Hypoxemia
deficient oxygenation of the blood
s/s: peripheral vasoconstriction, pale appearance, tachycardia, tachypnea, anxiety, confusion, poor infant feeding pattern.
Partial pressure of oxygen in arterial blood
(Po2)
Normal value: 80-100 mmHg
Decreased if child cannot inspire adequately
Partial pressure of carbon dioxide in arterial blood
(PCo2)
Normal value: 35-45 mmHg
Increased if child cannot expire adequately
The percentage of hemoglobin carrying oxygen
O2 saturation
Normal value: 95-100%
Decreased if O2 can't reach RBCs, if unoxygenated cells are being mixed with oxygenated ones, or if hemoglobin is defective
The hydrogen ion concentration of blood
pH
Normal Value: 7.35-7.45
Increased in respiratory alkalosis; decreased in respiratory acidosis
Bicarbonate available for buffering
Base excess
Normal value: -2.5 or +2.5 mEq/L
(+)= alkaline excess
(-)= alkaline deficit
Respiratory alkalosis
Cause: hyperventilation
Rapid, deep breathing, confusion, unconsciousness, elevated plasma pH, elevated urine pH, decreased Pco2, plasma bicarbonate initially normal, below 20 if compensated.
Respiratory acidosis
Cause: hypoventilation trapping carbon dioxide in alveoli
Shallow breathing, inability to expire freely, confusion, disorientation, decreased plasma pH, decreased uring pH, elevated Pco2, plasma bicarbonate initially normal or elevated, above 25 if compen
Acute infectious disorders
common cold, sinusitis, influenza, pharyngitis, epiglotitis, bronchiolitis (RSV), pneumonia, bronchitis, tuberculosis
Acute non-infectious disorders
epistaxis, pneumothorax, allergic rhinitis, asthma
Chronic disorders
laryngomalacia, cystic fibrosis, apnea
Acute nasopharyngitis (common cold)
caused by any number of different viruses (rhinoviruses, RSV, adenovirus) and are more severe in infants/children
viral particles are spread through the are and from person to person
DX by clinical presentation
acute nasopharyngitis TX:
treated at home/rest
antipyretics (NO ASPIRIN)
humidity, saline drops, bulb suctioning
decongestants
cough supressants that DO NOT contain alcohol.
acute nasopharynitis:
when to seek medical care
prolonged fever; increased throat pain or enlarged, painful lymph nodes; worsening cough > 10 days; earache, headache, tooth or sinus pain; unusual irritability or lethargy, skin rash
USUALLY 7-10 DAY COURSE.
Retropharyngeal Abscess
following an URI, suddenly they refuse to eat.
develop a high fever
cannot swallow saliva
physical assessment reveals enlargement of the regional lymph nodes
Retropharyngeal Abscess: DX and TX
Dx: x-ray, U/S
Tx: benzathine PCN G or PCN V, limit oral intake to fluids, side-lying position (d/t possible airway obstruction), surgical incision and drainage
Sinusitis
maxillary and ethmoid infections in younger children
after development of frontal sinuses may see infections there
ACUTE: < 30 days
CHRONIC: 4-6 weeks or >
Sinusitis s/s:
cough, fever, H/A, sinus pain and tenderness, purulent nasal drainage, halitosis, eyelid edema, irritability, poor appetite.
Organisms:
-steptococcal
-staphylococcal
-H influenza
Sinusitis: Dx and Tx
Dx by; H/P, x-ray, CT, or MRI
Tx: antibx for a min. of 10 days, antipyretic, symptomatic relief the same as for the common cold, analgesic (NO ASA!)
Influenza
caused by different viruses. Spread from DIRECT CONTACT OR DROPLET INHALATION. Symptomology most severe in infants. Common in winter months. Has a 1-3 day incubation period and affected persons are MOST INFECTIOUS FOR 24 HOURS BEFORE the onset of symptoms
Influenza s/s:
abrupt onset of fever, facial flushing, chills, h/a, myalgia, malaise, cough, coryza, dry/sore throat, ocular symptoms, decreased appetite.
Influenza Dx and Tx:
Dx by rapid assay test.
Tx: Symptomatic treatment (tylenol not ASA)
-antiviral drugs to reduce symptoms *
only if started within the first 24-48 hours
*
-inactivated influenza viral vaccines, especially for high-risk groups.
COMPLICATIONS: bacterial infec
Pharyngitis
viral or bacterial, streptococcal group A B-hemolytic streptococci (strep-throat) place the child at risk for:
-acute rheumatic fever
-abscesses
-acute glomerulonephritis
Usual a brief illness (if viral)
Pharyngitis s/s
pharyngitis, headache, fever, difficulty swallowing, abdominal pain, inflammation of tonsils and pharynx, anterior cervical lymphadenopathy
Pharyngitis Tx
if bacterial: PCN, erythromycin, amoxicillin, penicillin+rifampin
-macolides and cephalosporins if PCN allergy
Pharyngitis nursing care:
throat swab for culture, cool/warm compresses to the neck, saline gargles, liquids, antibiotic therapy.
