Thursday, February 26, 2009

Pediatric Nursing: Respiratory Disorders 2

An inflammatory condition of the lungs

in which alveoli fill with fluid or blood

resulting in poor oxygenation and air


High fever
Thick green, yellow, or blood tinged secretions
Grunting respirations
Rales, crackles, diminished breath sounds
Cough and cyanosis
Infiltrate seen on x-ray

Assess for respiratory distress
NPO (rr > 60 = high risk for aspiration)
IV fluids
Oxygen as need to keep oxygen saturation above 95%
Deep suctioning
Acetaminophen for fever / antibiotics

Pneumonia Isolation
Respiratory isolation
May be taken off isolation if RSV negative and on antibiotics for 24 hours.

Pathophysiology: Cystic Fibrosis
A chronic, progressive, genetic illness involving the digestive system and lungs.
Abnormality of the exocrine glands
Sweat and mucous glands
Mucus of CF is thick and viscous
Causes scar tissue
Leads to irreversible lung damage

Exocrine Gland Dysfunction
Mucous secretions are thick and tenacious
Dysfunction of mucous producing glands leads to multiple gastrointestinal absorption problems.
Blocked pancreatic ducts
No secretion of digestive enzymes

Meconium ileus at birth
Failure to thrive
Steatorrhea stools / constipation
Voracious appetite with poor weight gain
Recurrent respiratory infections
Chronic cough
Malabsorption of intestines

Positive sweat test
Genetic marker
Life long management
Enzyme replacement with eating
Daily CPT postural drainage
Inhaled bronchodilators
Control of lung infections
Nutritional supplements as needed

Enzymes to help digest food
Antibiotics to control infection
Bronchodilators to open airways
Vitamin C to improve absorption of other meds
Vitamins E, A, D, K / fat soluble vitamins

Long Term Complications
Nasal polyps
Rectal polyps / prolapse
Hyperglycemia / diabetes

Asthma is a chronic, inflammatory lung disease involving recurrent breathing problems.
Caused by complex, multicellular reaction in the airway characterized by:
Airway inflammation
Airway hyper-responsiveness to a variety of triggers

Tightness of chest
Prolonged expiratory phase
X-ray = hyper-expansion of lungs

Medical Management
High fowlers position / bed rest
Pulse oximetry
Nebulized albuterol
Methylprednisone / Solu-medrol IV
IV fluids
Oxygen to keep oxygen sats > 95%

Home Management
Peak flow spirometer
Identify triggers
Maximize lung function
Optimal physical growth
Optimal psycho-social state
Maximum participation

Peak Flow Monitoring

  • Spirometry measures how
    much and how fast air is
    forcefully expelled from fully
    inflated lungs.

  • Recommended standard of care
    for management of asthma.

Home Medications
Rescue drugs: short acting albuterol beta 2 agonist – used as a quick-relief agent for acute bronchospasm and for prevention of exercise induced bronchospasm.
Anti-inflammatory or preventative: low-dose inhaled corticosteroid: inhaled or oral prednisone
Allergy: Singulair

Bronchodilators rapidly relax the airway smooth muscle cells, thus reversing the bronchospasm until anti-inflammatory effect of steroids is attained.
Via mouth piece 3 years and older
Via facial mask for less than 3 years

Steroids reduce the inflammatory component of bronchial obstruction, decrease mucus production and mediator release, as well as the late phase (cellular) inflammatory process.
Methyl prednisone IV in severe cases
May need Reglan if experiencing GI upset
PO prednisone – always give with food to decrease GI upset

Oral prednisone (Pedia-pred, Prelone, Liquid pred) recommended for short course in moderate or severe exacerbation
Inhaled: Pulmicort, AeroBid, Flovent
Infant: mask should fit firmly: cataracts
Older child: rinse and spit after treatment to prevent thrush

Family Teaching:
Teach how to use medication
When to use and how often
No OTC drugs
Increase fluid intake
Signs and symptoms of respiratory distress

Bronchopulmonary Dysplasia

It occurs in newborns who are born prematurely and or have a variety of pulmonary disorders and who require ventilatory support with high pressure and oxygen in the first 2 weeks of life.

Fibrosis of airways and marked hyperplasia of the bronchial epithelium
Increased fluid in the lungs, as a result of disruption of the alveolar-capillary membrane
Over distention due to damage to alveolar supporting structures resulting in air trapping
Fibrosis, airway edema, and broncho-constriction

BPD Symptoms
Persistent respiratory distress
Dependent on supplemental oxygen
Failure to thrive
Gastro-esophageal reflux
Pulmonary hypertension

Long Term Management
Supplemental oxygen
Diuretics (pulmonary hypertension)
Anti-inflammatory medication
Nutritional support: po formula + NG supplement
Gastrostomy tube (GER)
Bicarbonate in formula due to chronic state of acidosis

Long-term Outcomes
Oxygen dependent
Visual problems
Feeding difficulties
Developmental delay
Learning difficulties