Guided Lecture Notes, Chapter 18, Nursing Care of the Child With a Respiratory
Disorder
Learning Objective 1. Distinguish differences between the anatomy and physiology of
the respiratory system in children versus adults.
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Teach your students that respiratory disorders are the most common causes of
illness and hospitalization in children and account for the majority of acute
illnesses in children.
Emphasize the fact that newborns are obligatory nose breathers until at least 4
weeks of age and cannot automatically open their mouths to breathe if the nose is
obstructed.
Discuss how the anatomy of the nose and throat differs in infants, making them
more prone to acquire infections. (Refer to PowerPoint slide 2.)
Point out that the airway lumen is smaller in infants and children than in adults
and when edema, mucus, or bronchospasm is present, the capacity for air passage
is greatly diminished. Note that a small reduction in the diameter of a child’s
airway will result in an exponential increase in resistance to airflow, causing
increased work or breathing. (Refer to PowerPoint slide 3 and Figure 18.1.)
Explain the occurrence of congenital laryngomalacia due to the funnel shape and
location of the larynx, increasing the chance of aspiration of foreign material into
the lower airways. (Refer to Box 18.1.)
Note that the child's airway is highly compliant, making it quite susceptible to
dynamic collapse during airway obstruction.
Discuss the location of the trachea at the third thoracic vertebra in children as
opposed to the sixth in adults and how this difference is important when
suctioning children and assessing for risk for aspiration. Review the differences in
the lower respiratory structures. (Refer to PowerPoint slide 4.)
Point out that children have a significantly higher metabolic rate than adults and
how this affects normal oxygen transport.
Learning Objective 2. Identify various factors associated with respiratory illness in
infants and children.
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Emphasize the fact that children exposed to environmental smoke have an
increased incidence of respiratory illnesses such as asthma, bronchitis, and
pneumonia (WHO, 2011).
Discuss what the nurse would inspect and observe when conducting a physical
assessment for respiratory disorders. (Refer to PowerPoint slide 5 and Figures
18.4 and 18.5.)
Review the breath sounds heard over the anterior and posterior chest and axillary
areas including wheezing and rales. Note that breath sounds should be equal
bilaterally, and prolonged expiration is a sign of bronchial or bronchiolar
obstruction.
Remind students that when percussing the chest, sounds that are not resonant in
nature should be noted. (Refer to PowerPoint slides 6, 7, and 8.)
Learning Objective 3. Discuss common laboratory and other diagnostic tests useful in
the diagnosis of respiratory conditions.
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Review the laboratory and diagnostic tests most commonly used for a child with a
respiratory disorder. (Refer to Common Laboratory and Diagnostic Tests 18.1.)
Discuss the laboratory and diagnostic tests ordered for the assessment of RSV
bronchiolitis. (Refer to PowerPoint slide 9.)
Note the common laboratory and diagnostic tests ordered for the assessment of
pneumonia. (Refer to PowerPoint slide 10.)
Outline the laboratory and diagnostic tests ordered for the diagnosis and
assessment of cystic fibrosis. (Refer to PowerPoint slide 11.)
Learning Objective 4. Describe nursing care related to common medications and other
treatments used for management and palliation of respiratory conditions.
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Discuss common medical treatments and medications used to treat respiratory
illness in children. (Refer to PowerPoint slides 12, 13, and 14; Common
Medical Treatments 18.1; and Drug Guide 18.1.)
Teach your students that therapeutic management of respiratory distress syndrome
(RDS) focuses on intensive respiratory care, usually with mechanical ventilation.
Note that newer techniques for ventilatory support are also available. (Refer to
PowerPoint slide 15 and Table 18.2.)
Learning Objective 5. Recognize risk factors associated with various respiratory
disorders.
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Remind your students that acute infectious disorders include the common cold,
sinusitis, influenza, pharyngitis, tonsillitis, laryngitis, croup syndromes,
respiratory syncytial virus (RSV), pneumonia, and bronchitis. (Refer to
PowerPoint slide 16.)
Discuss the risk factors for severe influenza infection, including chronic heart or
lung disease (such as asthma), diabetes, chronic renal disease, or immune
deficiency or children with cancer receiving chemotherapy.
Teach your students that pneumonia is an inflammation of the lung parenchyma
caused by a virus, bacteria, Mycoplasma, or fungus. Point out that respiratory
viruses are the most common cause of pneumonia in younger children and the
least common cause in older children.
Outline risk factors for tuberculosis. (Refer to PowerPoint slide 17.)
Tell your students that acute respiratory distress syndrome (ARDS) occurs
following a primary insult such as sepsis, viral pneumonia, smoke inhalation, or
near drowning. Note that respiratory distress and hypoxemia occur acutely within
72 hours of the insult in infants and children with previously healthy lungs.
Review risk factors for acquiring a pneumothorax, including chest trauma or
surgery, intubation and mechanical ventilation, or a history of chronic lung
disease such as cystic fibrosis.
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Discuss the risk factors for apnea and SIDS. (Refer to Box 18.4 and Figure
18.15.)
Learning Objective 6. Distinguish different respiratory disorders based on their signs
and symptoms.
