AspirationInhalation of a foreign object into the airway occurs most frequently in infants and toddlers | Signs & Symptoms | • Choking, hard, forceful coughing | • Increased respiratory difficulty (stridor) | Management | • Subdiaphragmatic thrusts (Heimlich Maneuver) | • Stand behind the child & place fist under diaphramgm | • upside down with finger inside mouth, trust the back |
Status AsthmaticusRecurrent diffuse, obstructive pulmonary disease process caused by airway inflammation and hyperreactivity. Occurs when children fail to respond | Clinical Manifestation | • Wheezing changes as disease progresses | • Inspiratory & expiratory wheeze: airways obstructed | • Little air movement heard (tight): complete obstruction | • Retractions, hr & rr elevated, cyanosis, hypoxia | • Prolonged expiratory phase | Pathophysiology | Smooth muscle spasm to mucosal edema leading to mucosal plugging causing obstruction, air trapping leading to hypoxemia | Nursing Care | • Aerosol administration of a bronchodilator (albuterol) | • IV corticosteroids to reduce symptoms | • O2 by face mask or nasal prongs | • IV infusion for hydration | • Monitor I &O : measure the specific gravity of urine | • In severe attacks, ET intubation & mech. ve | Diagnostic Tests | • Chest radiography: detect foreign body, infiltration | • Lab test: evaluate degree of acidosis & infection | • Spirometry: to assess severity of disease | • Pulse oximetry: reveals the low oxygen sat level. |
Extreme emergency because a child may die of heart failure caused by the combination of: exhaustion, atelectasis, respiratory acidosis from bronchial plugging. | | Cystic Fibrosisis a chronic, progressive, and frequently fatal. Caused by abnormality of chromosome 7 CFTR gene. genetic disease of the body's mucus glands. life span of 30 yrs | CF affects | Respiratory | Increased mucus secretions | Digestive | Decreased pancreatic enzymes | Sweat glands | increase salt in sweat | Reproductive | Infertility | Clinical Manifestation | • productive cough, wheezing, hyperinflation of lungs | • Clubbing of extremities, fat soluble deficiencies | • Malnutrition, steatorrhea, strong salt in perspiration. | Treatments | • Preventing and controlling lung infections | • Loosening and removing mucus from the lungs | • Preventing and treating intestinal blockage | • Providing adequate nutrition | Medications | • Antibiotics (gentamycin) | • Mucus thinning drugs: cough up mucus | • Bronchodilators: help keep the airways open | • Oral pancreatic enzymes: help absorb nutrients | Tests and Diagnosis | Sweat test | sweat saltier than normal | Genetic test | defect on chromosome 7 | Imaging test | Damage to lungs or intestines | Function test | How much air, how fast, how well | Sputum culture | Analyzed bacteria | Organ func. | health of pancreas and liver |
Laryngotracheobronchitis (Croup)Pathophysiology | • viral infection of parainfluenza or H.influenza causes swelling of the laynx, trachea, and large bronchi. | • Swelling due to infiltration of WBC causes airway obstruction thus, increased work of breathing. (stridor) | Signs & Symptoms | • Barking cough ( inspiratory stridor ) | • Marked retractions, temp is mildly elevated | • Marked retractions, hoarseness | • Difficulty breathing worsen at night | Nursing Care | • Assess airway obstruction by elev. respi status | • Provide warm, moist envi. & give 02 for hypoxia | • Corticosteroid (dexamethasone or epinephrine | • IV therapy to keep child hydrated | • Keep emergency equipment (tracheostomy, intubation) | Health Teachings | • bath with hot water to produce steam |
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