UPPER RESPIRATORY

DISORDERS
 RHINITIS
□inflammation and irritation of the nasal mucous
membrane
□it affects 10%-30% of the total population
worldwide
□can be acute or chronic, allergic or non-allergic
ETIOLOGY
□Changes in temperature
□Odors
□Drug induced
□Allergen
□Non-allergen
 TYPES OF RHINITIS
Acute Rhinitis Chronic Rhinitis
□ commonly results from □ usually occurs with
viral infections, also be a chronic rhinosinusitis
result of allergies, □ inflammation is
bacteria long term
□ Inflammation is short term □ last for more than four
□ lasts a few days or up consecutive weeks.
to four weeks
 TYPES OF RHINITIS
ALLERGIC RHINITIS
□Inflammation of the nasal mucosa caused by
inhaled airborne allergen that triggers an immune
response
□Most common allergic reaction
□Most common in young children and adolescents
 Types of Allergic Rhinitis
Seasonal Allergic Perennial Allergic rhinitis
Rhinitis/ Hay fever
□occurs year round
□occurs occasionally
(spring, fall, summer)
□caused by airborne
pollens from trees,
grass, weeds or mold.
□ Symptoms are episodic
 PATHOPHYSIOLOGY
Allergens
Nasal congestion
Mucosal edema,
nasal mucosa Rhinorrhea
Itching
Sneezing.
IgE local inflammation and increased
capillary permeability.

Mast cells and basophils(Mediators) histamines and leukotrienes

Clinical Manifestations
□ Paroxysmal sneezing attacks
□ Rhinorrhea- profuse watery nasal discharge
or runny nose
□ Nasal obstruction
□ Itchiness in the eyes, ears and nose
and throat
□ Headache/ sinus pain
RHINORRHEA Paroxysmal Sneezing attacks
 Clinical Manifestations
□Allergic salute-upward rubbing
of the nose with the palm of the
hand
□Allergic shiners- dry circles
under the eyes
Allergic salute Allergic shiners
 Diagnostic Test
Skin testing
□ Confirms hypersensitivity to allergens
CBC and Nasal smear
□High eosinophils
Rhinoscopy
□Visualization of nasopharynx to rule out
nasal obstruction
 NURSING DIAGNOSIS
□ Ineffective breathing pattern rt
nasal obstruction
□ Ineffective Airway Clearance
 MEDICAL MANAGEMENT
▪Eliminate the allergen
▪Anti-Histamines
a. Older Sedating antihistamines
□ Inexpensive, OTC, short acting and effective
□ Diphenhydramine (Benadryl)
□ Chlorphenamine
□ SE: sedation, drowsiness, dry mouth,
nausea, dizziness, blurred vision and
nervousness
 Nursing Considerations on Older
Sedating antihistamines
□Avoid driving cars
□ Should be taken at night
 New-Non Sedating Anti-histamine
□ more expensive, long acting and effective
□ Loratadine (Claritin)
□ Fexofenadine (Allegra)
□ Cetirezine
 Decongestant
□ Pseudoephedrine, phenylephrine
□ Shrink the nasal mucous
membrane by vasoconstriction, for
nasal decongestion
□ Has rebound effect- nasal mucosal
edema
Anti-cholinergic agents
□ Produce bronchodilation by reducing intrinsic vagal tone to
the airways
□ Act as drying agents, inhibits mucous secretions.
□ Atropine sulfate
Corticosteroids (oral/ intranasal)
□ Reduce inflammation of nasal mucosa/ for severe
congestion
□ Prevent mediator release
□ Beconase, Flonase, Nasacort., Nasalide,Nasarel, Nasonex.
Intranasal cromolyn sodium (Nasalcrom)
□ Mast cell stabilizer
□ Hinders the release of chemical mediators
and histamines from the mast cells
Immunotherapy/allergy shots
□ Involves injecting the child with larger doses of
allergen to reduce the magnitude of body’s allergic
response
□ Keep epinephrine at the bedside and monitor the RR
 NURSING INTERVENTIONS
□ Minimize contact with allergens (dust, molds, animals,
fumes, powders, sprays, and smoking)
□ Encasing bed pillows and mattress using dust proof covers
□ Washing bed linens and stuffed animals in hot water weekly
□ Install air cleaners
□ Keep the household humidity at 40%-50%
□ Limit the number of indoor plants
 NURSING INTERVENTIONS
□ Ventilate the house
□ Keep pets outside the house if possible
□ Dry shoes thoroughly
□ Use saline nasal sprays and aerosol
□ Instruct to blow into the nose before applying the
any medication into the nasal cavity
 VIRAL RHINITIS
(COMMON COLDS)
□ an infectious, acute inflammation of mucous
membrane of the nasal cavity caused by a virus.
□ most common cause- Rhinovirus
□ Others: coronavirus, adenovirus, influenza virus,
and parainfluenza virus
 Clinical Manifestations
□ Low grade fever,
□ Nasal congestion,
□ Rhinorrhea, Halitosis,
□ Sneezing, teary watery eyes, sore throat,
general malaise and muscle aches
□ Symptoms may last from 1-2 weeks
DIAGNOSTICS
□Nasal swab
□Rhinoscopy
 NURSING DIAGNOSIS
□ Ineffective breathing pattern rt nasal obstruction
□ Ineffective Airway Clearance rt nasal obstruction
MEDICAL MANAGEMENT
□ Adequate fluid intake and rest
□ Warm salts gargles- soothe the throat
□ NSAIDS- aspirin or ibuprofen
□ Antihistamines- used to relieve sneezing, rhinorrhea and
nasal congestion
□ Petrolleum jelly can soothe irritated skin around the nares
□ Expectorant (Guaifenesin) and nasal
decongestant (Phenylephrine (Neo-Synephrine)
 MEDICAL MANAGEMENT
□Zinc lozenges and zinc nasal spray
□Steam inhalation or heated humidified air
 NURSING INTERVENTIONS
□ Hand hygiene
□ Wear surgical mask
□ Cover mouth when coughing or sneezing
□ Cough or sneeze into the upper arm
□ Adequate fluid intake and rest
□ Warm salts gargles soothe the throat
□ Administer NSAIDS, Antihistamines, Zinc lozenges and zinc
nasal spray, Steam inhalation or heated humidified air for 15-20
minutes
 RHINOSINUSITIS
▪ inflammation of one or more paranasal sinuses
and nasal cavity
▪ precipitated by congestion from viral upper
respiratory infection and nasal allergy.
▪ Classified by duration of symptoms:
▪ Acute( less than 4 weeks), sub acute (4-12
weeks) and chronic (more than 12 weeks)
▪ Can be cause by bacterial or viral infection
 TYPES of RHINOSINUSITIS
Acute ▪ Temporary inflammation
Rhinosinusitis
▪ classified as Acute
bacterial rhinosinusitis
or Acute viral
rhinosinusitis.
▪ Rapid onset and
duration of less than 4
weeks)
 Chronic
Sinusitis
▪A usual complication
of acute sinusitis.
▪Symptom persist
more than 12 weeks
or even years
▪ Prolong inflammation
and impairment
 TYPES of RHINOSINUSITIS

