Pediatric acute respiratory conditions

Nasopharyngitis

Viral upper respiratory infection/common cold with runny/stuff nose, cough, sore throat, watery eyes, fatigue that lasts 7 days

Why can infants with with cold have vomiting or diarrhea?

May swallow respiratory mucus because they cannot effectively blow their nose

How is a common cold treated

Supportive care with cool-mist humidification, saline nasal spray/wash, suctioning, and increased fluids

Why are OTC medications mostly contraindicated (cough suppressant, antihistamine, decongestant)?

Contains multiple ingredients to treat multiple symptoms, increasing risk of adverse effects and accidental overdose

Acute streptococcal pharyngitis

Inflammation caused by Group A beta-hemolytic Streptococcus

What are signs and symptoms of strep pharyngitis?

Bright-red throat, enlarged tonsils with white exudate, severe sore throat, fever, petechiae, dysphagia

How is strep diagnosed?

Rapid strep test and/or throat culture (done when rapid is negative but child is symptomatic)

What is the treatment for bacterial diseases?

Generally, a 10-day antibiotic course with penicillin or amoxicillin (e.g. cephalosporin or ceftriaxone if allergic)

Kissing tonsils

Tonsils meet at midline and can obstruct airway (4+)

Tonsillitis

Inflammation of tonsils → red, enlarged tonsils and adenoids w/ exudate, sore throat w/ pain, fever, difficulty swallowing

Indications for tonsillectomy/adenoidectomy

Significant airway obstruction evidenced by snoring, apnea, or related growth/behavior problems

What are signs of bleeding after T&A?

Bright-red emesis, frequent swallowing/throat clearing, fresh blood in secretions, restlessness (tachycardia, tachypnea, pallor)

What actions should be avoided after T&A?

Coughing, throat clearing, nose blowing, and straws

What fluids should be avoided after T&A?

Citrus juices to avoid irritation to surgical site and red/brown liquids because they can be confused with blood

How is viral tonsillitis treated?

Supportive care, including hydration, cool fluids/popsicles, salt-water gargles in older children, and antipyretics

Bronchitis

Inflammation of larger airways/bronchi and trachea due to virus → dry hacking/barking cough, nasal congestion, fever, rhonchi/rales

Bronchitis nursing management

Symptomatic care, hydrate lots to loosen secretions and maintain hydration, expectorant may be used; AVOID cough suppressants to secretions to be coughed up

Bronchiolitis

Inflammation of the smaller airways (bronchioles) typically by RSV → clear rhinorrhea then cough, increased RR, accessory muscles, mild fever

Bronchiolitis nursing management

Maintain airway patency is priority; clearing nasal/airway secretions helps infant breathe while feeding

What are signs that bronchiolitis is worsening?

Increasing RR, worsening retractions, falling SpO2, poor feeding, lethargy, apnea, slowing RR after previous tachypnea

What happens in bacterial pneumonia?

Alveoli become infected and filled with inflammatory/purulent secretions → consolidation, impaired gas exchange, and increased work of breathing (chest pain in older children)

Diagnostic tests for pneumonia

Pulse oximetry, chest X-ray, cultures when indicated, CBC

Nursing interventions for pneumonia

Hydration, elevated HOB, oxygen, suctioning, CPT, rest and cluster care

Empyema

Collection of infected/purulent fluid in the pleural space

Epiglottitis

Life-threatening inflammation and swelling of the epiglottis that can rapidly obstruct the airway, typically from bacterial infection (Hib vaccine)

What are the 4 D’s of epiglottitis?

Dysphagia, dysphonia, drooling, and distress

What are signs and symptoms of epiglottitis?

Sudden high fever, drooling, 4 D’s, severe respiratory distress, sitting upright leaning forward

Nursing considerations for epliglottitis

Protect airway, humidified 100% blow-by oxygen, and keep the child calm and upright (crying completely obstructs airway); do NOT use tongue blade or throat swab

What should be done immediately when epiglottitis is suspected?

Call anesthesia/ENT STAT and have emergency airway/intubation equipment available

What is croup (laryngotracheobronchitis)

Viral infection causing edema and inflammation of the larynx and trachea, narrowing upper airway → barking/seal-like cough, hoarseness, inspiratory stridor

Medications used for croup

Dexamethasone for airway inflammation and nebulized racemic epinephrine to rapidly decrease airway edema

Stridor

High-pitched, harsh, noisy sound usually heard during inspiration, caused by upper-airway obstruction

Home management for croup

Keep child calm and upright, hydration, cool mist; seek care if stridor at rest, cyanosis, retractions