VIRAL PHARYNGITIS

NURSING CARE FOR CHILD

o Adenovirus
WITH RESPIRATORY ILLNESSES o Si/Sx: sore throat, febrile, general malaise,
Learning Outcomes erythematous pharynx, leukocytosis
o Management: warm compress, gargle with warm
1 Describe respiratory illnesses that occur in pediatrics. water
2 Assess an infant who is born with respiratory illnesses. o WOF: dehydration
3 Utilize knowledge respiratory illnesses to promote
quality maternal and child health nursing care. BACTERIAL PHARYNGITIS

Course Outline o Group A beta-hemolytic streptococcus

o Streptococcal infections – kidney and cardiac
RESPIRATORY DISORDERS
damage
□ Acute Nasopharyngitis
o Si/Sx: erythematous throat & tonsils, enlarged
□ Pharyngitis tonsils, white exudation in tonsillar crypts, fever,
□ Tonsillitis sore throat, difficulty swallowing, lethargy, headache
□ Epistaxis o Culture: (+) Streptococcus bacteria10-days oral
□ Sinusitis antibiotics
□ Laryngitis o Pen G
□ Laryngotracheobronchitis o Clindamycin
□ Aspiration o NO cephalosporin or broad spec
o Urine test after 2wks if AGN appear in 1-2 wks
□ Influenza
□ Bronchitis
□ Respiratory Synctial Virus Bronchiolitis
□ Asthma
□ Status Asthmaticus
□ Pneumonia

RESPIRATORY DISORDERS

ACUTE NASOPHARYNGITI S
TONSILLITIS
o Incubation: 2-3 days
o Etiology: rhinovirus, coxsackievirus, RSV, adenovirus,
and parainfluenza and influenza viruses
o Manifestations: nasal congestion, watery rhinitis,
low-grade fecver, swollen cervical lymph nodes
o Prognosis: cough or sore throat
o Secondary symptoms: vomiting & diarrhea
o Management: symptomatic management because
common cold has no specific treatment.
o Acetaminophen/ibuprofen
o 18 y/o = no ASA
o Saline nose drops/ nasal spray
o Guaifenesin
o Infection and inflammation of tonsils (palantine)
o Adenitis: adenoid tonsils infection & inflammation
o Manifestation: same with pharyngitis
o “drooling” the throat can’t swallow saliva
o Enlarged and erythematous tonsillar tissue
o Presence of pus to the tonsillar crypts
o Adenoid: nasal quality of speech, mouth breathing,
difficulty hearing, halitosis and sleep apnea
o Antipyretic/ Analgesic
o Antibiotics for 10 days
o Tonsillectomy or Adenoidectomy
o WOF: hemorrhage

PHARYNGITIS

o Infection & inflammation of the oropharynx

o Etiology can be viral or bacterial
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 LARYNGITIS

o Inflammation of the larynx

o Etiology: pharyngitis or excessive use of voice
(shouting or loud cheering)
o Si/Sx: brassy, hoarsness of voice, inadible to make
sounds
o Warm or cold fluids
o Rest voice for 24 hours
o Infants: meet their needs to avoid crying
o Older children: avoid speaking, writing
EPISTAXIS communication

o Nosebleed
o Etiology: trauma, inadequate humidification,
strenuous exercise, associated with respi illnesses
and with several systemic illnesses (rheumatic fever,
scarlet fever, measles, & chicken pox)
o Upright position with head tilted slightly forward.
o Apply pressure to the sides of the nose with fingers.
o Cold compress
o Keep the child quiet/ stop crying
LARYNGOTRACHEOBRONCHITIS
o Epinephrine (1:1000)
o Known as croup
o Trachea, larynx, and major bronchi inflammation
o Can be caused by parainfluenza virus; H. influenza
o Mild upper respiratory tract infection at bedtime and
may distract sleep d/t extreme respi distress
o Night: croupy or barking cough. Inspiratory stridor,
and marked retractions
o Severe symptoms last for hours except rattling cough
that subside in the morning
SINUSITIS o Hot shower or steaming until symtoms subside
o Infection and inflammation of the sinuses o Not relieved: bring to emergency department
o Rare: < 6 y/o d/t undeveloped frontal sinuses o Normal/ slightly elevated temperature
o Si/Sx: fevr, purulent discharge, headache, tenderness o Corticosteroid/ racemic epi via nebulizer
over affected sinuses o IV therapy, monitor I&O and urine specific gravity
o Nasal & throat culture: (+)
o Antipyretic/ analgesic/ antibiotics
o Oxymetalozine hydrochloride

