Pediatric Nursing

1
Pediatric Nursing

• Module 2 Caring for Children with Alterations in
  Oxygenation
• Chapters 19, 20

2
Differences between Children and Adults

• Chest/Respiratory System
• Obligate nasal breathers gt6wks
• Short neck
• Smaller, narrower airways
• more susceptible to airway obstruction and
  resp. distress
• Tongue is larger in proportion to the mouth
• more likely to obstruct airway in unconscious
  child

3
Differences between Children and Adults

• Chest/Respiratory System
• Smaller lung capacity and underdeveloped
  intercostal muscles, poor chest musculature
• less pulmonary reserve, lung damage w/o fx
• Children rely on diaphragm breathing
• high risk for resp. failure if the diaphragm
  unable to contract

4
Adjunct Assessments

• Temperature
• Febrile state increases oxygen consumption
• Fluid Needs
• Vomiting/diarrhea are commonly associated with
  respiratory illness
• Increase respiratory efforts, increased fluid
  losses with decreased po intake requires an
  increase in fluid needs

5
Respiratory System

• Inspection
• Chest
• Size, symmetry movement
• Infancy shape is almost circular
• lt 6-7 years respiratory movement primarily
  abdominal or diaphragmatic
• Respirations
• Rate, rhythm, depth, quality, effort
• gt60 /min in small children significant
  respiratory distress

6
Respiratory Assessment

• Retractions
• Substernal
• Subcostal
• Intercostal
• Suprasternal
• Supraclavicular
• Effort
• Grunting
• Nasal flaring

7
Respiratory Assessment

• Color
• Mucous membranes
• Nailbeds
• Skin
• Cyanosis

8
Respiratory Assessment

• Auscultation
• Listen comparing one areas to the other
• Equality of breath sounds
• Diminished
• Poor air exchange
• Abnormal breath sounds
• Rales
• Rhonchi
• Wheezing
• Grunting
• Present on inspiration or expiration

9
Upper Respiratory Tract Infections Tonsillitis

• Tonsils
• Lymphoid tissues
• Abundance in children especially tonsils
• Tonsillectomy
• Pre-op
• Bleeding time
• Loose teeth

10
Tonsillectomy

• Post-op
• T A position
• Semi prone with head turned to the side
• Monitor for bleeding
• Frequent swallowing
• Persistent pulse of 120 or greater at rest
• Restlessness
• Pallor
• Vomiting bright red blood
• May bleed for 5-10 days post-op
• Home care
• Diet

11
Otitis Media
Acute infection of the middle ear

• Generally bacterial
• H. influenza
• S. pneumoniae
• Signs/Symptoms
• Fever (maybe)
• Pulling, tugging on ears
• GI upset vomit/diarrhea, poor appetite

12
Otitis Media

• Irritability
• URTI
• Treatment
• Antibiotics
• Ampicillin, amoxicillin
• Nursing Concerns
• - compliance
• - chronic or recurrent otitis media
• - hearing loss can lead to speech impediments

13
Croup - Acute Laryngotracheal Bronchitis

• Upper airway problem
• Edema, swelling of the larynx
• Viral 3 months to 3 years
• Bacterial 3 to 7 years
• Signs/Symptoms
• Croupy cough
• Inspiratory stridor
• Hoarseness
• Fever
• Drool

14
Croup

• Primary concern
• Obstruction of the airway
• Sedatives are contraindicated
• Treatment racemic epinephrine, cool mist

15
Infections of the Lower AirwaysBroncholitis /
RSV -Respiratory Syncytial Virus

• Common cause of bronchiolitis or the common cold
  in infants
• Signs/Symptoms
• Pharyngitis
• Fever
• Otitis media
• Tachypnea
• Apnea spells
• Poor air exchange
• Secretions

16
RSV

• Treatment
• Aerosol respiratory treatments
• Supplemental 02
• Vaccine for high risk infants