Acute Chronic Rhinosinusitis

Rhinosinusitis ▪ Brought by allergy,
▪ Seasonal, allergy asthma, cystic
fibrosis,
▪ Symptoms go away
immunodeficiency
▪ Usually virus
▪ Difficult to treat
•Often continuous
with acute
 Pathophysiology
Acute that blocks the sinuses.

Rhinosinusitis
•unresolve viral or
bacterial infection or an
exacerbation of allergic
rhinitis.
•the sinus cavity is
invaded by bacteria
causing mucosal
inflammation and edema
Chronic Rhinosinusitis
•a complication of
acute sinusitis.
•Prolong and repeated
infections result in
irreversible changes in
the mucosal lining of the
sinus.
 Pathophysiology
Acute Chronic Rhinosinusitis
Rhinosinusitis ▪Nasal polyps, deviated
▪Inflammation and septum, inhibit sinus
infection interfere with drainage which can lead
protection cleansing to infection.
action of the cilia ▪ Obstruction in the ostia or
the osteomeatal complex
▪Impaired muco-
ciliary transport
 Pathophysiology
Acute overgrowth

Rhinosinusitis
•Nasal congestion caused
by inflammation and
edema of the nasal lining
and production of thick
mucus obstructs the
paranasal sinuses
provide an excellent
medium for bacterial
Chronic Rhinosinusitis
 Unresolve viral or bacterial infection deviated septum, nasal polys, tumors or
or exacerbation of allergic rhinitis by hypertrophied turbinates,

