Alterations in oxygenation
LEANNE ASHLEY D. BONIFACIO, RN, MN
divisions of the respiratory system
UPPER RESPIRATORY
TRACT
•
•
•
•
•
LOWER RESPIRATORY
TRACT
Nose
Paranasal sinuses
Pharynx
Larynx
Epiglottis
• Bronchi
• Bronchioles
• Alveoli
presentation title
3
R E S P I R AT O RY T R A C T D I F F E R E N C E S I N
CHILDREN
Frontal and
sphenoidal sinuses
do not develop until
6 to 8 years of age
Tongues are large in
proportion to the
mouth
Infants have small
nares and are
obligate nose
breathers
Airway is smaller in
diameter and shorter
in length
Airway structures
have greater laxity
Have large
occiputs when
compared with an
adult
a. Infant’s large occiput has
caused flexion of the head
and subsequently caused the
base of the tongue to obstruct
the upper airway.
b.Placing a towel under the
shoulders and neck allowing
more extension of the head
and an opening of the upper
airway
relieves
the
obstruction.
physical assessment of a
child with a respiratory
disorder
Cough
▪ Initiated by stimulation of the nerves of the
respiratory tract mucosa.
▪ Clears excess mucus or foreign bodies from the
respiratory tract or as a response to gastric
contents refluxed into the airway.
❑ Paroxysmal coughing - series of expiratory coughs
after a deep inspiration.
Rate & Depth of Respirations
▪ Tachypnea - often is the first indicator
of respiratory distress in young children
▪ Assess not only the rate but also the
depth and quality of respirations and
other vital signs
Retractions
▪ Created when the child must inspire
more forcefully than normal to
inflate their lungs because of an
airway obstruction or stiff,
noncompliant lungs.
Restlessness
▪ Children
hypoxia
or
can
infants
become
who
have
anxious
and
restless.
▪ May be one of the first signs of
airway
obstruction
or
the
respiratory obstruction is becoming
acute.
Cyanosis
▪ Can indicate hypoxia.
▪ Not always an accurate indication of
the degree of airway difficulty.
Clubbing of Fingers
▪
A change in the angle between the
fingernail and nail bed because of
increased capillary growth in the
fingertips.
Adventitious Sounds
o Rhonchi - vibrations produced as air is forced past an
obstruction, such as mucus in the nose or pharynx.
o Stridor - harsher, strident sound on inspiration if the
obstruction is at the base of the tongue or in the larynx.
o Wheezing - expiratory whistle sound if an obstruction is in the
lower trachea or bronchioles.
o Rales - fine crackling sounds if the alveoli become fluid filled.
Chest Diameter
▪ “Pigeon breast” - elongated
anteroposterior diameter of
the chest due to chronically
trapped air in lung alveoli
(hyperinflation).
common disorders of the
respiratory system in children
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i. UPPER RESPIRATORY
TRACT
CHOANAL ATRESIA
➢ Congenital obstruction of the posterior
nares by an obstructing membrane or
bony growth, which prevents a newborn
from drawing air through the nose and
down into the nasopharynx
17
Cause & risk factors
• Exact cause is unknown.
• Thought to be a combination of genetic and environmental
factors.
• More common in females.
• Higher risk if the birth parent takes certain thyroid medications
during pregnancy
• There are also potential links between choanal atresia and high
pre-pregnancy intake of vitamin B12, zinc, and niacin.
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19
Most common anomaly associated
with choanal atresia
presentation title
SIGNS & SYMPTOMS
• Chest retracts unless the child is breathing through mouth
or crying.
• Difficulty breathing following birth, which may result in
cyanosis (bluish discoloration), unless infant is crying.
• Inability to nurse and breathe at same time.
• Inability to pass a catheter through each side of the nose
into the throat.
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Management & interventions
➢Assist in resuscitation if indicated.
➢Monitor vital signs closely.
➢Aid in providing supplemental oxygen.
➢Give intravenous (IV) fluid as ordered to maintain their
glucose and fluid level until surgery can be performed.
➢Surgery is the only definitive treatment to correct the
obstruction and restore airflow.
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ACUTE NASOPHARYNGITIS
➢Also known as the “common cold”
➢ It is the most frequent infectious disease in
children
➢Incubation period is typically 2 to 3 days
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Cause & risk factors
▪ Viruses: rhinovirus, respiratory syncytial virus (RSV), adenovirus,
parainfluenza viruses, influenza viruses
▪ Children who are in ill health from some other cause, or who have
a
compromised immune system, are more susceptible.
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SIGNS & SYMPTOMS
• Nasal congestion
• Sore throat
• Low-grade fever
• Cough
• Cervical lymph nodes
• Watery rhinitis
may be swollen and
• Difficulty
palpable
breathing
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Management & interventions
➢No specific treatment.
➢ Encourage increased fluid intake.
➢Remove nasal mucus via a bulb syringe
➢Emphasize
before feeding (for infants) as needed.
importance
of
hand
hygiene.
➢Administer antipyretics for fever as ordered.
➢Educate parents regarding use of
➢Administer nasal saline drops/spray
➢ Place the child in a semi-Fowlers position
using pillows to facilitate lung expansion.
cool-mist vaporizers.
