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Respiratory Alterations

Learn about pediatric respiratory system differences, common conditions like Acute Viral Nasopharyngitis, Strep Throat, and Ear Infections, and their diagnosis and treatment. Understand pediatric respiratory anatomy and management strategies.

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Respiratory Alterations

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  1. Respiratory Alterations NUR 264 Pediatrics Angela J. Jackson, RN, MSN

  2. Respiratory Alterations: Developmental Differences • Lungs require longer gestation time to form than any other body system • Children have a smaller nasopharynx – easily occluded during infections • Lymph tissue (tonsils, adenoids) grows rapidly in early childhood, atrophies after age 12 • Smaller nares – easily occluded during infection. Infants are nose breathers • Eustachian tubes are shorter and more horizontal, facilitating transfer of pathogens into the middle ear

  3. Respiratory Alterations: Developmental Differences • Long, floppy epiglottis – vulnerable to swelling and obstruction • Thyroid, cricoid, tracheal cartilages are immature and collapse when neck is flexed • Diaphragmatic-abdominal breathing normal in neonate until approximately 5y/o due to position of ribs which affect chest wall expansion • Chest wall is supple and very compliant • Irregular patterns of breathing in newborns and infants • Pediatric arrests usually occur from respiratory arrest or shock, not cardiac arrest

  4. Choanal Atresia • Congenital membranous or bony obstruction between the nose and nasopharynx

  5. Choanal Atresia • Can obstruct one or both posterior nasal openings • Unilateral can be overlooked until open nasal passage becomes obstructed • Bilateral – severe signs of distress in newborn • More common in girls • Treatment: surgery

  6. Congenital Laryngeal Stridor: Laryngomalacia • Laryngeal cartilage is soft and flaccid, causing the supraglottic structures to collapse into the airway, resulting in partial obstruction and stridor

  7. Laryngomalacia • Stridor with retractions • Infant’s cry is normal • Cyanosis is uncommon • Place in prone position to decrease obstruction • Occurs more frequently in boys • Treatment: Tracheostomy

  8. Acute Viral Nasopharyngitis (Common Cold) • Inflammation of the nasopharynx • Self-limiting viral infection • The inflammatory process is associated with tissue swelling and the formation of exudate. • Nasal congestion caused by edema and secretions impede airflow through the nasal passages

  9. Acute Viral Nasopharyngitis: Clinical Manifestations • Nasal stuffiness • Rhinitis • Sneezing • Nasal discharge • Coughing • Sore throat • Fever • Irritability • Malaise • Poor feeding

  10. Acute Viral Nasopharyngitis: Diagnosis and Treatment • Diagnosis is based on client history and physical exam • Supportive care • Decongestants • Saline nasal spray • Fluids • Vaporizer • Antipyretics • Cough suppressants

  11. Acute Streptococcal Pharyngitis (Strep Throat) • Bacterial pharyngitis • Caused by Group A beta-hemolytic streptococcus • Red throat, petechia on palate • Throat pain • Fever • Abdominal pain • Fine raised rash • Anterior cervical adenopathy

  12. Strep Throat • Diagnosed with throat cultures, rapid strep screen • Treated with one dose IM penicillin or 10 day course of antibiotics • Replace toothbrush • Test and treat other members of family • Complications: acute glomerulonephritis, Rheumatic Fever

  13. Tonsillitis - Adenoiditis • Viral or bacterial infection of the palatine and or pharyngeal tonsils (adenoids) • Children are more prone to tonsillitis because of the large amount of lymphoid tissue and frequent respiratory infections

  14. Tonsillitis – Adenoiditis: Clinical Manifestations • Sore throat • Difficulty swallowing • Fever • Nasal congestion

  15. Tonsillitis – Adenoiditis: Diagnosis • Based primarily on symptoms and visual inspection of the throat • Throat cultures and rapid strep screening are used to determine etiologic agents

