Respiratory

● Upper Airway
○ Structures: nostrils, nasal cavity, mouth, pharynx (throat), larynx (voice box)
● Lower Airway
○ Structures: trachea, lungs (bronchi, bronchioles, and alveoli)
○ Diaphragm
■ Contracts on inhalation to enlarge chest cavity
■ Relaxes on exhalation to force air out of lungs
● Complications
○ Physical Changes
■ Retractions (subcostal / substernal / intercostal / suprasternal)
■ Nasal flaring
○ Lung Sounds
■ Crackles
■ Wheezing
■ Stridor
● Respiratory Distress
○ What?
○ S/S
○ Tx
○ Nursing Interventions
■ Suctioning
■ Oxygen administration
■ NPO
Respiratory Complications
● Tonsillitis
○ What? Inflammation of the tonsils, which are masses of lymph-type tissue found in the
pharyngeal area.
○ S/S
■ Patient reports sore throat with difficulty swallowing
■ Tonsil inflammation with redness and edema
■ Mouth breathing / mouth odor
■ Snoring
■ Nasal qualities in the voice
■ LAB: (+) Group A Beta-Hemolytic Streptococci (GABHS)
○ Tx
■ Medical
● Analgesics (hydrocodone indicated for the child having difficulty
drinking fluids)
● Antipyretics (decrease fever and manage pain)
● Antibiotics (treatment of GABHS infection)
■ Surgical
● Tonsillectomy → surgically remove tonsils
● Constant swallowing indicates bleeding
 ○ Nursing Interventions
■ Warm fluids and warm salt water gargle
● Croup
○ What? Infection of the upper airway, which causes swelling around the vocal cords and
obstructs breathing.
○ S/S
■ Predictive signs (absence of cough, drooling, agitation)
■ Tripod position → sitting upright with chin pointed out, mouth open and
tongue protruding.
■ Dysphonia → thick, muffled voice and frog like croaking sounds
■ Dysphagia → difficulty swallowing
■ Inspiratory Stridor
■ Suprasternal and substernal retractions
■ Sore throat and high fever
○ Tx
■ Corticosteroids (reduce inflammation of the airway)
■ IV fluids
■ IV Antibiotics
○ Nursing Interventions
■ Protect airway
■ Prepare equipment for intubation in case of emergency
■ Humidified oxygen
● Epiglottitis
○ What? Inflammation of the epiglottis making it hard to breathe.
■ Caused by a bacterial infection that can spread through the upper respiratory tract
(ex. Hib)
○ S/S
■ Sudden very sore throat
■ Fever
■ Trouble swallowing
■ Blue skin colored
■ Stridor
■ Tripod position
○ Tx
■ IV antibiotics
■ Steroids to ease airway
■ IV fluids for hydration
● Bronchiolitis/Respiratory Syncytial Virus (RSV)
○ What? A common lung infection in young children and infants which causes
inflammation and congestion of the small airways (bronchioles) in the lung.
○ S/S
■ Initial: rhinorrhea, intermittent fever, pharyngitis, coughing, sneezing
■ Progression: increasing coughing, sneezing, fever, tachypnea and retractions,
copious secretions
 ■ Severe: tachypnea (>70), apneic spells, poor air exchange, poor breathing sounds,
cyanosis
○ Complications
■ Apnea spells
○ Tx
■ Lab: nasopharyngeal swab
■ Medications as prescribed (no corticosteroids / no bronchodilators)
■ Antibiotics if infection
■ Suction as needed
■ Supplemental oxygen / IV fluids
● Pneumonia
○ What? Inflammation of the lungs caused by bacteria, viruses or chemical irritants, where
the air sacs (alveoli) fill with pus and liquid.
■ We have natural protection from infections with mucociliary clearance, coughing,
and secretion of IGA. This can fail due to altered immune system, infection from
the bloodstream, or aspiration.
○ S/S
■ High fever - Adventitious breath sounds (rhonchi, crackles)
■ Productive cough - Dullness with percussion
■ Tachypnea - Pale color to cyanosis
■ Retractions and nasal flaring -Chest pain
■ Increased work of breathing - Lack of appetite / vomiting
○ Labs
■ Chest X Ray
■ Gram stain / sputum culture
■ Nasopharyngeal specimen
○ Tx
■ Outpatient → oral antibiotics (unless viral), rest, pain meds, antipyretics
■ Inpatient → IV antibiotics, supportive care
■ Bacterial → IV antibiotics, antipyretics, IV fluids, oxygen, continuous pulse
ox
■ Viral → oxygen with mist, continuous pulse ox, antipyretics, CPT
○ Complications
■ Pneumothorax → accumulation of air in pleural space
■ Pleural Effusion → accumulation of fluid in pleural space
○ Nursing Interventions
■ Mostly able to treat at home
● Bronchopulmonary Dysplasia (BPD)
○ What? Chronic lung disease following premature birth and respiratory support provided
in the neonatal period. Major cause of mortality and long-term morbidity in infants.
