Chapter 40.

Nursing Care of a Child with Respiratory Disorder

Terms:
1. Adventitious sounds - extra or abnormal breathing sounds
a. Stridor - is a continuous high-pitched, crowing sound heard predominantly on
inspiration.
- the cause of this sound is generally the partial obstruction of the larynx
or trachea.
- may be heard in conditions such as croup and foreign body obstruction.
- it’s typically loudest over the anterior neck, as air moves turbulently over
a partially-obstructed upper airway.
b. Wheezing - a high-pitched continuous musical sound.
- this is caused by air passing through an obstructed, narrow airway.
- what we often refer to as rhonchi is the sonorous wheeze, which refers to
a deep, low-ptched rumbling or coarse sound as air moves through
tracheal/bronchial passages in the presence of mucus or respiratory secretions.
-it is commonly heard in the lungs during expiration.
- it may be heard in asthma, emphysema, and chronic bronchitis

C. Crackles - are also known as alveolar rales

-the sound crackles create are fine, short, high-pitched, intermittent
crackling sound
- the cause of crackles can be from air passing through fluid, pus or
mucous.
- commonly heard in the bases of the lung lobes during inspiration.
- coarse crackles sound quality is low-pitched and moist, it may be heard
in pulmonary edema and bronchitis.
-Fine crackles sound quality is like hair rubbing near the ear and may be
heard in congestive heart failure and pulmonary fibrosis
D. Pleural rub- results form the movement of inflamed pleural surfaces against one
another during chest wall movement
- harsh grating or creaking
- potential causes are tuberculosis and pneumonia.
-best heard in the lower anterior lungs and lateral chest during both
inspiration and expiration.

2. Aspiration - inhalation of foreign object into the airway

3. Atelectasis - collapse of alveoli
4. Clubbing - a change in the angle between the fingernail and nailbed because of increased
capillary growth in the fingertips; a response to hypoxia
5. Cyanosis - a blue tinge to the skin indicating hypoxia
6. Expiration - carbon dioxide-filled air discharged to the outside
7. Hypoxemia - deficient oxygenation of the blood
8. Hypoxia - inadequate oxygenation of body tissue
9. Inspiration - delivery of warmed moistened air via the respiratory system tot he alveoli
10. Paroxysmal coughing - series of expiratory coughs after a deep inspiration
11. Pneumothorax - the presence of atmospheric air in the pleural space
12. Retraction - indentation of intercostal spaces reflecting difficulty breathing

Asthma
Asthma is a chronic inflammatory disorder of the airways in which many cells play a
role, including mast cells, eosinophils, T-lymphocytes and neutrophils. In susceptible
individuals, this inflammation causes symptoms which are usually associated with widespread
but variable inflow obstruction that is often reversible either spontaneously or with treatment.
Asthma tends to occur in children with a tendency to react with hypersensitivity to
allergens. Mast cells release histamine and leukotrienes that result in diffuse obstructive and
restrictive airway disease.

Mechanism of disease
Asthma primarily affects the small airways and involves three separate processes: bronchospasm,
inflammation of bronchial mucosa, and increased bronchial secretions (mucus).

Signs and Symptoms:

Wheezing, exhausted, paroxysmal cough with thick mucus production

Treatment: Control of triggers

Avoidance of triggers which include irritant gases, weather changes, cold air, exercise,
respiratory infections, certain foods, additives and drugs.

Therapeutic Management
Child with mild, persistent Asthma
Usually is prescribed an inhaled anti-inflammatory corticosteroid as Fluticasone daily.
Child with moderate persistent symptoms
Usually is prescribed an inhaled anti-infammatory corticosteroid daily and a long-acting
bronchodilator at bedtime.

Pneumonia
Cause. Possibly bacterial (pneumococcal, streptococcal, staphylococcal, so chlamydial)
or Viral (Respiratory syncytial virus RSV)

Pneumococcal Pneumonia: with this, children may have blood-tinged sputum as exudative
serum and red blood cells invade the alveoli. After 24-48 hours, the alveoli are no longer filled
with red blood cells and serum, but fibrin, leukocytes and pneumococci. At this point, the child’s
cough no longer raises blood-tinged sputum but thick purulent material.
S/s: high fever, nasal flaring, chest pain, chills, dyspnea. Taychypnea and tachycardia develop.
Crackles may be present. Breath sounds become bronchial.
Therapeutic Management:
Either Ampicillin or a third-generation cephalosporin.
Humidified oxygen
Chlamydial Pneumonia: Symptoms usually begin gradually with nasal congestion and a sharp
cough. It progress to tachypnea with wheezing and crackles. It is treated with Erythromycin.
Viral Pneumonia: There may be diminished breath sounds and fine crackles.
Therapeutic management:
Antipyretic for the fever
Intravenous fluid if the child is dehydrated or exhausted from feeding