Tonsillitis
Tonsils are masses of lymphoid tissue located in the pharyngeal cavity. They filter and protect the respiratory and ailimentary tracts from invasion f pathogenic organisms.
Waldeyer tonsillar ring, facial, pharyngeal (adenoids), lingual, tubal.
TONSILITIS
Therapeutic management of tonsilitis
-may be viral or bacterial.
-if viral is self-limiting, tx is symptomatic
-abx for bacterial infxn
-tonsillectomy (removal of palantine tonsils), adenoidectomy.
-contraindications-- cleft palate, acute infxns at time of surgery, uncontrolled systemic dise
Nursing care of Tonsillitis
Post-op
-provide comfort measures (mist vaporizer, ice collar, tetracaine lollipops, soft diet)
-minimize activites that precipitate bleeding ( frequent coughing/clearing of the throat, frequent suctioning)
-place child side lying or on abdomen to facilit
Infectious mono
-Viral (Ebstein-Barr virus), self limiting
-"kissing disease"
-transmitted via oropharyngeal secretions (spit, snot, slobber)
-more common in adolescents and young adults
Infectious mono s/s
fever, malaise, sore throat, lymphadenopathy, rash, splenomegaly, hepatomegaly.
Dx: Monospot test or Epstein-Barr titers.
Infectous mono management
Symptomatic
-analgesics
-salt water gargles
-bed rest/ frequent rest periods
-corticosteroids if edema threatens the airway
-no strenuos activity or contact sports if splenomegaly or hepatomegaly are present
Infectious mono complications
splenic rupture, Guillain Barre syndrome, aseptic meningitis
**
STREP+MONO= NO AMPICILLIN --> SEVERE ALLERGIC REACTION
**
Acute laryngitis
Common in older children and adolescents
S/S: sore throat, hoarseness or loss of voice, nasal congestion, fever, headache, myalgia, malaise
The disease is almost always self-limited
Tx is symptomatic with fluids and humidified air and *
voice rest
*
Croup (Laryngotracheobronchitis)
-an inflammation of the mucosa lining the larynx, trachea, and bronchi causing a narrowing of the airway
-affects children less than 5 years of age
-parainfluenza virus, RSV, influenza A and B, mycoplasma pneumonia
Progression of symptoms in Croup stage I
-hoarseness, seal-like cough, fearful, inspiratory stridor
Progression of symptoms in Croup stage II
-use of accessory muscles, lower rib retractions, labored respirations, continuos stridor
Progression of symptoms in Croup stage III
-serious trouble, restlessness, sweaty, tachypnea, hypoxemia, CO2 retention
Progression of symptoms in Croip stage IV
-permanent cyanosis, DEATH!
Croup is...
usually self-limited and only lasts 3-5 days with symptoms worse at night.
usually manged outpatient
-cool car ride, steamy shower
Aggressive management of Croup
-maintain an airway
-high humidity with cool mist
-racemie epinephrine: causes mucosal vasoconstriction that decreases subglottic edema, onset of action is rapid
-corticosteroids
-comfort measures
-drinking fluids except when respirations are greater than
Epiglottitis
-serious obstructive inflammatory process that occurs in children between 2-7 years of age
-haemophilus influenzae
-clinical manifestations: sudden high fever, tripod position, substernal retractions, cyanosis, epiglottis is cherry red and edematous, droo
Epiglottitis s/s
-excessive drooling is the universal sign
-in addition, the child will have a sudden onset of dysphagia or difficulty swallowing, stridor, and high-grade fever.
-the child may also be in the TRIPOD POSITION upon arrival
Epiglottitis dx and tx
Dx: lateral neck xray
-NEVER ATTEMPT TO VISUALIZE THE EPIGLOTTIS WITH A TONGUE BLADE OR OBTAIN A THROAT CULTURE unless means of providing and artificial airway is readily available.
Tx:
-intubation, blood gases, pulse oximetry
-tracheostomy
-IV fluids
-co
RSV/ Bronchiolitis
-acute inflammation of the small bronchi and bronchioles
-air is trapped and atelectasis occurs
-*
infections occur in winter and spring and primarily affects children under 2 years of age
*
-RSV causes over half of all pediatric hospitalizations for bron
RSV s/s
initial: runny nose, couch, sneez, fever, anorexia, wheezing
progression of illness: tachypnea, retractions, more wheezes, airhunger, cyanosis
severe: tachypnea >70bpm, poor breath sounds, apneic spells.
