Nursing Care of Pediatric Patient With Respiratory Illness Flashcards
How is the pediatric respiratory system different from the adults?
Nares, infants are obligate nose breathers for up to 4-6 weeks.
Mouth-oral cavity out of proportion to large tongue and tonsils.
Faster respiratory rate 30-60 RR for infant.
Bronchioles and intercostal muscles are immature.
Pediatric Assessment Triangle
Appearance, Circulation, Work of Breathing
TICLS
Tone, Interactiveness, Console-ability, Look/gaze, Speech
Visual Circulation Cues
Color, Pallor, cyanosis, ashen, mottled.
Pediatric Respiratory Assessment
Color, Cap Refill, Feeding/swallowing problems, Nasal congestion, runny nose, cough,. stridor, behavior changes, irritability, lethargy.
Respiratory tests
CXR, Pulse ox, cultures.
Nursing Management of Respiratory Distress
02 sat below 95%, Confirm if accurate, determine if probe is functioning, Raise HOB or sit up, open airway with suction, administer O2 by blow by, mask, nasal cannula, then bag if O2 drops. Report to PCP or instructor.
Assessment of changes
VS, HR, RR, BP, mentition, tone, color
Foreign body aspiration risk
Infants toddlers, preschoolers, young adults, teens
Location of most foreign body aspiration
right bronchus
Foreign body aspiration - clinical presentation
choking, cough, gagging, hoarseness, wheezing, stridor, drooling, asymmetrical breath sounds.
Foreign body aspiration - clinical diagnostics
xray, bronchoscopy
Foreign body aspiration - clinical management
assess S&S, location and degree of obstruction.
chest thrusts and back blows for infant
abdominal thrusts
bronchoscopy: sedation/surgery to remove object.
pass through GI tract - NO LAXATIVES
Best approach is prevention
Apnea
cessation of respiration greater than 20 seconds, first sign of infant in distress
Apnea of prematurity
occurs in preterm infants due to immature neurological and respiratory systems.
ALTE - Apparent Life Threatening Event
Episode of apnea accompanied by color change, hypotonia, chocking, gagging in infant >37 weeks
May be GERD or shaken baby syndrome
SIDS
< 1 year of age, death occurs during sleep. leading cause of infant death 1 month-1 year.
SIDS Risks
Prematurity, drug exposure, siblings who have dies of SIDS, prenatal/postnatal maternal smoking, sleeping in prone position.
SIDS assessment
no characteristic findings, found dead
Obstructive Sleep Apnea
Apnea following excessive snoring. infant is asleep, airways relaxxed, decrased tone or obsruction, decreaseed ventilation and hypoxia.
Obstructive Sleep Apnea causes
facial malformations, obesity, large tonsils and tongues
Obstructive Sleep Apnea complications
failure to thrive, cognitive impairment, systemic HTN
Obstructive Sleep Apnea Diagnostic
sleep study
Obstructive Sleep Apnea treatment
tonsilectomy, craniofacial repair, CPAP machine
Croup
upper airway syndrome, can have swelling of epiglottis, larynx, trachea
3 types of croup
acute spasmodic laryngitis, acute laryngotracheobronchitis LTB, epiglotitis (most dangerous).
acute spasmodic laryngitis (croup)
viral/allergic, sudden onset, peaks at night and resolves by morning and reoccurs, mild hoarseness and slight stridor.
acute spasmodic laryngitis treatment (croup)
humidity, cold foods
laryngotracheobronchitis LTB (croup)
viral, usually in winter, barking cough, inspiratory stridor, retractions, low fever. Potential for airway obstruction!
laryngotracheobronchitis LTB treatment (croup)
humidity, steroids, racemic epinephrine nebulizer.
epiglotitis (croup) DEFINITION
inflammation of epiglottis causing airway obstruction within minutes to hours.
epiglotitis (croup) s&s
bacterial HIB, incidence decrease with immunization, always sudden severe rapid onset, high fever, child may lean forward and drool, cough is usually not present.
epiglotitis (croup) treatment
maintain airway, be ready to intubate, have tracheotomy kit at bedside, O2, IV fluids, antibiotics. avoid throat culture and keep child calm. NO THROAT CULTURE, they cause laryngospasms and respiratory arrest.
Nasopharyngitis (upper airway disorder)
A cold, caused by rhinovirus, nasal discharge, irritability, sore throat, cough, general discomfort
Nasopharyngitis (upper airway disorder) treatment
clear airways, saline drops, bulb syringe, humidifier, adequate fluid intake, prevention of fever
Pharingitis (upper airway disorder)
strep throat, treat all to prevent consequences, T&A
Tonsillectomy and adenoidectomy post op care.
nothing warm, observe for bleeding, frequent swallowing, relieve pain and encourage fluids. position on side to facilitate drainage, soft cold diet, no dairy, bleeding 5-10 days.
