L6 Care of the Patient with Reproductive & Respiratory Disorder

Human Sexuality Laboratory and Diagnostic Examinations

● Sexual identity Diagnostic tests for the female

○ The sense of being feminine or ❑ Colposcopy; laparoscopy

masculine ❑ Papanicolaou (Pap) smear
❑ Biopsies: Breast, cervical, endometrial
● Influences on sexual health
❑ Dilation and curettage
○ Overall wellness includes sexual health, ❑ Cultures and smears
and sexuality should be part of the ❑ Schiller’s iodine test
health care program ❑ Hysterograms
❑ Mammography; pelvic ultrasonography
● Illness and sexuality ❑ Tubal insufflation (Rubin’s test)
○ Illness may cause changes in a patient’s ❑ Human chorionic gonadotropin; serum CA-125
self-concept and result in an inability to Diagnostic tests for the male
function sexually
❑ Testicular biopsy
Assessment ❑ Semen analysis
● History Taking ❑ Prostatic smears
❑ Cystoscopy
❑ Menarche, Menopause, premenopausal ❑ Rectal digital exam
syndrome ❑ Prostate specific antigen (PSA)
❑ No. of pregnancy, parity, term, abortion and live THE REPRODUCTIVE CYCLE
birth
❑ Planning method Menarche
❑ Are you sexually active? Is your sexual partner of ❑ The beginning of menses
the same sex or different gender? ❑ Follows breast development by 2 to 2½ years
❑ How many sexual partners have you had in the ❑ Average age range is between 9 and 17 years
past 6 months? ❑ Cycle length ranges from 24 to 32 days
❑ Do you practice safer sex”? STI’s? ❑ The average flow lasts 3 to 5 days
❑ Have you had a vaccine against HPV? ❑ The average flow is 35 mL/cycle
❑ Excessive weight loss or gain
❑ Disfiguring scar from surgery or accident Amenorrhea
❑ Hair loss such as occurs with chemotherapy
(Etiology/pathophysiology)
❑ Surgery or inflammation or infection of the
reproductive organs ❑ Absent or suppressed menstrual flow
❑ Chronic fatigue or pain ❑ Clinical manifestations/assessment
❑ Spinal cord injury ❑ No menstrual flow for at least 3 months
❑ Presence of retention catheter ❑ Medical management/nursing interventions
❑ Based on underlying cause
❑ Hormone replacement may be necessary
Physical Examination
Dysmenorrhea
❑ Distribution of body hair (triangle-shaped pubic
(Etiology/pathophysiology)
hair in women, --- diamond-shaped pubic hair in
men) ❑ Uterine pain with menstruation
❑ Signs of bleeding (metrorrhagia, post-coital ❑ The causes of dysmenorrhea can relate to an
bleeding, spotting) endocrine imbalance, an increase in
❑ Erectile dysfunction, failure to achieve orgasm or prostaglandin secretions, or chronic illness,
pain during intercourse fatigue, and anemia.
L6 Care of the Patient with Reproductive & Respiratory Disorder

(Clinical manifestations/assessment) Analgesics; diuretics; progesterone

❑ Breast tenderness; headache ❑ Dietary recommendations:

❑ Abdominal distention; nausea and vomiting
High in complex carbohydrates
❑ Vertigo
❑ Palpitations Moderate in protein
❑ Excessive perspiration
❑ Colicky, cyclic pain; dull pain in the lower pelvis Low in refined sugar and sodium

(Medical management/nursing interventions) Limit caffeine, chocolate, and alcohol

❑ Exercise ❑ Reduce or eliminate smoking

❑ Nutritious foods, high in fiber ❑ Exercise; adequate rest, sleep, and relaxation

❑ Warm compress to pelvic area Menopause

❑ Mild analgesics (Etiology/pathophysiology)

