Children’s Respiratory
Disorders
Epiglottis - RSV/Bronchitis - Pneumonia Asthma - Cystic Fibrosis
Marydelle Polk, Ph.D., ARNP-CS
Florida Gulf Coast University
Objectives
Describe factors that influence the
etiology and course of respiratory
infections in children.
Differentiate among Epiglottis,
RSV/Bronchitis, Pneumonia, Asthma,
and Cystic Fibrosis in terms of
etiology, defining characteristics, and
nursing management.
Respiratory System
The respiratory system
permits ventilation
through the process of
inspiration and expiration
Respiratory Infections
Influencing factors
* Age
* Anatomical Size
* Resistance
* Seasonal Variations
Etiology
* H. influenza, Group A -Hemolytic
Streptococcus, Staphylococci,
Chlamydia trachomatis, Mycoplasma,
pneumoccoci
Epiglotitis
Definition
A severe bacterial infection which
causes inflammation of the epiglottis
and surrounding areas.
Incidence
Usually occurs between the ages of
2 – 5 years of age, but can occur
from 7 mos. – 11 years – rarely to
adulthood.
Epiglottitis
History
Abrupt onset – History of
pharyngitis.
Clinical Signs & Symptoms
Wakes up looking very ill, fever,
sore throat, dysphagia, drooling,
dyspnea, “dog position.”
Epiglotitis
Clinical Signs & Symptoms
* Anxious/apprehensive
* Muffled, froglike croaking
* Quiet inspiratory stridor
Always observe for the absence of
cough, drooling and agitation –
hallmarks of epiglottis.
REMEMBER !!!
1. Never examine the pharynx.
2. Leave the child in a sitting position
– preferably in parent’s lap.
3. Child is anxious – Do not cause
further distress and never leave the
child alone.
4. Cyanosis is a late sign of hypoxia
(PO2 < 50).
Nursing Diagnoses
Ineffective breathing pattern r/t
inflammatory process.
Fear/anxiety r/t difficult breathing and
unfamiliar place/procedures.
Nursing Coventions
Observe for progressive worsening of
respiratory status.
Prepare for tracheostomy.
Be prepared for administration of O2,
IV antibiotics, sedation.
Monitor VS, LOC, O2 levels, fluid status.
Provide calm reassuring support to child
and parents.
Prevention is via the H. influenza B
vaccine.
Nursing Coventions
Administer antipyretic medication,
tepid sponge baths, or cooling
mattress if indicated.
If needed, provide cool mist for
humidifying air.
Ensure adequate rest and provide a
less stressful environment.
Organize nursing care to give
adequate rest periods.
Early Epiglottitis
Note the
tripod
(dog-like)
position
and the
leaning
forward
Progressive Epiglottitis
Bronchiolitis
Definition – An acute viral infection
primarily occurring at the level of the
bronchioles.
Etiology – Respiratory Syncytial Virus
(RSV). Subgroup A > B in children
developing bronchiolitis and
pneumonia.
Incidence and Transmission
* URI of the infant – 2-5 mos. Rare in
children over 2 years. Considered
to be the most important pathogen
in the infant. Usually preceded by a
viral URII (RSV).
* Increased incidence due to (1)
direct contact – hands, eyes, nose,
mucous membranes and (2) the
virus has a long life span.
Clinical Manifestations
Mild (Initial phase)
*
*
*
*
Rhinorrhea
Pharyngitis
Coughing and sneezing
May present with ear or eye
infection
* History of intermittent fever
Clinical Manifestations
Moderate (Progressive)
*
*
*
*
 coughing and wheezing
Air hunger and  WOB
Tachypnea and retraction
Cyanosis
Sternal Retractions
When an
infant/child
is
retracting
like this –
what else
would you
observe?
Clinical Manifestations
Severe
*
*
*
*
*
Tachypnea > 70 breaths/minute
Listlessness
Apnea spells
Poor air exchange
 breath sounds
Nursing Diagnoses
Ineffective breathing r/t poor gas
exchange.
Altered activity level r/t work of breathing.
Potential of fluid volume deficit r/t poor
fluid intake.
Nursing Coventions
Provide  humidity – cool, moist
oxygen
Adequate fluid intake
Ongoing assessment and monitoring
of O2 status, VS, activity level
Possible administration of antiviral
agents (RespiGam – used more for
prophylactic value)
Nursing Coventions
Conserve child’s energy
Observe for signs of dehydration:
*
*
*
*
Sunken fontanel
Poor skin turgor
Dry mucous membranes
Decreased and concentrated
urinary output
Remember…
As this infection is due to a virus –
standard Rx may not prove to be
effective in non-complicated situations,
including:
* antibiotics
* bronchodilators
* corticosteroids
* cough suppressants
Pneumonia
Inflammation of the alveoli
caused by bacteria, virus,
Mycoplasma organisms,
aspiration, or inhalation.
Types of Pneumonia
Lobar – Large areas (segments) of
one or both lungs are
involved.
Broncho – bronchioles become clogged
with thick mucopurulent
mucus  consolidates into
patches in nearby lobes.
Types of Pneumonia – con’t.
