Respiratory

Most common illnesses in infants and children are respiratory tract infections (RTIs).
Predisposing factors:
- Activity levels, lack of hygiene awareness, and decreased resistance to viruses/bacteria leads to higher rates of RTIs in children compared to adults.
Incidence and severity of RTIs are influenced by infectious agents, age, and natural defenses of the child.
- Adults generally have more robust immune responses than children.
Infants and small children have narrower airways, making them more prone to respiratory difficulties due to:
- Size of their airway.
- Greater difficulty handling mucus.
- Predominance of nose breathing in infants.

Common therapeutic measure for symptomatic relief is using warm or cool mist.
- Moisture soothes inflamed membranes.
- Beneficial for laryngeal involvement or hoarseness.
A time-honored method:
- Create steam in a closed bathroom by running a hot shower in an empty tub, allowing the child to breathe in warm steam for 10-15 minutes.
- A child should be upright and quiet while in the steam environment.

Common respiratory tract infection in children characterized by inflammation of the middle ear.
Eustachian tube (connects middle ear to throat) is oriented horizontally in children under 6, increasing susceptibility to ear infections.
- In adults, the tube is slanted downwards, facilitating drainage.
Pathophysiology:
- Ear infections commonly caused by Streptococcus pneumoniae and Haemophilus influenzae.
- Dysfunction of the eustachian tube leads to fluid accumulation.
Diagnostic examination:
- Use of an otoscope shows bulging, redness of the tympanic membrane (eardrum).
- A pneumatic otoscope tests membrane mobility with air pressure.
Treatment procedures:
- Tympanocentesis: Procedure to remove fluid from behind the eardrum using a small needle; performed only by physicians for diagnostics and in stubborn cases.
- Medications: First-line antibiotic is amoxicillin; pain managed with acetaminophen or ibuprofen, and benzocaine ear drops.
- In chronic cases, tympanostomy tubes inserted for fluid drainage.
Nursing interventions:
- Educate parents on the importance of completing antibiotic courses.
- Advise breastfeeding to reduce risks and emphasize hand hygiene and immunization for prevention.

Spread via direct contact and respiratory droplet infection from contaminated secretions.
Clinical features: Viral infection affecting upper and lower respiratory tract causing fever, cough, and muscle aches.
Diagnostic tests:
- Rapid antigen tests to detect antigens triggering immune responses (nasal swab).
- PCR could confirm rapid antigen tests (amplifies genetic material).
Antiviral therapies: Should be initiated within 48 hours.
Supportive care: Hydration and oxygen therapy as needed.
Nursing interventions:
- Encourage fluid intake and monitor respiratory distress.
- Teach proper hand hygiene and respiratory etiquette for prevention.
- Address vaccine hesitancy, educating families on importance.

A serious obstructive inflammatory process predominantly in children aged 2-5 years.
Clinical signs predictive of epiglottitis:
- Absence of spontaneous cough.
- Presence of drooling.
- Agitation and difficulty breathing.
Emergency preparedness:
- Ensure emergency airway equipment and trained personnel are available for treatment.
- Visualization of throat should be delayed until emergency personnel are present to avoid stimulating airway obstruction.
Pathophysiology: Bacterial infection (commonly Haemophilus influenzae) leading to swelling of the epiglottis and airway obstruction.
Diagnostic imaging:
- Lateral neck X-ray showing a thumb sign, indicating swollen epiglottis.
Emergency treatment:
- Stabilization of the airway, prepare for intubation, initiate IV antibiotics.
- Do not use a tongue depressor for throat examination; keep the child calm and avoid agitation.

Bronchiolitis: Acute viral infection affecting bronchioles predominantly in children under 1 year old.
Most common cause: RSV, leading to frequent hospitalizations in infants.
Symptoms: Wheezing, coughing, retractions observed in affected children.
Treatment: Symptomatic, may include cool humidified oxygen and bronchodilators.
- Severe cases may require mechanical ventilation and frequent respiratory assessments.
Prevention: Monthly intramuscular injection of palivizumab for high-risk infants.
Transmission: Direct contact with respiratory secretions, necessitating strict hygiene protocols and contact precautions.

Classification: Based on site (lobar, bronchial, interstitial) or by etiologic agent (viral vs. bacterial).
- Aspiration pneumonia may occur from inhalation of foreign material.
Treatment management:
- Viral pneumonia is mostly symptomatic whereas bacterial pneumonia requires antibiotics and possibly oxygen therapy.
- Agitation in children must be minimized; cluster care techniques recommended for nursing.
Key terms:
- Cluster care: Coordinated provision of care tasks to minimize disruption.
Signs of bacterial pneumonia: Fever, cough, tachypnea; diagnosed through chest X-ray, blood, and sputum cultures.
Focus on hydration and managing fever; prevention through vaccination and avoiding smoke exposure.

ARDS in children can result from trauma, serious infections, and other conditions leading to respiratory distress and hypoxemia in 72 hours post-injury.
Nursing management components include:
- Careful monitoring of oxygenation and cardiopulmonary status.
- Maintaining vascular volume and hydration (parenterally if needed).
Pathophysiology: Severe lung inflammation and alveolar damage.
Diagnosis includes cough, hypoxemia, and chest imaging showing diffuse infiltrates.
Treatment may include mechanical ventilation and careful fluid management; prevention focuses on early treatment of infections and risk avoidance.
The role of interdisciplinary teams (ICU clinicians, social workers) is significant in managing complex cases of ARDS.