Transcript CHAPTER 24

Respiratory Alterations
Aloha Hand MSN, RN
 Variations
in the pediatric
population
o Small airways
o Fewer alveoli
o Increased chest compliance
24-2
 Nasopharyngitis
 Tonsillitis
and pharyngitis
 Otitis media
 Croup
 Bronchiolitis
 Pneumonia
 Sinusitis
24-4
 Incidence
and etiology
 Pathophysiology
 Clinical manifestations
 Diagnosis
 Treatment
(continues)
24-5
 Nursing
o
management
Assessment
• Degree and duration of symptoms
• Eating and drinking
• Fever or cough
• Hydration, nasal discharge, respiratory
distress
(continues)
24-6

Planning: Education of the family
o Hydration
o Complications
o Preventing spread
24-7
 Incidence
and etiology
o Usually viral
o Bacterial: Group A beta-hemolytic
streptococcus (GABHS)
 Pathophysiology
 Clinical manifestation
 Diagnosis: Throat culture or rapid strep
screen
(continues)
24-8
Treatment
Tonsillectomy

Post-op complications
24-9
 Incidence
o
o
o
o
and etiology
Inflammation of the middle ear
Acute otitis media (AOM)
Otitis media with effusion (OME)
Chronic otitis media
 Pathophysiology
 Clinical
manifestations
 Diagnosis and treatment
(continues)
24-10
 Nursing
o
o
management
Assessment
• Signs and symptoms
Planning
• Family education: Risk factors
• Pain relief
• Antibiotic treatment
24-13
 Incidence
and etiology
 Pathophysiology
 Clinical manifestations
o Croupy or “barking” cough
o Inspiratory stridor
o Some degree of respiratory distress
 Diagnosis
24-14
 Nebulized
racemic epinephrine
 Systemic or nebulized corticosteroids
 Fluids, rest, comfort
24-15
 Life-threatening
bacterial infection
 Respiratory distress, fever, sore throat,
dysphagia, drooling, agitation,
and lethargy
24-16
 Incidence
and etiology
 Pathophysiology
 Diagnosis
 Clinical manifestations/diagnosis
o
o
o
o
Acute, typically viral, infection of bronchioles
Usually young children
Causes inflammation of bronchioles
Wheezing is classic manifestation
24-17
 Usually
home management with rest, adequate
fluid intake, fever management
 Hospitalized if dehydrated or exhibiting
respiratory distress
o Humidified oxygen
o
o
IV fluids
Ribavirin
 Prevention
24-18
 Ineffective
airway clearance related to air
trapping and increased mucus production
 Deficient fluid volume related to poor fluid
intake and fever
 Deficient knowledge of caregivers due
to unfamiliarity with disease and
its management
24-19
Family teaching for home care
 Acute setting focus on adequate ventilation and
fluid balance
o Nasopharyngeal suctioning
o Supplemental oxygen
o Raising head of bed, consolidating care, encouraging
caregiver involvement
o IV fluids
o Antipyretics

24-20
 Acute
inflammation of the pulmonary parenchyma
 Can be primary disease or complication of
another disease
 Incidence and etiology
 Pathophysiology
 Clinical manifestations
 Diagnosis
24-21
 Viral
pneumonia: Supportive
 Bacterial pneumonia: Antibiotics
 Usually at home
 Hospitalized: Oxygen therapy, chest
physiotherapy, IVs, and antipyretics
24-22
 Impaired
gas exchange related to ventilation
or perfusion abnormalities caused by
pulmonary infection
 Ineffective airway clearance related to
airway edema and debris and exudate
in airway
 Ineffective breathing pattern related to an
inflammatory infection of the lower airway
24-23
 Supportive
care
 Antibiotics
 Restore
and maintain hydration
 Turn every two hours
 Chest physiotherapy
 Pain assessment and management
 Family teaching
24-24
 Accumulation
of thick mucus in the
nasal passages
 Incidence and etiology
 Pathophysiology
 Clinical manifestations
 Diagnosis
 Treatment: Antibiotics, saline drops, and
sprays
 Nursing management and family education
24-25
Allergic
rhinitis
Asthma
24-26
 Incidence
o
o
o
and etiology
Seasonal allergies usually related to outdoor
allergens such as trees, grass, and weed
pollens
Perennial allergies usually related to dust
mites
and mold
Predisposes to otitis media, sinusitis, and
asthma
 Pathophysiology
 Clinical
manifestations/diagnosis
24-27


Environmental controls and avoidance
of allergens
Antihistamines, decongestants, and
nasal cromolyn
24-28
 Impaired
oral mucous membranes
related to mouth breathing
 Deficient knowledge of caregiver
related to child with environmental
allergies
24-29
 Education
to reduce allergens in the home
and the diet and to avoid exposure
 Adequate oral fluids
 Lip balm
 Skin testing and administration
of immunotherapy
24-30
Incidence and etiology
 Pathophysiology
o Characterized by chronic inflammation,
bronchoconstriction, and bronchial
hyper-responsiveness
 Clinical manifestations
o Wheezing, coughing, and dyspnea
o Airways are damaged over time
 Diagnosis
o Classified by severity of symptoms

