Transcript The child with Respiratory Alteration

The child with Respiratory Alteration
Lecture 4
Part Two
TUBERCULOSIS
• Tuberculosis is a highly contagious disease caused by
inhalation of droplets of Mycobacterium tuberculosis
or Mycobacterium bovis.
• Annually about 1,000 U.S. children contract active
tuberculosis disease.
• Non white children and children with chronic illness or
malnutrition are more susceptible to infection.
• The incubation period is 2 to 10 weeks.
Types
• Latent TB. In this condition, you have a TB
infection, but the bacteria remain in body in
an inactive state and cause no symptoms. It
can turn into active TB,
• Active TB. This condition makes patient sick
and can spread to others. It can occur in the
first few weeks after infection with the TB
bacteria, or it might occur years later.
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Signs and symptoms
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Coughing that lasts three or more weeks
Coughing with blood
Chest pain, or pain with breathing or coughing
Unintentional weight loss
Fatigue
Fever
Night sweats
Chills
Loss of appetite
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Diagnostic test
• Skin test : A small amount of a substance
called PPD tuberculin is injected Within 48 to
72 hours, a health care professional will check
arm for swelling at the injection site.
• Chest X-ray or a CT scan.
• Sputum tests
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Drug Therapy
• The American Academy of Pediatrics
recommends:
• a 6-month course of oral therapy. The first
two months consist of isoniazid, rifampin, and
pyrazinamide given daily.
• This is followed by twice-weekly isoniazid and
rifampin.
• Ethambutol or streptomycin is given via
intramuscular injection
Nursing Management
Hospitalization of children with tuberculosis is necessary
only for the most serious cases.
Nursing management is aimed at providing supportive care
and encouraging adherence to the treatment regimen.
Supportive care includes ensuring adequate nutrition and
adequate rest, providing comfort measures such as fever
reduction, preventing exposure to other infectious diseases,
and preventing reinfection.
Preventing Infection
• Tuberculosis infection is prevented by avoiding contact
with the tubercle bacillus.
• hospitalized children with tuberculosis must be isolated
according to hospital policy to prevent nosocomial
spread of tuberculosis infection.
• Promotion of natural resistance through nutrition, rest,
and avoidance of serious infections does not prevent
infection.
• Pasteurization of milk has helped to decrease the
transmission of Mycobacterium bovis. Administration
of bacille Calmette-Guérin (BCG) vaccine can provide
incomplete protection against tuberculosis
EPISTAXIS
Epistaxis (a nosebleed) occurs most frequently
in children younger than adolescent age.
Bleeding of the nasal mucosa occurs most
often from the anterior portion of the septum.
Epistaxis may be recurrent and idiopathic
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Nursing Management
The child should sit up and lean forward (lying down
may allow aspiration of the blood).
Apply continuous pressure to the anterior portion of
the nose by pinching it closed.
Encourage the child to breathe through the mouth
during this portion of the treatment.
Ice or a cold cloth applied to the bridge of the nose
may also be helpful.
The bleeding usually stops within 10 to 15 minutes.
Apply petroleum jelly or water-soluble gel to the nasal
mucosa with a cotton-tipped applicator to moisten the
mucosa and prevent recurrence.
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Neonatal respiratory distress syndrome (NRDS)
It results from lung immaturity and a
deficiency in surfactant, so it is seen most
often in premature infants.
Diabetic mothers, cesarean section deliveries
without preceding labor, and those
experiencing perinatal asphyxia. It is believed
that each of these conditions has an impact
on surfactant production
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Other Names for Respiratory Distress
Syndrome
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Hyaline membrane disease
Respiratory distress syndrome
Infant respiratory distress syndrome
Surfactant deficiency
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• The administration of surfactant via
endotracheal tube shortly after delivery helps
to decrease the incidence and severity of
NRDS.
• Management of NRDS focuses on intensive
respiratory care, usually with mechanical
ventilation.
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Signs and Symptoms of Respiratory Distress Syndrome
• Rapid, shallow breathing
• Sharp pulling in of the chest below and
between the ribs with each breath
• Grunting sounds
• Flaring of the nostrils
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Complications
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Air leak syndrome (pneumothorax) .
Bronchopulmonary dysplasia(atelectasis).
Patent ductus arteriosus.
congestive heart failure
Intraventricular hemorrhage,
Retinopathy of prematurity.
Necrotizing enterocolitis.
Complications resulting from intravenous catheter
use (infection, thrombus formation), and
developmental delay or disability
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Diagnostic test
• Chest x ray. A chest x ray creates a picture of
the structures inside the chest, such as the
heart and lungs.
• Blood tests. Blood tests are used to see
whether an infant has enough oxygen in his or
her blood.
• Echocardiography (echo). This test uses sound
waves to create a moving picture of the heart.