  16. Tonsillitis – Adenoiditis: Treatment • Tonsillectomy may be indicated for recurrent infection, or when enlarged tonsils interfere with eating or breathing • Viral infection: supportive care • Warm saline gargles • Antipyretics

  17. Otitis Media • Inflammation of the middle ear • One of the most common infectious diseased in childhood • Primary causative factor: abnormal functioning of eustachian tube

  18. Otitis Media: Clinical Manifestations • Pain • Fever • Irritability • Diarrhea and vomiting • May have decreased hearing

  19. Otitis Media: Diagnosis • Otoscopic examination • Red, bulging tympanic membrane • Diminished movement with pneumatic otoscopic assessment

  20. Otitis Media: Treatment • Antibiotics for 10 days • Tympanostomy tubes for recurrent or unresolving OM and/or hearing loss

  21. Acute Epiglottitis • Serious obstructive inflammatory process of epiglottis • Occurs principally in children between 2 and 5 years of age • Caused by infection with Haemophilus influenzae • Requires immediate treatment

  22. Epiglottitis: Clinical Manifestations • Abrupt onset • Child complains of sore throat and pain on swallowing • Fever • Child appears sicker than clinical findings suggest • Insists on sitting upright and leaning forward, with the chin thrust out, mouth open and tongue protruding (tripod position) • Drooling is common • Child is irritable and extremely restless, has an anxious, apprehensive and frightened expression • Voice is thick and muffled • Inspiratory stridor

  23. Acute Epiglottitis: Treatment • Intubation or tracheostomy may be necessary for the child with respiratory distress • Antibiotics, initially given IV followed by PO administration, for 10 days • IV fluids, antipyretics, corticosteroids, keep child calm • The epiglottal swelling usually decreases after 24 hours of antibiotic therapy, and is near normal by the third day

  24. Laryngotracheobronchitis (Croup) • Viral syndrome manifested by a croupy or “barking” cough, inspiratory stridor, and respiratory distress • Inflammation of the larynx, trachea, and bronchi causes narrowing of the airways • Seen predominately in children between 6months and 3 years of age

  25. Croup: Clinical Manifestations • Hoarse or “barking” cough • Nasal drainage • Sore throat • Low-grade fever • Tachycardia • Tachypnea • Inspiratory stridor

  26. Croup: Treatment • Nebulized racemic epinephrine • Corticosteroids • Fluids • Rest • Humidity

  27. Bronchiolitis • Acute viral infection of the bronchioles, occurring most often in young children • RSV is the most common causative agent • 95% of children have had bronchiolitis by the age of 3

  28. Bronchiolitis: Pathophysiology • Inflammation causes airway edema • The bronchioles are narrowed and occluded • Occlusion causes air trapping, which leads to hyperinflation of some alveoli and atelectasis in others • Overall effect is hypoventilation

  29. Bronchiolitis: Clinical Manifestations • Rhinorrhea • Sneezing • Decreased appetite • Low-grade fever • Coughing • Wheezing, nasal flaring, retractions • Crackles • Tachypnea

  30. Bronchiolitis: Diagnosis • History and physical exam • Nasopharyngeal washings • Chest x-ray

  31. Bronchiolitis: Treatment • Humidified O2 • Bronchodilators • Suctioning • Oxygen saturation monitoring • IV fluids • Strict handwashing and contact precautions • Prophylaxis: Synergis IM once a month

  32. Pneumonia • Acute inflammation of the pulmonary parenchyma • Seen frequently in childhood, occurring most often in infancy and early childhood • Viruses are the primary causative agent except in neonatal cases of pneumonia

  33. Pneumonia: Clinical Manifestations • Cough • Malaise • Chest pain • Fever • Anorexia • Headache • Tachypnea • Wheezing

  34. Pneumonia: Treatment • Cough, deep breath, change position often • CPT, O2, IS • IV fluids • Antibiotics, antipyretics • Cool mist, suctioning • Rest