24-31
 Mild
intermittent
 Mild persistent
 Moderate persistent
 Severe persistent
 Pg
813-818 outlines categories
24-33
 Short-acting
inhaled beta-2 agonists
 Inhaled corticosteroids
 Long-acting inhaled beta-2 agonists
 Leukotriene modifiers
 Inhaled antiasthmatics
 Methylxanthines
 Systemic corticosteroids
24-34
 Risk
for suffocation related to
airway obstruction
 Ineffective airway clearance related to
allergic and inflammatory processes
 Interrupted family processes related to child
with chronic illness
24-35
 Family
education related to
self-management
 Medication administration
24-36
 Cystic
fibrosis
 Respiratory distress syndrome
 Tuberculosis
24-37
 Incidence
o
and etiology
Inherited disorder affecting the exocrine
glands
 Diagnosis
 Pathophysiology/clinical
o
o
manifestations
Alterations in sweat electrolytes and mucus
production lead to multisystem damage
Chronic infection and airway obstruction
lead to bronchiectasis, pneumothorax, and
cor pulmonale
24-38
 Maximize
o
o
o
lung functioning
Promote the removal of secretions from
the lungs
Prevent and treat lung infections
Manage pulmonary complications
(continues)
24-39
 Medications
o
o
o
Inhaled recombinant human deoxyribonuclease (DNase)
Antibiotics
Pancreatic enzymes and vitamins A, D, E,
K
(continues)
24-40




Chest physiotherapy
Treat asthma
Supplemental oxygen as needed
Dietary supplements
24-41
 Incidence
and etiology
o Premature infant
 Clinical manifestations
24-42
 Prevention
 Diuretics
 Prenatal
Steroids and post as well
 Bronchodilators
 Mechanical ventilation
 Family education
 Ensuring nutritional intake
24-43
 Incidence
and etiology
o Mycobacterial infection
 Pathophysiology
o Organ damage and central nervous
system complications if untreated
 Clinical manifestations
24-44
 Medications
 Family
and community education
 Annual tuberculosis testing for
high-risk groups
24-45
 Clinical
manifestations
o Common in children age 6 months
to 4 years
 Treatment
o Prevention
24-46
 Clinical
manifestations
o Lung damage resulting
from thermal and chemical
factors
 Treatment:
Monitoring,
oxygen therapy, and
supportive care
24-47
Cardiovascular
Alterations
Aloha Hand, MSN, RN
 Normal
cardiac
anatomy
 Normal
hemodynamics
 History
 Physical
examination
 Diagnostic
 Nursing considerations for a child
undergoing cardiac catheterization
 Incidence
and etiology
o Congenital heart defects
o Tachyarrhythmias
o Bradyarrhythmias
 Clinical manifestations
o Newborns and infants
o Children and adolescents (see Box 25-3, pg
857)
Diagnosis
 Treatment

o
o
Surgery
Medications
Nutritional support
 Nursing management

o
Assessment
•
Physical assessment
•
Family support, caregiver role, and interaction with child
(continues)
o
Nursing diagnoses
•
•
•
Decreased cardiac output
Excess fluid volume
Imbalanced nutrition: Less than
body requirements
Outcome identification and planning
 Evaluation
 Family teaching
o
25-54
 Abnormal
connection between the right and left
atria
 Incidence and etiology
 Pathophysiology
 Clinical manifestations
 Diagnosis
 Treatment
o Diuretics for congestive heart failure
o Surgical repair
25-55
Incidence and etiology
 Pathophysiology
o Blood flows left to right and recirculates through
pulmonary artery to lungs.
o Increase in pulmonary blood flow leads to heart
enlargement and Pulmonary vessel congestion
o Degree of left to right shunting depends on:
1. size of defect
2. pulmonary resistance

