Nursing Care of Children

with Alterations in
health status (Acute &
Chronic)

A. Alterations in Oxygenation
https://youtu.be/oX3CZnrLxbQ
 EPIGLOTTITIS

DESCRIPTION:

➢ Inflammation of the epiglottitis occurs most frequently

between 2-5 years of age, which may be caused by
Hemophilus influenzae type B streptococcus pneumoniae.
➢ Considered an emergency situation.
 ASSESSMENT:

▪ High fever
▪ Sore, red, and inflamed throat.
▪ Absence of spontaneous cough
▪ Drooling
▪ Difficulty in swallowing
▪ Muffled voice
▪ Inspiratory stridor aggravated by
supine position
▪ Tachycardia
▪ Tachypnea progressing to more
severe respiratory distress.
▪ Agitation
▪ Tripod positioning
INTERVENTIONS:
• Maintain a patent airway.
• Assess respiratory status and breath sounds.
• Assess temperature.
• No attempts should be made to visualize the posterior
pharynx , obtain throat culture or take oral temperature.
• Prepare the child for lateral neck films to confirm the
diagnosis.
• Maintain on NPO status.
• Do not leave the child unattended.
• Do not force the child to lie down.
• Do not restrain the child.
• Have resuscitation equipment available.
Medications as Prescribed:
✓ Administer intravenous fluids.
✓ Administer intravenous antibiotics;
usually followed by oral antibiotics
to complete a 7-10 day course.
✓ Administer analgesic and antipyretics
(acetaminophen) Tylenol to reduce
fever and throat pain as prescribed.
✓ Administer corticosteroids
(prednisone) Deltasone to decrease
inflammation.
✓ Provide cool mist oxygen therapy.
 LARYNGOTRACHEOBRONCHITIS

DESCRIPTION:

➢Inflammation of the larynx, trachea and

bronchi.
➢May be viral or bacterial; most frequently
occurs in children younger than 5 years.
➢Characterized by gradual onset that may
be preceded by an upper respiratory
infection.
 ASSESSMENT:
STAGE 1 STAGE 3
• Low grade fever
• Restlessness
• Fear
• Seal bark and brassy cough • Anxiety
• Inspiratory stridor • Pallor
• Irritability and restlessness • Diaphoresis
STAGE 2 • Tachypnea

• Continuous respiratory stridor STAGE 4

• Retractions
• Use of accessory muscles
• Crackles and wheezing
• Labored Respirations
Intermittent cyanosis progressing
to permanent cyanosis Apneic
episodes progressing to cessation
of breathing.
INTERVENTIONS:

• Maintain a patent airway.

• Assess respiratory status and sternal retractions.
• Monitor oxygen saturation.
• Monitor for pallor and cyanosis.
• Elevate the head of the bed and provide bed rest.
• Avoid cough syrups, such guaifenesin/Robitussin and cold
medicines which may dry and thicken secretions.
• Provide and encourage fluid intake if able to take orally.
Medications as Prescribed:

✓ Administer intravenous fluids.

✓ Administer analgesic and antipyretics
(acetaminophen) Tylenol to reduce .
✓ Administer corticosteroids (prednisone)
Deltasone to decrease inflammation.
✓ Administer bronchodilators to relax
smooth muscles.
✓ Administer nebulized epinephrine
(racemic epinephrine).
✓ Administer antibiotics, noting that they
are not indicated unless a bacterial
infection is present.
LUNG RETRACTIONS
Suprasternal and
Intercostal Retractions
Supraclavicular
Retractions

Subcostal Retractions
Substernal Retractions
 BRONCHITIS
DESCRIPTION:

➢ Infection of major bronchi; may be referred to us

tracheobronchitis.
➢ Usually occurs in association with an upper respiratory infection.
➢ Mild, self limiting disorder; causative agent most often viral.
 ASSESSMENT:

• Fever
• Dry hacking and non productive
cough that is worse at night and
becomes productive in 2-3 days.
INTERVENTIONS:
• Treat the symptoms as needed.
• Monitor respiratory distress.
• Provide cool humidified air.
• Monitor for signs of dehydration, such as sunken fontanels,
non elastic skin turgor, decreased urinary output, dry mucous
membranes and decreased tear production.
• Provide and encourage fluid intake if able to take orally.
Medications as Prescribed:

✓ Administer analgesic and

antipyretics (acetaminophen)
Tylenol to reduce fever.

