Children with
Respiratory Disorders
Respiratory Tract
Development
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Trachea and esophagus originate from one hollow tube,
separate at 4 weeks gestation
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Diaphragm forms in by 7th week gestation
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Alveoli and capillaries formed by 24-28 weeks gestation
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Surfactant produced in 24th week
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by 35th week, lungs mature enough to work outside of
uterus
Normal Respirations
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Ventilation - process of breathing air into and out of lungs
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Ventilation affected by chest expansion, vagus nerve and
respiratory center in medulla, and chemoreceptors that
can increase respirations.
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Newborn: 40-60 BPM, 1-3 mos.: 35-55 BPM, 3-6 mos.:
30-45 BPM, 6-12 mos.: 25-40 BPM, 1-3 yrs.: 20-30 BPM,
3-6 yrs.: 20-25 yrs., 6-12 yrs.: 14-22 BPM, >12 yrs.: 1218 BPM
Disorders and Dysfunctions
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Nasopharyngitis - A “cold”, is also known as coryza,
rhinovirus
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S/S - Mucous in upper airways, fever (common in under
3), sore throat, cough, and general discomfort
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Treatment - no cure, Rest, Clear airways (moist air),
adequate fluid intake, prevention of fever, skin care to
nares and lips
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Teach parents and children to wash their hands to
prevent spread of infection
Disorders and Dysfunctions
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Acute Pharyngitis - inflammation of structures in the
throat.
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Common in kids 5-15, 80% caused by a virus
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S/S - fever, malaise, dysphagia and anorexia,
hoarseness, bacterial infection may lead to Strep Throat
requiring antibiotic tx
Disorders and Dysfunctions
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Croup - general term applied to a number of conditions
whose chief symptom is a “barking” croupy cough and
stridor, can be a respiratory emergency
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Can be benign congenital laryngomalacia or spasmodic
laryngitis which is relieved by providing fluids and
humidity
Disorders and Dysfunctions
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Acute Croup (laryngotracheobronchitis), a viral condition,
usually preceded by a mild upper respiratory infection
which progresses into the development of the
characteristic barking cough
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Crying and agitation worsen symptoms
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Treatment - (home): humidity, (Hospital): nebulizers,
mist(croup) tent, IV fluids, cardiorespiratory monitor, O2,
corticosteriods.
Disorders and Dysfunctions
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Epiglottitis - swelling of tissue above vocal cords, caused
by H. influenzae type B, occurring mostly in kids 3-6 yrs.
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Epiglottitis is a life-threatening medical emergency
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Onset is abrupt, S/S - child sits up, leaning forwards with
mouth open and drools due to swallowing difficulty. Child
is wide-eyed and anxious/restless. emits frog-like
croaking on inspiration with no cough. Careful inspection
to prevent laryngospasm (have tracheostomy set at
bedside)
Disorders and Dysfunctions
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Epiglottis - continued
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Treatment with immediate tracheostomy or endotracheal
intubation with O2 to prevent respiratory arrest
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Prevention - it is recommended that H. influenzae type B
vaccine is given at the beginning of 2 mos. for all children
to decrease incidence.
Disorders and Dysfunctions
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Bronchitis - an infection of the bronchi, usually a
secondary condition associated with colds or other
communicable diseases, mostly affects kids under age 4
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Gradual onset of unproductive “hacking” cough after
having a cold.
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Treatment - cough suppressants at HS, usually recovery
is uneventful with care provided at home.
Disorders and Dysfunctions
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Bronchiolitis - a viral infection of the small airways in
lower respiratory tract occurring in infants and kids 6
mos. to 2 yrs.
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S/S - upper respiratory infection/cold with nasal
discharge, followed by the development of wheezing
cough and respiratory distress. feeding affected and child
becomes irritable and dehydrated. 50% caused by the
respiratory syncytial virus
Disorders and Dysfunctions
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RSV - most common cause of viral pneumonia, and is
the single most important respiratory pathogen in infancy
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Infants 2-7 mos. can become seriously ill because their
airways are so small and prone to obstruction. Spread by
direct contact with secretions. RSV survives more than 6
hours on countertops and is NOT spread by the airborne
route
Disorders and Dysfunctions
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Prevention of RSV with use of antibody monthly IM
injections for at risk infants
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Nurses caring for infants with RSV should not be
assigned to also care for at risk infants.
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Monitor O2 saturations, maintain O2 sats 90-95%,
suction mucous, monitor IV fluids, minimum urine output
should be 2-1 ml/kg/hr for infants and children, inhaled
bronchodilators or steroids
Disorders and Dysfunctions
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Pneumonia - inflammation of the lungs in which the
alveoli become filled with exudate and surfactant may be
reduced.
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Group B strep is the most common cause of pneumonia
in newborns, other causes of pneumonia in children
include bacterial and viral, and can occur in different
areas of the lung (bronchial, lobular)
Disorders and Dysfunctions
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Pneumonia - manifestations vary dependent on age and
causative organism. Typical S/S are: fever, cough,
tachypnea, chest pain, listless, sternal retractions, nasal
flaring, increased white blood cell count
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Treatment - antipyretics, O2, IV or PO fluids, amoxicillin
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Stress transmission precautions (cover coughs), handwashing. Plan activity to promote rest.