❑ Prostaglandin inhibitors ❑ The normal decline of ovarian function resulting

from the aging process
Abnormal uterine bleeding
❑ May be induced by irradiation of the ovaries or
Menorrhagia surgical removal of both ovaries
❑ Excessive bleeding during the regular menstrual ❑ Not considered complete until 1 year after the
flow last menstrual period
❑ Causes: Endocrine disorders; inflammatory
disturbances; uterine tumors (Clinical manifestations/assessment)
Metrorrhagia ❑ Decrease in frequency, amount, and duration of
❑ Uterine bleeding between regular menstrual the normal menstrual flow
periods or after menopause ❑ Shrinkage of vulval structures; shortening of the
❑ May indicate cancer or benign tumors of the vagina
uterus ❑ Dryness of the vaginal wall; pelvic relaxation
Premenstrual syndrome (PMS) ❑ Loss of skin turgor and elasticity
(Etiology/pathophysiology) ❑ Increased subcutaneous fat; decreased breast
❑ Believed to be related to the neuroendocrine tissue; thinning of hair
events occurring within the anterior pituitary ❑ Osteoporosis
gland
(Medical management/nursing interventions)
(Clinical manifestations/assessment)
❑ Estrogen therapy
❑ Irritability, lethargy, and fatigue
❑ Sleep disturbances; depression ❑ Premarin
❑ Headache; backache; breast tenderness ❑ Provera
❑ Vertigo
❑ Abdominal distention ❑ Calcium supplements
❑ Acne
Male climacteric
(Medical management/nursing interventions)
(Etiology/pathophysiology)
❑ Pharmacological management:
L6 Care of the Patient with Reproductive & Respiratory Disorder

❑ Gradual decrease of testosterone levels and ❑ Causative organisms: E. coli; staphylococcal;

seminal fluid production; 55 to 70 years of age streptococcal; T. vaginalis; C. albicans;
Gardnerella
(Clinical manifestations/assessment)
(Clinical manifestations/assessment)
❑ Decreased erections; decreased seminal fluid
❑ Enlarged prostate gland; decreased muscle tone ❑ Inflammation of the vagina
❑ Loss or thinning of hair ❑ Yellow, white, or grayish white, curd-like
(Medical management/nursing interventions) discharge
❑ Pruritus and vaginal burning
❑ Emotional support; treatment for impotence
(Medical management/nursing interventions)
Erectile dysfunction
❑ Douching
(Etiology/pathophysiology)
❑ Vaginal suppositories, ointments, and creams
❑ Inability of an adult man to achieve penile ❑ Organism-specific
erection ❑ Sitz baths
❑ Abstain from sexual intercourse during
Types treatment
❑ Functional ❑ Treat partner if necessary
❑ Anatomical
❑ Atonic Cervicitis
(Medical management/nursing interventions)
(Etiology/pathophysiology)
❑ Remove cause if possible
❑ Treat diseases ❑ Infection of the cervix
❑ Viagra
(Clinical manifestations/assessment)
❑ Mechanical devices: penile prosthesis
❑ Backache
❑ Whitish exudate
Infertility
❑ Menstrual irregularities
(Etiology/pathophysiology) (Medical management/nursing interventions)

❑ Inability to conceive after 1 year of sexual ❑ Vaginal suppositories, ointments, and creams;
intercourse without birth control organism-specific

(Medical management/nursing interventions) Pelvic inflammatory disease (PID)

❑ Depends on the cause (Etiology/pathophysiology)

❑ Hormone therapy
❑ Any acute, subacute, recurrent, or chronic
❑ Repair occlusion
infection of the cervix, uterus, fallopian tubes,
❑ Intrauterine insemination
and ovaries that has extended to the connective
❑ In vitro fertilization
tissues

Most common causative organisms

INFECTIONS OF THE FEMALE REPRODUCTIVE TRACT
❑ Gonorrhea; streptococcus; staphylococcus;
Simple vaginitis
Chlamydia; tubercle bacilli
(Etiology/pathophysiology) ❑ High risk: Surgical and examination procedures;
sexual intercourse (especially with multiple
❑ Common vaginal infection ❑ partners); pregnancy
L6 Care of the Patient with Reproductive & Respiratory Disorder

