NURSING CARE OF THE CHILD WITH RESPIRATORY DYSFUNCTION

Prepared By: Ana Maria M. Pingol RN MSN

 Nursing Assessment General Nursing Interventions Specific Disorders Nasopharyngitis Influenza Tonsillitis The Tonsillectomy patient Croup Bronchiolitis/ RSV Pneumonia Asthma Cystic fibrosis Otitis media SIDS

Components for Assessing Respiratory Function Respirations

Rate Depth Ease Labored Breathing Rhythm

 Evidence of infection Cough Wheeze Cyanosis Chest pain Sputum Bad breath
Head Bobbing- Respiratory Distress in infants.mp4 Stridor & Retractions.mp4

Grunting baby.mp4

General Nursing Interventions

Ease respiratory efforts
Warm/ cool mist therapy

Promote rest
Bed rest or quiet play

Promote comfort
Nose drops, throat irrigation decongestants

 Prevent spread of infection

General Hygienic measures Isolation

Reduce temperature
TSB antipyretics

Promote hydration
Oral and parenteral

Provide nutrition
Consider preference

Provide family support and teach home care

NASOPHARYNGITIS
The common cold (also known as nasopharyngitis, acute viral rhinopharyngitis, acute coryza, or a cold) is a viral infectious disease of the upper respiratory system, caused primarily by

 Fever

NASOPHARYNGITIS: CLINICAL MANIFESTATIONS

Watery and profuse nasal secretions (but may become more purulent and mucoid)

Irritability, restlessness Sneezing Vomiting or diarrhea Dryness and irritation of nose and throat Chilly sensation Muscular aches Cough, mild and occasional Edema and vasodialtion of mucosa

Common Cold
Medical Management
Antipyretics (avoid aspirin if influenza is suspected) Nasal decongestants Hydration For Cough: Antitussives, Expectorants, Mucolytics Antihistamines Bronchodilators

Common Cold: Nursing Management

Assess for signs and symptoms of respiratory distress Promote adequate hydration Encourage bed rest Administer prescribed meds and monitor fo side effects saltwater drops in the nostrils to relieve nasal congestion (you can buy these also called saline nose drops at any pharmacy)

Signs of Respiratory Complications: Evidence of earache Respirations faster than 50-60 breaths/ min Fever over 38.3oC Listlessness Increasing irritability Persistent cough for 2 days or more Wheezing Crying Refusal to eat Restlessness and poor sleep patterns

Common Cold: Nursing Management

a cool-mist humidifier to increase air moisture petroleum jelly on the skin under the nose to soothe rawness hard candy or cough drops to relieve sore throat (for kids older than 3 years) a warm bath or heating pad to soothe aches and pains steam from a hot shower to help patient breathe more easily

Common Cold: Preventive Measures

Hand washing Proper Nutrition Isolation of sick patients Proper disposal of secretions Surface disinfection of contaminated surfaces

INFLUENZA
Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family. Orthomyxoviridae (the influenza viruses), with types A and B causing epidemic disease.

Clinical Manifestations:
Onset is sudden chilly sensation, hyperpyrexia (39-39.5oC), malaise, sore throat, coryza, rhinorrhea, and myalgia Prostration and generalized aches and pains (most pronounced in the back and legs Headache with photophobia and retrobulbar pain

Clinical Manifestations:
Scratchy sore throat Substernal burning Nonproductive cough that eventually becomes more persistent and productive Lacrimation, mild conjunctivitis Nausea and vomiting in children Reddened tonsils and pharynx with no exudate

Complications Directly related to primary viral infection: Hemorrhagic pneumonia Encephalitis Reyes Syndrome Myocarditis SIDS Myoglobinuria Superimposed bacterial infection (pneumococcal or staphylococcal) Otitis media, Sinusitis, Pneumonia

Medical Management
Symptomatic Antipyretics and Analgesics (acetaminophen and aspirin) Antiviral drugs (Amantadine) Nasal decongestants Steam inhalation Antibiotics for superimposed bacterial infections

Nursing Management
Respiratory Isolation Promote Hydration Relieve Fever Limit strenuous activity Monitor for complications

Influenza: Preventive Measures

Immunization Avoidance of crowded places Public education regarding the importance of basic personal hygiene Frequent handwashing

COLD versus FLU S & SX Fever Headache General Aches Fatigue Runny Nose Sore throat Cough FLU characteristic Prominent COLD Rare Rare

Usual often severe Slight Extreme (2-3wks) Sometimes Sometimes Common; can become severe Mild Common Common Mild to moderate

