Pediatric Review Nursing

Course

Epiglottitis
• Life-threatening. Upper respiratory tract infection.
• Symptoms come on suddenly, usually fever is first symptom.
• Sore throat, dysphagia, hoarse/muffled voice, drooling saliva.
• Tripod position, noisy breathing, cyanosis.
• It involves swelling of the epiglottis, causing blockage of the flow of air into the lungs.
• Can be caused by bacteria, typical - Haemophilus influenzae type b (Hib).
• Affects children between 2 to 7 years old.
• Obstruction of passage of air to lungs.
• Treatment-The nurse and respiratory therapist treat the airway obstruction and treating
infection
• Oxygen, mechanical ventilation if necessary when the patient arrives to the ER
o Severe cases-tracheostomy
o CXR, ABGs, blood culture, means of intubation/tracheostomy at bedside
o IV for hydration and antibiotics
o Strictly monitor child; head elevated at all times
o Educational needs include
o Continue po antibiotics at home, teach side effects/possible reactions to meds
o Give acetaminophen, not aspirin, for fever; encourage fluid intake
o Call HCP if change in respiratory status, reaction to antibiotics, or any questions

Bronchiolitis
• Lower respiratory tract infection is the leading cause of hospitalization in young children under
the age of 2 and seen more frequently in boys.
• In most cases, pathogen is respiratory syncytial virus (RSV) and impacts children <2 years old.
Nasal swab will confirm the diagnosis.
• Produces inflammation, small airway obstruction, and air trapping.
• Wheezing is a common symptom.
• Presents like a cold with increasing tachypnea, increasing respiratory distress, adventitious lung
sounds, and fever 1 to 3 days after onset.
• In infants, check for apnea for 15 to 20 seconds could be the first sign.
• Infants may have difficulty feeding due to nasal congestion with resulting risk of dehydration.
• Treatment includes:
o Humidified oxygen via mask, ABGs
o Maintain hydration
o Control fever
o Elevate head, saline nose drops with bulb aspiration
o Institute contact precautions
o CBC, electrolytes, blood culture temp >100.4°F
o It has been found that bronchodilators, corticosteroids, and antiviral agents do not
provide significant benefits.
 • Teaching:
o Notify caregivers that patients may wheeze for 1 week and sometimes longer.
o Keep child home from day care or school until runny nose and fever resolve.
o Avoid smoking in the home, and keep child hydrated.
Pneumonia
• Lower respiratory infection
• causes inflammation of the lung parenchyma, resulting in fluid in the alveoli.
• Air sacs fill with exudate.
• Caused by bacteria, virus, chemical irritants, fungi, or parasite.
• Causes dyspnea, cough, tachypnea, sputum production.
• Adventitious lung sounds, retractions, pleuritic chest pain.
• Fatigue, poor feeding, vomiting.
• Treatment
• Oxygenation/mist tent, rest/conserve energy
• o Postural drainage
o Adequate hydration
o Encourage fluid intake
o Medications: antipyretics,
o bacterial-antibiotics, viral-antiviral, antitussives
o Educational needs include:
o Continue po antibiotics or antiviral at home, teach side effects/possible reactions
o Give acetaminophen, not aspirin, for fever