1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 16 The Child With Altered Respiratory Status

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Respiratory Conditions Seen During Childhood Acute or chronic Life threatening Primary clinical problem or secondary complication

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Respiratory System Variances in the Child System is physically smaller with much less reserve capacity. Fewer central and peripheral chemoreceptors in the circulatory system Airway is much smaller in diameter and shorter in length. Tongue is proportionally larger. Larynx is funnel shaped. Cartilaginous chest wall is twice as compliant and flexible.

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Respiratory System Variances in the Child—(cont.) Horizontal orientation of ribs prevents adequate leverage for intercostal muscles. Diaphragm, intercostal muscles, and the muscles supporting the head and upper/lower airways are underdeveloped. Lung tissue’s ability to inflate and deflate gradually increases throughout childhood.

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Differences in Size, Structure, and Function of the Child’s Respiratory System

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Information Obtained for a Respiratory System Assessment Past medical history, including birth history Previous health problem Childhood illnesses Immunizations Allergies Environment Things that make the symptoms worse (“triggers”) Potential comorbid conditions or symptoms Nutrition; general growth and development factors

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Stridor is a noise the infant may make as he or she attempts to provide a self-induced positive end- expiratory pressure (PEEP), which may signal respiratory distress. A. True B. False

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. False Stridor is a harsh, grating, whistling sound heard on inspiration and produced by turbulent airflow through laryngeal or tracheal obstruction. It is usually more pronounced when the child is crying or agitated. Grunting is a noise the infant may make as he or she attempts to provide a self-induced PEEP, which may signal respiratory distress.

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Diagnostic Tests and Procedures to Evaluate the Respiratory System Measurement of lung volumes and flow rates (pulmonary function tests and peak flow measurement) Direct or indirect blood and body fluid analysis (arterial blood gases, fluid cultures, sweat chloride test) Imaging techniques (radiographs, fluoroscopy, bronchography, CT scan, scintigraphy, MRI) Direct visualization of the respiratory tree (laryngoscopy, bronchoscopy)

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Diagnostic Testing

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Interventions for Children With Chronic Respiratory Conditions Oxygen Medications Airway clearance techniques Nutritional support Artificial airways Mechanical ventilation Tracheostomy

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Oxygen Delivery Methods Mask Nasal cannula Oxygen hood Oxygen tent Mechanical ventilation

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Delivering Oxygen by Mask

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Medication Routes of Administration for Respiratory Conditions Oral Inhaled Intravenous Injectable (SQ or IM)

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: Supplemental continuous gastrostomy tube or nasogastric tube feedings must be discontinued for at least 30 minutes before postural drainage and percussion. A. True B. False

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. True Traditionally, chest physiotherapy (also called postural drainage and percussion) has been the primary intervention for pulmonary conditions with hypersecretion or retained bronchial secretions. Supplemental continuous gastrostomy tube or nasogastric tube feedings must be discontinued for at least 30 minutes before postural drainage and percussion to avoid vomiting and nausea and to promote comfort.

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Laryngeal Mask Airway

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Possible Complications of a Tracheostomy Hemorrhage Edema Subcutaneous emphysema Pneumothorax Accidental decannulation

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Critical Components of Respiratory Care Preventive care Monitoring and early detection of symptoms Adequate management (in home or hospital) Health education

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: Congenital abnormalities or malformations of the respiratory systems are common in children. A. True B. False

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. False Congenital abnormalities or malformations of the respiratory systems are fortunately rare. Congenital conditions include choanal atresia, Pierre Robin syndrome, cleft palate, laryngomalacia, and tracheomalacia.

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Upper Respiratory Infections and Obstructions Allergic rhinitis Sinusitis Nasopharyngitis and pharyngitis Tonsillitis Croup

23. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Upper Respiratory Infections and Obstructions—(cont.) Acute epiglottitis Laryngotracheobronchitis Bacterial tracheitis Apnea Foreign body aspiration

24. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: The nurse should routinely attempt direct visualization of the upper airway in a child with symptoms of epiglottitis to confirm the diagnosis. A. True B. False

25. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. False The nurse should never attempt direct visualization of the upper airway in any child with symptoms of epiglottitis because it may precipitate complete airway obstruction and respiratory arrest. It should be attempted only by a person skilled in intubations and with all necessary equipment present at the bedside.

26. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Type of Apnea Central apnea –Impairment of the mechanisms that control breathing Obstructive apnea –Occurs when nasal air flow is absent despite normal or exaggerated respiratory effort Mixed apnea –Includes central and obstructive components and may require multiple treatment methods

27. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Lower Respiratory Infections and Obstructions Influenza Bronchiolitis Bronchitis Pneumonia

28. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chronic Conditions of the Respiratory System Asthma Bronchopulmonary dysplasia Cystic fibrosis

29. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Asthma Care Components Assessment and monitoring Education Control of environmental factors and comorbid conditions Medications Management and treatment of exacerbations

30. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Early Asthmatic Response

31. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk Factors for Asthma-Related Death Prior admission to ICU with or without intubation Two or more hospitalizations, three or more ER visits, or both in the past year Hospitalization or ER visit in the past month Current use of or recent withdrawal from systemic corticosteroids History of psychiatric disease or psychosocial issues History of nonadherence to asthma treatment plan

32. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Focus of Treatment for Cystic Fibrosis Ensuring optimal care, including treatments, routine monitoring, and general pediatric preventive care Facilitating access to pertinent health care resources and support Assisting the family in coordinating care and accessing medications, diet supplements, and medical equipment Supporting quality of life and independence