chapter 40 respiratory dysfunction all elsevier items and derived items 2014, 2010, 2006, 2002,...
DESCRIPTION
Viruses Respiratory syncytial virus (RSV) Others Group A β-hemolytic streptococci Staphylococci Haemophilus influenzae Chlamydia trachomatis, Mycoplasma organisms, pneumococci Infectious Agents 3 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.TRANSCRIPT
Chapter 40
Respiratory Dysfunction
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Upper respiratory tract Oronasopharynx, pharynx Larynx, upper trachea
Lower respiratory tract Lower trachea, bronchi Bronchioles, alveoli
Respiratory Infections
2All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Viruses Respiratory syncytial virus (RSV)
Others Group A β-hemolytic streptococci Staphylococci Haemophilus influenzae Chlamydia trachomatis, Mycoplasma organisms,
pneumococci
Infectious Agents
3All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
<3 Months: maternal antibodies 3-6 Months: infection rate increases Toddler and preschool ages: high rate of viral
infections >5 Years: increase in Mycoplasma pneumoniae
and β-hemolytic streptococcal infections Increased immunity with age
Age
4All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Diameter of airways is smaller Distance between structures is shorter, allowing
organisms to move rapidly Eustachian tubes are short and open
Size
5All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Immune system Malnutrition, anemia Allergies, asthma Preterm birth Cardiac anomalies Cystic fibrosis (CF) Day care
Resistance
6All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Most common during winter and spring Mycoplasmal infections: more common in fall
and winter Infection-related asthma: more frequent in cold
weather RSV season: considered winter and spring
Seasonal Variations
7All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Vary with age Generalized signs and symptoms and local
manifestations differ in young children Fever and meningismus Anorexia, vomiting, diarrhea, abdominal pain Cough, sore throat, nasal blockage or discharge Respiratory sounds
Clinical Manifestations
8All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Ease respiratory effort Promote rest and comfort Prevent spread of infection Reduce temperature Promote hydration and nutrition Provide support and reassurance
Care Management
9All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Nasopharyngitis: “common cold” Caused by numerous viruses
RSV, rhinovirus, adenovirus, influenza and parainfluenza viruses
Fever: varies with age of the child Managed at home No specific treatment
Upper Respiratory Tract Infections
10All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Causes and risks Group A β-hemolytic streptococcal infection Risk for rheumatic fever
Clinical manifestations Diagnostic evaluation Therapeutic management Nursing care
Acute Streptococcal Pharyngitis
11All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Acute Streptococcal Pharyngitis (Cont.)
12All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Frequent co-occurrence with pharyngitis Causes and pathophysiology Clinical manifestations Therapeutic management
Tonsillectomy and adenoidectomy Nursing care
Postoperative care
Tonsillitis
13All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Tonsillitis (Cont.)
14All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Commonly known as the “flu” Caused by orthomyxoviruses
Types A, B, and C Clinical manifestations Therapeutic management Prevention Nursing care
Influenza
15All Elsevier items and derived items © 2014, 2010, 2006, 2002 , Mosby, Inc., an imprint of Elsevier Inc.
Causes and pathophysiology Diagnostic evaluation Therapeutic management
Pharmacologic Surgical
Nursing care Prevention of recurrence
Otitis Media
16All Elsevier items and derived items © 2014, 2010, 2006, 2002 , Mosby, Inc., an imprint of Elsevier Inc.
Causes and pathophysiology Herpes-like Epstein-Barr virus
Diagnostic tests Therapeutic management Prognosis Nursing care
Infectious Mononucleosis
17All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Characterized by hoarseness, “barking” cough, inspiratory stridor, and varying degrees of respiratory distress
Croup syndromes affect larynx, trachea, and bronchi Epiglottitis, laryngitis, laryngotracheobronchitis (LTB),
tracheitis Most often caused by H. influenzae type B
Croup Syndromes
18All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
A medical emergency Clinical manifestations
Sore throat, pain, tripod positioning Drooling, difficulty swallowing Inspiratory stridor, mild hypoxia, distress
Therapeutic management Prevention of progressive respiratory obstruction Intubation or tracheostomy
Acute Epiglottitis
19All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Most common of the croup syndromes Generally affects children <5 years of age Organisms responsible
RSV, parainfluenza virus, M. pneumoniae, influenza A and B, pneumococci, staphylococci
Acute Laryngotracheobronchitis
20All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Usually preceded by an upper respiratory tract infection
Inspiratory stridor Suprasternal retractions Barking or “seal-like” cough Increasing respiratory distress and hypoxia Can progress to respiratory acidosis, and
respiratory failure
Manifestations of LTB
21All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Maintaining the airway Maintain hydration, orally or intravenously Nebulized mist with supplemental O2
Nebulizer treatments Epinephrine Steroids
Therapeutic Management
22All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Also known as “spasmodic croup” Paroxysmal attacks of laryngeal obstruction Occurs chiefly at night Inflammation: mild or absent Most often affects children 1-3 years of age Therapeutic management
Similar to that for infectious croup
Acute Spasmodic Laryngitis
23All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Infection of the mucosa of the upper trachea Distinct entity with features of croup and
epiglottitis Clinical manifestations similar to those of LTB May be complication of LTB Thick, purulent secretions that result in
respiratory distress
Bacterial Tracheitis
24All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Vigorous management Humidified oxygen Antipyretics Antibiotics Possible need for intubation Mechanical ventilation
Therapeutic Management
25All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Lower airways: considered the “reactive” portion of the lower respiratory tract
Include bronchi and bronchioles Cartilaginous support not fully developed until
adolescence Constriction of airways
Infections of the Lower Airways
26All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Also known as “tracheobronchitis” Mild, self-limiting disease
Causative agents Clinical manifestations Nursing care
Cough suppressants Fluids Rest
Bronchitis
27All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Respiratory syncytial virus Common, acute, viral infection Winter and early spring Diagnostic evaluation Therapeutic management Prevention, prophylaxis Nursing care
Respiratory Syncytial Virus and Bronchiolitis
28All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Primary disease or complication Causative agents
Inhaled organisms Bloodstream infection
Lobar pneumonia Pneumonitis Supportive and symptomatic care
Pneumonias
29All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Bacterial Viral Mycoplasmal Pneumococcal Development of vaccine
Causes of Pneumonias
30All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Causes of Pneumonias (Cont.)
