Child With Respiratory Dysfunction

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  1. Children are obligate nose breathers up until:
    4 weeks
  2. After 4 weeks of being obligate nose breathers, children are ____ until 6 years
    Abdominal breathers
  3. Description of child's airway
    • Short and Narrow upper airway
    • Flexible larynx (easily spasms)
    • Underdeveloped intercostal muscles
    • Larger tonsils and lymphoid tissues -- more prone to infection
  4. Resp Assessment Overview:
    • Age-appropriate assessment
    • Assess rate, depth, ease, rhythm
    • Oxygen Saturation!

    • ASK:
    • --evidence of infection?
    • --cough/wheeze?
    • --cyanosis around the mouth, face, or trunk?
    • --chest pain?
    • --nasal mucus or bad breath?
  5. Most common cause of illness in infancy and childhood
    Acute Respiratory infection
  6. Types of Upper Resp Infection
    • Acute viral nasopharyngitis (common cold)
    • Acute strep pharyngitis (strep throat)
    • Tonsillitis
    • Influenze
  7. Types of Lower Resp infection
    • Bronchitis
    • RSV/Bronchiolitis
    • Pneumonias
  8. Combination of Upper and Lower resp infection
    Croup Syndromes
  9. Sx of Resp Infection
    • Fever
    • Poor Feeding
    • Vomiting, Diarrhea
    • Abdominal pain
    • Nasal Blockage/Discharge
    • Cough
    • Change in resp sounds (wheeze, grunt, stridor, crackles, etc)
    • Sore Throat
    • Meningismus
  10. Nurse Management of Resp Infection
    • Easy respiratory efforts
    • (warm, cool, moist air)

    Promote rest

    • Promote comfort 
    • (suction before sleeping/eating; saline nose drops--no more than 3 days; decongestion medications)

    • Prevent spread of infection
    • (Handwashing, no sharing sippy cups, limit contact with other children)

    • Reduce body temp
    • (Tylenol-- make sure they know dosage)

    • Promote hydration
    • (suction before feeding)

    • Provide nutrition
    • (stay hydrated)

    Provide family support and home care
  11. Upper/Lower Croup Syndromes
    • Hoarseness, "barking" or "brassy" cough
    • Possible stridor, varying resp distress

    • -Larynx
    • -Trachea
    • -Bronchi

    • *Commonly caused by virus
    • (LBT and epiglottitis)
  12. S/S of Acute Epiglottitis
    High Grade fever

    Insists on sitting upright and leaning forward (usually in tripod position)

    Absence of spontaneous cough

    Drooling (can't swallow)


  13. Never assess acute epiglottitis by:
    using tongue depressor
  14. Acute Epiglottitis is a:
    Medical Emergency!
  15. Most common croup syndrome
    LTB (Laryngeothracheobronchitis)
  16. S/S of LTB (Laryngeothracheobronchitis)
    • Gradual Onset
    • (various viral agents-- 5 years of age)
    • Low Grade Fever
    • Current URI
    • Barky cough, Stridor
    • Dyspnea
  17. Treatment of LTB (Laryngeothracheobronchitis)
    Racemic epi (2 hour peak time...must monitor to make sure they don't rebound!)

    Corticosteroids (Dexamethasone)

    IV fluids
  18. Biggest concern for nursing management in a patient with croup syndromes

    Pulse Ox

    Resp Status (HR, RR, Retractions, Flaring, Restlessness)


    Comfort (keep pt calm bc crying can exacerbate inflammation)
  19. Most frequent cause of hospitalization in children <1 year old
  20. RSV is dx by
    Nasal Swab, CXR hyperinflated
  21. RSV is transmitted by:
    contact with secretions
  22. S/S of RSV/Bronchiolitis
    • UPI sx
    • Runny nose
    • Pharyngitis
    • Retractions
    • Fever
    • Throwing up after coughing
  23. Treatment of RSV/Bronchiolitis
    Supportive measures (virus...not much we can do)

    Breathing treatments

    Propping them up on pillows

    Hand washing

    Inform parents about injection so they can prevent RSV for the future
  24. Children with RSV are at risk for ____ due to them being unable to clear mucous like adults
  25. Nursing management of RSV
    Contact precautions

    Limit Visitors

    Encourage breastfeeding (or pump)

    Teach parents how to use nasal saline drops/bulb suction

    Teach parents to offer small amounts of fluid (risk for aspiration if they get too much)

