L3: Resp dysfunction Flashcards
Explain how age can influence resp infection
- After 3m infant’s maternal antibodies decrease so they are more at risk for infection.
- Toddlers and preschoolers are at risk bc they are exposed more.
- Some agents affect younger children more severely.
Explain how resp anatomy size can affect resp infection
- Smaller resp system means that agents can travel down the resp tract faster.
Explain how infection resistance can affect resp infection
The child’s resistance to infection
- inc resistance in breastfed babies
- dec resistance in babies exposed to 2nd hand smoking.
- dec resistance in babies with certain illnesses
Explain how season change can affect resp infection
Resp Infection is more common in winter and spring seasons
Why are children more susceptible to ear infections
In children the ear canal is horizontal so fluids are less likely to drain (into throat) and they will cause bacteria growth
Common symptoms of resp infection
- Fever (after 6m)
- Meningismus
- Anorexia
- vomiting
- diarrhea
- abd pain
- cough
- sore throat
- nasal block/ discharge
- Resp sounds
What is nasopharyngitis
Nasopharyngitis AKA “common cold”
Symptoms last ~10 days
Treatment:
- Rest is recommended
Tylenol and OTC meds for discomfort
Stay hydrated. Humidifiers may be beneficial
Cough suppressing meds are not recommended bc coughing is a way to get mucus out. However, they are recommended for dry coughs at night so kid can get some sleep.
Monitor for adverse effects
Parents should not give antihistamines bc they will not work
Fever varies with the age of the child.
Home management varies with age.
Anti body therapy will be considered if bacterial (not viral) infection arises
Prevention: There is no effective vaccine Avoiding contact with infected Hand hygiene Like COVID preventions
Caused by numerous viruses:
- RSV, rhinovirus, adenovirus, influenza, and para-influenza viruses
What is acute streptococcal pharyngitis (strep throat)
Caused by a Group A -hemolytic streptococci (GABHS) infection
80-90% cases are viral
Symptoms:
Very abrupt symptoms
Can be mild are severe
Characterized by fever, Nasophyringitis, abdominal pain, and headaches
- Risk of Rheumatic fever (RF) / Acute glomerulo-nephreritis (AGN)
Diagnosis:
Throat culture rapid test should be done to rule out Group AB hemolytic streptococcus and strep AB
Treatment:
Oral Penicillin within 10 days after diagnosis. Usually starts working after 24hrs. This is more recommended than IM Benzathine Penicillin G bc of IM injections are more painful
- Oral Erythromycin if child is allergic to penicillin.
Parents should be educated on how to use antibiotics properly
Cold/warm compress may provide relief
Gargling salt and water may provide throat relief
Pain medication is recommended
Keep hydrate
Children is non-infection after 24hrs of antibiotic therapy
Pt education
Discard toothbrush after recovery
Antibiotic use (do not stop until prescription is complete)
Disinfect area
what is Influenza
More severe in winter and in young children
Incubation is 1-3 days
Symptoms: may be subclinical, mild, moderate to severe Dry throat Flush face Photophobia Fatigue with fever and chills
Treatment:
No antibiotic bc it is viral
Control symptoms
Prevention:
Vaccine
Otitis media
Signs and symptoms:
- Ear ache
- fussy
- restless
- discharge
- fever
- Hearing loss if chronic
Diagnosis
- Visual inspection of the tympanic membrane: discoloured, immobile, bulging, inflamed
- C & S: if drainage present
Treatment:
Antibiotic is usually given if not recovered by follow up.
Myringotomy: is a surgical procedure to drain ear fluid if a further complication arises
Vaccines
NSG considerations: 5 key points
- Treating pain (pain meds can be used for children 6 months or older.)
- Drainage
- Prevent complication or reoccurrence
- Pt education
- Provide emotional support
Tonsillitis
Younger children have more tonsils tissue than adults. Because of the abundant lymphoid tissue and the frequency of upper respiratory infections, tonsillitis is a common cause of illness in young children.
Causes:
- The causative agent may be viral or bacterial
Group A -hemolytic strep (Streptococcus)
Serious sequelae if untreated (RF , AGN)
Symptoms:
- Breathing restriction bc of inflamed tonsils
Diagnosis
Marked enlargement of the palatine tonsils (“kissing” tonsils)
Throat culture to check for bacteria
Important to differentiate bw viral or bacterial to avoid unnecessary antibiotics
Treatment:
Antibiotics
- Tonsillectomy: If child has reoccurring tonsilitis they remove tonsilsProvide comfort and minimize activity
Cool mist vaporizer
Hard candy to increase saliva
Pain med
Opioids no longer recommended for children under 12yo
NSG alert
After tonsillectomy
if child keeps swallowing while sleeping that means there is bleeding. Nurse needs to notify surgeon immediately.