(Clinical manifestations/assessment) ❑ The tissue responds to the normal stimulation of

the ovaries; bleeds each month
❑ Fever and chills
❑ Severe abdominal pain (Clinical manifestations/assessment)
❑ Malaise
❑ Lower abdominal and pelvic pain
❑ Nausea and vomiting
❑ May radiate to lower back, legs, and groin
❑ Malodorous purulent vaginal exudate
(Medical management/nursing interventions)
(Medical management/nursing interventions)
❑ Antiovulatory medications; pregnancy
❑ Antibiotics; analgesics
❑ Laparoscopy; total hysterectomy
❑ Bed rest

Toxic shock syndrome Common sites of endometriosis

(Etiology/pathophysiology)

❑ Acute bacterial infection caused by

Staphylococcus aureus
❑ Usually occurs in women who are menstruating
and using tampons

(Clinical manifestations/assessment)

❑ Usually occurs between days 2 and 4 of the

menstrual period Disorders of the Female Reproductive System
❑ Flu-like symptoms; sore throat; headache
Vaginal fistula
❑ Red macular palmar or diffuse rash
❑ Decreased urinary output; BUN elevated (Etiology/pathophysiology)
❑ Pulmonary edema
❑ Abnormal opening between the vagina and
(Medical another organ

(Clinical manifestations/assessment)

❑ Urine and/or feces being expelled from vagina

(Medical management/nursing interventions)

❑ Oral or parenteral antibiotics

❑ Diet: high protein; increase vitamin C
❑ Surgery: Repair fistula; urinary or fecal diversion

Types of fistulas that may develop in the vagina and

uterus.
management/nursing interventions)

❑ Antibiotics; IV fluid therapy; oxygen

Endometriosis

(Etiology/pathophysiology)

❑ Endometrial tissue appears outside the uterus

L6 Care of the Patient with Reproductive & Respiratory Disorder

Displaced uterus ❑ Protrusion of cervix and vaginal walls in perineal

area
(Etiology/pathophysiology)

❑ Congenital
❑ Childbirth

Backward displacement

❑ Retroversion – the entire uterus is tipped

backward
The degree of prolapse directly influences the type and
❑ Anteversion – the entire uterus is tipped far
severity of symptoms experienced by the patient.
forward
❑ Retroflexion – uterine body is bent sharply back Medical management/nursing interventions
just above the cervix
❑ Anteflexion – uterine body is bent sharply The management of uterine prolapse can involve the use
forward at the junction with cervix of a positioning device or surgical interventions

Clinical manifestations/assessment ❑ Pessary

❑ Surgery
❑ Backache ❑ Vaginal hysterectomy
❑ Muscle strain ❑ Anteroposterior colporrhaphy
❑ Leukorrheal discharge
❑ Heaviness in the pelvic area Cystocele and rectocele

Medical management/nursing interventions Etiology/pathophysiology

❑ Pessary – device worn in the vagina to support Cystocele

the uterus ❑ Displacement of the bladder into the vagina
Rectocele
❑ Bladder Suspension ❑ Rectum moves toward posterior vaginal wall

Uterine prolapse

Etiology/pathophysiology

❑ Prolapse of the uterus through the pelvic floor

and vaginal opening

Clinical manifestations/assessment

❑ Fullness in vaginal area

❑ Backache
❑ Bowel or bladder problems
L6 Care of the Patient with Reproductive & Respiratory Disorder

Clinical manifestations/assessment Ovarian cysts

Cystocele Etiology/pathophysiology

❑ Urinary urgency, frequency, and incontinence; ❑ Benign tumors that arise from dermoid cells of
pelvic pressure the ovary

Rectocele Clinical manifestations/assessment

❑ Constipation; rectal pressure; hemorrhoids ❑ May be no symptoms

❑ Palpable on examination
Medical management/nursing interventions
❑ Disturbance of menstruation
❑ Surgical repair ❑ Pelvic heaviness; pain
❑ Anteroposterior colporrhaphy;
Medical management/nursing interventions
❑ bladder suspension
❑ Ovarian cystectomy

Leiomyomas of the uterus (fibroids, myomas)

Leiomyomas are the most common benign tumor of
the female reproductive tract.

