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Respiratory. Nur 106. Respiratory System. General Information Signs and symptoms of respiratory distress Common diagnostic tools Common medications and treatments. General Information. Fetus practices breathing in utero Normal to have amniotic fluid in lungs

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respiratory system
Respiratory System
  • General Information
  • Signs and symptoms of respiratory distress
  • Common diagnostic tools
  • Common medications and treatments
general information
General Information
  • Fetus practices breathing in utero
  • Normal to have amniotic fluid in lungs
  • Absorbed as soon as takes first breath
  • Meconium in the amniotic fluid is problem
  • Surfactant reduces surface tension in lungs so that lungs will remain open
  • Neonates are obligant nasal breathers
general information1
General Information
  • Normal respiratory rate: 30—50
  • Lumen of respiratory system is smaller in children
  • Eustachian tubes shorter and more horizontal
  • Metabolic rates are higher than adults
respiratory assessment
Respiratory Assessment
  • Auscultation
    • Absent or diminished lung sounds
    • Adventitious lung sounds
      • Crackles—passage of air through moisture
      • Wheezes—Narrowed passageways
respiratory assessment1
Respiratory Assessment
  • Observation
    • Barrel Shaped Chest
respiratory assessment2
Respiratory Assessment
  • Observation
    • Cyanosis
    • Club fingers
respiratory assessment3
Respiratory Assessment
  • Observation
    • Presence of retractions
      • Occur when airway obstructed in young children
      • Indication of severity of respiratory distress
respiratory assessment4
Respiratory Assessment
  • Infant’s chest walls more flexible, muscles immature, retractions common
respiratory assessment5
Respiratory Assessment
  • Retractions




common diagnostic tests
Common Diagnostic Tests
  • Chest xray
  • Bronchoscopy—visualizes trachea and bronchi directly
    • Under anesthesia
  • Pulmonary function tests—usually not until 5 to 6 years of age
  • Sputum culture—best collected in morning
common diagnostic tests1
Common Diagnostic Tests
  • Arterial blood gases
    • Heparinized syringe
    • Place on ice
    • Transport to lab immediately
    • Pressure to site for 5 minutes
  • Pulse oximetry
    • Oxygen saturation
    • SPo2
    • 87—93% safe levels of saturation
respiratory system1
Respiratory System
  • Laryngotracheobronchitis (croup)
  • Pnuemonia
  • Respiratory distress syndrome
  • Bronchopulmonary dysphasia
  • Cystic Fibrosis
  • Sudden Infant Death Syndrome (SIDS)
respiratory system2
Respiratory System
  • Asthma
  • Respiratory Syncyntial Virus
  • Pharyngitis
  • Allergic Rhinitis
  • Tonsillitis/adenoiditis
  • Influenza
  • Generalized infection of larynx, trachea and bronchi
  • Croup
  • Frequently shows symptoms of mild URI during day; at night, awakens with hoarse barking cough and severe respiratory distress
  • Most common organisms: RSV, parainfluenza virus and mycoplasma pneumoniae
ltb etiology
  • Affects children under 5 (smaller airways)
  • Affects boys more frequently than girls
  • Inflammation causes narrowing of airways
  • Onset gradual
  • May reoccur several nights in a row
ltb symptoms
LTB Symptoms
  • Low-grade fever
  • Barking cough
  • Respiratory stridor
  • Hypoxemia
  • Tripod position
ltb treatment
  • At home:
    • Hot steamy bathroom
    • Cool night air
    • Sit upright
    • Cool mist vaporizer in “home made tent”
    • Elevate head of crib
    • Increase fluids
ltb treatment1
  • Hospitalization
    • Croup tent
    • IV fluids—oral fluids may cause aspiration
    • Bronchodilators
    • Corticosteroids
    • Intubation equipment available
  • Inflammation of epiglottis
  • Life threatening obstruction
  • Usually bacterial (hemophilus influenza)
  • Sudden onset in healthy child: awakens with high fever, drooling and respiratory distress
  • Do NOT examine throat—may lead to spasm and complete obstruction
  • Inflammation/infection of bronchioles and alveloar spaces
  • Causative agents bacteria, viral, mycoplasma
    • Children under 5: Viral—RSV. Influenza, adenovirus,rhinovirus
    • Children over 5: Bacteria—streptococcus pneumoniae
  • Symptoms
    • Fever, cough, dyspnea, tachypnea
    • Rhonchi, crackles, wheezes
    • Decreased breath sounds with consolidation
  • Diagnosis
    • Xray
  • Treatment
    • Antibiotics, IV, fever control, airway management
respiratory distress syndrome
Respiratory Distress Syndrome
  • Formally called Hyaline Membrane Disease
  • Disease primarily of premature
    • Infant of a diabetic mother
    • White children more frequent than black
    • Boys more often than girls
  • Primary pathology is production

deficiency in surfactant



Lung Compliance


Work of breathing





Anaerobic metabolism



Adapted from: London, M; Ladewig, P; Ball, J; and Bindler, R. 2007. Maternal & Child Nursing Care, 2nd ed. Upper Saddle River, NJ, Prentice Hall, p.820.

