c

 
 

  - is an acute bacterial infection and inflammation of the epiglottis

and the surrounding areas that causes airway obstruction.

` pudden onset and infection progress rapidly causing acute respiratory

causing acute respiratory difficulty
` ›ccurs more often in winter
` xonsidered an emergency situation
` ›ccurs more frequently between 2 to 5 years of age

Etiology:

` xan either be bacterial or viral( staphylococci, streptococci, pneumococci,

candidas albicans
` emophilus influenza type B

pigns and symptoms;

r Begin as a mild upper respiratory tract infection

r |espiratory difficulty which can progress to severe respitatory distress in
a matter of minutes or hours; inspiratory stridor
r ÷ysphagia
r ÷rooling of saliva
r ÷ematous, cherry- red epiglottis
r Œuffled voice
r pudden increase in temperature
r „ripod positioning- while supporting the body with hands, the child
thrusts
r oarse or brassy cough( may or may not be present)
(2)

xomplications:

r mirway obstruction
r £aryngospasm
r ÷eath

Œanagement:

r Œaintain a patent airway

r mssess respiratory status and breath sound noting:
-nasal flaring
- use of accessory muscles
- presence of inspiratory stridor
- presence of circumoral cyanosis
- presence of intercostals retractions
r Œaintain position of comfort and security for the child to facilitate
breathing
r ºever leave the child unattended
r Œaintain º ›
r ÷o not restrain the child
r ÷o not force the child to lie down
r mdminister antibiotics( e.g. cefriaxone{ Xtenda}, ampicillin +
pulbactan{Unasyn} as ordered
r V fluids as ordered
r repare tracheostomy set or intubation for severe respiratory distress
r rovide cold, mist oxygen or moist air therapy, or cold humidification
r Ensure child is up to date with immunization ( ib accine) to prevent
occurrence of epiglottitis
r mssess temperature by axillary route
r ºo attempt should be made to visualize the throat or to obtain a throat
culture due to risk of laryngospasm which will result to complete airway
obstruction or respiratory collapse
(3)

£
   c


-Vnflammation of the larynx, trachea and the bronchi

- „he larynx and the upper airway get inflamed resulting in narrowing of
the airways

- it is a respiratory disease which afflicts infants typically aged between

3months and 3 years

Etiology: arainfluenza virus

pigns and symptoms:

r £ow to high grade fever

r ºausea and vomiting
r ºasal flaring
r oarseness
r peal- bark and brassy cough
r xontinuous inspiratory stridor
r Vntercostal retractions
r Use of accessory muscles for breathing
r xrackles and wheezing on auscultation
r |estlessness and irritability, anxiety
r mcidosis and x
2 retention
r |unny nose
r „achypnea
(4)

Vnterventions:

r Œaintain a patent airway

r mssess respiratory status: nasal flaring, sterna retraction, inspiratory
stridor
r Elevate head of bed
r rovide bed rest
r rovide humidified oxygen via cool mist tent for hospitalized child
r Vnstruct parents to use cool air vaporizer or humidifier at home; other
measure include having the child breath in a cool night air, or the air from
an open freezer, or taking a child to a cool basement
r Encourage fluid intake
r V
as prescribed to maintain hydration
r Bronchodilators to relax smooth muscles and relieve stridor
r xorticosteroids a prescribed for the anti inflammatory effect
(÷examethazone, ydrocortizone)
r mdminster nebulized epinephrine
r mdminister antibiotis as prescribed if bacterial infection is present
r ave resuscitation equipment available


c


 

` Vnfection of the major bronchi that may be referred to as

tracheobronchitis.

£aboratory/ ÷iagnostic test:

` „hroat swab- to determine causative agent

` xhest and neck X- ray ʹ end stage is to rule out epiglottitis

pigns and symptoms:

r
ever
r ÷ry, hacking and non- productive cough that is worse at night and
becomes productive in 2 to 3 days

Vnterventions:

r Œonitor for respiratory distress

r rovide cool humidified air
r Œonitor for signs of dehydration: sunken fontanel, poor skin turgor,
decreased and concentrated urine output
r Vncrease fluid intake; acetaminophen for fever


c


 

