1. Chapter 36 The Child with a Respiratory Disorder

2. 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

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

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

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

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

7. 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

8. 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

9. 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.

10. Croup Syndromes

11. 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

12. 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

13. 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

14. 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

15. 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

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

17. 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

18. 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

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

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

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

22. 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

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

24. 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

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

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

27. 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

28. 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

29. 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.

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