Key Pediatric Differences in the
Respiratory System
• Lack of /insufficient surfactant
• Alveoli developing
• Smaller airways
• Underdeveloped cartilage
1F
Key Differences (cont)
• Obligatory nose breather (infant)
• Intercostal muscles less developed
• Faster respiratory rate
• Eustachian tubes relatively horizontal
2
Respiratory Assessment
• RR first - full minute
• Breath sounds
• Quality
– Retractions
– Nasal flaring
• Color
• Cough
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4
Signs Respiratory Distress
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Cough
Hoarseness
Grunting
Stridor
Wheezing
Nasal flaring
Retractions
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Vomiting
Diarrhea
Anorexia
Tachypnea
Tachycardia
Restlessness
Cyanosis
5
Potential Nursing Diagnoses
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Ineffective Airway Clearance
Ineffective Breathing Patterns
Impaired Gas Exchange
Anxiety
Activity Intolerance
Risk for FVD
Altered nutrition
Altered comfort
Knowledge deficit
Ineffective coping – individual or family
6
Apnea
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Periodic breathing of newborn
True apnea
ALTE
Parental teaching
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Sudden Infant Death Syndrome
• The sudden and unexplained death of an
infant less than 1 yr old.
• Usually occurs during sleep.
• “Back to Sleep” campaign
• AAP revised SIDS guidelines (Pediatrics,
Vol. 116, No. 5, Nov. 2005)
8
Sepsis
• Def: a systemic bacterial infection spread
through bloodstream
• Neonates high risk: unable to localize
infection
• High Risk:
– Immunocompromised
– Skin defects/injuries
– Invasive devices
9
Assessment: Sepsis
• Know high risk children & monitor
– Hypo or hyperthermia
– Lethargy; poor feeding
– Jaundice, hepatosplenomegaly
– Respiratory distress
– Vomiting
– Hyper or hypoglycemia
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Otitis Media
Description: inflammation middle ear
– Acute otitis media
– Otitis media w/effusion
• Bacterial
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Risk Factors
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< 3 years
Bottle-fed babies
Passive smoke
Group child care
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Acute Otitis Media
• Definition
– Inflammation of middle ear
– Rapid onset
– Fever
– Otalgia
• Other Clinical Manifestations:
13 F
Treatment: AOM
• Primary Prevention
– pneumococcal vaccine
– No passive smoke
– Hold bottle fed babies upright
– handwashing
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AOM: Secondary Prevention
• Pain relief
• Rest
• Antibiotics after 48-72 hrs in selected
patients 6 mo to 2 yrs.
PEDIATRICS Vol. 113 No. 5 May 2004, pp. 14511465
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Nursing Dx: AOM
• Altered comfort r/t inflammation &
pressure
• Knowledge deficit r/t incomplete
understanding of disease
• Risk for Fluid Volume Deficit
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Otitis Media w/Effusion
• Definition
– Fluid in middle ear
– No s/s acute infection
• Clinical Manifestations:
17
F
Treatment: OME
• Antibiotics if > 3 mo.
• Assess for hearing loss ***
• Myringotomy w/placement
tympanostomy tubes
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Pharyngitis
• 80-90% sore throats viral in
origin
– Gradual onset
• Bacterial
– Group A beta-hemolytic strep
greatest concern.
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F
Therapeutic Management
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Primarily symptomatic
Pain relief
Rest
Abx only if positive bacterial culture
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Tonsillectomy/adenoidectomy
• Most common reason: OSA
• Monitor for post-op bleeding
– ***Excessive swallowing
– Elevated pulse, decreased BP
– Evidence of fresh bleeding
– Restlessness
• Pain meds – teach parents
• Fluids
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Croup Croup
• Broad classification of upper airway illness
• Group of conditions with:
– Inspiratory stridor
– Harsh cough
– Hoarseness
– Degrees of respiratory distress
• 4 different types
Fig. 45-UF03, p. 1209
22
F
Laryngotracheobronchitis
• Def: inflammatory condition of larynx,
trachea, bronchi
• viral
• Gradual onset
• harsh cough & insp. stridor
• Very important to differentiate from
epiglottitis
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LTB - treatment
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Racemic epinephrine via neb
Corticosteroids
Tylenol
Cool mist
Oxygen
Observe for sudden silent respiration
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Four D's of Epiglottitis
•Drooling
•Dysphagia
•Dysphonia
•Distressed respiratory
efforts
•Tripod position
•Do not: examine
•throat or do throat
culture!
