1. The child with respiratory Disorder
Lecture 3, Part one

2. Anatomy of the Respiratory System
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3. Anatomy of the Respiratory System (cont.)
What is respiration?
Respiration is the act of breathing:
inhaling (inspiration) - taking in oxygen.
exhaling (expiration) - giving off carbon dioxide.
What makes up the respiratory system?
The respiratory system is made up of the organs involved in the interchanges of gases, and consists of the:
- nose pharynx
- larynx trachea
- bronchi lungs
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4. Anatomy of the Respiratory System (cont.)
The upper respiratory tract includes the following:
nose
nasal cavity
Sinuses: ethmoid, frontal, maxillary, sphenoid
larynx
The lower respiratory tract includes the following:
Lungs
Trachea
Airways (bronchi and bronchioles)
Air sacs (alveoli)
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5. Structures of the lower airway

6. Variations in Pediatric Anatomy and Physiology
Nose
Newborns are obligatory nose breathers until at least 4 weeks of age.
Throat
The tongue of the infant relative to the oropharynx is larger than in adults.
Trachea
The airway lumen is smaller in infants and children than in adults. The infant’s trachea is approximately 4 mm wide compared with the adult width of 20 mm.
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7. Variations in Pediatric Anatomy and Physiology
Fewer alveoli
Constantly Growing
Alveoli Increase in Number & Size Until 12 yr
Primarily diaphragmatic breathers until ~ 6 yr
Increased chest compliance: poor expansion & decreased lung volume
The bifurcation of the trachea occurs at the level of the third thoracic vertebra in children, compared to the level of the fourth thoracic vertebra in adults
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8. Variations in Pediatric Anatomy and Physiology
infants are born with about 50 million alveoli. After birth, alveolar growth slows until 3 months of age and then progresses until the child reaches 7 or 8 years of age, at which time the alveoli reach the adult number of around 300 million. place the child at a higher risk of hypoxemia

9. Variations in Pediatric Anatomy and Physiology
More horizontal position of rib in infant and decreased expansion of lung capacity on thoracic inspiration.

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11. ASSESSMENT Observation Level of Consciousness, Activity; Awareness
Skin Color: Pink, Pale.
Cough : dry, wet, forceful or week
Child with Mild Cyanosis
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12. ASSESSMENT Clubbing finger
Observation (cont.)
Clubbing finger
Stridor: High-pitched sound produced by an obstruction of the trachea or larynx that can be heard at inspiration or expiration.
Nasal Flaring: Nostrils Flare in Attempt to Increase Airway Diameter
Retractions: Chest Wall is Drawn Inward During Inspiration Due to Flexible (Cartilage) Airway.
Evidence of infection.
Cyanosis
Sputum
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13. ASSESSMENT
Rate: Rapid (tachypnea), normal, or slow for the particular child.
Depth: Normal depth, too shallow (hypopnea), too deep (hyperpnea)
Ease: Effortless, labored (dyspnea), orthopnea, associated with intercostal or substernal retractions.
Labored breathing:Continuous, intermittent,
sudden onset, at rest or on exertion, associated with wheezing, grunting, associated with chest pain.
Rhythm
Bad breath

14. Chest Retraction
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15. Location of Retractions
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16. ASSESSMENT Auscultation
CRACKLES: Coarse or Fine; Related to Fluid in Airway (Pneumonia, CHF)
WHEEZES: Musical Sound Related to Turbulent Airflow in Constricted Airway (Asthma)
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18. UPPER RESPIRATORY TRACT INFECTION
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19. Nasopharyngitis Nasopharyngitis: Common cold .
Causes: rhinovirus, adenovirus, influenza virus, Resp. syncytial virus (RSV), Para influenza virus.
Clinical manifestations:
fever, irritability, restlessness, sneezing, vomiting, diarrhea. dryness, irritation of nose, & Throat, cough, sneezing , chilly sensation, muscular aches.
Physical signs: edema& vasodilatation of mucosa.
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20. Nasopharyngitis

21. Nasopharyngitis (cont.)
Therapeutic management:
Mostly treated at home , no vaccine, antipyretics for fever.
Decongestants: nose drops more effective than orally.
Cough: suppressant.
Antihistamine are ineffective.
Antibiotic: usually not indication.
Nursing consideration:
For nasal obstruction: elevate head of bed, suctioning and vaporization, saline nasal drops.
Maintain adequate fluid intake to prevent dehydration.
Avoiding spread the virus.
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22. Pharyngitis
Causes : 80-90%of cases are viral cause , other is group A and B hemolytic streptococci
Clinical manifestation:
May be mild so no symptoms.
Headache, fever, abdominal pain exudates on pharynx& tonsils, 3-5 days usually symptoms are subside
Complication if not treated :
Acute glumerulonephritis syndrome in about 10 days.
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23. Pharyngitis (cont.)
Diagnostic evaluation: throat culture should be performed to rule out.
Therapeutic management:
- If streptococcal sore throat infection: oral Penicillin for 10 days ,or IM Benzathine penicillin G.
Oral Erythromycin if the child has allergy to penicillin.
erythromycin, clarithromycin, azithromycin, clindamycin, oral cephalosporins, and amoxicillin with clavulanic acid
Nursing consideration:
- Obtain throat swab for culture.
Administer penicillin & analgesic.
Cold or warm compresses to the neck may provide relief.
Warm saline gargles.
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24. Pharyngitis (cont.) Nursing consideration (cont.)
Soft liquid food are more acceptable than solid.
Continue oral medication to complete the course.
IM injection applied in deep muscle as vastus lateralis or ventrogluteal muscle, use Emla cream before IM around 2 hours.
Nurse role to prevent the spread of disease.
- Children are considered non infectious to other 24 hours after initiation of antibiotics therapy.
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25. Tonsillitis
Tonsils are masses of lymphoid tissue, first immune defense.
Tonsillitis often occur with pharyngitis, viral or bacterial causes.
S& S:
Enlarge tonsils (kissing tonsils), difficult breathing & swallow.
Enlargement of adenoid, blocked postnasal space &mouth breathing.
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26. Tonsillitis

