nursing care of the child with respiratory dysfunction
TRANSCRIPT
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NURSING CARE OF THE CHILD WITH RESPIRATORY DYSFUNCTION
Prepared By:Ana Maria M. Pingol RN MSN
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– Nursing Assessment– General Nursing Interventions– Specific Disorders
• Nasopharyngitis• Influenza• Tonsillitis
– The Tonsillectomy patient• Croup• Bronchiolitis/ RSV• Pneumonia• Asthma• Cystic fibrosis• Otitis media• SIDS
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Components for Assessing Respiratory Function
• Respirations
– Rate
– Depth
– Ease
– Labored Breathing
– Rhythm
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• Evidence of infection
• Cough
• Wheeze
• Cyanosis
• Chest pain
• Sputum
• Bad breath
Stridor & Retractions.mp4
Grunting baby.mp4
Head Bobbing- Respiratory Distress in infants.mp4
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General Nursing Interventions
• Ease respiratory efforts
– Warm/ cool mist therapy
• Promote rest
– Bed rest or quiet play
• Promote comfort
– Nose drops, throat irrigation
– decongestants
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• Prevent spread of infection– General Hygienic measures– Isolation
• Reduce temperature– TSB– antipyretics
• Promote hydration– Oral and parenteral
• Provide nutrition– Consider preference
• Provide family support and teach home care
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NASOPHARYNGITIS
The common cold (also known as nasopharyngitis, acute viral rhinopharyngitis, acute coryza, or a cold) is a viral infectious disease of the upper respiratory system, caused primarily by rhinoviruses and coronaviruses
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NASOPHARYNGITIS: CLINICAL MANIFESTATIONS
• Fever• Watery and profuse nasal secretions (but may
become more purulent and mucoid)• Irritability, restlessness• Sneezing• Vomiting or diarrhea• Dryness and irritation of nose and throat• Chilly sensation• Muscular aches• Cough, mild and occasional• Edema and vasodialtion of mucosa
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Common Cold
• Medical Management– Antipyretics (avoid aspirin if influenza is
suspected)– Nasal decongestants– Hydration– For Cough: Antitussives, Expectorants, Mucolytics– Antihistamines– Bronchodilators
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Common Cold: Nursing Management
– Assess for signs and symptoms of respiratory distress
– Promote adequate hydration– Encourage bed rest– Administer prescribed meds and monitor fo side
effects– saltwater drops in the nostrils to relieve nasal
congestion (you can buy these — also called saline nose drops — at any pharmacy)
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Signs of Respiratory Complications:• Evidence of earache• Respirations faster than 50-60 breaths/ min• Fever over 38.3oC• Listlessness• Increasing irritability• Persistent cough for 2 days or more• Wheezing• Crying• Refusal to eat• Restlessness and poor sleep patterns
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Common Cold: Nursing Management
• a cool-mist humidifier to increase air moisture • petroleum jelly on the skin under the nose to soothe
rawness • hard candy or cough drops to relieve sore throat (for
kids older than 3 years) • a warm bath or heating pad to soothe aches and pains • steam from a hot shower to help patient breathe more
easily
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Common Cold: Preventive Measures
– Hand washing– Proper Nutrition– Isolation of sick patients– Proper disposal of secretions– Surface disinfection of contaminated surfaces
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INFLUENZA
Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family. Orthomyxoviridae (the influenza viruses), with types A and B causing epidemic disease.
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Clinical Manifestations:– Onset is sudden chilly sensation, hyperpyrexia (39-
39.5oC), malaise, sore throat, coryza, rhinorrhea, and myalgia
– Prostration and generalized aches and pains (most pronounced in the back and legs
– Headache with photophobia and retrobulbar pain
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Clinical Manifestations:– Scratchy sore throat– Substernal burning– Nonproductive cough that eventually becomes
more persistent and productive– Lacrimation, mild conjunctivitis– Nausea and vomiting in children– Reddened tonsils and pharynx with no exudate
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Complications– Directly related to primary viral infection:
• Hemorrhagic pneumonia• Encephalitis• Reye’s Syndrome• Myocarditis• SIDS• Myoglobinuria
– Superimposed bacterial infection (pneumococcal or staphylococcal)• Otitis media, Sinusitis, Pneumonia
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Medical Management– Symptomatic– Antipyretics and Analgesics (acetaminophen and
aspirin)– Antiviral drugs (Amantadine)– Nasal decongestants– Steam inhalation– Antibiotics for superimposed bacterial infections
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Nursing Management– Respiratory Isolation– Promote Hydration– Relieve Fever– Limit strenuous activity– Monitor for complications
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Influenza: Preventive Measures– Immunization– Avoidance of crowded places– Public education regarding the importance of
basic personal hygiene– Frequent handwashing
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COLD versus FLU
S & SX FLU COLD
Fever characteristic Rare
