Chapter 28 The Child with Respiratory Dysfunction Copyright
- Slides: 114
Chapter 28 The Child with Respiratory Dysfunction Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved.
General Aspects of Respiratory Tract Infections Respiratory infections are cause of majority of acute illnesses in children Upper respiratory tract Ø Oronasopharynx, larynx, and trachea Lower respiratory tract Ø Bronchi, bronchioles, and alveoli Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 2
Etiology of Dysfunction Infectious agents: Viruses Ø Ø RSV Parainfluenza Others Group A β-hemolytic streptococci Staphylococci Chlamydia trachomatis, Mycoplasma, pneumococci Ø Haemophilus influenzae Ø Ø Ø Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 3
Age Infants younger than 3 months—maternal antibodies 3 to 6 months—infection rate increases Toddler and preschool ages—high rate of viral infections Older than 5 years—increase in Mycoplasma pneumonia and β-strep infections Increased immunity with age Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 4
Size Diameter of airways plays significant role in respiratory illnesses Distance between structures is shorter, allowing organisms to rapidly move down Short eustachian tubes Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 5
Resistance Immune system Allergies, asthma Cardiac anomalies Cystic fibrosis Daycare Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 6
Seasonal Variations Most common during winter and spring Mycoplasmal infections more common in fall and winter Asthmatic bronchitis more frequent in cold weather RSV season considered winter and spring Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 7
Clinical Manifestations Vary with age Generalized signs and symptoms and local manifestations different in young children Ø Ø Fever Anorexia, vomiting, diarrhea, abdominal pain Cough, sore throat, nasal blockage or discharge Respiratory sounds Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 8
Nursing Considerations Assessment Nursing diagnosis Planning Implementation Evaluation Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 9
Nursing Interventions Ease respiratory effort Fever management Promote rest and comfort Infection control Promote hydration and nutrition Family support and teaching Prevent spread of infection Provide support and plan for home care Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 10
Upper Respiratory Tract Infections (URIs) Nasopharyngitis—“common cold” Caused by numerous viruses Ø Clinical manifestations Ø Ø Ø RSV, rhinovirus, adenovirus, influenza, and parainfluenza viruses Fever—varies with age of child Irritability, restlessness Decreased appetite and fluid intake Nasal inflammation Vomiting and diarrhea Home management—varies with age Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 11
Pharmacologic Treatments for URI OTC pediatric cold remedies are not recommended for treating “common cold” Antihistamines ineffective in most cases Antipyretics for comfort from fever Cough suppressants for dry cough Ø Caution alcohol content Decongestant to shrink swollen nasal passages Ø Nose drops more effective than oral administration Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 12
Pharyngitis Etiology and risks in children Clinical manifestations Diagnostic evaluation Therapeutic management Nursing care management Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 13
Acute Streptococcal Pharyngitis Group A β-hemolytic streptococci (GABHS) Diagnostic evaluation Ø Ø Manifestations/treatment regimen Risk for serious sequelae Ø Ø Ø Rapid antigen testing Culture Acute rheumatic fever Acute glomerulonephritis Scarlet fever (though rarely seen in United States) Nursing care management Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 14
Pharmacologic Interventions—Strep Penicillin Ø Oral • Needs 10 -day treatment to decrease risk of rheumatic fever and glomerulonephritis post strep • Issues with medication compliance IM: Penicillin G • Resolves compliance issue (one injection) • Painful injection • Penicillin G procaine is less painful injection • CANNOT give penicillin G by IV route Ø Erythromycin if penicillin allergy Ø Other antibiotics Ø Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 15
Tonsillitis and Pharyngitis Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 16
Tonsillitis Pathophysiology and etiology Clinical manifestations Therapeutic management Ø Ø Medical Surgical • Controversial • May be indicated with massive hypertrophy Nursing care management Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 17
Location of Various Tonsillar Masses Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 18
