Pediatric LPN Study Notes: Respiratory Disorders

Distinguish the differences between the respiratory tract of the infant and that of the adult.
Review the signs and symptoms of respiratory distress in infants and children.
Discuss the nursing care of a child with croup, pneumonia, and respiratory syncytial virus (RSV).
Recognize the precautions involved in the care of a child diagnosed with epiglottitis.
Compare bedrest for a toddler with bedrest for an adult.
Describe smoke inhalation injury as it relates to delivery of nursing care.
Discuss the postoperative care of a 5-year-old who has had a tonsillectomy.
Recall the characteristic manifestations of allergic rhinitis.
Discuss how sinusitis in children is different from that in adults.
Assess the control of environmental exposure to allergens in the home of a child with asthma.
Express five goals of asthma therapy.
Interpret the role of sports and physical exercise for the asthmatic child.
Recall four nursing goals in the care of a child with cystic fibrosis.
Devise a nursing care plan for the child with cystic fibrosis, including family interventions.
Review the prevention of bronchopulmonary dysplasia.
Examine the prevention of sudden infant death syndrome.

Pulmonary structures differentiate in an orderly fashion during fetal life.
Alveolar cells begin to produce surfactant at 24 weeks gestation, preventing alveolar collapse during respiration after birth.
Spontaneous respiratory movements occur in the fetus; however, gas exchange happens via placental circulation.
By 35 weeks gestation, the analysis of amniotic fluid shows the lecithin/sphingomyelin (LS) ratio, indicating fetal maturity and the fetus's ability to survive outside the uterus.

Definition: The process of breathing air into and out of the lungs, affected by several factors:
- Intercostal muscles, diaphragm, and ribs.
- The brain.
- Chemoreceptors, which monitor levels of carbon dioxide and oxygen in the blood.

Elevated CO2 levels in blood and low O2 saturation stimulate the brain to increase the respiratory rate.
In chronic lung disease, receptors may become tolerant to high CO2 and low O2 concentrations.
Administering supplemental oxygen increases O2 saturation, which may decrease respiratory effort (carbon dioxide narcosis), potentially leading to respiratory failure.

Definition: An upper respiratory tract infection, commonly known as a cold or coryza.
Symptoms: Nasal discharge, irritability, sore throat, cough, general discomfort.
Complications: May include bronchitis, pneumonitis, or ear infections.
Differentiation from allergic rhinitis:
- Allergic rhinitis does not present with fever, purulent nasal discharge, or reddened mucous membranes but will show sneezing and itchy, watery eyes.
Treatment and Care:
- Emphasis on rest, clear airways, and adequate fluid intake.
- Avoid nasal drops with oily base and ensure skin care.

Definition: Inflammation of the throat structures, common among children aged 5 to 15 years.
Most common cause: Viral infections, with Haemophilus influenzae prevalent in children younger than 3.
Symptoms include: Fever, malaise, dysphagia, anorexia, conjunctivitis, rhinitis, cough, hoarseness.
In children older than 2, streptococcal pharyngitis may cause high fever (up to 104°F).
Bacterial cases may require antibiotics to prevent complications like rheumatic fever, glomerulonephritis, and others.

Frontal sinuses develop around 8 years but mature around age 18.
Childhood sinusitis predominantly involves maxillary and ethmoid sinuses.
Suspect a sinus infection if an upper respiratory infection lasts beyond 10 days, requiring antimicrobial therapy.

Description: Characterized by edema below the vocal cords, potentially leading to airway obstruction, respiratory failure, and hypoxia.
Symptoms: “Barking” cough and inspiratory stridor, with six types of croup syndromes, including:
- Acute spasmodic laryngitis: Milder form.
- Acute laryngotracheobronchitis: The most common type.
- Congenital laryngeal stridor (laryngomalacia): Weak airway wall leading to inspiratory stridor; symptoms improve in prone or side-lying positions.
- Treatment may include increasing humidity and providing fluids for respiratory relief.
Laryngotracheobronchitis treatment involves cold water humidifiers, mist tents, or croupettes; sedatives are contraindicated due to respiratory depression risk.

Definition: Inflammation and swelling above the vocal cords, narrowing the airway inlet.
Causative agent: Primarily Haemophilus influenzae type B, particularly in children aged 3 to 6 years.
Characterized by abrupt onset, the child insists on an upright position, drools saliva due to swallowing difficulty; cough is typically absent.
Tracheotomy or endotracheal intubation is the treatment of choice to prevent hypoxia; parenteral antibiotics provide rapid improvement.

Definition: Inflammation of the lungs where alveoli get filled with exudate; may lead to reduced surfactant levels and shallow breathing.
Types classified by causative organisms (e.g., bacterial, viral); Group B streptococci is prevalent in newborns, and chlamydia in infants aged 3 weeks to 3 months.
Symptoms: Dry cough, fever, increased respiratory rate, chest X-ray confirms diagnosis, elevated white blood cells, may require sputum cultures.

Bronchitis: Infection of bronchi; rarely a primary infection, usually caused by multiple microorganisms; involves a nonproductive cough.
Bronchiolitis: Viral infection primarily affecting infants aged 6 months to 2 years, often leading to emergency hospital visits; RSV is a common cause.

RSV accounts for roughly 50% of bronchiolitis cases in children; it spreads through direct contact with infected respiratory secretions.
Incubation period is approximately 4 days. Precautions include contact isolation during hospitalization.
Treatment includes symptomatic care, potential supplemental oxygen, IV hydration, and antivirals like ribavirin.

Caregivers who are pregnant or wear contact lenses should not care for infants receiving ribavirin aerosol therapy.