respiratory distress syndrome1
Respiratory Distress Syndrome
  • Diagnosis: x-ray—diffuse bilateral density (white-out), and atelectasis
  • Antenatal prevention treatment: betamethasone
respiratory distress syndrome2
Respiratory Distress Syndrome

Nursing Care

  • Oxygenation/ventilation
    • Transcutaneous oxygen/CO2 monitoring
    • Blood gas monitoring
    • Oxygen
    • Continuous positive airway pressure (CPAP)
    • Respirator
respiratory distress syndrome3
Respiratory Distress Syndrome

Nursing Care

  • Correction of acid-base imbalance
  • Temperature regulation
  • Nutrition
  • Protect from infection
respiratory distress syndrome4
Respiratory Distress Syndrome
  • Surfactant Replacement Therapy
    • At birth and repeated as necessary
    • Endotracheal administration
bronchopulmonary dysplasia
Bronchopulmonary dysplasia
  • BPD
  • Chronic lung disease
  • Precipitating factors: prematurity, high oxygen concentrations, positive pressure ventilation
  • Symptoms: Persistent respiratory distress
    • Wheezing, tachypnea, pulmonary edema
    • Failure to thrive
bronchopulmonary dysplasia1
Bronchopulmonary Dysplasia
  • Nursing Care
    • Oxygen
    • Tracheostomy
    • Recurrent respiratory infections
      • Palivizumab, RSV immune globulin
    • Promote growth and development
bronchopulmonary dysplasia2
Bronchopulmonary Dysplasia
  • Medications:
    • Bronchodilators
    • Anti-inflammatory agents
    • Diuretics
    • Antibiotic Therapy
    • Vitamin A
cystic fibrosis
Cystic Fibrosis
  • Inherited—autosomal recessive
    • Both parents must be carriers
    • Each child has a 1 in 4 chance of being affected
    • Affects primarily white children

Father Mother

(carrier) (carrier)

Carrier Unaffected Affected Carrier

cystic fibrosis1
Cystic Fibrosis
  • Multi-system disease—affects exocrine glands
    • Bronchioles, small intestines, pancreas, bile ducts
  • Exocrine secretions—thick and tenacious
  • Abnormal sodium excretion
    • Sweat Chloride test
    • Heat Prostration
cystic fibrosis2
Cystic Fibrosis
  • Lungs—Secretions pool in bronchioles leading to infection and atelectasis
    • Barrel shape chest
    • Cyanosis
    • Clubbing of fingers and toes
    • Recurrent respiratory infections
cystic fibrosis3
Cystic Fibrosis
  • Pancreas—absence of pancreatic enzymes and malabsorption
  • Small intestine—Meconium hardens leading to meconium ileus
    • Stools are bulky and fatty (steatorrhea)
    • Large belly, wasted extremities
    • Fat soluble vitamin deficiencies
cystic fibrosis4
Cystic Fibrosis
  • Males usually sterile due to blocked vas deferens
  • Females may have trouble conceiving due to thick mucus in the reproductive tract
cystic fibrosis5
Cystic Fibrosis
  • Medical treatment
    • Bronchodilators
    • Antibiotics
    • Pancreatic enzymes
    • Vitamin supplements
    • Salt supplements in hot weather?
cystic fibrosis nursing interventions
Cystic FibrosisNursing Interventions
  • At birth—monitor for 1st meconium
    • Newborn screening—blood immunoreactive trypsinogen
  • Genetic counseling
  • Parent Education
    • High calorie, high protein, low fat diet
    • How to administer pancreatic enzymes
    • Protect from infection
    • Breathing exercises and care
cystic fibrosis breathing exercises
Cystic FibrosisBreathing Exercises
  • Physical activity
  • Chest percussion and postural drainage
cystic fibrosis medications
Cystic FibrosisMedications
  • Aerosol Bronchodilators—opens lungs
  • Aerosol DNAse—loosens secretions
  • Corticosteroids—Anti-inflammatory
  • Antibiotics—Treats infections
  • Pancreatic enzymes—Aids in digestion
  • Water soluble ADEK
sudden infant death syndrome
Sudden Infant Death Syndrome
  • Risk factors--infant
    • Race: (decreasing order of frequency) American Indian, black, Hispanic, white, Asian
    • Males more often than females
    • 2—4 months of age
    • Winter
    • Exposure to passive smoke
    • Prone sleeping
    • Overheating
sudden infant death syndrome1
Sudden Infant Death Syndrome
  • Risk factors--maternal
    • Age less than 20, short interval between pregnancies
    • Prenatal smoking, binge alcohol, drug use
    • Anemia
    • Poor prenatal care, poor weight gain during pregnancy
    • Hx of sexually transmitted disease or UTI
  • Hyper-reactive lungs
  • Chronic condition with acute exacerbations
  • Responds to environmental irritants
  • Bronchial spasm, increased airway resistance, air trapping
asthma etiology
  • Triggers include: inhalants, airborne pollens, stress, weather changes, exercise, viral or bacterial agents, allergens, strong emotions, etc.
  • Runs in families—genetics unclear
asthma pathology
  • Exposure to irritant
  • Constriction of bronchial smooth muscles
  • Edema of lung tissues
  • Increased respiratory secretions
  • Airway narrowing
    • Air trapping and hyperinflation of alveoli
asthma symptoms
  • Wheezing—can be heard at
  • Cough
  • Air trapping and hyperinflation leads to prolonged expiratory phase
  • Lips—dark red; may progress to cyanosis
  • Anxiety
  • Sitting upright, hunched over
asthma treatment
  • Quick relief medications
    • Nebulizer (metered dose inhaler)—note if contains steroids, spacer should be used to prevent yeast infections of the mouth
asthma metered dose inhaler use
AsthmaMetered Dose Inhaler--Use
  • Shake the inhaler well before use (3 or 4 shakes)
  • Remove the cap
  • Breathe out, away from your inhaler
  • Bring the inhaler to your mouth. Place it in your mouth between your teeth and close you mouth around it.
  • Start to breathe in slowly. Press the top of you inhaler once and keep breathing in slowly until you have taken a full breath.
  • Remove the inhaler from your mouth, and hold your breath for about 10 seconds, then breathe out.

