Lecture 03 Respiratory Illnesses

Question 1

Why are newborns able to retract their thoracic cage during labored breathing?

Answer 1

It’s due to their round and soft thoracic cage.

Question 2

Why are infant’s trachea and bronchi more likely to collapse?

Answer 2

Due to less tissue and cartilage

Question 3

Why are infants more likely to experience respiratory distress from mucous and edema?

Answer 3

Due to their smaller airways.

Question 4

Why are peds more likely to have rapid and widespread transmission of organisms?

Answer 4

They ahve shorter airway structures.

sidenote: kids have less smooth muscle

Question 6

When are infants obligatory nose breathers?

Answer 6

Less than 4~6 months old.

Their passages are smaller from 4 weeks to 6 months.

Question 7

What is breathing like in kids less than 6/7 years old?

Answer 7

Breathing is less rhythmic and diaphragmatic or abominal.

Periodic breathing in infants.

Assessment: have to check RR for a full minute

Respiratory rate is higher (increased metabolism) and responds dramatically to emotion, illness, fever and exercise.

Question 8

What are peds characteristics that affects the respiratory system? (5)

Answer 8

1. Respiratory tract has narrow lumen until 7~8 years old
2. Fewer alveoli until age 12
3. Respiraotry muscles are weaker, there is smaller vital capacity, thus less reserve
4. Immune system is immature (less lymphoid tissue)
5. Young children may have more severe symptoms

Question 9

What occurs to older children that are repeatedly exposed to viral illnesses?

Answer 9

It’ll increase their immunity.

Question 10

What are some S/S of an infant in respiratory distress?

Answer 10

1. Grunting sounds, nasal flaring, head bobbing
2. Different areas of infant’s body will be seen retracting: intercostal, subcostal, substernal, calvicular, suprasternal

Question 11

What would you do in Respiratory Func Assessment?

Answer 11

1. Ability to maintain airway
2. Breathing, the rate and mechanics of it
3. Skin color and temperature
4. Pulse Oximetry
5. Cap refill, circulation

Question 12

What are some symptoms of respiratory dysfunction? (9)

Answer 12

1. }Air hunger/restlessness
2. }Increased RR, effort, diminished breath sounds, apnea
3. }Nasal flaring, open mouth breathing
4. }Retractions (use accessory muscles)
5. }Grunting/stridor
6. }Decreased LOC or unresponsiveness to parents or pain
7. }Poor skeletal tone
8. }Cyanosis (circumoral)
9. }Decreased Oximetry (check O2 delivery system)

Question 13

Assessment of Worsening Condition. What is the first thing you should think about?

Answer 13

Know the baseline, is the child getting worse or better?

Look at respiratory pattern

}RR 70 to 80 for 2 days and is now 60

}Child wheezing last few days and now with decreased/absent wheeze

}Changes in oximetry (feeding, activity, rest)

}Apnea

Question 15

What are the some nursing diagnoses for ABC priorities?

Answer 15

1. }Ineffective airway clearance
   ◦Saline drops/bulb suctioning
2. }Ineffective breathing patterns
3. }Impaired gas exchange
4. }Anxiety/fear
5. }Inability to sustain spontaneous ventilation
6. }High risk infection
7. }Impaired communication

Question 16

What are 5 URI? Upper Respiratory Tract Illness?

Answer 16

1. Nasopharyngitis (common cold)
2. Pharyngitis
3. Tonsillitis
4. Influenza
5. Otitis Media (OM)

Question 17

Why do children have fewer respiratory infections as they grow older? (3)

Answer 17

}Increased immunity to virus from previous exposure

}Increased amount of lymphoid tissue as they grow

}Increased ability to resist viral illnesses

Question 18

What are 4 teaching points of managing nasopharyngitis?

Answer 18

}Home management with antipyretics, bulb suctioning as indicated, Normal Saline (NS) nasal drops, maintaining adequate fluid intake & comfort measures

}Teach parents signs of respiratory complications and when to seek medical attention

}Recurrent URI’s very common in children less than three years. As exposure & immunity increases, frequency drops.

}Ear infections commonly occur with/after a URI and signs of infection should be reported to provider.

