Nursing Care of a Child with

Respiratory Disorder
Disorders of the Upper Respiratory Tract
 Warms, humidifies and filters the air that enters the body
Disorders of the Upper Respiratory Tract
1. Choanal Atresia – a congenital obstruction of the
posterior nares by an obstructing membrane or bony
growth which prevents the newborn from drawing air
through the nose and down into the nasopharynx.
Maybe unilateral or bilateral
- newborns up to 3 months are naturally nose breathers
- With this condition they immediately develop signs of
respiratory distress
Choanal Atresia
Choanal Atresia
 Assessment:
-Passing a soft #8 or #10 French catheter through the
posterior nares to the stomach as part of birthing room
procedure confirms immediately that no atresia is present
-Holding the newborn mouth closed, then gently
compressing first one nostril, then the other. If atresia is
present, infants will struggle due to air hunger
Choanal Atresia
 Signs and symptoms:
- Breathing difficulty
- Cyanosis bilateral
- Feeding difficulty
- Noisy breathing
- Thick fluid draining from unilateral
one side of the nose
Choanal Atresia
 Management:
-local piercing of the obstructing membrane
-surgical removal of the bony growth
- IVF for difficulty with feeding until surgery can be
performed
- Some infants may need an oral airway inserted to
facilitate breathing through their mouths
Disorders of the Upper Respiratory Tract
2. Acute Nasopharyngitis (Common Cold)
- most frequent infectious disease in children
Incidence:
- toddlers: 10-12 colds per year
- School age & adolescents: 8-10 per year
Incubation period: 2-3 days
Caused by: rhinovirus, coxsackievirus, RSV, adenovirus,
parainfluenza & influenza virus
Acute Nasopharyngitis
 Assessment :
- Nasal congestion
- Watery rhinitis
- Sneezing
- Coughing
- Sore or scratchy throat
- Low fever
- Headache
- Tiredness
- Body aches
Acute Nasopharyngitis
 Management:
- No specific treatment
- Antibiotics for secondary bacterial invasion
- Antipyretic e.g. acetaminophen for fever
- Nose drops or nasal spray for nasal congestion
- Bulb syringe to remove nasal mucus
- Guaifenesin meds to loosen secretions
- Cool mist vaporizer to help loosen secretions
Disorders of the Upper Respiratory Tract
3. Pharyngitis – infection and inflammation of the throat
- Peak incidence: 5-15 years
- Incubation period: 2-5 days
- Bacterial or viral
- May occur as a result of a chronic allergy in which there
is a constant postnasal discharge resulting to secondary
irritation.
Pharyngitis
Types:
1. Viral Pharyngitis
Causative organism: Adenovirus
Symptoms: sore throat, fever, rhinorrhea, cough, general
malaise
PE: enlarges regional lymph nodes
Lab Exam: Increased WBC
Treatment: acetaminophen or ibuprofen; heat application
(warm towel or heating pad) on external neck; gargling
warm solution; liquid diet
Pharyngitis
2. Streptococcal Pharyngitis or Strep throat
Causative organism: Group A streptococcus
Assessment: back of throat and palatine tonsils are
erythemathous (bright red), Throat pain that usually comes
on quickly, Painful swallowing , Red and swollen tonsils,
sometimes with white patches or streaks of pus, Tiny red
spots on the area at the back of the roof of the mouth (soft
or hard palate), Swollen, tender lymph nodes in your neck,
Fever , Headache , Rash , Nausea or vomiting, especially in
younger children , Body aches
Pharyngitis
Pharyngitis
 Management:
- Antibiotics (Penicillin G; clindamycin; Cephalosporin;
Erythromycin) – complete days of treatment
 Strep infection may lead to inflammatory illnesses, including:
a. Scarlet fever, a streptococcal infection characterized by a
prominent rash
b. Inflammation of the kidney (poststreptococcal
glomerulonephritis)
c. Rheumatic fever, a serious inflammatory condition that can
affect the heart, joints, nervous system and skin
d. Poststreptococcal reactive arthritis, a condition that causes
inflammation of the joints
Disorders of the Upper Respiratory Tract
4. Retropharyngeal abscess – collection of pus in the
back of the throat caused by bacterial infection.
Symptoms : difficulty and pain when swallowing, a fever, stiff
neck, and noisy breathing.