Nursing Concerns—Post-Op Tonsillectomy Airway Ø Bleeding Ø Ø Ø Positioning Observation—frequent swallowing? Prevention of recurrent bleeding Maintain quiet environment Minimize agitation/crying NO suctioning Comfort Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 19
Infectious Mononucleosis Acute, self-limiting infection; common in younger than 25 -year-olds Etiology: EBV principal cause Clinical manifestations Diagnostic evaluation Ø Ø CBC Monospot Therapeutic management Nursing considerations Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 20
Influenza (Flu) Etiology—three types Epidemiology—significance to community Clinical manifestations Therapeutic management Prevention Nursing care management Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 21
Pharmacologic Intervention for Influenza in Children Antivirals for children Ø Ø Oseltamivir (Tamiflu) Zanamivir (RELENZA) Must start within 48 hours of symptom onset Avoid aspirin—possible link with Reye syndrome Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 22
Prevention of Influenza Vaccines: Now recommended for children > 6 mo New vaccine annually Injected and inhaled vaccines Contraindications to influenza vaccines Epidemiologic value of influenza vaccines in pediatric population Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 23
Otitis Media (OM) Pathophysiology and etiology Impact of passive smoke inhalation/crowded living conditions Clinical manifestations Diagnostics Therapeutic management Ø Ø Pharmacologic Surgical Nursing considerations Prevention of recurrence Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 24
OM and Infant Feeding Methods Breast-fed infants have less OM than bottlefed infants Ø Ø Immunoglobulin A Position in breast-feeding may decrease reflex in eustachian tubes Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 25
OM—Antibiotic Therapy? If over age 6 months—“watchful waiting” up to 72 hours for spontaneous resolution Antibiotics if <2 years with persistent acute symptoms of fever and severe ear pain Antibiotics if <6 months Topical relief—heat or cold or benzocaine drops (Rx) Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 26
Pharmacologic Interventions First-line antibiotics Ø Amoxicillin PO 80 to 90 mg/kg/day, divided twice daily × 10 days Second-line antibiotics Ø Ø Amoxicillin-clavulanate (Augmentin), azithromycin Cephalosporins IM • If highly resistant organism or noncompliant with oral doses • IM is painful Analgesic-antipyretic drugs Ø Ø Reconstitute with 1% lidocaine (without epinephrine) to decrease pain of injection Acetaminophen Ibuprofen (only if >6 months of age) No steroids, antihistamines, decongestants, antibiotic ear drops Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 27
Anatomic Position of ET in Child and Adult Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 28
Otitis Media with Effusion Clinical manifestations Prevention Ø Ø Ø PCV 7 vaccine Breastfeeding Preventing exposure to tobacco smoke Prognosis Nursing care management Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 29
Otitis Externa “Swimmer’s ear” Ø Infections of the external ear canal Etiology: Staphylococcus or Corynebacterium Clinical manifestations Nursing care management Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 30
Croup Syndromes Characterized by hoarseness, “barking” cough, inspiratory stridor, and varying degrees of respiratory distress Affect larynx, trachea, and bronchi Described by anatomic area primarily affected Ø Epiglottitis [or supraglottitis], laryngitis, laryngotracheobronchitis [LTB], and tracheitis Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 31
Larynx—Normal and Showing Edema of Croup Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 32
Croup Clinical manifestations Therapeutic management Nursing care management Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 33
Acute Epiglottitis Serious obstructive, inflammatory process Clinical manifestations Ø Ø Therapeutic management Ø Abrupt onset Sore throat, pain, tripod positioning, retractions Inspiratory stridor, mild hypoxia, distress Fever Potential for complete respiratory obstruction Prevention: Hib vaccine Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 34
Nursing Considerations—Epiglottitis Position for comfort Decrease anxiety No tongue blade Keep suction at bedside Keep emergency respiratory equipment at bedside Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 35
Acute Laryngitis More common in older children and adolescents Usually caused by virus Chief complaint: hoarseness Generally self-limiting and without long-term sequelae Therapeutic management Nursing care management Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 36
