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Chapter 24

Chapter 24. Caring for the Child with a Respiratory Condition . The Child’s Respiratory System. Differences between the child and adult Nares Epiglottis Thyroid, cricoid, and tracheal cartilage Neck muscles Soft tissue Trachea Lung tissue Abdominal versus thoracic breathing .

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Chapter 24

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  1. Chapter 24 Caring for the Child with a Respiratory Condition

  2. The Child’s Respiratory System • Differences between the child and adult • Nares • Epiglottis • Thyroid, cricoid, and tracheal cartilage • Neck muscles • Soft tissue • Trachea • Lung tissue • Abdominal versus thoracic breathing

  3. Congenital Respiratory Conditions and Structural Anomalies

  4. Choanal Atresia Signs and symptoms • Difficulty with nasal breathing Nursing care • Insert oral airway • Gavage feeding • Teach parents • Feed in a semi-upright position • Maintain aspiration precautions

  5. Nursing care Assist in the administration of surfactant Place in an incubator Use warm humidified oxygen Analyze laboratory values Monitor vital signs Provide adequate amount of calories and fluids Respiratory Distress Syndrome • Signs and symptoms • Rapid, shallow respiration • Audible grunting • Retractions • Nasal flaring • Cyanosis

  6. Esophageal Atresia and Tracheoesophageal Fistula • Signs and symptoms • Frothing and bubbling at mouth/nose • Excessive drooling/salivation • Coughing, cyanosis, and respiratory distress • Nursing care • Maintain patent airway • Prevent aspiration (no oral feedings) • After corrective surgery • Monitor vital signs • Maintain chest tubes/intubation • Provide parental nutrition, then oral feedings • Prevent infection

  7. Congenital Diaphragmatic Hernia • Signs & symptoms • Severe respiratory distress • Nursing care • Discuss surgery • Stabilize (oxygen and prevent further trauma) • Assist with endotracheal intubation • Insert orogastric or nasogastric tube • Administer surfactant • ECMO (full-term infants) • Monitor pulmonary and cardiac status • Provide postoperative care

  8. Nursing care Give oxygen Administer bronchodilators and corticosteroids Use pulse oximetry Evaluate blood test/x-ray results Administer diuretics (replace electrolytes) Monitor and maintain fluids Ensure proper nutrition Bronchopulmonary Dysplasia • Signs & symptoms • Tachypnea • Wheezing, rales, retractions, and cyanosis • Increased respiratory rate

  9. Cystic Fibrosis • Signs and symptoms • Wide range & severity varies • Multisystem • Nursing care • Ensure respiratory function (aerosol therapy, chest physiotherapy, and antibiotic therapy) • Promote good nutrition (replace pancreatic enzymes) • Find resources for parents • Teach parents • See Chapter 24 Care Plan

  10. Upper Airway Disorders

  11. Sinusitis • Signs and symptoms • Cold (thick, yellow-green discharge) • Postnasal drip • Headache • Irritability and fatigue • Swelling around the eyes • Nursing care • Give antibiotics • Give nasal spray/decongestant • Teach parents

  12. Nasopharyngitis • Signs and symptoms • Dryness and stuffiness • Clear, watery nasal secretions and lacrimation • sore throat, headache, and malaise • Nursing care • Promote symptomatic care (antipyretics and rest) • Give antihistamines/decongestants • Elevate head of bed • Promote adequate fluid intake (avoid milk products) • Teach hand washing and proper disposal of tissue paper into waste receptacle • Discuss prevention strategies

  13. Pharngitis • Signs and symptoms • Abrupt illness • Headache, fever and abdominal pain • Tonsils and pharynx (inflamed, large, red covered with yellow exudate) • Lymph nodes enlarged and tender • Pain on swallowing • Nursing care • Give antibiotics (teach parents to give full dose for prescribed duration) • Encourage bed rest • Apply cold or warm compress to neck • Encourage warm saline gargle • Give foods and liquids that can be tolerated • Teach about proper hand washing

  14. Tonsillitis • Signs and symptoms (acute) • Fever and chills • Foul breath • Dry throat, dysphagia, otaliga, headache, malaise, muscular pain, enlarged cervical nodes, and mouth breathing • Nursing care • Follow medical management (antibiotics, antipyretics, analgesics) • Tonsillectomy (postoperative care) • Assess for postoperative bleeding

  15. Croup Signs and symptoms • Hoarseness • Barking cough • Respiratory distress (varying degrees) • Respiratory infection • Nursing care • Maintain airway/adequate respiratory exchange • Use a cool mist vaporizer • Give nebulized racemic epinephrine • Give corticosteriods • Monitor respiratory and cardiac systems • Never assess child’s throat with tongue blade if epiglottis or bacterial tracheitis is suspected

