Respiratory Illness

Respiratory Illness in Children

Page 1: Overview

Respiratory illness is a significant concern in children due to the immaturity of their respiratory systems, making them more susceptible to infections and complications. These illnesses can lead to hospitalization in severe cases and may impact long-term lung development if not managed properly.

Page 2: Anatomy of the Respiratory System

Key Components:

  • First Rib: A crucial structural component for thoracic anatomy.

  • Right Lung:

    • Superior Lobe

    • Middle Lobe

    • Inferior Lobe

    • Horizontal and Oblique Fissures: Separate the lobes, playing a role in lung function.

  • Left Lung:

    • Superior Lobe

    • Inferior Lobe

    • Oblique Fissure

Other Structures:

  • Trachea: The airway leading to the lungs.

  • Sternum (Xiphoid Process, Manubrium): Key in protecting vital thoracic organs.

  • Seventh Rib: A critical support structure for the thorax.

Page 3: Respiratory Mechanics

Phases of Breathing:

  • Inspiration: Inhalation of air into the lungs facilitated by muscular contractions, primarily the diaphragm and intercostal muscles.

  • Expiration: Exhalation of air from the lungs, often a passive process during relaxed breathing.

Page 4: Differences in the Respiratory System of Adults and Children

Infants vs. Older Children:

  • Diaphragmatic Breathing: Predominates in infants and is the most efficient form for oxygen intake.

  • Airway Characteristics:

    • Airway cartilage in infants is soft and compressible, which can lead to increased airway resistance when inflamed.

    • Infants have 9 times more alveoli by age 12 compared to birth, allowing for increased gas exchange surface area.

    • Newborn airway diameter: 4 mm; Older child: 10 mm; Adult: 17-24 mm, illustrating significant growth and development.

    • Increased Susceptibility: Children are more vulnerable to inhaled irritants such as smoke and pollution due to their smaller airways and higher respiratory rates.

Page 5: Airway Anatomy Differences

Anatomical Features:

  • Children's Airway:

    • Proportionally larger tongue relative to the mouth.

    • Smaller pharynx contributes to easier airway obstruction.

    • Larger and floppier epiglottis that may obstruct the airway more easily.

    • Larynx is positioned more anteriorly and superiorly, compared to adults.

    • Narrowest points at the cricoid region, which is more susceptible to obstruction.

  • Adult's Upper Airway: Generally more rigid and less anatomically unique; better able to withstand respiratory challenges.

Page 6: Anatomy Differences

Developmental Perspective:

Highlights disparities in airway structure and function, emphasizing the need for tailored approaches to pediatric respiratory care.

Page 7: Lung Function

Ventilation and Perfusion:

  • Ventilation (V): Efficient airflow to and from the alveoli is crucial for effective gas exchange.

  • Perfusion (Q): Blood flow to alveolar capillaries; imbalances can lead to conditions such as pulmonary embolism.

  • Compliance: Measurement of chest wall distensibility, critical for assessing lung function.

  • Resistance: Influenced by factors such as airflow velocity, gas properties, airway diameter, and length, particularly relevant during respiratory illness.

  • Diffusion: Movement of gases across a concentration gradient, vital for oxygenating blood.

  • Oxygenation: Adequate supply of oxygen to body cells is crucial for metabolism and overall health.

Page 8: Compliance Curves in Respiratory Conditions

Observations:

Curves represent compliance differences in conditions such as COPD, normal lung function, and diseases like fibrosis and pneumothorax, informing treatment approaches.

Page 9: Airway Resistance

Key Concept:

Airway resistance increases as airway diameter decreases, impacting airflow and leading to respiratory distress in children.

Resistance Measurements:

Ranges from the trachea to bronchioles are identifiable, assisting in diagnosis and management of respiratory conditions.

Page 10: Physical Assessment of Children

Assessment Techniques:

  • Inspection (I): Monitor for color changes, nasal flaring, and unique respiratory patterns indicating distress.

Common Patterns:

  • Tachypnea (rapid breathing), bradypnea (slow breathing), and various types of respirations (e.g., Kussmaul and Cheyne-Stokes) can indicate different underlying health issues.

  • Auscultation (A): Classification of breath sounds:

    • Vesicular: Soft, swishing sounds felt over the entire lung surface; normal breath sounds in healthy lungs.

    • Bronchovesicular: Sounds over upper chest areas where large airways are located; inspiration is louder than expiration; indicative of airflow issues.