○ Risk Factors
■ Prolonged mechanical ventilation - Emphysema
■ High concentrations inspired oxygen - IUG restriction
 ■ Infection - Maternal Smoking
○ S/S
■ Areas of dysplasia in lung
■ Area of scar tissue inside the lung
■ Unable to wean from oxygen therapy
○ Tx
■ Fluid restriction
■ Oxygen supplement as needed
■ RSV antibody
● Sudden Infant Death Syndrome (SIDS)
○ What? The sudden and unpredictable death of an infant without an identified cause, even
after investigation and autopsy.
○ Risk Factors
■ Maternal smoking during pregnancy - Prematurity
■ Sleeping with parent or adult - Low Apgar
■ Nonstandard crib bed - Viral Illness
○ S/S
■ History of events prior to discovery of infant
■ History of illnesses
■ Presence of risk factors
○ Reduce Risk
■ Back to sleep - prevent overheating
■ Avoid tobacco smoke - avoid co sleeping
■ Firm, tight fitting mattress in infant’s crib
■ No pillows, blankets or stuffed animals
■ Keep infants head uncovered during sleep
● Intermittent Asthma
○ What? Asthma that occurs 0-2 times per week.
○ S/S wheezing, SOB, cough
■ Nighttime findings
● 0-4 years: none
● 5-11 years: two times a month or less
■ Chest tightness - Anxiety
■ Audible wheezing/coarse lung sounds - Sweating
■ Coughing - Mucus Production
■ Restlessness - Accessory Muscles
○ Triggers
■ Allergens - Infections/cold
■ Exercise - Animal hair
■ Cold air or changes in temperature - Strong emotions
○ Tx
■ Bronchodilators
● Short Acting Beta Agonist: Albuterol, Levalbuterol, Terbutaline
Use: Acute exacerbations, prevention of exercise induced asthma
 Intermittent: use less than twice a week
● Cholinergic Antagonist: ACh, Atropine, Ipratropium
Use: blocks the parasympathetic nervous system to provide relief of
acute bronchospasm
■ Anti-Inflammatory
● Corticosteroids: methylprednisolone, prednisone (oral)
Use: oral is used for short periods of time
● Controlled Asthma
○ Tx
■ Bronchodilators
● Long Acting Beta Agonist: Formoterol, Salmeterol
Use: prevent exacerbations by keeping the airways open (12 hrs)
■ Anti-Inflammatory
● Corticosteroid: fluticasone (inhaled)
Use: daily for preventative use
● Leukotriene: zafirlukast, montelukast (singulair)
● Combination: fluticasone/salmeterol (Advair)
○ Nursing Interventions
■ Observe oral mucosa for infection secondary to use of inhaled medication
■ Encourage fluids
■ Instruct client to rinse mouth after use of a corticosteroid inhaler
● Cystic Fibrosis
○ What? A respiratory disorder that results from inheriting a mutated gene.
■ Characterized by mucus glands that secrete an increase in the quantity of thick,
tenacious mucus, which leads to mechanical obstruction of organs (pancreas,
lungs, liver, small intestine)
○ S/S
■ Early: wheezing, rhonchi, dry non productive cough
■ Increased involvement: dyspnea, paroxysmal cough, obstructive emphysema
(xray)
■ Advanced: cyanosis, barrel shaped chest, clubbing of fingers, bronchitis episodes
■ GI: steatorrhea, voracious or loss of appetite, failure to gain weight, delayed
growth, deficiency of fat soluble vitamins, anemia
■ Skin: sweat, tears and saliva are high in NaCl
■ Endocrine: viscous cervical mucus, decreased/absent sperm
○ Labs
■ Blood specimen (detect deficiency of fat soluble vitamins - A, D and E)
■ Sputum Culture (detection of infection - pseudomonas aeruginosa, Hib, staph
aureus, e. Coli, klebsiella pneumoniae)
○ Diagnostic Procedures
■ DNA testing → isolate mutation
■ Chest Xray → indicates atelectasis and obstructive emphysema
■ Abdominal Xray → detect meconium ileus
■ Stool Analysis → presence of fat and enzymes
 ■ *Sweat Chloride Test → expected chloride content < 40 / expected sodium <
70
○ Tx
■ Respiratory Medications
● Short Acting Beta Agonist (Albuterol)
● Cholinergic Antagonist (Ipratropium)
● Fluticasone/Salmeterol (Advair)
● *Mucolytic: Dornase Alfa → decrease viscosity of mucus
■ Antibiotics
● Ex: tobramycin, ticarcillin, gentamicin
● Administration: IV or Aerosol
● Use: pulmonary infection
■ Pancreatic Enzymes
● Use: pancrelipase treats pancreatic insufficiency associated with cystic
fibrosis
● Given: within 30 minutes of eating
■ Vitamins (A, E, D, K) fat soluble in a water-soluble form
○ Nursing Interventions
■ Pulmonary Management
● Chest Physiotherapy (CPT)
● Forced Expiration
● Administer aerosol as prescribed
● Provide oxygen as needed
■ GI Management
● Well balanced high protein/caloric diet
● Administer motility medications for GERD
● Pancreatic enzymes should be administered with every meal and snack.
● High protein diet due to increased need for calories
● Added salt for the increase in sodium loss when sweating
● Infants: predigested formulas (Pregestimil) and/or enteral feedings
■ Endocrine Management
● Monitor blood glucose levels → insulin as needed