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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