Upper and Lower Respiratory Infections (URIs )

1. Upper and Lower Respiratory Infections (URIs)

2. Upper Respiratory Infections (URIs) Objectives: List 3 of the most common URIs in children. Describe postoperative care of the child with a tonsillectomy. Outline nursing care plan for a child with acute otitis media. Outline nursing care plan for a child with acute otitis media.

3. Upper Respiratory Infections (URIs) Outlines: The most common URIs in children. Postoperative care of the child with a tonsillectomy. Nursing care plan for a child with acute otitis media. Nursing care plan for a child with acute otitis media.

4. Risk Factors Dr. Afkar Ragab • Age • Child’s health condition • Environmental factors e.g. pollution, overcrowding • Mother or care giver level of education • Culture • Nutritional status of the child

5. Upper Respiratory Infections (URIs) Common upper of respiratory tract infections in children: Tonsillitis. Otitis media.

6. Tonsillitis The tonsils are masses of lymphoid tissue located in the pharyngeal cavity. Functions of tonsils: To filter and protect the respiratory and alimentary tracts for invasion by pathogenic organisms. They also may have a role in antibody formation.

7. Tonsillitis is a swelling of the tonsils, which are areas of lymphoid tissue on either side of the throat. Tonsils can become swollen when they are infected by bacteria or a virus. This is a common occurrence in children.

9. Symptoms of tonsillitis may include: • Sore throat. • Difficult swallowing • Fever. • Headache. • White patches in the throat or tonsils. • Red, swollen tonsils. • Pain when swallowing. • Vomiting. • Sore glands in the throat or jaw.

11. Chronic tonsillitis

12. Therapeutic management • Tonsillitis is self-limiting. • Throat cultures positive ----antibiotic if bacterial infection. • Tonsillectomy-----removal of the palatine tonsils if massive hypertrophy, difficulty breathing or eating was present. • Adenoidectomy----(under 3 years of age) • If there is obstruction of nasalbreathing.

13. Tonsillectomy

14. Contraindications to either tonsillectomy or adenoidectomy Cleft palate. Acute infections at the time of surgery. Local inflamed tissues increase the risk of bleeding. Uncontrolled systemic disease.

15. Nursing diagnoses with a tonsillectomy: Impaired swallowing related to inflammation and discomfort. Pain related to surgery. Altered oral mucous membranes related to operative site. High risk for injury.

16. Nursing diagnoses with a tonsillectomy: Anxiety/fear related to unfamiliar event, discomfort. Altered family processes related to hospitalization of child. Ineffective airway clearance related to discomfort.

17. Nursing considerations with tonsillitis: Providing comfort. Soft liquid diet is generally preferred. cool mist. Warm salt gargles, throat lozenges.

18. Analgesic/antipyretic drugs as acetaminophen and codeine are useful to promote comfort (given rectally or IV.). If surgery is needed: Care after tonsillectomy: Children are placed on the abdomen or side to facilitate drainage of secretions.

19. If the child need suctioning must be performed carefully to avoid trauma to the oropharynx. * Alert child the bed rest for the remainder of day. * Discourage child from coughing frequently and blowing their nose, clear their throat and activities that may aggravate the operative site.

20. The throat is very sore ---- Ice collar may provide relief. Pain medication for at least the first 24 hours. Cool water, crushed ice, fluids, diluted fruit juices is given first. * Avoid red or brown color fluids. * Citrus fluids or juices may cause discomfort.

21. Minimizing activities or interventions may precipitate bleeding. Soft foods are started on the first or second post operative day. Observe post operative bleeding and other signs of Hage. Teach the family about home care because Hage may occur up to 10 days.

22. Otitis media

24. Impaired drainage negative pressure cause retention of fluids in middle ear. If the tube opens: difference of the pressure causes bacteria to be swept into middle ear organisms quickly proliferate, multiply and grow and invade the mucosa

25. Diagnosis: Otoscopy normal findingsIntact membrane, bright red and bulging. Abnormal findings: Slightly inflamed dull-gray membrane, visible fluid level.

26. The tympanic membrane as it appears in someone with acute otitis media

27. Acute Otitis media

29. Manifestations of otitis media: Follows an upper respiratory infection Earache (otalgia), pain that is more severe and continuous. Fever of 39 °C. Purulent otorrhea. Perforation of the ear drum. Infection of the mastoid space.

30. Infant or very young child: Crying. Fussy, restless, irritable. Tendency to rub, hold, or pull affected ear Rolls head side to side. Difficulty comforting child. Loss of appetite.

31. Older child: Crying and/or verbalizes feelings of discomfort. Irritability. Lethargy. Loss of appetite.

32. Chronic Otitis Media: Hearing loss. Difficulty communicating. Feeling of fullness, tinnitus, vertigo (dizziness) may be present

33. Therapeutic management: Administration of antibiotics child must improved within 48-72 h. Myringotomy (surgical incision of the eardrum) to relieve symptoms in some children. After antibiotics child should be assessed for effectiveness of TT and to identify potential complications: -Effusion or hearing impairment.

34. Analgesic/ antipyretic are used to alleviate discomfort and reduce an elevated temperature. Tympanostomy tubes (pressure equalizer tubes or facilitate continued drainage of fluid and allow ventilation of the middle ear).

35. Trans-tympanic drainage

36. Nursing interventions: Analgesics/ antipyretics. The application of heat with a heating pad on low setting -----may reduce the discomfort, local heat over the ear with child lying on the affected side. This position facilitates drainage. An ice bag placed over the affected ear may also be beneficial ( reduces edema and pressure).

37. External ear canal may be cleaned with sterile cotton swabs soaked in hydrogen peroxide. The skin around the ear become excoriated from the exudates------this is prevented by frequent cleansing and application of zinc oxide.

38. Teach the parent for temporary hearing loss. Complete use of antibiotics. Avoid supine position during infant feeding.

39. LARYNGOTRACHOBRONCHITIS CROUP SYNDROME . LTB is severe inflammation and partial obstruction of upper air way. It is also most often self-limited, but it occasionally is severe and, rarely, fatal. A barking cough, stridor, and fever are characteristic, and it is the most common cause of stridor in children

40. Etiology: • LTB usually results from viral infection; e.g.parainfluenza viruses, adenoviruses, respiratory syncytial virus, and measles viruses. • It also may be of bacterial origin (diphtheria or pertussis).

41. Incidence: LTB affects boys more than girls, typically between ages 6 months and 3 years. Incidence peaks in the winter months.

42. Assessment Finding Health history and physical examination typically reveal one or more of the following. • Upper respiratory infection. • Substantial and suprasternal retractions. • Barking cough, hoarseness. • Pallor and cyanosis. • Irritability and restlessness. • Low-grade fever. • Crackles

43. Nursing Diagnosis Ineffective airway clearance. Anxiety and ineffective breathing pattern. Altered family process. High risk for fluid volume deficit. High risk for injury. Parents / mother knowledge deficit.

46. Lower respiratory tract infection

47. Bronchitis Bronchitis means that the tubes that carry air to thelungs(the bronchial tubes) are inflamed and irritated. When this happens, the tubes swell and producemucus. This making cough.

48. Bronchitis

49. Causes of Acute Bronchitis virus. bronchitis after having anupper respiratory tract infection bacteria In rare cases breathing in things that irritate the bronchial tubes, such as smoke. inhales food or vomit into the lungs.

50. Symptoms A cough, which is the main symptom of acute bronchitis. It may be dry at first (does not producemucus) and after a few days may bring up mucus from the lungs (productive cough). The mucus may be clear, yellow, or green. Sometimes, small streaks of blood may be present.