Download Resp 8-15_

PEDIATRIC RESPIRATORY
DISORDERS
HANNAH O’HANDLEY RN, MSN, CPNP
PEDIATRIC ANATOMIC DIFFERENCES
• LARGE HEAD WITH LITTLE OR NO NECK
STRUCTURE/SUPPORT
• TONGUE IS PROPORTIONATELY LARGER
• AIRWAY MORE ANTERIOR & FUNNEL
SHAPED (SMALLEST AT CRICOID)
• UNDERDEVELOPED MANDIBLE
• TRACHEA & BRONCHI SIGNIFICANTLY
SMALLER & CLOSER TOGETHER
http://www.trekearth.com/gallery/Asia/Philippines/photo70337.htm
PEDIATRIC ANATOMIC DIFFERENCES
INFANT BREATHING
• THE NURSE ASSESSES THE 3 MONTH OLD INFANT FOR SUCTION NEEDS
AND THE FOLLOWING IS THE MOST SIGNIFICANT FOR THE NEED TO
SUCTION THE INFANT WITH THE BULB SYRINGE.
A. RESP RATE OF 34 PER MINUTE
B. REGULAR HEART RATE OF 120 PER MINUTE
C. OCCASIONAL PRODUCTIVE COUGH
D. IRRITABILITY AND NOT EATING
UPPER AIRWAY
INFECTIOUS DISEASES
UPPER AIRWAY ANATOMY
TONSILLECTOMY & ADENOIDECTOMY:
• Complications:
– Dehydration
– Hemorrhage
• Medical Management:
– Pain Management
• Opioids
• Tylenol or Ibuprofen
• Nursing Management:
• HX loose teeth, bleeding tendencies, baseline vitals
– Assessment Focus: INCREASED SWALLOWING, frequent
throat clearing, no coughing, blowing nose
– Positioning, abd or side until awake
– Nutrition & Hydration Management: NO RED LIQUODS
– Education, no ASA, motrin, advil, no bleeding
CROUP SYNDROMES
(ALSO UPPER AIRWAY)
ACUTE LARYNGOTRACHEOBRONCHITIS
(LTB OR CROUP)
• ETIOLOGY: VIRUSES CAUSE INFLAMMATION OF LINING OF UPPER
AIRWAYS
• SYMPTOMS: SEAL BARK COUGH
• MEDICAL MGMT:
• HUMIDITY
• OXYGEN THERAPY
• RACEMIC EPINEPHRINE
• STEROIDS
http://www.airandwatercentre.com/store/SEURLF/ASP/SFS/CID.6/PID.307/SFE/productdetails.htm
CROUP
• HTTP://WWW.YOUTUBE.COM/WATCH?V=Z1_UKQMPYLA&PLAYNEXT=1&
LIST=PLF3D6CD903F95137C&INDEX=49
Supraglottic obstruction
Subglottic obstruction
LTB/CROUP
NURSING MANAGEMENT
• HTTPS://WWW.YOUTUBE.COM/WATCH?V=P7VGXSXNJYE
• ASSESSMENT
• HUMIDIFICATION
• MEDICATION ADMINISTRATION
• EDUCATION
LTB CROUP
• AN INFANT HAS LARYNGOTRACHEOBRONCHITIS. ON ASSESSMENT,
WHICH SYMPTOM SHOULD THE NURSE ANTICIPATE?
A. LOW GRADE FEVER.
B. CHERRY RED EPIGLOTTIS
C. DROOLING
D. BARKING COUGH AND INSPIRATORY STRIDOR
ACUTE EPIGLOTTITIS
MEDICAL EMERGENCY
• ETIOL: H INFLUENZA B
• SYMPTOMS:
• DIAGNOSIS: X-RAY
• COMPLICATIONS: AIRWAY
OBSTRUCTION
• MEDICAL MGMT:
• INTUBATION
• OXYGEN THERAPY
• IV ANTIBIOTICS CEFOTAXIME
• STEROIDS
• PREVENTION: HIB IMMUNIZATION
http://www.learningradiology.com/archives2007/COW%20269-Epiglottitis/caseoftheweek269page.html
THUMB PRINT X-RAY EPIGLOTTITIS
EPIGLOTTITIS:
NURSING MANAGEMENT
• KEEP CHILD CALM!!
• NEVER VISUALIZE EPIGLOTTIS OR PERFORM THROAT CULTURE
• POSITIONING
• ASSESSMENT
• ADMINISTER MEDICATIONS
• EDUCATION
EPIGLOTTITIS
•
A.
