Ch 38 Peds Respiratory Flashcards
Epiglottitis
bacterial form of croup
may be caused by H. influenzae type b or Strep pneumoniae
children immunized with Hib less risk
occurs most freq in children 2 - 8 yrs
onset abrupt, typically in winter
*emergency –> can rapidly progress to severe resp distress
Epiglottitis assessment
fever large, cherry red, edematous epiglottis no spontaneous cough drooling swallowing pain muffled voice retractions inspiratory stridor, worse in supine tripod positioning
Epiglottitis interventions
assess temp via axillary
pulse ox
lateral neck films to confirm dx
NPO
do not leave child unattended
do not place in supine position
do not agitate child
may need to delay IV line to not agitate child
administer abx (IV then oral)
admin corticosteroids to decrease inflammation and reduce throat edema
nebulized epinephrine may be rx for severe cases
heliox (helium and oxygen mix) may be rx to reduce mucosal edema
cool mix o2
prepare for endotracheal intubation or tracheotomy for severe resp distress
ensure immunizations up to date
if epiglottitis suspected
NO attempt should be made to visualize the post pharynx, obtain a throat culture, or take an oral temp.
spasm of the epiglottis can occur and lead to complete airway obstruction.
Laryngotracheobronchitis
inflammation of the larynx, trachea, and bronchi most common type of croup may be viral or bacterial most frequently in children < 5 yrs parainfluenzae virus types 1 & 2 respiratory syncytial virus (RSV) Mycoplasma pneumoniae influenza gradual onset that may be preceded by an upper respiratory infection
Laryngotracheobronchitis symptom progression
Stage 1: fever, hoarseness, SEAL bark and brassy cough, insp stridor, fear, irritability
Stage 2: continuous resp stridor, retractions, use of accessory muscles, crackles, labored respirations
Stage 3: continued restlessness, anxiety, pallor, diaphoresis, tachypnea, signs of anoxia and hypercapnia
Stage 4: intermittent cyanosis progressing to permanent cyanosis, apneic episodes progressing to cessation of breathing
Laryngotracheobronchitis interventions
elevate head of bed and provide rest
humidified o2 via cool air / mist tent as rx
cool air vaporizer at home
no cough syrups or cold medicines –> may dry and thicken secretions
corticosteroids may be rx
nebulized epinephrine (for children w severe disease - stridor at rest, retractions, or difficulty breathing)
heliox
upper resp infection - hospital
isolation precautions should be implemented for a hospitalized child until cause of infection is known
Bronchitis
inflammation of trachea and bronchi (tracheobronchitis)
usually occurs w upper resp infection
usually mild disorder, usually viral
bronchitis assessment
fever
dry, hacking, nonproductive cough that is worse at night
cough becomes productive in 2 - 3 dys
bronchitis interventions
tx sxs as necessary
cool, humidified air to child
cough suppressants may be rx
oxygen delivery systems
oxygen mask
nasal cannula
oxygen tent
oxygen hood, face tent
oxygen mask
advantages: various sizes, higher O2 than cannula, predicatable conc. of O2 (Venturi)
disadvantages: skin irritation, fear of suffocation, moisture on face, possible aspiration of vomit, difficulty in controlling )2 conc except w Venturi
Nasal cannula
adv: low - mod O2 conc (22-40%), able to eat / talk while on O2, better able to observe child
disadv: must have patent nasal passages, difficult to control O2 conc if child breathes through mouth, no mist
Oxygen tent
adv: lower O2 conc (FIO2 0.3-0.5), child able to receive desired O2 even while eating
disadv: necessity for tight fit around bed to prevent leakage of O2, cool / wet tent environment, poor access to child
oxygen hood, face tent
adv: provides high O2 conc (FIO2 up to 1.00), free access to child’s chest for assessment
disadv: high humidity environment, need to remove child for feeding and care
Bronchiolitis and RSV (respiratory synctial virus)
bronchiolitis: inflammation of the bronchioles that cauess production of thick mucus that occludes bronchiole tubes and small bronchi.
RSV: causes an acute viral infection and is an common cause of bronchiolitis
other organisms that cause bronchiolitis:
adenoviruses
parainfluenza viruses
human metapneumovirus
RSV
not airborne
highly communicable
transferred by direct contact w resp secretions
occurs primarily in winter / spring
rare in children > 2 yrs, peak incidence = 6mo
at risk children: children > 1 yr w chronic / disabling condition
dx: testing of nasal / nasophar secretions
RSV preventions
encouraging breast feeding
avoiding tobacco smoke exposure
good handwashing technique
admin of palivisumab (Synagis) (monoclonal antibody, for high risk infants, via IM - monthly injection)
palivisumab (Synagis)
RSV prevention IM injection monoclonal antibody monthly over a 5 mo period (nov - march) for high risk infants
bronchiolitis / RSV interventions
airway maintenance, cool humifiied air, O2
hospital - isolation (private room or w RSV pt)
no nursing care for RSV AND high risk pt
contact precautions
airway maintenance, 30-40 degree bed angle, neck slightly extended
periodic suctioning (before feeding)
ribavirin (Virazole) - antiviral med (via inhalation)
Pneumonia
inflammation of the pulmonary parenchyma or alveoli or both.
caused by a virus, mycoplasmal agents, bacteria, or aspiration of foreign subs
agent introduced via lungs or bloodstream
viral pneumonia
seen more often than bacterial pneumonia
seen in children of all ages
often asso. w viral upper resp infection
primary atypical pneumonia
mycoplasma pneumoniae or chlymydia pneumoniae
most often in the fall / winter
more common in crowded living conditions
children - 5 - 12 yrs old (most often)
bacterial pneumonia
often a serious infection req hospitalization when pleural effusion or empyema accompanies the disease
hospitalization also for children with staphylococcal pneumonia
aspiration pneumonia
when material enters the lung and causes inflammation and a chemical pneumonitis
sx: increasing cough or fever w fould smelling sputum, deteriorating results on cxrs
pneumonia prevention
vaccination of infants and children w pneumococcal vaccine
viral pneumonia assessment
acute onset
sx: fever, cough, diaphoresis, nonproductive or productive cough of small amts of whitish sputum
wheezes or fine crackles
viral pneumonia interventions
tx is symptomatic
o2 w cool humidified air as prescribed
primary atypical pneumonia assessment
acute
sx: fever, chills, anorexia, ha, malaise, myalgia, rhinitis, sore throat, dry, hacking cough
nonproductive cough –> production of seromucoid sputum –> mucopurulent / blood streaked sputum
