Alterations in Respiratory System and Hematologic Dysfunction Notes

Week 11: Alterations in Respiratory System & Hematologic Dysfunction

Learning Objectives

  • Describe and define common respiratory and blood disorders of childhood
  • Identify physical assessment components for pediatric patients with these disorders
  • Identify nursing interventions necessary to provide education for caring for a child with these disorders
  • Describe common diagnostic tests used in diagnosis and treatment of these disorders

Alterations in Respiratory System

Acute Viral Pharyngitis (Common Cold)
  • Definition: Self-limiting viral infection, resolving within 4-10 days.
  • Causative Agents: Commonly caused by rhinoviruses; also includes respiratory syncytial virus (RSV), adenovirus, influenza, and parainfluenza.
  • Transmission: Highly contagious, spreads through respiratory droplets; close contact with infected individuals increases risk.
  • Risk Factors: Seasonal variations (more common in colder months), weakened immune systems, poor hygiene practices.
  • Pathophysiology:
    • Virus invades nasal mucosa, replicates in epithelial cells.
    • Activation of immune response; inflammatory cytokines are released, worsening symptoms.
  • Clinical Manifestations:
    • Early: Sore throat, sneezing, nasal congestion.
    • Late: Fever, muscle aches, irritability, poor feeding.
  • Management:
    • No specific antiviral treatment; supportive care includes rest, hydration, and nutrition.
    • Saline drops, suctioning for infants, fever medications.
    • Avoid cough suppressants in children <1 year and avoid aspirin due to risk of Reye's syndrome.
  • Diagnostics: Primarily clinical diagnosis; laboratory tests may include CBC in complicated cases.
  • Nursing Management:
    • Elevate head during sleep, ensure hydration, educate about transmission prevention.
Acute Streptococcal Pharyngitis (Strep Throat)
  • Definition: Bacterial infection primarily caused by Group A beta-hemolytic Streptococcus.
  • Transmission: Via respiratory droplets; direct contact with contaminated surfaces.
  • Risks of Untreated Infection: Can lead to rheumatic fever or acute glomerulonephritis.
  • Clinical Manifestations:
    • Sore throat, headache, fever, cervical lymphadenopathy, tonsillar exudates.
  • Diagnostics:
    • Throat culture is the gold standard; can diagnose when rapid antigen tests are negative.
    • Anti-streptolysin O titers can assist in retrospective diagnosis.
  • Management:
    • Oral penicillin or intramuscular penicillin G; erythromycin if allergic.
    • Hydration and nutrition; recommend saltwater gargles.
    • Advise isolation from school for 24 hours post-antibiotic treatment.
  • Nursing Management:
    • Obtain throat swab, manage medications, apply compresses, ensure hydration, educate about transmission.
Tonsillitis
  • Definition: Inflammation of the palatine tonsils.
  • Causative Agents: Can be viral or bacterial, often caused by Group A Streptococcus.
  • Clinical Manifestations:
    • Dysphagia, odynophagia (painful swallowing), mouth breathing, cough, and visible pus (in bacterial cases).
  • Management:
    • Supportive care is common; recurrent cases may indicate the need for tonsillectomy.
  • Indications for Surgery:
    • More than 5 episodes per year for 2 consecutive years or obstructive sleep apnea due to tonsillar hypertrophy.
Croup Syndrome
  • Definition: General term for respiratory tract obstruction symptoms, characterized by hoarseness, barking cough, and stridor.
  • Risk Factors: Common in children 6 months to 3 years; viral infections, changes in weather.
  • Management:
    • Mild cases: supportive care, humidified air, hydration, oral dexamethasone.
    • Moderate to severe cases may need nebulized epinephrine and possibly hospitalization for severe respiratory distress.
Acute Epiglottitis
  • Definition: Life-threatening inflammation of the epiglottis, often due to Haemophilus influenzae type B.
  • Clinical Manifestations:
    • Fever, drooling, difficulty swallowing, stridor, child leaning forward in a tripod position.
  • Diagnostics:
    • Lateral neck X-ray, direct visualization not recommended to avoid airway obstruction.
  • Management:
    • Immediate antibiotics, corticosteroids, and prepare intubation equipment.
Acute Laryngitis
  • Definition: Inflammation of the larynx, causing hoarseness/loss of voice.
  • Common Causes: Viral infections, often associated with upper respiratory infections.
  • Clinical Manifestations:
    • Hoarseness, sore throat, dry hacking cough.
  • Management:
    • Supportive care, hydration, avoid whispering, and use of humidifiers.
Acute Laryngotracheobronchitis (ALTB)
  • Definition: Inflammation of the larynx, trachea, and bronchi, primarily viral.
  • Clinical Manifestations:
    • Barking cough, stridor, respiratory distress.
  • Management:
    • Maintain airway, provide humidified air, nebulized epinephrine, corticosteroids, and prepare for potential intubation.
Pneumonia
  • Definition: Infection that inflames the air sacs in the lungs, common in children.
  • Types: Lobar pneumonia, bronchopneumonia, interstitial pneumonia.
  • Common Causes: RSV, parainfluenza, streptococcal pneumonia.
  • Clinical Manifestations:
    • Fever, chills, cough, rapid/difficulty breathing, lethargy.
  • Diagnostics:
    • Chest X-ray, CBC, blood cultures, sputum swab.
  • Management:
    • Supportive care & antiviral medications for viral pneumonia; antibiotics for bacterial pneumonia; hospitalization for severe cases.

Conclusion

  • The content discussed addresses critical respiratory and hematologic dysfunctions seen in pediatric patients, focusing on the common disorders, their management, and nursing interventions.