TONSILLITIS
Inflammation of the tonsils caused by bacterial or viral infection; often occurs with pharyngitis

CLINICAL MANIFESTATIONS
Enlarged, reddened palatine tonsils with or without exudate kissing tonsils Difficulty swallowing or breathing Drooling Lymphadenopathy Mouth-breathing

THERAPEUTIC MANAGEMENT
Management for viral tonsillitis is symptom relief; similar to viral pharyngitis Bacterial tonsillitis: antibiotic therapy Soft/ liquid diet, nonirritating foods Saltwater gargles, lozenges, or anesthetic sprays Acetaminophen for pain relief and fever Tonsillectomy: removal of tonsils to

Care of the Post-Tonsillectomy Patient: Provide pain control with analgesics and ice collar Observe for excessive bleeding Offer clear, chilled fluids when awake and alert; avoid red-colored fluids; milk products are discouraged Teach child and parents that a sore throat is to be expected for approximately 1 week postoperatively Avoid strenuous activity for about 1

OTITIS MEDIA
A bacterial or viral infection in the middle ear, usually secondary to an upper respiratory tract infection

CLINICAL MANIFESTATIONS
Ear pain (otalgia) Irritability Diarrhea Fever Vomiting pulling at affected ear Red, bulging, nonmobile tympanic membrane May be asymptomatic in some children

 Avoid exposure of child to cigarette-smoke Antibiotics Acetaminophen or ibuprofen; codeine for severe pain Surgical management: Myringotomy Tympanostomy

THERAPEUTIC MANAGEMENT

CROUP
An acute viral inflammation of the upper and lower respiratory tracts, characterized by inspiratory stridor, subglottic swelling, and respiratory distress that is most pronounced on

CLINICAL MANIFESTATIONS
Croup usually begins with nonspecific respiratory symptoms, including: Rhinorrhea Sore throat Cough. Fever is generally low grade (38-39C) but can exceed 40C. Within 1-2 days, The characteristic signs of hoarseness, barking cough, and inspiratory stridor develop, often suddenly, along with a variable degree of respiratory distress. Symptoms are perceived as worsening at night Spasmodic croup typically presents at night with the sudden onset of "croupy" cough and

Scoring systems Croup scores have been developed to assist the clinician in assessing the degree of respiratory compromise. One of the most commonly cited is the Westley score. The score evaluates the severity of croup by assessing the following 5 factors, with a score range of 0 to 17: Inspiratory stridor: None - 0 points, Upon agitation - 1 point, At rest - 2 points Retractions: None - 0 points, Mild - 1 point, Moderate - 2 points, Severe - 3 points Air entry: Normal - 0 points, Mild decrease - 1 point, Marked decrease - 2 points Cyanosis: None - 0 points, Upon agitation - 4 points, At rest - 5 points Level of consciousness: Normal, including sleep - 0 points, Depressed - 5 points

 According to the Westley score, a score of less than 3 represents mild disease; a score of 3-6 represents moderate disease; and a score greater than 6 represents severe disease.

CROUP: THERAPEUTIC MANAGEMENT Fluids Cool mist/ humidified air Antibiotics Antipyretics Nebulized epinephrine Corticosteroids 100% oxygen Suctioning Intubation Vigilant observation of respiratory status

BRONCHIOLITIS (RSV)
An acute viral infection of the lower respiratory tract affecting infants and young children and characterized by respiratory distress, expiratory obstruction, wheezing, and crackles.

Signs and Symptoms

Dyspnea, cough, wheezing Fever Apnea in infants

Complications
Acute asthmatic episode Respiratory failure

RSV: Diagnostic Tests CBC Elevated granulocytes Chest X-ray will show bronchopneumonia and bronchiolitis ELISA

RSV: Medical Management:

Severe disease in infants and children requires hospitalization and close observation to ensure adequate respiration ABG/ pulse oximeter monitoring Supportive Ribavirin Respiratory support: CPT, humidified oxygen, assisted ventilation IV Fluids

RSV: Nursing Management:

Monitor closely for signs of respiratory fatigue or distress Monitor O2 saturation levels and response to therapy if patient is hypoxic Monitor for adequate hydration and nutrition. Prop infants up to an angle of 10 to 30 degrees to ease breathing In tachypneic patients and those in respiratory distress, oral fluids are contraindicated due to risk of aspiration Institute contact isolation. Strict handwashing.

