University of Saint Louis

Tuguegarao City, Philippines

SCHOOL OF HEALTH AND ALLIED

SCIENCES

MATERNAL AND CHILD

HEALTH NURSING
Prepared by: Jonalyn P. Santos, MSN
Lesson 7.
CARING FOR A CHILD
WITH RESPIRATORY
DISORDERS
General Symptoms of
Respiratory Disorders
• Hypoxia : Decreased levels of oxygen in the tissues
• Hypoxemia : Decreased levels of oxygen in arterial
blood
• Hypercapnia : Increased levels of CO2 in the blood
• Hypocapnia : Decreased levels of CO2 in the blood
• Dyspnea : Difficulty breathing
• Tachypnea : Rapid rate of breathing
• Cyanosis : Bluish discoloration of skin and mucous
membranes due to poor oxygenation of the blood
• Hemoptysis : Blood in the sputum
DISORDERS OF THE
UPPER RESPIRATORY
TRACT
CHOANAL ATRESIA
• Developmental failure of the nasal cavity
to communicate with the nasopharynx.
CHOANAL ATRESIA
• Rare congenital anomily
• 1 in 5000 to 8000 live births
• Female male ratio is 2:1
• Slightly increased risk exists in twins.
• Maternal age or parity does not increase
the frequency of occurrence.
Associated Disorders
• CHARGE: Coloboma, Heart disease, Atresia
of choanae, Retarded G and D, Genital
hypoplasia, Ear deformities or deafness
Etiology
• By the 38th day of development, the 2-
layer membrane consisting of nasal and
oral epithelia ruptures and forms the
choanae (posterior nares).
• Failure of this rupture results in choanal
atresia.
Types
• Unilateral or Bilateral
• Bony/ Mixed
• Congenital/ Acquired
Manifestations
• BILATERAL
• Complete nasal obstruction
• Immediate respiratory distress
• Potential death due to asphyxia
• Cyclic respiratory obstruction
• Child cries opens the mouth obstruction is
relieved
Manifestations
• UNILATERAL
• Rarely causes respiratory distress
• Mucoid discharge
• OTHER MANIFESTATIONS
• Feeding difficulty
• Respiratory collapse
• Failure to thrive
Diagnosis: Assessment
• Physical examination
• Passing of a feeding
tube through nose
Diagnosis: Assessment
• Observing misting
on a metal spatula
or laryngeal mirror
Diagnosis: Assessment
• Endoscopic
examination
Diagnosis
• Acoustic rhinometry: evaluates nasal
obstruction by analysing reflections of a
sound pulse introduced via the nostrils
• CT Scan: Confirmed with CT with
intranasal contrast that shows narrowing
of the posterior nasal cavity
Management
• IMMEDIATE
MANAGEMENT
• Breathe through
mouth
• Mc govern nipple
• Oropharyngeal airway
• Endotracheal
intubation
• Tracheostomy
RESPIRATORY INFECTIONS
• Organisms capable of infecting respiratory
structures include:
• Bacteria.
• Viruses: the majority of upper respiratory tract
infections are caused by viruses as rhinovirus
and parainfluenza virus.
• Fungi.
• Depending on the organism and extent of
infection, the manifestations can range from
mild to severe and even life threatening.
Rhinitis
• Allergic rhinitis • Nonallergic rhinitis
(hay fever) (common cold)
• Caused by: • Caused by:
• Pollen • Rhinoviruses,
• Dust mites • Adenoviruses,
• Mold • RSV
• Animal dander • Coxsackie's Viruses.
Rhinitis: Manifestations
• Manifestations • Complications
• Fever, • Acute otitis media,
• hinorrhea, • Pharyngitis,
• Sore throat, • Sinusitis,
• Cough • Conjunctivitis,
• Similar cases in the • Pneumonia,
family • Adenitis.
• Treatment:
SYMPTOMATIC
Pharyngitis
• Definition: Inflammatory syndrome of the
pharynx caused by several microorganisms
• Causes: most viral but may also occur as
part of common cold or influenza
syndrome
• The most bacterial cause is Group A
Streptococcus (Streptococcus pyogenes)-
5-20%
Pharyngitis
• Clinical presentation
with soreness of the
throat, may be
dysphagia and pain on
swallowing
• Fever
• Additional upper
respiratory symptoms
may also be present,
tender cervical
lymphadenopathy
Sinusitis
• Acute Bacterial: Bacterial Infection of the
paranasal sinuses lasting less than 30days
in which symptoms resolve completely
• Subacaute Bacterial Sinusitis: Lasting
between 30 and 90 days in which
synptoms resolve completely
Sinusitis
• Recurrent acute bacterial sinusitis: Each
episode lasting less than 30 days and
separated by intervals of at least 10days
during which the patient is asymptomatic
• Chronic Sinusitis: Episode lasting longer
than 90 days. Patients have persistent
residual respiratory stmptoms such as
cough, rhinnorrhoea or nasal obstruction.
Sinusitis: Causative Agents
• Acute sinusitis • Chronic sinusitis
• S.pneumoniae • S.pneumoniae
• H.infuenza • H.infuenza
• M.catarrhalis • M.catarrhalis
• Oral anaerobes
Sinusitis: Manifestation
• Facial pain or pressure
• Headache.
• Thick, purulent or discolored nasal discharge
• Is often thought to indicate bacterial sinusitis,
but it also occurs early in viral infections such as