Signs of Increasing Respiratory Distress in Children RESTLESSNESS Tachycardia Tachypnea Retractions Ø Ø Ø Substernal Suprasternal Intracostal Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 37
Acute Spasmodic Laryngitis Also called spasmodic croup, midnight croup Paroxysmal attacks of laryngeal obstruction Occurs chiefly at night Inflammation—mild or absent Most often affects children ages 1 through 3 Therapeutic management Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 38
Bacterial Tracheitis Infection of the mucosa of the upper trachea Distinct entity, features of croup and epiglottitis in older children (5 -7 yrs) Clinical manifestations Ø Ø Thick, purulent secretions Respiratory distress Stridor May develop life-threatening obstruction or respiratory failure Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 39
Therapeutic Management Humidified oxygen Antipyretics Antibiotics May require intubation Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 40
Infections of the Lower Airways Considered the “reactive” portion of the lower respiratory tract Includes bronchi and bronchioles Cartilaginous support not fully developed until adolescence Constriction of airways Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 41
Bronchitis Also called tracheobronchitis Definitions Causative agents Clinical manifestations Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 42
Bronchiolitis Acute viral infection—RSV or other viruses Occurs primarily at the bronchiolar level Typically affects infants May occur in older children with chronic illnesses Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 43
Respiratory Syncytial Virus (RSV) Etiology Pathophysiology and transmission Diagnostics Therapeutic management Prevention of RSV—prophylaxis Nursing considerations Severe RSV linked to asthma development Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 44
Pneumonia Lobar pneumonia Bronchopneumonia Interstitial pneumonia Pneumonitis Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 45
Etiology of Pneumonias Viral, atypical, bacterial Causative agent introduced into lungs through inhalation or from bloodstream “Atypical pneumonias” Ø Caused by pathogens other than most common and readily cultured bacteria Mycoplasma pneumoniae, chlamydial pneumonia Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 46
Pneumonia Etiology and epidemiology Clinical manifestations Ø Ø Diagnostic evaluation Therapeutic management Ø Ø Ø Fever, malaise, rapid respiration, and cough Chest or abdomen pain, nausea Prevention: PCV vaccine Therapies Complications Nursing care management Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 47
Differential Diagnosis X-ray Ø Ø Ø Pulmonary infiltrates Lobar consolidation Pleural effusion Lab tests Cultures—sputum, blood cultures, lung aspiration and biopsy Ø WBC Ø Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 48
Chlamydial Pneumonia Usually 2 -19 weeks after delivery Infected mother transmits to fetus via ascending infection or during delivery Infant is afebrile with cough, tachypnea, rales X-ray Antibiotic treatment Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 49
OTHER INFECTIONS OF THE RESPIRATORY TRACT Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 50
Pertussis (Whooping Cough) Caused by Bordetella pertussis In the United States, it occurs most often in children who have not been immunized Highest incidence in spring and summer Highly contagious Risk to young infants Vaccines Ø Ø Ø DTa. P × 5 in childhood “Booster” × 1 with TDa. P between ages 11 and 64 years Refer to Vaccine Information Statements (VIS) www. cdc. gov/vaccines/pubs/vis/downloads/vis-tdap. pdf Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 51
Tuberculosis (TB) Caused by Mycobacterium tuberculosis human and bovine varieties Pathophysiology Clinical manifestations Diagnostic evaluation Ø Ø Ø History and PE TB test and cultures X-ray Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 52
TB Testing Recommended = Mantoux test Ø Ø Positive reaction Ø Ø Ø Uses purified protein derivative (PPD) Standard dose and administration technique 5 -mm induration 10 -mm induration 15 -mm induration Recommendations for TB testing Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 53
TB Prognosis Latent TB infection (LTBI) Prevention BCG vaccine usage worldwide and in the United States Nursing considerations Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 54
Pharmacologic Management— Latent TB Infection (LTBI) Isoniazid (INH)—treat for 9 months Ø Daily OR alternatively 2 -3 ×/wk with direct observation of therapy (DOT) Rifampin—treat for 6 months if INH resistant Treatment not recommended for children with positive TB test result but no risk factors Treatment to reduce risk of developing active TB Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 55