PNEUMONIA
An acute infection of lung parenchyma including alveolar spaces and interstitial tissue

CLINICAL MANIFESTATIONS
Viral Pneumonia
Mild fever, nonproductive cough, rhinitis Wheezing, tachypnea, and increased respiratory distress

Bacterial Pneumonia
High fever, productive cough, ill appearance Retractions, grunting respirations, chills, chest pain Respiratory distress is significant and accompanied by restlessness and anxiety

Diagnostics: Chest x-ray, pulse oximetry, blood gas analyis, CBC, blood cultures

PNEUMONIA: THERAPEUTIC MANAGEMENT Monitor: breath sounds, RR, use of accessory muscles, color, O2 sat, level of activity, and restlessness every 2 hours Encourage to assume position of comfort, usually upright Assist with coughing and deep breathing exercises Administer antipyretics and analgesics Ensure adequate hydration Cool mist Suctioning as needed Cluster nursing care to allow periods of

ASTHMA
A pulmonary disease characterized by reversible airway obstruction, airway inflammation, and increased airway responsiveness to a variety of stimuli.

ASTHMA: CLINICAL MANIFESTATIONS Cough: hacking. Paroxysmal, irritative,

nonproductive; becomes rattling and productive Shortness of breath Prolonged expiratory phase Audible wheeze Malar flush, red ears Lips deep, dark red color; may progress to cyanosis of nail beds or circumoral cyanosis Restlessness and apprehension; Sweating Older children may sit upright with shoulders in a hunched-over position May speak in short, panting, broken phrases

ASTHMA: CLINICAL MANIFESTATIONS Chest: hyperresonance With repeated episodes:

barrel chest Elevated shoulders Use of accessory muscles of respiration Flattened malar bones, circles beneath the eyes, narrow nose, prominent upper teeth

 Eliminate allergen if possible Recognize that emotional overlay may trigger attacks Hyposensitization allergy shots Position of comfort --high Fowlers --leaning forward with chest on pillow placed on bedside table Education --swimming is good exercise --symptoms may decrease at puberty

THERAPEUTIC MANAGEMENT

Common medications Beta-Agonists (Ex. Albuterol) --provides bronchodilation --side effects: palpitations, tachycardia, tremors Corticosteroids --reduces inflammation and swelling Theophylline --prevents/reduces inflammation --prevents bronchoconstriction --side effects: gastric irritation, headache, palpitations, restlessness Cromolyn --prevents/reduces inflammation --does not work for acute attacks --not recommended under 5 years

CYSTIC FIBROSIS
An inherited disease of the exocrine glands primarily affecting the GI and respiratory systems, and usually characterized by COPD, exocrine pancreatic insufficiency, and abnormally high sweat electrolytes.

 Intestinal obstruction --meconium ileus (thick, putty-like meconium) Malabsorption syndrome --growth failure --large appetite with weight loss --steatorrhea (fatty stools) bulky, loose, foulsmelling stools --rectal prolapse Chronic pneumonia/obstructive emphysema --frequent respiratory infections Exocrine gland dysfunction --salty taste to skin

CYSTIC FIBROSIS: CLINICAL MANIFESTATIONS

CYSTIC FIBROSIS: THERAPEUTIC MANAGEMENT Observe for any respiratory impairment:

Cough, presence and color of sputum Dyspnea Color of nailbeds and mucous membranes Pulse oximetry Auscultate breath sounds for equality, crackles, wheezes Observe for digital clubbing

Parental support --may feel guilt since disease genetically linked --chronic terminal illness --expensive and time consuming to treat, use of special equipment --places limits on normal activities --use respite care as available Nutrition --need to increase calories, protein, salt --give water soluble vitamins Pancreatic enzyme replacement --give with ALL meals/snacks --dosage is determined by stools

CYSTIC FIBROSIS: THERAPEUTIC MANAGEMENT

THERAPEUTIC MANAGEMENT
Pulmonary hygiene --3-4 times daily percussion with postural drainage (CPT) --aerosols (nebulizer) therapy before and after CPT --breathing exercises --long term antibiotics and expectorants --oxygen should be given cautiously because of narcosis risk --avoid exposure to respiratory infections

SIDS
The sudden and unexpected death of any infant or young child in which a thorough postmortem examination fails to show an adequate cause.

Risk Factors
Prematurity Infections Brain stem defects Use of soft bedding Sleeping in prone position Maternal smoking during pregnancy Sibling with SIDS Low birth weight Increased incidence in cold weather Increased incidence in lower socioeconomic groups

THERAPEUTIC MANAGEMENT
Avoid questions that could imply parental negligence Provide emotional support Assure parent(s) that there is nothing that they could have done to prevent infants death Allow parents an opportunity to say goodbye An autopsy may likely be necessary to confirm cause of death