Nursing care of a family when a child has a respiratory disorder and vision and hearing assessment

What is contained in upper and lower resp. tract?

• Upper Respiratory Tract

  • Warms and filters air.

  • Nose, pharynx, upper trachea.

• Lower Respiratory Tract

  • Gas exchange.

  • Lower trachea, bronchi, bronchioles, lungs.

How is respiratory distress assessed in children?

• Movement

  • Symmetrical, coordinated, retractions

• Rate

  • Breaths per minute

• Rhythm

  • Regular, irregular, periodic

• Depth

  • Deep or shallow

• Quality

  • Effortless and automatic or difficult and labored

• Breath Sounds

  • Noisy, grunting, snoring, heavy

• Other Observations

  • Cyanosis

  • Clubbing of fingers

  • Adventitious sounds

  • Chest diameter

What is choanal atresia?

• Congenital obstruction of the posterior naures by a membrane or bony growth

  • Can use a cotton tip to see if it moves if not there means there is a blockage

• Can be on one side or both

• Until 3 months, babies are nose breathers

• Attempt to pass a 5, 6, 8 fr suction catheter

• Surgical intervention to correct

What are the symptoms and at home treatment of actute nasopharyngitis “common cold”

• Symptoms

  • Rhinitis

  • Cough

  • Fever

  • Sore throat

  • Can be severe in infants (3-6 mo) → lead to pneumonia

• Treatment at home includes:

  • Saline nasal drops → clearing nose is priority as most don’t quiet know how to breathe via mouth when they are very young (3-4 months)

  • Cough supression

  • Antipyretics

  • Pain relievers (ibuprofen)- not given under 6 months as kidneys not mature enough to process

  • Encorage fluid intake

What are the indications for tonsilectomy and post op complication

• Frequent strep infections

• Post op complications

  • Vital sign changes

  • Bleeding

    • If you notice consistant swallowing that can indicate bleed

    • may even have bloody emesis

    • Dot give red food, only give soft foods

  • Frequent swallowing

Acute Laryngotrachealbronchitis “Croup” (what is it?, S/S, treatment)

• Inflammation of the larynx, trachea, and major bronchi

• Viral/ bacterial infection of the upper airway

• Swelling in area of larynx, trachea or bronchi- narrow airway

• Incidence- age 5 or under

  • preceded by URI

  • low grade fever

• More dangerous in children than in adults

• HIB vaccine has decreased incidence

• Main concern; airway obstruction

• Symptoms

  • Respiratory distress

  • Harsh, Barking Cough

  • Inspiratory stridor

  • Substernal or suprasternal retractions

  • Agitation pallor or cyanosis

  • Increase heart rate

• Treatment

  • Cool mist humidifiers

  • Keep calm (crying aggravates the airway obstruction)

  • Fluids

  • Severe cases; hospilization

  • Racemic Epinephrine; constricts vessls which allows for airways to relax; given via neb, Corticoidsteroids (like dexamethasone)

  • IV antibiotics

  • Anti pyretics

Epiglottitis (what is it?, S/S, treatment)

• Cause: H. Influenza

• Abrupt onset with rapid progression

• Fever

• Cherry red, swollen epiglottis (do not look in throat)

• Inspiratory stridor

• Irritable, restless

• Hypoxia— acidosis and death

• Airway obstruction

• 4 D’s od epiglottitis: Drooling, Dysphagia (difficulty swallowing), Dysphonia (difficulty talking), Distressed respiratory efforts → can’t do a swab bc the airway will shut

Aspiration & Brochial obstruction

• Inhalation of a foreign object into the airway; ex. coin, peanut, formula/breast milk

• Foreign body in trachea or lodged in right main bronchus

Assessment of breath sounds?

• Normal breath sounds; inspiration is longer, louder and higher pitched then expiration

• Infants are obligatory nasal breathers

• Adventitious sounds

  • Crackles; air through moisture

  • Wheezes; air through narrow passages (d/t fluid, inflamation, spasms, tumor)

  • Course sounds: snoring sound, rhonchi air through thicker secretions

  • Stridor: High- pitched on inspiration in upper airway

Where are retractions observed and what are some other signs of respiratory infection/issues?

• Quality of pulse

• Color; circumoral cyanosis

• Cough

• Behavioral Changes

• Oximetry

• Signs of dehydration

• Sputum

What is the nursing care done for respiratory illness?

• Upper airway sx of nasal blockage, discharge; promote comfort, nose drops, nasal aspiratior, decongestants (can also suction nose)

• Cough; prevent spread of infection; handwashing, cover cough

• Sore throat:promote comfort: popsicles, analgesics

• Respiratory sounds: assess respiratory fuction/moniter for signs of respiratory distress

• Fever; control temp, cool liquids, antipyretics

• Promote hydration; sm. frequent fluids, pedialyte, popsicles, high calorie drinks

Bronchitis

• Inflammation of the major bronchi and trachea

• Cause: influenza viruses, adenovirus and mycoplasma pneumoniae etc.

• Most common in preschool and school aged Children

• Symptoms: Fever, cough, nasal congestion

Bronchiolitis (Clinical manifestation, Theraputic management, Nursing considerations?)

• Acute viral infection

• Usally begins in late fall- spring

• RSV: Respiratory syncytial virus

  • No cure just have to support then through disease

• >50% of cases in 1st 2 years of life

• Highest rate of clients attend daycare

• Reiunfection common at all ages

• Hand Washing!!!

