Pediatric
Nursing
Module 2 Caring for Children
with Alterations in Oxygenation
Chapter 12
Differences between Children and Adults
 Chest/Respiratory System
– Obligate nasal breathers >6wks
– Short neck
– Smaller, narrower airways
 = more susceptible to airway obstruction and resp. distress
– Tongue is larger in proportion to the mouth
 = more likely to obstruct airway in unconscious child
Differences between Children and Adults
 Chest/Respiratory System
– Smaller lung capacity and underdeveloped intercostal
muscles, poor chest musculature
 = less pulmonary reserve, lung damage w/o fx
– Children rely on diaphragm breathing
 = high risk for resp. failure if the diaphragm unable to contract
Adjunct Assessments
 Temperature
– Febrile state increases oxygen consumption
 Fluid Needs
– Vomiting/diarrhea are commonly associated
with respiratory illness
– Increase respiratory efforts, increased fluid
losses with decreased po intake requires an
increase in fluid needs
Respiratory System
 Inspection
– Chest
 Size, symmetry movement
 Infancy shape is almost circular
 < 6-7 years respiratory movement primarily
abdominal or diaphragmatic
– Respirations
 Rate, rhythm, depth, quality, effort
 >60 /min in small children = significant respiratory
distress
Respiratory Assessment
 Retractions
– Substernal
– Subcostal
– Intercostal
– Suprasternal
– Supraclavicular
 Effort
– Grunting
– Nasal flaring
Respiratory Assessment
 Color
– Mucous membranes
– Nailbeds
– Skin
– Cyanosis
Respiratory Assessment
 Auscultation
– Listen comparing one areas to the other
 Equality of breath sounds
 Diminished
 Poor air exchange
– Abnormal breath sounds
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Rales
Rhonchi
Wheezing
Grunting
– Present on inspiration or expiration
Upper Respiratory Tract Infections
Tonsillitis
 Tonsils
– Lymphoid tissues
– Abundance in children
especially tonsils
 Tonsillectomy
– Pre-op
 Bleeding time
 Loose teeth
Tonsillectomy
 Post-op
– T & A position
 Semi prone with head turned to the side
– Monitor for bleeding
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Frequent swallowing
Persistent pulse of 120 or greater at rest
Restlessness
Pallor
Vomiting bright red blood
May bleed for 5-10 days post-op
– Home care
 Diet
Otitis Media
Acute infection of the middle ear
 Generally bacterial
– H. influenza
– S. pneumoniae
 Signs/Symptoms
– Fever (maybe)
– Pulling, tugging on ears
– GI upset – vomit/diarrhea, poor appetite
Otitis Media
– Irritability
– URTI
 Treatment
– Antibiotics
Ampicillin, amoxicillin
Nursing Concerns
- compliance
- chronic or recurrent otitis media
- hearing loss can lead to speech impediments
Croup - Acute Laryngotracheal
Bronchitis
 Upper airway problem
– Edema, swelling of the larynx
– Viral 3 months to 3 years
– Bacterial 3 to 7 years
 Signs/Symptoms
– Croupy cough
– Inspiratory stridor
– Hoarseness
– Fever
– Drool
Croup
 Primary concern
– Obstruction of the airway
– Sedatives are contraindicated
– Treatment – racemic epinephrine, cool mist
Infections of the Lower Airways
Broncholitis / RSV -Respiratory Syncytial Virus
 Common cause of bronchiolitis or the common cold in
infants
 Signs/Symptoms
– Pharyngitis
– Fever
– Otitis media
– Tachypnea
– Apnea spells
– Poor air exchange
– Secretions
RSV
 Treatment
– Aerosol respiratory treatments
– Supplemental 02
– Vaccine for high risk infants
Long Term Respiratory Dysfunction
Asthma
 Chronic inflammatory disease of
airways
– airway inflammation
– bronchospasm
– obstruction
 Triggers
– environmental, chemical, tobacco,
exercise, cold air, infection,
medication, foods, emotions
Asthma
 Signs and Symptoms
– Respiratory
 cough
 auscultation - prolonged expiration, wheeze,
diminished breath sound
 shortness of breath
– short panting phrases
– Other
 restlessness, apprehension, cyanosis, sweating
Cystic Fibrosis
Cystic Fibrosis
 Hereditary disease of the exocrine glands
thick, tenacious secretions of the mucousproducing glands especially of the bronchi
and pancreatic ducts
 Lungs
– Chronic lung disease
 Bronchial obstruction
– pulmonary hypertension
 Over inflation of the lungs
 Repeated lung infections
Cystic Fibrosis
 G.I System
– Pancreatic ducts
– Blockage of enzymes
needed for digestion
 Sweat glands
– Secretions contain
excessive amount of
salt
Cystic Fibrosis
 Signs/symptoms
– Newborn meconium ileus
– Tastes salty when kissed
– Recurrent respiratory illnesses
– Failure to gain weight with a good
appetite
– Malasbsorption of fats and proteins
 Stools are foul smelling, frothy and
bulky
 Pot belly with wasted buttocks
Cystic Fibrosis
 Diagnosis
– Family history of CF
– Repeated illnesses/hospitalization with
respiratory problems or failure to thrive
– Absence of pancreatic enzyme or stool studies
– + sweat chloride tests
 Concentration of Cl > 60mEq/L
Cystic Fibrosis
 Treatment
– Nutritional
 Pancreatic enzymes with meals and snacks
 Vitamin replacement – A,D,E,K
 High protein, high calorie diet
– Pulmonary
 Thin the secretions, keep them mobile
– CPT
– Aerosol Treatment
 bronchodilators, D-nase
Cystic Fibrosis
 02 when needed
 Antibiotics for resp. infections
 Pulmonary complications
– Atelectasis
– Lung abscesses
– Pneumothorax
– Emphysema
 Prognosis
– Life expectancy teen years to early 20s
SIDS
 Sudden Infant Death Syndrome
 Unexplained death of infant less than 1 year
of age
 More common in males
 Prevention
 Nursing concerns
Respiratory – Nursing Diagnosis
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Impaired gas exchange
Ineffective airway clearance
Ineffective breathing pattern
High risk fluid volume deficit
Altered tissue perfusion
Anxiety
Activity Intolerance
Altered growth/development
Knowledge deficit
Nursing Interventions
 Assess respiratory status
– Tachypnea, labored breathing, shallow
breathing
– Effort
 Retractions
 Nasal flaring
 Head bobbing
– Grunting
– Apnea
– Poor air exchange
– 02 saturation
Nursing Interventions
 Oxygenation/ventilation needs
– Administer O2
 Incubator/oxygen hood
 Nasal prongs
 Mist tent
– Tracheotomy – croup
 Decrease respiratory efforts
 Infant car seat
 Knee-chest position
Nursing Interventions
 Maintain airway
– Head tilt – do not hyper
extend neck
– Aerosol treatment
– CPT
– Suction bulb syringe, BBG
or tracheal bronchial
 Fluids
– IV or po
Nursing Interventions
 Labs
 Medications
 Conserve energy
– Organize care
 Monitor vital signs
 Teaching