the common cold
• Other nonspecific symptoms include cough,
sneezing, and fever
• Tooth pain, most often involving the upper
molars, is associated with bacterial sinusitis
Sinusitis: Management
• Antibiotics are recommended for Acute Bacterial
Sinusitis to achieve a more rapid clinical cure
• Amoxicillin at 45 or 90 mg/kg.day or Ceftriaxone
• Most response in 48-72 hours
• Duration : until symptom free plus 7 days
• Chronic treatment Same as acute sinusitis
(Duration For 2-4 weeks)
• If not resolving in 24 to 48 hours of Rx may need
surgical intervention ( frontal sinus trephination
or external sinusectomy)
LARYNGOTRACHEBRONCHITIS
(CROUP)
• Laryngotracheitis
Laryngotracheobronc
hitis
• most common
etiology for
hoarseness, cough,
and onset of acute
stridor in febrile
children
LARYNGOTRACHEBRONCHITIS
(CROUP)
• Viral respiratory
illnesses
• Characterized by
marked swelling of
the subglottic region
of the larynx
• Croup primarily
affects children <6
years old
Incidence
• Male-to-female ratio for is approximately
1.4:1.
• Primarily a disease of infants and toddlers,
croup has a peak incidence from age 6-36
months (3 y).
Etiology
• Viruses causing acute infectious croup are
spread through either:
• Direct inhalation from a cough and/or sneeze
• By contamination of hands from contact with
fomites
• Parainfluenza viruses (types 1, 2, 3) are
responsible for as many as 80% of croup
cases
• Parainfluenza types 1 and 2, accounting for
nearly 66% of cases.
Etiology
Croup: Manifestations
• Seal-like barking cough or hoarseness.
• Worse at night and can last 5 to 6 days.
• Inspiratory stridor
• Variable degree of respiratory
• distressDecrease breath sounds.
• Dyspnea
• Fever low grade (38-39°C) but can exceed
40°C.
Croup: Manifestations
• Steeple or pencil
sign of the
proximal trachea
evident on this
anteroposterior
film
Weastley Score for Croup
• Evaluates the severity of croup by
assessing the following 5 factors, with a
score range of 0 to 17
Complications
• Rare
• Less than 5% of children who were diagnosed
with croup required hospitalization .
• Less than 2% of those who were hospitalized
were intubated.
• Death occurred in approximately 0.5% of
intubated patients.
• A secondary bacterial infection may result in
pneumonia or bacterial tracheitis
Diagnosis
• Croup is primarily a clinical diagnosis, with
the diagnostic clues based on presenting
history and physical examination findings.
• Laboratory test results rarely contribute to
confirming this diagnosis. The complete
blood cell (CBC) count is usually nonspecific
• Pulse oximetry is helpful to assess for the
need for supplemental oxygen support and
to monitor for worsening respiratory.
Management
• Current cornerstones in the treatment of
croup are corticosteroids and nebulized
epinephrine
• Nebulized racemic epinephrine is typically
reserved for patients in moderate to severe
distress.
• Steroids have proven beneficial in severe,
moderate, and even mild croup
• Careful monitoring of: Heart rate, Respiratory
rate, Respiratory mechanics, Pulse oximetry
Discharge Criteria
• Patients can be discharged home only if
they demonstrate:
• Healthy color
• Good air entry
• Baseline consciousness
• No stridor at rest
• Have received a dose of corticosteroids.
DISORDERS OF THE
LOWER RESPIRATORY
TRACT
BRONCHITIS
• Swelling and irritation in child's air passages.
• This irritation may cause him to cough or
have other breathing problems.
• Acute bronchitis often starts because of
another illness, such as a cold or the flu.
• The illness spreads from your child's nose
and throat to his windpipe and airways
• Acute bronchitis lasts about 2 weeks and is
usually not a serious illness.
Etiology and Risk Factors
• Infection: Acute bronchitis is most often
caused by a type of germ called a virus. It may
also be caused by other germs, such as
bacteria, yeast, or a fungus.
• Viral :Adenovirus, Influenza, Parainfluenza,
Respiratory syncytial virus, Rhinovirus, Human
bocavirus, Coxsackievirus, Herpes simplex virus
• Bacterial :S pneumoniae, M catarrhalis, H
influenzae , Chlamydia pneumoniae ,
Mycoplasma species
Etiology and Risk Factors
• Polluted air: Acute bronchitis can be caused when
your child breathes air that has chemical fumes,
dust, or pollution.
• Cigarette smoke: If you smoke around your child, he
may be at higher risk for acute bronchitis.
• Medical problems: Your child may be more likely to
get bronchitis if he has other medical problems.
Examples include asthma, frequent swollen tonsils,
allergies, or heart problems.
• Premature birth: Babies who are premature (born
too early) may be at higher risk for bronchitis.
Manifestations
• retrosternal pain during deep breathing or
