Chapter 40

Nursing Care of a Family When a

Child Has a Respiratory Disorder
Upper Respiratory Tract Disorders #1

❖Choanal atresia
❖Acute nasopharyngitis
o Assessment
o Therapeutic management

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Upper Respiratory Tract Disorders #2

❖Pharyngitis
o Viral pharyngitis
o Streptococcal pharyngitis
o Retropharyngeal abscess

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Upper Respiratory Tract Disorders #3

❖Epistaxis
❖Sinusitis
❖Laryngitis
❖Congenital laryngomalacia/tracheomalacia

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Upper Respiratory Tract Disorders #4

❖ Laryngotracheobronchitis (Croup)
o Assessment
o Therapeutic management
❖Epiglottitis
o Assessment
o Therapeutic management

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Upper Respiratory Tract Disorders #5

❖Aspiration
❖Bronchial obstruction
o Assessment
o Therapeutic management

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Lower Respiratory Tract Disorders #1

❖Influenza
❖Bronchitis
❖Bronchiolitis
o Respiratory syncytial virus

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Lower Respiratory Tract Disorders #2

❖Asthma
o Mechanism of disease
o Assessment
▪ History
▪ Physical assessment

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Lower Respiratory Tract Disorders #3

❖Asthma—(cont.)
o Pulmonary function studies
▪ Peak expiratory flow rate monitoring
o Therapeutic management
o Allergy triggers
❖Status asthmaticus: failure to respond to first-line
therapy.

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Lower Respiratory Tract Disorders #4
❖Pneumonia
o Pneumococcal pneumonia
o Chlamydial pneumonia
o Viral pneumonia
o Mycoplasmal pneumonia

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Lower Respiratory Tract Disorders #5

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Lower Respiratory Tract Disorders #6

❖Atelectasis
o Primary atelectasis
o Secondary atelectasis

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Pneumothorax

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Lower Respiratory Tract Disorders #7

❖Pneumothorax
❖Bronchopulmonary dysplasia
❖Tuberculosis
o Assessment
o Therapeutic management

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Lower Respiratory Tract Disorders #8

❖Cystic fibrosis
o Pancreas involvement
o Lung involvement
o Sweat gland involvement

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Lower Respiratory Tract Disorders #9

❖Cystic fibrosis—(cont.)
o Assessment
▪ Sweat testing
▪ Duodenal analysis
▪ Stool analysis
▪ Pulmonary testing
o Therapeutic management

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2020 National Health Goals Related to
Respiratory Illness in Children #1

❖Reduce hospitalizations for asthma in children under

5 years of age from a baseline of 41.4 out of 10,000
children to a target level of 18.1 out of 10,000
children.
❖Reduce invasive pneumococcal infections in children
under 5 years from 20.3 out of 100,000 children to
12.0 out of 100,000 children.

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2020 National Health Goals Related to
Respiratory Illness in Children #2

❖Reduce the number of courses of antibiotics

prescribed solely for the common cold from 1,728
out of 100,000 children to 864 out of 100,000
children.
❖Increase the proportion of children 6 months to 2
years of age who are immunized yearly against
seasonal influenza from 25% to 80%.

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2020 National Health Goals Related to
Respiratory Illness in Children #3
❖Increase the proportion of children 2 to 4 years of
age who are immunized yearly against seasonal
influenza from 23% to 80%.

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Nursing Process: Respiratory Disorder

❖Assessment
❖Nursing diagnosis
❖Outcome identification and planning
❖Implementation
❖Outcome evaluation

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Assessing Respiratory Illness #1

❖Physical assessment
o Cough
▪ Paroxysmal coughing
o Rate and depth of respirations
o Retractions
o Restlessness
o Cyanosis

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Sites of Respiratory Retractions

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Assessing Respiratory Illness #2

❖Physical assessment—(cont.)
o Clubbing of fingers
o Adventitious sounds
o Chest diameter

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Clubbing of Fingers

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Assessing Respiratory Illness #3

❖Laboratory tests
o Blood gas analysis
▪ Pulse oximetry
▪ Nasopharyngeal culture
▪ Sputum analysis

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Assessing Respiratory Illness #4

❖Diagnostic procedures
o Chest radiography
o Bronchoscopy
o Pulmonary function studies

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Nursing Diagnoses
❖Activity intolerance
❖Fatigue
❖Fear
❖Impaired gas exchange
❖Impaired social interaction
❖Ineffective breathing pattern
❖Deficient knowledge

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Quality & Safety Education for Nurses
(QSEN)
❖Patient-Centered Care
❖Teamwork & Collaboration
❖Evidence-Based Practice
❖Quality Improvement
❖Safety
❖Informatics

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Therapeutic Techniques #1

❖Humidification
❖Inhalation devices
❖Coughing
❖Mucus-clearing devices
❖Chest physiotherapy

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Use of a Nebulizer

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Use of a Flutter Device

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Positions for Bronchial Drainage

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Therapeutic Techniques #2

❖Therapy to improve oxygenation

o Oxygen administration
o Pharmacologic therapy
▪ Metered-dose inhalers
o Incentive spirometry
o Breathing techniques

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Therapeutic Techniques #3

❖Therapy to improve oxygenation—(cont.)

o Endotracheal intubation
o Tracheostomy
▪ Suctioning technique

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Therapeutic Techniques #4

❖ Therapy to improve oxygenation—(cont.)

o Assisted ventilation
❖ Lung transplantation

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Question #1

When assessing a child for cyanosis, which is

important for the nurse to remember?
A. Cyanosis is an early indicator of respiratory distress.
B. The degree of cyanosis is not an accurate indicator of the
degree of hypoxia.
C. Cyanosis is caused by a decrease in the depth of respirations.
D. Cyanosis will be present if the child has had a large loss of
blood volume.

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Answer to Question #1

B. The degree of cyanosis is not an accurate indicator

of the degree of hypoxia.
Rationale: If the hemoglobin is low (decreased number of
RBCs), there may not be much cyanosis as the red blood
cells, which when not completely oxygenated, are what gives
the blood the dark color. Cyanosis is present with a PO2 of
less than 40 mmHg, which is usually a later sign in
respiratory distress.

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Question #2
Which is the primary nursing responsibility when a 4-
year-old child with a tracheostomy tube eats?
A. Prevent aspiration of food or fluids into the tube.
B. Limit ingestion of too much fluid.
C. Foster smooth passage of foods through the tube opening.
D. Prevent dyspnea from eating too rapidly.

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Answer to Question #2

A. Prevent aspiration of food or fluids into the tube.

Rationale: Because preschoolers are not necessarily neat
eaters, protecting the tube from food entering it is
important.

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Question #3

A child is to use an incentive spirometer four times

daily. Which statement suggests that the child
understands the purpose and correct technique of the
procedure?
A.“To do this right, I take in a very deep breath.”
B.“Using this will help me cough less.”
C.“The harder I blow out, the better I am doing.”
D.“This will make more room for my heart in my chest.”

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Answer to Question #3

A. “To do this right, I take in a very deep breath.”

Rationale: The purpose of incentive spirometry is to make
the child take a deep breath to aerate the lungs better.

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