P E D I A T R I C N U R S I N G

Principles of Growth & Development  Pulmonic Stenosis

❉Pilliteri iii.Decreased Pulmonary Blood
I. Acute Conditions of the Neonate Flow
a. Respiratory Distress Syndrome  Tetralogy of Fallot
b. Meconium Aspiration Syndrome  Tricuspid Atresia
c. Apnea of Prematurity iv. Mixed Blood Flow
d. Sudden Infant Death Syndrome  Transposition of Great
e. Retinopathy of Prematurity Arteries
❉Pilliteri
 Total Anomalous
Pulmonary Venous
II. Newborn Screening
Return
a. Congenital Hypothyroidism  Truncus Arteriosus
b. Congenital Adrenal Hyperplasia
 Hypoplastic Left Heart
c. Galactosemia
Syndrome
d. Phenylketonuria
b. Acquired Cardiovascular Diseases
e. Glucose-6-Phosphate-Dehydrogenase i. Bacterial Endocarditis
Deficiency
ii. Rheumatic Fever
f. Maple Syrup Urine Disease
❉Pilliteri / Wong
iii. Kawasaki Disease

III. Respiratory System Disorders V. Gastrointestinal System Disorders

a. Acute Viral Nasopharyngitis a. Motility Disorders
b. Acute Streptococcal Pharyngitis i. Hirschsprung Disease
c. Tonsillitis ii. Irritable Bowel Syndrome
d. Croup Syndrome b. Inflammatory Conditions
i. Acute Epiglottitis i. Acute Appendicitis
ii. Acute Laryngitis ii. Meckel’s Diverticulum
iii. Acute Laryngotracheobronchitis c. Obstructive Disorders
iv. Acute Spasmodic Laryngitis i. Hypertrophic Pyloric Stenosis
v. Bacterial Tracheitis ii. Intussusception
e. Lower Respiratory Disorders d. Malabsorption Disorders
i. Acute Bronchitis i. Celiac Disease
ii. Bronchiolitis e. Cleft Lip & Palate
f. Long Term Respiratory Disorders
i. Asthma VI. Renal & Urinary System Disorders
ii. Cystic Fibrosis a. Acute Glomerulonephritis
b. Nephrotic Syndrome
IV. Cardiovascular System Disorders c. Wilm’s Tumor
a. Congenital Heart Disease d. Epispadia & Hypospadia
i. Increased Pulmonary Blood
Flow VII. Hematological System Disorders
 Ventricular Septal a. Anemia
Defect i. Iron-Deficiency Anemia
 Atrial Septal Defect ii. Pernicious Anemia
 Patent Ductus iii. Sickle Cell Anemia
Arteriosus iv. Aplastic Anemia
 Atrioventricular Canal b. Hemophilia
Defect c. Idiopathic Thrombocytopenic Purpura
ii. Obstructive Defects
 Coarctation of the VIII. Neurological System Disorders
Aorta a. Spina Bifida
 Aortic Stenosis b. Hydrocephalus

Wong’s Nursing Care of Infants and Children

10th Edition
Marilyn J. Hockenberry, PhD, RN, PPCNP-BC, FAAN
I. Acute Conditions of the Neonate
a. Respiratory Distress Syndrome – “Hyaline Membrane Disease”
Surfactant deficiency

Signs & Symptoms: Risk Factors:

 Subtle signs:  Preterm infants
o Low body temperature  Multiple pregnancies
o Nasal flaring  Infants of diabetic mom
o Sternal and subcostal retractions  CS
o Tachypnea (>60 cpm)
o Cyanotic mucous membranes
 Expiratory grunting Diagnostic Tests:
 Fine rales  CXR: (+) opacities; ground glass (haziness)
 Diminished breath sounds  ABG: Respiratory acidosis
 Amniocentesis: L/S ratio = 2:1
 LATE SIGN: Acrocyanosis