Mucosal inflammation and edema

Cilia becomes paralyzed

Excellent medium for bacterial growth

Excessive mucus production

Secondary Infection Congested sinuses

 CAUSES
Acute Chronic Rhinosinusitis
Rhinosinusitis ▪Acute Rhinosinusitis
▪ BACTERIAL ▪Deviated septum
•Streptococcus ▪Aerobic and
Pneumoniae,less anaerobic bacteria
common S. aureus, ▪Nasal polyps
Moraxella
Catarhalis. ▪Tumor
 CAUSES
Acute Chronic Rhinosinusitis
Rhinosinusitis Diseases
▪VIRAL (H. Influenzae) •Cystic fibrosis
▪Allergy •Asthma
▪Irritants-many irritants •Chronic tonsilitis
can swell the sinuses and •Hypertrophied adenoids
sometimes paralyzed the
cilia.
 CAUSES
Acute Chronic Rhinosinusitis
Rhinosinusitis
▪ Foreign bodies such as
nasal endotracheal tubes,
naso-gastric tubes
▪ Dryness
▪ Certain
medications-antihistamines
 CLINICAL MANIFESTATIONS
Major Minor
▪ Facial pian, ▪Tooth pain, ear pain
pressure fullness pressure fullness
▪ Chronic nasal ▪Headaches
congestion discharge
▪Halitosis
▪ Anosmia
▪Fatigue, cough
▪ High fever
 Diagnostics Findings
▪ Sinus aspiration
▪ Sinus X rays and CT scan
▪ Nasal and sinus endoscopy
 Medical Management
□Antibiotic- for Acute rhinosinusitis- 10-14 days, for CRS
and recurrent sinusitis is 2-4 weeks up to 12 months
▪ Amoxicillin-cluvanic acid (Augmentin)- antibiotic
of choice
▪ Penicillin
▪ Doxycycline, levofloxacin, moxifloxacin
▪ Cephalosphorins
Analgesics
▪ NSAIDS and acetaminophen
Intranasal Saline lavage
▪ can reduce inflammation and clear the passages
of stagnant mucus
Topical Decongestant and nasal spray
▪ can increase the patency and improve drainage of
the sinuses.
▪ Pseudoephedrine
Intranasal corticosteroids
▪ to produce complete or marked improvement in
acute symptoms either viral or bacteria
▪ Beclomethasone
▪ Mometasone
▪ Side effects: nasal irritation, head ache, nausea,
light headedness, rhinorrhea, watery eyes, sneezing,
dry nose and throat
 Surgical management
Functional Endoscopic Sinus Surgery/(FESS)
▪ one of the most common surgical methods to treat
chronic sinus infections.
▪ uses a magnifying endoscope to see and remove
affected tissue and bone.
▪ to flush out infected material, open up blocked passages
▪ To correct structural deformities that obstruct the
ostia (openings) of the sinuses
2. Cauterizing polyps, correcting of deviated septum,
incising and draining the sinuses and removal of
tumors
3. Computerized Guided Surgery- is used to increase
the precision of the surgical procedure and to
minimized complications
4. Caldwell Luc Surgery (Radical Antrum)
Surgery- incision in between the upper gum and
upper lip and done in maxillary sinusitis
To prevent trauma on incision
▪ Do not chew on the affected side
▪ Caution with oral hygiene
▪ Do not wear dentures for 10 days
▪ Advise the client not to blow on the nose 2 weeks
after the removal of packing to prevent bleeding
▪ Avoid sneezing for 2 weeks after surgery
 Nursing Interventions
•Apply warm compresses in the nose, face, and eye part
•Drink plenty of water
•Avoid coffee and liquor
•Steam the sinuses.
•Rest.
•Elevate the head part when sleeping.
•Avoid swimming or diving while in acute infection
 Nursing Interventions
▪ Stop smoking or any type of tobacco
▪ Instruct the correct use of nasal spray
▪ With recurrent sinusitis to begin decongested
▪ Irrigate nasal passages with saline
▪ Assess high fever, severe headache and nuchal rigidity
▪ Referral to primary care provider if periorbital edema and severe
pain on palpation occur
 PHARYNGITIS
□inflammation of the pharynx and surrounding
lymphoid tissue
□can be viral, bacteria or fungus
Bacterial pharyngitis
▪ Group A Betahemolytic
Streptococcus
(GABHS)
▪ Group B and streptococci,
N. Gonorrhea,
Mycoplasma Pneumoniae
▪ Abrupt onset
▪ Usually Severe sore throat
Viral Pharyngitis
•Adenovirus, influenza virus,
Epstein bar virus, and
herpes simplex virus,
coxsackie virus
•Gradual onset
•Sore throat (reaches a
peak on 2nd or 3rd day)
Bacterial pharyngitis Viral Pharyngitis
•High fever 39C-40C •Low grade fever
•Abdominal pain, vomiting, •Hoarseness, cough,
headache anorexia (early)
•Enlarge cervical •Enlarge cervical lymphnodes
lymphnodes
 TYPES OF PHARYNGITIS
Acute Pharyngitis
□ A sudden painful inflammation
of the pharynx, back portion of
the throat, soft palate and
tonsils
□ Commonly referred - “Sorethroat”
 ETIOLOGY
□Exposure to viral agents or bacterial origin
□Viral infection- adenovirus, influenza virus,
Epstein bar virus, and herpes simplex virus
□Bacterial agent - Group A Beta-hemolytic
Streptococcus (GABHS) commonly referred to as
Group A Streptococcus (GAS) or Streptococcal
Pharyngitis.
 Bacterial or viral infection