Question 19

How useful could cool mist be? What is a risk of it?

Answer 19

}Cool mist safer (decreased risk burns) with no evidence of advantage to steam

}Both promote a more comfortable environment; loosen secretions

}They DO NOT decrease viscosity of secretions

}Risk for growth of organisms exists in both (less with cool water)

}NS Nebs (may loosen secretions, so it’s easier to suck out secretions, and open the airway)

Question 20

What should you look for in Feeding Patterns during an Assessment of Worsening Condition?

Answer 20

Feeding Patterns

1. }Increased feeding time or disinterest
2. }Decreased sats with feeding
3. }Increased respiratory effort
4. }Gagging difficulty swallowing when eating
5. }Apnea
6. }Is it safe to eat or drink?
7. }LOC (alertness, activity, response to stimuli & parents)

Question 21

Why is routine use of decongestants not recommended?

What about vasoconstrictive nose drops?

Answer 21

}Routine use not recommended for infants and young children. It’s because they can be overdosed. It can also increase HR, and that should be avoided.

}Use of vasoconstrictive nose drops such as Neo-Synephrine can have rebound congestion if used more than 3 days

Question 22

80 to 90% of pharyngitis are viral, however you need to rule out strep throat because

Answer 22

you need to treat it accordingly.

Group A beta hemolytic streptococci can cause pharyngitis.

Question 23

Unilateral nasal discharge with frequent sneezing should alert the nurse to suspect?

Answer 23

Obstruction of some type in the nose

Question 24

Sudden coughing with high-pitched wheezing sounds may be related to what nursing diagnosis?

Answer 24

}Foreign body ingestion. Could have gone down trach instead of esophagus.

Question 25

What is Croup Syndrome?

Answer 25

A group of symptoms that includes hoarseness, resonant cough that’s barky or brassy, inspiratory stridor, and respiratory distress

Question 27

What does croup syndrome affect?

Answer 27

1. Larynx
2. Trachea
3. epiglottis
4. bronchi

Inflames the mucosa lining of larynx, and teachea, causes narrowing of airway. The area affected is often age related.

}Child attempting to inhale past the obstruction produces characteristic inspiratory stridor, suprasternal retractions & barky seal like cough.

Question 28

What are the causes of croup?

Answer 28

They’re often viral.

Causes: parainfluenza, RSV, influenza A &B, mycoplasma pneumonia

Question 30

What is Epiglottis?

Causes?

Answer 30

Bacterial form of croup, H influenza.

usually caused by H influenza type B or strep pneumonia

Question 32

What occurs to the body when a person has epiglottitis?

Answer 32

Inflammation and swelling of epiglottis; partial upper airway obstruction.

Occurs frequently between ages 2 to 8.

Onset is abrupt

Question 33

What are assessments for epiglottis?

Answer 33

1. }Progressive stridor
2. }Severe respiratory distress
3. }Hypoxia/dyspnea
4. }Refuses to swallow/drooling due to very sore throat
5. }Sits up/leans forward with chin thrust out (tripod position)
6. }Cyanosis/pallor
7. }Decreased LOC
8. }Rapid onset and progression
9. Diagnosis based on history, symptoms, culture, lateral neck x-ray shows rounded & enlarged epiglotti

Question 34

What are 3 Lower Respiratory Tract illnesses?

Answer 34

1. Bronchitis
2. Bronchiolitis (RSV)
3. Pneumonia

Question 35

How could you prevent epiglottis?

Answer 35

HIB Vaccine

Question 37

Why are kids prone to Lower Resp Illnesses?

Answer 37

Cartilaginous suport of large airways are not fully developed until adolescence. So the smooth muscle in structures causes constriction of airway, esp bronchioles.

Question 38

What type of inflammation is occurring in Bronchiolitis?

