NCM 102Pediatric Nursing

Prepared by: Adahlia T. Basco RN, MAN

RESPIRATORY TRACT DISORDER

(Laryngotracheobronchitis) Inflammation of the larynx, trachea and major bronchi One of the most frightening diseases of early childhood for both parents and children

Croup

Signs and symptoms Fever (low grade to high) Irritability and restlessness Hoarse voice Seal bark and brassy cough Inspiratory stridor and suprasternal retractions Use of accessory muscle for breathing

Management Maintain patent airway Assess respiratory status, monitor for nasal flaring, sternal retraction and inspiratory stridor Monitor for pallor or cyanosis Elevate the head of the bed and provide bed rest Provide humidified oxygen via cool mist tent for the hospitalized child

Management Run the hot water on the shower or hot water tap in the bathroom until filled w/ steam, then keep the child in warm moist environment If steam doesnt relieve the symptoms, bring the child to ER Mist tent administer at 10 LPM Nebulize w/ Corticosteroids and Epinephrine Fluids

Instruct the parent to use a cool air vaporizer or humidifier at home Other measure includes having the child breath in the cool night air or the air from an open freezer or taking the child to a cool basement or garage Provide and encourage fluid intake (IV may beprescribed to maintain hydration status if the child is unable to take oral fluids).

Administer acetaminophen Avoid cough syrups and cold medicines which may dry the throat.

Epiglottitis Inflammation of the epiglottis caused by Haemophilus influenzae bacteria. Creates an emergency because swollen epiglottis is unable to rise and allow the airway to open Common in children 2-7 years old

Clinical Manifestations Sudden onset, anxious muffled voice Difficulty swallowing Drooling, tripod position Very soar throat Retractions, fever, irritability Cherry red epiglottis leukocytosis

Management Do not agitate the child Never leave the child unattended Do not inspect throat Position: High Fowlers Administer O2, moist air ET at bedside, tracheostomy at OR Antibiotics

Tonsillitis Infection and inflammation of palatine tonsils All of the tonsils are easily infected because of the bacteria that pass through or are screened through the lymph nodes

Clinical Manifestations Sore throat High fever Tonsillar tissues appear bright red Pus can be detected

Tonsilitis

Tonsillectomy Removal of tonsils and adenoids is performed for chronic enlargement that interferes with breathing (sleep apnea), chronic otitis media or recurrent tonsillitis

Pre operative Interventions Prepare child according developmental stage Demonstrate use of collar, tell child of sore throat after surgery Check for loose teeth

Post operative Interventions Assess airway, prone position w/ head to side Observe for bleeding Give pain relievers Cool clear non-red fluids Apply ice collar 20min on, 20 min off

LOWER RESPIRATORY TRACT DISORDERS

Asthma A chronic condition of the hyper responsiveness of the airway, causing edema, increased mucous production and broncho spasm Maybe exacerbated by various triggers Occur initially before 5 y/o

asthma

asthma

asthma

Asthma Chronic inflammatory disease of the airway Cause by physical and chemical irritant Food Fallen Cockroaches Activity stress dust mites smokes animal dander Temperature changes respiratory infection

Allergic reaction in the airways can cause an immediate reaction like obstruction that can precipitate a late bronchial obstructive reaction

Irritants

Common symptoms is coughing in the absence of respiratory infection specially at night Also known as status asthmaticus Child display respiratory distress despite a vigorous treatment measure A medical emergency that can result in respiratory failure and death if left untreated.

Risk factors for developing asthma hay fever (allergic rhinitis) and other allergies -- this is the single biggest risk factor;

eczema: another type of allergy affecting the skin; and genetic predisposition: a parent, brother, or sister also has asthma.

Management Nebulized with bronchodilators O2 to maintain O2 sat >95% Corticosteroid Elevate head on bed, fluids Teach home management: trigger identification, s/s of distress, meds and side effects

Measurements of how well you are breathing include the following: Spirometer: This device measures how much air you can exhale and how forcefully you can breathe out. The test may be done before and after you take inhaled medication. Spirometry is a good way to see how much your breathing is impaired during an attack. Peak flow meter: This is another way of measuring how forcefully you can breathe out during an attack.

Spirometer and Peak Flow Meter

Asthma Oximetry: A painless probe, called a pulse oximeter, will be placed on your fingertip to measure the amount of oxygen in your bloodstream. There is no blood test than can pinpoint the cause of asthma. Your blood may be checked for signs of an infection that might be contributing to this attack. In severe attacks, it may be necessary to sample blood from an artery to determine exactly how much oxygen and carbon dioxide are present in your body.

