Acute Nasopharyngitis (The common cold)

Responsibility of the nurse: Rest, increase fluid intake, increase humidity, nasal drainage, ie. CHICKEN SOUP, nasal drop 15-20 minutes before feeding and at bedtime, prevention of lip excoriation r/t mouth breathing. This is the most common respiratory infection in infants and children. The nasal accessory sinuses and the nasopharynx are involved. ETIOLOGY:- Viruses cause an acute inflammation of the upper respiratory tract. Bacteria are the cause of the purulent second stage. This may be pneumococus, streptococus, or staphylococus. Clinical Manifestations:The child is irritable, sneezing, nasal discharge at 1st thin and later on become purulent, sore throat, vomiting diarrhea, fever, anorexia, cough, general malaise. In infants obstruction of nostrils interferes with sucking. COMPLICATIONS OF NASOPHARYNGITIS: Sinusitis, mastoiditis, otitis media, brain abscess, tracheitis, bronchitis or pneumonia TX.- Chicken Soup b/c it acts as an antiinflammatory inhibiting neutrophils (immune system cells that cause inflammation, it speeds up & thins out mucous through the nose reliving congestion. REST, NUTRITION, FLUIDS, CLEAN HUMIDIFIER. NO ABX- Its use for nasopharyngitis/common cold causes antibiotic resistance.

TONSILITIS & PHARYNGITIS: S/S- sore throat, painful swallowing, fevermothbreathing dries throat. Etiology- Tonsilitis is often viral so tx is managed symptomatically.

TX.- Saline gargles, non asprin and antipyretics, EXCEPT, NO Antipyretics if child has bleeding disorder)

(*Asprin and *Salicylates should be avoided inchildren.)

ASTHMA Asthmatic Bronchitis is MORE frequent in the COLD weather.

OTITIS MEDIA Infection of the middle ear, usually secondary to respiratory infection. B/C a child's eustacian tube is narrow & horizontal, it allows nasopharyngeal secretions AND microorganisms to ENTER, INFECT, INFLAME & cause EDEMA & SWELLING of the tube which BLOCKS DRAINAGE and CAUSES PRESSURE on the drum and RUPTURE! More common in infancy due to short Eustachian tube and lying position of the infant. Tobacco use INCREASES risk of infection. BREASTFEEDING DECREASES risk! Clinical features: PAIN, crying, baby pulling at ear, fever, vomit DIARRHEA, cold s/s. then exudation occurs Diagnosis: By otoscope examination of the ear drum Complications: Ruptured ear drum from fluid pressure buildup. Hearing LOSS, SPEECH PROBs, abcess formation, meningitis, lateral sinus thrombosis, and septicemia. Treatment: Amoxicillin or Augmentin. If not bacterial NO abx needed b/c it causes abx drug resistance. PARENT TEACHING! FINISH ABX!!!

If VIRAL, (no fever) treat symtomatically, NO antibiotics. IF CHRONIC: (2 or more ear inf in 6/mos) Audiology assessments with ABX and/or STEROID TX. Tympanostomy- Pressure equalizing tubes put in ear drums to allow drainage, minimize hearing loss, speech probs. EAR PLUGS for bathing/swimming! _____________________________________________________________

CROUP
CROUP TREATMENT: Nebulized epinephrine & Corticosteroids. Cool mist BLOW-BY, NOT tent or mask! Take child outside in cool air or stand by cool shower mist. CROUP symptoms: SEVERE obstruction of upper airway! BARKING cough and INSPIRATORY stridor. Airway narrows= s/s of resp distress> Wheezing & Retractions.
May become hypoxic and rarely need intubation.

LARYNEO-TRACHEO-BRONCHITIS-

EPIGLOTITTIS: (Death can occur QUICKLY)

*Bacterial infection (caused by Haemophilus influenza B) *** Epiglotittis can lead to ** COMPLETE AIRWAY OBSTRUCTION!! ** Child is IN RESP DISTRESS- ANXIOUS, drooling, sitting

leaning forward with their JAW THRUST OUTWARD b/c they cant breathe in difficult inspiratory effort!. Not talking, drinking coughing. *** ALWAYS REMEMBER the 4 D'sm (5) 1.Drooling 2.Dysphagia (can't swallow) 3.Dysphonia (can't talk) 4.Difficult inspiratory effort 5.Distressed looking or anxious NURSING MANAGEMENT:

#1 - Keep EMERGENCY TRACH EQUIPMENT READY!!