B.
C.
D.
A CHILD IS BROUGHT TO THE EMERGENCY DEPARTMENT
WITH AN ABRUPT ONSET OF DECREASED APPETITE,
STRIDOR, HIGH FEVER, AND AGITATION. WHAT
INFORMATION IS NEEDED TO DETERMINE THE NURSE’S
PRIORITY INTERVENTION?
AUSCULTATE THE CHILD’S BREATH SOUNDS.
ASK IF THE CHILD HAS BEEN AROUND ANYONE SICK.
ASK IF THE CHILD WILL LIE DOWN.
DETERMINE IF THE CHILD HAS BEEN DROOLING
LOWER AIRWAY
INFECTIOUS DISEASES
BRONCHIOLITIS
• VIRAL INFECTION OF THE LOWER AIRWAYS
(BRONCHIOLES)
• OCCURS IN WINTER & EARLY SPRING
• INFANTS & TODDLERS AFFECTED MOST SEVERELY
• RESPIRATORY SYNCYTIAL VIRUS (RSV)
• MOST COMMON CAUSE
• CAUSES CILIATED CELLS OF BRONCHIOLES TO SWELL, LOSE CILIA
& PRODUCE COPIOUS MUCUS.
• CAUSES OBSTRUCTION OF AIRWAYS, AIR TRAPPING & OVERINFLATION OF LUNGS.
• CAUSES CENTRAL APNEA
BRONCHIOLITIS
• S/S:
• DX: DFA OR ELISA FOR
RSV ANTIGEN DETECTION
BY NASAL WASH
• MEDICAL MGMT:
•
•
•
•
AIRWAY MAINTENANCE
http://www.nlm.nih.gov/medlineplus/ency/article/001564.htm
HUMIDIFIED OXYGEN
HYDRATION (IV FLUIDS)
PHARMACOLOGIC TREATMENT
• RIBAVIRIN
BRONCHIOLITIS:
NURSING MANAGEMENT
NO ORAL FEEDING RESP UNDER 60 PER MINUTE
• AIRWAY
• MAINTAIN ISOLATION PRECAUTIONS (DIRECT CONTACT)
• HYDRATION: NO PO THEN IV FLUIDS
• MEDICATION ADMINISTRATION: PRN AEROSOLS
• EDUCATION
• PREVENTION PALIVIZUMAB (SYNAGIS)ANTIBODY VACCINE
• INFANT CARE AT HOME
02 SATURATION
• AN INFANT WITH BRONCHIOLITIS HAS AN 02
SATURATION OF 89%. THE NURSES FIRST
INTERVENTION SHOULD BE THE FOLLOWING:
A. GIVE A NEBULIZER TREATMENT
B. SIT THE INFANT UPRIGHT AND CHECK THE
SENSOR
C. INCREASE THE 02
D. SUCTION THE NARES
NON-INFECTIOUS
RESPIRATORY
DISORDERS
FOREIGN BODY ASPIRATION
• AGES 1-3 YEARS
• FOODS/OBJECTS FREQUENTLY ASPIRATED:
• S/S: COUGH, WHEEZE, GAGGING
• MEDICAL MGMT:
• DEPENDS ON SEVERITY/LOCATION
• CXR
• REMOVAL OF OBJECT
• NRSG MGMT:
• EDUCATION
• CPR
• PREVENTION IS KEY
http://www.iressa.com/iressaPAT/10250_26429_0_0_0.aspx?mid=28
INFANT SPECIFIC
RESPIRATORY
DISORDERS
APNEA
• PERIODIC BREATHING IN NORMAL
• IRREGULAR PATTERN OF RESPIRATION—MAY PAUSE FOR
UP TO 20 SEC BEFORE CONSIDERED APNEA.