Physical Assessment: enlarged regional lymph nodes
Diagnostic exam: UTZ, Computed tomography (CT scan)
reveal bulging tissue in the pharynx
Treatment:The abscess is drained surgically, and antibiotics
are given to eliminate the infection
Retropharyngeal abscess
 Nursing Management:
 Infants in side-lying position to drain forward secretions
 Avoid foods that can cause irritation like toast crust that
may cause rupture of abscess
 T-berg position during incision of abscess to promote
drainage
 Suction of drainage from abscess while maintaining T-berg
position
 Monitor v/s & observe bleeding (frequent swallowing)
that maybe aspirated
 Oral fluid is introduced with intact gag reflex/swallowing
Disorders of the Upper Respiratory Tract
5. Tonsillitis – infection and inflammation of palatine tonsils.
Adenitis – infection & inflammation of the adenoid
(pharyngeal tonsils) located in pharynx
Tonsillitis
Signs & symptoms
 Red, swollen tonsils
 White or yellow coating or patches on the tonsils
 Sore throat
 Difficult or painful swallowing
 Fever
 Enlarged, tender glands (lymph nodes) in the neck
 A scratchy, muffled or throaty voice
 Bad breath
 Stomachache, particularly in younger children
 Stiff neck
 Headache
Tonsillitis
In young children who are unable to describe how they feel,
signs of tonsillitis may include:
 Drooling due to difficult or painful swallowing
 Refusal to eat
 Unusual fussiness
Tonsillitis
Therapeutic Management:
1. antipyretic, antibiotic (penicillin or amoxicillin)
2. Surgical: Tonsillectomy- removal of palatine tonsils
-done by laser or ligation – no suture so chance of hemorrhage
is higher
- On the day or surgery, important to check for loose teeth to
prevent aspiration
- Post surgery – good light to check for posterior bleeding
- Diet: clear liquid diet
- Contraindications: carbonated beverage, Kool aid, citrus foods,
milk
- Ages 4-7: prepare the child for surgery in advance for 1 week
- The lesser the age of the child, the lesser the day of
preparation
Disorders of the Upper Respiratory Tract
6. Epistaxis (nosebleed) Bleeding can range from a
trickle to a strong flow, and the consequences can range
from a minor annoyance to life-threatening hemorrhage.
Causes:
 Local trauma (eg, nose blowing and picking)
 Drying of the nasal mucosa – susceptable to cracking and
bleeding
Epistaxis
Epistaxis
Management:
1. Bleeding can usually be controlled by pinching the nasal
alae together for 10 min while the patient sits upright (if
possible).
2. If this maneuver fails, a cotton pledget impregnated with
a vasoconstrictor (eg, phenylephrine 0.25%) and a
topical anesthetic (eg, lidocaine 2%) is inserted and the
nose pinched for another 10 min
3. A cotton or gauze nasal pack to provide continued
pressure maybe necessary
Disorders of the Upper Respiratory Tract
7. Sinusitis – infection and inflammation of sinus cavities
- Rare in children younger than 6 years since frontal sinuses
do not develop fully until that age
- May occur as primary infection or secondary one in older
children when streptococcal, staphylococcal or H.
influenza microorganisms spread from nasal cavity to
sinuses
- Signs & Symptoms: fever, a purulent nasal discharge,
headache and tenderness over the affected sinus
- Treatment:
- antipyretic for fever, analgesic for pain, antibiotic for
specific microorganisms
Sinusitis
-Oxymetazoline hydrochloride (Afrin) as nose drops or
nasal spray to shrink edematous membranes & allows
infected material to drain from sinuses
Disorders of the Upper Respiratory Tract
8. Laryngitis – inflammation of the larynx (voice box)
from overuse, irritation or infection
Signs & symptoms: brassy, hoarse voice sounds or inability
to make audible voice sounds
Management:
-sips of fluid offer relief from annoying tickling sensation
-rest voice for at least 24 hours
-attempt to give their needs before they have to cry
-offer paper and pencil to communicate while resting the
voice
Laryngitis
Disorders of the Upper Respiratory Tract
9. Congenital Laryngomalacia/Tracheomalacia – infant’s
laryngeal structure is weaker than normal & collapses more
than usual on inspiration
Signs & symptoms:
-Laryngeal stridor – high pitched crowing sound on
inspiration intensified when in supine or sucking
-retraction of sternum & intercostal spaces on inspiration
Congenital Laryngomalacia/Tracheomalacia
Congenital Laryngomalacia/Tracheomalacia
 Management:
-no routine therapy other than feeding slowly & provide
rest periods.