Headache Prominent Rare
General Aches Usual often severe Slight
Fatigue Extreme (2-3wks) Mild
Runny Nose Sometimes Common
Sore throat Sometimes Common
Cough Common; can become severe
Mild to moderate
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TONSILLITIS
Inflammation of the tonsils caused by bacterial or viral infection; often occurs with pharyngitis
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CLINICAL MANIFESTATIONS
• Enlarged, reddened palatine tonsils with or without exudate
• “kissing” tonsils• Difficulty swallowing or breathing• Drooling• Lymphadenopathy• Mouth-breathing
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THERAPEUTIC MANAGEMENT
• Management for viral tonsillitis is symptom relief; similar to viral pharyngitis
• Bacterial tonsillitis: antibiotic therapy• Soft/ liquid diet, nonirritating foods• Saltwater gargles, lozenges, or anesthetic
sprays• Acetaminophen for pain relief and fever• Tonsillectomy: removal of tonsils to prevent
recurrent tonsillitis
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Care of the Post-Tonsillectomy Patient:• Provide pain control with analgesics and ice
collar• Observe for excessive bleeding• Offer clear, chilled fluids when awake and
alert; avoid red-colored fluids; milk products are discouraged
• Teach child and parents that a sore throat is to be expected for approximately 1 week postoperatively
• Avoid strenuous activity for about 1 week
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OTITIS MEDIAA bacterial or viral infection in the
middle ear, usually secondary to an upper respiratory tract infection
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CLINICAL MANIFESTATIONS
• Ear pain (otalgia)• Irritability• Diarrhea• Fever• Vomiting• pulling at affected ear• Red, bulging, nonmobile tympanic membrane• May be asymptomatic in some children
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THERAPEUTIC MANAGEMENT• Avoid exposure of child to cigarette-smoke
• Antibiotics
• Acetaminophen or ibuprofen; codeine for severe pain
• Surgical management:
– Myringotomy
– Tympanostomy
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CROUPAn acute viral inflammation of the upper and lower respiratory tracts, characterized by inspiratory stridor, subglottic swelling, and respiratory distress that is most pronounced on inspiration
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CLINICAL MANIFESTATIONS• Croup usually begins with nonspecific respiratory
symptoms, including:• Rhinorrhea• Sore throat• Cough.• Fever is generally low grade (38-39°C) but can exceed
40°C. Within 1-2 days,• The characteristic signs of hoarseness, barking cough, and
inspiratory stridor develop, often suddenly, along with a variable degree of respiratory distress.
• Symptoms are perceived as worsening at night• Spasmodic croup typically presents at night with the
sudden onset of "croupy" cough and stridor.
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Scoring systems• Croup scores have been developed to assist the clinician in
assessing the degree of respiratory compromise. One of the most commonly cited is the Westley score. The score evaluates the severity of croup by assessing the following 5 factors, with a score range of 0 to 17:
• Inspiratory stridor: None - 0 points, Upon agitation - 1 point, At rest - 2 points
• Retractions: None - 0 points, Mild - 1 point, Moderate - 2 points, Severe - 3 points
• Air entry: Normal - 0 points, Mild decrease - 1 point, Marked decrease - 2 points
• Cyanosis: None - 0 points, Upon agitation - 4 points, At rest - 5 points
• Level of consciousness: Normal, including sleep - 0 points, Depressed - 5 points
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• According to the Westley score, a score of less than 3 represents mild disease; a score of 3-6 represents moderate disease; and a score greater than 6 represents severe disease.
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CROUP: THERAPEUTIC MANAGEMENT• Fluids• Cool mist/ humidified air• Antibiotics• Antipyretics• Nebulized epinephrine• Corticosteroids• 100% oxygen• Suctioning• Intubation• Vigilant observation of respiratory status
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BRONCHIOLITIS(RSV)
An acute viral infection of the lower respiratory tract affecting infants and young children and characterized by respiratory distress, expiratory obstruction, wheezing, and crackles.
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Signs and Symptoms– Dyspnea, cough, wheezing– Fever– Apnea in infants
Complications– Acute asthmatic episode– Respiratory failure
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RSV: Diagnostic Tests–CBC
• Elevated granulocytes–Chest X-ray will show
bronchopneumonia and bronchiolitis–ELISA
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RSV: Medical Management:– Severe disease in infants and children requires
hospitalization and close observation to ensure adequate respiration
– ABG/ pulse oximeter monitoring– Supportive Ribavirin– Respiratory support: CPT, humidified oxygen,
assisted ventilation– IV Fluids
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RSV: Nursing Management:– Monitor closely for signs of respiratory fatigue or
distress– Monitor O2 saturation levels and response to
therapy if patient is hypoxic– Monitor for adequate hydration and nutrition. – Prop infants up to an angle of 10 to 30 degrees to
ease breathing– In tachypneic patients and those in respiratory
distress, oral fluids are contraindicated due to risk of aspiration
– Institute contact isolation. Strict handwashing.