RSV brochiolitis is...
highly contagious and spread via DIRECT CONTACT with secretions of from contaminated particles (not airborne)
-therefore should be isolated according to hospital policy
Dx: by nasal-pharyngeal swabs ELISA test
-may also utilaze pulse ox, chest x-rays, and
RSV brochiolitis management:
Children exprience copious secretions and interventions should be aimed at this problem.
-Beware that a slowing resp rate in the tachypneic infant may indicate tiring and PENDING APNEA *
not always a good sign
*
RSV prophylaxis
Synagis injections are given monthly to qualifying children less than 2 yrs f age to prevent severe RSV disease in those more susceptable:
-premature
-chronic lung disease
-certain congenital heart diseases
-immunocompromised
*
VERY EXPENSIVE
*
Pneumonia
inflammation of the pulmonary perenchyma from the spread of infectious organisms to the lower resp tract.
-lobar pneumonia: most of the pulmonary lobes are involved
-bronchopneumonia: exudate in the terminal bronchioles
-interstitial pneumonia: inflammati
Pneumonia s/s
fever, cough, increased resp, lethargy, poor feeding, GI disturbances, chills, H/A, dyspnea, chest pain, abd pain
Pneumonia Dx
-pulse ox
-chest x-rays: air trapping, infiltrates, and consolidation
-sputum culture: to determine bacteria
-WBC count: elevated with bacterial pneumonia
*
mostly viral but can be bacterial
*
Viral pneumonia
-Occur more commonly than bacterial pneumonias in younger children
-RSV accounts for the largest percentage
-Apiration may also be a cause for pneumonia
-The child is more susceptable to secondary bacterial invasion
-Tx is sympotmatic (antipyretics, hydra
Primary atypical pneumonia
-mycoplasma pneumoniae is the most common cause of pneumonia in children between ages 5-12 years of age
-most people recover from this acute illness in 7-10 days
-hospitalization is rarely necessary
*
bacterial, dehydrated
*
Bacterial pneumonia
-onset is abrupt usually preceded by a viral infection
-abx therapy, bed rest, antipyretic
-hospitalization
Nursing care or pneumonia
-supportive and symptomatic
-possible isolation procedures (based on type)
-mist tent with or without oxygen
-vital signs
-resp assessment
-psych support
-teach vaccination
Epistaxis
common in children, generally r/t trauma or dryness of the air
can be a/w a number of illnesses:
-scarlet fever
-rheumatic fever
-measles
-varicella
Epistaxis Tx
-calm the child/parent
-sit upright
-lean forward
-apply pressure to the sides of the nose with your fingers
-should stop within 10-15 min
-vaseline to nasal mucosa to moisten and prevent reccurence
-nasal packing may be necessary
Aspiration
-inhalation of a foreign object in the airways
-most frequently in children 6mo-5yrs
-immediate reaction is choking and hard forceful coughing
--may progress to wheezing and stridor or decreased breath sounds
Aspiration management
-if no sound can be heard, a series of heimlich subdiaphragmatic abdominal thrusts are recommended for children until the object is forced out of the trachea or until the child collapses
-items smaller than 1.25 in are aspired easily
-PREVENTION IS KEY!!
Respiratory Distress Syndrome (RDS)
in neonates as a result of lung immaturity and a defiency of surfactant
-this causes the lungs to be stiff and noncompliant resulting in poor gas exchange
RDS s/s
within several hours of birth there are signs of resp distress including tachypnea, retractions, nasal flaring, grunting, cyanosis, and an alteration in breath sounds
*
02 intervention is usually necessary
*
RDS risk factors
-premature
-with diabetic mothers
-C-section w/o preceding labor
-perinatal asphyxia
RDS tx
Surfactant is given via an endotracheal tube after birth to decrease the incidence of severity
NSG goals: monitor for lung expansion, normothermia, prevent infection, maintain fluid balance, adequate nutrition
Pneumothorax
a collection of air in the pleural space, may occur spontaneously or as the result of another condition. The air causes partial lung collapse and therefore decreased ventilation
Pneumothorax s/s
-chest pain, tachypnea, tachycardia, retractions, nasal flaring, absent/diminished breath sounds on affected side, or grunting
DX: x-ray
**
MORE PAIN THAN OTHER ACUTE D/O
**
Pneumothorax Tx
-needle aspiration or placement of a chest tube to evacuate air or if small may resolve spontaneously.