Acute Otitis Media `
inflammation of inner ear, children prone, caused by HIB, strep, feeding in supine position.
Acute Otitis Media `nursing care
assess for fever and pain level, administer meds, frequency may warrant surgery myringotomy - incision and tube. keep ear dry, will fall out by themselves or taken out by provider.
Bronchiolitis (Lower Air Way) cause
viral RSV and influenza A and B, can be bacterial
Bronchiolitis (Lower Air Way) S&S
rhinorrhea, pharyngitis, coughing, sneezing, wheezing, intermittent fever. can become tachypnic >70 R
Bronchiolitis (Lower Air Way) treatment
supportive humidified O2, rest, push po fluids or IV if aspiration risk,
Respiratory Syncytial Virus (RSV)
Transmitted through close or direct contact.
Respiratory Syncytial Virus (RSV) S&S
Airways swell and produce excess secretions causing obstructions and bronchospasm. URI, fever, rhinitis, progessing to wheezing and coarse breath sounds, less PO intake, less energy, less sleep.
Respiratory Syncytial Virus (RSV) Diagnosis
Culture done on nasal secretion, child put on contact.
Respiratory Syncytial Virus (RSV) treatment
Humidified O2, CPT, isolation precautions, handwashing, IVF’s, suction, family support. Bronchodialators, inhaled steroids, Synagis immunoglobin for preemies.
Pneumonia
Viral or bacterial, inflammation of the bronchioles and alveolar spaces of lung resulting in exudate, areas of plugging and consolidation interfering with gas exchange. Cough, SOB with exertion.
Pneumonia nursing management
Tylenol and ibuprofen, cough suppressants not advised for younger children, but expectorants are good, fluids, nutrition, O2 PRN.
Asthma definition
chronic inflammatory obstructive airway disease characterized by wheezing. Affects large and small airways with increased mucous, swelling, and bronchospasm. Triggered by cold weather, allergies, infection,environment.
Asthma nursing management
assess RR, HR, color, O2, cap refill. breath sounds, air movement, peak flow movement, assess fluid status, high risk of aspiration, STRICT I&O, promote rest to conserve energy.
Asthma medications
Nebulizer inhalation with MASK for children. B adrenergic short acting albuterol and lezabuterol. B andrenergic long acting salumeterol. Corticosteroid (pulmicort, advair). MDI metered dose inhaler with spacer.
Asthma home management
goal is prevention. peak flow to monitor, home log of treatments, avoid triggers, determine need for nebulizer, determine need for steroid maintenance, have clear follow up plan with PCP.
Status asthmaticus
severe unrelenting respiratory distress with bronchospasm, persists even with meds, medical emergency. Death can result from poor teaching and mismanagement of disease.
Broncho Pulmonary Dysplasia (BPD) definition
a fibrioud or thikenining of lung caused by excessive oxygenation of premature babies for a prolonged period of time. RDS main reason for oxygenation. COPD in little people
Broncho pulmonary Dysplasia (BPD) S&S
respiratory distress, tachypnea, wheezing, retractions, grunting, irritability, barrel chest, clubbing, cardiac anomalies, heart failure, jugular vein distention, Normal activities can increase demand for O2 and distress.
Broncho pulmonary Dysplasia (BPD) medical management
Respiratory support, humidified O2, mechanical ventilation, suction, CPT 3x a day. Bronchodilators, diuretics, anti-inflammatories, antibiotics when needed. Prevention is key. nutritional support via NG to conserve energy.
Broncho pulmonary Dysplasia (BPD) nursing management
support safe weaning from O2, promote normal growth and development, prepare family for home care needs, teach about monitoring of RR, HR, color, and behabioral changes. discuss clear parameter in acute illness.
Cystic Fibrosis
major cause of serious lung disease in children, inherited from autosomal recessive. involves exocrinne glands excreeting thick fluid.
Cystic Fibrosis assessment
wheezing, dyspnea, cough, cyanosis, generalized obstructive emphysema (clubbing barrrel chest). Right sided heart failure
Cystic Fibrosis presentations
generalized obstructive emphysema (clubbing barrrel chest). Right sided heart failure, salty sweat, steatorrhea bulky floating stools, productive cough, frequent URI, weight loss. meconium ileus in the new born, small bowel obstruction as young infant, fecal impaction/intussesception, elevated chloride on sweat test.
Cystic Fibrosis nursing management
Therapy, O2 PRN, antibiotic, aerosol and MDI’s, postural drainage, breathing exercises, prevention of infection. pancrease with meals, hygiene, teeth, promote growth and development, assist with families adjustment.