Etiology/pathophysiology

❑ Arise from the muscle tissue of the uterus

❑ Stimulated by ovarian hormones

Clinical manifestations/assessment

❑ Pelvic pressure; pain; backache

❑ Dysmenorrhea; menorrhagia
❑ Constipation; urinary symptoms
Medical management/nursing interventions
❑ Surgery: Myomectomy; hysterectomy
Cancer of the cervix
• Cancer is the second leading cause of death in
women.
• Cervical cancer is a disease that impacts women
in their childbearing years.
• The Pap smear is a screening tool to identify
problematic cervical cell changes.
Etiology/pathophysiology

❑ Squamous cell carcinoma

❑ Carcinoma in situ
❑ If untreated, invades the vagina, pelvic wall,
bladder, rectum, and regional lymph nodes

High risk

❑ Sexually active during teens

❑ Multiple sexual partners
❑ Multiple births
❑ Chronic cervical infections
L6 Care of the Patient with Reproductive & Respiratory Disorder

Clinical manifestations/assessment Clinical manifestations/assessment

❑ Few symptoms in early stages Early

❑ Leukorrhea
❑ Vague abdominal discomfort
❑ Irregular vaginal bleeding; spotting
❑ Flatulence; mild gastric disturbance
❑ Advanced
▪ Pain in the back, upper thighs, and legs Advanced
Medical management/nursing interventions ❑ Enlarged abdominal girth
❑ Flatulence; constipation
Carcinoma in situ
❑ Urinary frequency
❑ Removal of the affected area ❑ Nausea and vomiting
❑ Weight loss
Early carcinoma
Medical management/nursing interventions
❑ Hysterectomy
❑ Intracavitary radiation Surgery
❑ Brachytherapy
❑ TAH-BSO and omentectomy
Advanced carcinoma
Radiation and/or chemotherapy
❑ Radical hysterectomy with pelvic lymph node
Conditions involving hormonal issues, disease process,
dissection
and other disorders can necessitate surgical
intervention. The removal of the uterus is known as a
hysterectomy.
Cancer of the endometrium
There are differing types of hysterectomies. The medical
• Cancer of the endometrium occurs more
terminology used to refer to the surgical procedure is
frequently in postmenopausal women
based upon the type of surgical incision and the organs
Etiology/pathophysiology affected.

❑ Adenocarcinoma of the uterus

Clinical manifestations/assessment Hysterectomy

❑ Postmenopausal bleeding (50% will have cancer) Total hysterectomy

❑ Abdominal pressure; pelvic fullness ❑ Removal of the uterus including the cervix
TAH-BSO
Medical management/nursing interventions ❑ Removal of the uterus, fallopian tubes, and
❑ Surgery: total abdominal hysterectomy with ovaries
bilateral salpingo-oophorectomy (TAH-BSO) Radical hysterectomy
❑ Radiation; chemotherapy ❑ TAH-BSO with removal of the pelvic lymph nodes
Vaginal hysterectomy
❑ The uterus is removed through the vagina
Cancer of the ovary Abdominal hysterectomy
❑ Abdominal incision is made to perform
Etiology/pathophysiology procedure
❑ Fourth most common cause of cancer death in
women

High risk: infertile; anovulatory; nulliparous; habitual

aborters; high-fat diet; exposure to industrial chemicals
L6 Care of the Patient with Reproductive & Respiratory Disorder

Disorders of the Female Breast Breast cancer

• Breast cancer is the most common cancer in
Fibrocystic breast condition
women.
Fibrocystic breast disease refers to development of
• Only lung cancer outranks breast cancer in the
benign tumors of the breast. These tumors rarely ever
number of deaths per year.
become cancerous and are almost never seen in most
Etiology/pathophysiology
menopausal women.
❑ Unknown cause; usually adenocarcinoma
Etiology/pathophysiology
Clinical manifestations/assessment
❑ Hyperplasia and cystic formation in mammary
❑ Small, solitary, irregular-shaped, firm, non-
ducts
tender, and non-mobile tumor
Clinical manifestations/assessment
❑ Change in skin color
❑ Cysts are soft, well-differentiated, tender, and
❑ Puckering or dimpling of tissue
freely moveable; often bilateral and multiple
❑ Nipple discharge; retraction of nipple
❑ Axillary tenderness
Medical management/nursing interventions
Medical management/nursing interventions
❑ Depends on the stage
❑ Eliminate methylxanthines (caffeine,
❑ Radiation
theophylline)
❑ Chemotherapy
❑ Danazol (danocrine)- synthetic androgen that
❑ Surgery
inhibits the release of gonadotropins
▪ Lumpectomy
❑ Vitamin E (alpha-tocopherol) a potent
▪ Mastectomy—simple, radical
antioxidant

