Anatomy of the respiratory system

Transcription

1 Miss. kamlah 1

2 Anatomy of the respiratory system The respiratory system is divided into two divisions; upper & lower airways. The uppers is consisting from: nose, pharynx, larynx & epiglottis. The larynx divides the upper from the lower airways. The lower airways consist of trachea, bronchi, bronchioles & alveoli. During respiration: respiratory system delivers warmed, moistened air to alveoli; gas exchange occur; then carbon dioxide filled air is transferred outside the lungs. Miss. kamlah 2

3 Pediatric differences The child s respiratory system grows constantly & changes until 12 years of age. 1- Upper & lower airway differences: Children have smaller nasopharynx which would occluded easily during infections. Children have small oral cavity & large tongue that would increase the risk of obstruction. Children have small nares that would be easily occluded. Miss. kamlah 3

4 Children have immature thyroid, cricoid and tracheal cartilages, which would be easily collapsed when neck is flexed. Children have fewer muscle functioning, which will leads lungs to not being able to compensate for edema, spasm & trauma. Newborns and infants until 2-3 month are nose breathers. Miss. kamlah 4

5 The child s airway is shorter & narrower than an adults. The trachea diameter can be estimated by the child s little finger; it increase in length rather than diameter in the first 5 years of life. Child --- 4mm Adult --- 8mm The bifurcation of the trachea is at T3 while in adults is at T6. Miss. kamlah 5

6 Assessing respiratory illness in children Position of comfort Lung auscultation Color Tripod position (sitting forward with arms on knee for support & extending the neck. Diminished or absent breath sounds. Presence of adventitious sounds ( wheezing, crackles). Color of the mucus membrane (pink, cyanotic) with & without crying. Clubbing nail Presence of clubbing nail. Miss. kamlah 6

7 Retractions Presence of visible appearance of the chest being drawn on inspiration. Respiratory efforts Cough Retractions in the supraclavicle suggest upper airway obstruction. Retractions in intercostal s muscle suggest lower airway obstruction. Presence of nasal flaring. Presence of tachycardia. Presence of paradoxical breathing ( chest & abdomen do not raise at the same time). Presence of cough; dry, productive, brassy (musical, noisy). Miss. kamlah 7

8 Measure Normal value Clinical significance P mmhg Decrease when child cannot inspire adequately PCO mmhg Increase when the child cannot expire adequately O2 saturation % Decrease if O2 cannot reach RBC ph Decrease if CO2 is being retained as carbonic acid in blood HCO meq/l Increase in respiratory alkalosis; decreased in respiratory acidosis. Base excess -2.5 or meq/l (+) = alkaline excess (-) = alkaline deficit Miss. kamlah 8

9 Disorders of the nose & throat Nose bleed is common in school-age child, commonly caused by irritation from nose picking, foreign bodies, low humidity, forceful coughing, allergies. Or it could be related to systemic disease (bleeding disorder). To stop the nosebleed the child must be sit upright with head tilted forward to prevent blood drip down the throat cause vomiting. Miss. kamlah 9

10 The nares should be squeezed just below the nasal bone & held for minute, while the child breath from his mouth. If bleeding does not stop, cotton ball soaked with epinephrine or lidocaine may be inserted to the affected nares to provide topical vasoconstriction or anesthesia. Post the bleeding, the child may be vulnerable to other episodes, so child must avoid hot bathes, hot drinks, vigorous exercise, bending over for the next 2-3 days. Miss. kamlah 10

11 To prevent epistaxis: Educate parents to: Provide humidity in the child s room. Discourage the child from picking or rubbing the nose or inserting foreign objects into nose. Miss. kamlah 11

12 Known as the common cold, it causes inflammation of the nose & throat. The most common viruses that cause the infection includes rhinovirus & coronavirus; and from bacteria is group A streptococcus. The organism incubate for 1-3 days and the infection is communicable for several hours before the symptoms occur for 1-2 days. Symptoms last for days. Disease spread through direct or indirect contact with the patient (air droplets). Miss. kamlah 12

