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Nursing Assessment General Nursing Interventions Specific Disorders Nasopharyngitis Influenza Tonsillitis The Tonsillectomy patient Croup Bronchiolitis/ RSV Pneumonia Asthma Cystic fibrosis Otitis media SIDS
Evidence of infection Cough Wheeze Cyanosis Chest pain Sputum Bad breath
Head Bobbing- Respiratory Distress in infants.mp4 Stridor & Retractions.mp4
Grunting baby.mp4
Promote rest
Bed rest or quiet play
Promote comfort
Nose drops, throat irrigation decongestants
Reduce temperature
TSB antipyretics
Promote hydration
Oral and parenteral
Provide nutrition
Consider preference
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
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
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
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
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.
Complications
Acute asthmatic episode Respiratory failure
RSV: Diagnostic Tests CBC Elevated granulocytes Chest X-ray will show bronchopneumonia and bronchiolitis ELISA
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.
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
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
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