Inflammatory Disorders of the Male Reproductive

Acute mastitis
System
Etiology/pathophysiology
❑ Acute bacterial infection of the breast
Clinical manifestations/assessment Prostatitis
❑ Breasts are tender, inflamed, and engorged
• Prostatitis is an infection of the prostate gland. It
Medical management/nursing interventions
most commonly occurs because of a bacterial
❑ Keep breasts clean
infection in the bloodstream or from an infection
❑ Application of warm packs
that has descended from the kidneys.
❑ Support: Well-fitting bra
❑ Systemic antibiotics Etiology/pathophysiology

❑ Acute or chronic infection of the prostate gland

Chronic mastitis Clinical manifestations/assessment
Etiology/pathophysiology
❑ Fibrosis and cysts in the breast ❑ Chills and fever
Clinical manifestations/assessment ❑ Dysuria; urgency and frequency of urination
❑ Tender, painful, and palpable cysts ❑ Cloudy urine
❑ Usually unilateral ❑ Perineal fullness; lower back pain
Medical management/nursing interventions ❑ Arthralgia; myalgia
❑ Same as for acute mastitis ❑ Tenderness, edema, and firmness of the prostate

Medical management/nursing interventions

❑ Antibiotics
❑ Digital massage of the prostate
❑ Sitz baths
L6 Care of the Patient with Reproductive & Respiratory Disorder

❑ Monitor I&O Disorders of Male Genital Organs

Phimosis
• Phimosis results when the foreskin over the
glans penis is too small and cannot be retracted.
• It can cause a localized infection
Etiology/pathophysiology
❑ Prepuce is too small to allow retraction of the
foreskin over the glans
❑ Usually congenital; may be due to inflammation
or disease
Clinical manifestations/assessment
❑ Infection of foreskin and glans penis
❑ Occasionally causes obstruction of urine flow
Epididymitis Medical management/nursing interventions
❑ Circumcision
• Epididymitis is a commonly occurring infection of
the male reproductive tract. Common causative
organisms include Escherichia coli,
Streptococcus, and Neisseria gonorrhoeae.
Etiology/pathophysiology

❑ Infection of the epididymis

Clinical manifestations/assessment
Paraphimosis
❑ Scrotal pain and edema
• Etiology and pathophysiology
❑ Pyuria; chills and fever
o An edematous condition of the retracted
Medical management/nursing interventions uncircumcised foreskin preventing a
normal return over the glans
❑ Bed rest
• Medical management/nursing interventions
❑ Elevate scrotum; cold compresses
o Warm compresses
❑ Antibiotics
o Circumcision