-emphasize to parents early care if signs of URTI should
develop since laryngeal collapse maybe intense
- Advise parents to bring child to physician if strido become
more intense
Disorders of the Upper Respiratory Tract
10. Croup (Laryngotracheobronchitis) – inflammation of the
larynx, trachea, and major bronchi
Incidence: children between 6 months & 3 years
Cause: viral infection such a parainfluenza virus
Assessment:
C-rackles & inspiratory stridor
R-uddy, brassy, spasmodic cough (seal bark)
O-obstruction of airways
U-sually hoarse voice
P-ersistent laryngospasm
Management: same as epiglottitis
Disorders of the Upper Respiratory Tract
11. Epiglottitis – inflammation of the epiglottis, which is
the flap of the cartilage that covers the opening of the
larynx to keep out food and fluid during swallowing.
-an emergency because the swollen epiglottis cannot rise
and allow the airway to open
-either bacterial or viral
-Causative organisms: H. Influenza type B (primary) .
Pneumococci, streptococci, staphylococci
Epiglottitis
A-cherry red appearance & muffled voice
B-acterial infection (H. Influenza, Pneumococci, streptococci,
staphylococci)
C-auses inspiratory stridor
D-rooling Management:
-yspnea *
-ysphagia
-ysphonia
Management:
A- irway –Tripod or sniffing dog position
Epiglottitis
Management:
B-reath: Instances to allow breathing
1. open freezer-to subside edematous vessels
2. cool night air
3. cool basement garage
4. hot shower steam
5. cool mist vaporizer (O2 tent)
-give plastic toys, no battery
-clothes made of cotton
-tuck the linens well
Epiglottitis
Management:
D-rugs Cephalosporine (Cefotaxime)
-iet: N-PO
N-o examination of throat
N-o throat swabs
E-ncourage Hib vaccination
 Comparison of Laryngotracheobronchitis (CROUP) and Epiglotitis
Assessment Laryngotracheobronchitis Epiglottitis

Usually pneumococci or
Causative organism Usually viral
streptococci

Usual age of child 6 months to 3 years 3 years to 6 years

Seasonal occurrence Late fall and winter None

Preceded by upper respiratory Preceded by upper respiratory

Onset pattern
infection infection; suddenly very ill

Presence of fever Low grade Elevated to about 103 degree F

Retractions and stridor;

Drooling; very-ill appearing,
prolonged inspiratory phase of
Appearance neck hyperextended to
respirations; not very ill-
breathe
appearing

Cough Sharp, barking Muffled

Disorders of the Upper Respiratory Tract
12. Aspiration –inhalation of a foreign object into the airway
occurs frequently to infants and toddlers
-maybe coin, peanut etc.
-immediate reaction is choking & forceful coughing to
dislodge the object
-if airway becomes so obstructed, no coughing or speech,
requires immediate intervention
1. Subdiaphragmatic abdominal thrust-stand behind the child
and place a fist just under the child’s diaphragm, a point
below the anterior rib cage. Embrace the child, grip your fist
with your other hand and pull back and up with a rapid
thrust
Subdiaphragmatic abdominal thrust
Aspiration
2. For infants, back thrust – turn the infant prone over
your arm and administer up to five quick back blows
forcefully between the infant’s shoulder blades using the
heel of the hand. If the object is not expelled, turn the infant
while carefully supporting the head and neck & hold the
infant in supine position keeping the head lower than the
chest. Provide a quick downward thrusts in the lower third
of the sternum
Disorders of the Lower Respiratory Tract
Disorders of the Lower Respiratory Tract
1.Influenza – involves inflammation & infection of the
major airways
Causative organisms: orthomyxovirus influenza type A, B or
C.
Signs & symptoms: cough, fever, fatigue, aching pains, sore
throat & often accompanying GIT symptoms like vomiting
or diarrhea.
