Week 10 Respiratory Illness Book

It can present at the time of birth and a transient condition

respiratory distress

It can be an indication of an infection, cardiac condition, or underlying lung disease

respiratory distress

the findings for this are dyspnea, nasal flaring, shortness of breath, tachypnea, bradypnea, retractions.

respiratory distress

use of accessory muscles

retraction

It is a common diagnostic category used in respiratory distress

Ineffective Airway Clearance

The problem may be characterized through presentations such as ineffective/absent cough, nasal flaring, excessive sputum, or adventitious breath sounds

Ineffective Airway Clearance

2 parts of respiratory tract

Upper Respiratory Tract, Lower Respiratory Tract

URT compose of

nose, paranasal sinuses, pharynx, larynx, epiglottis

LRT compose of

bronchi, bronchioles, alveoli

The respiratory system delivers warm and moistened air to the alveoli, transports O2 across alveolar membrane to hemoglobin-laden RBCs, and allow CO2 to diffuse from RBCs back to alveoli

Inspiration

CO2 filled air is discharged to outside

Expiration

the _____ and _____ are present at birth (respiratory system)

ethmoid and maxillary sinuses

the _____ and ________ do not develop until 3 to 7 years of age

sphenoid and frontal sinuses

Because there is a rapid growth of lymphoid tissue, _______ becomes normally enlarged in early school aged children

tonsillar tissue

It is not a prominent finding in infants when the lumen of the airway is severely compromised due to smaller amount of smooth muscle in the airway, hence infant do not develop bronchospasms (sudden tightening of the muscles around the airways in the lungs)

wheezing

Assessment of respiratory Illness in children inldues (3)

history taking, physical examination, laboratory testing

Assessment of acute respiratory Illness in children inldues (2)

interview, health history

deficient oxygenation in the blood

hypoxemia

Its symptoms may be insidious but can present w/ tachypnea, irritability, decreased alertness, decreased activity

Hypoxemia

Included in the health history

use of medications and treatments consisting of natural health products that were prescribed and/or administered to the child

Physical assessment of a child w/ respiratory disorder includes a general observation of the infant or child, utilizing this assessment tool

Pediatric Assessment Triangle

Rapid 1st step determination can be made as to a child’s severity of illness before performing a hands on assessment

Pediatric Assessment Triangle

____ is best heard when infant is calm and relaxed, best observed in the beginning of physical exam

breath sounds

this reflex is initiated by stimulation of the nerves of the respiratory tract mucosa by the presence of dust, chemicals, mucus, or inflammation.

Cough Reflex

It is a useful procedure to clear excess mucus or foreign bodies from the respiratory tract or as a response to gastric contents refluxed into the airways

Coughing

Refers to series of expiratory coughs after a deep inspiration

Paroxysmal coughing

Commonly occurs in children w/ pertussis or in those who aspirated a foreign body or liquid when they attempted to drink

Paroxysmal Coughing

Some children vomit after coughing episode

posttusive emesis

1st indicator of respiratory distress as children increase respiratory effort in order to supply more oxygen to the tissues (early sign)

Tachypnea

when children and infants experience this, they become anxious and restless

hypoxia

_____ and _____ are indications of worsening respiratory distress

anxiousness and restlessness

Blue, gray, or purplish tinge to the skin or mucous membranes can indicate hypoxia

Cynanosis

Difficult to using visual inspection, influenced by skin color

Cyanosis

Children with chronic respiratory illnesses can develop ____ due to an effort to supply more oxygen to distal parts of the body

clubbing of the fingers

A change in the angle between the finger nail and nail bed because of increased capillary growth in the fingertips in an attempt to supply more oxygen to distal body cells

clubbing of the fingers

extra or abnormal breath sounds

adventitious breath sounds

Acute or chronic respiratory illness can cause this problem which can be heard through Auscultation

adventitious breath sounds

vibrations produced as air is forced past an obstruction such as mucus in the nose or pharynx , cause a snoring sound

Rhonchi

If the obstruction is at the base of the base of tongue or larynx, it causes a harsher, strider sound on inspiration

stridor

If the obstruction is in the lower trachea or bronchioles, it produces an expiratory whistle sound

wheezing

If alveoli becomes fluid filled, fine crackling sounds are heard

rales

It occurs when alveoli are so fluid filled that little or no air can enter them

absent breath sound

with chronic obstructive lung disease, children may be unable to exhale completely, thus allowing air to be trapped in the alveoli which can cause the alveoli to expand beyond its elastic capacity which can increase chest diameter, it is called ___

Hyperinflation

Hyperinflation of alveoli may produce an elongated anteroposterior diameter of the chest, termed as _____

pigeon breast

Several Laboratory Test can be used to confirm or rule out presence of respiratory illness and to help identify the cause and severity of the problem (5)

Analysis of Arterial Blood Gases or Pulse Oximetry, Radiographs, Nasoesophageal swabs, pulmonary function testing, sputum analysis

Noninvasive technique for estimating arterial oxygen saturation either as a single meausrement or via continuous monitoring

Pulse Oximetry

It is recommended for all newborns prior to hospital discharge in order to increase detection of congenital heart disease