• Clinical manifestations

  • Low grade fever

  • Copious clear rhinorrhea

  • Pulmonary changes

    • Inflamation of bronchioles; Mucus gets stuck in alveoli → can turn into pneumonia

    • Excessive mucus

    • Obstucted bronchioles

    • Bronchioles constrict leading to hyper inflation of lungs

• Management:

  • Prevention Is Key!!!

    • Limit contacts

    • Monoclonal antibody (synergist)

    • Contact precautions in hospital

  • Mild Illness

    • Nasal suctioning w/saline

    • Fluid balance

    • Reducing fever

    • Decreasing anxiety of

  • Moderate to Severe RSV Illness Management

  • Moderate Illness

    • Supplemental oxygen NC/HFNC

    • Keep calm

    • Encourage fluids

    • PG feeds for infants

  • Severe Illness

    • IV fluids

    • Ribavirin

    • Intubation

    • ECMO

• Nursing Considerations — RSV

  • Consider isolation precautions

    • Private room

    • Paired with another RSV patient

  • PPE to protect self… contagious!!!!

    • Nursing assignments… be smart

    • Contact precautions

Reactive Airway Disease: Asthma (incidence, clinical manifestation, risk factors, management)

• Asthma is a reversible obstuctive airway disease

• Leading cause of acute and chronic illness in children

• Highest number of hospital admissions

• 5 million children in USA affected

• Number of cases increasing each year

• Resp. illness #2 cause of death

• Incidence:

  • Higher among male children than female, until 12 years of age

  • Equal among Whites and African- Americans

  • Death rate among African- American 3X higher than whites

• Clinical Manifestation:

  • Wheezing: Expiratory and/or inspiratory

  • Dyspnea

  • Use of accessory muscles

  • Cough (non-productive or productive)

  • Tachypnea

  • Restlessness, apprehension

  • Diaphoresis

  • Abdominal pain due to labored breathing

  • Fatigue an difficulty talking → kids can go south real fast bc they are so small

• Risk factors

  • Genetics

  • Allergens

  • Stress

  • Pollution

  • Non-compliance with daily medications

• Prevention

  • Identify triggers and allergens

  • Treat acute respiratory illness

• Medications

  • Rescue bronchodilators

    • Educate on side effects: N/V, tachycardia, restlessness, palpitations

  • Daily meds: Flovent, QVAR

• Medication Delivery

  • MDI (metered-dose inhaler)

  • Nebulizer

Pneumonia; Clamydia, Bacterial, viral (clinical manifestations, treatment)

• Inflamation of lung parenchyma

• Bacterial or viral → can be d/t Mom having infection that leads to infection in baby

• Aspiration Pneumonia

• Clinical Manifestation

  • Mild cases: Low fever & Cough

  • Moderate/severe cases:

    • High fever

    • Cough

    • Headache

    • Malaise

    • Infiltrates on Chest X-Ray

    • WBC > 20,000

• Treatment:

  • Antibiotics (bacterial only) PO or IV

  • Increase fluids

  • Anti-pyretics

  • Cool mist humdifiers

  • Avoid exposureto smoke

  • Decrease anxiety and rest

Cystic Fibrosis (what is it, Diagnosis, Incidence, Treatment)

• Respiratory System: Thick mucous blocks airways

• Digestive system: Pancreatic ducts blocked- malabsorption → want to take pancreatic enzyme so body can digest nutrients

• Integumentary system: Broken chloride channel- salty skin-dehydration

• Reproductive system: 98% males infertile

• Growth & development

• Diagnosis (sweat test/NSB)

  • Prenatal screening *recessive

  • Newborn screen

  • Meconium plug/ileus → can indicate CF

  • Sweat test measures the amount of chloride (a component of salt) in the sweat

  • There are no needles involved in this test

  • Most reliable test for cystic fibrosis

• Incidence

  • Primarily a caucasian disease

  • CF gene

  • The incidence of CF 1 in 4,000 live white births

  • Lower in African Americans

  • Rare in latinos and asians

  • In each pregnancy, there is 25% chance of CF, 25% chance the child will be unaffected, and 50% chance that the child will be a carrier

• Treatment

  • Aimed at preventing and treating pulmonary infections

    • Antibiotics

    • Mobilization of secretion

    • Exercise

  • Maintaining optimal nutritional status

    • Pancreatic enzyme with every meal and snack

    • Dosage is adjusted according to stool formation

    • Extra salt, increase calories and protien

  • Promoting psychological adjustment

Pneumothorax

• Air in pleural space Causing atelectasis → check for obstruction or mechanical problems first

• 1% of newborns – occurs with first breath

• Absent or decreased breath sounds on affected side

• Treatment: oxygen, needle decompression, chest tube → to continue to remove air

Cataracts

• Opacity of the lens

• Congenital: inherited at birth

• Can develop in childhood

• Red reflux is white/cloudy

• Surgical correction

Otitis Externa

• Swimmers ear

  • ear infection would get ear tubes

• Inflammation in canal

• Tenderness when touching outside of ear

• Canal filled with purulent discharge

• Usually bacterial

• Rapid onset treated with drops

• Symptoms

  • Earache

  • Fever

  • Pulling at ears

  • Crying

  • Sleep disturbance

  • Vomiting

  • Bulging, red

• Risk factors

  • Exposure to other children

  • Family history

  • Use of pacifiers past 6 months

  • Smoke in household

  • Formula feeding

  • Propping bottle

  • Allergies

• Nursing Care

  • Pain relief; analgesics

  • Prevet complications; (hearing loss) complete AB tx

  • Edication; breast feeding, hold infant up when feeding, do not prop bottle, avoid smoke exposure

  • Emotional support