Key Pediatric Differences in the Respiratory System Lack of /insufficient surfactant Alveoli developing Smaller airways Underdeveloped cartilage F 1

Key Differences (cont) Obligatory nose breather (infant) Intercostal muscles less developed Faster respiratory rate Eustachian tubes relatively horizontal 2

Respiratory Assessment RR first - full minute Breath sounds Quality –Retractions –Nasal flaring Color Cough 3

4

Signs Respiratory Distress Cough Hoarseness Grunting Stridor Wheezing Nasal flaring Retractions Vomiting Diarrhea Anorexia Tachypnea Tachycardia Restlessness Cyanosis 5

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 6

Apnea Periodic breathing of newborn True apnea ALTE Parental teaching 7

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) 8

Sepsis Def: a systemic bacterial infection spread through bloodstream Neonates high risk: unable to localize infection High Risk: –Immunocompromised –Skin defects/injuries –Invasive devices 9

Assessment: Sepsis Know high risk children & monitor –Hypo or hyperthermia –Lethargy; poor feeding –Jaundice, hepatosplenomegaly –Respiratory distress –Vomiting –Hyper or hypoglycemia 10

Otitis Media Description: inflammation middle ear –Acute otitis media –Otitis media w/effusion Bacterial 11

Risk Factors < 3 years Bottle-fed babies Passive smoke Group child care 12

Acute Otitis Media Definition –Inflammation of middle ear –Rapid onset –Fever –Otalgia Other Clinical Manifestations: F 13

Treatment: AOM Primary Prevention –pneumococcal vaccine –No passive smoke –Hold bottle fed babies upright –handwashing 14

AOM: Secondary Prevention Pain relief Rest Antibiotics after hrs in selected patients 6 mo to 2 yrs. PEDIATRICS Vol. 113 No. 5 May 2004, pp

Nursing Dx: AOM Altered comfort r/t inflammation & pressure Knowledge deficit r/t incomplete understanding of disease Risk for Fluid Volume Deficit 16

Otitis Media w/Effusion Definition –Fluid in middle ear –No s/s acute infection Clinical Manifestations: F 17

Treatment: OME Antibiotics if > 3 mo. Assess for hearing loss *** Myringotomy w/placement tympanostomy tubes 18

Pharyngitis 80-90% sore throats viral in origin –Gradual onset Bacterial –Group A beta-hemolytic strep greatest concern. F 19

Therapeutic Management Primarily symptomatic Pain relief Rest Abx only if positive bacterial culture 20

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 21

Fig. 45-UF03, p F Croup 22 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 23

LTB - treatment Racemic epinephrine via neb Corticosteroids Tylenol Cool mist Oxygen Observe for sudden silent respiration 24

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 25 F

Brochiolitis Lower airway 50% RSV (respiratory syncytial virus) –Contact and droplet precautions –Mycoplasma, parainfluenza, adenovirus Usually young infants who need hospitalization. 26

Patho of Bronchiolitis Virus invades mucosal cells Cells die: debris Irritation  increased mucus & bronchospasm Air trapping 27

Bronchiolitis Clinical Manifestation Tachypnea Wheezing, crackles, or rhonchi Retractions Fever- maybe Difficulty feeding Cyanosis 28

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 SeeWhat 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 30

Asthma Reactive airway disease –Bronchospasm –Edema –Increased mucus production Triggers –Dusts, pollen, food, strenuous exercise, weather changes, smoke, viral infections F 31

Asthma Clinical Manifestations Wheezing Dyspnea w/prolonged expiration Nonproductive cough Tachypnea, orthopnea Tripod position Fatigue 32

Asthma treatment Short-acting bronchodilator Mast cell inhibitor Systemic corticosteroids Inhaled steroids Leukotriene receptor antagonist Peak expiratory flow rate Immunizations 33

Cystic Fibrosis Mechanical obstruction r/t increased viscosity of mucous secretions. Autosomal recessive disorder 34

Cystic Fibrosis: A Multisystem Disorder Respiratory system Digestive system Integumentary system Reproductive system Growth and development F 35

Assessment findings - CF Salty-tasting skin Profuse sweating Frequent infections Dry, non-productive cough Increased amt, thickness of secretions Wheezing Cyanosis 36

Assessment findings – CF (cont) Digital clubbing Increased A-P diameter of chest Steatorrhea Thin extremities Muscle wasting Failure to thrive Meconium ileus 37

Cystic Fibrosis: Interventions strengthen 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 39

CF interventions (cont) Strengthen FLD/extrapersonal environment –Child's and family's emotional needs –Prepare the family for home care 40