Hydrocele

• Etiology/pathophysiology
o Accumulation of fluid between the
membranes of the testes
• Clinical manifestations/assessment
o Enlargement of the scrotum; pain
• Medical management/nursing interventions
L6 Care of the Patient with Reproductive & Respiratory Disorder
o Aspiration of fluid
o Surgical removal of testicular sac
o Bed rest; elevate scrotum;
compresses
Varicocele
• Etiology/pathophysiology
o Dilation of scrotal veins causing
obstruction and malfunction of
circulation
• Clinical manifestations/assessment
o Engorgement and elongation of the
scrotum
o Pulling sensation in scrotum; dull, aching
pain
• Medical management/nursing interventions
o Surgery: Removal of obstruction
o Bed rest
o Elevate scrotum; cold compresses
Cancer of the Male Reproductive Tract
Cancer of the testis
• Etiology/pathophysiology
o Cause unknown
o Most common malignancy in men ages
15-35 years
• Clinical manifestations/assessment
o Enlarged scrotum; feeling of heaviness
o Firm, painless, smooth mass
• Medical management/nursing interventions
o Radical inguinal orchiectomy
o Radiation and/or chemotherapy
o Teach testicular self-examination
Cancer of the penis
cold
• Etiology/pathophysiology
o Very rare
• Clinical manifestations/assessment
o Painless, wart-like growth or ulceration,
usually on the glans penis
• Medical management/nursing interventions
o Surgery
▪ Removal of tissue
▪ Partial or total amputation of
the penis
▪ Metastasis: Radical surgical
procedures
Sexually Transmitted Diseases
Genital herpes (HSV)
• Etiology/pathophysiology
o Infectious viral disease; usually acquired
sexually
o Common sexually transmitted disease
• Clinical manifestations/assessment
o Fluid-filled vesicles
o Eventually rupture and develop shallow,
painful ulcers
o Fever; malaise
o Dysuria
o Leukorrhea (female)
• Medical management/nursing interventions
o No cure; treat symptoms
o Acyclovir (Zovirax)
o Sitz baths
o Local anesthetic; analgesics
o Keep lesions clean and dry
o GOOD handwashing
o No sexual contact while lesions are
present
o Encourage use of condoms
L6 Care of the Patient with Reproductive & Respiratory Disorder

Syphilis o Most common STD

• Clinical manifestations/assessment
• Etiology/pathophysiology
o Vaginal (female)
o Treponema pallidum organism
▪ Urinary frequency and pain
o Transmission occurs primarily with
▪ Yellowish discharge
sexual contact
▪ Nausea and vomiting
• Clinical manifestations/assessment
o Urethra (male)
o Incubation period
▪ Urethral discomfort; dysuria
▪ No symptoms
▪ Yellowish discharge containing
o Primary stage
pus
▪ Chancre; headaches; enlarged
▪ Red and swollen meatus
lymph nodes
o Rectal (male and female)
o Secondary stage
▪ Perineal discomfort; purulent
▪ Rash on palms of hands and
rectal discharge
soles of feet
o Pharyngitis (male and female)
▪ Generalized enlargement of
▪ Sore throat and swallowing
lymph nodes
discomfort
o Latent stage
▪ Edema of the throat
▪ No symptoms
o Medical management/nursing
o Tertiary or late stage
interventions
▪ Lesions may affect many
▪ Pharmacological management
different systems; may be fatal
• Penicillin
• Medical management/nursing interventions • Rocephin
• Doxycycline or
o Pharmacological management
tetracycline
o Penicillin o Patient education
o TREAT ALL SEXUAL CONTACTS
o Tetracycline or erythromycin, if allergic
to penicillin

o May be treated in any stage; damage

from previous stages will not be
reversed

o Treat all sexual contacts

Trichomoniasis – “ Trich”

• Etiology/pathophysiology
o T. vaginalis protozoan
o Usually sexually transmitted but could
be transmitted with contaminated
Gonorrhea douche nozzle, douche container or
• Etiology/pathophysiology washcloth,
o N. gonorrhoeae • Clinical manifestations/assessment
o Transmitted by sexual contact o Most are asymptomatic
L6 Care of the Patient with Reproductive & Respiratory Disorder