Vomit will be dark brown and may have old blood in it. Notify parents of this so that they are not concerned
Child is placed on side/abdomen when asleep to rid them of secretions. Routine suction is avoided to prevent trauma.
Children are sat up when awake. Secretions and vomit needs to be inspected for fresh bleeding.
Pain medication. Commonly given rectally or IV
Antiemetic for vomiting
Avoid foods with red colouring so we don’t mistake it for blood
Infectious mononucleosis
An acute, self-limiting infectious disease that is common among adolescents.
Causes:
- The herpes-like Epstein-Barr virus (EBV) is the only cause
- Characterized by an increase in the mononuclear elements of the blood and by general symptoms of an infectious process.
Symptoms:
Usually mild but occasionally can be severe. Rarely, accompanied by serious complications.
- Edema
Treatment:
- No specific treatment exists for infectious mononucleosis.
Relieve the symptoms, manage headache, fever & malaise
Limit food intake to manage pain. Milkshake instead of solid food.
Limit exposure to only family
Inspect airway for edema to avoid airway compromise
Teach pt to seek help if asap:
Difficult breathing
Severe pain that child cannot drink
Abd pain
Croup syndromes
Not one condition but a group of illnesses
Symptoms:
- Characterized by bark cough, inspiratory stridor, and varying degrees of respiratory distress
- affect larynx, trachea, and bronchi
Epiglottitis / Laryngotracheobronchitis (LTB)
Laryngitis / Tracheitis
Prevention and cause
With widespread immunization programs (H. influenza B), the cause of most cases of croup syndrome in Canada is now attributed to viruses (i.e., parainfluenza virus, human meta-pneumovirus, influenza types A and B, adenovirus, and measles).
Kids are more at risk bc of smaller airways.
Croup: Acute epiglottitis
Common in infants and toddler, rare after 7yrs
Prevention:
Incidence is dropping due to preventive vaccines
Caused by:
H. influenza & S. pneumonia (most common); Staphylococcus aureus, Hemophilus parainfluenza
Symptoms:
Sore throat, pain, tripod positioning, retractions, fever
Frog-like croaking sound on inspiration / Tripot position
Obstruction of airway can lead to death
Treatment
Potential for respiratory obstruction / ABCD assessment
Considered a medical emergency
Examination of throat with depressed tongue is avoided until proper treatment equipment is available. Examination can further obstruct airway
Swelling will decrease after 24hrs of antibiotis and will disappear after 3rd day
Nursing care considerations
Act quickly and calmy
Reassure pts
Position pt to what is more comfortable
What are the 4 D of diagnosis for acute epiglottitis
Dyspnea
drooling
dysphonia: speaking
dysphagia
Croup: acute laryngotracheobronchitis (LTB)
Most common of the croup syndromes
Generally affects children under 5 years
Caused by:
RSV, human metapneumovirus, parainfluenza virus, Mycoplasma pneumoniae, influenza A and B
Does not occur with acute epiglottitis
Symptoms:
Croup cough
Hypoxia
Resp distress > resp acidosis, death
Treatment Airway management Hydration (oral or IV) Nebulizer to reduce inflammation If stable, Infants can be treated on parents lap for comfort.
Early signs:
Breathing difficulty
Restlessness
Acute spasmodic Laryntigitis
Symptoms:
Spasmodic croup
- Paroxysmal attacks of laryngeal obstruction occur chiefly at night
- Inflammation is mild or absent
- Child usually feels well the following day
Therapeutic management
- Prevention same as LTB
Bacterial Tracheitis
Typically occurs between 5 and 7 years of age
Caused by:
Infection of mucosa of the upper trachea
Symptoms:
- Distinct entity with features of croup and epiglottitis
similar to LTB but unresponsive to LTB therapy
Thick, purulent secretions result in respiratory distress.
Therapeutic management: Pain med Intubation or mechanical ventilation Closely observed if not intubated or ventilated Antibiotic Manage airway
NSG care:
Careful obs for resp failure
Bronchitis (tracheobronchitis)
Is the Inflammation of the large airway (trachea & bronchi)
Causes
Primary cause are viral agents but could be other agents
Predominant characteristics:
- persistent dry, hacking cough (worse at night) becoming product in 2-3 days
- Usually mild, self-limiting illness
Treatment
symptomatic treatment, including analgesics, antipyretics and humidity.