27. Therapeutic management:
Throat culture to determine the causative agent ,viral or bacterial
Tonsillectomy (surgical removal of the palatine tonsils) may
be indicated for massive hypertrophy that results in difficulty
breathing or eating.
Adenoidectomy (the surgical removal of the adenoids)
Contraindicating for Ts &As: cleft palate, tonsillitis, blood disorder.
Nursing consideration:
Providing comfort & maintain minimize activities.
A soft or liquid diet is prescribed.
Warm salt water gargles
Analgesic, antipyretic.
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28. Tonsillitis Post operative care:
Position (place child on abdomen or side).
Discourage child from coughing frequency.
Some secretion are common as dried blood.
Crushed ice& ice water to relief pain.
Analgesic may be rectally or IV, avoid oral route.
Generally, removal of the tonsils should not occur until after 3 or 4 years of age
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29. Tonsillitis Post operative care (cont.): Soft food, milk or ice cream
Check post operative signs of Hemorrhage:
Increase pulse more than 120b/min.
Pallor.
Frequent swallowing.
Vomiting of bright blood
Decrease blood pressure is late sign of shock.
Note: use good light to look direct on site of operation.
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30. Otitis Media:OM
OM is inflammation of middle ear..
Its incidence is highest in the winter months. Many cases of bacterial OM are preceded by a viral respiratory tract infection.
Episode of acute OM occur in the first 24 month, decrease at 5 years, r/to drainage through the Eustachian tube & inflammatory of Resp. system.
Etiology:
- Acute (AOM): streptococcus, Haemophilus influenza, are the most common bacteria.
OM: blocked Eustachian tube from edema of URTI , allergic hypertrophy adenoid.
Chronic (COM): extension of AOM.
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31. Otitis Media:OM (cont.)
Diagnostic evaluation: assessment of tympanic membrane with otoscope:-
AOM: purulent discolored effusion, bulging
S&S: otalgia (earache), fever, purulent discharge, infant rolls his head from side to side, loss of appetite, crying or verbalized feeling of discomfort (older child).
COM: hearing loss, feeling of fullness, vertigo, tinnitus.
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32. Otitis Media:OM (cont.)
Therapeutic management:
Antibiotic for days e.g. Amoxicillin.
Myringotomy: surgical incision of eardrum& grommets.
Hear test after 3 month of AOM.
Routine immunization with the pneumococcal conjugate
vaccine PCV 7 (Prevnar) has reduced the incidence of AOM in some infants and children
Nursing consideration:
Relieving pain. analgesic drug +ice bag on ear.
Facilitate drainage & topical A.Biotics.
Preventing complication.
Instruct family to be careful when deal with child. With temporary hearing loss.
Preventing OM during infant feeding and setting after that.

33. Otitis Media:OM

34. CROUP SYNDROMES
Croup is a general term applied to a group of symptoms characterized by hoarseness, a resonant cough described as “barking” varying degrees of respiratory distress resulting from swelling or obstruction in the region of the larynx and subglottic airway.
Acute infections of the larynx are of greater importance in infants and small children than they are in older children

35. parainfluenza virus (types 1, 2, and 3), influenza types A and B,
human coronavirus, rhinoviruses, enteroviruses, adenoviruses, RSV, and measles.
Bacteria such as Mycoplasma pneumonia can also cause croup.

36. The number of croup cases increases in the late autumn through early winter months.
It occurs primarily in children 6 months to 3 years of age and is rare after 6 years of age.
Hospitalization may be necessary for some children with croup

37. Student assignment Page: 1186 -1187 ACUTE LARYNGOTRACHEOBRONCHITIS
ACUTE SPASMODIC LARYNGITIS
Nursing care of croup
Page:

38. Lower Respiratory Tract Infections
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39. 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.
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40. 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.
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42. Bronchiolitis & 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.
One of the Most Frequent Cause of Hospitalization in Infants
Virus or Bacteria Causes Inflammatory Response & Obstruction of Small Airways From Edema
RSV is responsible of 80% of cases during epidemic periods.
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43. Pneumonia Pneumonia: is inflammation of the pulmonary parenchyma.
Common in children but more frequently occur in infancy & early childhood.
Types of pneumonia (depend on place):
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.
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44. Pneumonia (cont.)
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; whitish sputum, nasal flaring, retraction, chest pain, pallor to cyanosis, irritable, restless, anorexia, vomiting, diarrhea, abdominal pain.
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45. Pneumonia (cont.) Viral Pneumonia (cont.): Treatment:
symptomatic: O2 therapy, Comfort.
Chest physiotherapy and postural drainage.
Antipyretics, Fluid intake, & Family supports.
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46. 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: bed rest, antipyretic, fluid intake, need hospitalization when pleural effusion or empyema, I.V fluid, O2 therapy.
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47. Bacterial Pneumonia (cont.)
Complication:
Tension pneumothorax and empyema if the causative agent is staphelococcus auoraus,
lung abscess if pnumococcal 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.
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48. Bacterial Pneumonia (cont.)
Nursing consideration:
Administer of O2 therapy , 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.
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