Key Pediatric Differences in the Respiratory System
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Key Pediatric Differences in the Respiratory System
• Lack of /insufficient surfactant• Alveoli developing• Smaller airways• Underdeveloped cartilage
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Key Differences (cont)
• Obligatory nose breather (infant)• Intercostal muscles less developed• Faster respiratory rate• Eustachian tubes relatively horizontal
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Respiratory Assessment
• RR first - full minute• Breath sounds• Quality
– Retractions– Nasal flaring
• Color• Cough
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Signs Respiratory Distress
• Cough• Hoarseness• Grunting• Stridor• Wheezing• Nasal flaring• Retractions
• Vomiting • Diarrhea• Anorexia• Tachypnea• Tachycardia• Restlessness• Cyanosis
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Potential Nursing Diagnoses• Ineffective Airway Clearance• Ineffective Breathing Patterns• Impaired Gas Exchange• Anxiety• Activity Intolerance• Risk for FVD• Altered nutrition• Altered comfort• Knowledge deficit• Ineffective coping – individual or family
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Apnea
• Periodic breathing of newborn• True apnea• ALTE• Parental teaching
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Sudden Infant Death Syndrome
• The sudden and unexplained death of an infant less than 1 yr old.
• Usually occurs during sleep.• “Back to Sleep” campaign• AAP revised SIDS guidelines (Pediatrics,
Vol. 116, No. 5, Nov. 2005)
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Sepsis• Def: a systemic bacterial infection spread
through bloodstream• Neonates high risk: unable to localize
infection• High Risk:
– Immunocompromised– Skin defects/injuries– Invasive devices
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Assessment: Sepsis• Know high risk children & monitor
– Hypo or hyperthermia– Lethargy; poor feeding– Jaundice, hepatosplenomegaly– Respiratory distress– Vomiting– Hyper or hypoglycemia
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Otitis Media
Description: inflammation middle ear– Acute otitis media– Otitis media w/effusion
• Bacterial
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Risk Factors
• < 3 years• Bottle-fed babies• Passive smoke• Group child care
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Acute Otitis Media• Definition
– Inflammation of middle ear–Rapid onset–Fever–Otalgia
• Other Clinical Manifestations:
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Treatment: AOM• Primary Prevention
–pneumococcal vaccine–No passive smoke–Hold bottle fed babies upright–handwashing
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AOM: Secondary Prevention• Pain relief• Rest• Antibiotics after 48-72 hrs in selected
patients 6 mo to 2 yrs.
PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1451-1465
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Nursing Dx: AOM
• Altered comfort r/t inflammation & pressure
• Knowledge deficit r/t incomplete understanding of disease
• Risk for Fluid Volume Deficit
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Otitis Media w/Effusion• Definition
–Fluid in middle ear–No s/s acute infection
• Clinical Manifestations:
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Treatment: OME
• Antibiotics if > 3 mo.• Assess for hearing loss ***• Myringotomy w/placement
tympanostomy tubes
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Pharyngitis
• 80-90% sore throats viral in origin–Gradual onset
• Bacterial–Group A beta-hemolytic strep
greatest concern.
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Therapeutic Management• Primarily symptomatic• Pain relief• Rest • Abx only if positive bacterial culture
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Tonsillectomy/adenoidectomy
• Most common reason: OSA• Monitor for post-op bleeding
– ***Excessive swallowing– Elevated pulse, decreased BP– Evidence of fresh bleeding– Restlessness
• Pain meds – teach parents• Fluids
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Fig. 45-UF03, p. 1209F
Croup
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Croup
• Broad classification of upper airway illness• Group of conditions with:
– Inspiratory stridor– Harsh cough– Hoarseness– Degrees of respiratory distress
• 4 different types
Laryngotracheobronchitis
• Def: inflammatory condition of larynx, trachea, bronchi
• viral• Gradual onset • harsh cough & insp. stridor• Very important to differentiate from
epiglottitis
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LTB - treatment
• Racemic epinephrine via neb• Corticosteroids • Tylenol• Cool mist• Oxygen • Observe for sudden silent respiration
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Four D's of Epiglottitis•Drooling•Dysphagia•Dysphonia•Distressed respiratory efforts
•Tripod position•Do not: examine •throat or do throat culture!•Do: reassure, keep calm, anticipate intubation
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Brochiolitis
• Lower airway• 50% RSV (respiratory syncytial virus)
– Contact and droplet precautions– Mycoplasma, parainfluenza, adenovirus
• Usually young infants who need hospitalization.
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Patho of Bronchiolitis• Virus invades
mucosal cells• Cells die: debris• Irritation
increased mucus & bronchospasm
• Air trapping
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BronchiolitisClinical Manifestation
• Tachypnea• Wheezing, crackles, or rhonchi• Retractions• Fever- maybe• Difficulty feeding• Cyanosis
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Changes to Bronchiolitis Management
• Decrease in the amount of nasal swabs being ordered
• Decrease in orders for CPT by RT
• Decrease in continuous O2 saturation monitoring
• Decrease in use of albuterol treatments
• Discharge orders for patients with > 90% O2 saturations while asleep
• When cohorting patients, infection control may be consulted
• Teach parents CPT for comfort measures
• Increase amount of intermittent O2 sat checks (ex. Q4h)
• Increase use of Racemic Epi
• Accept O2 saturations as low as 88% when a patient is sleeping
• Continue suctioning as usual
What You Will See What You Will Do
For patients placed on Isolation Precautions: Gowns, Gloves, & MASKS are encouraged
Bronchiolitis Nursing Interventions
• Facilitate gas exchange
• Monitor I & O (for DFV)• IV prn• Reduce fever• Reduce anxiety
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Asthma
• Reactive airway disease –Bronchospasm–Edema– Increased mucus production
• Triggers– Dusts, pollen, food, strenuous exercise,
weather changes, smoke, viral infections
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AsthmaClinical Manifestations
• Wheezing• Dyspnea w/prolonged expiration • Nonproductive cough• Tachypnea, orthopnea• Tripod position• Fatigue
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Asthma treatment• Short-acting bronchodilator• Mast cell inhibitor • Systemic corticosteroids• Inhaled steroids• Leukotriene receptor antagonist• Peak expiratory flow rate• Immunizations
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Cystic Fibrosis
• Mechanical obstruction r/t increased viscosity of mucous secretions.
• Autosomal recessive disorder
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Cystic Fibrosis: A Multisystem Disorder
• Respiratory system• Digestive system• Integumentary system• Reproductive system• Growth and development
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Assessment findings - CF
• Salty-tasting skin• Profuse sweating• Frequent infections• Dry, non-productive cough• Increased amt, thickness of secretions• Wheezing• Cyanosis
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Assessment findings – CF (cont)
• Digital clubbing• Increased A-P diameter of chest• Steatorrhea• Thin extremities• Muscle wasting• Failure to thrive• Meconium ileus
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Cystic Fibrosis: Interventionsstrengthen lines of resistance
• Facilitate airway clearance and gas exchange.– CPT– Pulmozyme
• Prevent infection– Immunizations– TOBI– Azithromycin
• Promote increased exercise tolerance.38
CF: Interventions
Provide optimal nutrition for growth.• High-calorie, high protein• Pancreatic enzymes with every meal
– Creon, Pancrase– Dosage adjusted to stool formation
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CF interventions (cont)
Strengthen FLD/extrapersonal environment–Child's and family's emotional needs –Prepare the family for home care
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