Care of Mother and Child at risk or problem

Unique characteristics of pediatric respiratory system anatomy and physiology and application of
to the care of children with respiratory condition

The pediatric respiratory system is way different from adult respiratory system. The ribs are more
horizontally positioned in infants and young children than in adults and older children, minimizing chest
movement. In infants, the rib cartilage is springy, making the chest wall less rigid. This can cause the
chest wall to retract and reduce tidal volume during respiratory distress episodes. Until a child reaches
school age, the intercostal muscles that run between the ribs are not fully developed. This can make it
difficult to raise the rib cage, especially when the back is flat. Typically, the back of a child's head is
larger than in adults. When a child is lying on his or her back, this may cause the neck to flex and result
in a partially obstructed airway. The internal diameter of a child's airways is smaller. More serious
distress may be caused by any inflammation or obstruction. Pediatric airways in general are smaller,
less rigid, and more susceptible to obstruction. Children also have higher respiratory rate than adults,
making them more susceptible to airborne agents.

Providing care to pediatric clients with respiratory conditions begins with a thorough assessment;
obtaining the child's respiratory status from observation of physical signs and behavior. Auscultation
for lung fields is helpful in identifying pathologic conditions, it is also essential in determining patency
of airways. Palpation and percussion provide information regarding areas of pain and tissue density.
Respiration should also be included in the assessment such as respiratory rate, regularity, symmetry,
depth, effort, and use of accessory muscle when breathing. The care provider must know the normal
values of respirations in the child's age and size. Care provider should take note of retraction, nasal
flaring, head bobbing, noisy breathing, stridor, grunting, wheezing, changes in skin’s color, chest pain,
nail clubbing, and cough. Monitoring the child’s respiratory status with interpreting the blood gasses,
use of pulse oximetry, transcutaneous monitoring, and end-tidal carbon dioxide monitoring is very
essential.

Overall care of a child with respiratory condition requires a lot of skills and gentleness. Their respiratory
system is not yet fully developed. Nurses must use therapeutic communication to the child’s significant
others in order for them to accept the condition of their child. Being their companion in the child’s
health will help in the healing process.

References:

Marilyn J. Hockenberry, D. W. (2019). Wong's Nursing Care of Infants and Children . St. Louis, Missouri:
Elsevier .

Amat, Saimon Rafael T. BSN 2Y2-3s

 Care of Mother and Child at risk or problem
Nursing Care Plan for a 9-year old child with asthma

Assessment Diagnosis Planning and Implementation Evaluation

Goal and objectives Intervention
Subjective data: Ineffective After 15 minutes of nursing After 15 minutes of
airway clearance intervention, the client nursing intervention,
related to maintains airway patency. the client maintains
Objective data: increase sputum airway clearance.
 Crackles production as  Maintain adequate,  Monitor respiration
 Wheezes evidenced by patency airway and breath sounds,
 Restlessness crackles, noting rate and
 Ineffective wheezes, sounds
cough ineffective Rationale: indicative of
 Difficulty cough, and respiratory distress and/or
verbalizing difficulty accumulation of secretion.
verbalizing
 Evaluate client’s
cough/gag reflex,
amount or type of
secretions, and
swallowing ability
Rationale: to determine
ability to protect own airway

 Position head
appropriately for
age and condition
Rationale: to open or
maintain open airway in an
at-rest or compromised
individual.

 Insert oral airway

when needed
Rationale: to maintain
anatomical position of
tongue and natural airway,
especially when
tongue/laryngeal edema or
thick secretion may block
airway.

 To mobilize  Encourage deep-

secretions breathing and
coughing exercise.

Amat, Saimon Rafael T. BSN 2Y2-3s

 Care of Mother and Child at risk or problem
Rationale: to maximize
effort

 Administer
medication (e.g.,
expectorants, anti-
inflammatory
agents,
bronchodilators,
and mucolytic
agents) as prescribe
by the school
physician
Rationale: to relax smooth
respiratory musculature,
reduce airway edema, and
mobilize secretion.

 Promote wellness  Call the client’s

guardian
 Provide
information about
necessity of raising
and expectorating
secretion versus
swallowing them
Rationale: to report changes
in color and amount in the
event that medical
intervention may be needed
to prevent or treat infection.

 Clear the client to

go home from the
school clinic.

References:

Marilynn E. Doenges, M. F. (2019). Nurse's Pocket Guide: Diagnoses, Prioritized Interventions, and
Rationales. Philadelphia, Pennsylvania: F. A. Davis Company.

Amat, Saimon Rafael T. BSN 2Y2-3s