Key Pediatric Differences in the

Respiratory System
• Lack of /insufficient surfactant
• Alveoli developing
• Smaller airways
• Underdeveloped cartilage

1F
 Key Differences (cont)

• Obligatory nose breather (infant)

• Intercostal muscles less developed
• Faster respiratory rate
• Eustachian tubes relatively horizontal

2
 Respiratory Assessment
• RR first - full minute
• Breath sounds
• Quality
– Retractions
– Nasal flaring
• Color
• Cough

3
4
 Signs Respiratory Distress
• Cough • Vomiting
• Hoarseness • Diarrhea
• Grunting • Anorexia
• Stridor • Tachypnea
• Wheezing • Tachycardia
• Nasal flaring • Restlessness
• Retractions • Cyanosis
5
 Potential Nursing Diagnoses
• Ineffective Airway Clearance
• Ineffective Breathing Patterns
• Impaired Gas Exchange
• Anxiety
• Activity Intolerance
• Risk for FVD
• Altered nutrition
• Altered comfort
• Knowledge deficit
• Ineffective coping – individual or family 6
 Apnea

• Periodic breathing of newborn

• True apnea
• ALTE
• Parental teaching

7
 Sudden Infant Death Syndrome
• The sudden and unexplained death of an
infant less than 1 yr old.
• Usually occurs during sleep.
• “Back to Sleep” campaign
• AAP revised SIDS guidelines (Pediatrics,
Vol. 116, No. 5, Nov. 2005)

8
 Sepsis
• Def: a systemic bacterial infection spread
through bloodstream
• Neonates high risk: unable to localize
infection
• High Risk:
– Immunocompromised
– Skin defects/injuries
– Invasive devices

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 Assessment: Sepsis
• Know high risk children & monitor
– Hypo or hyperthermia
– Lethargy; poor feeding
– Jaundice, hepatosplenomegaly
– Respiratory distress
– Vomiting
– Hyper or hypoglycemia

10
 Otitis Media

Description: inflammation middle ear

– Acute otitis media
– Otitis media w/effusion
• Bacterial

11
 Risk Factors
• < 3 years
• Bottle-fed babies
• Passive smoke
• Group child care

12
 Acute Otitis Media
• Definition
– Inflammation of middle ear
– Rapid onset
– Fever
– Otalgia
• Other Clinical Manifestations:

13 F
 Treatment: AOM
• Primary Prevention
– pneumococcal vaccine
– No passive smoke
– Hold bottle fed babies upright
– handwashing

14
 AOM: Secondary Prevention

• Pain relief
• Rest
• Antibiotics after 48-72 hrs in selected
patients 6 mo to 2 yrs.
PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1451-
1465

15
 Nursing Dx: AOM

• Altered comfort r/t inflammation &

pressure
• Knowledge deficit r/t incomplete
understanding of disease
• Risk for Fluid Volume Deficit

16
 Otitis Media w/Effusion
• Definition
– Fluid in middle ear
– No s/s acute infection
• Clinical Manifestations:

17
F
 Treatment: OME
• Antibiotics if > 3 mo.
• Assess for hearing loss ***
• Myringotomy w/placement
tympanostomy tubes

18
 Pharyngitis
• 80-90% sore throats viral in
origin
– Gradual onset
• Bacterial
– Group A beta-hemolytic strep
greatest concern.

19
F
 Therapeutic Management
• Primarily symptomatic
• Pain relief
• Rest
• Abx only if positive bacterial culture

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 Tonsillectomy/adenoidectomy
• Most common reason: OSA
• Monitor for post-op bleeding
– ***Excessive swallowing
– Elevated pulse, decreased BP
– Evidence of fresh bleeding
– Restlessness
• Pain meds – teach parents
• Fluids
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 Croup Croup
• Broad classification of upper airway illness
• Group of conditions with:
– Inspiratory stridor
– Harsh cough
– Hoarseness
– Degrees of respiratory distress
• 4 different types

