Transcript NURSING CARE OF THE CHILD

NURSING CARE OF THE
CHILD WITH A
RESPIRATORY
ALTERATION
CHAPTER 45
ASSESSING RESPIRATORY
ILLNESS IN CHILDREN
• Physical assessment
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cough
rate & depth of respirations
retractions
restlessness
cyanosis
clubbing of fingers
adventitious sounds
chest diameters
ASSESSING RESPIRATORY
ILLNESS IN CHILDREN
• Laboratory tests
– blood gas studies
• pulse oximetry
• transcutaneous oxygen monitoring
– nasopharyngeal culture
– respiratory syncytial virus nasal washings
– sputum analysis
ASSESSING RESPIRATORY
ILLNESS IN CHILDREN
• Diagnostic procedures
– chest x-ray
– bronchography
– pulmonary function studies
THERAPEUTIC TECHNIQUES USED IN
THE TREATMENT OF RESPIRATORY
ILLNESS IN CHILDREN
• Expectorant therapy
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oral fluid
liquefying agents
humidification
coughing
chest physiotherapy
mucus-clearing device
THERAPEUTIC TECHNIQUES USED IN
THE TREATMENT OF RESPIRATORY
ILLNESS IN CHILDREN
• Therapy to improve oxygenation
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oxygen administration
pharmacologic therapy
incentive spirometry
breathing techniques
tracheostomy
endotracheal intubation
assisted ventilation
DISORDERS OF THE UPPER
RESPIRATORY TRACT
• Acute nasopharyngitis ( common cold)
– Viral and DOES NOT need an antibiotic
– Fever and green mucus do not necessarily
mean bacterial infection
– Treat the symptoms but suppressing a
productive cough is not good
– Using a humidifier is good but a vaporizer
can be dangerous
Allergic Rhinitis
• S/S
– Sneezing, nasal engorgement, watery nasal d/c
– Allergic salute leading to an allergic crease
– Allergic shiners
– Headaches
• Therapeutic management
– Avoidance of allergens
– Antihistamines, leukotriene inhibitors,
intranasal corticosteroids
– immunotherapy
DISORDERS OF THE UPPER
RESPIRATORY TRACT
• Pharyngitis
– viral pharyngitis
• Usually milder with “cold” symptoms
• Treat the symptoms
– streptococcal pharyngitis
• Assessed with a throat culture or a rapid strept
• May be accompanied by a sandpaper rash, petechiae, abdominal pain,
vomiting
• Rarely accompanied by “cold” symptoms
• If untreated, may result in Rheumatic fever
• Treated or not, some children will develop acute glomerulonephritis
DISORDERS OF THE UPPER
RESPIRATORY TRACT
• Tonsillitis
– Infection and inflammation of the palatine tonsils
– S/S
• Sore throat
• Drooling
• Fever
– Management
• Most common cause is group A beta-hemolytic streptoccus, treated with Amoxil
• If strept negative, assumed to be viral and treated with comfort measures
• Tonsillectomy
– Less common today
– Usually done for three or more cases of Strept throat in six months, mouth
breathing, sleep apnea
– Risk for hemorrhage is greater because site is cauterized and not sutured
– Observe closely for frequent swallowing, changes in BP
– Don’t allow red foods, drinks to be consumed
DISORDERS OF THE UPPER
RESPIRATORY TRACT
• Epistaxis
– Usually comes from “picking” but may come
from lack of humidity, resp. illness, or
systemic illness
– Keep children in an upright position with
head tilted forward applying pressure to the
sides of the nose
• Croup (Laryngotracheobronchitis)
– Characterized by “barking” cough, stridor,
and retractions
– Danger from laryngeal inflammation closing
off airway
– Emergency measures include putting child in
a hot, steamy bathroom or receiving racemic
epi via nebulizer in the ER
DISORDERS OF THE UPPER
RESPIRATORY TRACT
• Epiglottitis
– Airway emergency
– S/S
• Severe inspiratory stridor with a very sore throat
• High fever, hoarseness
• If this is suspected, never attempt to visualize epiglottis with
a tongue blade or obtain a throat culture
– Management
• Possible tacheostomy, antibiotics