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Treatments
• Surfactant replacement therapy.
• Breathing support from a ventilator or nasal
continuous positive airway pressure (NCPAP)
machine.
• Oxygen therapy.
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Prevention
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Seeing your doctor regularly during your pregnancy
Following a healthy diet
Avoiding tobacco smoke, alcohol, and illegal drugs
Managing any medical conditions
Preventing infections.
Some cases can be prevented or at least made less
sever by treating the mother with a medication called
betamethasone before birth
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Nursing Management
• Nursing care of the child with NRDS is mainly
supportive and occurs in the intensive care unit.
• Closely monitor respiratory and cardiovascular status.
• Comfort measures such as hygiene and positioning as
well as pain and anxiety management.
• Maintenance of nutrition, and prevention of infection
are also key nursing interventions.
• Psychological support of the family as well as
education
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ASTHMA
• Asthma is a chronic inflammatory airway
disorder characterized by airway hyper
responsiveness, airway edema, and mucus
production. Airway obstruction resulting from
• asthma might be partially or completely
reversed
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ASTHMA
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Symptoms of Asthma
1. Wheezing
2. Coughing: Cough may be the only symptom of
asthma, especially in cases of exercise-induced
or nocturnal asthma.
3. Chest tightness: The child may feel like the chest
is tight or won't expand when breathing in.
4. Other symptoms: Infants or young children may
have a history of cough or lung infections
(bronchitis) or pneumonia
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Causes of Asthma
1. Respiratory infections: These are usually viral
infections. In some patients, other infections with
fungi, bacteria, or parasites might be responsible.
2. Allergens: An allergen is anything in a child's
environment that causes an allergic reaction.
Allergens can be foods, fungi, or dust mites.
3. Irritants: Tobacco smoke, cold air, chemicals,
perfumes, paint odors.
4. Weather changes.
5. Emotional factors.
6. Gastroesophageal reflux disease (GERD).
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The Five Parts to an Asthma Treatment Plan
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Step 1: Identifying and controlling asthma triggers
Step 2: Anticipating and preventing asthma flares.
Step 3: Taking medications as prescribed.
Step 4: Controlling flares by following the doctor's
written step-by-step plan.
• Step 5: Learning more about asthma, new
medications, and treatments.
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Laboratory and diagnostic studies
• Pulse oximetry: oxygen saturation may be significantly
decreased or normal during a mild exacerbation
• Chest x-ray: usually reveals hyperinflation
• Blood gases: might show carbon dioxide retention and
hypoxemia
• Pulmonary function tests (PFTs): can be very useful in
determining the degree of disease.
• Allergy testing: skin test or RAST can determine allergic
triggers for the asthmatic child
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Nursing care
• Ineffective airway clearance RT
bronchoconstriction, increased mucus production
– Keep the patient adequately hydrated
– Instruct patient or parents to avoid bronchial irritants such
as cigarette smoke, extremes of temperature.
– Teach early signs of infection for parents.
– Administer nebulization as ordered
– Administer medications as ordered
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Nursing care
• Ineffective breathing pattern r/t presence of
secretions AEB productive cough
– Assess patient’s respiratory rate, depth, and rhythm.
Obtain pulse oximetry.
– Monitor and record vital signs.
– Auscultate breath sounds and assess airway pattern
– Elevate head of the bed and change position of the pt
– Encourage deep breathing and coughing exercises.
– Encourage increase in fluid intake
– rest and limit physical activities.
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Tracheostomy
• A tracheostomy is an artificial opening in the airway,
usually a plastic tracheostomy tube is in place to
form a patent airway.
• Thetracheostomy facilitates secretion removal,
reduces work of breathing, and increases patient
comfort.
• In some cases the tracheostomy facilitates
mechanical ventilation weaning.
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• It may be permanent or temporary depending on the
condition that leads to the tracheostomy.
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Complications
• Hemorrhage, air entry, pulmonary edema and
respiratory arrest.
• Tube occluded and ventilation compromised.
• Complications of chronic tracheostomy
include infection, cellulitis, and formation of
granulation tissue around the insertion site.
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Nursing Management
• In the immediate postoperative period the infant
or child may require restraints to avoid accidental
dislodgment of the tracheostomy tube.
• Provide humidity to either room air or oxygen.
• Tracheostomies require frequent suctioning to
maintain patency.
• Perform tracheostomy care every 8 hours or per
institution protocol.
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References
• http://nurseslabs.com/bronchial-asthmanursing-care-plans/
• http://www.nhs.uk/Conditions/Respiratorydistress-syndrome/Pages/Introduction.aspx
• http://www.mayoclinic.org/diseasesconditions/tuberculosis/basics/treatment/con
-20021761
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Homework 3
Nursing care:
• Child with status asthmaticus
• Cystic fibrosis
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