**
IF A CHEST TUBE BECOMES DISLODGED, APPLY VASELINE GAUZE AND AN OCCLUSIVE DRESSING, PERFORM RESP ASSESSMENT, AND NOTIFY PHYSICIAN
**
Allergic rhinitis
-chronic condition affecting up to 40% of kids
-a/w eczema and asthma
-may be seasonal or perennial
Pathophys:
-allergins bing to IgE on mast cells and release histamine and leukotrienes which cause edema, mucus production, sneezing, rhinorrhea, and itchi
Allergic rhinitis s/s
in addition to other s/s, may also see "allergic shiners" and the "allergic salute" (nasal crease)
Dx: based on s/s, nasal smears, positive allergy skin test, and positive RAST tests.
Asthma
Chronic inflammatory d/o of the airways that causes:
-hyperresponsiveness
-edema
-mucus production
Most common chronic illness of childhood
-characterized by wheezing, breathlessness, chest tightness, cough
Asthma triggers
allergens, exercise, cold air, changes in weather, infections, animals, food additives, medications, strong emotions, GERD, nuts, milk, edocrine factors like menses, pregnancy
DX evaluation of asthma
-physical examination
-x-ray
-pulmonary function tests
-spirometry
-peak expiratory flow rate/meter
-skin testing
-radioallergosorbent test
-ABGs
TX of asthma
-allergin control
-**
treatment is based upon the indivual's level of asthma control
**
-Drug therapy
--Leukotriene modifiers
-exercised induced brochospasm/ asthma
-chest physiotherapy
-hyposensitization
-ASTHMA ACTION PLANS ON FILE!!!
Status asthmaticus
-medical emergency that can result in resp failure
-profuse sweating, remains sitting upright
-humidified oxygen
-IV therapy
-Albuterol, blood gases
-SubQ epinephrine
**
IRREVERSIBLE ASTHMA ATTACK!!
**
Nursing care of the asthmatic child
-avoid known allergies (identify them!)
-relieve bronchospasm: many children can recognize signs of an impending attack
-objective signs
-education
-infection control
-avoid allergenic foods
Choanal atresia
Congenital obstruction of the posterior nares by an obstructing membrane or bony growth, preventing a newborn from drawing air through the nose and down into the nasopharynx
-unilateral
-bilateral
-local piercing or surgical correction
**
NEWBORNS ARE NOS
Choanal atresia s/s:
cyanosis, apnea, no feeding, immediate resp distress
Congenital laryngomalacia/tracheamalacia
-infants laryngeal structure is weaker and collapses easier on inspiration causing laryngeal stridor
-you may see sternal and intercostal space retractions
-improves at about 1 year of age
-parents must feed these infants slower than usual
Cystic Fibrosis
inherited condition where chromosome 7 has mutated
Clinical features: increased viscosity of mucous gland secretions, elevation of sweat electrolytes, increased enzymes in saliva, abnormal nervous system function, meconium ileus, prolapse of the rectum, p
Dx evalutation of CF
-family Hx
-absence of pancreatic enzymes
-increase in electrolyte concentration of sweat (Na and Cl)
-chronic pulmonary involvement
-sweat chloride test (>60 meq/L)
-chest x-ray: patch atelectasis, obstructive emphysema
72 hour stool analysis (detection
Therapeutic management of pulmonary problems with CF
-Goals: prevent pulmonary infection, remove mucopurulent secretions, administer antimicrobial agents
-Chest physiotherapy BID using a flutter mucus clearance device
-bronchodilator medication prior to CPT
-pulmozyme (decreases viscosity)
-IV abx
- judicia
Therapeutic management of GI problems with CF
These children have hepatic insufficiency with impaired intestinal absorption
-pancreatic enzymes with each meal
-high protein/ high calorie diet (they poop most of it out)
-water-miscible forms of vitamins (ADEK)
-supplemental feedings
CF presentation
-wheezing respiration, dry nonproductive cough
-generalized obstructive emphysema
-patchy atelectasis
-cyanosis
-clubbing of fingers and toes
-repeated bronchitis and pneumonia
Nursing care of the child with CF
Assessment:
-Resp
-GI
-Family support
-Education
-Evaluation
The plan of care and education for CF
-frequent skin care to prevent breakdown over bony prominences
-diet: extra fluids to prevent dehydration, high protein/high calorie, don't restrict salt
-medications
-CPT, postural drainage and breathing exercises
-yearly pneumococcus/ influenza vaccine
Apnea
Absence of breathing for >20 secs
-may occur with illness or be totally dependant of other problems
-if with illness, tx underlying dx
Apnea Tx
-stimulation
-rescue breathing/ bag and mask
-caffeine or theophylline to stimulate respirations
-home apnea monitors
-(d/c after 3mo if no events)
*
teach parents what to do, look at the baby first
*
To avoid apneic episodes...