ASPIRATION

o Inhalation of foreign object into the airway

o Common in infants and children
o Universal choking sign and hard forceful choking

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 o Cough with no sound: obstructed airway
o subdiaphragmatic abdominal thrust
o Back thrust
ASTHMA
INFLUENZA
o Inflammation and infection of major airways
o Caused: orthomyxovirus influenza type A, B, C
o Si/Sx: cough, fever, fatigue, aching pains, sore throat,
often accompanying GI Si (vomiting/ diarrhea)
o Antipyrects
o Oseltamivir
o Flu vaccine
BRONCHITIS
o Inflammation of major bronchi & trachea
o Mild URTI 1 to 2 days: febrile and dry, hacking cough
o Cough can interfere sleep of pt
o Si/Sx may last a wk and 2wks full recovery
o Auscultation: rhonchi & coarse crackles
o CXR: diffuse alveolar hyperinflation & some markings
in the hilus of the lungs
o Goal: relieving respi Sx like reducing fever and
maintaining adequate hydration
o Antibiotics and expectorant
STATUS ASTHMATICUS
RESPIRATORY SYNCTIAL VIRUS BRONCHIOLITIS
o RSV: pathogenic RNA that is most common cause of
bronchiolitis in young children
o Si/Sx: mild URTI, lethargic, cyanotic, dehydration,
respiratory distress (nasal flaring, retractions,
grunting, rales, wheezing)
o Monitor: apnea
o Supportive therapy: supplemental oxygen and
hydration
o Life-threatening apnea = mechanical ventilation
o Ribavirin
o Isolation infected patients
o Immediate hypersensitivity (type 1) response
o Common chronic illness
o RF: children with atopy or hypersensitive to allergens
such as pollens, molds, house dust, food, cold air,
irritating odors, air pollutants
o Mast cells release histamine & leukotrienes = triad of
inflammation, bronchoconstriction, & increased
mucous secretion = diffuse obstructive & restrictive
airway disease
o Hx: what the child was doing, what action were
taken, and describe home environment
o Findings: wheezing, cyanosis, elevated eosinophil,
bronchospasm, longer expiration, retractions
o Decreased wheezing = less air can go = hypoxemia =
cyanosis
o Chronic: barrel-shaped chest & nail clubbing
o Goals: environmental control, skin testing &
hyposensitization, symptomatic relief
o NO cough suppressants
o Pharmacological: inhaled steroids (fluticasone) and
long acting bronchodilator [bedtime], short-acting
beta-2- agonist bronchodilator (albuterol/
terbutaline), leukotriene receptor antagonist
(montelukast)
o WOF: dehydration
o Encourage drink fluids but not milk or other milk
products
o Child fails to respond to first-line therapy
o Extreme emergency
o Acute respi distress: Increased HR & RR, decreased
O2 sat, low PO2, elevated PCO2 = acidosis, limited
breath sounds
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 o This condition can be triggered by respiratory
infection
o Cultures from coughed sputum
o Broad spec antibiotics
o Nebulization with inhaled beta-2-agonist continuous
o IV corticosteroids
o O2 via face mask or cannula
o Drinking tends to aggravate coughing > IVF D5
0.45NaCl
o No cold drinks
o Monitor I&O, urine specific gravity

PNEUMONIA

o Infection & inflammation of alveoli

o Types: HAI or CAI
o Etiology: bacteria/ viral/ aspiration
o Pneumocystitis carinii pneumonia is associated with
HIV/AIDS

PNEUMOCOCCAL PNEUMONIA

o Manifestation: high fever, nasal flaring, retractions,

chest pain, chills, dyspnea, tachypnea, and
tachycardia
o Lung space with exudates = diminished respi
function
o Bronchial breath sounds
o Crackles = presence of fluids
o Percussion: dullness (consolidation)
o Leukocystosis
o Antibiotics: ampicillin or 3rd gen cephalosporins
o Rest to avoid exhaustion
o Turning & repositioning to avoid pooling of
secretions
o IVF
o Humidified O2
o Chest physiotherapy
o Pneumococcal vaccine

VIRAL PNEUMONIA

o Generally caused: URTI – RSVs, myxoviruses, or

adenoviruses
o Si/Sx 1-2days = low-grade fever, nonproductive
cough, tachypnea
o Diminished breath sounds & fine rales
o RSV -> apnea
o CXR: diffuse infiltrated areas
o Symptomatic management: antipyretics & IVF if
dehydrated

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