Chain of Survival and EMSC

Chain of Survival and EMSC

Chapter 25 The Child with a Respiratory Disorder Copyright 2019, Elsevier Inc. All rights reserved. Ventilation The process of breathing air into and out of the lungs, affected by Intercostal muscles, diaphragm, ribs Brain Chemoreceptors Copyright 2019, Elsevier Inc. All rights reserved.

2 Respiratory system The airway is shorter and narrower, easily obstructed Also allows infectious organisms to travel to the respiratory tract easily These infectious agents have easy access to the shorter and straighter eustachian tube, leading to ear infections Copyright 2019, Elsevier Inc. All rights reserved.

3 Copyright 2019, Elsevier Inc. All rights reserved. 4 Copyright 2019, Elsevier Inc. All rights reserved. 5 Nasopharyngitis (1 of 2) Upper respiratory tract infection

A cold, also known as coryza, most common infection of the respiratory tract Nasal discharge, irritability, sore throat, cough, and general discomfort Complications include bronchitis, pneumonitis, and ear infections Copyright 2019, Elsevier Inc. All rights reserved. 6 Nasopharyngitis (2 of 2) Allergic rhinitis

Is not the same as a cold Child will not have a fever, purulent nasal discharge, or reddened mucous membranes Will have sneezing and itchy, watery eyes Copyright 2019, Elsevier Inc. All rights reserved. 7 Acute Pharyngitis

Inflammation of the structures of the throat Common in children 5 to 10 years old Virus most common cause Haemophilus influenzae most common in children younger than 3 years Symptoms: fever, malaise, dysphagia, and anorexia, conjunctivitis, rhinitis, cough, and hoarseness with gradual onset; lasts no longer than 5 days In child older than 2 years, streptococcal pharyngitis may include fever of 40C (104F). May require antibiotics if cause is bacterial Copyright 2019, Elsevier Inc. All rights reserved. 8 Sinusitis in Children Frontal sinuses are present around 8 years of

age but are not fully mature until around age 18 years. Proximity of the sinus to the tooth roots often results in tooth pain when a sinus infection occurs. Maxillary and ethmoid sinuses are most often involved in childhood sinusitis. Suspect sinus infection when a URI lasts longer than 10 days. Requires antimicrobial therapy Copyright 2019, Elsevier Inc. All rights reserved.

9 Croup Syndromes (1 of 2) Congenital laryngeal stridor (laryngomalacia) Weakness in airway walls; floppy epiglottis that causes stridor on inspiration Symptoms lessen when infant is placed prone or propped in side-lying position. Usually clears spontaneously as child grows and muscles strengthen Copyright 2019, Elsevier Inc. All rights reserved.

10 Laryngotracheobronchitis Viral condition resulting in edema, destruction of respiratory cilia, and exudate, which causes respiratory obstruction Begins a URI, then a barking or brassy cough and stridor develops The infant or child prefers to be held or to sit upright (orthopnea) Hypoxia, tachycardia, and diminished breath

sounds follow Copyright 2019, Elsevier Inc. All rights reserved. 11 Treatment and nursing care Increase humidity in childs environment: Cold-water humidifier Put child in bathroom with hot shower running Moist air will usually relieve laryngeal spasm

If hospitalized, child will be placed in croupette or mist tent Opiates are contraindicated Copyright 2019, Elsevier Inc. All rights reserved. 12 Croup Syndromes (2 of 2) Epiglottitis Swelling of the tissues above the vocal cords Narrows airway inlet

Caused by H. influenzae type B Most often seen in children 3 to 6 years of age Can occur in any season Course is rapid, progressive, and life threatening Copyright 2019, Elsevier Inc. All rights reserved. 13 Epiglottitis

Child will sit up with hands on lap or table- the classic tripod position Child will appear wide-eyed and anxious Cough is absent Do not introduce a tongue blade to examine throat-will precipitate an episode of laryngospasm Copyright 2019, Elsevier Inc. All rights reserved. 14 Bronchitis Infection of bronchi