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Review the common signs and symptoms of sinusitis, including cough, fever,
halitosis, facial pain, eyelid edema, irritability, and poor appetite.
Note that onset of pharyngitis is often quite abrupt and the history may include
fever, sore throat and difficulty swallowing, headache, and abdominal pain. (Refer
to Figure 18.7.)
Note the signs and symptoms of bronchiolitis (RSV). (Refer to PowerPoint slide
18.)
Discuss the signs and symptoms of a pneumothorax. (Refer to PowerPoint slide
19 and Figures 18.9 and 18.10.)
Note the signs and symptoms of the following chronic respiratory disorders:
allergic rhinitis, asthma, chronic lung disease (bronchopulmonary dysplasia),
cystic fibrosis, and apnea. (Refer to PowerPoint slide 20 and Figure 18.11.)
Discuss the characteristics (airway hyperresponsiveness, airway edema, and
mucus production) and signs and symptoms of asthma. (Refer to PowerPoint
slides 21, 22, and 23; Figures 18.12 to 18.14; and Table 18.3.)
Point out that cystic fibrosis is the most common debilitating disease of childhood
among those of European descent. Then, discuss the signs and symptoms of, and
risk factors for, the disease. (Refer to PowerPoint slide 24 and Table 18.5.)
Learning Objective 7. Discuss nursing interventions commonly used for respiratory
illnesses.
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Discuss the variety of methods that oxygen may be delivered to a child. (Refer to
PowerPoint slide 25 and Figure 18.6.)
Point out that therapeutic management of the common cold is directed toward
symptom relief and includes promoting comfort, providing family education, and
preventing spread of the cold. (Refer to Comparison Chart 18.1, Box 18.2, and
Teaching Guidelines 18.1.)
Teach your students that nursing management of mononucleosis is primarily
symptomatic and includes analgesics, salt water gargles, bed rest, rest periods,
and avoiding contact sports.
Note that children with croup may be hospitalized if they have significant stridor
at rest or severe retractions after a several-hour period of observation. (Refer to
Comparison Chart 18.2.)
Warn your students not to under any circumstance attempt to visualize the throat
of a child with epiglottis as reflex laryngospasm may occur, precipitating
immediate airway occlusion. (Refer to PowerPoint slide 26.)
Review the procedure for maintaining a patent airway. (Refer to Nursing
Procedure 18.1.)
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Emphasize the fact that the most important nursing intervention related to foreign
body aspiration is prevention. (Refer to Figure 18.8.)
Note that the stepwise approach to asthma treatment involves increasing
medications as the child’s condition worsens, then backing off treatment as he or
she improves. (Refer to Box 18.3.)
Learning Objective 8. Devise an individualized nursing care plan for the child with a
respiratory disorder.
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Review the postoperative care of a child following tonsillectomy. (Refer to
PowerPoint slide 27.)
Discuss the nursing management of pneumonia including diagnoses, goals, and
interventions. (Refer to Nursing Care Plan 18.1.)
Ask your students to prepare a nursing care plan for a child who has one of the
following acute noninfectious disorders: epistaxis, foreign body aspiration,
respiratory distress syndrome, acute respiratory distress syndrome, or
pneumothorax. (Refer to PowerPoint slide 28.)
Discuss the education provided to families of children with allergic rhinitis.
(Refer to Teaching Guidelines 18.4.)
Teach your students that anti-inflammatory inhaled medications are used for
maintenance of chronic lung disease, and short-acting bronchodilators are used as
needed for wheezing episodes. Further, note that supplemental long-term oxygen
therapy may be required in some infants.
With the class participating, develop a nursing care plan for a child with a
tracheostomy. (Refer to Nursing Procedure 18.3.)
Learning Objective 9. Develop child/family teaching plans for the child with a
respiratory disorder.
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Discuss teaching guidelines for a child with croup. Brainstorm with the class to
develop a teaching plan for a child with croup. (Refer to Teaching Guidelines
18.2.)
Review safety measures to teach parents of children with aspiration pneumonia to
prevent recurrent or further aspiration. (Refer to Teaching Guidelines 18.3.)
Tell your students that children with asthma and their families need a teaching
plan focused on the appropriate use of nebulizers, metered-dose inhalers, spacers,
dry-powder inhalers, and Diskus, as well as the purposes, functions, and side
effects of the medications they deliver. Point out that the teaching requires a
return demonstration of equipment. (Refer to PowerPoint slide 29, Table 18.4,
and Teaching Guidelines 18.5.)
Learning Objective 10. Describe the psychosocial impact of chronic respiratory
disorders on children.
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Remind your students that fear of an exacerbation and feeling “different” from
other children can harm a child’s self-esteem. Brainstorm with the class to devise
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of list of interventions to promote self-esteem in children with respiratory
disorders.
Point out that transferring control of asthma care to the child is an important
developmental process that will increase the child’s feeling of control over the
illness.
Emphasize the fact that a nurse who understands the family’s issues and concerns
and provides culturally sensitive education and interventions is better able to plan
for support and education regarding chronic respiratory disorders. (Refer to
PowerPoint slide 30.)