o Male: Urethritis, dysuria, urinary o Treat underlying condition

frequency, pruritus, and purulent
exudate
o Female
▪ Frothy, gray, green, or yellow
malodorous discharge
▪ Pruritus
▪ Edema
▪ Tenderness of vagina
▪ Dysuria and urinary frequency
▪ Spotting; menorrhagia;
dysmenorrhea Chlamydia
o Medical management/nursing
• Etiology/pathophysiology
interventions
o Chlamydia trachomatis
▪ Pharmacological management
• Clinical manifestations/assessment
• Metronidazole (Flagyl)
o Usually asymptomatic
o Patient education
o Male
o TREAT ALL SEXUAL CONTACTS
▪ Scanty white or clear exudate
▪ Burning or pruritus
▪ Urinary frequency; mild dysuria
o Female
▪ Vaginal pruritus or burning
▪ Dull pelvic pain
▪ Low-grade fever
▪ Vaginal discharge; irregular
bleeding
o Medical management/nursing
interventions
Candidiasis – “yeast” or “thrush”
▪ Pharmacological management
• Etiology/pathophysiology • Tetracycline;
o Fungal infection caused by C. albicans doxycycline; Zithromax
and C. tropicalis o TREAT ALL SEXUAL CONTACTS
• Clinical manifestations/assessment
o Mouth: Edema; white patches
o Nails: Edematous, darkened,
erythematous nail base; purulent
exudate
o Vaginal: Cheesy, tenacious white
discharge; pruritus; inflammation of the
vagina Nursing Process
o Penis: Purulent exudate • Nursing diagnoses
o Systemic: Chills; fever; general malaise o Anxiety
• Medical management/nursing interventions o Body image, disturbed
o Coping, ineffective
o Pharmacological management o Fear
▪ Nystatin (Mycostatin) o Fluid volume, deficient
o Health maintenance, ineffective
▪ Topical amphotericin B
L6 Care of the Patient with Reproductive & Respiratory Disorder
o Infection, risk for
o Knowledge, deficient
o Pain, acute and chronic
o Self-esteem, situational low
o Sexual dysfunction
o Skin integrity, impaired
o Tissue perfusion, ineffective
o Urinary elimination, impaired
Pediatric Respiratory Disorder
“Respiratory emergencies are 1 of the most common
reasons parents seek evaluation for their children in the
Emergency department”
Respiratory disorders are the 2nd leading cause of ER
visits in children (#1 is injury and poisoning).
Key Pediatric Differences in the Respiratory System
• Lack of insufficient surfactant
• Alveoli is still developing
• Smaller airways
• Underdeveloped cartilage
Resp. infections most common cause of illness in infants
& children. I’ll talk about just a few.
1. Surfactant: [alveoli collapse easier]
2. Alveoli developing in # & size rapidly to age 3;
slower but still increasing until around age 8:
born w/25M, 300M by adult. [increased risk for
more rapid development of hypoxemia i.e. not as
many alveoli to compensate]
3. Smaller airways & Underdeveloped cartilage:
• Increase airway resistance; small
changes in diameter cause greater
increase in resistance. Infant 4mm; adult
12-16mm.
• [takes less mucus, edema to close up.
Bronchioles, trachea collapse easier]
• More flexible larynx: more susceptible to
spasm, collapse
• Tonsilar tissue enlarged – relative to rest
of nasopharynx – easier to obstruct
AIRWAY
• Nose: generally smaller, increased resistance,
smaller septum and nasal bridge is flat and
flexible, obligatory nose breathers
• Vocal cords: located at C304 versus C5-6 in
adults, larynx is more anterior. It contributes to
aspiration if neck is hyperextended
• Cricoid ring: is the narrowest part of the airway
instead of vocal cords
• Airway diameter: is 4 mm vs 20 mm in adult
• Tracheal rings: more elastic and cartilaginous,
can easily crimp off trachea
• More Smooth muscle, makes airway more
reactive or sensitive to foreign substances
• Head to body ratio and relative size and location
of anatomic features make children more
susceptible to head and abdominal injury
L6 Care of the Patient with Reproductive & Respiratory Disorder

• Underdeveloped anatomy leads to chest Underlying Principles

pliability and less protection of thoracic cage and
• Use Systemic approach
less effective use of accessory muscles
• Complete initial exam and reassess regularly
• Arrest: cardiac arrest typically results from
• Assess the effects of treatment/interventions
untreated respiratory arrest
• Correct life-threatening abnormalities before
• Obligatory nose breather (infant)
moving on to the next part of assessment
• Intercostal muscles less developed
• Faster respiratory rate Physical Assessment
• Eustachian tubes relatively horizontal
Cough

