Respiratory Dysfunction
ACUTE LARYNGOTRACHCOBRONCHITIS (LTB) : server inflammation and obstruction of the upper airway , the most common form of croup .
Etiology and incidence :
1.
LTB usually results from viral infection , common causative organisms include par influenza viruses , adenoviruses , respiratory syncytial virus, and influenza and measles viruses.
2.
It also may be of bacterial origin ( diphtheria or pertussis)
3.
LTB affect boys more than girls , typically between ages 6 months and 3 years
4.
Incidence peaks in the winter months
Path physiology :
1.
LTB usually is preceded by an upper respiratory infection , which proceeds to laryngitis and then descends into the trachea and sometime the bronchi.
2.
The flexible larynx of a young child is particularly susceptible to spasm which may cause complete airway obstruction,
3.
Profound airway edema may lead to obstruction and seriousy compromised ventilation.
Assessments findings :
1.
Health history and physical examination typically reveal one or more of the following : a.
Upper respiratory infection b.
Aspiratory stridor c.
Substernal and suprasternal retractions d.
Barking cough , hoarseness e.
Pallor or cyanosis

f.
Restlessness , irritability g.
Low- grade fever h.
Crackles , rhonchi, expiratory wheezing and localized areas of diminished or absent breath sounds
2.
Diagnosis is based on symptom
Nursing diagnosis :
1.Ineffective airway clearance
2. Anxiety
3. ineffective breathing pattern
4. family coping potential for growth
2.
3.
4.
a.
b.
5. Altered family processes
6. High risk for fluid volume deficit
7. knowledge
Planning and implementation :
1.
Assess for airway obstruction by evaluating respiratory status : color , respiratory effort , evidence of fatigue and vital signs . keep emergency equipment at the bedside
Administer oxygen therapy as ordered to alleviate hypoxia
Administer IV fluids as ordered to ensure adequate hydration.
Administer prescribed medication as ordered , which may include :
Racemic epinephrine via nebulizer
Antibiotics , if LTB is bacterial in origin
5.
Help reduce the child’s anxiety by maintaining a quiet environment , promoting rest and relaxation and minimizing intrusive procedures , encourage parents to bring a favorite toys for the child.

6.
Support parents by answering questions and explaining all treatments and procedures . encourage them to be present and participate in their child’s care , as appropriate.
Bronchiolitis : An inflammatory process affecting the bronchioles and alveoli .
Etiology :Respiratory syncytial virus
Path physiology :
1.
The inflamed bronchioles become edematous and respiratory secretions accumulate there by occluding the bronchiolar lumen .
2.
The narrowing of the small airways compromises expiration and causes air to be trapped in the alveoli.
3.
Inadequate ventilation results in hypoxemia and hypercapnia.
Assessments findings :
The child may have clinical manifestations of an upper infection :
1.
fever
Nasal drainage , sneezing , coughing , poor appetite and a low – grade
2.
As these mild symptoms worsen , expect of respiratory distress, tahcypnea, shallow respiration , aspiratory crackles , expiratory wheezing tachycardia , chest retraction , dyspnea and a productive or congested cough
3.
In infants who are breast – feeding an inability to suck may cause feeding difficulties from increased respiratory effort
Nursing diagnoses :
1.
Activity intolerance
2.
Ineffective airway clearance

3.
4.
Ineffective breathing pattern
High risk for fluid volume deficit
Planning and implementation
1.
status
Assess for respiratory distress by monitoring vital signs and respiratory
2.
a.
b.
c.
Ease respiratory effort by :
Administering oxygen therapy as ordered
Suctioning as needed
Changing position frequently and elevating the head of the bed
3.
Promote rest by maintaining bed rest and organizing nursing care to minimize disturbances.
4.
Ensure adequate nutrition by providing small amount of feed at time .
5.
Support the child’s family by answering questions and explaining all treatments and procedures encourage parents to participate their child’s care as appropriate .
6.
Provide family teaching ,covering : home care and follow- up measures.