-keep newborn in a normo-thermic environment
-avoid excessive vagal stimulation
-admin. caffeine or theophylline as ordered
Hypoxemia
deficient oxygenation of the blood
s/s: peripheral vasoconstriction, pale appearance, tachycardia, tachypnea, anxiety, confusion, poor infant feeding pattern.
Partial pressure of oxygen in arterial blood
(Po2)
Normal value: 80-100 mmHg
Decreased if child cannot inspire adequately
Partial pressure of carbon dioxide in arterial blood
(PCo2)
Normal value: 35-45 mmHg
Increased if child cannot expire adequately
The percentage of hemoglobin carrying oxygen
O2 saturation
Normal value: 95-100%
Decreased if O2 can't reach RBCs, if unoxygenated cells are being mixed with oxygenated ones, or if hemoglobin is defective
The hydrogen ion concentration of blood
pH
Normal Value: 7.35-7.45
Increased in respiratory alkalosis; decreased in respiratory acidosis
Bicarbonate available for buffering
Base excess
Normal value: -2.5 or +2.5 mEq/L
(+)= alkaline excess
(-)= alkaline deficit
Respiratory alkalosis
Cause: hyperventilation
Rapid, deep breathing, confusion, unconsciousness, elevated plasma pH, elevated urine pH, decreased Pco2, plasma bicarbonate initially normal, below 20 if compensated.
Respiratory acidosis
Cause: hypoventilation trapping carbon dioxide in alveoli
Shallow breathing, inability to expire freely, confusion, disorientation, decreased plasma pH, decreased uring pH, elevated Pco2, plasma bicarbonate initially normal or elevated, above 25 if compen
Acute infectious disorders
common cold, sinusitis, influenza, pharyngitis, epiglotitis, bronchiolitis (RSV), pneumonia, bronchitis, tuberculosis
Acute non-infectious disorders
epistaxis, pneumothorax, allergic rhinitis, asthma
Chronic disorders
laryngomalacia, cystic fibrosis, apnea
Acute nasopharyngitis (common cold)
caused by any number of different viruses (rhinoviruses, RSV, adenovirus) and are more severe in infants/children
viral particles are spread through the are and from person to person
DX by clinical presentation
acute nasopharyngitis TX:
treated at home/rest
antipyretics (NO ASPIRIN)
humidity, saline drops, bulb suctioning
decongestants
cough supressants that DO NOT contain alcohol.
acute nasopharynitis:
when to seek medical care
prolonged fever; increased throat pain or enlarged, painful lymph nodes; worsening cough > 10 days; earache, headache, tooth or sinus pain; unusual irritability or lethargy, skin rash
USUALLY 7-10 DAY COURSE.
Retropharyngeal Abscess
following an URI, suddenly they refuse to eat.
develop a high fever
cannot swallow saliva
physical assessment reveals enlargement of the regional lymph nodes
Retropharyngeal Abscess: DX and TX
Dx: x-ray, U/S
Tx: benzathine PCN G or PCN V, limit oral intake to fluids, side-lying position (d/t possible airway obstruction), surgical incision and drainage
Sinusitis
maxillary and ethmoid infections in younger children
after development of frontal sinuses may see infections there
ACUTE: < 30 days
CHRONIC: 4-6 weeks or >
Sinusitis s/s:
cough, fever, H/A, sinus pain and tenderness, purulent nasal drainage, halitosis, eyelid edema, irritability, poor appetite.
Organisms:
-steptococcal
-staphylococcal
-H influenza
Sinusitis: Dx and Tx
Dx by; H/P, x-ray, CT, or MRI
Tx: antibx for a min. of 10 days, antipyretic, symptomatic relief the same as for the common cold, analgesic (NO ASA!)
Influenza
caused by different viruses. Spread from DIRECT CONTACT OR DROPLET INHALATION. Symptomology most severe in infants. Common in winter months. Has a 1-3 day incubation period and affected persons are MOST INFECTIOUS FOR 24 HOURS BEFORE the onset of symptoms
Influenza s/s:
abrupt onset of fever, facial flushing, chills, h/a, myalgia, malaise, cough, coryza, dry/sore throat, ocular symptoms, decreased appetite.
Influenza Dx and Tx:
Dx by rapid assay test.
Tx: Symptomatic treatment (tylenol not ASA)
-antiviral drugs to reduce symptoms *
only if started within the first 24-48 hours
*
-inactivated influenza viral vaccines, especially for high-risk groups.