Fig. 45-UF03, p. 1209 22

F
 Laryngotracheobronchitis
• Def: inflammatory condition of larynx,
trachea, bronchi
• viral
• Gradual onset
• harsh cough & insp. stridor
• Very important to differentiate from
epiglottitis

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 LTB - treatment
• Racemic epinephrine via neb
• Corticosteroids
• Tylenol
• Cool mist
• Oxygen
• Observe for sudden silent respiration

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Four D's of Epiglottitis
•Drooling
•Dysphagia
•Dysphonia
•Distressed respiratory
efforts
•Tripod position
•Do not: examine
•throat or do throat
culture!
•Do: reassure, keep
calm, anticipate
intubation
25
F
 Brochiolitis
• Lower airway
• 50% RSV (respiratory syncytial virus)
– Contact and droplet precautions
– Mycoplasma, parainfluenza, adenovirus
• Usually young infants who need
hospitalization.

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Patho of Bronchiolitis
• Virus invades
mucosal cells
• Cells die: debris
• Irritation 
increased mucus &
bronchospasm
• Air trapping

27
 Bronchiolitis
Clinical Manifestation
• Tachypnea
• Wheezing, crackles, or rhonchi
• Retractions
• Fever- maybe
• Difficulty feeding
• Cyanosis

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 Changes to Bronchiolitis Management
What You Will See
• Decrease in the amount of
nasal swabs being ordered
• Decrease in orders for CPT
by RT
• Decrease in continuous O2
saturation monitoring
• Decrease in use of albuterol
treatments
• Discharge orders for
patients with > 90% O2
saturations while asleep
For patients placed on Isolation Precautions: Gowns, Gloves, & MASKS are encouraged
What You Will Do
• When cohorting patients,
infection control may be
consulted
• Teach parents CPT for
comfort measures
• Increase amount of
intermittent O2 sat checks
(ex. Q4h)
• Increase use of Racemic
Epi
• Accept O2 saturations as
low as 88% when a patient
is sleeping
• Continue suctioning as
usual
 Bronchiolitis Nursing Interventions

• Facilitate gas exchange

• Monitor I & O (for DFV)

• IV prn
• Reduce fever
• Reduce anxiety
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 Asthma
• Reactive airway disease
– Bronchospasm
– Edema
– Increased mucus production
• Triggers
– Dusts, pollen, food, strenuous exercise,
weather changes, smoke, viral infections

31
F
 Asthma
Clinical Manifestations
• Wheezing
• Dyspnea w/prolonged expiration
• Nonproductive cough
• Tachypnea, orthopnea
• Tripod position
• Fatigue

32
 Asthma treatment
• Short-acting bronchodilator
• Mast cell inhibitor
• Systemic corticosteroids
• Inhaled steroids
• Leukotriene receptor antagonist
• Peak expiratory flow rate
• Immunizations

33
 Cystic Fibrosis
• Mechanical obstruction r/t increased
viscosity of mucous secretions.
• Autosomal recessive disorder

34
 Cystic Fibrosis:
A Multisystem Disorder
• Respiratory system
• Digestive system
• Integumentary system
• Reproductive system
• Growth and development

35
F
 Assessment findings - CF
• Salty-tasting skin
• Profuse sweating
• Frequent infections
• Dry, non-productive cough
• Increased amt, thickness of secretions
• Wheezing
• Cyanosis
36
 Assessment findings – CF
(cont)
• Digital clubbing
• Increased A-P diameter of chest
• Steatorrhea
• Thin extremities
• Muscle wasting
• Failure to thrive
• Meconium ileus
37
Cystic Fibrosis: Interventions
strengthen lines of resistance
• Facilitate airway clearance and gas
exchange.
– CPT
– Pulmozyme
• Prevent infection
– Immunizations
– TOBI
– Azithromycin
• Promote increased exercise tolerance.
38
 CF: Interventions
Provide optimal nutrition for growth.
• High-calorie, high protein
• Pancreatic enzymes with every meal
– Creon, Pancrase
– Dosage adjusted to stool formation

39
 CF interventions (cont)
Strengthen FLD/extrapersonal
environment
– Child's and family's emotional needs
– Prepare the family for home care

40