➢Caution parents not to give Aspirin
for children below 18 years of age :
Reye’s syndrome
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TONSILLITIS
➢Inflammation of the tonsils, two
oval-shaped pads of tissue at the
back of the throat.
❖ Frequent tonsillitis:
•More than 7 episodes in 1 year
•More than 5 episodes a year during a 2-year period
•More than 3 episodes a year during a 3-year period
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Cause & risk factors
• Most often caused by a viral infection (rhinovirus, adenovirus, respiratory syncytial
virus or RSV)
• Can also be caused by bacterial infection (group A streptococcus)
o Risk factors:
• Between ages 5 and 15 years
• Crowded environments
• Poor hand hygiene
• Not able to complete the whole course of antibiotic (bacterial tonsillitis)
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SIGNS & SYMPTOMS
▪ Red, swollen tonsils
▪ White or yellow
coating or patches
on the tonsils
▪ Sore throat
▪ Difficult or painful
swallowing
▪ Enlarged, tender glands
(lymph nodes) in the neck
▪ A scratchy, muffled or
throaty voice
▪ Bad breath
▪ Stomachache
▪ Neck pain or stiff neck
▪ Headache
▪ Fever
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❑ In young children
who are unable to
describe how they
feel, signs of
tonsillitis may
include:
▪ Drooling
▪ Refusal to eat
Management & interventions
➢Encourage rest and plenty of sleep.
➢Provide adequate fluids.
➢Provide comforting foods and beverage.
➢Prepare a saltwater gargle.
➢Instruct parents to keep child away from irritants.
➢Medications: antipyretics, analgesics, antibiotics (if caused by bacterial
infection)
➢Surgery: Tonsillectomy
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Nursing interventions post-op
(tonsillectomy)
• Place the child prone or side-lying position.
• Apply an ice collar postoperatively and administer pain medication as
ordered.
• Encourage the caregiver to remain at the bedside.
• Give small amounts of clear fluids or ice chips when child is fully awake
• Discourage the intake of: milk, ice cream, pudding, orange juice,
lemonade.
• Assess for subtle signs of hemorrhage.
• Teach and demonstrate breathing exercises.
• Have suction equipment available at the bedside - done only during an
airway obstruction
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presentation title
CROUP
➢Inflammation of the larynx,
trachea, and major bronchi.
➢Causes swelling in the airways
and problems breathing.
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Cause & risk factors
Viruses that are known to cause croup are:
• Children between 6 months and
• Parainfluenza virus
3 years of age
• Most common in boys
• Respiratory syncytial virus (RSV)
• Family history of croup or
recurrent croup
• Influenza virus
• Adenovirus
• Enteroviruses
Risk factors:
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SIGNS & SYMPTOMS
• Barking cough (croupy cough)
• Mildly elevated temperature
Signs of severe croup include:
• Inspiratory stridor
• Marked retractions
Fatigue
Diminished breath sounds
Hypoxia
Cyanosis
• Nasal flaring
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Management & interventions
▪ Do not elicit a gag reflex in any child with a croupy, barking cough and
provide comfort to prevent crying.
▪ Provide measures for a child to remain calm using distraction, toys, etc.,
while monitoring for respiratory changes.
▪ Place child in semi-upright position.
▪ Provide supplemental oxygen as ordered.
▪ Educate importance of proper hand hygiene and keeping child away from
anyone that’s sick.
Medications:
• Inhaled bronchodilators – epinephrine, albuterol
• Corticosteroids – dexamethasone
• Antipyretics as needed
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presentation title
pharyngitis
➢ Infection and inflammation of the throat.
➢ More commonly known as sore throat.
➢ Although rare, streptococcal infections can
lead to acute rheumatic fever and
glomerulonephritis if not treated.
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Cause & risk factors
• Either bacterial or viral in origin
oViral: rhinovirus, influenza, adenovirus, coronaviruses, and parainfluenza
oBacterial: Group A β-hemolytic streptococcus (most frequently involved in
bacterial pharyngitis in children)
• May occur as a result of a chronic allergy
Risk factors:
• being between 5 to 15 years of age
• close contact with infected individuals
• being in small spaces with large groups of people
• immunosuppression
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SIGNS & SYMPTOMS
❖ Viral Pharyngitis:
❖Streptococcal Pharyngitis:
• Markedly erythematous (bright red)
back of the throat and palatine tonsil
• Enlarged tonsils
• White exudate in the tonsillar crypts
• Petechiae on the palate
• Child typically appears ill
• Fever
• Sore throat
• Headache
• Stomach ache
• Difficulty swallowing
• Scarlatiniform rash may develop
• Sore throat
• Fever
• Rhinorrhea
• Cough
• General malaise
• regional lymph nodes may be enlarged
• Erythema in the back of the pharynx and the
palatine arch
• Exudate may or may not appear on the tonsils.
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Viral pharyngitis resulting in visible
redness
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A case of strep throat
Management & interventions
▪ Encourage warm salt water gargles.
▪ Encourage adequate oral hydration.
▪ Encourage rest.
▪ Ice collar may be applied to severe sore throats.
▪ Instruct child / parent to perform proper mouth care.
▪ Avoid exposure to environmental pollutants
▪ Instruct caregivers on the compliance of antibiotic treatment.
Medications:
Oral analgesic
Antibiotics (penicillin, cephalosporin) – bacterial
etiology
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