DISORDERS OF THE EAR
• Otitis Externa
– Swimmer’s ear
– Pain upon manipulation of the pinna
– Treatment…Floxin Otic Gtts
• Impacted cerumen
– Wax seldom needs removing, serves to cleanse the
outer ear
– Using Qtips can push wax further into the canal
– Cerumex will remove hard wax if necessary
DISORDERS OF THE EAR
• Acute otitis media
– Common childhood disorder
– Occurs most often following a “cold” and in homes
with smoking
– S/S
• Pulling on ears
• Fever
• On inspection, TM appears inflamed and light reflex is
absent, fluid may be present causing bulging of TM
(serous)
– Probably overtreated
DISORDERS OF THE EAR
• Otitis Media with Effusion
– Results from chronic Otitis Media
– s/s
• Pressure in the ear
• Muffled hearing
• On inspection
– Level of fluid behind TM
– distorted light reflex
– TM immobile
– Treatment
• Myringotomy tubes
– Tubes come out on their own within 6-12 months
– Water shouldn’t enter the ears while tubes are in place
– Will have hearing impairment with tubes
DISORDERS OF THE LOWER
RESPIRATORY TRACT
• Bronchiolitis
– Most common causative agent, RSV
– Usually in children younger than 2
– S/S
• Resp distress with exp wheezing
– Management
• Humidified oxygen, albuterol, steroids
• Possibly Ribavirin if RSV positive
DISORDERS OF THE LOWER
RESPIRATORY TRACT
• Asthma
– Hypersensitivity response connected to other atopic
conditions (i.e. eczema and allergic rhinitis)
– Characterized by exp wheezing and coughing
– Treated according to how many times they must use their
rescue inhaler (short acting beta2agonist) weekly and
how often they are awakened at night with symptoms
– All but the mildest stage require an inhaled steroid to
minimize chronic lung changes according to the NIH
• Pneumonia
– Many different types
– Clinical presentations
• Chlamydial…wheezes, hx of conjunctivitis
in first 2 weeks of life
• Viral…rhinorrhea, low-grade fever, nonproductive cough
• Bacterial…acute onset of fever, productive
cough, pleural pain, toxic appearance,
poor feeding, lethargy
• Mycoplasma (community
acquired)…staccato cough
– Management
• Depends on type
Foreign Body Aspiration
• Children will put anything into their mouth!
– The usual-hot dogs, grapes
– The unusual-Barbie shoes, Christmas ornaments
• Suspect aspiration when…
– Choking, coughing, wheezing unilaterally occurs
• Treatment
– Bronchoscopy, laryngoscopy
Apnea
• Defined as the cessation of breathing for 20
seconds or longer
• When combined with color change or a change
in muscle tone, is referred to as an apparent lifethreatening event
• Infants are sent home with apnea monitors,
parents trained in CPR, and resuscitation
equipment.
Sudden Infant Death Syndrome
• Characterized by the sudden, unexplained death
of an infant
• Etiology is unknown but several theories exist
• Most victims are boys, under 6 mos, lower
socioeconomic status, and in winter months.
• At present, putting healthy infants to sleep on
their back has reduced the SIDS rate in the US
drastically.
DISORDERS OF THE LOWER
RESPIRATORY TRACT
• Cystic fibrosis
– Autosomal recessive inheritance
– Disorder of the exocrine glands where secretions have
difficulty flowing through gland ducts
– pancreas involvement
• Inability of child to digest fat, protein, and some sugars
cause stools to be large, bulky, greasy, and foul
(steatorrhea)
• Children appear malnourished because of poor absorption
• Suspect CF with an infant with a meconium plug
DISORDERS OF THE LOWER
RESPIRATORY TRACT
• Cystic fibrosis
– lung involvement
• Thick secretions provide a medium for infection
• Symptoms of emphysema occur
– sweat gland involvement
• Skin has salty taste, test is called “sweat test”
– Management
• High calorie, high protein, moderate fat diet
• Synthetic pancreatic enzyme at meals
• Chest physiotherapy