COMPLICATIONS: bacterial infec
Pharyngitis
viral or bacterial, streptococcal group A B-hemolytic streptococci (strep-throat) place the child at risk for:
-acute rheumatic fever
-abscesses
-acute glomerulonephritis
Usual a brief illness (if viral)
Pharyngitis s/s
pharyngitis, headache, fever, difficulty swallowing, abdominal pain, inflammation of tonsils and pharynx, anterior cervical lymphadenopathy
Pharyngitis Tx
if bacterial: PCN, erythromycin, amoxicillin, penicillin+rifampin
-macolides and cephalosporins if PCN allergy
Pharyngitis nursing care:
throat swab for culture, cool/warm compresses to the neck, saline gargles, liquids, antibiotic therapy.
Tonsillitis
Tonsils are masses of lymphoid tissue located in the pharyngeal cavity. They filter and protect the respiratory and ailimentary tracts from invasion f pathogenic organisms.
Waldeyer tonsillar ring, facial, pharyngeal (adenoids), lingual, tubal.
TONSILITIS
Therapeutic management of tonsilitis
-may be viral or bacterial.
-if viral is self-limiting, tx is symptomatic
-abx for bacterial infxn
-tonsillectomy (removal of palantine tonsils), adenoidectomy.
-contraindications-- cleft palate, acute infxns at time of surgery, uncontrolled systemic dise
Nursing care of Tonsillitis
Post-op
-provide comfort measures (mist vaporizer, ice collar, tetracaine lollipops, soft diet)
-minimize activites that precipitate bleeding ( frequent coughing/clearing of the throat, frequent suctioning)
-place child side lying or on abdomen to facilit
Infectious mono
-Viral (Ebstein-Barr virus), self limiting
-"kissing disease"
-transmitted via oropharyngeal secretions (spit, snot, slobber)
-more common in adolescents and young adults
Infectious mono s/s
fever, malaise, sore throat, lymphadenopathy, rash, splenomegaly, hepatomegaly.
Dx: Monospot test or Epstein-Barr titers.
Infectous mono management
Symptomatic
-analgesics
-salt water gargles
-bed rest/ frequent rest periods
-corticosteroids if edema threatens the airway
-no strenuos activity or contact sports if splenomegaly or hepatomegaly are present
Infectious mono complications
splenic rupture, Guillain Barre syndrome, aseptic meningitis
**
STREP+MONO= NO AMPICILLIN --> SEVERE ALLERGIC REACTION
**
Acute laryngitis
Common in older children and adolescents
S/S: sore throat, hoarseness or loss of voice, nasal congestion, fever, headache, myalgia, malaise
The disease is almost always self-limited
Tx is symptomatic with fluids and humidified air and *
voice rest
*
Croup (Laryngotracheobronchitis)
-an inflammation of the mucosa lining the larynx, trachea, and bronchi causing a narrowing of the airway
-affects children less than 5 years of age
-parainfluenza virus, RSV, influenza A and B, mycoplasma pneumonia
Progression of symptoms in Croup stage I
-hoarseness, seal-like cough, fearful, inspiratory stridor
Progression of symptoms in Croup stage II
-use of accessory muscles, lower rib retractions, labored respirations, continuos stridor
Progression of symptoms in Croup stage III
-serious trouble, restlessness, sweaty, tachypnea, hypoxemia, CO2 retention
Progression of symptoms in Croip stage IV
-permanent cyanosis, DEATH!
Croup is...
usually self-limited and only lasts 3-5 days with symptoms worse at night.
usually manged outpatient
-cool car ride, steamy shower
Aggressive management of Croup
-maintain an airway
-high humidity with cool mist
-racemie epinephrine: causes mucosal vasoconstriction that decreases subglottic edema, onset of action is rapid
-corticosteroids
-comfort measures
-drinking fluids except when respirations are greater than
Epiglottitis
-serious obstructive inflammatory process that occurs in children between 2-7 years of age
-haemophilus influenzae
-clinical manifestations: sudden high fever, tripod position, substernal retractions, cyanosis, epiglottis is cherry red and edematous, droo
Epiglottitis s/s
-excessive drooling is the universal sign
-in addition, the child will have a sudden onset of dysphagia or difficulty swallowing, stridor, and high-grade fever.
-the child may also be in the TRIPOD POSITION upon arrival
Epiglottitis dx and tx
Dx: lateral neck xray
-NEVER ATTEMPT TO VISUALIZE THE EPIGLOTTIS WITH A TONGUE BLADE OR OBTAIN A THROAT CULTURE unless means of providing and artificial airway is readily available.
Tx:
-intubation, blood gases, pulse oximetry
-tracheostomy
-IV fluids
-co
RSV/ Bronchiolitis
-acute inflammation of the small bronchi and bronchioles
-air is trapped and atelectasis occurs
-*
infections occur in winter and spring and primarily affects children under 2 years of age
*
-RSV causes over half of all pediatric hospitalizations for bron
RSV s/s
initial: runny nose, couch, sneez, fever, anorexia, wheezing
progression of illness: tachypnea, retractions, more wheezes, airhunger, cyanosis
severe: tachypnea >70bpm, poor breath sounds, apneic spells.
