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Respiratory
Disorders
(DDX)
Narendra Shanmugam
Group 22
6th year 2nd semester
2016
Objectives
Respiratory System
Respiratory Infections
Influencing factors
* Age
* Anatomical Size
* Resistance
* Seasonal Variations
Etiology
* H. influenza, Group A -Hemolytic
Streptococcus, Staphylococci,
Chlamydia trachomatis,
Mycoplasma,
pneumoccoci
Epiglotitis
Definition
Incidence
Epiglottitis
History
Epiglotitis
Clinical
Always
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
Fear/anxiety
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
Etiology
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)
Clinical Manifestations
Severe
*
*
*
*
*
Nursing Diagnoses
Nursing Coventions
Provide
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
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
Types of Pneumonia
Lobar
Broncho
Primarily
occurs within the
alveolar walls and
interlobular tissues.
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
Pain
Nursing Coventions
Administer
inflammatory process of
the large airways, which results in
heightened airway reactivity.
An
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
Nursing Coventions
Allergy
Drug
control
therapy
Chest
PT
Hydration
Exercise
Keeping
up with immunizations/flu
vaccine
Desensitization
therapy
O2 Delivery Devices
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
Cystic Fibrosis
Areas
*
*
*
*
of involvement
Respiratory system
Integumentary system
GI system
Reproductive system
Cystic Fibrosis
Major
Nursing Coventions
Administer
Nursing Coventions
Administer
The End...