31All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Caused by Bordetella pertussis In United States, occurs most often in children
who have not been immunized Highest incidence in spring and summer Highly contagious Risk to young infants Vaccines
Pertussis (Whooping Cough)
32All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Caused by Mycobacterium tuberculosis, human and bovine varieties
Transmission modes Urban, low income, nonwhite population
Clinical manifestations Diagnostic evaluation Prognosis and prevention
Tuberculosis (TB)
33All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Recommended procedure is Mantoux test Purified protein derivative used Standard dose and administration technique
Positive reaction 5-mm induration 10-mm induration 15-mm induration
Recommendations for TB testing
Tuberculosis Testing
34All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Isoniazid (INH) Rifampin Pyrazinamide Ethambutol 6-Month regimen Prophylaxis for patient at high risk: INH for 12-24
months
Therapeutic Management of Tuberculosis
35All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Risk among small children (1-3 years of age) Beads, paper clips, other small objects in the nose Hotdogs, peanuts, popcorn, marbles, and coins
Diagnostic evaluation Therapeutic management Nursing care
Foreign Body Aspiration
36All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Risk for child with feeding difficulties Prevention of aspiration Feeding techniques, positioning Avoidance of aspiration risks
Hydrocarbons, lipids Solvents Talcum powder
Aspiration Pneumonia
37All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Movement of fluid into the lungs Pathophysiology
Cardiogenic Noncardiogenic
Therapeutic management Nursing care of the child with pulmonary edema
Pulmonary Edema
38All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Acute lung injury Characterized as respiratory distress and
hypoxia within 72 hours after serious injury or surgery
Causes Sepsis Trauma Drug overdose Near drowning
Acute Respiratory Distress Syndrome
39All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Pathophysiology Treatment Prognosis
Mortality rates remains high Nursing care
Intensive care
Acute Respiratory Distress Syndrome (Cont.)
40All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Severity depends on nature of substance, environment, and duration of contact
Local injury Systemic injury Therapeutic management
Humidifying oxygen at 100%
Smoke Inhalation Injury
41All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Passive (secondhand) smoke Scope of the problem Effects on the growing fetus Effects on children
Exposure to Environmental Tobacco Smoke
42All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Chronic inflammatory disorder of airways Recurring symptoms Bronchial hyperresponsiveness Airway obstruction
Limited airflow or obstruction that reverses spontaneously or with treatment
Causes and pathophysiology
Asthma
43All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Asthma (Cont.)
44All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Step 1: mild, intermittent asthma Step 2: mild, persistent asthma Step 3 or 4: moderate, persistent asthma Step 5 or 6: severe, persistent asthma Clinical features of each classification
Classification of Asthma Severity in Children Aged 5 Years and Older
45All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Diagnostic evaluation Pulmonary function tests Skin testing for allergens
Therapeutic management Goal: to maintain normal activities levels Prevention of exacerbations
Diagnosis and Management of Asthma
46All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Long-term control medications Quick-relief medications Metered-dose inhaler Corticosteroids Cromolyn sodium
Drug Therapy for Asthma
47All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Drug Therapy for Asthma (Cont.)
48All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Albuterol, metaproterenol, terbutaline Long-term bronchodilators (salmeterol
[Serevent]) Theophylline: monitor serum levels Leukotriene modifiers Others
Drug Therapy for Asthma (Cont.)
49All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Exercise Breathing exercises Hyposensitization Prognosis
Asthma Interventions
50All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Asthma Interventions (Cont.)