13 Clinical manifestations Infant < 3 months Lethargy Irritability Poor Feeding Fever Infant > 3 months Fever Vomiting Diarrhea Sneezing Restlessness Older children Dry, irritated nose. Chills, fever Headache, malaise, sneezing Nasopharyngitis does not need hospitalization or any medical interventions, just support therapy. Miss. kamlah 13

14 Symptomatic Therapy For children who cannot breath from mouth, nasal drop of normal saline should administer every 3-4 hours especially before feeding. Administration of Antihistamines would be helpful (as doctor order). Administer Antipyretic to decrease the fever. Aspirin is not recommended for children below 5 years, due its association with Reyes syndrome. Hot fluide and vitamine C. Room humidification would help in preventing drying nasal secretions. Encourage rehydration (increase oral intake). Miss. kamlah 14

15 Infection that affects the pharynx, including the tonsils. 80% of these infections are caused by viruses (most commonly enteroviruses). Bacterial pharyngitis is known as strep throat; because % of bacteria is caused b group A beta-hemolytic streptococcus Throat culture is needed to identify the causative agent. Miss. kamlah 15

16 Clinical manifestations Viral Nasal congestion Mild sore throat Cough Hoarseness Fever < 38 C Minimal tonsillar exudates Mild pharyngeal redness Bacterial Abrupt onset Tonsillar exudates Anorexia, nausea, vomiting. Sever sore throat Headache, malaise. Fever > 38 C Dysphagia Miss. kamlah 16

17 Pharyngitis is treated by giving oral Penicillin or injection if the child have no allergy to Penicillin. If he have allergy, Erythromycin is the second drug of choice. For viral infection, symptomatic treatment alone is used. Nursing interventions: reduce the child pain & discomfort. Decrease fever. Increase oral intake. Gargling with warm salt water (1 tsp in 250 ml). Encourage bed rest. Miss. kamlah 17

18 Complications of Pharyngitis: Otitis media. Cervical adenitis. Lower respiratory tract infection. Rheumatic fever. Glomerulonephritis. Miss. kamlah 18

19 Tonsillitis & Adenoiditis Tonsillitis is an infection of the palatine tonsils; while adenitis refer to infection of the adenoid pharyngeal tonsils. Different types of tonsils: The palatine tonsils: are located on both sides of the pharynx. Adenoid: are in the nasopharynx. Tubal tonsils: are located at the entrance to the Eustachian tubes. Lingual tonsils: are located at the base of the tongue. Miss. kamlah 19

20 Clinical manifestations All symptoms of sever pharyngitis: Sore throat Difficult & painful swallowing. High fever. Lethargic. Pharyngeal pain & edema. Mouth breathing. Sleep apnea that results from pharyngeal obstruction ## throat culture will reveal viral cause in children < 3 and bacterial cause in children > 3 years. Miss. kamlah 20

21 Antipyretic for fever. An analgesia for pain. Treatment Full 10 days course for antibiotic, such as Penicillin. If the cause is virus, no therapy other than comfort measures or fever reduction are needed Surgical treatment: Which includes removal of the palatine tonsils. IF -Tonsillitis is recurrent -3 or more times in one year- removal must mot be before 3-4 years. - IF there is sleep apnia Miss. kamlah 21

22 Why we should not remove tonsils before 3-4 years of age? Excessive blood loss in small children. The possibility of regrowth. Hypertrophy of lymphoid tissue. Tonsillectomy: refer to removal of palatine tonsils. Adenoidectomy: refer to removal of the pharyngeal tonsils. Miss. kamlah 22

23 Nursing management for tonsillectomy Preoperative preparations includes: Complete history. Physical examination. Pt, PTT. Complete blood counts. Urine analysis. Assessment if the child have loose teeth. ## Tonsillectomy must not be done if the organs are infected. Miss. kamlah 23

