Pediatric Respiratory Issues Lecture Notes

Child Respiratory Issues

Introduction

This study guide focuses on respiratory issues in children, highlighting the anatomic and physiological differences between pediatric and adult patients, specific respiratory diseases, and their management.

Anatomical Differences: Pediatric vs. Adult

Airway

  • Large Tongue: Relative to the size of the oropharynx. This anatomical feature is a common cause of airway obstruction.

  • Obligate Nose Breathers: Infants primarily breathe through their noses, which results in respiratory distress if nasal congestion occurs due to blood, mucus, edema, or foreign objects obstructing the airway.

  • Smaller Airway Diameter: A smaller diameter means that any obstruction can lead to significant respiratory distress.

  • Cricoid Cartilage: The cricoid cartilage is the narrowed area in the airway and is essential to recognize due to its implications for airway management.

  • Short Neck and Trachea: Both anatomical features contribute to ease of airway dislodgement during procedures like intubation.

  • ET Tube Size: Cuffed versus uncuffed endotracheal (ET) tubes should be chosen carefully based on the child's anatomical features.

Breathing Mechanics

  • Compensatory Mechanisms: Less effective in children due to immature respiratory systems, leading to rapid deterioration of respiratory status under stress.

  • Higher Metabolic Rate: Children have a much higher metabolic rate, which increases the oxygen demand, especially during illness.

  • Respiratory Rate Variation: Changes with age; infants can sustain a respiratory rate greater than 60 breaths per minute, putting them at risk for respiratory arrest.

  • Thin Chest Wall: This feature coupled with poorly developed intercostal muscles can impair effective breathing, especially in acute illness.

  • Diaphragm Position: The diaphragm is positioned more flatly in infants, contributing to tidal volume restrictions during stress.

  • Surface Area for Gas Exchange: Divided into fewer, smaller alveoli, limiting the capacity for efficient gas exchange and requiring efforts to increase lung volume during respiratory distress.

Circulation and Cardiac Function

  • Increased Circulating Blood Volume: A feature of normal childhood physiology, placing infants at risk for significant circulatory compromise from even small fluid losses.

  • Rapid Heart Rate: Higher in infants, compensating for their relatively low stroke volume. Tachycardia can be an early sign of shock.

  • Myocardial Compliance: The myocardium is less compliant, reflecting a reduced contractile mass which can lead to quicker decompensations during illnesses.

  • Renal Function: Immature renal systems lead to rapid dehydration unless fluids are carefully monitored.

Neurodevelopmental Considerations

  • Immature Reflexes: Infants present with immature reflexes such as the Babinski reflex, which remains until walking begins.

  • Intracranial Pressure: Increased intracranial pressure can be accommodated by head size increases in children, implying the need for careful neuro monitoring.

  • Body Temperature Regulation: Immature physiologic responses affect the ability to regulate body temperature, impacting thermal stability during respiratory illnesses.

Exposure and Environmental Factors

  • Heat Production: Infants less than 3 months cannot shiver, increasing the risk of hypothermia.

  • Body Surface Area to Weight Ratio: Infants and young children have a higher ratio, leading to enhanced heat loss.

  • Increased Metabolic Demand During Illness: This can lead to respiratory depression and hypoglycemia in the event of significant heat loss.

Pediatric Respiratory Issues

Common Respiratory Problems

  • Upper Airway Problems: Croup, epiglottitis, and foreign body aspiration.

  • Lower Airway Problems: Asthma, bronchiolitis, pertussis, pneumonia, RSV, cystic fibrosis, and tuberculosis.

Asthma

  • Definition: A condition that inflames and narrows the airways, leading to difficulty breathing and impaired lung function. It is the most common chronic illness among children.

  • Signs & Symptoms (S&SX): Paroxysmal cough, tachypnea (>32 for infants), retractions, cyanosis, clubbing of fingers, adventitious breath sounds (wheezing), hypoxemia, chest tightness, and shortness of breath.

