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Respiratory Nur 106.

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Presentation on theme: "Respiratory Nur 106."— Presentation transcript:

1 Respiratory Nur 106

2 Respiratory System General Information
Signs and symptoms of respiratory distress Common diagnostic tools Common medications and treatments

3 General Information Fetus practices breathing in utero
Normal to have amniotic fluid in lungs Absorbed as soon as takes first breath Meconium in the amniotic fluid is problem Surfactant reduces surface tension in lungs so that lungs will remain open Neonates are obligant nasal breathers

4 General Information Normal respiratory rate: 30—50
Lumen of respiratory system is smaller in children Eustachian tubes shorter and more horizontal Metabolic rates are higher than adults

5 Respiratory Assessment
Auscultation Absent or diminished lung sounds Adventitious lung sounds Crackles—passage of air through moisture Wheezes—Narrowed passageways

6 Respiratory Assessment
Observation Barrel Shaped Chest

7 Respiratory Assessment
Observation Cyanosis Club fingers

8 Respiratory Assessment
Observation Presence of retractions Occur when airway obstructed in young children Indication of severity of respiratory distress

9 Respiratory Assessment
Infant’s chest walls more flexible, muscles immature, retractions common

10 Respiratory Assessment
Retractions Suprasternal Intercostal Substernal

11 Common Diagnostic Tests
Chest xray Bronchoscopy—visualizes trachea and bronchi directly Under anesthesia Pulmonary function tests—usually not until 5 to 6 years of age Sputum culture—best collected in morning

12 Common Diagnostic Tests
Arterial blood gases Heparinized syringe Place on ice Transport to lab immediately Pressure to site for 5 minutes Pulse oximetry Oxygen saturation SPo2 87—93% safe levels of saturation

13 Respiratory System Laryngotracheobronchitis (croup) Pnuemonia
Respiratory distress syndrome Bronchopulmonary dysphasia Cystic Fibrosis Sudden Infant Death Syndrome (SIDS)

14 Respiratory System Asthma Respiratory Syncyntial Virus Pharyngitis
Allergic Rhinitis Tonsillitis/adenoiditis Influenza

15 Laryngotracheobronchitis
Generalized infection of larynx, trachea and bronchi Croup Frequently shows symptoms of mild URI during day; at night, awakens with hoarse barking cough and severe respiratory distress Most common organisms: RSV, parainfluenza virus and mycoplasma pneumoniae

16 LTB Etiology Affects children under 5 (smaller airways)
Affects boys more frequently than girls Inflammation causes narrowing of airways Onset gradual May reoccur several nights in a row

17 LTB Symptoms Low-grade fever Barking cough Respiratory stridor
Hypoxemia Tripod position

18 Respiratory Distress Tripod Position

19 LTB Treatment At home: Hot steamy bathroom Cool night air Sit upright
Cool mist vaporizer in “home made tent” Elevate head of crib Increase fluids

20 LTB Treatment Hospitalization Croup tent
IV fluids—oral fluids may cause aspiration Bronchodilators Corticosteroids Intubation equipment available

21 Epiglottitis Inflammation of epiglottis Life threatening obstruction
Usually bacterial (hemophilus influenza) Sudden onset in healthy child: awakens with high fever, drooling and respiratory distress Do NOT examine throat—may lead to spasm and complete obstruction

22 Pneumonia Inflammation/infection of bronchioles and alveloar spaces
Causative agents bacteria, viral, mycoplasma Children under 5: Viral—RSV. Influenza, adenovirus,rhinovirus Children over 5: Bacteria—streptococcus pneumoniae

23 Pneumonia Diagnosis Treatment Symptoms Xray
Fever, cough, dyspnea, tachypnea Rhonchi, crackles, wheezes Decreased breath sounds with consolidation Diagnosis Xray Treatment Antibiotics, IV, fever control, airway management

24 Respiratory Distress Syndrome
Formally called Hyaline Membrane Disease Disease primarily of premature Infant of a diabetic mother White children more frequent than black Boys more often than girls Primary pathology is production deficiency in surfactant

25 Surfactant Lung Compliance Atelectasis Work of breathing Ventilation Metabolic Respiratory PO2 Anaerobic metabolism Acidosis CO2 Adapted from: London, M; Ladewig, P; Ball, J; and Bindler, R Maternal & Child Nursing Care, 2nd ed. Upper Saddle River, NJ, Prentice Hall, p.820.