Unproductive hacking cough Seldom primary infection Caused by variety of microorganisms Cough suppressants before bedtime so child can sleep OTC agents such as antihistamines, cough expectorants, and antimicrobial agents are normally not helpful. Copyright 2019, Elsevier Inc. All rights reserved. 15 Bronchiolitis

Viral infection of the bronchioles (small airways) Occurs in children 6 months-2 years of age Excess mucus leads to obstruction-leads to atelectasis, and hypoxia can occur Treatment is symptomatic and similar to treatment for croup Copyright 2019, Elsevier Inc. All rights reserved. 16 Influenza

Virus can be responsible for much morbidity and mortality in children Spread by droplets Can be diagnosed with a nasal swab or nasopharyngeal wash Antivirals can be given, even to newborns Annual vaccinations are given throughout flu season Copyright 2019, Elsevier Inc. All rights reserved. 17

Respiratory Syncytial Virus (RSV) Responsible for 50% of cases of bronchiolitis in infants and young children Spread by direct contact with respiratory secretions Survives more than 6 hours on countertops, tissues, and bars of soap Incubation approximately 4 days If hospitalized, place in contact isolation precautions

Copyright 2019, Elsevier Inc. All rights reserved. 18 RSV Diagnosed by nasopharyngeal washings Nurses caring for these children should not be given any other children to care for-it is very transmissible Child will be in a mist tent and on contact isolation

Ineffective breathing pattern is the most important nursing diagnosis May be at risk for asthma later in life Copyright 2019, Elsevier Inc. All rights reserved. 19 Copyright 2019, Elsevier Inc. All rights reserved. 20 Copyright 2019, Elsevier Inc. All rights reserved. 21 Pneumonia

Inflammation of lungs in which the alveoli become filled with exudate and surfactant may be reduced Breathing shallow, resulting in decreased oxygenated blood Many types, classified according to causative organism (i.e., bacterial, viral) Group B streptococci most common cause in newborns Chlamydia most common cause in infants 3 weeks to 3 months of age Copyright 2019, Elsevier Inc. All rights reserved. 22

Pneumonia Productive cough Fever; may be as high as 104 Child will be tachypneic, with shallow breaths Sternal retractions may be seen Child is listless Copyright 2019, Elsevier Inc. All rights reserved. 23 Treatment and nursing care

Treatment depends on the causative organism (bacterial/viral) Oxygen is administered for dyspnea or cyanosis Rest, fluids, and a cough med before bed is the standard home treatment Rest and quiet acticities are planned Copyright 2019, Elsevier Inc. All rights reserved. 24 Smoke Inhalation Injury

May cause carbon monoxide poisoning Prevents oxygen from combining with Hgb so carboxyhemoglobin cannot be formed Has three stages Pulmonary insufficiency in first 6 hours Pulmonary edema from 6 to 72 hours Bronchopneumonia after 72 hours Can lead to atelectasis

Severe exposure can inhibit secretion of surfactant and cause hyaline membrane to form, leading to acute respiratory disease syndrome (ARDS). Copyright 2019, Elsevier Inc. All rights reserved. 25 Carboxyhemoglobin (COHb) Pulse oximetry readings are of little value in carbon monoxide poisoning because pulse

oximetry does not detect COHb, and readings may appear normal. Treatment is often symptomatic. Includes oxygen administration Careful monitoring of intake and output Frequent assessments of arterial blood gas reports Copyright 2019, Elsevier Inc. All rights reserved. 26 Tonsillitis and Adenoiditis Tonsils and adenoids are made of lymph tissue and are part of bodys defense against infection. Tonsillitis and adenoiditis

Difficulty swallowing and breathing Provide cool mist vaporizer, salt-water gargles, throat lozenges (if age-appropriate), cool liquid diet, acetaminophen Removal of tonsils and adenoids not recommended if younger than 3 years of age. Tonsillectomy done only if persistent airway obstruction or difficulty breathing occurs Copyright 2019, Elsevier Inc. All rights reserved. 27 Post-op care

Child is placed on side, to facilitate drainage Monitor child for s/s of bleeding(increased heart rate/respirations, restlessness, also frequent swallowing) Child may have ice pop or ice cream, but noting red or brown-colored Appropriate pain relief (opioids and nonopioids) Minimize crying/fussiness Copyright 2019, Elsevier Inc. All rights reserved.

