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Key Pediatric Differences in the Respiratory System

Key Pediatric Differences in the Respiratory System. Lack of /insufficient surfactant Alveoli developing Smaller airways Underdeveloped cartilage. F. Key Differences (cont). Obligatory nose breather (infant) Intercostal muscles less developed Faster respiratory rate

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Key Pediatric Differences in the Respiratory System

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  1. Key Pediatric Differences in the Respiratory System Lack of /insufficient surfactant Alveoli developing Smaller airways Underdeveloped cartilage F

  2. Key Differences (cont) Obligatory nose breather (infant) Intercostal muscles less developed Faster respiratory rate Eustachian tubes relatively horizontal

  3. Respiratory Assessment RR first - full minute Breath sounds Quality Retractions Nasal flaring Color Cough

  4. Signs Respiratory Distress Cough Hoarseness Grunting Stridor Wheezing Nasal flaring Retractions Vomiting Diarrhea Anorexia Tachypnea Tachycardia Restlessness Cyanosis

  5. Potential Nursing Diagnoses Ineffective Airway Clearance Ineffective Breathing Patterns Impaired Gas Exchange Anxiety Activity Intolerance Risk for FVD Altered nutrition Altered comfort Knowledge deficit Ineffective coping – individual or family

  6. Apnea Periodic breathing of newborn True apnea ALTE Parental teaching

  7. Sudden Infant Death Syndrome The sudden and unexplained death of an infant less than 1 yr old. Usually occurs during sleep. “Back to Sleep” campaign AAP revised SIDS guidelines (Pediatrics, Vol. 116, No. 5, Nov. 2005)

  8. Sepsis • Def: a systemic bacterial infection spread through bloodstream • Neonates high risk: unable to localize infection • High Risk: • Immunocompromised • Skin defects/injuries • Invasive devices

  9. Assessment: Sepsis • Know high risk children & monitor • Hypo or hyperthermia • Lethargy; poor feeding • Jaundice, hepatosplenomegaly • Respiratory distress • Vomiting • Hyper or hypoglycemia

  10. Otitis Media Description: inflammation middle ear Acute otitis media Otitis media w/effusion Bacterial

  11. Risk Factors < 3 years Bottle-fed babies Passive smoke Groupchild care

  12. Acute Otitis Media Definition Inflammation of middle ear Rapid onset Fever Otalgia Other Clinical Manifestations: F

  13. Treatment: AOM Primary Prevention pneumococcal vaccine No passive smoke Hold bottle fed babies upright handwashing

  14. AOM: Secondary Prevention Pain relief Rest Antibiotics after 48-72 hrs in selected patients 6 mo to 2 yrs. PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1451-1465

  15. Nursing Dx: AOM Altered comfort r/t inflammation & pressure Knowledge deficit r/t incomplete understanding of disease Risk for Fluid Volume Deficit

  16. Otitis Media w/Effusion Definition Fluid in middle ear No s/s acute infection Clinical Manifestations: F

  17. Treatment: OME Antibiotics if > 3 mo. Assess for hearing loss *** Myringotomy w/placement tympanostomy tubes

  18. Pharyngitis 80-90% sore throats viral in origin Gradual onset Bacterial Group A beta-hemolytic strep greatest concern. F

  19. Therapeutic Management Primarily symptomatic Pain relief Rest Abx only if positive bacterial culture

  20. Tonsillectomy/adenoidectomy Most common reason: OSA Monitor for post-op bleeding ***Excessive swallowing Elevated pulse, decreased BP Evidence of fresh bleeding Restlessness Pain meds – teach parents Fluids

  21. Croup Croup • Broad classification of upper airway illness • Group of conditions with: • Inspiratory stridor • Harsh cough • Hoarseness • Degrees of respiratory distress • 4 different types Fig. 45-UF03, p. 1209 F

  22. Laryngotracheobronchitis Def: inflammatory condition of larynx, trachea, bronchi viral Gradual onset harsh cough & insp. stridor Very important to differentiate from epiglottitis

  23. LTB - treatment Racemic epinephrine via neb Corticosteroids Tylenol Cool mist Oxygen Observe for sudden silent respiration

  24. Four D's of Epiglottitis Drooling Dysphagia Dysphonia Distressed respiratory efforts Tripod position Do not: examine throat or do throat culture! Do: reassure, keep calm, anticipate intubation F

  25. Brochiolitis • Lower airway • 50% RSV (respiratory syncytial virus) • Contact and droplet precautions • Mycoplasma, parainfluenza, adenovirus • Usually young infants who need hospitalization.

  26. Patho of Bronchiolitis Virus invades mucosal cells Cells die: debris Irritation  increased mucus & bronchospasm Air trapping

  27. BronchiolitisClinical Manifestation Tachypnea Wheezing, crackles, or rhonchi Retractions Fever- maybe Difficulty feeding Cyanosis

  28. Changes to Bronchiolitis Management What You Will See What You Will Do Decrease in the amount of nasal swabs being ordered Decrease in orders for CPT by RT Decrease in continuous O2 saturation monitoring Decrease in use of albuterol treatments Discharge orders for patients with > 90% O2 saturations while asleep When cohorting patients, infection control may be consulted Teach parents CPT for comfort measures Increase amount of intermittent O2 sat checks (ex. Q4h) Increase use of Racemic Epi Accept O2 saturations as low as 88% when a patient is sleeping Continue suctioning as usual For patients placed on Isolation Precautions: Gowns, Gloves, & MASKS are encouraged

  29. Bronchiolitis Nursing Interventions Facilitate gas exchange Monitor I & O (for DFV) IV prn Reduce fever Reduce anxiety

  30. Asthma Reactive airway disease Bronchospasm Edema Increased mucus production Triggers Dusts, pollen, food, strenuous exercise, weather changes, smoke, viral infections F

  31. AsthmaClinical Manifestations Wheezing Dyspnea w/prolonged expiration Nonproductive cough Tachypnea, orthopnea Tripod position Fatigue

  32. Asthma treatment Short-acting bronchodilator Mast cell inhibitor Systemic corticosteroids Inhaled steroids Leukotriene receptor antagonist Peak expiratory flow rate Immunizations

  33. Cystic Fibrosis Mechanical obstruction r/t increased viscosity of mucous secretions. Autosomal recessive disorder

  34. Cystic Fibrosis: A Multisystem Disorder Respiratory system Digestive system Integumentary system Reproductive system Growth and development F

  35. Assessment findings - CF Salty-tasting skin Profuse sweating Frequent infections Dry, non-productive cough Increased amt, thickness of secretions Wheezing Cyanosis

  36. Assessment findings – CF (cont) Digital clubbing Increased A-P diameter of chest Steatorrhea Thin extremities Muscle wasting Failure to thrive Meconium ileus

  37. Cystic Fibrosis: Interventionsstrengthen lines of resistance Facilitate airway clearance and gas exchange. CPT Pulmozyme Prevent infection Immunizations TOBI Azithromycin Promote increased exercise tolerance.

  38. CF: Interventions Provide optimal nutrition for growth. High-calorie, high protein Pancreatic enzymes with every meal Creon, Pancrase Dosage adjusted to stool formation

  39. CF interventions (cont) Strengthen FLD/extrapersonal environment Child's and family's emotional needs Prepare the family for home care

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