` Vnflammation of the fine bronchioles and small bronchi that causes a thick
production of mucus that occludes bronchioles and small bronchi
` ighly communicable and is transferred by hands

xause: |espiratory syncytial virus (|p ), also known as humanpneumovirus

` |p invades bronchioles causing increased production of mucus and

airway edema

pigns and symptoms:

r Upper respiratory infection symptoms such as rhinorrhea and low- grade

fever, increased tenacious mucus production
r £abored, rapid breathing
r ºasal flaring and retractions
r ÷ifficulty feeding or refusal to eat
r Vrritability from air hunger
r Expiratory wheezes or grunt
r Œalaise
r ÷iminished breath sound
r acking cough
r „achypnea

Vnterventions:

r Œaintain patent airway

r osition the child at a 3
to 4
degree angle with the neck slightly
extended to maintain an open airway and decrease pressure on the
diaphragm
r rovide cool humidified air
r Encourage fluids
(7)

r Vsolate the child in a single room or place in a room with another child
with |p
r Œaintain good handwashing procedure
r Ensure that nurses caring for this children do not care for other- high risk
children
r oear gowns when soiling of clothing may occur during care
r mdminister |ibavirin ( irazole) ʹ an anti- viral respiratory medications
mdministration of |ibavirin:
 mdminister via aerosol by hood, tent, mask, or through ventilator
tubing
 regnant health care provider should not care for a child receiving
|ibavirin
 ºurses wearing contact lenses should wear goggles when coming in
contact with |ibavirin, because the mist may dissolve soft lenses
u repare for administration of |p immune globulin vaccine( |p -
VV )
` Used prophylactically to prevent |p infection in high- risk infant
` ºot administered to infants or children with congestive heart failure
c!


"# 

` Vnflammation of the pulmonary tissue associated with consolidation of

the alveolar space.
` Vnflammation of the alveoli caused by a virus, mycoplasmal agents,
bacteria, or the aspiration of foreign substances
` xausative agent is usually introduced into the lungs through the
inhalation or from the blood stream

xlassifications:

1. neumonitis ʹ inflammation of the wall of the alveoli, alveolar sacs and

ducts of bronchioles.
2. £obar pneumonia ʹ inflammation of one or more lobes of the lungs with
complete consolidation
3. Bronchopneumonia ʹ inflammation of the bronchioles with exudates

1. iral neumonia ʹ occurs more frequently than bacterial and often

associated with a viral upper respiratory infection.
pigns and symptoms:
u Œild fever, cough, malaise, high fever
u pevere non- productive cough or productive cough with small
amount of whitish sputum
u oheezes or fine crackles
Vnterventions:
u ›xygen with cool mist as prescribed
u Vncrease fluid intake
u mntipyretics for fever as prescribed
u xhest physiotherapy and postural drainage as prescribed
u mntimicrobial therapy is reserved for children in whom the
presence of infection is demonstrated by cultures
 (9)

2. $%&%& %'$%- Œycoplasma pneumonia

` most common cause of pneumonia in children between the ages- of 5 and
12
` ›ccurs primarily in the f al and winter months and prevalent in crowded
living conditions

pigns and symptoms:

u
ever, chills, anorexia, headache, malaise and muscle pain

u |hinitis, sore throat, dry hacking cough
u ºon- productive cough initially then production of seromucoid
sputum that becomes mucopurulent or blood- streaked

Vnterventions: pymptomatic

3. %'% '$%- is often a serious complication; hospitalization is

indicated when pleural effusion or empyema accompanies the disease
and is mandatory for children with staphylococcal pneumonia

or infant:
u mcute onset, fever , toxic appearance
u Vrritability, lethargy, poor feeding, fever maybe accompanied by
seizure
u |espiratory distress( air hunger, tachypnea and circumoral
cyanosis)
›r older children:
u eadache chills, abdominal pain , chest pain, meningeal symptoms
u ÷iminished breath sound or scattered crackles
u ms the infection resolves, coarse crackles, and wheezing are heard
and the cough becomes productive with purulent sputum
(1
)

Vnterventions:

u mntimicrobial therapy as soon as diagnosis is established

u ›xygen for respiratory distress
u puction mucus
u xhest physiotherapy and ostural drainage
u Encourage child to lie on affected side( is pneumonia is
unilateral)
u Vncrease fluid intake
u Vnstitute isolation with pneumococcal or staphylococccal





















c


""£ c $%&$ '( )'

` Vs a contagious disease caused by Œycobacterium tuberculosis, an acid-

fast bacillus
` Œode of transmission: inhalation of droplets from individuals with active
tuberculosis

pigns and pymptoms;