coughing.
• Generally, the clinical course of acute bronchitis is
self-limited, with complete healing and full return
to function typically seen within 10-14 days
following symptom onset.
• Constant cough. The cough may last up to a
month. Cough may be dry, or cough up with
mucus. Mucus may be green, yellow, white, or
have streaks of blood in it. Chest pain may appear
when he coughs or takes a deep breath.
Manifestations
• Fever, body aches, and chills.
• Sore throat and a runny or stuffy nose.
• Short of breath and wheezes (makes a
high-pitched noise) when breathing.
• Tiredness more than usual.
Management
• Medical therapy generally targets symptoms and
includes use of analgesics and antipyretics.
Antitussives and expectorants are often prescribed
• The prototype antitussive, codeine, has been
successful in some chronic-cough and induced-
cough models, such asguaifenesin or
dextromethorphan.
• Bronchodilators ,albuterol may be worthwhile, as
it may provide significant relief of symptoms for
some patients.
Management
• Antibiotics. When bacterial etiology is
suspected or as prophylaxis to secondary
infections.
• Antivirals. When viral etiology is
suspected.
• Corticoids inhalative
Complications
• Complications are extremely rare and
should prompt evaluation for anomalies of
the respiratory tract, including immune
deficiencies. Complications may include
the Following:
• Bronchiectasis
• Bronchopneumonia
• Acute respiratory failure
ASTHMA
• A chronic inflammatory disease of the
airways with the following clinical features:
• Episodic and/or chronic symptoms of airway
obstruction
• Bronchial hyperresponsiveness to triggers
• Evidence of at least partial reversibility of the
airway obstruction
• Alternative diagnoses are excluded
Etiology
• Although the cause of childhood asthma
has not been determined, contemporary
research implicates a combination of
• Environmental exposures and
• Inherent biologic and
• Genetic vulnerabilities .
Incidence
• Asthma is a common chronic disease,
causing considerable morbidity.
• Boys (14% vs 10% girls) and children in
poor families (16% vs 10% not poor) are
more likely to have asthma.
• Approximately 80% of all asthmatic
patients report disease onset prior to 6 yr
of age.
Types of Childhood Asthma
• Recurrent wheezing in early childhood,
primarily triggered by common viral
infections of the respiratory tract, and
• Chronic asthma associated with allergy
that persists into later childhood and often
adulthood.
Manifestations
• Intermittent dry coughing
• Expiratory wheezing
• Shortness of breath and chest tightness
• Intermittent, nonfocal chest pain.
• Respiratory symptoms can be worse at night
• Daytime symptoms, often linked with
physical activities or play.
• Limitation of physical activities, general
fatigue.
Asthma Inducers
• Inducers causes both of the airway to be inflamed
and the airway hyper-responsive.
• The symptoms that cause induces often last longer.
• A common form of inducers is allergens. Inhalant
allergens are the most important inducer.
• Exposure to any allergen may cause inflammation
after a 7-8 hours.
• Because inflammation occurs so slowly it is often
impossible for the physician to identify the asthma
attack.
Asthma Inducers
Asthma Triggers
• Triggers is when the airway become
irritated and tightening and as a result
causes bronchoconstriction.
• Triggers do not cause inflammation.
• The symptoms and bronchoconstriction
caused by triggers then are immediate and
short lived.
• If inflammation is already present the
airway will react more quickly to triggers.
Asthma Triggers
Management
• Assessment and monitoring of disease activity;
• Education to enhance the patient's and family's
knowledge and skills for self-management;
• identification and management of precipitating
factors and co-morbid conditions that may
worsen asthma; and
• Appropriate selection of medications to address
the patient's needs.
• The long-term goal of asthma management is
attainment of optimal asthma control.
Management
• Medications to reduce
bronchoconstrictions:
• Beta 2 Agonist
• Anticholinergics
• Theophylline
Management
• Medications to reduce inflammations:
• Steroids ( oral, Parenteral & Inhalers)
• Not steroids:
• Leukotriene modifiers ( montelukast is
available worldwide; zafirlukast is mentioned
only in NAEPP and pranlukast only in
• Cromolyn & Nedocromil (Reduction of
mast cell degranulation)
Management
• Long-term control medications:
• Corticosteroids (mainly ICS, occasionally
OCS).
• Long Acting Beta Agonists (LABA’s) including
salmeterol and formoterol,
• Leukotriene Modifiers (LTM)
• Cromolyn & Nedocromil
• Methylxanthines: (Sustained-release
theophylline)
Questions?