Childrens

Respiratory
Disorders
(DDX)
Narendra Shanmugam
Group 22
6th year 2nd semester
2016

Objectives

Describe factors that influence the

etiology and course of respiratory
infections in children.

Differentiate among Epiglottis,

RSV/Bronchitis, Pneumonia, Asthma, and
Cystic Fibrosis in terms of etiology,
defining characteristics, and nursing
management.

Respiratory System

The respiratory system

permits ventilation through
the process of inspiration
and expiration

Respiratory Infections

Influencing factors
* Age
* Anatomical Size
* Resistance
* Seasonal Variations

Etiology
* H. influenza, Group A -Hemolytic
Streptococcus, Staphylococci,
Chlamydia trachomatis,
Mycoplasma,
pneumoccoci

Epiglotitis
Definition

A severe bacterial infection which

causes inflammation of the epiglottis
and surrounding areas.

Incidence

Usually occurs between the ages of

2 5 years of age, but can occur
from 7 mos. 11 years rarely to
adulthood.

Epiglottitis
History

Abrupt onset History of

pharyngitis.
Clinical Signs & Symptoms
Wakes up looking very ill, fever,
sore throat, dysphagia, drooling,
dyspnea, dog position.

Epiglotitis
Clinical

Signs & Symptoms

* Anxious/apprehensive
* Muffled, froglike croaking
* Quiet inspiratory stridor

Always

observe for the absence of

cough, drooling and agitation
hallmarks of epiglottis.

REMEMBER !!!
1. Never examine the pharynx.
2. Leave the child in a sitting position
preferably in parents lap.
3. Child is anxious Do not cause
further distress and never leave the
child alone.
4. Cyanosis is a late sign of hypoxia
(PO2 < 50).

Nursing Diagnoses

Ineffective

breathing pattern r/t

inflammatory process.

Fear/anxiety

r/t difficult breathing

and
unfamiliar place/procedures.

Nursing Coventions
Observe for progressive worsening of
respiratory status.
Prepare for tracheostomy.
Be prepared for administration of O2,
IV antibiotics, sedation.
Monitor VS, LOC, O2 levels, fluid
status.
Provide calm reassuring support to
child and parents.
Prevention is via the H. influenza B
vaccine.

Nursing Coventions
Administer

antipyretic medication,
tepid sponge baths, or cooling
mattress if indicated.
If needed, provide cool mist for
humidifying air.
Ensure adequate rest and provide a
less stressful environment.
Organize nursing care to give
adequate rest periods.

Early Epiglottitis
Note the
tripod

(doglike)
position
and the
leaning
forward

Progressive Epiglottitis

Bronchiolitis
Definition

An acute viral infection

primarily occurring at the level of
the bronchioles.

Etiology

Respiratory Syncytial Virus

(RSV). Subgroup A > B in children
developing bronchiolitis and
pneumonia.

Incidence and Transmission

* URI of the infant 2-5 mos. Rare in

children over 2 years. Considered

to be the most important pathogen
in the infant. Usually preceded by a
viral URII (RSV).
* Increased incidence due to (1)
direct contact hands, eyes, nose,
mucous membranes and (2) the
virus has a long life span.

Clinical Manifestations
Mild

*
*
*
*

(Initial phase)

Rhinorrhea
Pharyngitis
Coughing and sneezing
May present with ear or eye
infection
* History of intermittent fever

Clinical Manifestations
Moderate

*
*
*
*

(Progressive)

coughing and wheezing

Air hunger and WOB
Tachypnea and retraction
Cyanosis

Clinical Manifestations
Severe

*
*
*
*
*

Tachypnea > 70 breaths/minute

Listlessness(lack of energy)
Apnea spells
Poor air exchange
breath sounds

Nursing Diagnoses

Ineffective breathing r/t poor gas

exchange.

Altered activity level r/t work of

breathing.

Potential of fluid volume deficit r/t

poor
fluid intake.

Nursing Coventions
Provide

humidity cool, moist

oxygen
Adequate fluid intake
Ongoing assessment and monitoring
of O2 status, VS, activity level
Possible administration of antiviral
agents (RespiGam used more for
prophylactic value)

Nursing Coventions
Conserve
Observe

*
*
*
*

childs energy

for signs of dehydration:

Sunken fontanel
Poor skin turgor
Dry mucous membranes
Decreased and concentrated
urinary output

Remember
As this infection is due to a virus
standard Rx may not prove to be
effective in non-complicated situations,
including:
* antibiotics
* bronchodilators
* corticosteroids
* cough suppressants

Pneumonia

Inflammation of the alveoli

caused by bacteria, virus,
Mycoplasma organisms,
aspiration, or inhalation.