Cough suppressants at night for rest. Take with precaution. Maybe only in early days (before product)
RSV
- Most common infectious disease of lower airways
Seen almost exclusively in infants 2-12 month of age (preterm & chronically ill infants); uncommon after 2 yr of age
Common in Winter & Spring
Caused by:
- Inflammation of the bronchioles
RSV: most common pathogen
Symptoms:
begin like a cold worsening (wheeze, resp distress, intercostal retractions, cyanosis, variable temp)
Hard to breath
Children usually recover
Treatment Supply oxygen if SPO2 is lower than 90% Hydrate Suction PRN Bronchodilator
Considerations:
Children with RSV are either isolated separately or together
Wear proper PPE when entering room
Prevention
Pavilizumab IV injections (monthly) during RSV season
Hand hygiene
Prevent smoke exposure
Restart breastfeeding as soon as infant is stable
Pertussis (Whooping Cough)
- Primarily occurs in children under 4 and not immunized
- Up to four infants die annually in Canada
- Risk to young infants
Caused by:
- Bordetella pertussis
- Highly contagious, lasts 6 to 10 weeks
Symptoms:
Apnea (stop breathing more than 20sec) is common
Whooping cough spasms
Treatments: - Can be managed at home Hydration Antibiotics Admission to hospital if its severe or if apnea occurs
Prevention:
Vaccines
Exposure can cause lifetime of natural immunity
Its returning for pt2!
Bc of the antivaxers
Tuberculosis (TB)
Caused by: Mycobacterium tuberculosis, human and bovine varieties Risk factors: People with HIV or AIDS Exposure to someone with TB or had it and wasn’t treated properly Indigenous communities with high rates LTC homes Etc… transmission mode through airway.
Symptoms(Box 45-10, p. 1358)
A whole lot of symptoms
Fever• Malaise• Anorexia• Weight loss (or failure to grow in child)• Cough (may or may not be present; progresses slowly over weeks to months)• Aching pain and tightness in the chest• Hemoptysis (rare)
With progression:
Increased respiratory rate• Poor expansion of lung on the affected side• Diminished breath sounds and crackles• Dullness on percussion• Persistent fever• Pallor, anemia, weakness, and weight loss
Diagnostic evaluation
- Based on TBT test and physical assessment, health history, X-ray, etc…
TB testing (next slide)
False positives are common. Test is usually positive 2-10 weeks after administration
If vaccined, they will always be positive for TB tests. Further exams are necessary. X-ray or blood test
Treatment Nutrition Prevent exposure to other illnesses Assess family members Antibiotic therapy Support individuals Monitor medication adherence Bronchoscopy to remove tuberculous granulomatous polyp Can return to regular activities once receiving pharmacotherapy.
Prognosis:
Most recover espthose with meningitis TB
Under 2yo are more at risk
Prevention:
- Isolating active contagious cases. Wear proper PPE
Vaccine is being withdrawn in most
Most hospitalized cases are not contagious
Tb testing
Recommended procedure is tuberculin skin test (TST)
Uses purified protein derivative
Standard dose and administration technique
Positive reaction test
5-mm and greater induration:
for those who had exposure to someone with TB, positive X-ray, symptoms, children with HIV or AIDS
10-mm and greater induration:
For those with tb risk factors
For those who are at risk for dissemination: 4yo/younger, has other illness
15-mm and greater:
Those who are 4yr or older and have TB risk factors
Recommendations for TB testing
- screen only children who are at high risk for TB infections or who are progressing from latent to active TB disease
pneumonias
Air sacs inflame and fill with liquid bc of infection
Classified by the causing agent:
Viral pneumonia (most common): Pneumonia caused by viruses like flu, RSV, etc..
Primary atypical pneumonia (M. pneumonia and Chlamydia pneumonia most common)
Bacterial pneumonia (S. pneumonia most common)
Aspiration of a foreign substance
Box 45-9 p. 1355 for General signs of pneumonia:
- Fever which is usually quite high (≥ 39.5°C)
Respiratory
Cough—Nonproductive to productive with whitish sputum• Tachypnea• Breath sounds—Rhonchi or fine crackles• Dullness with percussion• Chest pain; abdominal pain with lower lobe involvement• Retractions• Nasal flaring• Pallor to cyanosis (depends on severity)
Chest x-ray film—Diffuse or patchy infiltration with peribronchial distribution
Behaviour—Irritable, restless, lethargic
Gastrointestinal—Anorexia, vomiting, diarrhea, abdominal pain
Treatment Take care of symptoms Oxygen Antibiotics Monitor chest tube Suction Educate parent for at home care
Complications:
Continuous closed-chest drainage if purulent fluid is aspirated. If a lot of purulent fluid is obtained, they administer antibiotics to area and stop drainage for 1hr. Closed drainage is stopped until fluid is free of pathogens (usually stopped before 5-7 days)
Surgery may be necessary id reoccurrence is frequent
Prevention
heptavalent pneumococcal conjugate vaccine
Foreign Body Aspiration
Risk among children / May result in life-threatening airway obstruction (infants more at risk)
Diagnostic evaluation
History & physical signs
Radiographic, bronchoscopy or fluoroscopy depending on the suspected location
Therapeutic management:
Abdominal thrusts / Back blows
Endoscopy or bronchoscopy with sedation
Prevention Patient education (children may imitate parent when they hold things with their mouths)
Nursing care management
Recognize illness and observe worsening signs
Back blow or abd thrust if full chocking
Encouraging coughing
Aspiration Pneumonia
- Pneumonia caused by substances entering lungs
child with feeding difficulties are at risk
Symptoms: increasing cough or fever foul-smelling sputum, deteriorating chest radiographs, signs of lower airway involvement
Prevention
Feeding techniques, positioning
Side-lying if risk of vomiting
Acute Respiratory Distress Syndrome (ARDS)
- respiratory distress and hypoxemia that occur within 72 hours of a serious injury or surgery in a person with previously normal lungs.