  16. Otitis Media/Externa • Signs and symptoms • severe ear pain • itching & drainage • erythema & edema • Nursing care • Give antibiotic ear drops • Give corticosteroids and analgesics • Teach parents to have child avoid getting ears wet

  17. Otitis Media • Signs and symptoms • Pain • Irritable and pulls on affected ear • Febrile (104°F [40°C]) • Lymph gland enlargement • Rhinorrhea, vomiting, diarrhea, and loss of appetite • Nursing care • Administer antibiotics used judiciously • Give analgesics • Teach parents about prevention strategies

  18. Lower Airway Disorders

  19. Bronchitis • Signs and symptoms • Cough (dry to productive and worsens at night) • Rhinorrhea • Nursing care • Give symptomatic care (antipyretics, analgesics, humidity) • Give adequate oxygen • Administer bronchodilators • Use cool-mist vaporizer • Give fluids • Promote bed rest • Teach parents to avoid secondhand smoke • Promote adequate nutrition

  20. Nursing care Give symptomatic care Administer antibiotics (bacterial) Give oxygen with cool mist Give chest physiotherapy Promote postural drainage Give bronchodilators Encourage fluid intake Give antitussive medication at bedtime Position on affected side Monitor vital signs and breath sounds Teach parents Pneumonia • Signs and symptoms • High fever • Cough • Rapid respirations • Chest pain • Retractions • Nasal flaring • Malaise • Rhonchi or fine crackles

  21. Infectious Conditions

  22. Pertussis • Signs and symptoms • Catarrhal, paroxysmal, convalescent • Nursing care • Limit paroxysms (observe severity of cough, nutrition, rest, and recovery) • Give antibiotic therapy • Promote adequate nutrition • Discuss vaccination (DTaP) • Teach parents about hospitalization • Droplet precaution • Vital signs and oxygen saturation • Hydration, nutrition, and fluids

  23. Tuberculosis • Signs and symptoms • Asymptomatic early • Low-grade fever, mild cough, and flu-like symptoms • Anorexia and weight loss • Nursing care • Promote proper nutrition • Give anti-TB drugs • Give supportive care • Prevent reinfection

  24. Influenza • Signs and symptoms • Sudden fever and chills • Flushed face • Photophobia, myalgia, hyperesthesia, and exhaustion • Nursing care • Promote rest and fluids (electrolyte solution) • Give medication for fever and pain • Give antiviral drugs • Give antibiotics only if evidence of bacterial infection • Discuss influenza vaccine for prevention

  25. Pulmonary Noninfectious Irritation

  26. Foreign Body Aspiration • Signs and symptoms • Choking, gagging, wheezing, and coughing • Obstruction = dyspnea, cough, stridor, hoarseness, inability to speak and breathe • Nursing care • Laryngoscopy or bronchoscopy to remove obstruction • Monitor vital signs and assess LOC • Explain procedures • Ensure NPO, cool-mist vaporizer, and antibiotic therapy • Heimlich maneuver

  27. Smoke Inhalation • Signs and symptoms • Heat (edema of the upper airway) • Chemical (airway erythema, edema, ulceration) • Systemic (headache, malaise, nausea, dizziness, andalterations in mental status) • Nursing care • Provide immediate administration of oxygen • Monitor respiration and circulation • Nutrition • Maintain normal development

  28. Passive Smoking • Signs and symptoms • Stuffy, runny nose; watery eyes; sneezing; coughing; wheezing; headache; and nausea • Nursing care • Control passive smoking • Provide health education • Teach parents about a smoke-free environment

  29. Respiratory Conditions Related to Allergens

  30. Allergic Rhinitis • Signs and symptoms • Sneezing, itching, rhinorrhea, postnasal drip, congestion, headache, earache, tearing, red eyes, eye swelling, fatigue, drowsiness, and malaise • Nursing care • Administer antihistamines, nasal corticosteroid sprays, decongestants, and leukotriene inhibitors • Identify triggers • Educate parents about allergy shots

  31. Asthma • Signs and symptoms • Wheezing, prolonged expiratory phase • Tachypnea • Retractions and nasal flaring • Chronic = cough at night, barrel chest, elevated shoulders • Nursing care • Administer drug therapy • Quick relief • Long-term control • Asthma Action Plan • Instruct about the use of apeak flow meter • Understand symptom relief • Educate parents • Status asthmaticus is persistent & intractable asthma in which the child does to respond to therapy and a medical emergency ensures

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