28 Allergic Rhinitis Inflammation of nasal mucosa caused by an allergic response Often occurs during specific seasons Not a life-threatening condition Accounts for many lost school days Copyright 2019, Elsevier Inc. All rights reserved. 29 Allergic rhinitis

Child will have same symptoms as a cold, except there will be no fever or sore throat Child will have watery, itchy eyes The main challenge is to help the parent recognize the differences between allergic rhinitis and a cold Copyright 2019, Elsevier Inc. All rights reserved. 30 Asthma

Rarely diagnosed in infancy Increased susceptibility of infants to respiratory obstruction and dyspnea may result from Decreased smooth muscle of an infants airway Presence of increased mucus glands in the bronchi Normally narrow lumen of the normal airway Lack of muscle elasticity in the airway Fatigue-prone and overworked diaphragmatic muscle on which infant respirations depend Copyright 2019, Elsevier Inc. All rights reserved. 31

Asthma Manifestations Obstruction most severe during expiration. During acute episodes, patient coughs and wheezes and has difficulty breathing, particularly during expiration. Signs of air hunger, such as flaring of the nostrils, and use of accessory muscles may be evident; orthopnea appears. Chronic asthma is manifested by discoloration beneath the eyes (allergic shiners), slight eyelid eczema, and mouth breathing.

Copyright 2019, Elsevier Inc. All rights reserved. 32 Asthma Can be brought on by allergic reactions, cold air, physical activity or emotional upsets A recurrent and reversible episode of bronchospasm, with cough and wheezing Diagnosis: H&P, s/s, allergy testing Child and family need to be educated about meds and avoiding triggers

Copyright 2019, Elsevier Inc. All rights reserved. 33 Nursing care Keep environment clean and free of dust and mold Medications:

Short-acting beta-agonists Corticosteroids Long-acting beta-agonists, inhaled steroids Methylxanthines Metered-dose inhaler Copyright 2019, Elsevier Inc. All rights reserved. 34 Copyright 2019, Elsevier Inc. All rights reserved. 35 Copyright 2019, Elsevier Inc. All rights reserved. 36 Copyright 2019, Elsevier Inc. All rights reserved.

37 Status Asthmaticus This is a medical emergency. Continued severe respiratory distress that is not responsive to drugs, including epinephrine and aminophylline ICU admission, supplemental oxygen, IV medications, and frequent vital signs (including pulse oximetry readings) are essential. Copyright 2019, Elsevier Inc. All rights reserved.

38 Cystic Fibrosis Multisystem disease in which thick, viscid secretions affect Respiratory systemobstructed by secretions Digestive systemsecretions prevent digestive enzymes from flowing to GI tract; results in poor absorption of food Bulky, foul-smelling stools that are frothy because of the undigested fat content

Skinloss of electrolytes in sweat causes salty skin surface Reproductive systemsecretions decrease sperm motility; thick cervical mucus can inhibit sperm from reaching fallopian tubes Copyright 2019, Elsevier Inc. All rights reserved. 39 Nursing Care for Cystic Fibrosis (1 of 2)

Oxygen therapy Antimicrobial therapy Aerosol therapy Use of inhalers Postural drainage Breathing exercises Prevention of infection is essential. Oral pancreatic preparations are given to help child to digest and absorb food. Diet should be high in protein and calories. Free access to salt Copyright 2019, Elsevier Inc. All rights reserved. 40 Nursing Care for Cystic Fibrosis

(2 of 2) General hygiene Care should be given to diaper area. Frequent changes of position help prevent development of pneumonia. Child wears light clothing to prevent overheating. Teeth may be in poor condition because of dietary deficiencies. Long-term care

Goals include minimizing pulmonary complications, ensuring adequate nutrition, promoting growth and development, and assisting family to adjust to chronic care required. Copyright 2019, Elsevier Inc. All rights reserved. 41 Bronchopulmonary Dysplasia (1 of 2) Respiratory distress syndrome (RDS) in the newborn is major reason why oxygen and ventilators are used. Main cause of RDS in the newborn is prematurity Goal of treatment

Administer only the amount of oxygen required to prevent hypoxia at the minimum ventilator pressures needed to prevent tissue trauma. Antenatal steroids hasten lung development during preterm labor. Administration of surfactant within 15 minutes of delivery may also be helpful. Copyright 2019, Elsevier Inc. All rights reserved. 42 Copyright 2019, Elsevier Inc. All rights reserved.