1. Obligatory nose breathers (up to 4 mo):

• small midface, tongue large in relation to

size of face & close to palate, Tonsillar
tissue enlarged : [increased distress from
nasal congestion; difficulty eating when
stuffed – can’t breathe & eat at same
time]
2. Less developed intercostal muscles: [retraction
of chest wall, increased risk for obstruction,
hypoxia, resp. failure]
• Use abdominal muscles to breath, rather
than chest wall.
Rate and depth of Respiration
3. Faster respiratory rate: [Increased metabolic
needs: increased O2 needs; lose more water-
insensible loss]
• NB 30-60
• 6 mo: 20-40
• 1 yr: 20-30
• 6 yr: 18-23
• Eustachian tubes relatively horizontal
• useful procedure to clear excess mucus or
foreign bodies from the respiratory tract.
• Could lead to exhaustion, increase chest
pressure and decrease venous return leads to
fainting, increase in CNS pressure leads to
bleeding of CNS.
• Paroxysmal coughing- series of expiratory
coughs after a deep inspiration. Common in
children with pertussis (whooping cough)
• Tachypnea- first indicator of airways obstruction
• Anoxia- lack of oxygen in body cells
• Retractions- intercostal space draw inward
during inspiration
• Supraclavicular or suprasternal retractions-
upper airway obstruction
• Intercostal or subcostal muscle retraction- lower
airway obstruction

Airway urgencies can quickly progress to airway

emergencies

ABCDE Assessment tool

L6 Care of the Patient with Reproductive & Respiratory Disorder

• Retractions w/resp distress – up until 6 years of Diagnostic Procedure

age
• Chest Radiography
• Intercostal muscles immature; ribs cartilage –
• Bronchography – a radiopaque is introduced into
makes chest wall flexible.
the respiratory tract by ultrasonic nebulizer or a
• Nasal flaring also a sign of resp distress- primarily
catheter inserted into the trachea before an X-
infants & toddlers.
ray
• Abdominal breathing normal
• Pulmonary Fuction Test – measure the inertia,
• Restlessness- may be due to hypoxia of the brain
elasticity and flow resistance and ventilation.
• Cyanosis
• Clubbing of fingers- change in the angle between
the fingernail and nail bed because of increased
Signs Respiratory Distress
capillary growth in the fingertips due to chronic
respiratory illness • Cough
• Hoarseness
• Grunting
Adventitious Sounds • Stridor
• Wheezing
Rhonchi- snoring, mucus in the nose or pharynx
• Nasal flaring
Stridor- harsher strident sound on inspiration, • Retractions
obstruction in the larynx or at the base of the tongue. • Vomiting
Wheezing- expiratory whistle sound, obstruction in the • Diarrhea
lower trachea or bronchioles • Anorexia
• Tachypnea
Ralse- fine cracking sound, if alveoli become fluid filled • Tachycardia
Diminished or absent breath sounds- occur when alveoli • Restlessness
are fluid filled that little or no air can enter them. • Cyanosis

Chest diameters- with chronic obstructive lung disease,
children may be unable to exhale completely thus
allowing air to be trapped in lung alveoli (hyperinflation)-
pigeon chest
Laboratory Test
Vomiting, diarrhea, anorexia: common 1st signs of illness
in children.
• Watch for dehydration
• Tachycardia: compensatory for any distress.
• ‘respiratory distress’ (clinical manifestation) vs
‘respiratory distress syndrome’ (a diagnosis)

Blood Gas Analysis – invasive method in determining the

effectiveness of ventilation and acid-base status. Potential Nursing Diagnoses

Pulse oximetry- non-invasive technique for measuring • Ineffective Airway Clearance

oxygen saturation • Ineffective Breathing Pattern
• Impaired Gas Exchange
Nasopharyngeal Culture- culture of the causative
• Anxiety
microorganism
• Activity Intolerance
Respiratory Syncytial virus nasal washings- nasal • Risk for FVD
washing with saline solution to diagnose infection caused • Altered nutrition
by respiratory syncytial virus (RSV) • Altered comfort
• Knowledge deficit
Sputum Analysis
• Ineffective coping- individual or family
L6 Care of the Patient with Reproductive & Respiratory Disorder

Other than trauma---

5 Most Common Respiratory Emergencies

• Asthma
• Croup
• Bronchiolitis
• Epiglotitis
• Foreign bodies

Upper Airway Disease

Nose – Pharynx – Larynx

• Awake/Crying
• It child improves
o Nose/Pharynx
• If child deteriorates
o Larynx

Lower Airway Disease

Noise during Exhalation

Distal to Thoracic Inlet

Trachea, Bronchi, Peripheral Airways