NRSB 341 S 17 Peds The Child with

Objectives: • • • Discuss differences in the respiratory system for the pediatric population. Discuss common alterations in the respiratory system common to pediatrics. Recognize the signs & symptoms of respiratory distress in pediatric population. Apply nursing interventions to alterations in respiratory system in pediatrics. Verbalize common ear and eye alterations in pediatric population. Explain the structure/function of the immune system and apply to pediatric immunologic disorders. Recognize infection control measures for prevention of disorders. Discuss the nurse role in intervention/education with the child/family diagnosed with an immunological disorder. Recognize common allergies and nursing assessment and interventions with allergy. Describe the most common childhood cancers, assessment, common treatments. Address pharmacological principles when caring for children with alterations in respiratory, Immune, Cancer systems. All Elsevier items and derived items © 2013, 2009, Mosby, Inc. , an imprint of Elsevier Inc. 2

General Aspects of Respiratory Infections • Upper respiratory tract – Nose, pharynx, larynx, upper trachea • Lower respiratory tract – Lower trachea, bronchi and bronchioles, alveoli • Croup syndromes – Infections of the epiglottis or larynx Copyright © 2017, Elsevier Inc. All Rights Reserved. 3

Infectious Agents • Viruses – Respiratory syncytial virus (RSV) • Others – Group A beta-hemolytic streptococci (GABHS) – Staphylococci – Chlamydia trachomatis, Mycoplasma organisms, pneumococci – Haemophilus influenzae Copyright © 2017, Elsevier Inc. All Rights Reserved. 4

Age • In infants younger than 3 months, maternal antibodies offer protection • In infants age 3 to 6 months, the infection rate increases • In toddlers and preschoolers, there is a high rate of viral infections • In children older than 5 years, there is an increase in GABHS and Mycoplasma pneumoniae infections • Increased immunity develops with age Copyright © 2017, Elsevier Inc. All Rights Reserved. 5

Size • Diameter of airways is smaller • Distance between structures is shorter, allowing organisms to rapidly move down • Short and open eustachian tubes Copyright © 2017, Elsevier Inc. All Rights Reserved. 6

Resistance • • • Immune system deficiencies Allergies, asthma Cardiac anomalies Cystic fibrosis Exposure to infections in daycare Exposure to second-hand smoke Copyright © 2017, Elsevier Inc. All Rights Reserved. 7

Seasonal Variations • Most common during winter and spring • Mycoplasmal infections are more common in fall and winter • Asthmatic bronchitis is more frequent in cold weather • RSV season is typically winter and early spring Copyright © 2017, Elsevier Inc. All Rights Reserved. 8

Clinical Manifestations of Respiratory Infections • Vary with age • Generalized signs and symptoms and local manifestations differ in young children – Fever – Anorexia, vomiting, diarrhea, abdominal pain – Cough, sore throat, nasal blockage or discharge – Respiratory sounds Copyright © 2017, Elsevier Inc. All Rights Reserved. 9

Nursing Interventions for Respiratory Infections • • • Ease the respiratory effort Manage fever Promote rest and comfort Control infection Promote hydration and nutrition Provide family support and teaching Copyright © 2017, Elsevier Inc. All Rights Reserved. 10

Upper Respiratory Tract Infections (URIs) • Acute nasopharyngitis (common cold) • Caused by numerous viruses – RSV, rhinovirus, adenovirus, influenza, and parainfluenza viruses • Fever varies with the child’s age • Home management varies with age Copyright © 2017, Elsevier Inc. All Rights Reserved. 11

Pharyngitis • • • Causes and risks Clinical manifestations Diagnostics Therapeutic management Nursing considerations

Pharyngitis (Cont. ) Copyright © 2017, Elsevier Inc. All Rights Reserved. 13

Tonsillitis • • Pathophysiology and etiology Clinical manifestations Therapeutic management Nursing considerations Copyright ©

Influenza • • Clinical manifestations Therapeutic management Prevention Nursing considerations Copyright © 2017, Elsevier

Otitis Media (OM) • Pathophysiology and etiology • Diagnosis • Therapeutic management – Pharmacologic – Surgical • Nursing considerations • Prevention of recurrence Copyright © 2017, Elsevier Inc. All Rights Reserved. 16

Infectious Mononucleosis • Characterized by increased mononuclear elements of the blood; general symptoms of an infectious process • Common among adolescents • Principal cause is Epstein-Barr virus • Self-limiting; no specific treatment Copyright © 2017, Elsevier Inc. All Rights Reserved. 17