 Œaybe asymptomatic
 Body malaise
 „he test will
 mnorexia
 oeight loss
 £ymphadenopathy
 ppecific symptoms related to site of infection such as brain, lungs or
bones maybe present

÷iagnostic Exam:

1.Œantoux test:

V will produce a positive reaction 2- 1
weeks after the initial

infection
V ÷etermines whether the child has been infected and has developed
a sensitivity to the protein of the tubercle bacillus; a positive
reaction in a previously negative test indicates that the child has
been infected since the last test

2. pputum culture:

V ÷efinite diagnosis is made by demonstrating the presence of

mycobacteria in a culture
(12)

Vnterventions

1. Œedications:
V Vsoniazid (Vº), |ifampin( |Vfadin), yrazinamide
V m 9-month course of Vº maybe prescribed to prevent a latent
infection from oproigressing to clinically active „B
V m 12- month course maybe prescribed for the child infected with
V
V |ecommendation for the child with active „B:
u Vsoniazid, |ifampin, yrazinamide daily for 2 months,
then Vº and |ifampin 2 times weekly for 4 months
2. lace on airborne precautions until medications have been initiated
3. ptress importance of adequate rest and diet
4. Vnstruct measure to prevent transmission of tuberculosis


(13)

mp„Œm

` m chronic inflammatory disease of the airways or spasm of the bronchial

smooth muscles
` xommon symptoms is coughing in the absence of respiratory infection
especially at night
` Œost common chronic disease among children

xauses („riggers)

m Vndoor allergens:
a) ÷ust mites c) stuffed toys/ furnitures
b) ollution d) et dander
m ›utdoor allergens:
a) ollens b) Œolds
m
ood allergens
 xhocolates b)
udge brownies
m „obacco smoke
m xhemical irritants
m xold air/ temperature changes
m Extreme emotional arousal/stress
m |espiratory infection
m mctivity

ptatus asthmaticus - a condition wherein the child displays respiratory

distress despite vigorous treatment measures.

„hree components of msthma attack:

1. Bronchospasm 2. Œucus production 3. mirway edema

 (14)

pigns and pymptoms:

V Expiratory wheezing is the major sign

V ÷yspnea with prolonged expiration; reduced expiratory flow;
respiratory distress
V xhest tightness
V xough particularly at night or in the early morning
V ºasal flaring
V |etractions/ use of accessory muscles
V mnxiety, irritability
V ÷iaphoresis
V àounger children assume a tripod sitting position
V „achypnea
V Exercise intolerance

„reatment:

 mvoidance of triggers is the best therapy

 osition comfortably on bed
 |espiratory status
 mdminister quick relief medications ( rescue medications) to treat
symptoms and exacerbations
u phort ʹacting B2 agonist ʹ decrease acute bronchospasm;Ex.
palbutamol ( entolin)
u mnticholinergic: decrease bronchospasm and secretion of mucus in
airways ; used for severe symptoms; Ex. Vpratropium
bromide(mtrovent)
u pystemic corticosteroids ʹ decrease inflammation in airways; to
treat reversible airway obstruction
 (15)
 £ong- term control ʹ preventer medication
u „o achieve and maintain control of inflammation
u
u
u xorticosteroids: Ex. rednisone, Œethylprednisolone (Œedrol),
ydrocortisone( polu- cortef), Budesonide(Budecort),

luticasone(
lixotide)
u ºon-steroidal anti-inflammatory drugs (ºpmV÷p)
u £ong-acting B2 agonists- not for quick relief
Ex.palmeterol(perevent); palmeterol+
luticasone (peretide)
u £eukotriene Vnhibitors:
V revents inflammatory response caused by exposure to allergens; Ex .
Œontelukast (pingulair), Zafirlukast(mccolate)
 muscultate breath sounds for baseline assessment and to determine
response to medication
 xhestphysiotherapy including breathing exercises and physical training
 mllergen control- prevention and reduction of exposure to airborne and
environmental allergens,and extreme environmental temperature; pkin
testing to identify allergens
 mvoid exposure to individuals with viral respiratory infection
 Encourage increase oral fluid intake
 Early recognition of an asthma attack
 mdequate rest, sleep and well- balanced diet
 ÷evelop an exercise program
 xough effectively
 Meep immunization up- to- date; mnnual influenza vaccination is
recommended
c 


