-
Children are obligate nose breathers up until:
4 weeks
-
After 4 weeks of being obligate nose breathers, children are ____ until 6 years
Abdominal breathers
-
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
-
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?
-
Most common cause of illness in infancy and childhood
Acute Respiratory infection
-
Types of Upper Resp Infection
- Acute viral nasopharyngitis (common cold)
- Acute strep pharyngitis (strep throat)
- Tonsillitis
- Influenze
-
Types of Lower Resp infection
- Bronchitis
- RSV/Bronchiolitis
- Pneumonias
-
Combination of Upper and Lower resp infection
Croup Syndromes
-
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
-
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
-
Upper/Lower Croup Syndromes
- Hoarseness, "barking" or "brassy" cough
- Possible stridor, varying resp distress
- *Commonly caused by virus
- (LBT and epiglottitis)
-
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)
Agitation
****NEVER ASSESS WITH TONGUE DEPRESSOR IF YOU SEE THIS
-
Never assess acute epiglottitis by:
using tongue depressor
-
Acute Epiglottitis is a:
Medical Emergency!
-
Most common croup syndrome
LTB (Laryngeothracheobronchitis)
-
S/S of LTB (Laryngeothracheobronchitis)
- Gradual Onset
- (various viral agents-- 5 years of age)
- Low Grade Fever
- Current URI
- Barky cough, Stridor
- Dyspnea
-
Treatment of LTB (Laryngeothracheobronchitis)
Racemic epi (2 hour peak time...must monitor to make sure they don't rebound!)
Corticosteroids (Dexamethasone)
IV fluids
-
Biggest concern for nursing management in a patient with croup syndromes
AIRWAY MANAGEMENT
Pulse Ox
Resp Status (HR, RR, Retractions, Flaring, Restlessness)
Reassurance
Comfort (keep pt calm bc crying can exacerbate inflammation)
-
Most frequent cause of hospitalization in children <1 year old
RSV/Bronchiolitis
-
RSV is dx by
Nasal Swab, CXR hyperinflated
-
RSV is transmitted by:
contact with secretions
-
S/S of RSV/Bronchiolitis
- UPI sx
- Runny nose
- Pharyngitis
- Retractions
- Fever
- Throwing up after coughing
-
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
-
Children with RSV are at risk for ____ due to them being unable to clear mucous like adults
Asthma
-
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
-
Worst time of the year for RSV patients
WINTER
-
Inflammation of lung parenchyma
Pneumonia
-
S/S of Pneumonia
- Fever
- Cough
- Crackles on auscultation
- Malaise
- Resp Distress
- GI symptoms
-
Management of Pneumonia
- Promote oxygenation
- Ensure comfort
- Decrease fever (tylenol)
- IVFs
- Antimicrobial Therapy
-
Leading cause of chronic illness in children
Asthma
-
Classic signs of asthma exacerbation
- Dyspnea
- Wheezing
- Coughing
- ***A child profusely sweating, remains sitting upright, refusing to lie down is in severe respiratory distress
-
Asthma management
- Allergen control
- Peak flow monitoring
- Drug therapy
- (MDIs, Corticosteroids, Beta-adrenergic agonists, Anticholinergics)
-
Corticosteroids act as:
Antiinflammatories (smooths everything out)
-
Short acting asthma med to be used during asthma attack
- Albuterol/Zopenex
- (Beta-adrenergic agonist)
-
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!!!
-
Asthma Allergens/Irritants
- Animal Dander
- Dust Mites
- Cockroaches
- Indoor Mold
- Pollen and Outdoor Mold
- Tobacco Smoke
- Strong Odors
- Vacuum cleaning
-
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
-
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
-
-
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)
-
Organs affected by CF
- Sinuses
- Lungs
- Skin
- Liver
- Pancreas
- Intestines
- Reproductive Organs
-
Cystic Fibrosis is characterized by:
Abnormal Chloride Movement
Increased viscosity of mucous gland secretions (thick)
Elevation of sweat electrolytes
-
Earliest sign of CF
meconium ileus as newborn
-
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
-
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
-
Physical Characteristics of CF
- Barrel Chest
- Coarse Lung Sounds
- Clubbing of Nail Beds
- Small or think for age
- Distended abdomen
- (kind of like COPD)
-
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)
-
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
-
Family/Patient Support for CF
- Education (NG tube at night...S/S of infection)
- Support Groups (CF foundation)
|
|
