The Child with a Respiratory Disorder Chapter 36: The Child with a Respiratory Disorder

Respiratory System Respiratory system grow and changes until about 12 years of age. Children have larger tongues in proportion to their mouth, shorter necks, narrower airways and their structure is closer together which leads to the possibility of respiratory obstruction

The Child with Respiratory Disorders An infant or child's respiratory system, because of its small size and underdeveloped anatomic structures, is more prone to respiratory problems. Smaller structures lead to a greater chance of obstruction and respiratory distress. The ability to breath through your mouth is not automatic but develops as the child neurologic development increases. As the child grows age 2-3 years, the use of the thoracic muscles takes the place of the use of the diaphragm and abdominal muscles for breathing and is completed by age 7.

Acute Nasopharyngitis (Common Cold) The most common complication of acute nasopharyngitis (common cold) is otitis media. viral origin such as rhinoviruses, coxsackievirus, respiratory syncytial virus (RSV), influenza virus, parainfluenza virus, or adenovirus. Bacterial invasion of the tissues might cause complications such as ear, mastoid, and lung infections. The infant should be protected from people who have colds because complications in the infant can be serious.

Clinical Manifestations- The child older than age 3 months usually develops fever early in the course of the infection, often as high as 102°F to 104°F (38.9°C to 40°C). Younger infants usually are afebrile. The child sneezes and becomes irritable and restless. The congested nasal passages can interfere with nursing, increasing the infant’s irritability The child might have vomiting or diarrhea, which might be caused by mucus drainage into the digestive system. Treatment an uncomplicated cold may not need any treatment in addition to rest, increased fluids and adequate nutrition, normal saline nose drops, suction with a bulb syringe, and a humidified environment. Acetaminophen or children’s ibuprofen may be administered as an analgesic and antipyretic.

Allergic Rhinitis (Hay Fever) Clinical Manifestations A watery nasal discharge, postnasal drip, sneezing, and allergic conjunctivitis are the usual symptoms of allergic rhinitis. Headaches are common in older children. Treatment When possible, offending allergens are avoided or removed from the environment. Antihistamines such as pseudoephedrine (Dimetapp) and decongestants can be helpful for some patients. Hyposensitization can be implemented, particularly if antihistamines are not helpful or are needed chronically. Be sure to reinforce teaching with the family caregivers about the importance of avoiding allergens and administering antihistamines to decrease symptoms.

Back pressure to blood circulation around the eyes leads to dark areas under the eyes in the child with allergic rhinitis. The child pushes the nose upward in the “allergic salute” to relieve itching and open the airway.

Tonsillitis and Adenoiditis The child with tonsillitis may have a fever, sore throat, difficulty swallowing, hypertrophied tonsils, and erythema of the soft palate. Exudate may be visible on the tonsils. Treatment of tonsillitis consists of analgesics, antipyretics, and antibiotics. Surgical removal of the tonsils and adenoids may be indicated.

Tonsillitis and Adenoiditis (cont.) The most common complication of a tonsillectomy is hemorrhage or bleeding. The child must be observed, especially in the first 24 hours, after surgery and in the 5th to 7th postoperative days for unusual restlessness, anxiety, frequent swallowing, or rapid pulse. Vomiting bright, red-flecked emesis or bright red oozing or bleeding may indicate hemorrhage. If noted, these should be reported immediately.

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.

Spasmodic Laryngitis Spasmodic laryngitis may be of infectious or allergic origin. An attack is often preceded by a runny nose and hoarseness. The child awakens after a few hours of sleep with a bark- like cough; respiratory difficulty; stridor; and may be anxious, restless, and hoarse. Humidified air is used to decrease the laryngospasm. A low dose of an emetic may be used to reduce spasms of the larynx

Acute Laryngotracheobronchitis Acute laryngotracheobronchitis is often caused by the staphylococcal bacterium. The child may become hoarse and have a barking cough and elevated temperature. Breathing difficulty, a rapid pulse, and cyanosis may occur. Antibiotics are given and the child is placed in a croupette or mist tent with oxygen. Epiglottitis is an acute inflammation of the epiglottis and is not commonly seen.

Acute Bronchiolitis (Respiratory Syncytial Virus Infection) Bronchiolitis/RSV is caused by a viral infection. Dyspnea occurs as well as a dry and persistent cough, extremely shallow respirations, air hunger, and cyanosis. Suprasternal and subcostal retractions are present with respirations as high as 60 to 80 breaths per minute. Diagnosis is made from clinical findings confirmed by laboratory testing (enzyme-linked immunosorbent assay [ELISA]). The child is hospitalized, placed on contact and droplet transmission precautions, and treated with high humidity by mist tent, rest, and increased fluids. Ribavirin (Virazole), an antiviral drug, may be used.

The “tripod” position of the child with epiglottitis.

Asthma An asthma attack can be triggered by a hypersensitive response to allergens; foods such as chocolate, milk, eggs, nuts, and grains; exercise; or exposure to cold or irritants such as wood-burning stoves, cigarette smoke, dust, and pet dander. Infections, stress, or anxiety can also trigger an asthma attack. During an asthma attack, the combination of smooth muscle spasms, which cause the lumina of the bronchi and bronchioles to narrow; edema; and increased mucus production cause respiratory obstruction.

Asthma (cont.) The goals of asthma treatment include preventing symptoms, maintaining nearly normal lung function and activity levels, preventing recurring exacerbations and hospitalizations, and providing the best medication treatment with the fewest adverse effects. Nursing care is focused on maintaining a clear airway, maintaining an adequate fluid intake, and relieving fatigue and anxiety.

Note airway edema, mucus production, and bronchospasm occurring with asthma.

Asthma

Asthma

Bacterial Pneumonia Bacterial pneumonia is usually caused by pneumococcal or H. influenzae bacterium. The onset is usually abrupt, following a mild upper respiratory illness. Symptoms may include a high temperature, respiratory distress with air hunger, flaring of the nostrils, circumoral cyanosis, and chest retractions. Tachycardia and tachypnea are present, with a pulse rate as high as 140 to 180 beats per minute and respirations as high as 80 breaths per minute.

Bacterial Pneumonia (cont.) Anti-infectives, such as penicillin or ampicillin, have proved to be the most effective in the treatment of pneumonia. If the child has a penicillin allergy, cephalosporin anti- infectives are also used. Nursing care is focused on maintaining respiratory function, preventing fluid deficit, maintaining body temperature, preventing otitis media, conserving energy, and relieving anxiety.

Cystic Fibrosis CF causes the exocrine (mucus-producing) glands to produce thick, tenacious mucus, rather than thin, free- flowing secretions. These secretions obstruct the secretory ducts of the pancreas, liver, and reproductive organs. The sweat chloride test, which shows elevated sodium chloride levels in the sweat, is the principal diagnostic test used to confirm CF. Family history, analysis of duodenal secretions for trypsin content, history of failure to thrive, chronic or recurrent respiratory infections, and radiologic findings also help diagnose the disorder.

Cystic Fibrosis (cont.) The most common and serious complications of CF arise from respiratory infections, which may lead to severe respiratory concerns. Pancreatic enzymes given with meals and snacks are used in the dietary treatment of children with CF. The child's diet is high in protein and carbohydrates, and salt in large amounts is allowed. The use of chest physiotherapy, antibiotics, and inhalation therapy help in the prevention and treatment of respiratory infections.

Pulmonary Tuberculosis Tuberculosis can be detected by doing a tuberculin skin test using purified protein derivative. When a person has a positive reaction to the skin test, additional evaluation using radiography is done to confirm the disease. INH and rifampin are used to treat tuberculosis and are given for 9 to 18 months.