"*

 #c
+*

 Unexpected death of an apparently healthy infant under 1 year of

unknown cause
 Œost frequent during winter months
 ÷eath occur usually during sleep
 mge: frequent from 2 ʹ 4 months of life
 igher incidence in:
u Œales
u Œultiple birth an premature infants
u ºewborn with low m m| score
u Vnfants with xºp disturbances
u Vnfants with respiratory disorders
u Vnfants sleeping on abdomen
u Vnfants using soft moldable pillows and mattress
 mppearance when found:
u mpneic, blue, lifeless
u
rothy blood in nose and mouth
u xhild maybe found in any position but typically is found in a
disheveled bed with blankets over the head and huddled in a corner
u xhild maybe clutching beddings
u xhild maybe wet and full of stool
 revention:
u lace infant in supine position for sleep
u poft , moldable mattress and beddings such as pillows or quilts
should not be used
u ptuffed animals should be removed from cribs while infant ius
sleeping
u ÷iscourage bed sharing( sleeping with adults)
(17)

 Vnterventions;
u mvoid implying wrongdoing, abuse or neglect
u pupport parents;
u Be nonjudgmental abt. arents attempts at resuscitation

 

,

r Bleeding from the nose caused by:

 m local disturbance of the tissue which usually occur from trauma such as
picking of the nose, from falling, hit on the nose by another child
 ÷ecreased humidity
 xan occur with nasal polyps, sinusitis, allergic rhinitis
 ptrenous exercise
 perious systemic disorder such as blood dyscrasias
r mssessment:
u istory of frequency and duration of bleeding
u xlotting time and gb level
u mmount of blood lost is estimated by noting the amount of
saturated paper
r Vntervention:
u Meep child in upright position with head slightly tilted forward
u mpply pressure to the sides of the nose with your fingers
u mpply cold compress
u Œake effort to quiet the child and help him stop crying
u £ast resort: Epinephrine (1:1


) maybe applied to the bleeding site
to constrict blood vessels
u ºasal packing to provide continuous pressure


c !


#

 Vnfection of the middle ear occurring as a result of a blocked eustachian

tube which prevents normal drainage
 xauses:
u Bottle propping
u xleft lip/palate
u U|„V
 pigns and symptoms:
u
ever , irritability
u £oss of appetite
u |olling of head from side to side
u ulling on or rubbing the ear
u Earache ( otalgia)
u pigns of hearing loss
u urulent, foul smelling ear discharge
u |ed opaque, bulging tympanic membrane
 xomplication:
u Bacterial meningitis
 Vnterventions:
u Vncrease oral fluid intake
u „each patient to fed infant in an upright position
u rovide local heat and have the child lie with the affected ear down
u „pB if there is fever
u mdminister analgesics as prescribed
u Vnstruct parents in the appropriate procedure to clean drainage from
the ear with sterile cotton swabs
u Vnstruct on procedure in administration of medication
u Œassive dosage of antibiotic to prevent bacterial meningitis
u pcreening for hearing loss
(19)

u purgery: Œeringotomy with tympanostomy tube insertion

 Vnterventions postoperatively:
u Meep ears dry
u oear earplugs during bathing, shampooing and swimming
u ÷iving and submerging under water are not allowed


c-.


%))')

„onsillitis- inflammation and infection of the tonsils

mdenoiditis ʹ Vnflammation and infection of the adenoid

pigns and symptoms:

V ersistent or recurrent sore throat

V Enlarged, bright red tonsils that maybe covered with white exudates
V ÷ifficulty in swallowing
V Œouth breathing and unpleasant mouth odor
V
ever, cough
V Enlarged adenoids may cause nasal quality of speech, mouth breathing,
hearing difficulty; snoring or obstructive sleep apnea

Vnterventions:

 reoperatively:
` mssess for signs of active infection
` mssess bleeding and clotting studies
` repare the child preoperatively
` mssess for any loose teeth to decrease the risk of aspiration
during surgery
 ostoperatively:
V osition the client prone or side- lying to facilitate drainage
V ave suction equipment ready but do not suction unless there is airway
obstruction
V Œonitor for signs of hemorrhage
V ÷iscourage coughing or clearing the throat
V rovide clear, cool non- citrus and non- carbonated fluids
V mvoid milk products initially because they will coat the throat
V
(21)
 V mvoid red liquids which will simulate the appearance of blood when
patient vomits
V ÷o not give straw, spoon or sharp objects that can be put in the mouth
V mdminister acetaminophen for sore throat
V ºotify physician for bleeding
V Meep child away from crowds until healing occurred