  35. Asthma • Chronic inflammatory disorder of airways with bronchoconstriction and bronchial hyperresponsiveness • Most common pediatric chronic illness

  36. Asthma: Pathophysiology • Exposure to irritant causes constriction of bronchial smooth muscles, edema, increased mucus production, airway narrowing • Bronchial muscles go into spasm, resulting in increased respiratory effort, increased airway resistance, air trapping, hyperinflammation of airway • Risk factors: hereditary, environmental stimuli, stress, weather changes, exercise, viral or bacterial agents, food additives

  37. Asthma: Clinical Manifestations • Recurrent episodes of wheezing • Breathlessness • Nasal flaring, retractions, head bobbing • Chest tightness • Cough • Prolonged expiration • Dyspnea • Tachypnea, tachycardia, barrel chest develops

  38. Asthma: Diagnosis • Chest x-ray shows hyperinflation of the airways • PFT’s show decreased peak expiratory flow rate

  39. Asthma: Treatment • Avoidance of triggers • Regular peak flow monitoring • Medications • Short-acting beta-2 agonists (albuterol) • Inhaled corticosteroids (beclomethasone) • Systemic corticosteroids • Antileukotrienes (Singulair) • Long-acting bronchodilators (Serevent) • Anticholinergics (atrovent)

  40. Cystic Fibrosis • Autosomal recessive disorder that affects the exocrine glands • Causes the body to produce thick, sticky mucus that clogs the lungs, the GI tract and the GU tract • Affects approximately 30,000 children and adults in the United States • Median age of survival is 33.4 years

  41. Cystic Fibrosis: Clinical Manifestations • Salty taste to the skin • Foul smelling, greasy stools • Delayed growth • Thick sputum • Chronic coughing or wheezing • Frequent chest and sinus infections with recurring pneumonia or bronchitis • Clubbing of fingers and toes • Intussusception • Rectal prolapse • Meconium ileus

  42. Cystic Fibrosis: Diagnosis • History and physical exam • Sweat test • DNA analysis

  43. Cystic Fibrosis: Treatment • Antibiotics • Mucus-thinning drugs (Pulmozyme) • Bronchodilators • Bronchial airway drainage • Oral enzymes • High calorie diets • Lung transplant

  44. Cystic Fibrosis: Complications • Chronic respiratory infections • Bronchiectasis (irreversible dilation and destruction of the bronchial walls) • Pneumothorax • Cor pulmonale (failure of the right ventricle of the heart) • Chronic diarrhea • Severe nutritional deficiencies • Type 1 diabetes • Liver damage • Infertility

  45. Cystic Fibrosis: Nursing Considerations • Infection control • Maintain adequate nutrition • Medication administration • P&PD • Family teaching • Support groups

  46. Bronchopulmonary Dysplasia • Chronic lung disease that primarily affects premature infants who have respiratory distress syndrome • 9 out of 10 babies with BPD weighed 1500 grams or less at birth • 1 out of 3 babies born weighing less than 1000 grams gets BPD • 5,000 to 10,000 babies in the U.S. get BPD each year

  47. BD: Pathophysiology • Poor lung compliance requires mechanical ventilation • Trauma to the pulmonary structures occurs, leading to interstitial edema and epithelial destruction • Inflammatory response causes airway obstruction • Tissue and pulmonary vasculature damage results in a ventilation/perfusion imbalance that leads to hypercapnia and hypoxemia

  48. BP: Clinical Manifestations • Rapid, shallow breathing • Retractions • Cough • Wheezing • Cor pulmonale • Pulmonary edema • Dependence on supplemental O2 for more than 28 days • Respiratory acidosis

  49. BP: Diagnosis • History and physical exam • RDS that does not improve within two weeks • Prolonged mechanical ventilation • Prolonged need for supplemental O2 • Chest x-ray

  50. BP: Treatment • Prevention is the primary focus • Prenatal steroids to promote the maturation of fetal lungs • Administration of surfactant • Diuretics, steroids, bronchodilators • Supplemental O2

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