The Child with Respiratory Dysfunction

Question 1

Anatomical Differences of the Respiratory Tract

Answer 1

• Poorly developed accessory muscles
• Thoracic cage relatively soft & thin chest wall
• 1:1 Anterior Posterior to Transverse ratio
• Chest circumference less than head circumference
• Obligatory nasal breathers
• Tongue larger proportionately
• Respiratory rate of:
  — 60 at birth: less rhythmic
  — 26 at 2 years
  — 18 at 10 years
• Immature immune system

Question 2

Components of Assessing Respiratory Function
Respirations

Answer 2

• Rate
• Depth
• Ease
• Labored Breathing
• Rhythm
• Restlessness
• Accessory muscles
• Retractions
• Nasal flaring
• Other Observations:
  — Evidence of infection
  — Cough
  — Adventitious sounds
  — Cyanosis
  — Chest pain
  — Sputum
  — Halitosis (bad breath)

Question 3

Nasopharyngitis:
Treatment

Answer 3

• URI- Upper respiratory Infection or common cold
  Treat with:
• Humidifier
• decongestant
• antipyretics
• fluids
• saline nose drops
• *Do not give infants <2 yrs cough and cold products unless instructed by physician

Question 4

Tonsillitis/Pharyngitis
S/S:

Answer 4

• Throat infection
• redness
• exudate
• Mouth breathing
• Enlarged cervical lymph nodes

Question 5

Tonsilectomy Nursing Considerations

Answer 5

• Maintain patent airway
• Minimizing activities or interventions that precipitate bleeding
• Cool-mist vaporizer
• Soft to liquid diet
• Non-vigorous Warm saltwater gargles
• Analgesic/antipyretic drugs
• Avoid red drinks or red foods
• Avoid irritating, sharp or highly seasoned foods
• Discouraging the child from coughing or clearing the throat or putting objects in the mouth

Question 6

Otitis Media (OM)
S/S

Answer 6

OM is primarily a result of a Dysfunctioning Eustachian Tube
- Ear pain
- Pulling at ears
- Redness of tympanic membrane
- purulent drainage after tympanic membrane ruptures
- postarticular and cervical lymph node enlargement
- Fever: 104° common
- Diarrhea & vomitting
- Irritability
- sucking aggravate pain
- Decreased drinking and eating and sucking (appetite)

• note:
  — Otitis media with [pleural] effusion (OME) is diagnosed with the presence of fluid behind the tympanic membrane, without acute onset or signs of inflammation or infection.
  — Acute Otitis Media (AOM) on the other hand, while it may include Eustachian tube dysfunction and middle ear fluid, it must include signs of acute inflammation or infection.

Question 7

Otitis media treatment

Answer 7

• Antibiotics- Amoxicillin
• Decongestant
• Antipyretic and Analgesic
• Myringotomy (tubes)
• Tympanostomy tubes

Question 8

Otitis media teaching

Answer 8

• Decrease exposure to secondhand smoke
• Pacifier or bottle or breast while laying down can increase incidence
• Get immunizations- Hib and Pneumococcal
• Take complete course of antibiotics
• Recognize s/s of tympanic membrane rupture

Question 9

Croup Syndromes

Answer 9

• Upper airway illnesses caused by swelling of epiglottis and larynx.
  — Acute Spasmotic Laryngitis
  — Laryngotracheobronchitis (LTB)- (pic below)
  — Bacterial Tracheitis
  — Epiglottitis

Question 10

Acute Epiglottitis
What?
Cause?
Onset is:

Answer 10

• Or acute supraglottitis, is a serious obstructive inflammatory process
• Occurs in children between 2 and 5 years of age
• Causative agent usually Haemophilus influenzae- Bacterial
• Onset of epiglottitis is usually abrupt

Question 11

Acute Epiglottitis:
S/S

Answer 11

• Tripod position supported by arms, chin thrust out, mouth open
• Drooling
• inspiratory stridor
• strident cough
• Irritability or lethargy
• increased pulse
• epiglottis edema
• cherry red
• High Fever
• pain
• obstructed airway=hypoxia=acidosis=death

Question 12

Epiglottis Treatment:

Answer 12

• decrease anxiety
• Don’t examine throat
• Position for comfort
• trach tray available

Question 13

Croup (Acute Laryngotracheobronchitis LTB):
S/S

Answer 13

• age 3 months to 3 years
• Upper respiratory infections frequently preceed LTB
• Restlessness
• retractions
• slow onset
• Barking cough
• Crowing sounds
• Inspiratory stridor
• Occurs at night
• Increase in fall and winter
• May progress to hypoxic state
• May have slight temperature: 102°

Question 14

Therapeutic Management & Nursing Care of LTB (croup)

Answer 14

• Teach parents signs of respiratory distress
• High humidity with cool mist provides relief for most children
• With severe respiratory distress child NPO
• Corticosteroids
• Watch for symptoms of respiratory distress

Question 15

Respiratory Syncytial Virus (RSV)/Bronchiolitis
peaks when

Answer 15

in Fall/Winter

Question 16

Respiratory Syncytial Virus (RSV)/Bronchiolitis
S/S

Answer 16

• Tachypnea
• Retractions/nasal flaring
• Rhinorrhea
• Pharyngitis
• Cough & sneezing
• Wheezing
• Severe Mucous
• Possible ear or eye infection
• Intermittent fever

Question 17

Respiratory Syncytial Virus (RSV)/Bronchiolitis:
Treatment

Answer 17

• Hydration
• Humidified O2
• Nasopharyngeal suctioning
• Corticosteroids
• Respiratory therapy
• Synagis for at risk infants