Pharmacologic Management— Active TB First 2 months—daily INH + rifampin + ethambutol + pyranizamide (PZA) Next 4 months—give 2 -3 ×/wk INH + rifampin Alternative treatment regimens may be used by TB specialists DOT—direct observation of treatment Decreases rates of relapse, treatment failures, and drug resistance Ø Recommended for children and adolescents in the United States Ø Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 56
Isolation for TB Airborne precautions until Effective pharmacologic treatment is underway AND Ø Sputum smears show decrease in organisms AND Ø Cough is improving Ø All family contacts treated with airborne precautions until demonstrated to NOT have active TB Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 57
Community Health Issues Early diagnosis and intervention Promote optimal health Prevent recurrent infection Relationship of living conditions to disease management Nursing care management Case finding: follow-up of known contacts Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 58
RESPIRATORY DISTURBANCE CAUSED BY NONINFECTIOUS IRRITANTS Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 59
Foreign Body Aspiration Risk among young children Pathophysiology Clinical manifestations Diagnostic evaluation Therapeutic management Nursing care management Teaching needs for child safety Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 60
Mechanisms of Airway Obstruction by FB Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 61
Aspiration Pneumonia Risk for child with feeding difficulties Clinical manifestations Therapeutic management Prevention of aspiration Feeding techniques, positioning Avoid these aspiration risks: • Oily nose drops and petroleum distillates • Solvents • Talcum powder Ø Ensure safety in the environment Ø Ø Ø Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 62
Pathogenesis Severity of lung injury depends on ingested substance Hydrocarbons Petroleum distillates often contain heavy metals or other toxic chemicals Ø Often found in home or garage Ø Severe effect even with small amount ingested Ø Spread over surface of tissues and interfere with gas exchange Ø Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 63
Clinical Manifestations— Hydrocarbon Pneumonia Coughing, vomiting, aspiration CNS—agitation, restlessness, confusion, drowsiness, and coma Elevated body temperature (37. 8° to 40° C) Dyspnea, cyanosis, tachycardia, tachypnea, nasal flaring, and retractions Hemoptysis, pulmonary edema, severe cyanosis, and death within 24 hours of aspiration Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 64
Acute Lung Injury (ALI)/Acute Respiratory Distress Syndrome (ARDS) Continuum of symptoms of ALI, with ARDS the most severe form Characterized as respiratory distress and hypoxia within 72 hours after serious injury or surgery in person with previously normal lungs Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 65
ARDS (Cont. ) Pathophysiology Therapeutic management Ø Ø Ø Oxygenations and pulmonary perfusion Treatment of infection Maintain adequate cardiac output Prognosis Nursing care management Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 66
Inhalation Injury— Smoke and Carbon Monoxide Severity depends on nature of substance, environment, and duration of contact Inhalation injuries more deadly than flames Local injury Systemic injury Therapeutic management Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 67
Suspicion for Inhalation Injuries History of exposure to flames whether or not burns are present Soot around nose or in sputum, singed nasal hairs, or mucosal burns of the nose, lips, mouth, or throat Hoarse voice and cough Increased inspiratory and expiratory stridor Tachypnea, tachycardia, abnormal breath sounds Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 68
Inhalation Injuries— Pulmonary Complications Early carbon monoxide poisoning, airway obstruction, and pulmonary edema ARDS 24 to 48 hours after injury Late complications—bronchopneumonia and pulmonary emboli Airway compromise from eschar after a severe burn Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 69
Smoke Inhalation Injuries Heat injury Ø Ø Local chemical Injury Ø Thermal injury to upper respiratory tract Reflex glottis closure Insoluble gases in the lower respiratory tract Systemic injury Ø Carbon monoxide causing tissue hypoxia Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 70
Inhalation Injuries Therapeutic management Ø Ø Ø Scope of the problem Typically 100% oxygen Careful monitoring and support Bronchodilators Management of airway Nursing care management Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 71