Treatment: antipyretic (acetaminophen); Oseltavimir
(Tamiflu)-antiviral that halts proliferation of virus for 1 year
and above
Protection: anti-flu vaccine yearly
Disorders of the Lower Respiratory Tract
2. Bronchitis-inflammation of the major bronchi and
trachea
Causative organisms: influenza viruses, adenovirus &
Mycoplasma pneumoniae
Incidence: affect pre-school & school age
Signs & symptoms: fever & cough
Management: antipyretic; more fluid intake; antibiotic for
bacterial infections; expectorant if mucus is viscid
Disorders of the Lower Respiratory Tract
3. Bronchiolitis – inflammation of the fine bronchioles and
small bronchi
-most common lower respiratory illness in children
younger than 2 years; peak at 6 months
-children who develop asthma on the later life have
numerous instances of bronchiolitis during their first year of
life
Causative organisms: adenovirus, parainfluenza virus, RSV
Bronchiolitis
Signs & Symptoms:
For the first few days, the signs and symptoms of
bronchiolitis are similar to those of a cold:
 Runny nose
 Stuffy nose
 Cough
 Slight fever (not always present)
After this, there may be a week or more of difficulty
breathing or a whistling noise when the child breathes out
(wheezing).
Many infants also have an ear infection (otitis media).
Bronchiolitis
The following signs and symptoms are reasons to seek prompt
medical attention:
 Audible wheezing sounds due to increase expiratory phase of
respiration as accumulated mucus & inflammation block small
bronchioles
 Breathing very fast — more than 60 breaths a minute
(tachypnea) — and shallowly
 Labored breathing — the ribs seem to suck inward when the
infant inhales
 Sluggish or lethargic appearance
 Refusal to drink enough, or breathing too fast to eat or drink
 Skin turning blue, especially the lips and fingernails (cyanosis)
Bronchiolitis
Management:
1. For less severe symptoms: antipyretics, adequate
hydration, monitor for progression of the condition
2. Hospitalization for tachypneic, has marked retractions,
listless and history of poor fluid intake
3. For severe symptoms: humidified oxygen, adequate
hydration, nebulized bronchodilators, epinephrine &
anti-inflammatory medications e.g. budesonide
Bronchiolitis
Disorders of the Lower Respiratory Tract
4. Asthma-a condition in which your airways narrow and
swell and produce extra mucus. This can make breathing
difficult and trigger coughing, wheezing and shortness of
breath.
-tends to occur in children with atopy or those who are
hypersensitive to allergens like pollens, molds, house dust,
food
Asthma
Pathophysiology:
Asthma
 Statistics and Epidemiology
 Asthma is considered as the most common chronic
disease of childhood, and is a disruptive disease that
affects school and work attendance.
 Asthma affects more than 22 million people in the United
States.
 Asthma accounts for more than 497, 000 hospitalizations
annually.
 The total economic cost of asthma exceeds $27.6 billion.
Asthma
Causes
1. Allergy. Allergy is the strongest predisposing factor for
asthma.
2. Chronic exposure to airway irritants. Irritants can
be seasonal (grass, tree, and weed pollens) or perennial
(mold, dust, roaches, animal dander).
3. Exercise. Too much exercise can also cause asthma.
4. Stress/ Emotional upset. This can trigger constriction
of the airway leading to asthma.
5. Medications. Certain medications can trigger asthma.
Athma
Clinical Manifestations
 Most common symptoms of asthma are cough (with or
without mucus production), dyspnea, and wheezing (first
on expiration, then possibly during inspiration as well).
 Cough. There are instances that cough is the only
symptom.
 Dyspnea. General tightness may occur which leads to
dyspnea.
 Wheezing. There may be wheezing, first on expiration,
and then possibly during inspiration as well.
 Asthma attacks frequently occur at night or in the
early morning.
 Athma
 An asthma exacerbation is frequently preceded by increasing
symptoms over days, but it may begin abruptly.
 Expiration requires effort and becomes prolonged.
 As exacerbation progresses, central cyanosis secondary to severe
hypoxia may occur.
 Additional symptoms, such as diaphoresis, tachycardia, and a
widened pulse pressure, may occur.
 Exercise-induced asthma: maximal symptoms during exercise,
absence of nocturnal symptoms, and sometimes only
a description of a “choking” sensation during exercise.
 A severe, continuous reaction, status asthmaticus, may occur. It is
life-threatening.
 Eczema, rashes, and temporary edema are allergic reactions that
may be noted with asthma.
Asthma
Prevention
 Patients with recurrent asthma should undergo tests to
identify the substances that precipitate the symptoms.
