Respiratory Disorders

Gail C. Hoyer2010-1

Foreign Body Aspiration

• Definition– Inhalation of any object (solid, or liquid, food or

non food) into the respiratory tract– A major health threat for infants and toddlers due

to their increased tendency to put objects in their mouth

• Pathophysiology– Severity depends on size and composition of

object and its location in the respiratory tract

Foreign Body Aspiration: Manifestations

• Manifestations– Dysphonia (muffled hoarse,

or absent voice sounds)– Wheezing may also occur and

may last up to hours depending where object has lodged

– If a child can not say “P” words they have diminished expiratory effort

– If prolonged, s/s of hypoxia will become evident• Anxiety, upright position neck

extended• Irritability and decreased

responsiveness

Foreign Body Aspiration: Nursing Interventions

• Assessment and Diagnosis– Physiological Assessment– Psychosocial Assessment– Developmental Assessment

• Planning and Implementation– Complete obstruction

• Infant– Back blows and chest thrusts

• Child– Abdominal thrusts

– Partial Obstruction• Resuscitation equipment at bedside• Avoid anxiety increasing procedures to prevent a complete

obstruction• Evaluation

Croup Syndromes

• Croup- broad group of upper airway illnesses that result from swelling of the epiglottis and larynx

• Syndromes– Laryngotracheobronchitis- most common– Epiglottitis (Supraglottitis)– Bacterial Thracheitis

• The initial symptoms of all three conditions – Stridor, “seal like” barking cough, and hoarseness

LTB: Nursing Interventions• Assessment and Diagnosis

– Respiratory assessment– Cardio-respiratory monitoring and pulse oximetry

• Planning and Implementation– Maintaining Airway Patency

• Oxygen• Position• Communication• Medications (beta-agonists and beta adrenergics, and corticosteroids)• Albuterol, racemic epinephrine, dexamethasone

– Meet Fluid and Nutritional Needs– Discharge Planning and Home Care Teaching

• Evaluation

Epiglottitis (Supraglottitis): Nursing Interventions

• Assessment and Diagnosis– Airway management-

• Intubation is the treatment (do not leave the child unattended)• Position• Respiratory assessment

– Drug therapy• Antibiotics to treat infection

– Hydration– Emotional and Psychosocial support of the child and parents

• Postpone anxiety provoking procedures• Planning and Implementation

– Pt will be in a critical care setting while intubated– Teach parents about intubation and prepare for discharge

• Evaluation

Bacterial Tracheitis: Nursing Interventions

• Secondary infection of the upper trachea following a viral LTB– Staphylococcus aureus, group a streptococcus, moraxella

catarrhalis, or haemophilis influnzae• Commonly misdiagnosed for LTB– Similar symptoms but patient gets worse with therapy

instead of better– Diagnosed by blood cultures

• Nursing– Critical care setting

• Intubation– Frequent suctioning, oxygen or humidified air, antibiotics– Refer to epiglottitis

Bronchiolitis and RSV• Bronchiolitis

– Lower respiratory tract infection that occurs when a viral or bacterial organism causes inflammation and obstruction of the bronchioles

• Etiology– RSV is the most common

cause• Occurs in annual epidemics

from October to march• Transmitted through direct

contact with respiratory secretions or indirectly through contaminated surfaces

Bronchiolitis: Manifestations and Clinical Therapy

• Manifestations– Mild-rhinitis, cough, low grade fever, wheezing,

tachypnea, poor feeding, vomiting, and diarrhea– Severe- tachypnea greater than 70bpm, grunting,

increased wheezing, retractions, nasal flaring, irritability, lethargy, poor fluid intake, and a distended abdomen from over-expanded lungs

• Clinical Therapy– No treatment– Isolation– Antipyretics– Ribavirin

• Expensive with marginal benefit and high risk to caregivers

Bronchiolitis: Nursing Interventions

• Assessment and Diagnosis– Physiologic Assessment– Psychosocial Assessment

• Planning and Implementation– Maintain Respiratory Function– Support Physiologic Function– Reduce Anxiety– Discharge Planning and Home Care Teaching

• Evaluation

Asthma• Definition

– Common chronic disorder of the airways that is characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresonsiveness, and underlying inflammation