Invasion of CA into the pharynx

Antigen antibody reaction occurs

Histamin and prostaglandin

releases

Inflammation of
pharynx
 Pathophysiology
□ The body response by triggering an inflammatory
response in the pharynx.
□ This results in pain, fever, vasodilation, edema, and tissue
damage as evidence by redness and swelling and exudates
in the tonsillar pillars, uvula, and soft palate
 Clinical Manifestations
□ Red pharyngeal membrane and enlarge tonsils with
white purple exudate
□ Enlarge and tender cervical lymph nodes
□ Fever more than 38.3C
□ Sore throat
□ Difficulty in swallowing
□ Unpleasant mouth odor
□ Decrease appetite
 Assessment
Inspection
▪ the pharynx and tonsils for erythema, exudates
▪ Check the temperature
▪ Cervical enlargement
▪ Mouth breathing
 Diagnostics Test
□Rapid streptococcal antigen test
□Throat culture
 Medical Management
Bacterial pharyngitis Viral pharyngitis
▪ Antibiotics ▪ Supportive measures
□ Penicillin - First line, Treatment of
choice, Oral for 5 days,

□ Macrolides- Second line-

Clarithromycin, Azithromycin- once a
day for 3 days due to its long half life

□ Cephalosphorins- third line for 5-10

days
Aspirin or acetaminophen
□ Analgesics to reduce
pain Benzocaine
□ Gargle to relieves symptoms
DIET
□ Soft diet
□ Cool beverages (ice pops), warm liquids
□ Fluids 2-3 L/day
 NURSING INTERVENTIONS
▪ Bed rest during febrile stages
▪ Used tissues should be
disposed properly
▪ Cover mouth when coughing
or sneezing
▪ Advised warm gargles
▪ Apply ice collar
▪ Do not to share eating
utensils, glasses, food and
towels
▪ Complete the antibiotic therapy
 Chronic Pharyngitis
□Persistent inflammation of the pharynx
□Hypertropic, Atrophic, Chronic granular
 TYPES OF CHRONIC
PHARYNGITIS
Hypertropic- characterized by general thickening and
congestion of the pharyngeal mucous membrane
Atrophic- late stage of CP , the membrane is thin,
whitish, and at times wrinkled
Chronic granular- characterized by numerous
swollen lymph follicles on the pharyngeal wall.
 ETIOLOGY
□ Common in adults who works in dirty
surroundings
□ Excessive use of voice
□ Suffer from chronic cough
□ Habitual use of alcohol and tobacco
CLINICAL MANIFESATIONS
□ Constant irritation or fullness of the throat
□ Mucous in the throat
□ Difficulty of swallowing
□ Prolong and severe sore throat
 MEDICAL MANAGEMENT
□Avoid exposure to irritants
□Nasal spray -Ephedrine sulfate or phenyleprine- to reduce
nasal congestion
□Antibiotics
□Surgery- Tonsillectomy
 NURSING INTERVENTIONS
□Refrain from overusing the voice
□Avoid exposure to irritants
□Avoid alcohol and stop smoking
□Encourage soft diet
 Tonsilitis/ Adenoiditis
▪ Tonsils and adenoids inflamed due
to infectious agent causing AIR WAY
OBSTRUCTION
▪ Causes: bacteria Group A Beta
hemolytic Streptococcus and virus
influenza
 Acute Tonsilitis
□ an inflammation of
the tonsils in combination
with an inflammation of the
pharynx
□ common in children and
young adults
Chronic Tonsillitis
□persistent infection of
the tonsils.
□formation of small pockets
(crypts) in the tonsils
□symptoms that persist
beyond two weeks.
•
 Acute Tonsilitis Chronic Tonsillitis
□ caused by viruses and •Signs last for
group A streptococci two weeks
(GAS)
□ lasts 4 to 10 days.
□ Symptoms will usually
go away after 3 to 4
days
 Clinical Manifestations
□Persistent and recurrent sore □Dysphagia due to severe
throat pain often radiates to the ear
□Inflame tonsils and adenoids □Mouth breathing and Foul
□Snoring breath odor