(continues)
25-56
 Clinical
o
o
manifestations
Asymptomatic if small VSD
Congestive heart failure if large
defect
(tachypneic, diaphoretic, fatigues
easily, underweight for age)
No cyanosis
1-57
 Diagnosis:
Loud holosystolic murmur
 Xray and echocardiogram
 Treatment
o May close by two years of age
o 75-80% will close spontaneously
o Surgical repair
25-58
 Incidence
and etiology
 Pathophysiology: Left to right shunt
(blood from aorta flows into pulmonary artery and
pulmonary circulation)
 Clinical
o
o
manifestations (depends on size of shunt)
Asymptomatic (small)
Congestive heart failure (large)
(continues)
25-59
 Diagnosis
Continuous murmur below left
clavicle
o X-ray or echo
 Treatment
o Indomethacin for preterm only
(not effective in term infants)
o
25-60
o
o
Surgery
o Surgical ligation (tying off) via
incision.
Nonsurgical closure
o Coils to occlude PDA
1-61
 Incidence
and etiology
 Pathophysiology: Free communication
between all chambers
 Clinical manifestations
o
o
Signs and symptoms of congestive
heart failure
Long systolic or holosystolic murmur
(continues)
25-62
 Diagnosis
X-ray
o Echocardiogram
o Cardiac catheterization
 Treatment
o Treat congestive heart failure
o Surgical repair
o
25-63
 Incidence
 Pathophysiology:
Oxygenated and
unoxygenated blood mix
 Clinical manifestations
o
o
o
Mildly cyanotic newborn
Congestive heart failure
Loud continuous murmur with loud
click
(continues)
25-64
 Diagnosis
X-ray
o Echocardiogram
o Cardiac catheterization
 Treatment
o Treat congestive heart failure
o Surgical repair
o
25-65
 Incidence
 Pathophysiology
o
o
o
Obstruction of blood flow from RV to
pulmonary artery
Increased RV pressure
Decreased amount of blood flow to lungs
(continues)
25-66
 Clinical
o
o
manifestations
Mild to moderate in newborns:
Can be asymptomatic in infants
Severe pulmonary stenosis:
Dyspnea with exertion and
fatigue
(continues)
25-67
 Diagnosis
clinical exam, chest x-ray, echocardiogram
 Treatment
o Surgical
o Balloon valvuloplasty
o Surgical valvotomy
25-68
4 components:
Ventricular septal defect
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
 Incidence and etiology
 Pathophysiology
(continues)
25-69
 Clinical
o
o
manifestations
Varies with degree of pulmonary stenosis
Cyanotic or without cyanosis
 Diagnosis
 Treatment
o
o
o
Surgical correction
Preoperative management
Palliative: Modified Blalock-Taussig shunt
25-70
 Incidence
 Pathophysiology
o
Unoxygenated blood enters right
atrium and right ventricle then flows
out to the lungs
 Clinical
o
o
manifestations
Initially appears normal
Cyanosis develops within a few hours
of birth
(continues)
25-71
 Diagnosis
 Treatment
o
o
o
o
Mechanical ventilation
Pharmacologic support for cardiac
output, correction of metabolic acidosis
Balloon atrial septostomy
Surgical repair
25-72
 Incidence
 Pathophysiology
 Clinical
manifestations: Cyanotic
within first day of life
 Diagnosis
(continues)
25-73
 Treatment
o
o
Surgical
1. Blalock-Taussig shunt
2. Glenn shunt (4-6 months)
3. Fontan procedure (2 yrs)
Preoperative prostaglandin (to keep
open)
25-74
 Incidence
 Pathophysiology
o
o
Narrowing of the aorta
Increased resistance to blood flow from
the left ventricle
(continues)
25-75
 Clinical
o
o
manifestations
Congestive heart failure in
symptomatic infant (once PDA closed)
Asymptomatic in older child
•
Evaluation of murmur or hypertension
o
o
Upper extremity hypertension
Differences in blood pressure between upper
and lower extremities
(continues)
25-76
 Diagnosis
 Treatment
o
o
Surgical
Balloon angioplasty
25-77
 Incidence
 Pathophysiology
 Clinical
o
o
manifestations
Evaluation of murmur in older child
Critical aortic stenosis in infant
•
•
Critically ill
Shock
 Diagnosis
(continues)
25-78
 Treatment
o
Critically ill infant
•
•
o
Prostaglandin
Surgical correction: Balloon
valvuloplasty
Older child
•
•
Balloon valvuloplasty
Valve replacement
25-79
 Incidence
 Pathophysiology
 Clinical
o
o
manifestations
Cyanosis within hours of birth
Cardiovascular collapse
Hypotension, tachycardia, cyanosis and
tachypnea
(continues)
25-80
 Diagnosis
 Treatment
1. No interventions
2. Cardiac transplantation
3. Palliative surgery
25-81
 Activities
 Diet
 Wound
care
 General considerations
 Medications
25-82
 Incidence
o
o
and etiology
Strep pharyngitis
Group A streptococci
 Pathophysiology
o
o
o
o
o
Pericarditis
Myocarditis
Valvulitis
Polyarthritis
Chorea
(continues)
25-83
 Clinical
manifestations
 Diagnosis
 Treatment
 Nursing management
 Family teaching
25-84
 Incidence
and etiology
 Pathophysiology
o Vasculitis
o Ectasia on echocardiogram
o Pancarditis
(continues)
25-85
 Clinical
manifestations
 Diagnosis (Box 25-6)
 Treatment
 Nursing management
 Family teaching
25-86
 Incidence
and etiology
 Pathophysiology
 Clinical manifestations
 Diagnosis
 Treatment
 Nursing management
 Family teaching
25-87
 Incidence
and etiology
 Clinical manifestations
 Diagnosis
(continues)
25-88
 Treatment
Nonpharmacologic
•
Weight reduction
•
Dietary intervention
•
Exercise
o Pharmacologic
 Nursing management
 Family teaching
o
25-89
 Indications
 Transplant
listing
 Surgical process
 Post-transplant issues
 Family teaching
25-90
 Supraventricular
tachycardia
 Complete heart block
 Ventricular tachycardia
 Nursing management
25-91
3
Types
 Hypovolemic
 Maldistributive
 Cardiogenic
(continues)
25-92
 Incidence
and etiology
 Pathophysiology
 Clinical manifestations
 Diagnosis
 Treatment
 Nursing management
 Family teaching
25-93
Family
issues
Exercise
Growth and
development
25-94