Management acute episode Assess airway Administer oxygen Administered quick relief medication as prescribed Continuously monitor respiratory status, pulse oximetry and color, be alert to decrease wheezing and silent chest which may signal inability to move air

Asthma

Initiate an IV line and prepare to correct dehydration, acidosis and electrolytes imbalance. Prepare the child for x-ray Prepare to obtain ABG and serum electrolytes

medication Quick relief ( rescue medication) To treat symptoms and exacerbation Short acting B2 agonist for acute exacerbation ( alupent, albuterol Anti-cholinergic for relief of acute bronchospasm (atropine sulfate) Systemic corticosteroid anti inflammatory action to treat reversible airflow obstruction

Long term control (preventer, medication) Achieve and maintain control of inflammation Corticosteroids NSAID inhibit acute airway narrowing(cromolyn sodium,ibuprofen) Nedocromil Sodium- an antiallergic and anti inflammatory used for maintenance therapy Long acting B2 agonist-for the prevention of EIB (bricanyl, terbutaline, ventolin, alupent)

Long acting bronchodilator-used for long term prevention of symptoms (serevent) Peak expiratory flow meters(PEFMs)-way of measuring how forcefully you can breathe out during an attack. MDI metered dose inhaler-method of providing beta agonist

Classification of Severity of asthma Mild intermittent: This includes attacks no more than twice a week and nighttime attacks no more than twice a month. Attacks last no more than a few hours to days. Severity of attacks varies, but there are no symptoms between attacks. Mild persistent: This includes attacks more than twice a week, but not every day, and nighttime symptoms more than twice a month. Attacks are sometimes severe enough to interrupt regular activities.

Moderate persistent: This includes daily attacks and nighttime symptoms more than once a week. More severe attacks occur at least twice a week and may last for days. Attacks require daily use of quick-relief (rescue) medication and changes in daily activities. Severe persistent: This includes frequent severe attacks, continual daytime symptoms, and frequent nighttime symptoms. Symptoms require limits on daily activities.

Allergic control Prevent and reduce exposure to airborne allergens Skin testing to identify allergens Dust mites- maintain the humidity in the house under 50% Cockroaches- cleaning kitchen floors and cabinet, taking the trash out in the evening

Allergic control

Home Care Measures Instruct measures to eliminate allergens Avoid extremes environmental temperature Avoid exposure to individual with viral respiratory infection Instruct the child how to recognize early symptoms of an attack Instruct the child in the administration of medication as prescribed

Instruct the child in the use of nebulizer, MDI, or PEFM. Instruct the cleaning of devices used for inhaled medication( oral candidiasis may occur with the use of aerosolized steroid) Encourage adequate rest and sleep and well balanced diet Adequate fluid intake to liquefy secretions Assist in developing an exercise program

MDI & PEFM

Medication

Instruct the child the procedure for respiratory treatment and exercise as prescribed Encourage the child to cough effectively Encourage the parent to keep immunization up to date; annual flu vaccine are recommended Inform other health care providers and school personnel of the asthma condition Allow the child to take control of self care measure on the basis of age appropriateness

How do I use a meter-dose correctly? Remove the cap and hold the inhaler upright. Shake the inhaler. Tilt your head back slightly and breathe out. Hold the inhaler A or B are the most effective, but C is okay for people who are unable to use A or B. Spacers are useful for all patients, especially young children and older adults (see picture B). Press down on the inhaler to release the medicine as you start to breathe in slowly. Breathe in slowly for 3 to 5 seconds. Hold your breath for 10 seconds to allow medicine to go deeply into your lungs. Repeat puffs as directed. Wait 1 minute between puffs to allow the second puff to get into the lungs better.

How do I use a meter-dose inhaler

How do I use a meter-dose inhaler

Bronchitis Inflammation of the major bronchi and trachea One or more common illnesses that affect pre-school and school age children

Bronchitis

bronchitis chronic bronchitis is a serious long-term disorder that often requires regular medical treatment. inflammation and swelling of the lining of the airways that lead to narrowing and obstruction of the airways. inflammation stimulates production of mucus, which can cause further obstruction of the airways and increase the likelihood of bacterial lung infections.

Clinical Manifestations Nasal stuffiness Fever and dry hacking cough, usually in conjunction with nasal congestion On auscultation: Rhonchi and coarse crackles (the sound of rales) can be heard

Management Monitor for respiratory distress Provide cool humidified air Monitor for signs of dehydration Sunken fontanel Poor skin turgor Decreased and concentrated urinary output

Increase fluid intake Administer acetaminophen

Bronchiolitis Respiratory Syncytial Virus (RSV) Causes inflammation of bronchioles and increased mucous production of lower airway in infants under 1 year old

Bronchiolitis

Signs and Symptoms URI symptoms Rhinorrhea Low grade fever

Lethargy, poor feeding and irritability in infant Tachypnea Increased difficulty in breathing Nasal flaring and retractions Expiratory wheezing and grunts Diminished breath sounds

Management Maintain patent airway Position the child at a 30-40 degree angle with the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm Provide cool, humidified oxygen Encourage fluids, IVF may be necessary until the acute stage has passed Assess for signs of dehydration

Management Contact isolation Administer O2 to maintain O2 sat via nasal cannula