26 Respiratory Distress Syndrome
Diagnosis: x-ray—diffuse bilateral density (white-out), and atelectasis Antenatal prevention treatment: betamethasone

27 Respiratory Distress Syndrome
Nursing Care Oxygenation/ventilation Transcutaneous oxygen/CO2 monitoring Blood gas monitoring Oxygen Continuous positive airway pressure (CPAP) Respirator

28 Respiratory Distress Syndrome
Nursing Care Correction of acid-base imbalance Temperature regulation Nutrition Protect from infection

29 Respiratory Distress Syndrome
Surfactant Replacement Therapy At birth and repeated as necessary Endotracheal administration

30 Bronchopulmonary dysplasia
BPD Chronic lung disease Precipitating factors: prematurity, high oxygen concentrations, positive pressure ventilation Symptoms: Persistent respiratory distress Wheezing, tachypnea, pulmonary edema Failure to thrive

31 Bronchopulmonary Dysplasia
Nursing Care Oxygen Tracheostomy Recurrent respiratory infections Palivizumab, RSV immune globulin Promote growth and development

32 Bronchopulmonary Dysplasia
Medications: Bronchodilators Anti-inflammatory agents Diuretics Antibiotic Therapy Vitamin A

33 Cystic Fibrosis Inherited—autosomal recessive
Both parents must be carriers Each child has a 1 in 4 chance of being affected Affects primarily white children Father Mother (carrier) (carrier) Carrier Unaffected Affected Carrier

34 Cystic Fibrosis Multi-system disease—affects exocrine glands
Bronchioles, small intestines, pancreas, bile ducts Exocrine secretions—thick and tenacious Abnormal sodium excretion Sweat Chloride test Heat Prostration

35 Cystic Fibrosis Lungs—Secretions pool in bronchioles leading to infection and atelectasis Barrel shape chest Cyanosis Clubbing of fingers and toes Recurrent respiratory infections

36 Cystic Fibrosis Pancreas—absence of pancreatic enzymes and malabsorption Small intestine—Meconium hardens leading to meconium ileus Stools are bulky and fatty (steatorrhea) Large belly, wasted extremities Fat soluble vitamin deficiencies

37 Cystic Fibrosis Males usually sterile due to blocked vas deferens
Females may have trouble conceiving due to thick mucus in the reproductive tract

38 Cystic Fibrosis Medical treatment Bronchodilators Antibiotics
Pancreatic enzymes Vitamin supplements Salt supplements in hot weather?

39 Cystic Fibrosis Nursing Interventions
At birth—monitor for 1st meconium Newborn screening—blood immunoreactive trypsinogen Genetic counseling Parent Education High calorie, high protein, low fat diet How to administer pancreatic enzymes Protect from infection Breathing exercises and care

40 Cystic Fibrosis Breathing Exercises
Physical activity Chest percussion and postural drainage

41 Cystic Fibrosis Medications
Aerosol Bronchodilators—opens lungs Aerosol DNAse—loosens secretions Corticosteroids—Anti-inflammatory Antibiotics—Treats infections Pancreatic enzymes—Aids in digestion Water soluble ADEK

42 Sudden Infant Death Syndrome
Risk factors--infant Race: (decreasing order of frequency) American Indian, black, Hispanic, white, Asian Males more often than females 2—4 months of age Winter Exposure to passive smoke Prone sleeping Overheating

43 Sudden Infant Death Syndrome
Risk factors--maternal Age less than 20, short interval between pregnancies Prenatal smoking, binge alcohol, drug use Anemia Poor prenatal care, poor weight gain during pregnancy Hx of sexually transmitted disease or UTI

44 Asthma Hyper-reactive lungs Chronic condition with acute exacerbations
Responds to environmental irritants Bronchial spasm, increased airway resistance, air trapping

45 Asthma--Etiology Triggers include: inhalants, airborne pollens, stress, weather changes, exercise, viral or bacterial agents, allergens, strong emotions, etc. Runs in families—genetics unclear

46 Asthma--Pathology Exposure to irritant
Constriction of bronchial smooth muscles Edema of lung tissues Increased respiratory secretions Airway narrowing Air trapping and hyperinflation of alveoli