51All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Medical emergency Respiratory failure and death if untreated
Continuation of respiratory distress despite vigorous therapeutic measures
Concurrent infection in some cases Therapeutic intervention
Improving ventilation Pharmacologic agents
Status Asthmaticus
52All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Prevent exacerbation Avoid allergens
Provide acute asthma care Relieve bronchospasm Monitor function with peak flowmeter Master self-management of inhalers, devices,
and activity regulation
Goals of Asthma Management
53All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Goals of Asthma Management (Cont.)
54
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Multisystem involvement Increased viscosity of mucous gland secretions Elevation of sweat electrolytes Increase in enzymatic constituents of saliva Autonomic nervous system abnormalities
Autosomal recessive trait Defective gene inherited from both parents with an
overall incidence of 1:4
Cystic Fibrosis
55All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Cystic Fibrosis (Cont.)
56All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Secretion results in mechanical obstruction Thick inspissated mucoprotein accumulates,
dilates, precipitates, and coagulates to form concretions in glands and ducts
Respiratory tract and pancreas are predominantly affected
Cystic Fibrosis: Increased Viscosity of Mucous Gland Secretion
57All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Sweat chloride test Newborn screening DNA identification of mutant genes Abnormal measurement of nasal potential
difference
Cystic Fibrosis: Diagnostic Evaluation
58All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Wheezing respiration, dry nonproductive cough Generalized obstructive emphysema Patchy atelectasis Cyanosis Clubbing of fingers and toes Repeated bronchitis and pneumonia
Cystic Fibrosis: Presentation
59All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Meconium ileus Distal intestinal obstruction syndrome Excretion of undigested food in stool; increased
bulk, frothiness, and foul odor Wasting of tissues Prolapse of the rectum
Cystic Fibrosis: Presentation (Cont.)
60All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Delayed puberty in girls Sterility in boys Parents’ report: child’s skin tastes “salty” Dehydration Hyponatremic/hypochloremic alkalosis Hypoalbuminemia
Cystic Fibrosis: Presentation (Cont.)
61All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Complications are present in almost all patients with CF, but onset/extent is variable
Stagnation of mucus and bacterial colonization result in destruction of lung tissue
Tenacious secretions are difficult to expectorate: they obstruct bronchi/bronchioles
Cystic Fibrosis: Pulmonary Complications
62All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Pseudomonas aeruginosa Burkholderia cepacia Staphylococcus aureus H. influenzae Escherichia coli Klebsiella pneumoniae
Cystic Fibrosis: Susceptibility to Infectious Pathogens
63All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Gradual progression follows chronic infection Bronchial epithelium is destroyed Infection spreads to peribronchial tissues,
weakening bronchial walls Peribronchial fibrosis ensues O2/CO2 exchange decreases
Cystic Fibrosis: Respiratory Progression
64All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Chronic hypoxemia: causes contraction/hypertrophy of muscle fibers in pulmonary arteries/arterioles
Pulmonary hypertension Cor pulmonale Pneumothorax Hemoptysis
Cystic Fibrosis: Further Respiratory Progression
65All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Thick secretions: block ducts and cause cystic dilation, degeneration, diffuse fibrosis
Prevents pancreatic enzymes from reaching duodenum
Impaired digestion/absorption of fat, steatorrhea Impaired digestion/absorption of protein,
azotorrhea
Cystic Fibrosis: Gastrointestinal Tract
66All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Endocrine function of pancreas initially stays unchanged
Eventually pancreatic fibrosis occurs; diabetes mellitus may result
Focal biliary obstruction results in multilobular biliary cirrhosis
Cystic Fibrosis: Gastrointestinal Tract (Cont.)
67All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Pancreatic enzyme deficiency Sweat gland dysfunction Failure to thrive Increased weight loss despite increased
appetite
Cystic Fibrosis: Gastrointestinal Tract (Cont.)
68All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Airway clearance therapies Bronchodilator medication Physical exercise Aggressive treatment of pulmonary infections Aerosolized antibiotics Home intravenous antibiotic therapy
Cystic Fibrosis: Respiratory Management
69All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Replacement of pancreatic enzymes High-protein, high-calorie diet: as much as 150%
recommended dietary allowance Relief of intestinal obstruction (ileus) Reduction of rectal prolapse Treatment of chronic gastrointestinal reflux
Cystic Fibrosis: Gastrointestinal Management
70All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Estimated life expectancy for child born with CF in 2009: 37.4 years
Progressive and incurable disease Transplantation
Increases life expectancy Availability of organs Surgical complications
Prognosis of Cystic Fibrosis
71All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Coping with emotional needs of child and family
Need for treatments multiple times a day
Frequent hospitalization Home care Implications of genetic transmission
of disease
Cystic Fibrosis: Family Support
72All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
The most important consideration in managing tuberculosis in children is:
A. Skin testingB. ChemotherapyC. Adequate nutritionD. Adequate hydration
Question
73All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.