Congenital Diaphragmatic Hernia Clinical manifestations Diagnosis Therapeutic management Ø Ø Fetal surgery After birth Nursing care management Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 72
CDH Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 73
LONG-TERM RESPIRATORY DYSFUNCTION Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 74
Allergic Rhinitis Seasonality vs. year-around Pathophysiology Clinical manifestations Diagnosis and treatment Ø Ø Immunotherapy OTC medications • Oral • Inhaled • Nasal sprays Nursing considerations Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 75
“Allergic Salute” Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 76
Differentiating Between “Allergies” and “Colds” Allergies occur repeatedly and are often seasonal Allergies are seldom accompanied by fever Allergies often involve itching in the eyes and nose Allergies usually trigger constant and consistent bouts of sneezing Allergies are often accompanied by ear and eye problems Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 77
Asthma Chronic inflammatory disorder of airways Bronchial hyperresponsiveness Episodic Limited airflow or obstruction that reverses spontaneously or with treatment Etiology and pathophysiology Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 78
Risk Factors for Asthma Age Atopy Heredity Gender Mother <age 20 years Smoking (maternal and grandmaternal) Ethnicity (African-Americans at greatest risk) Previous life-threatening attacks Lack of access to medical care Psychologic and psychosocial problems Linkages to allergic and inflammatory genes on chromosome 5 Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 79
Asthma Types and Categories Types Ø Recurrent wheezing usually precipitated by a viral respiratory tract infection (e. g. , RSV) Ø Chronic asthma associated with allergy persisting into later childhood and often adulthood Ø Associated with girls who develop obesity and early-onset puberty by age 11 Ø Cough-variant asthma Categories Ø Intermittent, mild persistent, moderate persistent, and severe persistent Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 80
Asthma Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 81
Asthma Severity Classification in Children 5 Years and Older Stage I—mild, intermittent asthma Stage II—mild, persistent asthma Stage III—moderate, persistent asthma Stage IV—severe, persistent asthma Clinical features of each classification Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 82
Asthma Clinical manifestations Ø Ø Ø Dyspnea Wheeze Cough Diagnostic evaluation Therapeutic management Ø Ø Ø General Allergen control and avoidance Drug therapy to prevent/relieve bronchospasm Maintain health and prevent complications Promote self-care Support child and family Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 83
Drug Therapy for Asthma Long-term control meds Ø Inhaled corticosteroids, cromolyn sodium and nedocromil, long-acting 2 -agonists, methylxanthines, and leukotriene modifiers Quick-relief (“rescue”) medications Ø Short-acting 2 -agonists, anticholinergics, and systemic corticosteroids are used as quick-relief (or rescue) medications Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 84
Drug Therapy for Asthma (Cont. ) Long-term bronchodilators Combination inhaled medications Theophylline—monitor serum levels Oral steroids Leukotriene modifiers Anticholinergics Epi-pen Magnesium sulfate Others Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 85
Asthma Drug Routes Inhaled for most medications MDI with spacer • Significance of the spacer Ø Nebulizer Ø Generally less effective in treating asthma Ø Ø Oral IV Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 86
Asthma Interventions Breathing exercises and physical therapy Chest physiotherapy (CPT) Hyposensitization Prognosis Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 87
Signs of SEVERE Respiratory Distress in Children with Asthma Remains sitting upright, refuses to lie down Sudden agitation Agitated child who suddenly becomes quiet Diaphoresis Pale Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 88
Status Asthmaticus Respiratory distress continues despite vigorous therapeutic measures Concurrent infection in some cases Therapeutic intervention Emergency treatment—epinephrine 0. 01 ml/kg sub. Q (maximum dose 0. 3 ml) IV magnesium sulfate IV ketamine IV corticosteroids Heliox Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 89
Asthma Action Plan Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 90
Cystic Fibrosis (CF) Autosomal recessive genetic disease Abnormal gene is located on the long arm of chromosome 7 95% known cases occur in Caucasians Most common lethal genetic illness among Caucasian children Approximately 3% of U. S. Caucasian population are symptom-free carriers Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 91
