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Annette Tomlinson
RESPIRATORY
DISORDERS
Common Acute
Respiratory Alterations
Nasopharyngitis
Tonsillitis and pharyngitis
Otitis media
Croup
Bronchiolitis
Pneumonia
Sinusitis
Respiratory Assessment
Assessment
Appearance
Respiratory Status
Chest Examination
Respiratory rate
Breath sounds
Inspiratory/Expiratory phases
Nursing Diagnoses
Nasopharyngitis
Common Cold may be viral or bacterial
Nursing Management
Assessment
Interventions
Nasopharyngitis (cont.)
Planning: education of the family
Hydration
Complications
Otitis media, sepsis, meningitis
Preventing spread
Tonsillitis and
Pharyngitis
Pharyngitis and tonsillitis are infections in the
throat that cause inflammation. If the tonsils
are primarily affected, it is called tonsillitis. If
the throat is primarily affected, it is called
pharyngitis. A child might even have inflammation
and infection of both the tonsils and the throat.
This would be called pharyngotonsillitis. These
infections are spread by close contact with other
individuals. Bacterial infections are more common
during the winter. Viral infections are more
common in summer and fall.
Tonsillitis and
Pharyngitis
sore throat
white spots or pus on the tonsils or throat
fever (either low grade or high)
swollen lymph nodes
headache
decrease in appetite
not feeling well
nausea
vomiting
stomach aches
painful swallowing
visual redness or drainage in the throat
Pharyngitis
Usually viral
Symptomatic treatment
acetaminophen (for pain)
increased fluid intake
throat lozenges
Bacterial : group A beta-hemolytic strep
Fluids, bland diet, pain & fever medications, antibiotics
Surgical Intervention
Tonsillectomy
Restores impaired functioning of nose and throat
Adenoidectomy
Post-operatively
Ice collar
Analgesics
Mouth care
Emotional support
Discharge Teaching
Sore throat for 10 days
Danger signs bleeding, infection
Soft diet no hard foods or acidic liquids
Otitis Media
Otitis media is an inflammation of
the middle ear (the cavity between
the eardrum and the inner ear).
Most common childhood disease
Complication of other infection or
allergy
Otitis Media
Factors for frequency:
Frequent URIs
Eustachian tubes short and lay on a
horizontal plane
Lying down pooling
Lymphoid tissue -- obstruction
Otitis Media
Symptoms
Pain = irritability, pulling/rubbing of ear,
rolling head
Anorexia = pain with swallowing
Fever
Lymph Nodes
URI
Vomiting/Diarrhea
Otitis Media
Interventions
Prevention
NO bottle propping
NO exposure to tobacco smoke
Early Treatment
Antibiotics compliance
Complications: hearing loss, meningitis, mastoiditis
Pain
Local heat, analgesics, ear drops
Myringotomy tubes
Laryngotracheobronchitis
(LTB)
Description
Inflammation of larynx, trachea, and bronchi
Commonly called CROUP
Laryngotracheobronchitis
(LTB)
Age Common in infants and toddlers
Agent Virus
Clinical Symptoms
Fever, irritability, restlessness, pallor or
cyanosis
Rales or rhonchi, inspiratory stridor,
retractions, crackles and wheezing on
auscultation
use of accessory muscles
Barking cough, hoarseness
Laryngotracheobronchitis (LTB)
Interventions
Acute Epiglottitis
Description
Bacterial form of croup; epiglottis is inflamed
Considered emergency situation
Age 3 to 7 years
Agent Bacterial (usually H. Flu)
Usually follows URI
Clinical Symptoms - Abrupt onset
4 classic signs- Dysphonia, dysphagia, drooling, and
distress
Sore throat, difficulty swallowing, drooling,
muffled voice, increased fever
Barking cough, hoarseness,
SEVERE respiratory distress; inspiratory stridor,
dyspnea, retractions,
Bright red, edematous epiglottis
Acute Epiglottitis
Assessment
Tripod positioning
Interventions
No attempts to: visualize posterior pharynx,
obtain throat culture, or take oral
temperature
Do not leave child unattended
Do not force child to lie down
Do not restrain child
Ensure up-to-date immunizations, including
Haemophilus influenzae type b (Hib)
conjugate vaccine
Acute Epiglottitis
Interventions
NEVER use a tongue blade to check the
throat!