**Keep child CALM! DO NOT LOOK IN or EXAMINE child's throat!! BLOW-BY OXYGEN ONLY. Face mask is too distressing! Closely monitor airway, abx, fluids & supportive comfort measures. Stress the importance of the HiB vaccine, it prevents epiglotittis.

Epiglotittis Dx.- via X-RAY

BRONCHIOLITIS Nursing Care:

6.Promote ventilation and fluid intake. 7.Effective airway clearance through nasopharyngeal suctioniong w/ catheter or bulb syringe.

8.O2 via nasal cannula Raising HOB, CLUSTER CARE. 9.Encourage caregiver involvement to reduce child's stress therefore workload of breathing. 10.IV fluids given until child can drink enough. 11.ANTIPYRETICS to reduce fever. 12.Give nebulized pulmonary medication and chest physiotherapy. 13.PREVENTION of RSV BRONCHIOLITIS is by consistent HANDWASHING! EVALUATION BY NURSE: Child with RSV BRONCHIOLITIS: #1. CLEAR lung sounds is primary criteria for evaluating resolution of ineffective airway clearance. #2. Moist mucous membranes and urine output are indicators of adequate PO fluid intake. #3. Parent teaching: Hygiene, as RSV is very contagious=HANDWASHING, promote fluids to liquify thick secretions, how to use bulb syringe An acute , viral infection causing inflammation of bronchioles. WHEEZING caused by airway obstruction from edema & secretions. Alveoli- Hyperinflation of some while collapse (atelectasis) of others. Bottom Line: The inflammation, obstruction and edema causes child to become HYPOVENTILATED. TX.- Humidified O2, antibiotics ONLY if bacterial, (Ribavirin (antiviral) is used ONLY in HIGH RISK populations. PREVENTION: Give pneumovax vaccine! -At 1st, mom see's, upper respiratory s/s's, rinorrhea, sneezing, low-grade fever, coughing, decreased appetite.

-THEN: Increased respiratory and pulse rate. Tachypnea & wheezing become very apparent. Also poor feeding, nasal flaring, retractions, wheezing, CRACKLES, intermittent CYANOSIS and a prolonged expiratory phase. Diagnostic Testing: WBCs are normal. NP or sputum culture. CXR- INFILTRATES and ATELECTASIS. Home mngmnt- Rest, fluids, and fever mngment. Hospitalized when: Respiratory distress, dehydrated. Child is given humidified O2, IV fluids, Mechanical ventilation indicated for respiratory failure.
COMPLICATIONS: Secondary bacterial infection.

PREVENTION- by using immunoglobulin or antibody drugs is ONLY recommnded for high risk infants/toddlers.

Allergic Rhinitis:
AKA "HAY FEVER"- predisposes kids to> otitis media, sinusistis and asthma.

PNEUMONIA
An acute resp. infection where alveoli are filled with pus & fluid which makes breathing painful and limits Oxygen intake. LOW BP & high pulse. Lungs: Cough w/ or w/out sputum, hemoptysis, SOB, pleuritic chest pain. High fever * chills, poor appetite, HA, nausea, clammy skin. Dx. CXR and sputum culture Aspiration Pneumonia: High risk are children w/ feeding problems. Avoid solvents, talcum powder, oily nose drops, Use good upright feeding position and technique. IF VIRAL: Use precautions, gown, mask, isolation and gloves. Viral Pneumonia= ISOLSATION and precautions.

Keep hydrated to liquify thick secretions so sputum can be coughed up!

**** If BACTERIAL PNEUMONIA- GIVE ABX ***** H. influenzae b and S. pneumoniae are both PREVENTABLE d/t the availibility of vaccinations

CHRONIC RESPIRATORY ISSUES:

ALLERGIC RHINITISASTHMA-

LESS COMMON CYSTIC FIBROSIS: TUBERCULOSIS: SINUSITIS:

FOREIGN BODY ASPIRATION

SMOKE INHALATION

R.S.V. / Respiratory Syncytial Virus

Adenovirus

Rhinovirus