Answer 38

• Tissue edema and mucous plugging occurs
• The viral infection affects small airways
• Inflammation of bronchioles prevents air from leaving alveoli r/t narrowing of air passages and mucous and exudate. Airway trapping occurs in small air passages
• Inflammation leads to necrosis and sloughing of epithelium into airway lumen

Question 39

Assessments for RSV (Respiratory Syncytial Virus)

Answer 39

1. }Lower airway infection usually follows URI
2. }Dry, persistent cough with dyspnea
3. }Tachycardia and tachypnea
4. }Retractions
5. }Fever (100 to 101) OR (37.8 to 38.4)
6. }Thick nasal secretions (ineffective airway clearance)
7. }Difficulty with feedings, irritability
8. }Expiratory grunts & wheezes
9. }Can lead to pneumonia if untreated
10. }RSV confirmed by viral culture (nasal swab)

Question 40

What are nursing interventions for RSV?

Answer 40

◦Monitor respiratory status, LOC, (detect early signs worsening condition, signs hypoxia)

◦Humidified oxygen (alleviate hypoxia & moisten secretions)

◦Maintain adequate hydration (keep secretions thin so can expectorate)

◦Emergency equipment at bedside (condition can deteriorate rapidly)

◦Keep Jack as quiet as possible (crying aggravates laryngospasm and increases hypoxia; rest Ô metabolic need for oxygen)

◦Position Jack upright with HOB elevated or held by parents (decrease pressure from abdominal contents on diaphragm)

Question 41

How is CF deterimental?

Answer 41

1. }There is an increased viscosity of mucous gland secretions causing mechanical obstruction, that results in a cascade of clinical manifestations.
2. }Mucous glands produce thick mucoproteins obstructing small passages in selected organs such as pancreas & bronchioles.
3. }Earliest manifestation of CF may be a meconium ileus in newborn, where small intestine is obstructed by thick, puttylike, mucousy meconium.

Question 42

What are 4 ways to diagnose CF?

Answer 42

1. }Sweat chloride test result of > 60 mEq/L
   Test indicated for children with recurrent respiratory infections, malabsorption or FT
   ◦Nail/Hair analysis (á Na)
   ◦Child tastes salty
2. }New methods for diagnosis in infancy (including NB screening)
3. }Malabsorption
   ◦High level of fecal fat
   ◦Most food passed undigested increasing # stools
   ◦Solids added; stools become frothy, fatty & foul smelling◦
4. }Frequent respiratory infections

Question 43

Why are pulmonary complications from CF so serious?

Answer 43

Increased viscosity of mucous gland secretion causes thick &

stagnating mucous & bacterial colonization resulting in destruction

of lung tissue. Pulmonary complications are most serious and life-

threatening aspect of CF.

Question 44

What are 3 primary goals with CF?

Answer 44

1. Prevent/Minimize Pulmonary complications. i.e ineffective airway r/t pulmonary secretion. Or impaired gas exchange r/t air trapping
2. Optimize growth and nutrition
3. Support child and family in management of chronic illness

Question 45

What are 6 ways to manage CF?

Answer 45

1. Chest physical therapy
   Enhance removal of thick mucous
   Device includes mechanical precursors, flutter valve and therapy vest
2. Exercise
3. Aerosol Therapy: Bronchodilators neb vest. May cause voice alteration and laryngitis
4. Oxygen Therapy for acute episodes
5. Ibuprofen for anti inflammatory effects: must monitor for adverse effects
6. Transplantation: doesn’t cure CF

Question 46

What is asthma?

Question 47

What occurs to the airways during an asthma exacerbation?

Answer 47

• Lining of airways becomes swollen
• airways produce a thick mucus
• muscles aroudn the airways tighten and makes the airway narrower

Question 48

What are Medications for long term control (preventive) of asthma? (3)

Answer 48

1. NSAID: cromoyn
2. Long acting beta agnoist: solmeterol (servent)
3. Leukotrienes: Inflammatory mediators (montelukast)

Question 49

What are quick relief medications for asthma? (Rescue Meds)

Answer 49

1. Corticosteroids: anti inflammatory
2. Short acting beta adrenergic agonist : albuterol. Relaxes smooth muscle of airways
3. Anticholinergics: atrovent (Ipatropium)

Question 50

What is pertussiss?

Why does it typically occur?

Answer 50

Pertussis is the whooping cough.

Acute infection usually in younger non immunized children.

High rate mortality and morbidity