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PNEUMONIA
An acute infection of lung parenchyma including alveolar spaces and interstitial tissue
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CLINICAL MANIFESTATIONS
• Viral Pneumonia– Mild fever, nonproductive cough, rhinitis– Wheezing, tachypnea, and increased respiratory distress
• Bacterial Pneumonia– High fever, productive cough, ill appearance– Retractions, grunting respirations, chills, chest pain– Respiratory distress is significant and accompanied by
restlessness and anxiety
• Diagnostics: Chest x-ray, pulse oximetry, blood gas analyis, CBC, blood cultures
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PNEUMONIA: THERAPEUTIC MANAGEMENT
• Monitor: breath sounds, RR, use of accessory muscles, color, O2 sat, level of activity, and restlessness every 2 hours
• Encourage to assume position of comfort, usually upright
• Assist with coughing and deep breathing exercises• Administer antipyretics and analgesics• Ensure adequate hydration• Cool mist• Suctioning as needed• Cluster nursing care to allow periods of
undisturbed rest
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ASTHMAA pulmonary disease characterized by reversible airway obstruction, airway inflammation, and increased airway responsiveness to a variety of stimuli.
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ASTHMA: CLINICAL MANIFESTATIONS• Cough: hacking. Paroxysmal, irritative, nonproductive;
becomes rattling and productive• Shortness of breath• Prolonged expiratory phase• Audible wheeze• Malar flush, red ears• Lips deep, dark red color; may progress to cyanosis of nail
beds or circumoral cyanosis• Restlessness and apprehension; Sweating• Older children may sit upright with shoulders in a hunched-
over position• May speak in short, panting, broken phrases
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ASTHMA: CLINICAL MANIFESTATIONS• Chest: hyperresonance• With repeated episodes:
– barrel chest– Elevated shoulders– Use of accessory muscles of respiration– Flattened malar bones, circles beneath the eyes,
narrow nose, prominent upper teeth
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THERAPEUTIC MANAGEMENT• Eliminate allergen if possible• Recognize that emotional overlay may trigger
attacks• Hyposensitization – “allergy shots”• Position of comfort--high Fowler’s--leaning forward with chest on pillow placed on
bedside table• Education--swimming is good exercise--symptoms may decrease at puberty
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Common medicationsBeta-Agonists (Ex. Albuterol)--provides bronchodilation--side effects: palpitations, tachycardia, tremorsCorticosteroids--reduces inflammation and swellingTheophylline--prevents/reduces inflammation--prevents bronchoconstriction--side effects: gastric irritation, headache, palpitations,
restlessnessCromolyn--prevents/reduces inflammation--does not work for acute attacks--not recommended under 5 years
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CYSTIC FIBROSISAn inherited disease of the exocrine glands primarily affecting the GI and respiratory systems, and usually characterized by COPD, exocrine pancreatic insufficiency, and abnormally high sweat electrolytes.
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CYSTIC FIBROSIS: CLINICAL MANIFESTATIONS• Intestinal obstruction
--meconium ileus (thick, putty-like meconium)• Malabsorption syndrome
--growth failure--large appetite with weight loss--steatorrhea (fatty stools) – bulky, loose, foul-smelling stools--rectal prolapse
• Chronic pneumonia/obstructive emphysema--frequent respiratory infections
• Exocrine gland dysfunction--salty taste to skin
• Diagnostic test – sweat chloride over 60 mEg/l
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CYSTIC FIBROSIS: THERAPEUTIC MANAGEMENT
• Observe for any respiratory impairment:– Cough, presence and color of sputum– Dyspnea– Color of nailbeds and mucous membranes– Pulse oximetry– Auscultate breath sounds for equality, crackles,
wheezes– Observe for digital clubbing
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CYSTIC FIBROSIS: THERAPEUTIC MANAGEMENTParental support--may feel guilt since disease genetically linked--chronic terminal illness--expensive and time consuming to treat, use of special
equipment--places limits on “normal” activities--use respite care as availableNutrition--need to increase calories, protein, salt--give water soluble vitaminsPancreatic enzyme replacement--give with ALL meals/snacks--dosage is determined by stools
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THERAPEUTIC MANAGEMENT
Pulmonary hygiene--3-4 times daily – percussion with postural drainage
(CPT)--aerosols (nebulizer) therapy before and after CPT--breathing exercises--long term antibiotics and expectorants--oxygen should be given cautiously because of narcosis
risk--avoid exposure to respiratory infections
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SIDS
The sudden and unexpected death of any infant or young child in which a thorough postmortem examination fails to show an adequate cause.
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Risk Factors• Prematurity• Infections• Brain stem defects• Use of soft bedding• Sleeping in prone position• Maternal smoking during pregnancy• Sibling with SIDS• Low birth weight• Increased incidence in cold weather• Increased incidence in lower socioeconomic
groups
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THERAPEUTIC MANAGEMENT
• Avoid questions that could imply parental negligence
• Provide emotional support• Assure parent(s) that there is nothing that
they could have done to prevent infant’s death
• Allow parents an opportunity to say goodbye• An autopsy may likely be necessary to confirm
cause of death