17
Pneumonia

• Classified according to etiology
• viral, bacterial, fungal, aspiration
• Signs and Symptoms
• Respiratory
• rhonchi, rales
• dull to percussion
• retractions, nasal flaring
• cough

18
Pneumonia

• Systemic
• high fever
• Neurological
• irritable, restless, lethargic
• pain
• Gastrointestinal
• a/v/d
• abdominal pain

19
Chest X-ray Pneumonia
20
Long Term Respiratory DysfunctionAsthma

• Chronic inflammatory disease of airways
• airway inflammation
• bronchospasm
• obstruction
• Triggers
• environmental, chemical, tobacco, exercise, cold
  air, infection, medication, foods, emotions

21
Asthma

• Signs and Symptoms
• Respiratory
• cough
• auscultation - prolonged expiration, wheeze,
  diminished breath sound
• shortness of breath
• short panting phrases
• Other
• restlessness, apprehension, cyanosis, sweating

22
Cystic Fibrosis
23
Cystic Fibrosis

• Hereditary disease of the exocrine glands thick,
  tenacious secretions of the mucous-producing
  glands especially of the bronchi and pancreatic
  ducts
• Lungs
• Chronic lung disease
• Bronchial obstruction
• pulmonary hypertension
• Over inflation of the lungs
• Repeated lung infections

24
Cystic Fibrosis

• G.I System
• Pancreatic ducts
• Blockage of enzymes needed for digestion
• Sweat glands
• Secretions contain excessive amount of salt

25
Cystic Fibrosis

• Signs/symptoms
• Newborn meconium ileus
• Tastes salty when kissed
• Recurrent respiratory illnesses
• Failure to gain weight with a good appetite
• Malasbsorption of fats and proteins
• Stools are foul smelling, frothy and bulky
• Pot belly with wasted buttocks

26
Cystic Fibrosis

• Diagnosis
• Family history of CF
• Repeated illnesses/hospitalization with
  respiratory problems or failure to thrive
• Absence of pancreatic enzyme or stool studies
• sweat chloride tests
• Concentration of Cl gt 60mEq/L

27
Cystic Fibrosis

• Treatment
• Nutritional
• Pancreatic enzymes with meals and snacks
• Vitamin replacement A,D,E,K
• High protein, high calorie diet
• Pulmonary
• Thin the secretions, keep them mobile
• CPT
• Aerosol Treatment
• bronchodilators, D-nase

28
Cystic Fibrosis

• 02 when needed
• Antibiotics for resp. infections
• Pulmonary complications
• Atelectasis
• Lung abscesses
• Pneumothorax
• Emphysema
• Prognosis
• Life expectancy teen years to early 20s

29
Respiratory Nursing Diagnosis

• Impaired gas exchange
• Ineffective airway clearance
• Ineffective breathing pattern
• High risk fluid volume deficit
• Altered tissue perfusion
• Anxiety
• Activity Intolerance
• Altered growth/development
• Knowledge deficit

30
Respiratory Nursing Diagnosis

• PC Atelectasis/Pneumonia
• PC Electrolyte Imbalance
• PC Hemorrhage
• PC Hypoxia

31
Nursing Interventions

• Assess respiratory status
• Tachypnea, labored breathing, shallow breathing
• Effort
• Retractions
• Nasal flaring
• Head bobbing
• Grunting
• Apnea
• Poor air exchange
• 02 saturation

32
Nursing Interventions

• Oxygenation/ventilation needs
• Administer O2
• Incubator/oxygen hood
• Nasal prongs
• Mist tent
• Tracheotomy croup
• Decrease respiratory efforts
• Infant car seat
• Knee-chest position

33
Nursing Interventions

• Maintain airway
• Head tilt do not hyper extend neck
• Aerosol treatment
• CPT
• Suction bulb syringe, BBG or tracheal bronchial
• Fluids
• IV or po

34
Nursing Interventions

• Labs
• Medications
• Conserve energy
• Organize care
• Monitor vital signs
• Teaching