atmosphere more saturated with water vapour  Mild sedation and postural drainage  IV therapy  Antibiotics  Aerosol therapy
  • 41. Bronchiectasis • Bronchiectasis is a chronic and permanent dilation of the bronchi and bronchioles. • It develops due to complete obstruction by inflammation , infection or inhalation of foreign body. • Incomplete obstruction of bronchi may result in obstructive emphysema. • Obstruction may develop due to collection of thick mucus in case of chronic bronchitis, bronchial asthma and cystic fibrosis.
  • 42. • Infection and obstruction lead to damage of the bronchial wall as formation of cultivation and tissue destruction. • It causes segmental areas of collapse, which exert negative pressure on the damaged bronchi leading them to dilation. • Collapse, emphysema and pneumonia usually accompany bronchiectasis. • The most common site of dilation is left lower lobe. • Right lower lobe may be affected due to foreign body and middle lobe due to tuberculosis. • History of bronchial occlusion and inflammation for a prolonged period leads to the development of the condition.
  • 44. Diagnosis History taking Physical examination X-ray= honeycomb appearance of affected part Bronchoscopy Broncho-graphy CT-scan Bacteriological study Sputum analysis
  • 45. Management  Appropriate systematic antibiotic therapy especially in acute exacerbation  Clearing secretion and exudates from air passage with postural drainage  Bronchodilators  Expectorants  Breathing exercise
  • 46. Nursing intervention  Assessing respiratory status, signs of complications, general health and ABG analysis  Providing rest, comfort and warm comfortable env.  O2 therapy  Removal of secretion  Oral care
  • 47. Pneumonia  Pneumonia is defined as an acute inflammation and consolidation of lung parenchyma.  It is 2nd leading cause of death in children under 5yr of age.
  • 48. Classification It can be classified on anatomical and etiologic basis. A) Classification on ANATOMICAL BASIS: • Lobar/lobular pneumonia: 1 or more lobes of lungs are involved • Interstitial pneumonia: interstitial tissues of lungs are affected • Bronchopneumonia: patchy consolidation of lungs
  • 50. B) Classification on an etiological basis:  Bacterial pneumonia: it may be cause by pneumococcus, streptococcus, staphylococcus  Viral pneumonia: it is caused by viruses like influenza, measles, respiratory syncytial virus  Fungal pneumonia: it may be caused by histoplasmosis and coccidiomycosis  Protozoal pneumonia: it is caused by pneumocystis carnii, toxoplasma gondii
  • 51. C) Miscellaneous types: • Aspiration pneumonia: it is caused by aspiration of food, nasal drops, amniotic fluid by newborn, water(drowning), and chemicals like kerosene oil etc. • Loffler’s pneumonia: it is condition in which eosinophils accumulate in lungs, in to parasitic infection. • Hypersensitivity pneumonitis: it is an inflammation of alveoli within lungs caused by hypersensitivity to inhaled dust. • Hypostatic pneumonia: it results from collection of fluid in dorsal region of lungs and occurs especially in those confined to bed for long time( bedridden)
  • 52. Clinical features: • Sudden onset • High fever with chills • Cough with thick sputum • Increased respiratory rate • Grunting respiration • Nasal flaring • Runny nose • Irritability • Malaise • Sore throat • Anorexia Late symptoms include: • Convulsion • Drowsiness • Inability to drink from mouth • Chest indrowing • Wheezing • Horseness of voice • Cyanosis • Pleural pain which may be increased by deep breathing and referred to shoulder or abdomen
  • 53. Pathogenesis Infectious agent foreign substances aspiration of gastric contents Inflammatory reaction of pulmonary tissues Edema of alveolar membrane Alveoli fill with exudate from inflammation Gases cannot cross edematous alveolar membrane Air cannot enter fluid-filled alveolar Hypoxia, Shortness of breathing Fatigue
  • 54. Diagnosis evaluation • History taking • Chest X-ray= X-ray finding suggesting bronchopneumonia include diffuse patchy consolidation in lungs. Consolidation is seen as homogenous opacity occupying the anatomic area of a lobe, usually in one lungs. • Nasopharynx or throat culture • Blood test
  • 55. Management • Antibiotics- penicillin, amoxicillin and clavulanic acid and macrolides including erythromycin, azythromycin and clorithromycin. • Antiviral therapy • Antifungal- fluconazole
  • 56. Nursing management • Make continuing assessment: - respiratory rate/patterns - observe the sign for distress • Facilitate respiratory effort - maintain airway and provide high humidity atmosphere - place child in semi-fowlers position - change the positions frequently to prevent pooling of secretion into the lungs - adm. Cough suppressants and bronchodilators • Control fever • Maintain fluid electrolyte balance along with nutritional status of the child • Promote rest and sleep
  • 57. Emphysema Emphysema results from distension and rupture of the alveoli due to the loss of elasticity of the lungs tissue with resultant air trapping.