• APNEA OF PREMATURITY (CENTRAL APNEA)
• IMMATURE NERVOUS SYSTEM
• ACUTE LIFE THREATENING EVENT (ALTE)
• ANY EVENT WHERE INFANT STOPS BREATHING
• OBSTRUCTIVE APNEA
• CESSATION OF RESPIRATION DUE TO OBSTRUCTION
APNEA (FOR ANY REASON)
• S/S: CESSATION OF RR FOR >19 SEC,
BRADYCARDIA, CYANOSIS
• MEDICAL MGMT: DEPENDS ON REASON
• APNEA MONITOR
• BAG BREATHING
• PHARMACOLOGICAL INTERVENTIONS
• NRSG MGMT:
• TACTILE STIMULATION
• ASSESSMENT
• EDUCATION
• USE OF MONITORS AT HOME
• CPR
http://www.topnews.in/caffeine-may-hold-long-term-benefits-very-premature-babies-25531
SUDDEN INFANT DEATH SYNDROME
• SUDDEN, UNEXPLAINABLE DEATH OF INFANT
YOUNGER THAN 1YO
• RISK FACTORS:
• CAUSE UNKNOWN, MANY HYPOTHESES
• WORK-UP:
• AUTOPSY
• THOROUGH INVESTIGATION
• PREVENTION: EDUCATION
• BACK TO SLEEP
• PACIFER USE
• RISK FACTORS
http://www.quadromed.com/en/products/index.php
NURSING MANAGEMENT
• SUPPORT FAMILY
• REASSURANCE
• SUPPORT GROUPS
http://bbsnews.net/bbsn_photos/Israel_Palestine/corrie_friends_grief
CHRONIC RESPIRATORY
DISORDERS OF
CHILDHOOD
CYSTIC FIBROSIS (CF)
• AUTOSOMAL RECESSIVE TRAIT
• EXOCRINE GLAND DYSFUNCTION WITH MULTI-SYSTEM INVOLVEMENT
• PULMONARY
• GI
• PANCREAS
• BILIARY
• SWEAT & SALIVARY GLANDS
• REPRODUCTIVE GLANDS
• MORE LIKELY IN CAUCASIAN
• LIFE EXPECTANCY AVERAGE: MID 40’S
Carrier Parents
25% Chance
Unaffected
50% Chance
Unaffected Carrier
25% Chance
Affected
PATHOPHYSIOLOGY
• MUTATION IN CYSTIC FIBROSIS TRANSMEMBRANE
REGULATOR (CFTR) GENE
• AFFECTS CL- CHANNELS IN EPITHELIAL CELLS
• LINING OF AIRWAYS, BILIARY TREE, INTESTINES, VAS DEFERENS, SWEAT
DUCTS, AND PANCREAS
• PRIMARY DEFECT
• FAULTY TRANSPORT OF CHLORIDE
IN AND OUT OF CELLS
• INCREASED VISCOSITY OF
MUCOUS SECRETIONS
• RESULTS IN MECHANICAL
OBSTRUCTION
CF DIAGNOSIS
• EVALUATION OF PHYSICAL FINDINGS,
NUTRITIONAL STATUS, & CHEST X-RAYS
• SIGNS/SYMPTOMS
• STOOL ANALYSIS
• STEATORRHEA
• AZOTORRHEA
• QUANTITATIVE SWEAT
CHLORIDE TEST
http://bp3.blogger.com/_aKuV0NZVE9Q/SFdVVeUlpGI/AAAAAAAAADQ/6qHkVxWwK5w/s1600-h/Finger+Clubbing.jpg
SWEAT CHLORIDE
• STANDARD DIAGNOSTIC TEST
• PILOCARPINE & WEAK ELECTRICAL CURRENT
• INDUCE SWEATING
• COLLECT SWEAT ON FILTER PAPER
• DETERMINE CHLORIDE CONTENT
•
NORMAL: < 29 MEQ/L
•
SUSPICIOUS: 30-59 MEQ/L
•
POSITIVE: > 60 MEQ/L
*CF FOUNDATION, 2012
MEDICAL MANAGEMENT
• CHEST PHYSIOTHERAPY (CPT)
• PREVENTION AND AGGRESSIVE TREATMENT OF
PULMONARY INFECTIONS
• PHARMACOLOGIC MEASURES:
•
•
•
•
BRONCHODILATORS
DORNASE ALPHA
PANCREATIC ENZYMES
WATER MISCIBLE VITAMINS ADKE
• HIGH CALORIE/PROTEIN DIET
• LUNG TRANSPLANT
• GENE THERAPY
http://blog.lib.umn.edu/trite001/pstl1082anatomy/2008/10/