Croup Syndromes • Characterized by hoarseness, barking cough, inspiratory stridor, and varying degrees of respiratory distress • Croup syndromes affect the larynx, trachea, and bronchi – Epiglottitis, laryngotracheobronchitis (LTB), tracheitis Copyright © 2017, Elsevier Inc. All Rights Reserved. 18

Acute Epiglottitis • Clinical manifestations – Sore throat, pain, tripod positioning, retractions – Inspiratory stridor, mild hypoxia, distress • Therapeutic management – Potential for respiratory obstruction • Nursing considerations • Prevention requires Haemophilus influenzae type b (Hib) vaccine Copyright © 2017, Elsevier Inc. All Rights Reserved. 19

Acute Laryngitis • More common in older children and adolescents • Usually caused by a virus • Chief complaint is hoarseness • Generally self-limiting and without longterm sequelae • Treatment is symptomatic Copyright © 2017, Elsevier Inc. All Rights Reserved. 20

Acute Laryngotracheobronchitis (LTB) • Most common croup syndrome • Generally affects children younger than 5 years of age • Organisms responsible – RSV, parainfluenza virus, Mycoplasma pneumoniae, influenza A and B viruses Copyright © 2017, Elsevier Inc. All Rights Reserved. 21

Manifestations of LTB • • • Inspiratory stridor Suprasternal retractions Barking or seal-like cough Increasing respiratory distress and hypoxia Can progress to respiratory acidosis, respiratory failure, and death Copyright © 2017, Elsevier Inc. All Rights Reserved. 22

Therapeutic Management of LTB • • Airway management Maintain hydration (oral or IV) High humidity with cool mist Nebulizer treatments – Epinephrine (racemic) – Steroids Copyright © 2017, Elsevier Inc. All Rights Reserved. 23

Acute Spasmodic Laryngitis • Also known as spasmodic croup or midnight croup • Recurrent paroxysmal attacks • Occurs chiefly at night • Inflammation is mild or absent • Therapeutic management Copyright © 2017, Elsevier Inc. All Rights Reserved. 24

Bacterial Tracheitis • Infection of the mucosa of the upper trachea • Distinct entity with features of croup and epiglottitis • Clinical manifestations are similar to those of LTB • Affects children younger than age 3 years • May be a complication of LTB • Thick, purulent secretions result in Copyright © 2017, Elsevier Inc. All Rights Reserved. 25

Therapeutic Management of Bacterial Tracheitis • • Humidified oxygen Antipyretics Antibiotics May require intubation

Infections of the Lower Airways • Considered the “reactive” portion of the lower respiratory tract • Includes bronchi and bronchioles • Cartilaginous support is not fully developed until adolescence • Constriction of airways Copyright © 2017, Elsevier Inc. All Rights Reserved. 27

Bronchitis • • Also known as tracheobronchitis Definitions Causative agents Clinical manifestations Copyright ©

Bronchiolitis and RSV • • Definitions Respiratory syncytial virus (RSV) Pathophysiology Diagnostics Therapeutic management Prevention of RSV: prophylaxis Nursing considerations Copyright © 2017, Elsevier Inc. All Rights Reserved. 29

Pneumonia • Causative organism varies greatly by age category • The most useful classification is etiologic agent – Viral – Bacterial – Mycoplasmal – Aspiration of foreign substances Copyright © 2017, Elsevier Inc. All Rights Reserved. 30

Clinical Manifestations of Pneumonia • Vary depending on – Age – Etiology – Systemic reaction to infection – Extent of the lesions – Degree of obstruction Copyright © 2017, Elsevier Inc. All Rights Reserved. 31

Question 1 Which of the following interventions would be an appropriate nursing intervention when caring for a child with pneumonia? A. Encourage rest. B. Instruct the child to avoid lying on the affected side. C. Administer analgesics. D. Place the child in the Trendelenburg Copyright © 2017, Elsevier Inc. All Rights Reserved. 32

Pertussis (Whooping Cough) • Caused by Bordetella pertussis • In the United States, it occurs most often in children who have not been immunized • Highest incidence is in spring and summer • Highly contagious • Risk to young infants • Effectiveness of vaccine (booster) Copyright © 2017, Elsevier Inc. All Rights Reserved. 33

Foreign Body Aspiration • More common in children 1 to 3 years of age • Diagnosis is based on the history and physical signs • May result in life-threatening airway obstruction • Nursing assessment must recognize the signs of foreign body aspiration • Prevention Copyright © 2017, Elsevier Inc. All Rights Reserved. 34

Aspiration Pneumonia • • Risk for a child with feeding difficulties Prevention of aspiration Feeding techniques and positioning Avoid aspiration risks – Oily nose drops – Solvents – Talcum powder Copyright © 2017, Elsevier Inc. All Rights Reserved. 35