Nursing care for children with respiratory dysfunction

Transcription

1 Nursing care for children with respiratory dysfunction 1

2 Lung Development

3 Specific Immunity to Respiratory Infection Secretory IgA in mucosal immunity IgG in systemic immunity

4 Risk Factors Associated with Respiratory Infection Physiologic Immune Deficiency in Children Low exposure to various pathogen

5 Development of Immune System Innate Immunity Complement Leukocyte Specific Immunity Antibody T lymphocyte

6 Respiratory system

7 7

8 Respiratory infection URI LRI Oronasopharynx, pharynx, larynx, the upper part of the trachea Lower trachea, mainstem bronchi, segmental bronchi, subsegmental bronchioles, terminal bronchioles, the alveoli Croup syndromes Infections of the epiglottis and larynx 8

9 Pediatric respiratory infection Age 0-4wks 4-12wks 12wks-4yrs 5yrs-Adoles GBS G(-) enteric L monocyto C trachomatis Viruses S pneumo B pertussis GBS G(-) enteric L monocyto Viruses S pneumo H influenzae M catarrhalis Group A strep M pneumo M tuberculosis M pneumo C pneumo S pneumo Viruses M tuberculosis

10 Etiology and characteristics I Infectious agents Virus RSV Group A β-streptococci, Haemophilus influenza, chlamydia trachomatis, mycoplasma, and pneumococci Age Toddlers and preschoolers high rate of viral infection Over 5 years of age high incidence of mycoplasma pneumonia & group A β- streptococcal infections 10

11 Etiology and characteristics II Size Diameter of the airways, distance between structures Resistance Deficiencies of the immune system, malnutrition, anemia, fatigue, allergies, asthma, cardiac anomalies, daycare attendance Seasonal variations Winter & spring RSV season 11

12 Clinical Manifestations Signs and symptoms associated with respiratory infections in infants and small children Fever Meningismus Anorexia Vomiting Diarrhea Nasal blockage Nasal discharge Cough Respiratory sounds Sore throat Abdominal pain 12

13 Assessment of respiratory function The pattern of respirations Rate Depth Ease Labored breathing Rhythm Other observations Evidence of infection Elevated temperature, enlarged lymph nodes, inflamed mucous membranes, and purulent discharges from the nose, ears, or lungs(sputum) Cough Wheeze Cyanosis Chest pain Sputum Bad breath 13

14 Diagnostic studies Chest X-ray CT Bronchoscopy Laryngoscopy Culture RAST for IgE Sweat test Mantaux test 14

15 Nursing Diagnoses Ineffective breathing pattern Fear/Anxiety Ineffective airway clearance Risk for infection Activity intolerance Pain Alerted family processes 15

16 Implementation Ease respiratory efforts Promote rest Promote comfort Prevent spread of infection Reduce temperature Promote hydration Provide nutrition Family support and home care 16

17 Ease respiratory efforts Warm and cool mist Use of steam vaporizers discouraged Running a shower of hot water into the empty bathtub or open shower stall with the bathroom door closed for 10 to 15 minues (mist tent effect without the fear) 17

18 Promote comfort Administration of nose drops and throat irrigations Nasal aspirator or a rubber ear syringe followed by instillation of saline nose drops Decongestants, vasoconstrictive nose drops or nasal sprays 15 to 20 minutes before feeding and at bedtime Phenylephrine (Neo-synephrine) 0.25% and ephedrine 1% Not for more than 3 days to avoid rebound congestion Hot or cold applications To provide relief for children with painful cervical adenitis 18

19 Controlling elevated temperatures Terms Set point Fever: increased set point Hyperthermia: normal set point Metabolic rates Increases 10% for every 1 C increase in temperature 19

20 Measures to reduce elevated temperature I Use of antipyretics to lower the set point Acetaminophen Every 4 hours but no more than 5 times in 24 hours (75 mg/kg-1 day) Ibuprofen, NSAIDS (nonsteroidal antiinflammatory drugs) 5mg/kg (<39.1 C ) 10mg/kg (>39.1 C ) every 6 to 8 hours Temperature retaken 30 minutes after 20

21 Measures to reduce elevated temperature II Environmental measures Used if tolerated by the child and if they do not induce shivering Cooling measures Effective if used 1 hour after an antipyretics given Wearing minimum clothing, exposing the skin to the air, reducing room temperature, increasing air circulation, and applying cool, moist compresses to the skin Sponging or tepid baths ineffective in treating febrile children, used for hyperthermia 21

22 Measures to reduce elevated temperature III Febrile seizures Occur in 3% to 4% of all children 3 months to 5 years of age 22

23 Dosage recommendations for acetaminophen (Tylenol) Age Weight(kg) Dose One time volume 4-11months kg 80mg 2.5mL 12-23months kg 120mg 3.5mL 2-3years kg 160mg 5mL 4-5years kg 240mg 7.5mL 6-8years kg 320mg 10mL 9-10years kg 400mg 12.5mL 11years kg 480mg 15mL 12years More than 43kg 640mg 20mL 23

24 Hyperthermia management Antipyretics No value because the set point is already normal Cooling measures 24

25 Evaluation: expected outcomes Continual reassessment and evaluation 25