Transcript Care of the Pediatric Patient with Respiratory Problems

Care of the
Pediatric Patient
with Respiratory
Problems
Elizabeth Allen RN, MSN
Learning Objectives
 Describe
Unique Characteristics of
Pediatric Respiratory System
 List Respiratory Conditions and Injuries that
Cause Respiratory Distress in Children
 Distinguish between Mild, Moderate, and
Severe Respiratory Distress
 Differentiate between Signs and
Symptoms of Upper and Lower Airway
Conditions
Differences in A&P
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Newborn- 3 months
obligatory nose
breathers
Child’s airway is shorter
and more narrow<6
years breathe with
diaphragm- intercostal
muscles immature
A newborn’s chest is
circular until age 6.
Decreased muscularity is
responsible for the thin
chest wall in infants.
Differences in A&P
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Child epiglottis
longer, floppier
Higher oxygen
demand in children
Immature Infant
Respiratory and
Neurologic System
Offers Less-Efficient
Response to Hypoxia
and Elevated PCO2
Pediatric Respiratory Assessment
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Noises
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Work of Breathing
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Stridor
Wheeze
Cough
Grunting
Cry
Rate
Head bobbing
Retractions
Nasal flaring
Pulse Oximetry
Auscultate
Diagnostic Tests
 Pulmonary
 Radiology
Function
 Chest
 Neck
 Arterial
Blood Gases
 Capillary Blood Gases
 Pulse oximetry
Respiratory Distress
 Can
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Lead to Respiratory Failure
Early recognition and intervention vital
 Mild
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Tachypnea, tachycardia, diaphoresis, mild retractions
 Moderate
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Flaring, moderate retractions, grunting, wheezing
Anxiety, irritability, confusion, mood changes
 Severe
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Dyspnea, severe retractions
Bradycardia, bradypnea
Stupor, coma
Cyanosis = late sign
How Long can the
child maintain
that level of effort?
Respiratory Distress
 Interventions
 Assessment
 Oxygen
 Airway
positioning
Tripod Position
 Medications
 Racemic Epinephrine
 Beta 2 Agonists/ Bronchodilators
 Corticosteroids
 Antibiotics
Apparent Life Threatening
Event (ALTE)
1
week to 2 months
 Identifying diseases and conditions
 GERD, acute respiratory infections,
seizures, Congenital heart defects,
metabolic conditions, child abuse
(Munchausen by proxy)
 Lab work
 Diagnostic testing
 Monitoring
 Home Education
Sudden Infant Death
Syndrome (SIDS)
 Etiology / Pathophysiology
 Genetic
 Clinical Manifestation
 Cardiopulmonary arrest
 Season
 Collaborative Care
 Back to Sleep
 Nursing Management
Safe Sleep Environment
 Supportive Care
Safe Sleep Environment
Respiratory Infection
Transmission
Airborne Isolation
 Small particles
 negative pressure room
Droplet
 Large
Isolation
particles- drop 3 feet
Contact
Isolation
Upper Airway
Problems
 Strep Throat/
 Viral tonsillitis
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Tonsillitis
Supportive care
Strep Throat- Streptococcus infection
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Fevers, gastritis
Positive rapid strep test or
positive culture
Treat with antibiotics
No longer contagious 24 hrs.
after first antibiotic dose
Upper Airway Problems
 Tonsillectomy
and possible
Adenoidectomy
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Post Op Care
 Pain
management
 Maintain hydration
 Evaluate for bleeding,
swelling or
airway compromise
Upper Airway Problems
 Croup
 Upper
airway
illness causing
inflammation in
larynx and
epiglottis
 Viral or bacterial
 Symptoms:
“Barking” cough
 Stridor
 Hoarseness
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 Laryngealtracheobronchitis
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Viral
Treatment
 Keep
child calm!!!
 Cold, humid night air
 Corticosteroids
 Racemic epinephrine
 Albuterol as needed
Upper Airway Treatment
Cool Mist Tent
Upper Airway Problems
 Epiglottitis
 Inflammation of the
epiglottis – life threatening
Symptoms: 3 D’s
 Bacterial
• Dysphagia
• Drooling
• Dysphonia
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Hx: Acute fever, sore throat,
dysphonia and dysphagia
Diagnostic testing
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Streptococcus
Staphylococcus
Haemophilus influenzae
type B
X-ray?