✓ Administer cough suppressants

such as guaifenesin/Robitussin.
 BRONCHIOLITIS AND RESPIRATORY
SYNCYTIAL VIRUS (RSV)
DESCRIPTION:
➢ This is an inflammation of bronchioles that causes a
production of thick mucus that occludes bronchiole tubes
and small bronchi.
➢ RSV is a common cause of bronchiolitis. Although not
airborne but highly communicable and is usually
transferred by direct contact with respiratory secretions.
➢ Rare in children older than 2 years, with a peak incidence
at approximately 6 mos. of age. Occurs primarily in the
winter and spring.
 ASSESSMENT:
INITIAL MANIFESTATIONS:
Rhinorrhea
Pharyngitis
Coughing
Wheezing
Intermittent fever
MANIFESTATIONS AS THE DISEASE
PROGRESSES:
Increased coughing and wheezing.
Signs of air hunger.
Tachypnea and retractions.
Periods of cyanosis.
MANIFESTATIONS IN SEVERE ILLNESS:
Tachypnea more than 70 breaths/min.
Decreased breath sounds and poor air
exchange.
Listlessness
Apneic Episodes
INTERVENTIONS:

• Maintain patent airway.

• Position the head 30-40 degree angle with the neck slightly
extended to maintain an open airway and decrease pressure
on diaphragm.
• Provide cool humidified air.
• Monitor for signs of dehydration, such as sunken fontanels,
non elastic skin turgor, decreased urinary output, dry mucous
membranes and decreased tear production.
• Provide and encourage fluid intake if able to take orally.
Medications as Prescribed:

The child with RSV:

✓ Isolate the child in a single room or place in a room
with another child with RSV.
✓ Maintain effective handwashing procedure.
✓ Ensure that nurses caring for these children do not
care for high risk children.
✓ Wear gowns when soiling of clothing may occur
during care.
✓ Administer ribavin (Virazole) an antiviral
medication.
✓ Prepare for the administration of respiratory
syncytial virus immune globulin (RSV-IG) or
RespiGam or palivizumab (Synagis).
PNEUMONIA
DESCRIPTION:

➢ Inflammation of the pulmonary of the pulmonary

parenchyma an/or alveoli caused by a virus,
mycoplasma agents, bacteria or aspiration of foreign
substances.

➢ The causative agent usually is introduced into the lungs

through inhalation or from the bloodstream.
 PNEUMONIA
DESCRIPTION:
Viral Pneumonia occurs more frequently than bacterial pneumonia and
often is associated with a viral upper respiratory infection.

ASSESSMENT:
o Acute or insidious onset.
o Symptoms range from mild fever , slight cough, and malaise to high
fever, severe cough and diaphoresis.

INTERVENTION:
❑ Treatment is symptomatic.
❑ Administer oxygen with cool mist as prescribed.
❑ Increased fluid intake.
❑ Provide and encourage fluid intake if able to take orally.
❑ Administer analgesic and antipyretics (acetaminophen) Tylenol to reduce
fever.
❑ Administer chest physiotherapy and postural drainage.
 PNEUMONIA
DESCRIPTION:
Primary Atypical Pneumonia is a common cause of pneumonia in
children between the ages of 5-12 years. More prevalent in crowded
living conditions.

ASSESSMENT:
o Acute or insidious onset.
o Fever lasting several days to 2 weeks, chills , headache, malaise and
myalgia.
o Rhinitis sore throat, dry throat, hacking cough.
o Non productive cough initially progressing to the production of semi
mucoid sputum that become mucopurulent or blood streaked.

INTERVENTION:
❑ Treatment is symptomatic.
❑ Recovery generally occur 7- 10 days
 PNEUMONIA
DESCRIPTION:
Bacterial Pneumonia is often serious infection requiring hospitalization when pleural
effusion or empyema accompanies the disease; hospitalization is also necessary for
children with staphylococcal pneumonia.

ASSESSMENT:
o Acute onset.
o Infant: Irritability, lethargy, poor feeding; abrupt fever (may be accompanied by seizures,
respiratory distress.
o Older child: Headache, chills, abdominal pain, chest pain and meningeal symptoms.
o Hacking non productive cough.
o Diminished breath sounds or scattered crackles.
o With consolidation, decreased breath sounds are more pronounced.
o As the infection resolves the cough becomes productive and the child expectorates purulent sputum;
coarse crackles and wheezing noted.
INTERVENTIONS:
• Maintain patent airway suctioning.
• Position to affected side if the pneumonia is unilateral.
• Provide cool humidified air.
• Monitor temperature frequently because of the risk for febrile
seizures.
• Provide and encourage fluid intake if able to take orally.
• Promote bed rest to conserve energy.
• Isolation precautions with pneumococcal or staphylococcal
pneumonia (per protocol)
• Administer chest physiotherapy and postural drainage.
INTERVENTIONS:

• Assess patent airway.