    • Bronchial: Harsh sounds over the trachea, with a shorter inspiratory phase, often suggestive of pathology.

Page 11: Common Cold

Overview:

  • Definition: Acute Viral Nasopharyngitis, a highly contagious upper respiratory infection.

  • Causes: Commonly caused by various viruses, including rhinoviruses, adenoviruses, and respiratory syncytial virus (RSV).

  • Impact: Most children develop immunity to several viral strains by age 5, contributing to decreased incidence in later childhood.

  • Symptoms: More pronounced in infants who may exhibit stronger responses to infections compared to adults.

Page 12: Clinical Manifestations

Symptoms by Age:

  • Younger Children: Sudden onset fever, irritability, decreased appetite, and prominent symptoms of upper respiratory tract infection.

  • Older Children: Low-grade fever, nasal discharge, muscular aches, and a persistent cough that may be dry or productive, indicating the severity and duration of illness.

Page 13: Therapeutic Management

Recommendations:

Most common colds are self-limiting with symptoms reaching a peak in 2-3 days; supportive care is essential. Over-the-Counter (OTC) treatments focusing on pain relief and cough management should be used cautiously without routine suppressants for productive coughs. Other Care: Ensuring adequate fluid intake, nasal suctioning, and promoting hand hygiene to prevent the spread of illness are crucial components of care.

Page 14: Acute Streptococcal Pharyngitis

General Information:

  • Causes: Group A beta-hemolytic strep (GABHS) is responsible for this bacterial infection of the throat.

  • Complications: Without treatment, complications can arise such as scarlet fever, glomerulonephritis, and rheumatic fever, which can have long-term health impacts.

Page 15: Quiz Question

  • Question: What type of infection is acute streptococcal pharyngitis?Choices: A. Viral, B. Viral Lower, C. Bacterial Upper, D. Bacterial Lower.

Page 16: Clinical Manifestations of GABHS

Symptoms:

Common symptoms include a severe sore throat, headache, fever, abdominal pain, and enlarged tonsils; these symptoms typically subside in 3 to 5 days with appropriate treatment.

Page 17: Cervical Lymphadenopathy

Characteristics:

  • Lymph Node Locations: Including preauricular, retropharyngeal, submandibular, and anterior cervical lymph nodes, indicative of systemic infections. Lymphadenopathy appears in 30%-50% of cases early on and assists in the diagnosis of streptococcal infections.

Page 18: Diagnostic Evaluation

Methods:

  • Rapid Strep Testing: Effective throat swabbing techniques for quick identification of GABHS.

  • Throat Culture: More definitive method used to rule out GABHS, particularly when rapid test results are negative.

Page 19: Therapeutic Management for GABHS

Recommended Treatments:

  • Antibiotics: Penicillin or amoxicillin (oral or IM) are standard treatments to eradicate the infection and prevent complications.

  • Supportive Treatments: Includes warm saltwater gargles and throat compresses to alleviate pain and discomfort; always assess compliance regarding infection control to prevent spread.

Page 20: Tonsillitis

Overview:

  • Causative Agents: Can be viral or bacterial; it is crucial to differentiate to provide appropriate treatment.

  • Function of Tonsils: Filter and guard the respiratory tract; involved in antibody production, playing a key role in the immune response.

Page 21: Location of Tonsillar Masses

Key Tonsils:

Includes pharyngeal, tubal, palatine, and lingual tonsils, each serving unique immunological functions.

Page 22: Clinical Manifestations of Tonsillitis

Symptoms:

Enlarged tonsils (kissing tonsils), difficulty swallowing, and offensive mouth odor are common symptoms.

Page 23: Therapeutic Management for Tonsillitis

Treatment Options:

Usually self-limiting if viral; if bacterial, antibiotics are essential. Surgical Interventions: Tonsillectomy may be indicated for severely recurring infections or airway obstruction due to enlarged tonsils.

Page 24: Post-Operative Care Post Tonsillectomy

Care Management:

Maintain hydration, provide a soft diet, and avoid citrus and red foods that may cause irritation. Monitoring for signs of hemorrhage is critical; patients typically resume normal activity in 1-2 weeks post-operation.

Page 25: Quiz Question

  • Scenario: A 5-year-old post-op tonsillectomy asks for a snack; best option?Choices: A. Banana, B. Red Popsicle, C. Milk, D. Pudding, E. Diluted Juice.