NURSING MANAGEMENT
• ASSESSMENT: MECONIUM ILEUS, FTT, SALTY
TASTING SKIN, HEAT INTOLERANCE, RECTAL
PROLAPSE
• RESPIRATORY
• HEMOPTYSIS: MEDICAL EMERGENCY
• MEDICATION ADMINISTRATION
• CPT
• NUTRITION MANAGEMENT
• GLUCOSE MONITORING IF DM
• EDUCATION
• REGIMEN MANAGEMENT
• PSYCHOSOCIAL ASPECTS OF CHRONIC
ILLNESS
HTTP://WWW.NATIONWIDECHILDRENS.O
RG/HOW-TO-USE-A-NEBULIZER
ASTHMA
• CHRONIC
INFLAMMATORY
DISORDER OF THE
AIRWAYS WITH 3
DISTINCT
CHARACTERISTICS:
• INFLAMMATION
• BRONCHOCONSTRICTION
• MUCUS PRODUCTION
http://www.aaaai.org/patients/topicofthemonth/1105/
ETIOLOGY/PREVALENCE
• ENVIRONMENTAL & GENETIC INFLUENCES
• EXPOSURE TO IRRITANT TRIGGERS A REACTION
• GENETIC DISPOSITION
• ESTIMATED 13.8 MILLION SCHOOL DAYS MISSED
• ALLERGY INFLUENCES DISEASE
• MANY DIFFERENT TYPES OF TRIGGERS OR ALLERGENS
• PREVALENCE HIGHER AMONG:
• AFRICAN AMERICAN, HISPANIC POPULATIONS
• URBAN/INDUSTRIALIZED AREAS
ASTHMATIC CHILDREN
• MANY ASTHMATIC CHILDREN ALSO HAVE
ECZEMA & ALLERGIES
• TRIGGER OF ATTACK MAY BE UNKNOWN
• RISK FACTORS:
•
•
•
•
•
•
•
BPD
PREMATURE INFANT
LOWER SOCIOECONOMIC CLASS
URBAN LIVING
HISPANIC OR AFRICAN AMERICAN
FAMILY HISTORY
MULTIPLE ALLERGIES
ASTHMA TRIGGERS
• OUTDOOR ALLERGENS
• TREES, WEEDS, GRASSES,
POLLEN, AIR POLLUTION
• INDOOR ALLERGENS
• DUST, DUST MITES, MOLD,
COCKROACHES
• CHEMICALS
• EXERCISE
• COLD AIR
• CHANGES IN WEATHER
• IRRITANTS
• TOBACCO SMOKE, SMOKE,
ODORS, SPRAYS
•
•
•
•
•
•
•
•
ANIMALS
**COLDS & INFECTIONS
MEDICATIONS
STRONG EMOTIONS
FOOD ADDITIVES
FOODS (NUTS, MILK, ETC)
ENVIRONMENTAL CHANGE
PHYSICAL CONDITIONS
• GERD
• ENDOCRINE FACTORS
• MENSES, PREGNANCY
ASTHMA
• S/S: COUGH, WHEEZING, RESPIRATORY DISTRESS,
PROLONGED EXPIRATORY PHASE
• DIAGNOSIS:
• HISTORY
• DISTRESS W/O INFECTION
• PFT’S
• MEDICAL MGMT:
• LIMIT EXPOSURE TO TRIGGERS
• PHARMACOLOGIC MANAGEMENT
• HTTP://WWW.NATIONWIDECHILDRENS.ORG/HOW-TO-USE-ANEBULIZER
ASTHMA MEDICATIONS
• AT HOME CARE INSTRUCTIONS FOR A CHILD WITH ASTHMA INCLUDE
INSTRUCTION THAT USE OF A BRONCODILATOR CAN RESULT IN:
(SELECT ALL)
A. DECREASED ACTIVITY LEVELS
B. GROWTH SUPPRESSION
C. WEIGHT GAIN
D. INSOMNIA
E. TACHYCARDIA
SPACER WITH INHALER
ASTHMA ACTION PLAN
• PEAK FLOW METER
• MEASURES PEAK EXPIRATORY FLOW
• GREEN
• 80-100% OF PERSONAL BEST
• ASTHMA UNDER CONTROL
• YELLOW
• 50-79% OF PERSONAL BEST
• MAY BE IN EXACERBATION—CALL PCP
• RED
• BELOW 50% OF PERSONAL BEST
• MEDICAL ALERT:
• GIVE ALBUTEROL, CALL PCP (OR GO TO ED)
NURSING MANAGEMENT
• ASSESSMENT
• RESPONSE TO MEDICATIONS
• MEDICATION ADMINISTRATION
• PATHWAYS
• WWW.YOUTUBE.COM/WATCH?V=XLUHXEJUARS
•
• EDUCATION!