Can occlude throat entirely from spasm
Bronchitis
Description
Infection of major bronchi
Assessment
Fever; dry, hacking, nonproductive cough,
worse at night; becomes productive in 2 to 3
days
Interventions
Monitor for respiratory distress
Provide cool, humidified air as prescribed
Monitor for signs of dehydration
Increase fluid intake as prescribed
Administer acetaminophen (Tylenol) for
fever as prescribed
Bronchiolitis and
Respiratory Syncytial Virus
(RSV)
Description
Highly communicable; usually transmitted by
direct contact with respiratory secretions
Assessment
Rhinorrhea
Diminished breath sounds
Low-grade fever Grunting
Lethargy
Expiratory wheezes
Poor feeding
Retractions
Tachypnea, dyspnea
Nasal flaring
Bronchiolitis and
Respiratory Syncytial
Virus (RSV)
Diagnostics
WBC normal
X-Ray reveals hyperaeration
Pneumonia
Description
Viral pneumonia
Bacterial pneumonia
Pneumonia
Assessment
Fever; nonproductive to productive cough;
malaise; rhinitis; sore throat; signs of
respiratory distress; diminished breath
sounds
Interventions
Administer oxygen with cool mist as
prescribed
Increase fluid intake
Administer chest physiotherapy, respiratory
therapy as prescribed
Administer acetaminophen (Tylenol) for
fever as prescribed
Administer antibiotics for bacterial
pneumonia as prescribed
HYPERACTIVE AIRWAY
DISEASE - ASTHMA
HYPERACTIVE AIRWAY
DISEASE - ASTHMA
Onset: 3-8 years
May have infant history of allergy
Allergic hypersensitivity to foreign
substances
Inheritable tendency
Chronic disorder
Asthma
Types of Asthma
Asthma
Pathophysiology
Edema and inflammation of the mucus
membranes
Tenacious secretions
Smooth muscle spasms of the bronchi
Asthma
Triggers (initiator of an attack)
Environmental substances
Temperature changes
Psychological stress
Physical stress
Respiratory tract infections
Asthma
Assessment
Asthma
Diagnostics
Chest x-ray reveals hyperinflation of
airways
Pulmonary function tests reveal reduced
peak expiratory flow rate
Asthma
Interventions: Acute episode
Medications
Quick relief (rescue): Short-acting 2 agonists,
systemic corticosteroids
Long term (preventer): Corticosteroids, antiallergy
agents, NSAIDs, long-acting 2 agonists, leukotriene
modifiers, long-acting bronchodilators, nebulizers
Chest physiotherapy
Breathing exercises; physical training
Asthma - Interventions
Assess for cyanosis/respiratory distress
Administer oxygen, monitor SaO2
Maintain IV access
Ensure fluid intake & med administration
High-Fowlers position
Cluster nursing care to conserve childs
energy
Asthma - Interventions
Medications
Bronchodilators (acute and daily use)
Parental, inhaled and oral routes
Corticosteroids
Reduces inflammatory response during or to prevent an
attack
Oral, inhaled, parenteral routes
NSAIDs
Used as prophylaxis/treatment
Oral, nasal, inhaled routes
Asthma - Interventions
Allergen control
Eliminate allergens
Avoid extreme temperature changes
Instruct child, parents to recognize early signs of
asthma attack
Instruct child, parents in correct administration of
medications
Cystic Fibrosis
Cystic Fibrosis
Diagnostics
Sweat test
Analyzes sodium and chloride content in sweat
Chloride concentration 60 meq/L is positive
Cystic Fibrosis
Diagnostic tests
Quantitative sweat chloride test: NaCl level higher than
60 mEq/L definitive for CF
Interventions
Measures to prevent, treat pulmonary infections,
improve aeration, remove secretions, administer
medications as prescribed, including antibiotics
Administer pancreatic enzymes PO as prescribed; highcalorie, high-protein diet; administer of vitamins A, D, E,
K as prescribed; ensure adequate salt intake
Home care
Instruct child, parents about treatment regimen
Inform child, parents about support through CF
Foundation
Medications
Inhaled recombinant human deoxyribonucleae
Antibiotics
Pancreatic enzymes and vitamins A,D,E,K
Pulmonary hygiene
Supplemental oxygen as needed
High calorie, high protein diet
Dietary supplements
CF Nursing Diagnosis
Description
Unexpected death of apparently healthy infant younger
than 1 year in which autopsy fails to demonstrate adequa
cause of death
Assessment
Child found apneic, cyanotic, lifeless
Frothy, blood-tinged fluid may be present in nose, mouth
Typically found in disheveled bed with blankets over head
huddled in corner
Diaper may be full of urine and/or stool
FB - Interventions
Respiratory assessment to determine
severity of problem and degree of
obstruction
Total airway obstruction
Back blows and chest thrusts for infants
Heimlich in children over 1 year
NPO
FB Nursing
Interventions
Tuberculosis (TB)
Description
Assessment
May be asymptomatic
If symptoms develop, include malaise, fever,
cough, weight loss, anorexia, lymphadenopathy
Mantoux test
Tuberculosis (TB)
Sputum culture
Definitive diagnosis made with
presence of mycobacterium in sputum
Interventions
Administer 9-month course of isoniazid
(INH) or rifampin (Rifadin) and pyrazinamide as
prescribed to prevent TB after exposure
If active TB, place on airborne, respiratory
precautions
If active TB, administer medications daily for 2
months, then twice weekly for 4 months as prescribed
Instruct family in prevention of TB transmission
1.
2.
3.
4.
37-67
Answer: 4
Rationale:
Clinical manifestations suggestive of
airway obstruction include tripod
positioning (leaning forward supported by
arms, chin thrust out, mouth open), nasal
flaring, tachycardia, high fever, and sore
throat. Options 1, 2, and 3 are incorrect.
37-68