47 Asthma--Symptoms Wheezing—can be heard at Cough Air trapping and hyperinflation leads to prolonged expiratory phase Lips—dark red; may progress to cyanosis Anxiety Sitting upright, hunched over

48 Asthma Treatment Quick relief medications
Nebulizer (metered dose inhaler)—note if contains steroids, spacer should be used to prevent yeast infections of the mouth

49 Asthma Metered Dose Inhaler--Use
Shake the inhaler well before use (3 or 4 shakes) Remove the cap Breathe out, away from your inhaler Bring the inhaler to your mouth. Place it in your mouth between your teeth and close you mouth around it. Start to breathe in slowly. Press the top of you inhaler once and keep breathing in slowly until you have taken a full breath. Remove the inhaler from your mouth, and hold your breath for about 10 seconds, then breathe out.

50 Asthma Medications--Acute
Corticosteroids—oral or inhaled Prednisone, Methylprednisolone Β-Adrenergic agonists (Bronchodilators) Albuterol, epinephrine, terbutaline Short acting (inhaled) used to relieve an on-going attack Long acting (oral or inhaled) to control frequent attacks

51 Asthma Medications--Chronic
Cromolyn sodium—used prophylactically Inhalant Suppresses inflammation Not bronchodilator Prevents release of histamine

52 Asthma Reducing Triggers
Smoke free environment Allergy proofing home: Bedroom of primary importance Pillows and mattress enclased in covers Eliminate stuffed toys, plants, carpets, drapes Do not store out of season clothing in room

53 Status Asthmaticus The continued presence of severe respiratory distress despite vigorous therapeutic measures Medical emergency that can lead to respiratory failure and death Sudden onset of agitation or the agitated child who suddenly becomes quiet may be seriously hypoxic

54 Bronchiolitis Inflammation of the bronchioles
Edema, accumulation of mucus, air trapping and atelectasis Major concern for small infants Most common caustive agent is the respiratory syncytial virus (RSV) Often fatal

55 RSV Most important respiratory pathogen in infancy and early childhood
Not airborne Can remain viable for hours on nonporous surfaces Most frequent problem in winter and spring

56 RSV Prevention Infants up to 24 months with chronic lung disease
RSV Immune Globulin (RSV-ICIV): Antibodies against RSV. Given monthly IV beginning of season Palivizumab (monoclonal antibody): Given monthly IM

57 Pharyngitis “Sore throat” Most are caused by viruses
Most common bacteria—group A beta-hemolytic streptococcus (strept throat) Symptoms—fever, sore throat, dehydration Treatment—symptomatically If bacterial—10 days of penicillin

58 Tonsillitis/adenoiditis
Tonsils: Masses of lymphoid tissue located in pharyngeal cavitiy. Purpose: Filter pathogens Size: Children relatively large Infection can be viral or bacterial If greater than 3 infections per year, may do tonsillectomy

59 Tonsillectomy Surgical removal of palatine tonsils
Adenoidectomy—surgical removal of pharyngeal tonsils Pre-op prep same as for all surgeries

60 Tonsillectomy Recovery room Position on abdomen or side
Suction with care

61 Tonsillectomy Post op care Bedrest for day
Clear liquids advance to full then soft Cold Avoid red coloring Ice collar Analgesics

62 Tonsillectomy Post op risk—hemorrhage Up to 10 days post op Symptoms
Bright red bloody emesis Frequent swallowing Pulse greater than 120

63 Tonsillectomy Recommendations to prevent post-op hemorrhage
Avoid irritating foods Avoid gargles or vigorous toothbrushing Discourage coughing or throat clearing Use ice collar Avoid medications known to promote bleeding Limit activity

64 Allergic Rhinitis Hay fever Seen mostly in older children and adults
Treatment: antihistamine, allergy avoidance

65 Influenza Viral Symptoms last 4 to 5 days
Complications include pneumonia, encephalitis, otitis media Do not treat with aspirin because of possible link to Reye Syndrome

66 General Treatment for Respiratory Conditions
Position to promote oxygenation Humidification Fluid intake—clear liquid, avoid milk Oxygen??? Medications include bronchodilators, anti-inflammatories, antibacterial and antiviral agents

67 Foreign Body Aspiration
Peak age: under 3 Leading cause of death under 1 FB usually lodge in right main bronchus Partial or complete obstruction Sudden onset of coughing Heimlich Maneuver Surgical removal


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