Treatment/Interventions
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Antibiotics
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Cephalosporin
Airway management
Evaluation
Upper Airway Problems
Foreign Body
Aspiration
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Developmental- older
infants and Toddlers
Usually bronchial
obstruction, R bronchial
Signs
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Cough, weak cough
Stridor
Respiratory Distress
Muffled or hoarse voice
Drooling
Anxiety, irritability
Unilateral diminished
breath sounds
Aspiration
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Treatment
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Keep child calm
Position of comfort
Monitor
cardiorespiratory
status
Airway intervention if
necessary
CXR
Endoscopy
OR
Upper Airway Problems
 Otitis Media
 Inflammation of
middle ear
 84% infants have at
least 1 case before
age 3 years
 More common in:
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Kids with allergies
Families who smoke
Pacifiers
American Indian
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Symptoms
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Ear pain/ pulling at
ear
Fever
Vomiting/diarrhea
Irritability
Treatment Guidelines
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AAP
Avoid over treatment
with antibiotics
Educate families to
complete courseavoid drug resistance
Figure 19–9 This young child is pulling at the ear and
acting fussy, two important signs of otitis media. Ask the
parents about the presence of fever and night
awakenings, additional signs that are often observed in
children with this condition.
Upper Airway Problems
Otitis Media
 Repeated Otitis
Media
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Hearing Loss
Speech delay
Tympanostomy
Tubes
 Fall
out on own
 Drainage
Lower Airway Problems
Bronchitis/
Bronchiolitis
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Viral or bacterial
Underlying chronic illness
 Bronchiolitis
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(bronchioles)
RSV, parainfluenza,
adenovirus
Edema, debris clog and
narrow airway
 Clinical
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Therapy
Maintain Respiratory
Function
Close monitoring
Keep airways clear!
Oxygen
Humidity
Hydration
Nutrition
Rest
Anxiety
Discharge Planning
Lower Airway Problems
 Nursing
Diagnoses
for bronchiolitis?
 What’s your
priority?
 Breathing
pattern,
ineffective
 Ineffective airway
clearance
 Fluid volume
deficit, risk for
 Anxiety
Lower Airway Problems
Asthma
 Etiology/Pathophysiology
 Clinical Therapy
 Assessment
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
Peak Expiratory
Flow Rate
Respiratory Distress
 Triggers
 Interventions
 Medications
 Maintain
Airway
Patency
 Meet Fluid Needs
 Pediatric
Considerations
 Discharge Planning
 Evaluation
 Resource
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http://www.nhlbi.nih.gov/fil
es/docs/public/lung/asthm
a_actplan.pdf
Lower Airway Problems
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Asthma Exacerbation: Across the Room Assessment
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LOC
Asthma Exacerbation Video- follow link
Respiratory rate
https://www.youtube.com/watch?v=EK8nzKzdnIM
Retractions
Audible wheezing
Head bobbing
Grunting
Speaking
Then listen for wheezing, diminished breath sounds
Lower Airway Problems
 Know
your
Peak Flow
 Green
zone: 80%-
100%
 Yellow zone: 50%80%
 Red zone: below
50%
Lower Airway Problems
 Asthma
 Severity Scale
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Medications
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http://www.nhlbi.nih.gov/files/docs/guidelines/asthma_
qrg.pdf
Intermittent asthma to Persistent Asthma requiring daily
medications
Short acting Beta2 agonist
Inhaled corticosteroid
Montelukast
Evaluate control with medications
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PFT
Symptom tracking
Lower Airway Problems
(London et. al., 2014)
Lower Airway Problems
(London et. al., 2014)
Lower Airway Problems
(London et. al., 2014)
Lower Airway Problems
(London et. al., 2014)
Lower Airway Problems
Cystic
Fibrosis
 Autosomal
recessive disorder
 Incidence
 Pathophysiology
 Defective
chloride secretion and increased
sodium absorption.
 Rate of progression varies among children
 Clinical
manifestations
 Diagnostic Procedures- Sweat Chloride Test
 Resource
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http://www.cff.org/
Defective chloride-ion
transport
and decreased water
flow
across cell membranes –
excessive
electrolyte loss.
Lower Airway
Problems
 Cystic
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Assessment
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Chest Physiotherapy
Prophylactic antibiotics?
Nutrition
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Physiologic
Psychosocial
Developmental
Respiratory Therapy
(including)
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Fibrosis
Pancreatic Enzymes
Discharge Planning
Lower Airway Problems
 Cystic Fibrosis
 Clinical Therapy
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Maintain respiratory
function
Manage infection
Optimize nutrition
Prevent
gastrointestinal
blocking
Nursing Diagnoses
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Medications
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Pancreatic enzymes
Antibiotics- oral and
inhaled
Osmotic
medicationpolyethylene glycol
High calorie formula,
MCT
H2 blocker, PPI
Tracheostomy
Tracheostomy
Care
 Suctioning
 Routine
Care
 Emergency care
Tracheostomy