- Also referred to as adult RDS
Causes:
- Conditions that lead to life threatening lung inflammation: sepsis, trauma, viral pneumonia, fat emboli, drug overdose, lung transplant injury, smoke inhalation, near-drowning
Therapeutic management:
Basic supportive measures
Adequate oxygenation & pulmonary perfusion, CO, hydration
Mechanical ventilation for severe cases (Is invasive and requires sedation)
Treat cause
Diagnosis
Radiograph evidence of both lungs being opaque
No left-sided heart failure
Hypoxemia that is worse than ALI (acute lung injury)
Symptoms:
Symptoms of causing injury
As condition deteriorates child shows signs of resp distress
Prognosis: is improving but still high. mortality 18% to 49%
Children who recover have persistent cough & exertional dyspnea.
Nursing care management
Nutrition
Smoke Inhalation Injury
Severity depends on nature of substance, environment, and duration of contact
Three types of injuries:
Heat injury to upper air way. Glottis reflexively closes to prevent lower air way injury
Chemical injury: a chemical burns can occur in lower air way as insoluble gases. Soluble gasses dissolve in upper airway. Like chemical skin burn but is painless
Systemic injury: does not damage airway but stops cellular resp -> death. Example: CO
Therapeutic management
Symptomatic treatment
100% humidified Oxygen
Then monitor for resp distress or failure
Also, bronchidilators, corticosteroids, humidification, chest percussion, draining
Intubation is progresses
NSG care: Vitals and other resp assessment Chest physiotherapy Mech ventilation PRN Keep hydrated Pt education on smoke inhalation prevention
Environmental Tobacco Smoke Exposure
Scope of the problem: Cigarette / e-cigarette / Cannabis / Vaping Regulation? Nursing roles? Health care providers’ roles?
NSG care:
Pt education
Offer smoking cessation programs
Effects on children
Causes resp illness
Smoking exposure while pregnant can stunt growth, etc..
What is asthma
Chronic inflammation of the airways and hyperresponsiveness of the bronchial. During an asthma episode, thick mucous is secreted in the airways and the smooth muscle around the airways contract. It is one of the most common reasons for hospitalization in children. It lessens with age.
What are the symptoms of asthma
Classic - Dyspnea - coughing - wheezing upon expiration Other signs of difficulty breathing crackles in auscultation barrel chest, elevated shoulder, facial changes with recurring episodes
How do you treat asthma
inhaled anti-inflammatory and other acute asthma treatments
What is status asthmaticus
Asthma is getting worse even with treatment. Priority is to improve ventilation, prevent dehydration and acidosis, keep parents and children relaxed
What is cystic fibrosis
Genetic disease that causes abnormal chloride excretions and causes an exocrin abnormality. This causes too much mucus secretion in the lungs, GI tract, and reproductive system
Symptoms of Cystic fibrosis
For GI
- gain then loss of appetite
- mucousy meconium and constipation (ileus)
- weight loss and vit deficiency
Resp
- early: wheezing and dry cough
- mid: dyspnea, couching attack (paroxysmal), emphysema (air sac damage), lung collapse (atelectasis),
nursing care for cystic fibrosis
- prevent lung complications (with airway clearance therapy, inhaled bronchodilators, and coughing techniques, lung/heart transplants)
- nutrition
- physical activity
- promote reasonable quality of life (set future goals)
What is respiratory failure
Failure for resp system to provide enough O2 with or without CO2 retention
What is respiratory arrest
no respiration
What is apnea?
No respiration for more than 20s. Can be central (no effort), obstructive, or mixed
Resp failure diagnosis
- History of condition
- clinical manifestation
- measure atrial blood gases and pH
Cardinal signs of resp failure
- tachypnea
- restlessness
- tachycardia
- diaphoresis (sweating - not in newborns)
nursing care for resp failure
- maintain ventilation and maximize oxygen delivery
- correct hypoxemia and hypercapnia
- treat the underlying cause
- minimize extrapulmonary organ failure,
- apply specific and nonspecific therapy to control oxygen demands
- anticipate complications.
