Breathing remains primarily nasal until
5-6 months of age
Infants normally breathe with an
Irregular rhythm
Children breathe
Abdominally and diaphragmatically
Chest radiograph
X ray
See respiratory disease in lungs
CT scan
See tumors and large masses
Bronchoscopy
Biopsy of lung tissue/lesion, remove foreign tissue
Laryngoscopy
Direct view of larynx . Diagnosis of stridor
PULMONARY function testing
Spirometer direct measure of vital capacity and expiratory flow rate
Sputum cultures
Isolate pathogens
Transcutaneous monitoring
Electrode used to detect O2 and co2 concentrations
Cystic fibrosis
Inherited progressive autosomal recessive disorder affecting cells that produce mucous, sweat and digestive juices
People with cystic fibrosis
Have inherited two copies of the defective CF gene-one from each parent
Cystic fibrosis cause
Gene changes. Protein that regulates movement of salt in and out of cells
Cystic fibrosis results
Abnormal accumulation of thick, sticky mucus. Leads to obstruction in pancreas, respiratory, GI and GU systems
Cystic fibrosis in the respiratory system
Chronic infection, inflammation, bronchispasms Impaired has exchange Hypoxia Increased vascular resistance Heart pumps harder CHF
Cystic fibrosis early manifestation
Wheezing
Dry, non productive cough
Frequent respiratory infections
Cystic fibrosis late manifestations
Digital clubbing
Barrel chest
Nasal polyps
Cystic fibrosis digestive system pancreas
Mucus prevents release of digestive enzymes that allow body to break down food
Diabetes type 1
Bowel obstruction
Poor absorption of proteins, cholesterol, fats
Cystic fibrosis digestive
Bowel
Fecal impaction Intussusception Meconium ileus in newborn Recap prolapse Steatorrhea Growth retardation Delayed bone age
Cystic fibrosis physical manifestations
Protuberant abdomen
Wasted buttocks
Thin extremities
Chaotic fibrosis and skin
Parent may report salty taste when kissing infant
Xerostoma
Increased sodium and chloride in sweat
Cystic fibrosis reproductive system
Males are sterile
Females- fertility problems
Cystic fibrosis Dx and tests
DNA screenings Family history Clinical signs Pilocarpine lontophoresis (sweat test) Measures Na and Cl > 60mEq/l is diagnostic
Additional tests for cystic fibrosis
72 hour fecal fat Liver function Fasting glucose Chest X ray Sputum PULMONARY function
Cystic fibrosis goal
Prevent and treat lung infection
Nutritional
Adaptation to disease
Cystic fibrosis therapy
Segmental percussion and postural drainage
Excercise
Vitamin supplement a d e k
Antibiotics
Steroids PRN
Pancreatic enzymes( adjusted with stool fat)
Cystic fibrosis nursing care
Respiratory assessment every shift and PRN
Weight/ height
Malabsorption?
Calodrie intake?
Stools? Pain, blood in stool comstipation?
Cystic fibrosis interventions
Airway Infection Nutrition growth Excercise Emotional Home care
Acquired respiratory health problems
Asthma
Apnea
SIDS
Asthma - reactive airway disease
Genetics and environment
Decreased elastic lung recoil
Pro e to airway obstruction
Flexible rib cage, underdeveloped chest muscles lead to exhaustion
Asthma pathophysiology
Increased airway responsiveness to stimuli
Inflammation and EDEMA of mucus membranes
Bronchospasm
Hypoventilation indicates worsening condition
Asthma clinical manifestations
Wheezing
Hypoxia signs
Worsening symptoms after child goes to bed
Asthma diagnosis
Good response to nebulizer Strong family Hx of asthma or allergies PULMONARY function tests Peak expiratory flow rate X ray
Intermittent asthma
Symptoms < twice a week
Rx SABA albuterol
15 minutes before exercise
Mild persistent asthma
Symptoms > twice per week but < once per day, 1-4 nighttime symptoms/ month
Mild persistent asthma Rx
Beclomethasone by MDI > 5 yo
Budesonide- nebulizer for younger children
SABA used to relieve Sx
Moderate asthma
Daily symptoms, bronchodilator used daily, sleep disturbance greater than once per week
Moderate asthma Rx
Same as mild
May add LABA for children > 5 yo
Severe persistent asthma
Symptoms all day, sleep disturbance
Rx corticosteroids
LABD daily
Leukotriene blockers
Asthma therapy
Apply dust proof covers on pillows mattress
Over humidify rooms
Wood/ tile floors
Peak flow meter can detect start of attack
Asthma in the hospital
Cardiopulmonary status q 15-30 minutes until condition improves Humidified O2 IV fluids Rxs NPO status; monitor I&O Rest
Apnea
Cessation of breathing for 20 seconds or more cyanosis bradycardia
Often seen in premature infants
Apnea manifestations
Apparent life threatening events
Observer may relate infant would have died without intervention
Occur most often in 37 weeks or greater while sleeping eating or awake
Apnea: nursing
Continuous heart/ respiration monitoring
If apnea observed, record time, duration, skin color, HR and O2 sat
Set monitor alarm for respiration pause >15 seconds
Gently tap foot or trunk
Resuscitative equipment ready
SIDS
Unknown cause 2-4 months of age Winter and spring Prematurity Soft bedding Sleeping in prime position Maternal smoking Sibling died from SIDS LBW, poor
SIDS manifestations
Silent death
SIDS nursing considerations
Pacifier to sleep
On back
Croup
General term applied to a broad classification of upper airway illness result from swelling of the epiglottis and larynx
Croup cause
Parainfluenza virus
Types of croup
Laryngotracheobronchitis 6 months- 6 years More female, winter Acute spasmodic- 1-3 yo, anxious child, hereditary Bacterial tracheitis- Epiglottitis- unique
Epiglottitis
Medical emergency!!!!!!!