  • Treatment Goals: Reduce hospitalizations, minimize triggers, and increase immunization coverage.

  • Medications: Include Albuterol (rescue inhaler), metered-dose inhalers (MDI), injected beta-2 agonists, anticholinergics, and corticosteroids.

  • Triggers: Viral infections, smoke, cold weather, mold, pollutants, and allergens should be identified and managed.

  • Nursing Teaching: Emphasize the importance of correct medication usage, regular pediatric visits, and trigger avoidance.

Bronchiolitis

  • Definition: A lower respiratory infection most commonly caused by Respiratory Syncytial Virus (RSV), especially dangerous for infants under one year of age.

  • S&SX: Include increased cough, tachypnea, retractions, wheezing, decreased air entry, apneic spells, and fever.

  • Nursing Care: Includes placing the child in respiratory isolation, RSV swabbing, and medication administration (Albuterol is controversial). Emphasize suctioning, small frequent feeds, and maintaining O2 saturation above 94%.

Pertussis (Whooping Cough)

  • Definition: A highly contagious bacterial infection with an incubation period of 7-10 days, occurring in three phases: catarrhal, paroxysmal, and convalescent stages.

  • S&SX: Include runny nose, cough that worsens, and severe coughing fits. Infants may experience apnea during episodes.

  • Nursing Care: Focus on droplet precautions, medication adherence, and environmental management, including the use of clean mist vaporizers.

Pneumonia

  • Definition: An infection of the lower respiratory system caused by various pathogens, most commonly viral in children.

  • S&SX: Symptoms include cough, tachypnea, grunting, fever, and abdominal pain.

  • Nursing Care: Includes isolation precautions, medication administration, promoting good hygiene practices, and ensuring adequate fluid intake.

Croup (Laryngotracheobronchitis)

  • Definition: A viral infection causing inflammation of the larynx and trachea, predominantly affecting children aged 6 months to 3 years.

  • S&SX: Characterized by a barky cough, stridor, and retractions.

  • Nursing Care: Implement droplet isolation, cool mist therapy, corticosteroid administration, and monitoring for symptom resolution.

Epiglottitis

  • Definition: A potentially life-threatening inflammation of the epiglottis, often bacterial in nature, requiring emergency treatment.

  • S&SX: Includes high fever, difficulty swallowing, muffled voice, respiratory distress, and drooling. X-ray may show a “thumb sign.”

  • Nursing Care: Prioritize comfort, avoid invasive procedures until stabilization, and administer supplemental oxygen as tolerated.

Foreign Body Aspiration

  • Definition: Most commonly results from ingestion of food, toys, or small objects by children under 4.

  • S&SX: Vary based on obstruction location; may include drooling, stridor, and wheezing.

  • Nursing Care: Use BLS techniques for choking, maintain comfort, and prepare for potential bronchoscopy.

Cystic Fibrosis

  • Definition: An autosomal recessive genetic disorder affecting the lungs, pancreas, and digestive system.

  • S&SX: Thick secretions lead to lung infections, steatorrhea, and malabsorption of fat-soluble vitamins.

  • Nursing Care: Includes newborn screening, nutritional support, pulmonary management, and monitoring growth and disease progression.

Tuberculosis

  • Definition: An infectious bacterial disease caused by Mycobacterium tuberculosis, with various stages from infection to active TB.

  • S&SX: Include chronic cough, loss of appetite, fever, night sweats, and chest pain. Positive PPD/sputum cultures confirm the diagnosis.

  • Management: Requires a regimen of antituberculosis medications and dietary considerations, along with monitoring adherence to treatment protocols.

Conclusion

Effective management of respiratory issues in children is essential for improving health outcomes. This guide provides necessary insights into the differences in pediatric anatomy, common respiratory diseases, their symptoms, and treatment strategies. Understanding these key concepts is crucial for health practitioners working with this vulnerable population.