Nursing care of the child with a respiratory disorder
healthy people 2010
Reduce hospitalization rates for thre ambulatory care sensitive conditions : pediatric asthma and immunization -preventable pneumonia and influenza
Newborns are obligatory nose breathers until what age?
Which sinuses are present at birth and which are not? At what age are the absent sinuses developed?
Maxillary and ethmoid are present
Frontal and sphenoid sinuses are not present and develop by age 6-8 years
What factors related to a child's throat leads to an increased incidence of airway obstructions?
children tend to have enlarged tonsillar and adenoidal tissue even in the absence of illness.
Tongue is large in relation to oropharynx
How large is the infant trachea? adult trachea?
infant 4 mm wide
adult 20 mm wide
Why is the larynx funnel shaped in infants and children under 10 years of age?
the cricoid cartilage is underdeveloped
Why is there an increased chance of aspiration in infants and children?
the larynx and glottis are located higher in the neck which increases the chance of aspiration of foreign material into the lower airways.
What is congenital laryngomalacia?
very common condition of infancy, in which the soft, immature cartilage of the upper larynx collapses inward during inhalation, causing airway obstruction
inspiratory stridor present
suprasternal retractions may be present w/o other signs of resp distress
generally benign that improves by 1 year of age
Lower respiratory structures in children
bifurcation of trachea at level of third thoracic vertabra in chilren; level six in adults; contributes to risk of aspiration
alveoli develop at approx. at 24 weeks gest
term infants born with 50 million alveoli
adult number of alveoli of 300 million by the age of 7-8
Chest Wall of children
tidal volume of infants and toddlers almost completely dependent upon movement of diaphram
Metabolic rate and oxygen need in children
higher metabolic rate than adults
adult consume 3-4 L per minute
infants consume 6-8 L per minute
infants and children develop hypoxemia more rapidly
just around mouth
blue hands and feet
In which children would you not use the degree of cyanosis as an indicator of hypoxemia.
children with low red blood cells
what is the first sign of respiratory illness in infants and children (most often)?
A slow or irregular respiratory rate in an acutely ill infant or child is an ominous sign.
What is the action of an Expectorant (guaifenesin)?
Reduces viscostiy of thickened secrections by increasing respiratory fluid
What are the indications for expectorant (guaifenesin)?
conditions requiring mobilization and subseqent expectoration of mucus
What is the action of cough suppressants such as
relieves irritating, nonproductive cough by direct effect on the cough center in the medulla, which suppresses the cough reflex
What is the nursing implication of using cough suppressants?
use only with nonproductive coughs in the absence of wheezing
What is the action of brochdilators such as
(long acting) salmeterol
Relax airway smooth muscle, resulting in brochodilation
Indications for use of beta2-adrenergic agonists (bronchodilators)?
acute and chronic treatment of wheezing and brochospasm in asthma
chronic lung disease
prevent wheezing in exercise induced asthma
What are the actions of racemic epinephrine?
indicated for croup
What are the nursing implications for racemic epinephrine?
assess lung sounds and work of breathing
observe for rebound brochospasms
What is the action of anticholinergic (ipratropium)?
Produces brochodilation in asthma or chronic lung diease
What are the nursing implications of using anticholinergic (ipratropium)?
in children, generally used as an adjuct to beta2-adrenergic agonists for treatment of bronchospasm.
What are the actions of corticosteroids (inhaled) ?
anti-inflammatory effect to decrease the fequency and severity of asthma attacks. May also delay pulmonary damage that occurs with chronic asthma ; also used for chronic lung disease and croup syndrome
What are the nursing implications of inhaled corticosteroids?
not for treatment of wheezing
rinse mouth after inhalation to decrease incidence of fungal infections, dry mouth, and hoarseness
treatment of choice for asthma maintenance program
What is the action of Corticosteroids (oral, parenteral)?
suppress inflammation and normal immune response
used for acute asthma exacerbations, wheezing with chronic lung disease, and severe croup
What are the nursing implications of the use of corticosteroids (oral, parental)?
may cause hyperglycemia
may suppress reaction to allergy tests
consult physician if vaccinations are ordered during course of treatment
long term can result in peptic ulceration, altered growth, and numerous other side effects.
What are the actions of leukotriene receptor antagonists (montelukast, zafirlukast, zileuton)?
decrease inflammatory response by antagonizing the effects of leukotrienes to control asthma in children age 1 year and older
Action of montelukast ?
for allergic rhinitis in chldren 6 months and older.
What is the action of Methylzanthines such as
10-20 therapeutic blood level
provide for continuous airway relaxation in moderate or severe asthma in order to achieve long-term control
apnea of prematurity
Nursing implications of Methylxanthises ( theophylline, aminophylline).
monitor drug level routinely. Report signs of toxicity immediately:
Healthy people 2010
reduce the proportaion of children who are regularly exposed to tobacco smoke at home