Acute inflammation of epiglottis and surrounding tissue
Rapid onset
Complete airway obstruction
Epiglottitis cause
H influenzae
Affects 3-7 yo girls and boys equally Hib vaccine ( vaccine failure, atypical organism)
Epiglottitis
Epiglottitis assessment
4 Ds Dyspnea Dysphagia Drooling Distress DO NOT assess throat!!!!!! May cause complete obstruction
Croup manifestations
Barking cough Worse at night Inspiratory stridor Accessory muscles Frightened Agitation Cyanosis
Epiglottitis manifestations
Abrupt onset Rapid Tripod position. Chin thrust, mouth open Fever 102-104 Tacky Hypoxia symptoms
Croup Dx
Symptoms
Croup score
O2 status
Epiglottitis Dx
Exam of throat
Only do when intubating
Increased WBC
Lateral neck radiograph
Croup therapy
Humidity Increase fluids Antipyretics IV fluid IV antibiotics Racemic epinephrine Possible intubation
Epiglottitis therapy
Intubation
Fluids
Antibiotics
Bronchiolitis
Inflammation of bronchioles
Winter, spring
RSV 80% of cases
Inadequate hand washing
Bronchiolitis transmission
Live on paper up 1 hour
No porous surfaces up to 6 hours
Not airborne
Younger than 2 months hospitalized
Bronchiolitis pathophysiology
Upper respiratory infection (rsv)
EDEMA , mucus, cellular debris, obstruct bronchioles
Bronchioles constrict during expiration, cause hyperinflation of lungs
Atelectasis
Hypoxemia
Bronchiolitis manifestations
URI for days Tachypnea Wheezing, crackles, rhonchi Intercostal retractions Cyanosis
Bronchiolitis Dx
Chest X ray
Enzyme immunosorbent assay of nasal secretions
Bronchiolitis therapy
At home, fluids, rest Hospitalized: Cool, humidified O2 if says <90 IV fluids Assess repiratory status q 1-2 hrs
Bronchiolitis Rx
Palivizumab (synagis) IM Q month during RSV season used to reduce hospitalization of premature infants or children with heart/lung issues
Pneumonia
Infection of lung parenchyma
Bacterial, viral, aspiration, chemical
Pneumonia manifestations
Fever Cough Tachypnea Rhonchi, crackles, wheeze Retractions Nasal flaring Chest pain Cyanosis pallor Irritable Anorexia Vomiting diarrhea
Pneumonia Dx
X ray
Blood culture
Gram stain and culture of sputum
Pneumonia at home
Acetaminophen
Cool mist humidifier
Warm fluids
No smoking
Otitis media
Otitis media= effusion of middle ear
Otitis media with effusion= fluid behind tympanic membrane without signs of infection
Otitis media causes
Streptococcus pneumonia
Haemophilus influenzae
Nora Ella catarrhalis
Allergies
Otitis media manifestations
May start with symptoms of upper respiratory infection
Otitis media Dx
Hx
Pneumatic otoscopy
Typanometry
Otitis therapy
Prophylactic antibiotics for child with 3 or more distinct episodes in 6 months for four in one year
Myringotomy with tympanostomy tube persistent for more than 3 months associated with hearing loss
Foreign body aspiration
Normally less than 3 years
Leading cause of death under 1 year
Usually lodge in right main bronchus
Foreign body aspiration manifestations
Hoarseness Croup cough Wheezing stridor Cyanosis Dysphagia Dypnea
Foreign body aspiration Dx
Fluoroscopy and chest X ray
Tonsillitis
Inflammation and infection of palatine tonsil
Adenoiditis
Inflammation and infection of pharyngeal tonsils
Pharyngitis-tonsillitis causes
Adenoviruses
Coronaviruses
Enteroviruses
Tonsillitis- group A beta-hemolytic streptococcus
Pharyngitis- tonsillitis manifestations
Throat culture- bacterial or viral
Pharyngitis -tonsillitis therapy
Symptoms
Cool, bland diet
Pain
Rest