Page 26: Croup Syndromes

Characteristics:

Symptoms include hoarseness, barking cough, and inspiratory stridor; typically prevalent in children aged 6 months to 3 years. Types of Croup: Include epiglottitis, acute spasmodic laryngitis, and laryngotracheobronchitis, each requiring distinct management strategies.

Page 27: Acute Epiglottitis

Medical Emergency:

  • Age group typically affected: 2-5 years; most commonly caused by H. influenza; may also be viral or due to noninfectious causes.

  • Symptoms: Include an absence of cough, drooling, agitation, and difficulty swallowing (dysphagia); hospitalization and potential intubation may be necessary in severe cases.

Page 28: Management of Epiglottitis

Critical Responses:

Avoid throat examination unless in emergency situations to prevent exacerbation of airway obstruction. Critical care requirements: May include oxygen administration, IV fluids, and continuous monitoring.

Page 29: Acute Laryngotracheobronchitis (LTB)

Overview:

The most common type of croup affecting children aged 6 months-3 years. Viral agents such as parainfluenza are typical; symptoms may include low-grade fever, brassy cough, and varying respiratory distress.

Page 30: Acute Spasmodic Laryngitis

Features:

Nightly paroxysmal laryngeal obstruction primarily observed in ages 1-3 years; symptoms tend to resolve during the day, often requiring reassurance and humidity management.

Page 31: Croup Syndromes Comparison

Key Comparative Table:

Provides a breakdown of epidemiology and treatment recommendations, highlighting differences in age, symptoms, and management options between acute epiglottitis, LTB, and spasmodic laryngitis.

Page 32: Bronchitis

Overview:

Inflammation of large airways typically following an upper respiratory infection (URI); can complicate respiratory health. Common causative pathogens include viral strains, which can lead to persistent cough that may become productive, necessitating symptomatic treatment.

Page 33: Bronchiolitis

Key Aspects:

Recognized as the most common lower respiratory disease affecting infants, predominantly caused by RSV. Characterized by labored breathing and cough; typically occurs in infants aged 2-12 months, requiring specific nursing interventions.

Page 34: Management of Bronchiolitis

Nursing Considerations:

Home management for mild cases involves hydration and airway maintenance; monitor for any signs of respiratory distress. Hospitalization: Necessary for cases exhibiting severe respiratory distress accompanied by hypoxia.

Page 35: Pneumonia

Overview:

Inflammation can be viral or bacterial; age-specific causative pathogens can vary significantly, impacting clinical management. Clinical symptoms: Include high fever, productive cough, fatigue, and shortness of breath; urgent care may be required to prevent complications.

Page 36: Management of Pneumonia

Treatment Protocols:

  • Viral: Symptomatic care focusing on fever and hydration; bacterial: Administration of appropriate antibiotics is crucial.

  • Complications to monitor: Include pneumothorax, necessitating timely diagnostic imaging for effective treatment.

Page 37: Foreign Body Aspiration

Lifespan Risk:

Most common in children aged 1-3 years, representing a significant emergency risk; various small items may obstruct the airways and lead to acute respiratory distress.

Causative agents:

  • Seeds, nuts, carrots, popcorn, hot dogs, round candy, grapes, peanut butter, balloons, glass beads, marbles, pen, magnets, coins, medications, and disc batteries. Most inhaled FBs lodge in a mainstem or lobar bronchus, and the remaining lodge in the trachea.

Clinical Manifestations:

  • Laryngotracheal obstruction: Dyspnea, cough, stridor, hoarseness, and cyanosis.

  • Bronchial obstruction: Paroxysmal coughing, wheezing, asymmetric breath sounds, decreased airway entry, and dyspnea.

  • Larynx obstruction: Child is unable to speak or breath.

  • Nasal obstruction: Unilateral purulent drainage that does not improve over time.

Page 38: Management of Foreign Body Aspiration

Assessment and Interventions:

Immediate emergency response for choking is critical regardless of age; recognition of choking signs allows for timely intervention, potentially saving lives.

Therapeutic/Nursing Management:

  • Emergency management for choking: Use of abdominal thrusts for children older than 1 year of age; Back blows and chest thrusts for children younger than 1 year of age.

  • Recognize the signs of FB aspiration and implement immediate measures to relieve obstruction: (1) Cannot speak, (2) becomes cyanotic, and (3) collapses; these three signs indicate the child is truly choking; child can die within 4 minutes.

  • Prevention of Aspirations.