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					                                  Pediatric
                                  Nursing

 Module 2 Caring for Children
with Alterations in Oxygenation
        Chapters 19, 20
      Differences between Children and Adults



 Chest/Respiratory System
  – Obligate nasal breathers until >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
        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
        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
Bronchiolitis / 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
                   Pneumonia
 Classified according to etiology
  – viral, bacterial, fungal, aspiration
 Signs and Symptoms
  – Respiratory
      rhonchi, rales
      dull to percussion
      retractions, nasal flaring
      cough
                 Pneumonia
– Systemic
   high fever
– Neurological
   irritable, restless, lethargic
   pain
– Gastrointestinal
   a/v/d
   abdominal pain
Chest X-ray Pneumonia
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 mucous-
  producing 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
Respiratory – Nursing Diagnosis
   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
Respiratory – Nursing Diagnosis
   PC: Atelectasis/Pneumonia
   PC: Electrolyte Imbalance
   PC: Hemorrhage
   PC: Hypoxia
         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

				
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posted:8/12/2011
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