 Allergens. Allergens, either seasonal or perennial, can be
prevented through avoiding contact with them whenever
possible.
 Knowledge. Knowledge is the key to quality asthma
care.
 Evaluation. Evaluation of impairment and risk are key in
the control.
Asthma
Complications
 Complications for asthma include the following:
 Status asthmaticus. Airway obstruction in status
asthmaticus often results in hypoxemia.
 Respiratory failure. Asthma, if left untreated, progresses
to respiratory failure.
 Pneumonia. Mucus that pools in the lungs and becomes
infected can lead to the development of pneumonia.
Asthma
Assessment and Diagnostic Findings
 To determine the diagnosis of asthma, the clinician must
determine that episodic symptoms of airway obstruction are
present.
 Positive family history. Asthma is a hereditary disease, and
can be possibly acquired by any member of the family who has
asthma within their clan.
 Environmental factors. Seasonal changes, high pollen
counts, mold, pet dander, climate changes, and air pollution are
primarily associated with asthma.
 Comorbid conditions. Comorbid conditions that may
accompany asthma may include gastroeasophageal reflux, drug-
induced asthma, and allergic broncopulmonary aspergillosis.
 Asthma
Medical Management
Pharmacologic Therapy
 Short-acting beta2 –adrenergic agonists. These are the
medications of choice for relief of acute symptoms and
prevention of exercise-induced asthma.
 Anticholinergics. Anticholinergics inhibit muscarinic
cholinergic receptors and reduce intrinsic vagal tone of the
airway.
 Corticosteroids. Corticosteroids are most effective in
alleviating symptoms, improving airway function, and decreasing
peak flow variability.
 Leukotriene modifiers. Anti Leukotrienes are potent
bronchoconstrictors that also dilate blood vessels and alter
permeability.
 Immunomodulators. Prevent binding of IgE to the high affinity
receptors of basophils and mast cells
Asthma
 Peak Flow Monitoring
 Peak Flow Meter. Peak flow meters measure the highest
airflow during a forced expiration.
 Daily peak flow monitoring. This is recommended for
patients who meet one or more of the following criteria:
have moderate or severe persistent asthma, have poor
perception of changes in airflow or worsening symptoms,
have unexplained response to environmental or
occupational exposures, or at the discretion of the
clinician or patient.
 Function. If peak flow monitoring is used, it helps
measure asthma severity and, when added to
symptom monitoring, indicates the current degree
of asthma control.
Asthma
Nursing Management
 The immediate care of patients with asthma depend on the
severity of the symptoms.
Nursing Assessment
 Assessment of a patient with asthma includes the following:
 Assess the patient’s respiratory status by monitoring the
severity of the symptoms.
 Assess for breath sounds.
 Assess the patient’s peak flow.
 Assess the level of oxygen saturation through the pulse
oximeter.
 Monitor the patient’s vital signs.
Asthma
 Nursing Diagnosis
 Ineffective airway clearance related to increased
production of mucus and bronchospasm.
 Impaired gas exchange related to altered delivery of
inspired O2.
 Anxiety related to perceived threat of death.
Asthma
Nursing Care Planning & Goals
 Maintenance of airway patency.
 Expectoration of secretions.
 Demonstration of absence/reduction of congestion with
breath sounds clear, respirations noiseless, improved oxygen
exchange.
 Verbalization of understanding of causes and therapeutic
management regimen.
 Demonstration of behaviors to improve or maintain clear
airway.
 Identification of potential complications and how to initiate
appropriate preventive or corrective actions.
Asthma
Nursing Interventions
 The nurse generally performs the following interventions:
 Assess history. Obtain a history of allergic reactions to
medications before administering medications.
 Assess respiratory status. Assess the patient’s respiratory
status by monitoring the severity of symptoms, breath sounds,
peak flow, pulse oximetry, and vital signs.
 Assess medications. Identify medications that the patient is
currently taking.Administer medications as prescribed and
monitor the patient’s responses to those medications;
medications may include an antibiotic if the patient has an
underlying respiratory infection.
 Pharmacologic therapy. Administer medications as
prescribed and monitor patient’s responses to medications.
 Fluid therapy. Administer fluids if the patient is dehydrated.
Asthma
 Evaluation
 To determine the effectiveness of the plan of care, evaluation
must be performed. The following must be evaluated:
 Maintenance of airway patency.