Interstitial – Primarily occurs
within the alveolar walls and
interlobular tissues.
Incidence and Etiology
Incidence
10-20 % of the cases of pneumonia are
bacterial;
10 % are mixed – both viral and bacterial.
70 – 80 % are viral.
Etiology
Mycoplasma pneumoniae – most common in
children 5 – 12 years-of-age.
Chest x-rays - Pneumonia
Clinical Manifestations
 fever
Cough (productive or nonproductive)
Tachypnea
Fine crackles and rhonchi
Chest pain
Retractions and nasal flaring
Pallor to cyanosis
Irritability – restless – lethargic
GI disturbances (nausea, diarrhea, pain,
anorexia).
Nursing Diagnoses
Ineffective airway clearance r/t
inflammation.
Pain r/t inflammatory process:
pneumonia
Nursing Coventions
Administer and monitor antibiotic therapy
(bacterial).
Monitor fluid intake, VS (especially the
temperature – give antipyretics in needed
(fever/irritability), bed rest, cool mist
humidifier.
In-hospital – monitor O2 if child develops
respiratory distress.
Avoid cough suppressants.
Teach parents s/s of respiratory distress
and dehydration.
Conserve child’s energy.
Reactive Airway Disease - Asthma
Definition – inflammatory process of the large
airways, which results in heightened airway
reactivity.
An obstructive disorder – due to the
inflammation and edema of the mucous
membranes,  in thick, tenacious secretions,
spasms of the bronchial smooth muscle  a 
diameter of bronchioles.
Types of Asthma
Mild Intermittent Asthma
* S/S  2 times per week
* Exacerbations are brief
* Nighttime s/s  2 times per month
* Asymptomatic between episodes
* Does not require chronic drug therapy
* Teach and encourage parents to 
exposure to allergens
Types of Asthma
Mild Persistent Asthma
S/S > 2 times per week - < 1/day
Exacerbations may/may not affect
exercise
Nighttime s/s > 2 times per month
Tx with a nonsteroidal Rx - Cromolyn
Sodium, a low dose inhaled corticosteroid or a leukotriene inhibitor.
Types of Asthma
Moderate Persistent Asthma
*Daily s/s
*Daily use of short-acting 2-agonist or a low
dose long-acting bronchodilator
*Exacerbations affect exercise
*Exacerbations  2 times per week and may last
for days
*Nighttime s/s > 1 time per week
*May see Nedocromil (Tilade) given in children
5 years or younger in place of long-acting
bronchodilator
Types of Asthma
Severe Persistent Asthma
* Continual s/s
* Frequent exacerbations
* frequent nighttime s/s
* PEFR and/or FEV1 > 1 second and  60
% of predicted value
* Tx - high dose inhaled corticosteroids
(Vanceril, Flovent) plus oral steroids
as needed to control s/s
Asthma
Educate child and family about the
disease - assist them to identify the
triggers - help them in developing an
“asthma action” plan AND teach and
encourage child to use a peak flow
meter regularly as part of his/her
action plan to determine management
of their s/s.
Asthma
Guidelines for child:
 80% of child’s baseline is acceptable.
50 - 80% of child’s baseline indicates
obstruction.
 50% of child’s baseline indicates an
acute attack.
Nursing Diagnoses
Ineffective airway clearance r/t
allergenic response and inflammatory
process in bronchial airways.
Risk for suffocation r/t bronchospasm,
edema and  tenacious mucus.
Nursing Coventions
Allergy control
Drug therapy
Chest PT
Hydration
Exercise
Keeping up with immunizations/flu
vaccine
Desensitization therapy
O2 Delivery Devices
Metered Dose Inhaler-Spacer
Remember
Assessment - Teaching - Monitoring
are hallmarks of effective care for the
asthmatic child - whether in an acute
care facility or community health
center.
Cystic Fibrosis
Definition
An inherited, autosomal recessive disorder,
which affects the exocrine glands and results in
multisystem involvement.
Most significant factor - The  viscosity of
mucus gland secretions = obstruction
Cystic Fibrosis
Areas of involvement
*
*
*
*
Respiratory system
Integumentary system
GI system
Reproductive system
Cystic Fibrosis
Major signs and symptoms due to:
* Lack of sufficient pancreatic
enzymes.
* Gradual obstructive lung disease
*  sweat gland function.
Nursing Diagnoses
Ineffective airway clearance r/t
increased mucus production.
Alteration in nutrition -  body
requirements r/t malabsorption.
Nursing Coventions
Administer and monitor effects of antibiotic,
bronchodilator, and nutritional management.
Teach chest PT - MAINSTAY of therapy!
Teach proper postural drainage technique.
Promote exercise, deep breathing and
directed coughing.
Teach parents/child s/s of infection and
complications i.e. pneumothorax
Nursing Coventions
Administer and/or monitor pancreatic
enzyme replacement therapy. ** Always
administer with meals and snacks amount given relates to degree of
insufficiency and the child’s response to
the enzyme therapy. Goal is to prevent
FTT and to  number of stools.
Teach parents/child about s/s of Na+
depletion and rectal prolapse
The End...