43 Copyright 2019, Elsevier Inc. All rights reserved. 44 Bronchopulmonary Dysplasia (2 of 2) Symptoms of chronic respiratory distress include Wheezing

Retractions Cyanosis on exertion Use of accessory respiratory muscles Clubbing of the fingers Failure to thrive Irritability caused by hypoxia Copyright 2019, Elsevier Inc. All rights reserved. 45 Sudden Infant Death Syndrome (SIDS) (1 of 2)

Clinically defined as the sudden, unexpected death of an apparently healthy infant between 2 weeks and 1 year of age Clinical features of the disease remain constant. Death occurs during sleep. Infant does not cry or make other sounds of distress. Copyright 2019, Elsevier Inc. All rights reserved. 46 Sudden Infant Death Syndrome (SIDS) (2 of 2) Thought to be caused by a brainstem abnormality related to cardiorespiratory control

Overheating, irregular respiratory patterns Decreased arousal responses are contributing factors Increased risk factors include Maternal smoking or cocaine use that causes hypoxia of the fetus Preterm birth Poor postneonatal care Copyright 2019, Elsevier Inc. All rights reserved.

47

Recently Viewed Presentations

  • SMART LIGHTING Filters & The Behavior of L

    SMART LIGHTING Filters & The Behavior of L

    ECSE Department. Rensselaer Polytechnic Institute. Intro to ECSE Analysis. SMART LIGHTING. Outline. Open and Short Circuits. Behaving Like an Open or Short. Inductors at Low and High Frequencies. Starting Point for Exploration? Types of Filters. Short. Open. K. A. Connor.
  • The Webinar will begin at 1:00 P.M. Central

    The Webinar will begin at 1:00 P.M. Central

    Each group in the contact situation should have equal statusParticipants should experience a cooperative atmosphereMembers of the group should be working on common ...
  • Workplace Emotions, Attitudes, and Stress

    Workplace Emotions, Attitudes, and Stress

    Workplace Emotions, Attitudes,and Stress. McGraw-Hill/Irwin. ... • Support employee wellbeing. Employee. Involvement • Employees feel part of company • Involvement demonstrates trust. ... achievement, plan of action, consider alternatives, and.
  • The War in Vietnam

    The War in Vietnam

    Arial Rockwell Extra Bold Bauhaus 93 Times New Roman Default Design The War Comes Home: The Political Crises of the 1960s The New Left: The Port Huron Statement, 1962 Berkeley Free Speech Movement, 1964-65 Slide 4 TV and Vietnam Slide...
  • Aero-Engines 1903-2003

    Aero-Engines 1903-2003

    to buy the Hirth Motoren Company, which means, he is. now an engine manufacturer and may continue with. his engine activities. On the second flight the engine cowls are closed. On the right photo Udet makes a seating test. ......
  • VMware Error Examples - Cavium

    VMware Error Examples - Cavium

    Where to look for errors. Depending on the Version of VMware, SCSI errors are either in: var/log/Messages . OR vmkernel. The safest way to ensure you are provided the correct logs is to request a Vmsupport Dump.
  • CSE 190: Internet E-Commerce

    CSE 190: Internet E-Commerce

    Arial Default Design CSE 190: Internet E-Commerce Lecture 2 HTML HTML Basics HTML Example 1 HTML Example 2 HTML Example 3 Uniform Resource Locators HTML Forms Style Sheets HTML Style Sheets Style Sheet References Scripting within HTML Javascript References
  • VIL School STEM Engagement Plan

    VIL School STEM Engagement Plan

    Verizon Innovative Learning Minority Males. Confidential and proprietary materials for authorized Verizon personnel and outside agencies only.Use, disclosure or distribution of this material is not permitted to any unauthorized persons or third parties except by written agreement.