Comparison of Pediatric Respiratory Disorders

Name of Disorder Respiratory Distress RSV/Bronchiolitis Cystic Fibrosis (CF) Croup (Spasmodic and Epiglottitis
Syndrome (RDS) AKA LTB)
Hyaline Membrane MEDICAL
Disease (HMD) EMERGENCY
Pathophysiology Pulmonary Respiratory Syncytial Virus is a Autosomal recessive Acute upper airway Epiglottitis is
Immaturity and very common cause of genetic disease obstruction secondary to most commonly
surfactant deficiency Bronchiolitis A deletion occurring swelling of the larynx and caused by a
– atelectasis of the on the long arm of subglottic tissue typically bacteria called
lung chromosome 7 at caused by a viral infection Haemophilus
the cystic fibrosis (commonly caused by the influenzae type B
transmembrane parainfluenza virus) (Hib). It can also
conductase Usually mild, happen when the
regulator (CFTR) Laryngotrachobronchitis child breathes in
(LTB) and Spasmodic very hot steam,
croup (usually occurs at certain chemicals,
night) or smoke from a
fire.
Risk Factors Prematurity (< 36 Babies born prematurely, Children Salty taste to the Age: 6 months to 5 years, Most often
weeks) * refer to PP younger than 2 who were born child’s skin Usually preceded by URI affects children 2
slide with heart or lung disease, Infants (resulting from to 7 yo
and young children whose excess chloride loss
immune systems are weakened, via perspiration)
Children under 8 to 10 weeks old – Caucasian
attendance at daycare, smoking
environment, no breastfeeding
Diagnostics Radiography – Radiography – hyperinflation of Serum Radiography – steeple Patient history,
possible blood lungs, Nasal washing for a viral immunoreactive sign, patient history, clinical findings,
cultures antibody test (ELISA) trypsinogen (IRT) clinical findings, Diagnosis Laryngoscopy is
DNA analysis for is on the basis of the best way to
mutations in CFTR symptoms, especially the confirm the
Sweat Test > 60 characteristic cough and diagnosis, but it is
mmols/L, appearance of the throat. not advised to
radiography, and The child should also be attempt any
PFTs checked for fever, cold procedures
symptoms or recent viral without securing
illness. the airway.
 Blood and
epiglottis
cultures. Blood
cultures and
culture of the
epiglottis should
be performed
only after the
airway is secured;
blood cultures
may show
Haemophilus
influenzae type b
(Hib) between 12-
15% and 90% of
cases.
Lateral neck
radiography.
Never obtain a
lateral neck
radiograph
before achieving
definitive airway
control; if
radiography is
required, the
safest procedure
is to perform
portable
radiography at
the bedside.
Thumb sign
Percutaneous
transtracheal
ventilation. Also
termed needle
cricothyrotomy or
translaryngeal
 ventilation,
percutaneous
transtracheal
ventilation is a
temporizing
method used to
treat cases of
severe epiglottitis
when the patient
cannot be
intubated before
a formal
tracheostomy.
Assessments Continuous C-R Continuous C-R monitoring and Oz Respiratory Continuous C-R Continuous
monitoring and Oz pulse oximetry, O2 assessments before monitoring and Oz pulse airway
pulse oximetry, O2 concentrations, vitals, hydration and after PD and oximetry, O2 monitoring,
concentrations for status Chest PT (or concentrations, vitals, safeguarding
delivery system, pulmonary hydration status airway,
vitals, ABGs, glucose toileting), crackles, maintaining O2
wheezes concentrations,
respiratory
assessment.
Assess the child’s
breathing,
breathing
through the
mouth, stridor,
and hypoxia.
Cardiovascular
assessment.
Assess the child’s
pulse; assess for
tachycardia and a
thready pulse.
Gastrointestinal
assessment.
Assess if there is
 an inability to
swallow.
Signs and Symptoms Tachypnea, nasal Rhinorrhea, Low-grade fever, Chronic or recurrent Barky cough (croup cough) Fever is usually
flaring, retractions, cough Tachypnea, nasal flaring, productive cough – Suprasternal, substernal the first
grunting, head retractions, grunting, head copious amounts of or intercostal retractions symptom, and
bobbing, cyanosis, bobbing, cyanosis, apnea thick mucus, Upper Irritability temperatures
apnea secondary to secondary to respiratory failure, and/or lower Anxiety often reach 40°C.
respiratory failure, WOB, wheezes, crackles, and respiratory Hypoxia, carbon dioxide Dysphagia.
