Understanding Childhood Respiratory Conditions

1. Chapter 16 The Child With Altered Respiratory Status

2. Types of Respiratory Conditions Seen During Childhood • Acute or chronic • Life threatening • Primary clinical problem or secondary complication

3. Respiratory System Variances in the Child • System is physically smaller with much less reserve capacity. • Fewer central and peripheral chemoreceptors in the circulatory system • Airway is much smaller in diameter and shorter in length. • Tongue is proportionally larger. • Larynx is funnel shaped. • Cartilaginous chest wall is twice as compliant and flexible.

4. Respiratory System Variances in the Child—(cont.) • Horizontal orientation of ribs prevents adequate leverage for intercostal muscles. • Diaphragm, intercostal muscles, and the muscles supporting the head and upper/lower airways are underdeveloped. • Lung tissue’s ability to inflate and deflate gradually increases throughout childhood.

5. Differences in Size, Structure, and Function of the Child’s Respiratory System

6. Information Obtained for a Respiratory System Assessment • Past medical history, including birth history • Previous health problem • Childhood illnesses • Immunizations • Allergies • Environment • Things that make the symptoms worse (“triggers”) • Potential comorbid conditions or symptoms • Nutrition; general growth and development factors

7. Question Stridor is a noise the infant may make as he or she attempts to provide a self-induced positive end-expiratory pressure (PEEP), which may signal respiratory distress. A. True B. False

8. Answer B. False Stridor is a harsh, grating, whistling sound heard on inspiration and produced by turbulent airflow through laryngeal or tracheal obstruction. It is usually more pronounced when the child is crying or agitated. Grunting is a noise the infant may make as he or she attempts to provide a self-induced PEEP, which may signal respiratory distress.

9. Diagnostic Tests and Procedures to Evaluate the Respiratory System • Measurement of lung volumes and flow rates (pulmonary function tests and peak flow measurement) • Direct or indirect blood and body fluid analysis (arterial blood gases, fluid cultures, sweat chloride test) • Imaging techniques (radiographs, fluoroscopy, bronchography, CT scan, scintigraphy, MRI) • Direct visualization of the respiratory tree (laryngoscopy, bronchoscopy)

10. Diagnostic Testing

11. Interventions for Children With Chronic Respiratory Conditions • Oxygen • Medications • Airway clearance techniques • Nutritional support • Artificial airways • Mechanical ventilation • Tracheostomy

12. Oxygen Delivery Methods • Mask • Nasal cannula • Oxygen hood • Oxygen tent • Mechanical ventilation

13. Delivering Oxygen by Mask

14. Medication Routes of Administration for Respiratory Conditions • Oral • Inhaled • Intravenous • Injectable (SQ or IM)

15. Question Tell whether the following statement is true or false: Supplemental continuous gastrostomy tube or nasogastric tube feedings must be discontinued for at least 30 minutes before postural drainage and percussion. A. True B. False

16. Answer A. True Traditionally, chest physiotherapy (also called postural drainage and percussion) has been the primary intervention for pulmonary conditions with hypersecretion or retained bronchial secretions. Supplemental continuous gastrostomy tube or nasogastric tube feedings must be discontinued for at least 30 minutes before postural drainage and percussion to avoid vomiting and nausea and to promote comfort.

17. Laryngeal Mask Airway

18. Possible Complications of a Tracheostomy • Hemorrhage • Edema • Subcutaneous emphysema • Pneumothorax • Accidental decannulation

19. Critical Components of Respiratory Care • Preventive care • Monitoring and early detection of symptoms • Adequate management (in home or hospital) • Health education

20. Question Tell whether the following statement is true or false: Congenital abnormalities or malformations of the respiratory systems are common in children. A. True B. False

21. Answer B. False Congenital abnormalities or malformations of the respiratory systems are fortunately rare. Congenital conditions include choanal atresia, Pierre Robin syndrome, cleft palate, laryngomalacia, and tracheomalacia.

22. Upper Respiratory Infections and Obstructions • Allergic rhinitis • Sinusitis • Nasopharyngitis and pharyngitis • Tonsillitis • Croup

23. Upper Respiratory Infections and Obstructions—(cont.) • Acute epiglottitis • Laryngotracheobronchitis • Bacterial tracheitis • Apnea • Foreign body aspiration

24. Question Tell whether the following statement is true or false: The nurse should routinely attempt direct visualization of the upper airway in a child with symptoms of epiglottitis to confirm the diagnosis. A. True B. False

25. Answer B. False The nurse should never attempt direct visualization of the upper airway in any child with symptoms of epiglottitis because it may precipitate complete airway obstruction and respiratory arrest. It should be attempted only by a person skilled in intubations and with all necessary equipment present at the bedside.

26. Type of Apnea • Central apnea • Impairment of the mechanisms that control breathing • Obstructive apnea • Occurs when nasal air flow is absent despite normal or exaggerated respiratory effort • Mixed apnea • Includes central and obstructive components and may require multiple treatment methods

27. Lower Respiratory Infections and Obstructions • Influenza • Bronchiolitis • Bronchitis • Pneumonia

28. Chronic Conditions of the Respiratory System • Asthma • Bronchopulmonary dysplasia • Cystic fibrosis

29. Asthma Care Components • Assessment and monitoring • Education • Control of environmental factors and comorbid conditions • Medications • Management and treatment of exacerbations

30. Early Asthmatic Response

31. Risk Factors for Asthma-Related Death • Prior admission to ICU with or without intubation • Two or more hospitalizations, three or more ER visits, or both in the past year • Hospitalization or ER visit in the past month • Current use of or recent withdrawal from systemic corticosteroids • History of psychiatric disease or psychosocial issues • History of nonadherence to asthma treatment plan

32. Focus of Treatment for Cystic Fibrosis • Ensuring optimal care, including treatments, routine monitoring, and general pediatric preventive care • Facilitating access to pertinent health care resources and support • Assisting the family in coordinating care and accessing medications, diet supplements, and medical equipment • Supporting quality of life and independence