asthma medications acute
  • Corticosteroids—oral or inhaled
    • Prednisone, Methylprednisolone
  • Β-Adrenergic agonists (Bronchodilators)
    • Albuterol, epinephrine, terbutaline
    • Short acting (inhaled) used to relieve an on-going attack
    • Long acting (oral or inhaled) to control frequent attacks
asthma medications chronic
  • Cromolyn sodium—used prophylactically
    • Inhalant
    • Suppresses inflammation
    • Not bronchodilator
    • Prevents release of histamine
asthma reducing triggers
AsthmaReducing Triggers
  • Smoke free environment
  • Allergy proofing home:
    • Bedroom of primary importance
    • Pillows and mattress enclased in covers
    • Eliminate stuffed toys, plants, carpets, drapes
    • Do not store out of season clothing in room
status asthmaticus
Status Asthmaticus
  • The continued presence of severe respiratory distress despite vigorous therapeutic measures
  • Medical emergency that can lead to respiratory failure and death
  • Sudden onset of agitation or the agitated child who suddenly becomes quiet may be seriously hypoxic
  • Inflammation of the bronchioles
  • Edema, accumulation of mucus, air trapping and atelectasis
  • Major concern for small infants
  • Most common caustive agent is the respiratory syncytial virus (RSV)
  • Often fatal
  • Most important respiratory pathogen in infancy and early childhood
  • Not airborne
  • Can remain viable for hours on nonporous surfaces
  • Most frequent problem in winter and spring
rsv prevention
  • Infants up to 24 months with chronic lung disease
    • RSV Immune Globulin (RSV-ICIV): Antibodies against RSV. Given monthly IV beginning of season
    • Palivizumab (monoclonal antibody): Given monthly IM
  • “Sore throat”
  • Most are caused by viruses
  • Most common bacteria—group A beta-hemolytic streptococcus (strept throat)
  • Symptoms—fever, sore throat, dehydration
  • Treatment—symptomatically
  • If bacterial—10 days of penicillin
tonsillitis adenoiditis
  • Tonsils: Masses of lymphoid tissue located in pharyngeal cavitiy.
  • Purpose: Filter pathogens
  • Size: Children relatively large
  • Infection can be viral or bacterial
  • If greater than 3 infections per year, may do tonsillectomy
  • Surgical removal of palatine tonsils
  • Adenoidectomy—surgical removal of pharyngeal tonsils
  • Pre-op prep same as for all surgeries
  • Recovery room
    • Position on abdomen or side
    • Suction with care
  • Post op care
    • Bedrest for day
    • Clear liquids advance to full then soft
      • Cold
      • Avoid red coloring
    • Ice collar
    • Analgesics
  • Post op risk—hemorrhage
  • Up to 10 days post op
  • Symptoms
    • Bright red bloody emesis
    • Frequent swallowing
    • Pulse greater than 120
  • Recommendations to prevent post-op hemorrhage
    • Avoid irritating foods
    • Avoid gargles or vigorous toothbrushing
    • Discourage coughing or throat clearing
    • Use ice collar
    • Avoid medications known to promote bleeding
    • Limit activity
allergic rhinitis
Allergic Rhinitis
  • Hay fever
  • Seen mostly in older children and adults
  • Treatment: antihistamine, allergy avoidance
  • Viral
  • Symptoms last 4 to 5 days
  • Complications include pneumonia, encephalitis, otitis media
  • Do not treat with aspirin because of possible link to Reye Syndrome
general treatment for respiratory conditions
General Treatment for Respiratory Conditions
  • Position to promote oxygenation
  • Humidification
  • Fluid intake—clear liquid, avoid milk
  • Oxygen???
  • Medications include bronchodilators, anti-inflammatories, antibacterial and antiviral agents
foreign body aspiration
Foreign Body Aspiration
  • Peak age: under 3
  • Leading cause of death under 1
  • FB usually lodge in right main bronchus
  • Partial or complete obstruction
  • Sudden onset of coughing
  • Heimlich Maneuver
  • Surgical removal