• PEAK FLOW METER USE
• RESCUE MEDS –VS- CONTROLLER MEDS
• ACTION PLAN
• TRIGGERS
RESPIRATORY NANDA’S
•
•
•
•
•
•
•
•
•
•
•
•
•
ASTHMA
CF
NASOPHARYNGITIS
TONSILLITIS
STREP THROAT
BRONCHIOLITIS
PNEUMONIA
CROUP
EPIGLOTTITIS
FB ASPIRATION
APNEA
BPD
RDS
• ACTIVITY INTOLERANCE
• ACUTE PAIN
• ANXIETY
• INEFFECTIVE AIRWAY CLEARANCE
• RISK FOR ASPIRATION
• INEFFECTIVE BREATHING PATTERNS
• FLUID VOLUME DEFICIENT
• IMPAIRED GAS EXCHANGE
• RISK FOR INFECTION
• RISK FOR INFECTION TRANSMISSION
• DEFICIENT KNOWLEDGE
• DISTURBED SLEEP PATTERN
CHEST PHYSIOTHERAPY
• CHEST PHYSIOTHERAPY IS A STANDARD ADJUNCT TO THE TREATMENT FOR
CHRONIC CF. AND ASTHMA. WHEN SHOULD THE NURSE ADMINISTER THE
CHILD’S BRONCODILATOR IN CONJUNCTION WITH POSTURAL DRAINAGE?
HTTPS://WWW.BING.COM/VIDEOS/SEARCH?Q=CHEST+PERCUSSION+VIDEO+
ON+CHILD&VIEW=DETAIL&MID=0D0FF459B332E6D2CF8D0D0FF459B332E6D2
CF8D&FORM=VIRE
A. DURING POSTURAL DRAINAGE
B. ONE HOUR AFTER POSTURAL DRAINAGE
C. BETWEEN POSTURAL DRAINAGE TREATMENTS
D. ONE HOUR BEFORE POSTURAL DRAINAGE
HTTPS://WWW.YOUTUBE.COM/WATCH?V=HOJ4PDCKB2I
ACUTE OTITIS MEDIA (AOM)
• S. PNEUMONIAE, H. FLU, & M. CATARRHALIS MOST COMMON
BACTERIA
• GENERALLY OCCUR FOLLOWING VIRAL ILLNESS
• MOST COMMON IN CHILDREN <2YO
• S/S:
• MEDICAL MGMT:
• WAIT 72HRS BEFORE TREATING
• AMOXICILLIN 1ST LINE ATB
• ANTIHISTAMINES/DECONGESTANTS NOT RECOMMENDED
• NURSING MGMT:
• RELIEVE PAIN
• EDUCATION
DIAGNOSIS
• DECREASED TYMPANIC
MEMBRANE (TM) MOBILITY,
BULGING, RED TM
• NOT DX ON BASIS OF RED
TM ALONE
• MOBILITY CHECKED WITH
PNEUMATIC OTOSCOPE
NORMAL TM
HTTPS://WWW.YOUTUBE.COM/RES
ULTS?SEARCH_QUERY=USE+AN+
OTOSCOPE+ON+CHILD+EAR
ACUTE OM
CLEFT LIP (CL) & PALATE (CP)
• FACIAL MALFORMATIONS FROM FAILURE OF MAXILLARY & MEDIAN
NASAL PROCESSES TO FUSE TOGETHER
• UNILATERAL OR BILATERAL
• MAY INVOLVE LIP, SOFT & HARD PALATE
• MAY OCCUR ALONE OR W/ SYNDROMES
• CL APPARENT AT BIRTH
• PROGNOSIS: MAY HAVE:
•
•
•
•
•
SPEECH IMPAIRMENT
IMPROPER TOOTH ALIGNMENT
HEARING LOSS
RECURRENT OM
BODY IMAGE DISTURBANCES
CLEFT LIP & PALATE DEFORMITIES
MANAGEMENT
• MEDICAL MGMT:
• SURGICAL CLOSURE OF CLEFT
• FACILITATE NORMAL G&D
• SPEECH THERAPY
• NURSING MGMT:
• SUPPORT FAMILY
• FEEDING
• ESSR
• BREASTFEEDING
• POST-OP CARE
• AIRWAY!
• ELBOW RESTRAINTS
• PAIN MANAGEMENT
THE END!