c--



* 

V m chronic autosomal recessive multisystem disorder characterized by

exocrine gland dysfunction
V „he mucus produced by the exocrine gland is abnormally thick, causing
obstruction of the small passageways of the affected organ.
V xharacterized by serious and persistent lung infection, loose foul
smelling stool and failure to gain weight
V „he most common symptoms are pancreatic enzyme deficiency caused
by duct blockade, progressive chronic lung disease associated with
infection and sweat gland dysfunction resulting in increased sodium
and chloride sweat concentration
V |espiratory distress is prominent
V mn increase in sodium and chloride in sweat and saliva forms the basis
for the most reliable diagnostic test ʹ the sweat chloride test
V Œeconium ileus- is the earliest symptom of cystic fibrosis in newborn
infant which is t he obstruction of sticky, viscid meconium.

÷iagnostic „est:

1. Êuantitative sweat chloride test:

` „he production of sweat is stimulated ( ilocarpine
iontoporesis), the sweat is collected and the sweat
electrolytes are measured.
` £ess than 4
mEq/£ ʹ normal sweat chloride concentration
` m chloride concentration greater than 6
mEq/£ is a positive
test result
2. xhest X- ray to reveal atelectasis and obstructive emphysema
3. ulmonary function test- to provide evidence of abnormal small
airway obstruction
(23)

4. ptool/ fat or Enzyme analysis ʹ a 72 hour stool sample is collected

to check the fat and/or enzyme content.
ood intake is recorded
during the collection

pigns and pymptoms=( xystic
ibrosis)

|Ep V|m„›|à:

£Uºp:

V pymptoms are produced by the stagnation of mucus in the airway, leading

to bacterial colonization and destruction of lung tissues.
V Emphysema and atelectasis occur ʹ as the airways become increasingly
affected
V xontraction and hypertrophy of the muscle fibers in pulmonary arteries
and arteriole due to chronic hypoxemia, eventually leading to pulmonary
hypertension and eventually cor pulmonale
V neumothorax ʹ from ruptured bullae and hemoptysis from erosion of
the bronchial wall through an artery occur as the disease progresses
V oheezing and dry non-productive cough
V ÷yspnea, cyanosis
V xlubbing of fingers
V |epeated episodes of bronchitis and pneumonia

mp„|›Vº„Ep„Vºm£ pàp„EŒ;

mºx|Emp:

V Œeconium ileus in neonate

V Vntestinal obstruction ( distal intestinal obstruction syndrome)
V pteatorrhea
V ÷eficiency of the fat- soluble vitamins which causes easy bruising and
edema
V |ectal prolapsed
(24)

Vº„E|UŒEº„àm|à pàp„EŒ:

V mbnormally high concentration of sodium and chloride in sweat

V Vnfants tastes ͞salty͟ when kissed
V ÷ehydration and electrolyte imbalance especially during hyperthermic
condition
V
rosting of t the skin

|E |›÷Ux„V E pàp„EŒ:

V xan delay puberty in girls

V
ertility can be inhibited ʹ due to a highly viscous cervical secretions
which act as a plug and block entrance of sperm
V Œales are usually sterile, caused by the blockade of the vas deferens by
failure of normal development of duct structures

Vº„E| Eº„V›ºp;

1. |Ep V|m„›|à:
V reventing and treating pulmonary infection by removing
secretions
V mntimicrobial
V xhest physiotherapy n awakening and in the evening
V Bronchodilator
V „each child forced expiratory technique (huffing) to mobilize
secretions
V ÷evelop a physical exercise program
V ›xygen as prescribed
V Œonitor for hemoptysis
V £ung transplantation is a final therapeutic option for the child with
end- stage disorder


 (25)
2. mp„|›Vº„Ep„Vºm£ pàp„EŒ:
V |eplace pancreatic enzymes- administer with meals and snacks or
within 3
minutes of eating meals and snacks to ensure that
digestive enzymes are mixed with food in the duodenum.
V Enteric coated pancreatic enzymes should not be crushed or
chewed
V Encouraged a well- balanced, high protein, high caloric diet
V Œultivitamins and m ÷ E and M are given
V mssess weight and monitor failure to thrive
V Œonitor for constipation and intestinal obstruction
V Ensure adequate salt intake during extremely hot weather