Lower respiratory tract infections

Infection of the Lower Air ways Cartilaginous support of the air ways is not fully developed until adolescence, consequently the smooth muscle in these structures represents a major factor in the constriction of the airway.

Bronchitis Bronchitis or tracheobronchitis is inflammation of larger air way (trachea and bronchi). Causative agents: viruses or mycoplasma pneumonia. Ch-ch & symptoms: dry, nonproductive cough that worsens at night then become productive in 2-3 days. Bronchitis is a mild disease required symptomatic treatment as antipyretic, analgesic and humidity, cough suppressants may be useful at night.

Bronchiolitis and Resp. Syncytial Virus RSV Bronchiolitis: is an acute viral infection with maximum effect at the bronchiolar level, and rare in children older of 2 years. RSV is responsible of 80% of cases during epidemic periods. It is easily spread from hand to eye, nose or other mucous membranes. Pathophysiology of Bronchiolitis: In RSV bronchiole mucosa swell i.e. the Lumina are filled with mucous and exudates, varying degree of obstruction produced in the small air passage lead to hyper inflation __ obstructive emphysema and dilate of bronchial passage on inspiration allows sufficient space for intake of air but narrowing of the passage on expiration prevent air from leaving the lung__ so air trapped in distal to obstruction and cause progressive over inflation (emphysema).

Clinical manifestation Begins with SYMTOMS URTI: rhinorrhea (watery nasal discharge), low-grade fever, OM, conjunctivitis. Progress the illness: cough develops, Tachypnea, retraction, cyanosis. Sever illness: apneic spells, poor air exchange, poor breath sound. Apnea :the first recognized indication of RSV infection in very young infant.

Therapeutic management: Symptomatically with high humidity. Adequate fluid intake and rest, IV fluid if tachypnic child. Puls oximetry and ABGs. Bronchodilators, corticosteroids, cough suppressants, antibiotics are NOT effective in uncomplicated disease. Ribavirin: is antiviral against RSV. To prevent RSV infection: two products: RSV immune globulin (IVIG) monthly Palivizumab (IM. monthly)

Nursing consideration Patient needs separate-room (Resp. isolation) by using gloves, gown, mask, and goggles.. Hand washing. If Ribavirin is chosen for therapy ,should be given through O2 hood or tent or mask or ventilator because this drug aerosolized via small-particle aerosol generate Children who receiving RSV-IVIG must be monitored for volume overload during administration. Antibodies in RSV-IVIG may interfere with immune response to live virus vaccine (mump, rubella, measles and chicken pox) so this vaccines can be given after 9 months of last dose of RSV-IVIG. Emla cream can use before IVIG cannula insertion or IM injection Palivizumab.

Pneumonia Pneumonia: is inflammation of the pulmonary parenchyma. Common in children but more frequently occur in infancy & early childhood. Types of pneumonia: Lobar- Pneumonia: one-lobe or more (bilateral or double Pneumonia). Broncho Pneumonia: begins in the terminal bronchioles form consolidated patches in nearly lobules, also called lobular Pneumonia . Interstitial Pneumonia: inflammatory process is confined within the alveolar walls and peribronchial and interlobular tissues.

Pneumonia Morphology classification: viral, bacterial, mycoplasma , aspiration of foreign body, fungal. Viral Pneumonia: Occurs more than bacterial. Causes__ RSV, parainfluenza, influenza, adenovirus. Clinical symptoms: fever, cough, abnormal breath sound; fine crackles, whitish sputum, nasal flaring, retraction, chest pain, pallor to cyanosis, patchy infiltration can be seen in chest x-ray, irritable, restless, anorexia, vomiting, diarrhea, abdominal pain.

Pneumonia Treatment: symptomatic. O2 therapy. Comfort. Chest physiotherapy and postural drainage. Antipyretics. Fluid intake Family supports. Primary atypical pneumonia: mycoplasma Pneumonia: most common in children between 5-12 years, mostly in winter months, symptomatic treatments within 7-10 days.

Sever Acute Resp. Pneumonia (SARS) S&S: fever headache, cough, shortness of breath 2-7 days__ dry, non productive cough, dyspnea, some patient needs intubation. Caused by SARS co-V. Lab result: lymphopenia , leucopenia, thrombocytopenia, high LDH (lactate dehydrogenase), increase CK (cratinin kinas) ,positive antibodies for SARS core-virus after 21 days of illness. Treatment__ supportive care, AB, antiviral, steroid. Nursing consideration: Hand washing. Isolation room with negative pressure . N- 95 filtering disposable respirator for nurse who deal with patient of SARS

Bacterial Pneumonia Streptococcus Pneumonia is the most common cause in children and adult In infant mainly followed viral infection. Symptoms: fever, malaise, rapid& shallow respiration, cough, chest pain, abdominal pain?? Appendicitis, meningeal symptoms. Treatment: AB therapy , bed rest, antipyretic, fluid intake, need hospitalization when pleural effusion or empyema, I.V fluid, O2 therapy. Complication: Tension pneumothorax and empyema if the causative agent is staphelococcus auoraus, AOM,PE, lung abscess if pnumococcal pneumonia.

Bacterial Pneumonia Prognosis: is generally good if recognize the disease early & treat early. Prevention: pnumococcal poysaetheride vaccine for children older than 2 years who is risk. Nursing consideration: Administer of O2 therapy ,AB, rest, humidity. Assess Resp. status frequently. I.V fluid intake. Antipyretic. Lying the child on affected side. Suctioning by bulb syringe for infant. Chest physiotherapy & postural drainage. Family support & reassurance.

Foreign body aspiration FBA Common in age of 1-3 years. Severity is determined by the location of FB, types, extent of obstruction., a sharp or irritating objects produce irritation & edema. Diagnostic evaluation: Basic on Hx, & physical sign initially: shocking, gaggling, wheezing, coughing, dyspnea, strider. Cyanosis. Secondary symptoms: S&S of Resp. lesion. Radiographic examination. Bronchoscopy__ if FB in larynx or trachea. Fluoroscopic examination__ localizing FB bronchioles.

Foreign body aspiration FBA Therapeutic management: ER treatment of the choking child , by abdominal thrust for child older than 1 year,& back blows and chest thrust for children younger than 1 year of age. Endoscopy__ then put child in high humidity atmosphere. Treat secondary infection. Nursing consideration: The nurse should be know S&S of FBA. Back blows & Heimlich maneuver are simple procedure can be used by nurse & she must taught it to parents.

Foreign body aspiration FBA Signs of chocking: child cannot be speak. Become cyanotic. Collapses .child can die within 4 min. Follow up can be after FB removed__ chest physiotherapy, monitoring for respiratory distress & educate the parents. Aspiration pneumonia: is occur when food, secretion,… enter the lung cause inflammation Child at risk: who is unable to swallow (paralysis, weakness, congenital anomalies or absence cough reflex) . Or child who force-fed. Treatment: symptomatic Nursing care as care of pneumonia with other causes, and children with high risk must be put in right side position after fed.