Disorders and Dysfunctions
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Smoke inhalation - may cause carbon monoxide
poisoning
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3 stages of injury: pulmonary insufficiency (first 6 hrs).
pulmonary edema (6-72 hrs), bronchopneumonia (after
72 hrs)
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Pulse oximetry does not work for carbon monoxide
poisoning
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Respiratory arrest can occur with smoke inhalation. Keep
intubation tray readily available
Disorders and Dysfunctions
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Tonsillitis/Adenoiditis - located in the pharynx, made up
of lymph tissue acts as defense against infection.
Difficulty swallowing, blocked nasal passages are some
S/S.
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Removal of tonsils and adenoids is T&A, not
recommended for children under 3. Drainage facilitation
is important after surgery. Frequent swallowing while
child sleeping is an early sign of bleeding after
tonsillectomy. Avoid red colored liquids. Keep child quiet
for a few days after procedure.
Disorders and Dysfunctions
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Allergic Rhinitis - allergic response, caused by mast cells
in nasal mucous respond to an antigen, releasing
histamine which causes edema and increases
secretions.
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S/S - red/watery eyes, dark circles under eyes, mouth
breathing, allergic salute.
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Treat with antihistamines and decongestants
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Teach parents likely causes (animal dander, dust) and
how to reduce these allergens
Disorders and Dysfunctions
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Asthma - syndrome caused by increased responsiveness
of the tracheobronchial tree to a stimuli causing
constriction of airways. It is a recurrent and reversible
obstruction of the airways in which bronchospasm,
mucosal edema, and secretions contribute to narrowing
of the airways. The reaction may be triggered by an
allergen, environmental factors, rapid changes in
temperature/humidity, viral infection, emotional upset.
Disorders and Dysfunctions
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S/S - symptom onset may be slow or abrupt, trapped air
in lungs cause hyperinflation of lungs and can increase
the effort of breathing and strain the heart. Acute
episodes include cough, wheezes, difficulty breathing,
increasing heart rate and respiratory rate. Attacks often
happen at night.
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Shortness of breath, restricted breath sounds and rising
respiratory rate may indicate imminent respiratory failure
and needs prompt attention.
Disorders and Dysfunctions
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Asthma treatment - maintain pulmonary function,
maintain activity level, prevent chronic S/S, prevent
exacerbation. Medications include bronchodilators, antiinflammatory drugs, leukotriene modifiers.
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Teach control of environmental triggers, household
modifications, use of peek flow meters, how to use
inhalers properly
Disorders and Dysfunctions
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Status asthmaticus - continued severe respiratory
distress that is not responsive ti drugs, including
epinephrine and aminophylline and is a MEDICAL
EMERGENCY.
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Principles of asthma treatment: daily monitoring,
symptom diary, treatment plan, ID and avoid triggers
Disorders and Dysfunctions
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Cystic Fibrosis - occurs approximately 1 in 3000
caucasian births and 1 in 17,000 African American births.
It is an inherited recessive trait, both parents carry the
gene. Screening is done after birth of all infants.
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CF causes exocrine gland dysfunction that increases the
thickness of mucous gland secretions, and causes loss
of electrolytes in sweat because of abnormal chloride
movement
Disorders and Dysfunctions
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CF is a multi-system disease:
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Respiratory system-obstruction from thick secretions
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Digestive system-mucous prevents digestive enzyme
flow, results in poor nutrient absorption
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Skin-loss of electrolytes (salty skin)
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Reproductive system-decreased sperm motility,
thicken cervical mucous prevents perm from reaching
fallopian tubes
Disorders and Dysfunctions
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Treatment of CF:
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Respiratory-aerosol therapy, bronchodilators, postural drainage
(between meals), breathing exercises, prevention of infection
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Diet-pancreatic enzymes given with each meal, fat-soluble
vitamins, diet high in protein and calories, allow free access to
salt
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General hygiene-special skin care, position changes due to
low fat and muscle
Disorders and Dysfunctions
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CF long-term care - minimize pulmonary complications,
ensure adequate nutrition, promoting
growth/development, and assisting family adjust to
chronic condition. Give education to parent on diet,
medications, postural drainage, prevention of infection,
rest and medical supervision. encourage parent roomingin when child is hospitalized.
Disorders and Dysfunctions
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Sudden Infant Death Syndrome - SIDS is defined as
sudden, unexpected death of an apparently healthy
infant between 2 weeks and 1 year in which autopsy fails
to identify a cause.Incidence decreased by 38% when
“back to sleep” program implemented. Risk factors
include maternal smoking and cocaine use, and preterm
birth.
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Recommended that all parents be taught CPR, keep
pillow, stuffed animals and padding out of infant crib, and
keep blankets away from child’s face.
Question
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An 8-year old child has a history of asthma and lives with
her mother and younger sister. In assessing the home
environment, the nurse learns that the family lives in a
townhouse and has one cat and two dogs. The mother
smokes two packs of cigarettes a day, the child shares a
room with her younger sister, and the house is carpeted.
How could the mother modify the home environment to
better control her daughter’s asthma?
Answer
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Teach triggers (dust, animal dander, wool, feathers, pollen,
mold, cigarette smoke, and strong odors).
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Don’t expose to smoke or chemicals, get rid of animals
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Humidify living area and use HEPA filter
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Keep home free of dust and mold, remove carpeting if
possible, wash bedding in hot water
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remove stuffed animals, cover mattress/pillows
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