 Expectoration or clearance of secretions.
 Absence /reduction of congestion with breath sound clear,
noiseless respirations, and improved oxygen exchange.
 Verbalized understanding of causes and therapeutic
management regimen.
 Demonstrated behaviors to improve or maintain clear airway.
 Identified potential complications and how to initiate
appropriate preventive or corrective actions.
 Discharge and Home Care Guideli
Disorders of the Lower Respiratory Tract
5. Status asthmaticus
Status asthmaticus
Definition
 Status asthmaticus is severe and persistent asthma that
does not respond to conventional therapy; attacks can occur
with little or no warning and can progress rapidly to
asphyxiation.
 Infection, anxiety, nebulizer abuse, dehydration, increased
adrenergic blockage, and nonspecific irritants may contribute
to these episodes.
 An acute episode may be precipitated by hypersensitivity
to aspirin.
 Two predominant pathologic problems occur: a decrease in
bronchial diameter and a ventilation–perfusion abnormality.
Status asthmaticus
Nursing Priorities
 Maintain/establish airway patency
 Assist with measures to facilitate gas exchange.
 Enhance nutritional intake
 Prevent complications and slow progression of condition.
 Provide information about disease process, prognosis, and
treatment regimen.
Status asthmaticus
Medical Management
 Initial treatment: beta-2-adrenergic agonists,
corticosteroids, supplemental oxygen and IV fluids to hydrate
patient. Sedatives are contraindicated.
 Highflow supplemental oxygen is best delivered using a partial
or complete nonrebreather mask (PaO2 at a minimum of 92
mm Hg or O2 saturation greater than 95%).
 Magnesium sulfate, a calcium antagonist, may be administered
to induce smooth muscle relaxation.
 Hospitalization if no response to repeated treatments or
if blood gas levels deteriorate or pulmonary function scores
are low.
 Mechanical ventilation if patient is tiring or in
respiratory failure or if condition does not respond to
treatment.
 Status asthmaticus
Nursing Management
 Constantly monitor the patient for the first 12 to 24 hours, or
until status asthmaticus is under control. Blood pressure and
cardiac rhythm should be monitored continuously during the acute
phase and until the patient stabilizes and responds to therapy.
 Assess the patient’s skin turgor for signs of dehydration; fluid intake
is essential to combat dehydration, to loosen secretions, and to
facilitate expectoration.
 Administer IV fluids as prescribed, up to 3 to 4 L/day,
unless contraindicated.
 Encourage the patient to conserve energy.
 Ensure patient’s room is quiet and free of respiratory irritants (eg,
flowers, tobacco smoke, perfumes, or odors of cleaning agents);
nonallergenic pillows should be used
Disorders of the Lower Respiratory Tract
6. Bronchiectasis –chronic dilation and plugging of
bronchi. It may follow pneumonia, aspiration of foreign body,
pertussis or asthma
Signs & symptoms: chronic cough with mucopurulent
sputum, accompanying wheezing or stridor, cyanosis. For
chronic conditions: clubbing of fingers & easy fatiguability,
restricted growth & enlarged chest
Treatment: Inhaled mucolytic agent; bronchodilators, chest
physiotherapy; antibiotic if with infection
Disorders of the Lower Respiratory Tract
7. Pneumonia – infection and inflammation of the alveoli
Pneumonia
Two types:
1. Hospital acquired – pneumococcal or streptococcal
pneumonia
2. Community acquired – chlamydia, viral pneumonia
Pneumonia
-the most common pulmonary cause of death in infants
-newborns whoa are born more than 24 hours after
rupture of membranes are prone to pneumonia
development
Pneumococcal pneumonia
 Onset is generally abrupt & follows URTI
 In infants, pneumonia tends to remain bronchopneumonia
with poor consolidation (infiltration of exudate into the
alveoli)
 In older children, pneumonia may localize in a single lobe
& consolidation may occur
Assessment : blood tinged sputum within 24 hours followed
by thick, purulent materials after 24 hours; high fever, with
possible febrile seizures, nasal flaring, retractions, chest pain
, chills, dyspnea, crackles (rales) due to fluid filled alveoli,
tachypnea, tachycardia
Pneumococcal pneumonia
Management:
-antibiotics (ampicillin or 3rd generation cephalosporin,
augmentin for penicillin resistant)
-bed rest
-frequent turning & reposition
-IVF
-Antipyretic
-humidified oxygen
-chest physiotherapy
-encouraged coughing
-small, frequent feedings
Chlamydial Pneumonia
 Often seen in newborns up to 12 weeks of age because
this condition was contracted from the mother’s vagina
during birth
 Signs & symptoms: begins with nasal congestion and sharp
cough, fails to gain weight, pogressing to tachypnea,
wheezing & rales
 Laboratory assessment: elevate IgG & IgM antibodies,
peripheral eosinophilia & specific antibody to C.