Management:
1.) Surfactant replacement (Survanta)
o Intratracheal / advanced airway
o POSITION: Head held upright, then tilted downward
o Sprayed into the lungs by syringe / catheter through ET tube
o AFTER:
 DO NOT SUCTION – to avoid suctioning the drug away
 Place on ventilator
 Close monitoring
 WOF lung expansion
 Adjust settings accordingly – to prevent excessive lung pressure
o SE: Mucus plugging (buildup)
2.) Oxygen – CPAP / PEEP
o COMPLICATION: Retinopathy of prematurity & bronchopulmonary
3.) Ventilation = reversed I/E ratio (2:1)
4.) Jet ventilation – rapid, high-frequency, oscillatory
COMPLICATION: Pneumothorax
o Impaired cardiac output
o Increased pressure – intracranial & arterial  AVOID OVERHYDRATION
o Hemorrhage
5.) Liquid ventilation
o Perfluorocarbon – carries the oxygen when bubbled through it
o To distend the lungs
6.) ECMO – extracorporeal membrane oxygenation – to manage hypoxemia in newborns
o DURATION: 4-7 days
o Blood is removed from the baby’s right atrium, circulated through the ECMO machine
where it is oxygenated and rewarmed, return to the infant through the carotid artery
o COMPLICATION: Intracranial hemorrhage
o Ensure adequate blood volume & oxygen
o Bleeding precaution
7.) Keep the infant warm to  metabolic oxygen demand
o Cooling = acidosis
8.) Hydration & nutrition (gavage)
9.) Nitric Oxide = pulmonary vasodilation
10.) Indomethacin / ibuprofen – to close the PDA
o SE:  renal perfusion,  platelet count  Monitor UO & WOF bleeding
11.) Pancuronium (Pavulon) IV – muscle relaxant increasing pulmonary blood flow
o AT BEDSIDE: Atropine & neostigmine
12.) Terbutaline (tocolytic) – to prevent preterm birth
13.) Betamethasone – hastens the formation of lecithin
b. Meconium Aspiration Syndrome – release of meconium into the amniotic fluid aspirated by the
infant either in utero or with first breath at birth.

Pathophysiology: Signs & Symptoms:

Hypoxia Green to greenish black staining
 Hypoxic episode
Stimulation of vagal response Low Apgar score
 Tachypnea
Relaxation of rectal sphincter Retractions
 Cyanosis
Release of meconium into the amniotic fluid Coarse bronchial sounds
 Barrel chest = 2:2
Aspiration in utero / at first breath
Diagnostic Tests:
Air trapping Hypoxemia ABG
Respiratory acidosis CXR = bilateral coarse infiltrates
Pneumothorax Honeycomb effect = spaces of aeration
Bronchiolitis Pneumonia Diaphragm is pushed downward

Management:
Suction while at the perineum
DO NOT administer O2 under pressure UNTIL intubated/suctioned
Amnioinfusion – dilution of meconium in the amniotic fluid
Antibiotics – to prevent pneumonia
Surfactant – to  lung compliance
Maintain normothermic environment
Chest physiotherapy
ECMO

c. Apnea of Prematurity – pause in respirations >20 seconds with bradycardia

Types: Pathophysiology:
1.) Central – failure of the CNS to transmit signals Immature respiratory centers Apneic
to respiratory muscles Muscle weakness episodes
2.) Obstructive
3.) Mixed – most common

Management: (+) apnea:

Apnea monitor Gentle tactile stimulation – gentle shaking /
Ventilator flick the sole of the foot
Suction gently – indwelling NGT Resuscitate if no response
AVOID intermittent NGT – stimulates vagus nerve Raise chin gently
Careful burping Record episodes of apnea
Maintain normothermic environment Infant is NEVER SHAKEN = shaken baby
AVOID any vagal stimulation syndrome

Methylxanthines – CNS breathing WOF TOXICITY: Caffeine

stimulant Tachycardia at rest o Cafcit
o Aminophylline Vomiting  UO close monitoring
o Theophylline Irritability  WOF DHN
Diuresis
d. Sudden Infant Death Syndrome – “Crib Death” – sudden unexplained death in infancy
Peak of Incidence – 2-4 months

Risk Factors:
Abnormality / deficiency / infection involving neuro / respi

Signs & Symptoms:

Laryngospasm = no sound as they die
Blood-flecked sputum/vomitus on mouth/bed = result of death, not the cause

Diagnostic Tests:
Autopsy
Petechiae in the lungs
Respiratory tract inflammation & congestion

Management:
 Supine position with pacifier when sleeping
 Sleep with a fan in the room to keep the air moving – to prevent rebreathing of expired CO2
 Parents are counseled – death is not their fault

 Sleep assessment within the first 2 weeks of life or before discharge

 Continuous apnea monitoring

e. Retinopathy of Prematurity – “Retrolental Fibroplasia”

Partial or total blindness in children due to vasoconstriction of immature retinal blood vessels

Pathophysiology: Management:
Exposure to high concentration of oxygen  If (+) O2 = Monitor PO2 & ABG
(cause)  Cryosurgery
  Laser therapy
Constriction of immature BV o bright environment
 o Inform parents that infants eyelid will be
Proliferation of endothelial cells in the layer of closed & edematous
nerve fibers in periphery of retina

Retinal detachment

Blindness
II. Newborn Screening

The screening test is most reliable if the blood sample is taken after the infant has ingested a source
of protein. Because of early discharge of newborns, recommendations for screening include (1)
collecting the initial specimen as close as possible to discharge and no later than 7 days after birth,
(2) obtaining a subsequent sample by 2 weeks of age if the initial specimen is collected before the
newborn is 24 hours old, and (3) designating a primary care provider to all newborns before
discharge for adequate newborn follow-up screening.

When collecting the specimen, avoid “layering” the blood specimen on the special Guthrie paper.
Layering is placing one drop of blood on top of the other or overlapping the specimen.

Best results are obtained by collecting the specimen with a pipette from the heel stick and spreading
the blood uniformly over the blot paper.

a second newborn screening is performed when the infant is 1 to 2 weeks old, on the basis that a
maximum number of children with genetic disorders will be identified

a. Congenital Hypothyroidism – thyroid hypofunction; T3, T4 = mental retardation

Predisposing Factor: Underdevelopment of fetal thyroid d/to maternal hyperthyroidism

Assessment:
S/sx appears:  Floppy, rag doll appearance
o First 3 months if formula-fed o Short & thick neck
o 6 months if breastfed o Dull facial expression
o Open-mouthed
EARLY sign: excessive sleepiness o Short & fat extremities
o Hypotonic muscles
 Enlarged tongue = respiratory difficulty
= Noisy respirations / obstructions  Generalized obesity
 Sluggishness / choking = Poor suck  Dry skin & brittle hair
 Cold extremities  Anhidrosis
 Subnormal body temperature  Delayed / defective dentition
 Slow metabolic rate =  RR,  HR  Enlarged abdomen
 Jaundice  Chronic constipation
 Anemia = lethargy, fatigue

Diagnostic Tests:
 RAIU
 TSH

Management:
Sodium levothyroxine PO – gradually increased
WOF toxicity = s/sx of hyperthyroidism
Vitamin D – prevent ricketts
Periodic monitoring of thyroid hormones
b. Congenital Adrenal Hyperplasia – Excessive androgen production
Decreased enzyme activity required for the production of cortisol from the adrenal glands

Types:
1.) Partial deficiency / 21-hydroxylase deficiency
Aldosterone is produced = Sodium preservation

2.) Complete / salt-losing

Aldosterone & cortisol deficiency

21-hydroxylase
Adrenal glands CORTISOL  glucose & CHON metabolism / inflammatory response

ACTH

Enlargement of the adrenal gland

Assessment: Diagnostic Tests:

Androgen overproduction Chorionic villi sampling – 6-8 weeks
Precocious puberty – by 3-4 years old Amniocentesis – 15 weeks
Serum electrolytes = Na Cl,  K
♀ Virilization = Masculinization of females  Linear growth
♀ Ambiguous genitalia DNA analysis - for sex determination
♀ No breast development UTZ = genitalia
♀ Menstruation
♀ Enlarged clitoris Management:
Hydrocortisone PO – early in the AM (7-8AM)
♂ (-) spermatogenesis = sterility o Periodic analysis of serum cortisol levels
♂ Precocious genital development o OVER medication = CUSHING’S Syndrome
♂ Small testes o Under medication = occurs during periods of
stress & illness
Failure to thrive o  Dosage:
Weakness  Infection
Vomiting  Fever
Dehydration  Vomiting
Salt-losing crisis  Surgery
Hyponatremia  Fractures
Hyperkalemia  Major injuries
Early sexual maturation Aldosterone replacement
-enlargement of external sexual organs Assess electrolytes, hormones & Renin levels
-axillary, pubic & facial hair Clitoridectomy – at 1-3 y/o
-deepening of the voice Phallic reconstruction
-acne Hormone replacement
Short stature WOF s/sx of DHN
Mother: Dexamethasone
c. Galactosemia –abnormal amounts of galactose in the blood & urine
Deficient in liver enzyme: Galactose 1-phosphate uridyltransferase (GALT)

Pathophysiology:
Lactose  galactose
 
 Galactose 1-phosphate uridyltransferase

Glucose Galactosemia
Galactosuria

Assessment: (If untreated, may die within 3 days) Diagnostic Tests:

S/sx appear soon as begins formula feeding (+) galactosuria
 Lethargy Beutler Test – analyzes cord blood
 Hypotonia RBCs = uridine diphosphate-galactose
 Diarrhea transferase
 Vomiting
 Jaundice Management:
 Bilateral cataracts DIET: Galactose-free for life
 Splenomegaly Casein hydrolysates (Nutramigen) – formula
 Cataract made with milk subs
Monitor for hypoglycemia

d. Phenylketonuria – absence of the enzyme phenylalanine hydroxylase needed to metabolize the

amino acid phenylalanine

Phenylalanine hydroxylase  serotonin

Phenylalanine Tyrosine   tyrosine melanin: Fair skin
 Blue eyes
 Phenylalanine build up  CNS damage  Cognitively delay Blond hair
Bloodstream & urine
(hyperphenylalaninemia)

Assessment: Diagnostic Tests:

Urine = Musty / mousy odor Percutaneous umbilical cord blood sampling
 body pigment = fair skin, light blonde hair, Recombinant DNA techniques
blue eyes Guthrie test = Screening at birth after 2 full days of
Failure to thrive feeding / before the 2nd day of life
Frequent vomiting Serum phenylalanine > 4mg/dL
Hyperactivity, irritability, & unpredictable If (+) colostrum = repeat after 2 weeks
erratic behavior
Accompanying seizure
Prone to eczema (atopic dermatitis)

If untreated = IQ = <20

Management: Low phenylalanine diet

2 criteria: High: CHON-rich foods = Meat, eggs, milk = AVOID
 Meet the child’s nutritional need Low: Cereal, fruits, veggies, OJ, bananas, potatoes,
 Maintain phenylalanine levels within safe lettuce, spinach, peas
range
Monitor blood (Hgb), serum phenylalanine &
Formula low in phenylalanine = SE: loose stools tyrosine levels
Phenyl-Free 2 Monitor urine frequently
Phenex
Limited breastfeeding Teach the family re diet restrictions
Refer to registered dietitian
e. Glucose-6-Phosphate-Dehydrogenase Deficiency – premature destruction of RBC
G6PD – enzyme necessary for maintenance of RBC life

2 forms:
1.) Congenital nonspherolytic hemolytic anemia
 Hemolysis
 Jaundice
 Splenomegaly
 Aplastic crises
2.) Drug-induced hemolysis – self-limiting; child is normal until exposed to fava beans or certain
drugs
 Antipyretics
 Sulfonamides
 Antimalarials
 Aspirin (naphthaquinolones)

Diagnostic Tests:
Blood smear = (+) Heinz bodies
Rapid enzyme screening Test
RBC electrophoretic analysis

Assessment:
Fever
Back pain
s/sx of hemolysis

Management:
BT
Avoidance of drugs mentioned above

f. Maple Syrup Urine Disease –

-defect in metabolism of amino acids: leucine, isoleucine, & valine, that leads to cerebral
degeneration