    Monitor SpO2, Respiratory Status
  26. Worst time of the year for RSV patients
  27. Inflammation of lung parenchyma
  28. S/S of Pneumonia
    • Fever
    • Cough
    • Crackles on auscultation
    • Malaise
    • Resp Distress
    • GI symptoms
  29. Management of Pneumonia
    • Promote oxygenation
    • Ensure comfort
    • Decrease fever (tylenol)
    • IVFs
    • Antimicrobial Therapy
  30. Leading cause of chronic illness in children
  31. Classic signs of asthma exacerbation
    • Dyspnea
    • Wheezing
    • Coughing
    • ***A child profusely sweating, remains sitting upright, refusing to lie down is in severe respiratory distress
  32. Asthma management
    • Allergen control
    • Peak flow monitoring
    • Drug therapy
    • (MDIs, Corticosteroids, Beta-adrenergic agonists, Anticholinergics)
  33. Corticosteroids act as:
    Antiinflammatories (smooths everything out)
  34. Short acting asthma med to be used during asthma attack
    • Albuterol/Zopenex
    • (Beta-adrenergic agonist)
  35. Discharge teaching Nursing Management of Asthma
    How to prevent exacerbations

    How to recognize/respond to symptoms of bronchospasm

    How to promote normal activities

    How to maintain health and preven complications

    Asthma- Action Plan!!!
  36. Asthma Allergens/Irritants
    • Animal Dander
    • Dust Mites
    • Cockroaches
    • Indoor Mold
    • Pollen and Outdoor Mold
    • Tobacco Smoke
    • Strong Odors
    • Vacuum cleaning
  37. Treatment of Cystic Fibrosis
    Pulmonary Therapy (chest physiotherapy, aerosol therapy, and breathing exercises)

    Diet: increased Calcium, increased Protein

    • Meds:
    • antibiotics
    • supplemental vitamins
    • aerosol bronchodilators
    • mucolytics
    • pancreatic enzymes
  38. S/S of Cystic Fibrosis
    • Fatigue
    • Chronic Cough
    • Recurrent URIs
    • Thick, Sticky Mucus
    • Chronic Hypoxia (clubbing, barrel chest)
    • Decreased absorption of vitamins and enzymes
    • Abdominal Distention
    • Decreased Digestive Enzymes
    • Rectal Prolapse
    • Fatty, Stinky Stools (Steatorrhea)
    • Meconium Ileus in Newborn
    • Salty Taste on Skin
  39. Image Upload
  40. Cystic Fibrosis is an _____ Inheritance Pattern
    Autosomal Recessive

    (if both parents are carriers: 25% child doesn't have disease and is not a carrier; 50% don't have disease but both are carriers; 25% has disease)
  41. Organs affected by CF
    • Sinuses
    • Lungs
    • Skin
    • Liver
    • Pancreas
    • Intestines
    • Reproductive Organs
  42. Cystic Fibrosis is characterized by:
    Abnormal Chloride Movement

    Increased viscosity of mucous gland secretions (thick)

    Elevation of sweat electrolytes
  43. Earliest sign of CF
    meconium ileus as newborn
  44. S/S of CF
    Meconium ileus as newborn

    Pancreatic Fibrosis

    (Steatorrhea-- fatty stool, Azotorrhea--foul smelling stool from putrefied protein)

    Failure to thrive

    Recurrent Respiratory Infections

    Chronic Cough
  45. Diagnostics of CF
    Positive Sweat Test (mild electrical current pushes medicine into the skin to cause sweating; sweat is collected and salt content is measured)

    Genetic Marker
  46. Physical Characteristics of CF
    • Barrel Chest
    • Coarse Lung Sounds
    • Clubbing of Nail Beds
    • Small or think for age
    • Distended abdomen
    • (kind of like COPD)
  47. Lifelong Management for CF patient:
    Diet -- high calorie, high protein diet (150% of daily intake)

    Pancreatic enzyme with meals and snacks

    Glucose monitoring and insulin (if needed)

    Frequent PFTs (pulmonary function tests)

    Airway clearance (CPT, vest, inhaled bronchodilators)

    "Tune Ups" -- 2 weeks in hospital, PIC line replaced, etc...

    Nutritional supplements as needed

    Try to normalize them as much as possible!

    MUST stay 6ft away from others with CF (and they have to wear masks)
  48. Potential Complications of CF
    Rectal prolapse (bulky stools)

    Bowel obstruction

    Pulmonary complications

    Hyperglycemia/Diabetes (aren't able to release insulin properly)

    Infertility (mucus on the ovaries)

    Everything in their bodies are covered with mucous and it makes everything bulky and prevents their organs from functioning properly
  49. Family/Patient Support for CF
    • Education (NG tube at night...S/S of infection)
    • Support Groups (CF foundation)
Card Set:
Child With Respiratory Dysfunction
2015-02-26 01:45:27
Child Resp Dysfunction

Child with Resp Dysfunction
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