• Etiology and Pathophysiology– Caused by an interplay of multiple

factors• Environmental exposures, viral

illnesses, allergens, and a genetic predisposition

– Risk factors• Passive smoke exposure, indoor air

contaminants (pet dander, cockroach feces), outdoor air pollutants, recurrent respiratory viral infections, and allergic disease (atopic eczema, food allergies)

• Manifestations– asthma attack– asthma and children– Sudden cough, wheezing,

shortness of breath is referred to as an asthma episode or flare

• Clinical Therapy– Medications

• bronchodilators– Hydration– Education and support of

parents and child

Asthma: Nursing Interventions• Assessment and Diagnosis

– Physiologic– Assess Asthma Management– Psychosocial Assessment

• Planning and Implementation– Maintain Airway Patency– Meet Fluid Needs– Promote Rest and Stress

Reduction– Support Family Participation– Discharge Planning and Home

Care Teaching• Evaluation

Cystic Fibrosis• Definition

– Autosomal recessive disorder of the exocrine glands that results in physiologic alterations in the respiratory, gastrointestinal, and reproductive systems

• Etiology– Decreased chloride secretion due

to a defective protein results in increased sodium absorption, causing the body to produce unusually thick, sticky, mucus that clogs the lungs leading to infections, and obstructs the pancreas secretion of natural enzymes that enable the body to digest and absorb food

CF: Manifestations and Clinical Therapy

• Manifestations– Salty taste of skin noticed by

parents first– Newborns- meconium ileus– Stool- steatorrhea(fat or

greasy), frothy (bulky and large quantity), foul smelling, and floating

– Respiratory-chronic moist, productive cough and frequent respiratory infections

– GI- difficulty gaining weight because of malabsorption and increased metabolic rate

• Clinical Therapy– Sweat test

• Seat chloride concentration of 50 to 60 meq/L is suspicious. If the chloride is greater than 60meq/L is diagnosed with other signs

CF: Nursing Management• Assessment and Diagnosis

– Physiologic Assessment– Psychosocial Assessment

• Planning and Implementation– Provide Respiratory Therapy

• CPT, aerosol treatment with a bronchodilator– Administer Medications and Meet Nutritional Needs

• Antibiotics for acute exacerbation via PO, inhalation or IV• Pancreatic enzymes taken with all meals and snacks• Fat soluble vitamins (ADEK) in water form b/c not easily absorbed from food• Nutritional supplements or NG/GT feeding to meet high metabolic rate/demands

– Provide Psychosocial Support– Discharge and Home Care Teaching

• Finances– Nursing Care in the Community

• Evaluation

Pharyngitis• Acute pharyngitis is an infection that primarily affects the

pharynx including the tonsils• Major complaint- sore throat

– See page 1303 Clinical Manifestations• Nursing Management

– Symptomatic relief• Acetaminophen for pain and fever• Cool, non-acidic fluids and soft foods, ice chips, or frozen ice pops• Humidification, chewing gum, warm slat water gargle• Home remedies more effective than O.T.C. throat sprays

– Teach parents to complete 10-day course of antibiotic is prescribed for bacterial pharyngitis• Treating strep infections prevents infections such as rheumatic fever,

cervical adenitis, sinusitis, glomerulonephritis, or meningitis)

Pharyngitis: Manifestations

Otitis Media• Inflammation of the middle ear• Etiology– Specific cause unknown, but appears to be related to

Eustachian tube dysfunction– URI precedes the otitis media– Most common causative organisms of infection are

streptococcus pneumoniae, haemophilus influenzae, and moraxella catarrhalis

• Manifestations– Pulling at the ear– Diarrhea, vomiting and fever– Acting out and irritability may be a sign of hearing loss

Otitis Media: Nursing Management

• Assessment and Diagnosis

• Planning and Implementation– Preventative measures– Family stressor of

chronic otitis media– Pain relief Techniques– Hearing and Language

exams• Evaluation

Otitis Media and Otitis Media with Effusion

Acute otitis media- characterized by pain and a red, bulging non-mobile membrane

Otitis media with effusion-fluid line or air bubbles