Question 18

Foreign Body Aspiration (FBA):
S/S:

Answer 18

• Coughing
• choking
• gagging
• dysphonia
• wheezing
• dyspnea
• nasal flaring
• retractions
• *?inability to say P words
• anxiety
• decreased LOC

Question 19

Pediatric Asthma Overview

Answer 19

• Third leading cause of hospitalization in children younger than 15 years
• Leading cause of chronic illness in children
• Leading cause of school absences

Question 20

Asthma s/s

Answer 20

• Wheezing (usually on expiration)
• Decreased Breath Sounds
• Coughing, especially at night
• Shortness of Breath
• Chest Tightness
• Retractions and Nasal Flaring
• Use of Accessory Muscles
• Anxiety or Agitation
• Tachypnea

Question 21

Asthma triggers:

Answer 21

Smoke
- Colds
- Cockroaches
- Food, allergies
- Dust
- Mold and mildew
- Pollen
- Exercise
- Strong emotions
- Furry pets
- Changes in the weather
- Cold weather
- Strong smells

Question 22

Asthma treatment

Answer 22

• Oxygen if O2 saturation is less than 95%
• Respiratory Treatments- to decrease Bronchospasm and Inflammation
• IV (Solu-Medrol) or PO (Prednisone) corticosteroid to decrease inflammation

Question 23

Asthma
Nursing Interventions

Answer 23

• Assess lung sounds q4h
• Monitor vital signs and O2 saturation q4h
• Keep pt in High Fowler’s position
• Encourage coughing and deep breathing q2h
• Monitor hydration status

Question 24

Asthma
Patient and Family Teaching

Answer 24

• Identify and avoid triggers
• Recognize signs and symptoms of asthma exacerbation
• Medication
• Nebulizer and aerochamber use
• Peak Expiratory Flow Meter Use
• Avoid sick contacts
• Encourage child to receive an annual flu vaccine

Question 25

Cystic Fibrosis (CF)

Answer 25

- Autosomal recessive genetic condition found most often in Caucasian European decent. - Approximately 8 million people carry the gene. If both parents have the gene, they have a 25% chance the child will have CF. - It is caused by a genetic variation in the CFTR (Cystic Fibrosis Transmembrane Regulator channel in which chloride ions cannot pass through the skin, and membranes of organs. (lungs, pancreas, reproductive organs, GI Tract) This is what causes an extreme build up of mucus.

Question 26

Cystic Fibrosis (CF) S/S

Answer 26

- fatigue - Salty taste on skin - Chronic cough - Recurrent URIs - Thick, sticky mucus - Chronic hypoxia: clubbing, barrel chest - Decreased and absorbtion a Vitamins and enzymes - Abdominal distention - Decreased digestive enzymes - Rectal prolapse - Fatty, stinky stools (steatorrhea) - Meconium ileus in newborn

Question 27

Cystic Fibrosis (CF) Treatment

Answer 27

- diet: increased Ca/ protein - Pulmonary therapy - Chest physiotherapy — Postural drainage - Breathing exercises - Aerosol therapy - meds: — antibiotics — supplemental vitamins — aerosol Bronchodilators — mucolytics — pancreatic enzymes — salty snacks? Pretzels

Question 28

Cystic Fibrosis (CF) Impact on systems

Answer 28

Bronchi - Bronchial obstruction=chronic bronchial pneumonia; generalized obstructive emphysema Small intestine - inspissated meconium= intestinal obstruction of newborn Pancreatic ducts - secondary degeneration of pancreas= pancreatic achylia= malabsorption syndrome Bile ducts - focal biliary fibrosis with concretions= biliary cirrhosis= portal hypertension

Question 29

Cystic fibrosis effect on lungs What Treatment

Answer 29

Pneumonia: Poor oxygenation and gas exchange Treatments: - Antibiotics - O2 - Pulmonary aerosol treatments: — bronchodilators — mucolytics — steroids - CFTR modulators: Medications that work on specific genetic mutations in the protein that regulates the fluctuation of sodium (only for children 2yrs and older) - Chest physiotherapy (either a vibration vest or with hand) - This is to “jiggle” and break apart the mucus so it is easier to cough and expel.

Question 30

Cystic fibrosis effect on Pancreas Treatment

Answer 30

- Inability to absorb vitamins, especially fat soluble vitamins (A,D,E,K) - Inability to digest food Treatments: Pancreatic enzymes with each meal

Question 31

Cystic fibrosis effect on GI System Treatment

Answer 31

- Decreased absorption of nutrients - Rectal prolapse from constipation - Steatorrhea- fatty stools due to decreased ability to absorb fats - **Meconium Ilius in newborn. This is often the first sign that a child may have CF!! - Treatments: stool softeners, Vitamin supplementation- Especially Vit A,D,E.K, encourage salty snacks since they are often hyponatremic.

Question 32

Cystic fibrosis effect on skin Test?

Answer 32

- **Skin “tastes” salty (when parents kiss their child) due to decreased ability for sodium to flow through the channel and builds up underneath skin. - ** Sweat Chloride Test- diagnostic - A sample is obtained from the skin using a special filter paper/cloth. There shouldn’t be much if any chloride in sweat, but a CF patient usually has 2-5 times the amount. If they have 60 meq/L or more, that is diagnostic for CF.

Question 33

Cystic Fibrosis effect on reproductive tract

Answer 33

- Males- Vas deferens is blocked with mucous which leads to sterility. - Females- May delay puberty in females