  • 58. Risk factors/ causes Babies with a greater risk of are those with the following conditions: • Preterm birth, which often leads to respiratory disease • The lungs don't develop correctly (pulmonary hypoplasia) • Breathing in the first intestinal discharge (meconium) at birth • A lung infection (pneumonia) • Very fast breathing right after birth (transient tachypnea of the newborn)
  • 59. Classification • Obstructive emphysema: it occurs due to partial occlusion of bronchus or a bronchiole in case of atelectasis, bronchial asthma, lung infection etc • Compensatory emphysema: it occurs when normal lung tissue expands to fill up the areas of collapsed lung segments. • Congenital lobar emphysema: it is found in neonates and young children resulting from severe RD • Familial emphysema: it is found especially in female young child as progressive dyspnea, which is inherited as autosomal recessive trait.
  • 60. Clinical manifestation: Common features are: • Dyspnea • Tachypnea • Cough • Wheeze • Chest retraction • cyanosis
  • 61. Management Rx is depends upon the cause of the condition. Symptomatic Rx is important with, O2 adm Bronchodilators Mucolytic agents and antibiotics. Conservative treatment Lobectomy
  • 63. • Empyema is the collection of thick pus in the pleural cavity. • Empyema is the medical term for pockets of pus that have collected inside a body cavity. • It also termed as PYOTHORAX. • It developed directly from lungs or from neighboring structure or through blood. • It is fair common in infancy.
  • 64. Etiological factors • infections • Pneumococcus • Streptococcus • H. Influenza, etc • It may develop following pneumonia, lung abscess, pulmonary tuberculosis, chest injury, suppurative lung disease, septicemia and due to metastatic spread of suppurative foci from distant lesions such as osteomyelitis
  • 65. Clinical feature Many children do not have any symptoms of empyema, but they may have growth failure and some nonspecific symptoms like, Fever Cough Respiratory distress Chest pain Diarrhea Weight loss Clubbing Anemia Other feature malnutrition Chest signs are found as diminished movement of the affected side, mediastinal shift to opposite healthy side, widening and dullness of the intercostal spaces, dull percussion note and diminished air entry.
  • 66. Diagnostic evaluation • History taking • Physical examination • Pleural aspiration for biochemical and bacteriological examination. Complications: • Bronchopleural fistulas • Pyopneumothorax • Lung abscess • Purulent pericarditis • Osteomyelitis of rib • Septicemia • Meningitis • arthiritis
  • 68. Management • Management of empyema should be done with appropriate antibiotic therapy, inter-coastal drainage and symptomatic measures. • Antibiotic therapy should be started as early as possible and to be continued for 3-4 weeks. • Commonly used antibiotics are penicillin, cloxacillin, ampicillin, chloramphenicol, cephalexin etc. • Continuous closed intercoastal drainage is strongly recommended for management of empyema rather than the multiple aspiration of the pleural cavity. • Surgical drainage after thoracotomy may be needed to remove the collection, in case of severe respiratory difficulty. • Antipyretic • Analgesics • Nutritional supplementation
  • 71. • The word “asthma” means Struggling For Breath. • Asthma is a chronic inflammatory disease, characterized by airway obstruction( which is reversible either spontaneously or with medication), airway inflammation and an increased responsiveness of trachea and bronchi due to various stimuli. • It is chronic inflammatory disorder of lower airway due to temporary narrowing of bronchi by bronchospasm, mucosal edema and thick secretion.