• Continuously monitoring respiratory status.
• Prepare child for chest radiograph.
• Prepare to obtain samples for determining arterial blood gas
and serum electrolytes.
Medications as Prescribed:

✓ Administer analgesic and antipyretics

(acetaminophen) Tylenol to reduce
fever.
✓ Administer cough antitussive such as
guaifenesin/Robitussin.
✓ Administer O2 inhalation.
✓ Antimicrobial therapy is initiated as
soon as the diagnosis is suspected. IV
antibiotics is usually prescribed.
https://www.youtube.com/watch?v=3hTsve9jjsQ
 ASTHMA
DESCRIPTION:
➢ Is a chronic inflammatory disease of the airways.
➢ Commonly caused by physical and chemical irritants such as foods,
pollens dust mites, cockroaches, smoke, animal dander, temperature
changes, respiratory infection, activity and stress.
➢ The allergic reaction can cause immediate reaction with obstruction
occurring and it can be precipitate a late bronchial obstructive reaction
several hours after initial exposure.
➢ Common symptoms is coughing in the absence of respiratory infection,
especially at night.
 ASSESSMENT:
▪ Child has episodes of wheezing, breathlessness, dyspnea, chest
tightness, and cough, particularly at night or early in the morning.
▪ Exacerbations worsening episodes.
▪ It begins with irritability, restlessness and headache.
▪ The child experiences retractions.
▪ Respiratory symptoms include hacking non productive cough.
Medications as Prescribed:

✓ Administer humidified oxygen.

✓ Administer quick relief
medication. Anticholinergics and
systemic corticosteroids.
✓ Antiallergic medications.
✓ Nebulization or metered dose
inhaler.
https://www.youtube.com/watch?v=4aK76DoxKGk&t=28s
 CYSTIC FIBROSIS
DESCRIPTION:
➢ This is a chronic multisystem disorder (autosomal
recessive trait disorder) characterized by exocrine gland
dysfunction.
➢ CF is a fatal genetic disorder and respiratory failure is the
most common cause of death.
➢ It affects respiratory system Gastrointestinal system, and
Integumentary system.
INTERVENTIONS:

• Maintain a patent airway.

• Assess respiratory status and sternal retractions.
• Monitor oxygen saturation.
• Monitor for pallor and cyanosis.
• Elevate the head of the bed and provide bed rest.
• Chest Physiotherapy.
• Encourage a well balanced diet. High protein and high
caloric diet.
• No cough suppressant meds.
Medications as Prescribed:

✓ Administer antimicrobial
medications.
✓ Aerosolized antibiotics
✓ Antiallergic medications.
✓ Administer O2 inhalation.
 SUDDEN INFANT DEATH SYNDROME
DESCRIPTION:
➢ Unexpected death of an apparently healthy infant
younger than 1 year for whom a thorough autopsy to
demonstrate an adequate cause of death .
 ASSESSMENT:

▪ Child is apneic.
▪ Frothy blood tinged fluid is in
the nose and mouth
▪ Diaper may be wet and full of
stool.
▪ Child may be found in any
position but typically found
with blankets over the head and
huddled in a corner
INTERVENTIONS:

• Should be placed in supine position.

• Stuffed animals should be removed.
• Avoid overheating during sleep.
• Soft, moldable mattress should not be use for bedding
 TUBERCULOSIS
DESCRIPTION:
➢ Is a contagious disease caused by mycobacterium
Tuberculosis.
➢ Most children are infected by family member.
 ASSESSMENT:

▪ Maybe asymptomatic or
develops symptoms such as
malaise, fever, cough, weight
loss, anorexia and
lymphadenopathy.
▪ Mantoux test.
▪ Sputum culture.
INTERVENTIONS:

• Place on respiratory isolation.

• Maintain airborne precaution. (N95mask)
Medications as Prescribed:

✓ Administer 9 month course of Anti

Tb Meds. Recommendation for
Child:
• Isoniazid (IHN)
• Rifampin (Rifadin)
• Pyrazinamide
https://www.youtube.com/watch?v=KRtAqeEGq2Q&t=67s
 Thank you!!!
Sheena Mae Buana- Cañezal, RN., MN.

College of Nursing
Faculty