Pulse Oximetry Screening

It provides etiology of illness of upper respiratory tract

Nasoesophageal Culture

pH < 7.35 in blood

Acidemia

pH > 7.45 in blood

Alkalemia

CO2 > 45 mm/Hg

ventilatory failure, respiratory acidosis

CO2 < 35 mm/Hg

alveolar hyperventilation

HCO3 < 22 mEq/L

metabolic acidosis

HCO3 > 26 mEq/L

metabolic alkalosis

PO2: 80 mm/Hg - 100 mm/Hg

normal O2 level

PO2: 60 mm/Hg - 80 mm/Hg

mild hypoxemia

PO2: 40 mm/Hg - 60 mm/Hg

moderate hypoxemia

PO2: < 40 mm/Hg

severe hypoxemia

It is rarely feasible in children younger than school age unless collected from tracheostomy tube

Sputum Analysis

It may show areas of infiltration or consolidation in the lungs, if a foreign object is opaque, it may present itself in the lungs

Chest X-ray

It is more limited to infants because they cannot hold their breath

Chest-X ray

Other modalities for evaluation of respiratory tract

Computed Topography, Magnetic Resonance Imaging

It measures how much air the lungs can hold, how much air remains after exhalation, rate of airflow, and flow resistance

Pulmonary Function Test

It is the most common test of lung function in children and can be done in an office or specialty setting

Spirometry

a child breathes into this device which records the force of air exchange (FEV1), and the total amount of air exhaled (FVC).

Spirometry

A common way to measure respiratory impairment in the office and at home by having the child blow forcefully into the meter

Peak Flow meter

Can be used in children with conditions such as asthma to assess impairment compared to baseline measurements

Peak Flow Meter

Most frequent respiratory disorder seen in children and are caused by many family of viruses

Viral Upper Respiratory Infections

Viral Upper Respiratory Infections are commonly known as

common cold

VURIs spread easily through this transmission, via coughing, sneezing, and through hand contact such as touching a contaminated surface or shaking hands then touching one’s mucous membrane

Droplet Transmission

Frequent ____ or using _____ should be taught in children as young as toddlers

handwashing; alcohol based sanitizers

Yearly Influenza Vaccination is recommended for all infants ______ or older, ideally prior to the onset of influenza in the community

6 months

All children _____ or older may be offered injectable influenza Vaccine

6 months

For initial flu vaccine, children _____ to _____ , 2 doses are administered

6 months to 8 yrs old

For initial flu vaccine, children 6 months to 8 years old, 2 doses are administered __ weeks apart

4

Children over age of ____ may be administered Live Inactive Influenza Vaccine through nasal spray

2 years old

PRIMARY GOAL OF NURSING INTERVENTION FOR RESPIRATORY ILLNESS

maintain or re-establish adequate oxygenation, ventilation, and hydration.

Commonly used in home for symptomatic relief of common respiratory illness

Humidifiers

It adds moisture to a room by emitting stream of fine droplets of water into the air, providing either a cool or a warm mist to the entire room

Humidifiers

Mechanical devices that provide a stream of moistened air directly into the respiratory tract

Nebulizers

equally effective as nebulizers in the delivery of aerosolized medications and can be used with a mask or mouthpiece

Metered Dose Inhalers (MDIs)

delivers miniscule droplets into the respiratory tract to moisten even the smallest bronchioles

ultrasonic nebulizer

These are activated by child’s breath, so no coordination is needed between the dose and the inhalation

Breath Actuated Metered Dose Inhalers

It may be beneficial as a method of clearing mucus from the lungs. Therefore it should be often be encouraged rather than suppressed.

Coughing

changing child’s position or getting mild exercise or deep breathing encourages this

coughing

Simply changing child’s position may help mucus to move, initiate a cough reflex, expel mucus, and prevent mucus from pooling in certain lung areas to prevent infection and decreased lung function

Chest Physiotherapy

3 techniques involved with conventional Chest PhysioTherapy

Postural Drainage, Percussion, Vibration

It involves striking a cupped or curved palm against the chest

Percussion

It is done by pressing a vibrating hand against a child’s chest during exhalation

Vibration

In certain respiratory conditions or acute care situations, children may need supplemental ____________ to achieve adequate tissue oxygenation

oxygen administration

It requires careful administration and follow up assesment just like any other drug

oxygen

It provides a concentration of 50% oxygen at a flow rate of 4 L/min

Nasal Cannulas

infants younger than _____ are obligate nose breathers, so you must assess for nasal flaring or take consideration on the physical pressure of the device you are going to insert on an infant

18 months

It can be used to reduce bronchoconstriction, decrease work of breathing, and increase airway pressure in some patients w/ acute respiratory conditions

Heated Humidified high-Flow Nasal Cannula Oxygen Therapy

With it, heat is 34 to 37 C and humidified nearly 100% are combined with an oxygen flow rate that is beyond the child’s baseline inspiratory flow rate

Heated Humified High Flow Nasal Cannula Oxygen Therapy

In emergency situations, _______ is used with the goal of supplying as close to 100% oxygen as possible

Non-rebreather mask

It can be administered to moisten and loosen nasal secretions

Nasal Sprays (e.g normal saline)

It can reduce mucus production in the presence of allergies

Antihistamine

It can be taken orally or by inhalation that can reduce airway inflammation

corticosteroids

2 drugs used to open lower airways

Albuterol (Ventolin), Levalbuterol (Xopenex)