WOB rhonci infections: sinusitis, retention Dysphagia or
nasal polyps barrel Altered mental status difficulty in
Hospitalization: toxic appearance, chest, digital swallowing is one
poor feeding, lethargy, clubbing, FTT, of the symptoms
dehydration, s/s respiratory Pancreatic in the clinical
distress, hypoxemia insufficiency – triad. Drooling.
inadequate Due to dysphagia,
absorption of fat- drooling occurs
soluble vitamins and is also one of
intestinal the symptoms in
obstructions, the clinical triad.
meconium ileus, Respiratory
obstruction or distress. The last
intussusception at of the three
Steatorrhea: fatty, symptoms in the
bulky, greasy, smelly triad, fever with
stools associated
Poor weight gain respiratory
and growth despite distress or air
good appetite hunger occurs in
Vitamin deficiencies most patients.
Tripod position.
The child is very
anxious and
prefers to
breathe by sitting
up and leaning
forward with the
mouth open and
the tongue out.
 Goals Maintain O2 Maintain O2 perfusion – sats > Maintain O2 To maintain open airway To maintain open
perfusion – sats > 95% perfusion – sats > in hospitalized child airway in
95% 95%, meets hospitalized child
nutritional demands
RN Interventions maintaining Respiratory assessment q 1-2 Require chest Cool mist Place trach set at
thermoregulation, hours or as necessary physiotherapy (CPT) Education take bedside, allow
hydration, Maintain patent airway with postural infants/children outside in position of
administration of Humidity/oxygen drainage, flutter cool air, Infants and small comfort, sit
oxygen, Elevate HOB devices, children sit upright, on upright, on
maintaining Fluids/monitor I&O meds daily via parents lap, parents lap, do
mechanical Rest nebulizer, Hydration not lie flat, blow-
ventilation, Handwashing facilitating growth Allow oral fluids byoxygen,
administering total Clustering care and development Comfort measures
parenteral nutrition Cohorting for care/ Pancreatic enzymes Favorite toy, book, Most
(TPN), antibiotics if Chest physiotherapy? – evidence and supplemental children recover without
indicated, cluster does not support CPT practices in fat-soluble vitamins medical treatment. Administer
care activities, clearing the airway – nasal prescribed to The condition can be humidified blow-
suctioning, bonding suctioning as needed promote adequate distressing and parents by oxygen at a
digestion and should try to keep the rate
absorption of child calm. Sitting upright of 10 L/minute,
nutrients and or carrying the child in administration,
optimize nutritional cool fresh air can aid hydration as child
status breathing. will not want to
Increased-calorie, Plenty of cool drinks will swallow (make
high-protein diets prevent dehydration. If child NPO until
Facilitating coping the child has a fever, airway is stable),
and adjustment by Tylenol or ibuprofen anxiety control
the child and family should be given. The
child’s clothing can be
removed if the room is
warm. Cough medicines
that cause drowsiness
should be avoided. The
child should avoid smoky
environments.
Medications The main role of Antipyretics – acetaminophen for Refer to Power Nebulized epinephrine, Corticosteroids.
surfactant is to fever Point slides Racemic epinephrine IV antibiotics
prevent collapse of (watch for rebound effect (cefuroxime)
 the alveoli thereby Palivizumab (Synagis) Pancreatic – hold in ER for 4 – 6
reducing the effort prevention/prophylaxis administered before hours)
needed to expand given monthly during high season meals and snacks Dexamethasone
the lungs during (Sept to April) Anti-inflammatory effect,
inspiration (breathing Beta2 agonists: inhaled Heliox - is a breathing gas
in) and allow gas bronchodilators (albuterol or composed of a mixture of
exchange to take epinephrine) helium (He) and oxygen
place. Surfactant Ribavirin (virazole) (O2). Heliox is a medical
therefore helps (inhaled/aerosolized): antiviral treatment for patients
breathing to be Recommended only for the with difficulty breathing.
relatively effortless. highest-risk, most severely ill reduces edema,
Can be administered children
by ET tube through Improves oxygenation
mechanical Shortens infection
ventilation - S.E. rash, conjunctivitis, anemia,
endotracheal tube bronchospasm
instillation Given by inhalation- pregnant
women precautions
Precautions Betamethasone – Contact Isolation, droplet Infection control Wash hands -avoid Wash hands
corticosteroids precautions – HAND WASHING, measures, good people with known
gown, glove, maks – virus particles pulmonary hygiene infections
on fomites
Evaluations Maintains gas Maintains gas exchange O2 sats > Maintains gas To maintain open airway To maintain open
exchange O2 sats > 95% exchange O2 sats > and improved O2 airway and
95% 95%, meets energy saturation improved O2
expenditure needs saturation