  • 72. Etiological factors Bronchial asthma is the multifactorial. There are some predisposing and excitatory factors. A. Predisposing factors: • Heredity, with a family history of asthma and some other allergic disorders • Labile and over conscientious nature B. Excitatory factors: • Allergy to foreign substance produces allergic or extrinsic asthma - Inhalation of pollen, wool, feather, animal hair, smoke, dust - Ingestion of food, like egg, chocolate, some vegetables - Drugs
  • 73. • Respiratory infections • Worm infestation • Change in climate • Emotional disturbance due to anxiety, tension, fear and conflict • Excessive fatigue, exhaustion
  • 74. Classification Allergic or extrinsic asthma Non- allergic or intrinsic asthma It is produced by a hyper-immune (IgE) response to inhalation of specific allergen. The children usually have positive skin test to the offending allergen and positive family history of allergy. It is produced in response to unidentified or nonspecific factors of the environment. No hyper-immune response is produced. Inhalation of irritants like cigarette, odor, air pollution
  • 76. Pathophysiology Exposure to allergens or triggers(dust, pollen, smoke) Inflammatory response ( increased IgE) Bronchoconstriction Airway edema and increased mucous production Airway obstruction Hypoxia, wheezing, dyspnea, hyperventilation
  • 77. Clinical features: • The clinical feature of asthma have sudden onset and often occur at night. • Occasionally, asthma attack is preceded by asthmatic aura which is characterized by feeling of tightness in chest, restlessness, polyuria or coughing spell. • A typical asthmatic attack is manifested by: - Severe dyspnea - Bouts of cough - Wheezing - Cyanosis - Pallor - Sweating - Restlessness - Excessive use of accessory muscle of respiration - Extreme fatigue
  • 78. • Severe attack of asthma results in hypoxia, cyanosis and cardiac arrhythmias • In chronic cases the chest of the child becomes barrel shaped.
  • 80. Diagnostic evaluation • History • Physical examination • Pulmonary function test • Blood examination • Chest X-ray • Allergy test
  • 81. Management During acute attack, management aims at controlling bronchospasm and relieve inflammation. The medical management include: • Fast acting drugs: Salbutamol are 1st line Rx for bronchial asthma. Anticholinergic medications, such as Ipratropium bromide. • Long term control: Fluticasone oral inhalation is used to prevent difficulty breathing, chest tightness, wheezing, and coughing caused by asthma in adults and children. It is in a class of medications called corticosteroids. Fluticasone works by decreasing swelling and irritation in the airways to allow for easier breathing. • Other drugs: O2 therapy Magnesium sulfate- in severe asthma attack HOLIX, a mixture of helium and O2 may also be considered in severe unresponsive case.
  • 83. Nursing management • Providing emotional support and education • Administering adequate fluids • Provide rest and comfortable • Evaluate respiratory status and facilitate breathing
  • 85. A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. It may be develop due to rupture of sub-pleural or mediastinal nodes through the parietal pleura.  Pneumothorax usually occurs with fluid- Hydro pneumothorax  With blood- Hemo pneumothorax  With purulent material- pyo pneumothorax It may occur spontaneously as spontaneous pneumothorax (due to trauma or pathological process) or be introduced deliberately as artificial pneumothorax.
  • 86. Etiological factors: • The causes of pneumothorax in neonates are mainly the vigorous resuscitative procedures and staphylococcal infections. • In infancy, the common causes are infections (staphylococcal, pertussis) and iatrogenic problems (thoracocentesis, tracheostomy). • In older children, the common causes of pneumothorax are tuberculosis, empyema and foreign bodies.
  • 87. Clinical manifestations Dyspnea Cyanosis Chest pain Mediastinal shift to healthy side Hyper-resonant percussion note Flat percussion indicate presence of fluid
  • 88. Management Management of pneumothorax should be done promptly after the confirmation of diagnosis. Symptomatic and supportive care should be provided
  • 89. Pleural effusion • Pleural effusion is the collection of fluid in the thoracic cavity, between visceral and perietal pleura. • It is less common in children below 5 years.
  • 90. • Small effusion rarely produces symptoms or definite physical signs and usually detected by X-ray. • Large effusion may cause respiratory distress, chest pain and fever. • The fluid accumulates in pleural cavity may be transudate, exudate, serous, sanguineous, sterile, purulent or chylous. • Serous pleural effusion is commonly developed due to tuberculosis. • Hemothorax may result from trauma, malignancy or hemorrhagic diseases. • Chylothorax usually rare, it may occur due to injury of thoracic duct.
  • 91. Clinical manifestation • High fever • Cough • Chest pain on affected side that worsen on deep breathing and coughing • Abdominal pain • Weight loss • On examination, decreased chest movement on affected side, mediastinal shift to the opposite side, fullness of inter-coastal space, pleural rub, decreased breath sound, dull percussion note, decreased vocal resonance are usually found.
  • 92. Diagnostic evaluation History of illness Physical examination Chest X-ray X- ray = it shows a uniform opacity with curved upper border of fluid line.
  • 93. Management • Pleural effusion should be done according to the specific cause. • Specific chemotherapy along with symptomatic and supportive measures should be provided. • Relief of respiratory distress can be done by therapeutic thoracentesis for removal of collected fluid.