RSV brochiolitis is...
highly contagious and spread via DIRECT CONTACT with secretions of from contaminated particles (not airborne)
-therefore should be isolated according to hospital policy
Dx: by nasal-pharyngeal swabs ELISA test
-may also utilaze pulse ox, chest x-rays, and
RSV brochiolitis management:
Children exprience copious secretions and interventions should be aimed at this problem.
-Beware that a slowing resp rate in the tachypneic infant may indicate tiring and PENDING APNEA *
not always a good sign
*
RSV prophylaxis
Synagis injections are given monthly to qualifying children less than 2 yrs f age to prevent severe RSV disease in those more susceptable:
-premature
-chronic lung disease
-certain congenital heart diseases
-immunocompromised
*
VERY EXPENSIVE
*
Pneumonia
inflammation of the pulmonary perenchyma from the spread of infectious organisms to the lower resp tract.
-lobar pneumonia: most of the pulmonary lobes are involved
-bronchopneumonia: exudate in the terminal bronchioles
-interstitial pneumonia: inflammati
Pneumonia s/s
fever, cough, increased resp, lethargy, poor feeding, GI disturbances, chills, H/A, dyspnea, chest pain, abd pain
Pneumonia Dx
-pulse ox
-chest x-rays: air trapping, infiltrates, and consolidation
-sputum culture: to determine bacteria
-WBC count: elevated with bacterial pneumonia
*
mostly viral but can be bacterial
*
Viral pneumonia
-Occur more commonly than bacterial pneumonias in younger children
-RSV accounts for the largest percentage
-Apiration may also be a cause for pneumonia
-The child is more susceptable to secondary bacterial invasion
-Tx is sympotmatic (antipyretics, hydra
Primary atypical pneumonia
-mycoplasma pneumoniae is the most common cause of pneumonia in children between ages 5-12 years of age
-most people recover from this acute illness in 7-10 days
-hospitalization is rarely necessary
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bacterial, dehydrated
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Bacterial pneumonia
-onset is abrupt usually preceded by a viral infection
-abx therapy, bed rest, antipyretic
-hospitalization
Nursing care or pneumonia
-supportive and symptomatic
-possible isolation procedures (based on type)
-mist tent with or without oxygen
-vital signs
-resp assessment
-psych support
-teach vaccination
Epistaxis
common in children, generally r/t trauma or dryness of the air
can be a/w a number of illnesses:
-scarlet fever
-rheumatic fever
-measles
-varicella
Epistaxis Tx
-calm the child/parent
-sit upright
-lean forward
-apply pressure to the sides of the nose with your fingers
-should stop within 10-15 min
-vaseline to nasal mucosa to moisten and prevent reccurence
-nasal packing may be necessary
Aspiration
-inhalation of a foreign object in the airways
-most frequently in children 6mo-5yrs
-immediate reaction is choking and hard forceful coughing
--may progress to wheezing and stridor or decreased breath sounds
Aspiration management
-if no sound can be heard, a series of heimlich subdiaphragmatic abdominal thrusts are recommended for children until the object is forced out of the trachea or until the child collapses
-items smaller than 1.25 in are aspired easily
-PREVENTION IS KEY!!
Respiratory Distress Syndrome (RDS)
in neonates as a result of lung immaturity and a defiency of surfactant
-this causes the lungs to be stiff and noncompliant resulting in poor gas exchange
RDS s/s
within several hours of birth there are signs of resp distress including tachypnea, retractions, nasal flaring, grunting, cyanosis, and an alteration in breath sounds
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02 intervention is usually necessary
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RDS risk factors
-premature
-with diabetic mothers
-C-section w/o preceding labor
-perinatal asphyxia
RDS tx
Surfactant is given via an endotracheal tube after birth to decrease the incidence of severity
NSG goals: monitor for lung expansion, normothermia, prevent infection, maintain fluid balance, adequate nutrition
Pneumothorax
a collection of air in the pleural space, may occur spontaneously or as the result of another condition. The air causes partial lung collapse and therefore decreased ventilation
Pneumothorax s/s
-chest pain, tachypnea, tachycardia, retractions, nasal flaring, absent/diminished breath sounds on affected side, or grunting
DX: x-ray
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MORE PAIN THAN OTHER ACUTE D/O
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Pneumothorax Tx
-needle aspiration or placement of a chest tube to evacuate air or if small may resolve spontaneously.