□Fever □Ear pain

□Voice impairment due to
enlarge adenoids
 Diagnostics Tests
□Rapid Antigen Detection test- throat swab to determine
bacteria
□Throat culture
 Medical Management
▪ Bed rest
▪ Increase fluid intake
▪ Warm saline gargle
▪ Antimicrobial as ordered
▪ Penicillin- first line antibiotics for bacterial tonsilitis, or
Cephalosphorines (cefuroxime, ceftriaxone, cefalexin, cefazolin)
▪ Supportive therapy- for viral
 Surgery Management
Tonsillectomy and Adenoidectomy
□Removal of tonsils and adenoids
□indicated if tonsillitis recurs 5-6 times a year or for chronic
tonsilitis
□repeated episodes of tonsilitis
 Assessment
Pre Op Care Post Op care
□ Assess for fever, □Lateral/ prone head to the
increased WBC, side
presence of ear pain in
□Semi fowler once awake
the ears
□Monitor for hemorrhage
□ Check PT (N-PT: 11-12
seconds) and PTT.
 Signs of Hemorrhage
□Frequent and excessive swallowing
□Bright red vomitus
□Tachycardia, decreased BP and temperature
rise
□Restlessness
To promote comport
□Provide ice collar to the neck
□Give acetaminophen(non-aspirin) as ordered.
□Avoid administration of ASA
 Food and Fluids
▪Provide ice- cool fluids when awake
▪Provide bland foods.
▪Avoid red or dark foods
▪Avoid citrus juices, extremely hot or cold
•
 Health Education After T and A
▪ Participate only in quiet activities for 1 week after surgery

▪ Encourage abundant liquid. Avoid citirus juices which irritate

the throat for 10 days

▪ Full liquids on the second day and soft diet as the child tolerates
▪ Encourage the child to chew and swallow
▪ Do not give any straw, forks or pointed toys
▪ Avoid hard or scratchy foods (chips, pop corn) citrus
and spicy foods for 3 weeks
▪ Avoid red liquids
▪ Avoid clearing the throat
▪ Avoid coughing or sneezing, blowing the nose for 1-2 weeks
▪ Report signs and symptoms of bleeding and fever (38.3C)
▪ Throat discomfort or pain between 4th to 8th day is expected.
Notify the doctor if pain persist
▪ Rest for two weeks
▪ Avoid colds, overcrowded and public places to
prevent infections
▪ Follow up in 1 -2 weeks
Hi baby, Do I look good????
 EPISTAXIS
□refers to nose bleeding or hemorrhage from the nose
caused by ruptured tiny distended blood vessels in the
mucous membrane in any area of the nose
□ the most common is the Anterior nasal septum where
blood vessels in the Anterior ethmoidal artery,
Sphenopalatine artery, internal maxillary branches
are ruptured.
 Risk Factors
□ Local and □ Hypertension
Systemic Infection
□ Bleeding Disorders
□ Dryness leads to
□ Aspirin use
crust formation
□ Liver disease
□ Trauma
 Signs and Symptoms
▪ Excess blood loss - dizziness and fainting,
confusion, loss of alertness and light-headedness
▪ Elevated BP
▪ Low platelet count
 Nursing Diagnosis
▪ Deficient fluid volume related excessive blood loss
 Diagnostic Evaluation
□Inspection using nasal speculum
□CBC
 Medical Management
▪ Examine the nose and suction to determine the site
of bleeding
▪ Insert a nasal pack neo senephrine (pheneleprine hcl)
▪ Electrocautery and Cotton tampon Layered packing into
the nasal cavity
▪ Nasopharynx of balloon tamponade to apply pressure
 Nursing Interventions
▪ Apply pressure over the soft tissues of the
nose for 5-10minutes.
▪ Sit up, lean forward head tipped
▪ Apply cold compress/ ice pack
▪ Avoid blowing the nose after removal of the
nasal pack.
▪ Monitor VS, platelet count,
respiratory difficulty or obstruction
▪ Provide tissues and emesis basin
▪ Calm the patient
▪ Assess the patent airway and breathing
▪ IV infusions if necessary.
 CROUP
□a viral or bacterial infection of the upper
airway
□Symptoms are usually worse at night and
better in the day;
□they may recur for several night
□usually last 3-4 days
 viral or bacterial
infection