Pathophysiology Characterized by several unrelated clinical features Respiratory system GI system • small intestine • Pancreas • Bile ducts • Growth patterns Ø Reproductive system Ø Skin Ø Ø Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 92
Effects of Exocrine Gland Dysfunction in CF Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 93
Increased Viscosity of Mucous Gland Secretion Results in mechanical obstruction Thick, inspissated mucoprotein accumulates, dilates, precipitates, coagulates to form concretions in glands and ducts Respiratory tract and pancreas are predominantly affected Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 94
Diagnostic Evaluation Early infancy screening DNA testing Sweat chloride test Chest radiography History and physical exam Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 95
Respiratory Manifestations Present in almost all patients with CF, but onset/extent is variable Stagnation of mucus and bacterial colonization result in destruction of lung tissue Tenacious secretions are difficult to expectorate—obstruct bronchi/bronchioles Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 96
Respiratory Manifestations (Cont. ) Decreased O 2/CO 2 exchange Results in hypoxia, hypercapnia, acidosis Compression of the pulmonary blood vessels and progressive lung dysfunction lead to pulmonary hypertension, cor pulmonale, respiratory failure, and death Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 97
Infectious Pathogens Pseudomonas aeruginosa Burkholderia cepacia Staphylococcus aureus Haemophilus influenzae Escherichia coli Klebsiella pneumoniae Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 98
Respiratory Progression Gradual progression follows chronic infection Bronchial epithelium is destroyed Infection spreads to peribronchial tissues, weakening bronchial walls Peribronchial fibrosis Decreased O 2/CO 2 exchange Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 99
GI Tract Thick secretions block ducts → cystic dilation → degeneration → diffuse fibrosis Prevents pancreatic enzymes from reaching duodenum Impaired digestion/absorption of fat → steatorrhea Impaired digestion/absorption of protein → azotorrhea Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 100
GI Tract (Cont. ) Endocrine function of pancreas initially stays unchanged Eventually pancreatic fibrosis occurs; may result in diabetes mellitus Focal biliary obstruction results in multilobular biliary cirrhosis Impaired salivation Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 101
Clinical Manifestations Pancreatic enzyme deficiency Progressive COPD associated with infection Sweat gland dysfunction Failure to thrive Increased weight loss despite increased appetite Gradual respiratory deterioration Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 102
Presentation Wheezing respiration; dry, nonproductive cough Generalized obstructive emphysema Patchy atelectasis Cyanosis Clubbing of fingers and toes Repeated bronchitis and pneumonia Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 103
Presentation (Cont. ) Meconium ileus Distal intestinal obstruction syndrome Excretion of undigested food in stool— increased bulk, frothy, and foul Tissue wasting Prolapse of the rectum Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 104
Presentation (Cont. ) Delayed puberty in females Sterility in males Parents report children taste “salty” Dehydration Hyponatremic/hypochloremic alkalosis Hypoalbuminemia Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 105
Goals Prevent/minimize pulmonary complications Adequate nutrition for growth Assist in adapting to chronic illness Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 106
Respiratory Management Remove excessive mucous secretions Ø Ø Ø Aggressive treatment of pulmonary infections Ø Ø CPT Bronchodilator medication Forced expiration Home IV antibiotic therapy Aerosolized antibiotics Steroid use/nonsteroidal antiinflammatory Transplantation Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 107
Flutter Mucus Clearance Device Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 108
GI Management Replacement of pancreatic enzymes High-protein, high-calorie diet as much as 150% RDA Prevention/early management of intestinal obstruction Reduction of rectal prolapse Salt supplementation Oral glucose-lowering agents or insulin injections as needed Diet and exercise management Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 109