  • 95.  Cystic fibrosis is an inherited disease characterized by an abnormality in the body’s salt, water and mucous making cells.  It is chronic, progressive and usually fatal condition.  Children with cystic fibrosis have an abnormality in the function of a cell protein called Cystic Fibrosis Transmembrane Regulator (CFTR).  This cell protein controls the flow of water and certain salts in and out of body’s cells. As the movement of salt and water in and out of cells is altered, mucous becomes thickened.  Thick mucous can affect many organs and body system including:
  • 96. Clinical features • Each child may experience symptoms differently. Infants born with cystic fibrosis usually show symptoms within the first year. some children may not show symptoms until later in life. • The following symptoms may indicate cystic fibrosis- • Abnormalities in the glands that produce sweat and mucous • Thick mucous that accumulates in the lungs and intestines may lead to poor growth, frequent respiratory infections • Diarrhea may occur • Frequent episode of wheezing/ pneumonia • Persistent cough • Skin tastes like salt • Abdominal pain • Gas in intestines
  • 97. Other medical problems: Sinusitis Nasal polyps Clubbing of finger and toes Pneumothorax Hemoptysis Cor pulmonale Rectal prolapse Liver disease Diabetes Pancreatitis gallstones
  • 98. Diagnostic evaluation Physical examination History taking Genetic test Sweat (chloride) test Chest X ray Pulmonary function test Sputum cultures Stool evaluation
  • 99. Management At present there is no cure for cystic fibrosis. However, researches in gene therapy are being performed. The gene that causes cystic fibrosis has been identified and there is hope that will lead to an increased understanding of the disease. Also being researched are different drug regimens, to help treat cystic fibrosis. The goal of treatment are to ease severity of symptoms and slow the progress of the disease. Treatment may include:
  • 100. • Management of respiratory problems:  Chest physiotherapy ( to help loosen and clear lung secretion, it may include postural drainage and devices, such as a percussor or flutter, which vibrate the chest wall and loosen the secretion.)  Exercise (it help to loosen mucous, stimulate coughing and improve overall physical condition)  Medications (bronchodilators and anti- inflammatory medication)  Antibiotics ( to treat infection)
  • 101. • Management of digestive problems:  Appropriate diet  Pancreatic enzymes to aid digestion  Vitamin supplement  Psychosocial support is required to help the child and family to deal with issues such as independence, health, quality of life, finances and relationships.  Newer therapies include lung transplantation for patient with end-stage lung disease.
  • 103. • Lung abscess is a sever, localized suppurative infection in the lung, associated with necrotic cavity formation. • The cavity is surrounded by a fibrous reaction, forming the abscess wall. • Multiple small abscess formation may occur and sometimes referred to as “Necrotizing pneumonia”. • It may develop single abscess or multiple abscesses.
  • 104. Etiology and risk factors • The most frequent cause of lung abscess is aspiration of anaerobic organism from mouth, in those predisposed to pulmonary aspiration and having impaired immune defenses and cough reflex. • A pneumonitis develops which progresses to abscess formation over a period of days or weeks. • Mechanisms precipitating abscess formation include:  Inhalation of foreign body  Bacterial colonization in the lungs  Tricuspid endocarditis leading to septic pulmonary embolus  Extension of hepatic abscess  Bronchial carcinoma  Severe or incompletely treated pneumonia  Penetrating pulmonary trauma
  • 105.  Post general anesthesia  Pneumonia  Diabetes mellitus  Choking/ near-drowning/ aspiration  Severe periodontal disease  Stroke/cerebral palsy/cognitive impairment  Immunosuppression  Congenital heart disease  Chronic lung disease  Bacteremia
  • 106. Types of lung abscess
  • 107. Diagnostic evaluation • Blood and sputum cultures • ESR and C-reactive protein, which are usually elevated • Chest-X-ray shows walled cavity, usually with a fluid level. There may also be presence of an empyema or effusion. • CT-scan • Fibreoptic bronchoscopy • Trans-thoracic biopsy
  • 108. Management The management of lung abscess includes:  IV antibiotics are given usually about 2-3 weeks, followed by oral antibiotics for a further 4-8 weeks.  Recommended first line therapy includes beta-lactamase inhibitor or cephalosporin plus clindamycin, an alternative regimen is to begin with a broad spectrum cephalosporin and flucloxacillin.
  • 109.  If the condition fails to resolve, bronchoscopy/ trans-thoracic drainage/cardiothoracic surgical intervention may be considered.  Surgery may be necessary when reinfection of large cavitary lesion occur or there is evidence of underlying neoplasm.  The usual procedure done is lobectomy or pneumonectomy. Supportive measure include:  Analgesics  O2 if required  Rehydration, if indicated  Postural drainage with chest physiotherapy