Mucosal inflammation
and edema narrow airway

Sudden onset of harsh, cough, inspiratory stridor and hoarseness

Respiratory Distress

Substernal and suprasternal retraction, agitation, cyanosis, increase HR, restless

HYPOXIA
 TYPES OF CROUP
Acute Spasmodic Laryngitis/
Spasmodic Croup
□Subglottic (below the vocal cord) inflammation
□Occurs often in children 1-3 years of age
□Viral, emotional and genetic predisposition
□Sudden onset, usually at night
 Acute Spasmodic Laryngitis/
Spasmodic Croup
□Child is awaken with harsh cough, inspiratory
stridor, dyspnea and hoarseness of the voice
□Treatment: Humidity, Increased fluids, May
treat at home
 Acute Laryngo-Tracheo Bronchitis
□Inflammation of the larynx, trachea and brochi, glottis
and sub-glotis
□Most common type of Croup
□Common among 6mos-6 years
□CA: Viral (para influenza virus) or bacterial
 Clinical Manifestations
▪ Sudden onset of BARKING or SEAL-LIKE cough
with INSPIRATORY STRIDOR
▪ Hoarseness of the voice
▪ High Fever 40C
▪ Use of accessory muscles (Suprasternal, intercostal, and
suprasternal retractions)
Severe Croup
▪Cyanosis, Restlessness
▪Air hunger, Decrease breath sound
▪Hypoxemia, Hypercapnia
▪Tachycardia
•
 Acute Laryngotracheo bronchitis

Treatment
□Humidity,
□Epinephrine,
□IV fluids during respiratory distress
□Hospitalization
Acute Epiglottitis
□Inflammation of Supraglottic (above the vocal cords}
□3-7 years
□Bacteria (usually H. Influenzae)
□Sudden onset which may rapidly progress to complete
airway obstruction and death
□Sore throat, dyspnea and high fever
TREATMENT
•IV antibiotics
•Artificial airway
•Antipyretics
•IV fluids
•Intunbation
•Emergency hospitalization
Acute Bacterial Tracheitis
• Inflammation of Upper trachea
•Staphylococcus(most common)
•1 month-6 years
Signs and Symptoms
□Progresses upper respiratory infection (1-2
days)
□High fever
□Stridor
□Croupy cough
□Purulent secretions
TREATMENT
•Humidified oxygen
•Antipyretics
•IV antibiotics
•Intubation
•IV fluids
Diagnostic Evaluations
▪ Based on clinical symptoms
▪ ABG
▪ Pulse oximetry- decreased PaO2
NSG Diagnosis
▪Ineffective Airway Clearance
 Medical Management
▪Maintain a Patent
Airway ▪ IV fluids
▪Epinephrine nebulized ▪ Antipyretic
with oxygen ▪ Oxygen
▪Corticosteroid ▪ Intubation
▪Antibiotics
▪Acetaminophen
 Nursing Interventions
□Monitor signs of respiratory distress, LOC or
increased irritability, pulse oximeter readings
□Auscultate adventitious or diminished breath
sounds
□Notify the physician if increased respiratory
distress
□Administer humidified oxygen as ordered
 Nursing Interventions
▪Emergency intubation equipment
▪Administer aerosolized epinephrine
and dexamethasone as ordered.
▪Keep the child as quiet as possible
▪Upright position with the head of the
bed elevated
 Nursing Interventions
▪ P-atent airway
▪ E-levate the HOB
▪ V/S
▪ E-pinephrine and Dexamethasone
▪ R-esuscitation equipment available (Tracheostomy set/
Intubation set)
▪ H-umidify O2
 EVALUATION
▪ Pink mucous membranes and nail beds
▪ Clear breath sounds with effective air movement
▪ Normal RR, HR and oxygen saturation is
greater than 95%