Assessment: (If left untreated, infant may die 2-4 weeks)

Urine = Maple syrup odor d/to ketoacidosis
Feeding difficulty
(-) Moro reflex – startle reflex
Irregular respirations
Opisthotonos
Generalized muscular rigidity
Seizures

Diagnostic Tests:
Amniocentesis

Management:
DIET:  thiamine,  amino acids (LIV)
Dialysis
III. Respiratory System Disorders
a. Acute Viral Nasopharyngitis – “Common Cold”
Etiologic Agents:
 Rhinovirus
 Coxsackie virus
 RSV
 Adenovirus
 Parainfluenza
 Influenza

Assessment:
 Nasal congestion
 Watery rhinitis
Low-grade fever
 Edematous & inflamed mucous membrane
 DOB
 Open-mouth breathing
 Swollen cervical lymph nodes
 Thick, purulent nasal discharge
 Refuse feedings
 Dehydration
 Secondary symptoms: vomiting & diarrhea

Management:
 No specific treatment
 Antipyretics
 Aspirin should not be given to children < 18 y/o = Reye Syndrome
 Decongestants
 Saline drops / nasal spray = AVOID rebound congestion = should not be administered >3 days
 Bulb syringe before feedings – to remove nasal mucus
 Cool mist vaporizer

b. Acute Streptococcal Pharyngitis – infection and inflammation of the throat

Etiologic Agent: Group A Beta-Hemolytic Streptococcus
Mode of Transmission: Close contact / droplets

Assessment:
 Erythematous pharynx & palate
 Enlarged tonsils with white exudates
 Petechiae on palate
 High fever (40°C)
 Headache
 Dysphagia
 Lethargy
 Swollen abdominal lymph nodes = abdominal pain

Diagnostic Tests: Complications:

 Throat culture Rheumatic fever
 Rapid antigen test Acute glomerulonephritis

Management:
 Full 10-day course Pen G / clindamycin
o Erythromycin – if resistant / allergic
 Cold / warm neck compress
 Warm saline gargles
 Cool liquids / ice chips
 Discard toothbrush after 24 hours of taking antibiotics
c. Tonsillitis –infection & inflammation of palatine tonsils; often occurs with pharyngitis
Causative agent: viral / bacterial

Assessment:
 Dysphagia
 High fever
 Persistent cough
 Lethargic
 Pharyngeal pain & edema
 Nasal / muffled quality of speech
 DOB / Mouth breathing
 Difficulty hearing
 Halitosis
 Sleep apnea

Diagnostic Tests:
Throat culture = (+) GABHS

Management:
 Antipyretic
 Analgesics q4
 Full 10-day course of antibiotic – penicillin / amoxicillin
 DIET: Soft to liquid
 Cool mist vaporizer
 Warm saltwater gargles
 Warm fluids
 Throat lozenges

 Tonsillectomy – surgical removal of palatine tonsils

 CONTRAINDICATIONS:
 Cleft palate
 Acute infections at time of surgery
 Uncontrolled systemic diseases / blood dyscrasias
 <3 y/o

 POSTOP:
 NPO until (+) gag reflex
 Inspect all secretions & vomitus for bleeding
 AVOID:
o Coughing
o Clearing the throat
o Blowing the nose
 AVOID red/dark-colored foods/fluids
 AVOID straws
 AVOID citrus
 AVOID highly seasoned foods
 AVOID gargles / vigorous toothbrush

 Milk products = coats the mouth & throat = clear the throat
 WOF bleeding: frequent swallowing / clearing of the throat
 d. Croup Syndrome –group of symptoms characterized by hoarseness, resonant cough (“barking” / “brassy”), varying degrees of respiratory
distress due to swelling or obstruction in larynx & subglottic airway