Types of Pneumonia
Lobar

Large areas (segments) of

one or both lungs are
involved.

Broncho

bronchioles become clogged

with thick mucopurulent
mucus consolidates into
patches in nearby lobes.

Types of Pneumonia cont.

Interstitial

Primarily
occurs within the
alveolar walls and
interlobular tissues.

Incidence and Etiology

Incidence
10-20 % of the cases of pneumonia are
bacterial;
10 % are mixed both viral and bacterial.
70 80 % are viral.
Etiology
Mycoplasma pneumoniae most common in
children 5 12 years-of-age.

Chest x-rays - Pneumonia

Clinical Manifestations

fever
Cough (productive or nonproductive)
Tachypnea
Fine crackles and rhonchi
Chest pain
Retractions and nasal flaring
Pallor to cyanosis
Irritability restless lethargic
GI disturbances (nausea, diarrhea,
pain, anorexia).

Nursing Diagnoses
Ineffective

airway clearance r/t

inflammation.

Pain

r/t inflammatory process:

pneumonia

Nursing Coventions
Administer

and monitor antibiotic

therapy (bacterial).
Monitor fluid intake, VS (especially
the
temperature give antipyretics in
needed (fever/irritability), bed rest,
cool mist humidifier.
In-hospital monitor O2 if child
develops respiratory distress.
Avoid cough suppressants.
Teach parents s/s of respiratory
distress and dehydration.
Conserve childs energy.

Reactive Airway Disease Asthma

Definition

inflammatory process of
the large airways, which results in
heightened airway reactivity.

An

obstructive disorder due to the

inflammation and edema of the
mucous membranes, in thick,
tenacious secretions, spasms of the
bronchial smooth muscle a
diameter of bronchioles.

Types of Asthma
Mild

Intermittent Asthma
* S/S 2 times per week
* Exacerbations are brief
* Nighttime s/s 2 times per month
* Asymptomatic between episodes
* Does not require chronic drug
therapy
* Teach and encourage parents to
exposure to allergens

Types of Asthma
Mild

Persistent Asthma
S/S > 2 times per week - < 1/day
Exacerbations may/may not affect
exercise
Nighttime s/s > 2 times per month
Tx with a nonsteroidal Rx - Cromolyn
Sodium, a low dose inhaled corticosteroid or a leukotriene inhibitor.

Types of Asthma
Moderate Persistent Asthma
*Daily s/s
*Daily use of short-acting 2-agonist or a
low
dose long-acting bronchodilator
*Exacerbations affect exercise
*Exacerbations 2 times per week and
may last
for days
*Nighttime s/s > 1 time per week
*May see Nedocromil (Tilade) given in
children
5 years or younger in place of long-acting
bronchodilator

Types of Asthma
Severe

Persistent Asthma
* Continual s/s
* Frequent exacerbations
* frequent nighttime s/s
* PEFR and/or FEV1 > 1 second and
60
% of predicted value
* Tx - high dose inhaled corticosteroids
(Vanceril, Flovent) plus oral steroids
as needed to control s/s

Asthma
Educate

child and family about the

disease - assist them to identify the
triggers - help them in developing
an asthma action plan AND teach
and encourage child to use a peak
flow meter regularly as part of
his/her action plan to determine
management of their s/s.

Nursing Coventions
Allergy
Drug

control

therapy

Chest

PT

Hydration
Exercise
Keeping

up with immunizations/flu

vaccine
Desensitization

therapy

O2 Delivery Devices

Metered Dose Inhaler-Spacer

Remember
Assessment

- Teaching - Monitoring
are hallmarks of effective care for
the asthmatic child - whether in an
acute care facility or community
health center.

Cystic Fibrosis
Definition

An inherited, autosomal recessive

disorder, which affects the exocrine
glands and results in multisystem
involvement.
Most significant factor - The viscosity
of mucus gland secretions = obstruction

Cystic Fibrosis
Areas

*
*
*
*

of involvement

Respiratory system
Integumentary system
GI system
Reproductive system

Cystic Fibrosis
Major

signs and symptoms due to:

* Lack of sufficient pancreatic

enzymes.
* Gradual obstructive lung disease
* sweat gland function.

Nursing Coventions
Administer

and monitor effects of

antibiotic, bronchodilator, and
nutritional management.
Teach chest PT - MAINSTAY of therapy!
Teach proper postural drainage
technique.
Promote exercise, deep breathing and
directed coughing.
Teach parents/child s/s of infection
and complications i.e. pneumothorax

Nursing Coventions
Administer

and/or monitor pancreatic

enzyme replacement therapy. ** Always
administer with meals and snacks amount given relates to degree of
insufficiency and the childs response
to the enzyme therapy. Goal is to
prevent FTT and to number of stools.

The End...