trachomatis
 Treatment: macrolide antibiotic e.g. erythromycin
Viral Pneumonia
 Caused by RSV(respiratory syncitial virus), myxovirus or
adenovirus
 Signs & symptoms: begin with URTI infection, followed by
low grade fever, nonproductive cough & tachypnea.
Diminished breath sounds & fine rales on chest
auscultation
 Management: rest, antipyretic, IVF, lethargy
Mycoplasma Pneumonia
 Microorganisms are similar yet larger than virus
 Children over 5 years old are usually affected
 Signs & symptoms: fever, cough, feeling ill, enlarged
cervical lymph nodes, persistent rhinitis
 Treatment: Erythromycin (DOC), tetracycline
Lipid Pneumonia
 Caused by aspiration of an oily or lipid substances such as
peanuts, popcorn where a proliferative inflammatory
response occurs when lung lipases act on the aspirated
oil and followed by diffuse fibrosis of the bronchi or
alveoli
 Signs & symptoms: cough, dyspnea , general respiratory
distress
 Treatment : surgical resection of a lung portion to remove
a lung segment if it does not heal itself
Hydrocarbon Pneumonia
 Products like furniture polish, cleaning fluids, turpentine,
kerosene, gasoline insect sprays have hydrocarbon base that
cause childhood poisoning & result to hydrocarbon pneumonia
 Assessment: GI symptoms after swallowing the products,
drowsy, cough as vapors from stomach rise and are inhaled;
bronchial edema from irritation & inflammation, tachypnea &
dyspnea
 Management: Don’t induce vomiting, call poison control center,
gastric lavage when hospitalized, keen observation for evidence
of respiratory tract obstruction & increasing drowsiness &
CNS involvement, cool moist air by nebulizer, antipyretic,
frequent change of positions, chest physiotherapy
Disorders of the Lower Respiratory Tract
8. Atelectasis –collapse of the lung alveoli
2 Types:
1. Primary atelectasis –newborns who do not breath with
enough respiratory strength at birth to inflate lung
tissue or whose alveoli are immature or lacking with
surfactant
2. Secondary atelectasis -can be caused by a child
swallowing a foreign object, which then blocks the
airways or mucus plug that may occur with chronic
repiratory disease
Atelectasis
 Management: removal of foreign object by bronchospcopy,
plug is resolved, moved or expectorated, oxygen, assisted
ventilation, chest free from pressure to promote lung
expansion, loose clothing, semi-fowler’s position, increase
humidity in the environment to prevent further plugging,
suction, chest physiotherapy
Disorders of the Lower Respiratory Tract
9. Pneumothorax – presence of atmospheric air in the
pleural space causing alveoli to collapse
Causes: air seeping from ruptured alveoli & collects in the
pleural cavity or external puncture wounds allowing air to
enter the chest
Signs & symptoms: tachypnea, g runting respiration, flaring of
nares, cyanosis . Auscultation reveals absent or decreased
breath sounds on the affected side
Management: oxygen therapy, water seal drainage
Disorders of the Lower Respiratory Tract
10. Bronchopulmonary dysplasia - Bronchopulmonary
dysplasia (BPD) is a form of chronic lung disease that affects
newborns (mostly premature) and infants. It results from
damage to the lungs caused by surfactant deficiency,
mechanical ventilation (respirator) and long-term use of
oxygen. Most infants recover from BPD, but some may have
long-term breathing difficulty.
Signs & symptoms: tachypnea, retractions, nasal flaring ,
tachycardia, oxygen dependence & abnormal radiograph
findings showing areas of overinflation, inflammation &
atelectasis
Bronchopulmonary dysplasia
 Management: corticosteroid, bronchodilator via nebulizer,
monitoring of nutrition & fluid intake, parental support