•Do: reassure, keep
calm, anticipate
intubation
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F
Brochiolitis
• Lower airway
• 50% RSV (respiratory syncytial virus)
– Contact and droplet precautions
– Mycoplasma, parainfluenza, adenovirus
• Usually young infants who need
hospitalization.
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Patho of Bronchiolitis
• Virus invades
mucosal cells
• Cells die: debris
• Irritation 
increased mucus &
bronchospasm
• Air trapping
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Bronchiolitis
Clinical Manifestation
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Tachypnea
Wheezing, crackles, or rhonchi
Retractions
Fever- maybe
Difficulty feeding
Cyanosis
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Changes to Bronchiolitis Management
What You Will See
• Decrease in the amount of
nasal swabs being ordered
• Decrease in orders for CPT
by RT
• Decrease in continuous O2
saturation monitoring
• Decrease in use of albuterol
treatments
• Discharge orders for
patients with > 90% O2
saturations while asleep
What You Will Do
• When cohorting patients,
infection control may be
consulted
• Teach parents CPT for
comfort measures
• Increase amount of
intermittent O2 sat checks
(ex. Q4h)
• Increase use of Racemic
Epi
• Accept O2 saturations as
low as 88% when a patient
is sleeping
• Continue suctioning as
usual
For patients placed on Isolation Precautions: Gowns, Gloves, & MASKS are encouraged
Bronchiolitis Nursing Interventions
• Facilitate gas exchange
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Monitor I & O (for DFV)
IV prn
Reduce fever
Reduce anxiety
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Asthma
• Reactive airway disease
– Bronchospasm
– Edema
– Increased mucus production
• Triggers
– Dusts, pollen, food, strenuous exercise,
weather changes, smoke, viral infections
31
F
Asthma
Clinical Manifestations
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Wheezing
Dyspnea w/prolonged expiration
Nonproductive cough
Tachypnea, orthopnea
Tripod position
Fatigue
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Asthma treatment
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Short-acting bronchodilator
Mast cell inhibitor
Systemic corticosteroids
Inhaled steroids
Leukotriene receptor antagonist
Peak expiratory flow rate
Immunizations
33
Cystic Fibrosis
• Mechanical obstruction r/t increased
viscosity of mucous secretions.
• Autosomal recessive disorder
34
Cystic Fibrosis:
A Multisystem Disorder
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Respiratory system
Digestive system
Integumentary system
Reproductive system
Growth and development
35
F
Assessment findings - CF
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Salty-tasting skin
Profuse sweating
Frequent infections
Dry, non-productive cough
Increased amt, thickness of secretions
Wheezing
Cyanosis
36
Assessment findings – CF
(cont)
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Digital clubbing
Increased A-P diameter of chest
Steatorrhea
Thin extremities
Muscle wasting
Failure to thrive
Meconium ileus
37
Cystic Fibrosis: Interventions
strengthen lines of resistance
• Facilitate airway clearance and gas
exchange.
– CPT
– Pulmozyme
• Prevent infection
– Immunizations
– TOBI
– Azithromycin
• Promote increased exercise tolerance.
38
CF: Interventions
Provide optimal nutrition for growth.
• High-calorie, high protein
• Pancreatic enzymes with every meal
– Creon, Pancrase
– Dosage adjusted to stool formation
39
CF interventions (cont)
Strengthen FLD/extrapersonal
environment
– Child's and family's emotional needs
– Prepare the family for home care
40