Family Support Coping with emotional needs of child and family Child requires treatments multiple times per day Frequent hospitalization Implications of genetic transmission of disease Home care and support Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 110
Prognosis of CF Decreased life expectancy for child born with CF Maximize health potential Ø Ø Ø Nutrition Prevention/early aggressive treatment of infection Pulmonary hygiene Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 111
Prognosis of CF (Cont. ) New research—hope for the future Ø Ø Transplantation Gene therapy Bilateral lung transplants Improved pharmacologic agents Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 112
Obstructive Sleep Apnea Syndrome (OSAS) Prolonged partial upper airway obstruction during sleep Distinctly different in children than adults Clinical manifestations Ø Ø Snoring Enuresis Interrupted sleep patterns Neurobehavioral problems Therapeutic management Ø Ø Adenotonsillectomy CPAP Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 113
OSAS Nursing care management Assessment History and physical • Growth patterns • School and social performance • Secondary enuresis Ø Education of diagnostic testing Ø Counseling and support Ø Ø Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 114
- The child with a respiratory disorder chapter 25
- Conducting zone and respiratory zone
- True labour pains
- Arousal disorder symptoms
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- 전위 순회
- Hát kết hợp bộ gõ cơ thể
- Slidetodoc
- Bổ thể
- Tỉ lệ cơ thể trẻ em
- Chó sói
- Thang điểm glasgow
- Bài hát chúa yêu trần thế alleluia
- Các môn thể thao bắt đầu bằng tiếng nhảy
- Thế nào là hệ số cao nhất
- Các châu lục và đại dương trên thế giới
- Công của trọng lực
- Trời xanh đây là của chúng ta thể thơ
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- Phản ứng thế ankan
- Các châu lục và đại dương trên thế giới
- Thơ thất ngôn tứ tuyệt đường luật
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- Một số thể thơ truyền thống
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- Vẽ hình chiếu vuông góc của vật thể sau
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- đặc điểm cơ thể của người tối cổ
- Thế nào là giọng cùng tên?
- Vẽ hình chiếu đứng bằng cạnh của vật thể
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- Thẻ vin
- đại từ thay thế
- điện thế nghỉ
- Tư thế ngồi viết
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- Các loại đột biến cấu trúc nhiễm sắc thể
- Số nguyên tố là gì
- Tư thế ngồi viết
- Lời thề hippocrates
- Thiếu nhi thế giới liên hoan
- ưu thế lai là gì
- Sự nuôi và dạy con của hổ
- Sự nuôi và dạy con của hươu
- Sơ đồ cơ thể người
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- The human respiratory system chapter 7 handout
- Bronchide
- Chapter 22 respiratory system
- Chapter 15 respiratory system
- Chapter 16 respiratory emergencies
- Chapter 7 the respiratory system labeling exercises
- Chapter 34 circulation in humans concept mapping answer key
- Chapter 33 circulatory and respiratory systems
- Respiratory system organs
- Respiratory tree divisions
- Chapter 16 respiratory emergencies
- Chapter 17 respiratory system workbook answers
- Chapter 4 child development principles and theories
- Chapter 9 intellectual development of infants
- Chapter 46 the child with a cardiovascular alteration
- Child development principles and perspectives
- Chapter 30 the child with a skin condition
- Chapter 29 the child with a genitourinary condition
- Chapter 29 the child with a genitourinary condition
- Chapter 26 the child with a cardiovascular disorder
- Infants, children, and adolescents 8th edition
- Chapter 1 learning about children
- Chapter 24 the child with a musculoskeletal condition
- Chapter 27 the child with a condition of the blood
- Chapter 30 the child with a skin condition
- Chapter 30 the child with a skin condition
- Chapter 30 the child with a skin condition
- Chapter 26 the child with a cardiovascular disorder
- Normal level of vital signs
- Normal vital range for adults
- Bozeman respiratory system
- Unit 9 respiratory system
- Diagnostic test of respiratory system
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- Respiratory system
- Respiratory system larynx
- Respiratory system coloring page
- Primary bronchi
- Respiratory system purpose
- Conclusion about respiratory system
- Jobs of the respiratory system
- Interesting facts about respiratory system
- Sce physical examination
- Pontine respiratory group
- How respiratory system work with circulatory system
- Structure of the upper respiratory system
- How to draw the respiratory system
- Respiratory scale
- What is the major function of the respiratory system
- Respiratory system diagram unlabeled
- Respiratory system vocabulary