NCM-109-RESPIRATORY

Nursing Care of a Family When a Child Has a Respiratory Disorder

Importance of Early Assessment

• Respiratory illness can begin at birth, with neonates potentially having difficulties initiating their first breath or establishing regular respiration patterns.

• Apgar Score: A quick method to identify newborns experiencing respiratory difficulties.

• Establishing onset and duration of respiratory problems is crucial to assess severity.

• Signs indicating issues include:

  • Feeding difficulties due to nasal congestion.

  • Shortness of breath affecting activity (e.g., running).

  • Rapid change in child's condition during the first few hours of hospitalization.

Nursing Assessments

• Tachypnea: Increased respiratory rate can indicate worsening conditions.

• Retractions: Visual signs where the chest wall is pulled in during inhalation may signal respiratory distress.

Nursing Diagnosis

1. Alteration in Breathing Mechanisms

2. Ineffective Airway Clearance:

   • Signs include: ineffective cough, nasal flaring, excessive sputum production, adventitious breath sounds.

3. Emotional Distress: Addressing the anxiety created by respiratory issues.

Examples of Nursing Diagnoses

• Activity intolerance due to poor oxygenation.

• Fatigue related to gas exchange issues.

• Fear due to breathing difficulties.

• Impaired gas exchange from excessive mucus production.

• Ineffective breathing patterns due to fatigue.

• Deficient knowledge about ongoing treatments.

Assessment of Respiratory Illness in Children

• Comprehensive evaluation includes:

  1. History taking

  2. Physical Examination

  3. Laboratory Testing (if needed)

Physical Assessment

• Observational assessment of the child’s interaction and responsiveness (interactive, limp, pale).

• Key evaluation points includes:

  • Child's position and breathing pattern (anxious, fast or slow breathing).

  • Signs of distress (retractions, nasal flaring, grunting).

  • Breath sounds are most accurately assessed when the child is calm (ideally during sleep or relaxation).

Cough Assessment

• Cough Reflex: Acts to clear the respiratory tract from irritants such as dust and chemicals.

• Types of coughs:

  • Paroxysmal Coughing: Series of coughs following deep breath, often seen in pertussis or foreign body aspiration.

• Chronic cough may indicate conditions like asthma or cystic fibrosis.

Rate and Depth of Respirations

• Tachypnea: Often the first sign of respiratory distress in children, assessed by:

  • Rate

  • Depth

  • Quality

  • Vital signs measurement.

Retractions

• Occurs when increased effort is needed to inspire due to airway obstruction.

• Signs of restlessness might indicate worsening oxygen levels and respiratory obstruction.

Physical Indicators of Respiratory Issues

• Cyanosis: Bluish tinge suggesting hypoxia.

• Clubbing of Fingers: Occurs in chronic respiratory conditions; indicates inadequate oxygen supply.

• Adventitious Sounds: Abnormal breath sounds, indicating pathology such as rhonchi or stridor.

• Chest Diameter: An indicator of chronic obstructive lung disease.

Diagnostics and Laboratory Assessments

• Pulse Oximetry: Non-invasive method for estimating oxygen saturation - essential in acute settings.

• Observing for factors that could cause inaccurate readings:

  • Ambient light exposure.

  • Children with darker skin pigmentation.

  • Movement or medical conditions affecting perfusion.

Disorders of the Upper Respiratory Tract

• Functions include warming, humidifying, and filtering air; common disorders arise from infections or structural anomalies like Choanal Atresia.

Common Upper Respiratory Infections

Acute Nasopharyngitis (Common Cold)

• Most common infectious disease in children; can lead to secondary infections in those with underlying health conditions.

• Symptoms: nasal congestion, fever, throat irritation, and cough.

Therapeutic Management for Common Cold

• No specific antiviral treatment; care focuses on symptomatic relief with medications like acetaminophen or ibuprofen.

Pharyngitis

• Viral vs. Bacterial: Typically presents with mild symptoms, but bacterial infections (like Strep throat) may require antibiotics.

Important Conditions and Interventions

• Streptococcal Pharyngitis: Treated with antibiotics to prevent complications such as rheumatic fever.

• Retropharyngeal Abscess: Emergency requiring IV antibiotics and possibly surgical drainage.

Additional Respiratory Conditions

• Epistaxis: Nosebleeds are common, often due to trauma or dry air.

  • Management: Maintain upright position, apply pressure, avoid blowing the nose.

• Sinusitis & Laryngitis: Both may require different therapeutic interventions based on cause and severity.