Chapter 36 The Child with a Respiratory Disorder

The Child with Respiratory Disorders Anatomy and physiology Differences between children and adults Respiratory problems occur more often, with greater severity in infants and children Ability to mouth breath when the nose is blocked is not automatic

Acute Nasopharyngitis (Common Cold) Clinical manifestations Diagnosis Treatment and nursing care

Allergic Rhinitis (Hay Fever) Clinical manifestations Treatment and nursing care

Tonsillitis and Adenoiditis Potential complications of acute, chronic infection Clinical manifestations and diagnosis Treatment and nursing care Surgical controversy

Tonsillitis and Adenoiditis (cont.) Nursing process for the child having a tonsillectomy Assessment Selected nursing diagnoses Outcome identification and planning

Tonsillitis and Adenoiditis (cont.) Nursing process (cont.) Implementation Preventing postoperative aspiration Providing comfort, relieving pain Encouraging fluid intake Providing family teaching Evaluation: Goals and expected outcomes

Question What is one of the major nursing interventions with a child who has had a tonsillectomy? a. Family teaching b. Preventing preoperative aspiration c. Preventing excessive fluid intake d. Family interactions

Answer a. Family teaching Rationale: The child is typically discharged on the day of or the day after surgery if no complications are present. Instruct the caregiver to keep the child relatively quiet for a few days after discharge. Recommend giving soft foods and nonirritating liquids for the first few days. Teach family members that if at any time after the surgery they note any signs of hemorrhage (bright red bleeding, frequent swallowing, restlessness), they should notify the care provider. Provide written instructions and telephone numbers before discharge. Advise the caregivers that a mild earache may be expected on about the third day.

Croup Syndromes

Spasmodic Laryngitis Clinical manifestations and diagnosis Postsleep barking cough; increasing respiratory difficulty; stridor Anxiety, restlessness, hoarseness Treatment and nursing care Cool-mist humidifiers; possible low-dose emetic prescription

Acute Laryngotracheobronchitis Causes, risk factors Clinical manifestations and diagnosis Barking cough; difficulty breathing, rapid pulse Treatment Goal: Maintain airway and adequate air exchange Antimicrobial therapy; supersaturated atmosphere; nebulized epinephrine Severe symptoms: Intubation Nursing care: Close, careful observation

Epiglottitis Clinical manifestations and diagnosis Uncommon condition Sore throat; dysphagia; high fever; anxiety; tripod position breathing Treatment and nursing care Possible intubation; moist air; pulse oximetry; antibiotics

Acute Bronchiolitis (Respiratory Syncytial Virus Infection) Presentation Bronchi/bronchioles plugged with thick, viscid mucus Trapping air in lungs; exhalation difficult Clinical manifestations: Dyspnea; dry, persistent cough; extremely shallow respirations; air hunger; cyanosis; anxiety, restlessness Diagnosis: Confirmed by ELISA of mucus Treatment and nursing care Hospitalization with contact precautions; mist tent; rest; increased fluids

Asthma Also known as reactive airway disease: Hypersensitive response to allergens Clinical manifestations: Dry, hacking cough; wheezing; difficulty breathing Diagnosis: Auscultation; pulmonary function tests Treatment Bronchodilators; corticosteroids Leukotriene inhibitors; mast cell stabilizers Chest physiotherapy

Asthma (cont.) Nursing process for the child with asthma Assessment Selected nursing diagnoses Outcome identification and planning

Asthma (cont.) Nursing process for the child with asthma (cont.) Implementation Monitoring respiratory function Monitoring and improving fluid intake Promoting energy conservation Reducing child and parent anxiety Providing family teaching Evaluation: Goals and expected outcomes

Question What is the major goal of treatment for a child with acute laryngotracheobronchitis ? a. Decreasing child and parent anxiety b. Preventing migration of infection to heart or kidneys c. Maintaining airway d. Decreasing fluid intake

Answer c. Maintaining airway Rationale: The major goal of treatment for acute laryngotracheobronchitis is to maintain an airway and adequate air exchange.

Bacterial Pneumonia Clinical manifestations Abrupt; high fever; respiratory distress; tachycardia; tachypnea Diagnosis: Clinical observation; chest radiograph; secretion culture Treatment Anti-infectives; oxygen; IV fluids

Bacterial Pneumonia (cont.) Nursing process for the child with pneumonia Assessment Selected nursing diagnoses Outcome identification and planning

Bacterial Pneumonia (cont.) Nursing process for the child with pneumonia (cont.) Implementation Maintaining airway clearance Monitoring respiratory function Promoting adequate fluid intake Maintaining body temperature Promoting energy conservation Preventing additional infection Reducing child’s anxiety

Bacterial Pneumonia (cont.) Nursing process for the child with pneumonia (cont.) Implementation Promoting family coping Providing family teaching Evaluation: Goals and expected outcomes

Cystic Fibrosis Major dysfunction of all exocrine glands Clinical manifestations Pancreatic involvement; pulmonary involvement Other organ involvement Diagnosis Treatment Dietary treatment Pulmonary treatment Home care: Tremendous burden on family

Cystic Fibrosis (cont.) Nursing process for the child with cystic fibrosis Assessment Selected nursing diagnoses Outcome identification and planning

Cystic Fibrosis (cont.) Nursing process for the child with cystic fibrosis (cont.) Implementation Improving airway clearance Improving breathing Preventing infection

Cystic Fibrosis (cont.) Nursing process for the child with cystic fibrosis (cont.) Implementation Maintaining adequate nutrition Reducing the child’s anxiety Providing family support Providing family teaching Evaluation: Goals and expected outcomes

Pulmonary Tuberculosis Clinical manifestations Cough with sputum; fever; weight loss; malaise; night sweats Diagnosis Skin test/screening; radiograph Treatment Medication (isoniazid, rifampin) for nine to 18 months Prevention Vaccine: Only used in countries with high incidence

Question Tell whether the following statement is true or false. In the newborn, meconium ileus is the earliest sign/symptom of cystic fibrosis. Meconium ileus is treated with gently administered hyperosmolar enemas.

Answer True Rationale: In the newborn, meconium ileus is treated with hyperosmolar enemas, administered gently.