Acute Epiglottitis Acute LTB Acute Spasmodic Laryngitis Acute Tracheitis

Age group affected 2-5 yr but varies Infant or child <5 yr 1-3 yr 1 mo to 6 yr
Etiologic Agent Rapidly progressive Slowly progressive Sudden; at night Moderately progressive
Viral with allergic Viral or bacterial with
Onset Bacterial Viral
component allergic component
URI
URI
Croupy cough
Dysphagia Stridor
Stridor
Stridor aggravated when Brassy cough URI
Hoarseness
supine Hoarseness Croupy cough
Dyspnea
Major Symptoms Drooling Dyspnea Purulent secretions
Restlessness
High fever Restlessness High fever
Symptoms awakening child
Toxic appearance Irritability No response to LTB therapy
Symptoms disappearing
Rapid pulse and respirations Low-grade fever
during day
Nontoxic appearance
Tendency to recur
Corticosteroids
Airway protection, possible Fluids
intubation, tracheotomy Reassurance
Humidified oxygen Nebulized epinephrine Cool mist Antibiotics
Treatment
Fluids (possible short-term Reassurance Fluids
Antibiotics improvement)
Reassurance Heliox-moderate-to-severe
croup

Description
Age group affected
Etiologic Agent
Predominant Characteristics
Treatment
ASTHMA
Exaggerated response of bronchi to
a trigger such as URI, dander, cold
air, exercise
Bronchospasm, exudation, and
edema of bronchi
Infancy to adolescence or
adulthood
Most often viruses such as RSV in
infants but may be any of a variety
of URI pathogens
Wheezing
Cough
Labored respirations
Inhaled corticosteroids
Bronchodilators
leukotriene modifiers
Allergen
Control of triggers
BRONCHITIS BRONCHIOLITIS
Most common infectious disease of
Usually occurs in association with
lower airways
URI
Maximum obstructive impact at
Seldom an isolated entity
bronchiolar level
Usually children 2-12 mo of age;
First 4 yr of life rare after age 2 yr
Peak incidence approximately age
6 mo
Usually viral
Viruses, predominantly RSV; also
Other agents (e.g., bacteria, fungi,
adenoviruses, parainfluenza viruses,
allergic disorders, airborne irritants)
human meta-pneumovirus, and
can trigger symptoms
Mycoplasma pneumoniae
Labored respirations
Poor feeding
Cough
Tachypnea
Persistent dry, hacking cough Retractions
(worse at night), becoming Flaring nares
productive in 2-3 days Emphysema
Increased nasal mucus
Wheezing
May have fever
Provide supplemental oxygen if
saturations ≤90%;
Bronchodilators (optional)
Cough suppressants if needed Suction nasopharynx
Ensure adequate fluid intake
Maintain adequate oxygenation
CROUP SYNDROME:
1. Acute Epiglottitis – “Acute supraglottitis”; MEDICAL EMERGENCY
Mode of transmission: Droplet

Causative agent: H. influenzae Diagnostic Tests:

X-ray - lateral neck
Assessment: Leukocytosis
 Awakes suddenly at bedtime with of sore ABG
throat & dysphagia Blood culture
 Fever
 Tripod position Management:
 (-) cough  Nasotracheal intubation / tracheostomy
 Drooling  Humidified O2
 Agitation  Full course antibiotic therapy – cefotaxime
 Frog-like croaking sound on inspiration  Corticosteroids
 Retractions – substernal & suprasternal  H. influenzae type B conjugate vaccine at 2 months
 Large, cherry-red edematous epiglottis  Droplet isolation precaution
 Inspiratory stridor  READY AT BEDSIDE: Resuscitation equipment & suction
 IVF

2. Acute Laryngitis – complication of pharyngitis / excessive use of voice

Causative agent: Virus

Assessment:
 Brassy, hoarse voice
 URT symptoms
 Coryza
 Sore throat
 Nasal congestion

Management: Self-limiting
 Sips of fluid
 Rest the voice for 24 hours

3. Acute Laryngotracheobronchitis – most common type of croup; preceded by URI

Causative Agents: Diagnostic Tests:

Parainfluenza virus 1, 2, 3  O2 sat
RSV Respiratory acidosis
Influenza type A & B
Measles Management:
M. pneumoniae  Cool mist via face mask or blow-by
 Cool-temperature therapy modalities
Assessment: (worse at night) o Breathe in cool night air
 Low-grade fever o Cold-water vaporizer / humidifier
 Awakes suddenly at bedtime with barky, brassy o Stand in front of open freezer
cough (seal-like cough)  Nebulized epinephrine – rapid onset of action
 Inspiratory stridor  Dexamethasone PO / IM
 Suprasternal & intercostal retractions  Nebulized budesonide in conjunction with
 Nasal flaring dexamethasone IM
 restlessness  Child’s preference of beverage
 Cough  IVF / IV steroids
 Hoarseness  AT BEDSIDE: intubation equipment
 Tachypnea  Bag and valve mask equipment
CROUP SYNDROME:
4. Acute Spasmodic Laryngitis – “Spasmodic Croup” / “Midnight Croup” / twilight Croup”
- Paroxysmal attacks of laryngeal obstruction occurs chiefly AT NIGHT

Predisposing Factor:
History of previous attacks lasts for 2-5 days followed by uneventful recovery

Assessment:
 No fever
 Awakes suddenly at bedtime with barking, metallic cough
 Hoarseness
 Noisy inspirations
 Restlessness

Management:
 Cool mist
 Humidification
 Sudden exposure to cold relieves the spasm
 Racemic epinephrine
 Corticosteroid

5. Bacterial Tracheitis = croup + epiglottitis ; complication of LTB

- Infection of the mucosa & soft tissues of upper trachea

Causative Agents: S. aureus

Assessment:
 S/sx of LTB but unresponsive to LTB therapy
 Thick, purulent tracheal secretions
 Croupy cough
 Stridor unaffected by position
 (-) drooling
 Respiratory distress
 High fever

Diagnostic Tests:
 X-ray – AP / lateral neck = narrowing & infiltrates (Steeple’s sign)
 Endoscopy
 Cultures

Management:
 Antibiotics 10-day course
 Antipyretics
 Fluids
 Bronchodilators
 ET intubation
 Mechanical ventilation
e. Lower Respiratory Disorders –
1. Acute Bronchitis – “Tracheobronchitis” – inflammation of large airways (major bronchi and trachea)
Causative Agents:
Influenza virus
Adenovirus
M. pneumoniae

Assessment: Diagnostic Tests:

 Mild URTI 1-2 days CXR = diffuse alveolar hyperinflation
 Fever
 Dry, hacking, non-productive cough worse at night Management:
o Productive in 2-3 days  Self-limiting
 Nasal congestion  Symptomatic treatment
 Rhonchi , coarse crackles (rales)  Analgesics
 Anti-pyretics
 Humidifier

2. Bronchiolitis – inflammation of fine bronchioles and small bronchi

Occurs in winter & spring

Mode of Transmission: Direct contact with Diagnostic Tests:

respiratory secretion (<3 feet) Rapid Immunofluorescent Antibody-Direct
Incubation Period: 2-8 days Fluorescent Antibody Staining
ELISA
Causative Agents: Leukocytosis
RSV  ESR
Adenovirus CXR = pulmonary infiltrates d/to atelectasis
Parainfluenza virus Throat culture

Assessment:
Initial With Progression of Illness Severe Illness
Rhinorrhea Increased coughing and wheezing Tachypnea >70 breaths/min
Pharyngitis Fever Listlessness
Coughing, sneezing Tachypnea and retractions Apneic spells
Wheezing Refusal to nurse or bottle feed Poor air exchange; poor breath
Possible ear or eye infection Copious secretions sounds
Intermittent fever Cyanosis

Management:
 Symptomatic treatment
 O2
 CPT
 Suction
 IVF
 NG fluids
 Short-acting β–agonist bronchodilator
 Racemic epinephrine
 3% nebulized (hypertonic) saline
 Palivizumab (Synagis) – for high-risk infants – IM / IV once every 30 days (15 mg/kg)
 Rivabirin (synthetic nucleoside analog) – inhaled antiviral agent

 Droplet, Contact, Standard Precautions

 Isolation Precautions
 Normal saline drops & bulb suction before breastfeeding & h.s.
f. Long Term Respiratory Disorders –
1. Asthma –
2. Cystic Fibrosis –