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IF A CHEST TUBE BECOMES DISLODGED, APPLY VASELINE GAUZE AND AN OCCLUSIVE DRESSING, PERFORM RESP ASSESSMENT, AND NOTIFY PHYSICIAN
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Allergic rhinitis
-chronic condition affecting up to 40% of kids
-a/w eczema and asthma
-may be seasonal or perennial
Pathophys:
-allergins bing to IgE on mast cells and release histamine and leukotrienes which cause edema, mucus production, sneezing, rhinorrhea, and itchi
Allergic rhinitis s/s
in addition to other s/s, may also see "allergic shiners" and the "allergic salute" (nasal crease)
Dx: based on s/s, nasal smears, positive allergy skin test, and positive RAST tests.
Asthma
Chronic inflammatory d/o of the airways that causes:
-hyperresponsiveness
-edema
-mucus production
Most common chronic illness of childhood
-characterized by wheezing, breathlessness, chest tightness, cough
Asthma triggers
allergens, exercise, cold air, changes in weather, infections, animals, food additives, medications, strong emotions, GERD, nuts, milk, edocrine factors like menses, pregnancy
DX evaluation of asthma
-physical examination
-x-ray
-pulmonary function tests
-spirometry
-peak expiratory flow rate/meter
-skin testing
-radioallergosorbent test
-ABGs
TX of asthma
-allergin control
-**
treatment is based upon the indivual's level of asthma control
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-Drug therapy
--Leukotriene modifiers
-exercised induced brochospasm/ asthma
-chest physiotherapy
-hyposensitization
-ASTHMA ACTION PLANS ON FILE!!!
Status asthmaticus
-medical emergency that can result in resp failure
-profuse sweating, remains sitting upright
-humidified oxygen
-IV therapy
-Albuterol, blood gases
-SubQ epinephrine
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IRREVERSIBLE ASTHMA ATTACK!!
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Nursing care of the asthmatic child
-avoid known allergies (identify them!)
-relieve bronchospasm: many children can recognize signs of an impending attack
-objective signs
-education
-infection control
-avoid allergenic foods
Choanal atresia
Congenital obstruction of the posterior nares by an obstructing membrane or bony growth, preventing a newborn from drawing air through the nose and down into the nasopharynx
-unilateral
-bilateral
-local piercing or surgical correction
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NEWBORNS ARE NOS
Choanal atresia s/s:
cyanosis, apnea, no feeding, immediate resp distress
Congenital laryngomalacia/tracheamalacia
-infants laryngeal structure is weaker and collapses easier on inspiration causing laryngeal stridor
-you may see sternal and intercostal space retractions
-improves at about 1 year of age
-parents must feed these infants slower than usual
Cystic Fibrosis
inherited condition where chromosome 7 has mutated
Clinical features: increased viscosity of mucous gland secretions, elevation of sweat electrolytes, increased enzymes in saliva, abnormal nervous system function, meconium ileus, prolapse of the rectum, p
Dx evalutation of CF
-family Hx
-absence of pancreatic enzymes
-increase in electrolyte concentration of sweat (Na and Cl)
-chronic pulmonary involvement
-sweat chloride test (>60 meq/L)
-chest x-ray: patch atelectasis, obstructive emphysema
72 hour stool analysis (detection
Therapeutic management of pulmonary problems with CF
-Goals: prevent pulmonary infection, remove mucopurulent secretions, administer antimicrobial agents
-Chest physiotherapy BID using a flutter mucus clearance device
-bronchodilator medication prior to CPT
-pulmozyme (decreases viscosity)
-IV abx
- judicia
Therapeutic management of GI problems with CF
These children have hepatic insufficiency with impaired intestinal absorption
-pancreatic enzymes with each meal
-high protein/ high calorie diet (they poop most of it out)
-water-miscible forms of vitamins (ADEK)
-supplemental feedings
CF presentation
-wheezing respiration, dry nonproductive cough
-generalized obstructive emphysema
-patchy atelectasis
-cyanosis
-clubbing of fingers and toes
-repeated bronchitis and pneumonia
Nursing care of the child with CF
Assessment:
-Resp
-GI
-Family support
-Education
-Evaluation
The plan of care and education for CF
-frequent skin care to prevent breakdown over bony prominences
-diet: extra fluids to prevent dehydration, high protein/high calorie, don't restrict salt
-medications
-CPT, postural drainage and breathing exercises
-yearly pneumococcus/ influenza vaccine
Apnea
Absence of breathing for >20 secs
-may occur with illness or be totally dependant of other problems
-if with illness, tx underlying dx
Apnea Tx
-stimulation
-rescue breathing/ bag and mask
-caffeine or theophylline to stimulate respirations
-home apnea monitors
-(d/c after 3mo if no events)
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teach parents what to do, look at the baby first
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To avoid apneic episodes...
-keep newborn in a normo-thermic environment
-avoid excessive vagal stimulation
-admin. caffeine or theophylline as ordered