24 Post operative interventions includes: place the child on prone position with the head on the side to reduce the pressure on the operative site & prevent obstruction. (the head must be lower than the body). Why?? Monitor for bleeding, if bleeding is heavy, return the child to the operation room to make suture to halt bleeding. The most dangerous period is 24 hrs after operation, so observe V/S carefully. Assess for signs of bleeding ( increase in pulse or respiratory rate, frequent swallowing, feeling of anxiety) Miss. kamlah 24

25 If bleeding occur, elevate the head & turn the child to his side. Avoid red fluid or red Jell-O, that could vomiting being mistaken with bleeding. Offer frequent sips of clear cold liquid, popsicles (liquid ice cream). Start soft diet 9 mashed potatoes, soups, cooked fruits after hrs, and soft food for the first weeks to prevent pharyngeal irritation. Apply an ice cooler around the neck. Having the child gargle with solution of baking soda & salt (0.5 tsp in 250 ml). Miss. kamlah 25

26 Nursing Diagnosis Related tonsillitis: Acute pain related to inflammation of the pharynx. Risk for ineffective breathing patterns related to obstruction by enlarged tonsils. Risk for deficit fluid volume related to inadequate intake. Impaired swallowing related to inflammation & pain. Deficit knowledge (parents) related to home care following discharge. Miss. kamlah 26

27 Otitis Media Is an inflammation of middle ear, it is one of the most prevalent disease of early childhood. 70% of child have one episode in the first year of life and 50% of them have 2-3 episode by 3 years of age. The highest incident at 6 months to 2 years. It caused by streptococcus pneumonia, hemophilia influenza, staphylococcus. Miss. kamlah 27

28 Factors that increase risk Child with smoker person more risk for develop OM than those who live with no smoking, because tobacco smoke inhalation increase the risk of blocked Eustachian tube and congestion of soft nasopharyngeal tissue lead to OM. Bottle feeding during sleep Children who use pacifiers for several hours daily. More common in winter. Children with cleft lip or palate, Down syndrome. Miss. kamlah 28

29 Causes of non infectious type is unknown, but many risk factors :- Blocked Eustachian tube. Edema or infections of URT. Allergic rhinitis. Hypertropic adenoids. Methods of feeding ( breast feeding infant less like to develop OM because the breast milk have IgA that limits the exposure of the Eustachian tubes to microbial pathogens ). Miss. kamlah 29

30 Pathophysiology All of the previous risk factors could lead to obstruction of the eustachian tube, which will leads eustachian tube s mucus membrane to become edematous. As result the normal air flow to middle ear is blocked. & the air in the middle air absorbed into the blood stream. Which will leads fluid to shifts into middle ear, and provides good area for rapid growth of pathogens. Miss. kamlah 30

31 terms OM Acute OM OM with Effusion (OME) Chronic (OME) Definition General term for inflammation of the middle ear An acute onset of ear pain, redness of tympanic membrane lasting approximately 3 weeks. Inflammation of the middle ear in which a collection of fluid is present in the middle ear space. OME persist beyond 3 months. Miss. kamlah 31

32 Clinical manifestations In acute OM: Ear pain (Otalgia, earache), rapid onset, irritability, poor feeding, malaise, bulging tympanic membrane, poorly mobile tympanic membrane. Rolling the head from side to side In OM effusion: Difficulty of hearing, signs of acute inflammation are not present, tympanic membrane is retracted, Feeling of fullness in ear, popping sensation during swallowing and feeling of motion in the ear if air present above level of fluid. Miss. kamlah 32

33 Medical Treatment For acute otitis media: Treatment with antibiotic for 10 days in children under 6 years of age and for 5-7 days in children above 6 years. First line therapy is Amoxicillin at a dose of mg/kg/day. Second drug is Cefuroxime (second generation of cephalosporin), at dose of 10 mg/kg/day. For OM with effusion: Myringotomy (surgical incision of the tympanic membrane) may be performed. Tympoanostomy may be inserted to drain fluid from the middle ear (pressure equalizing tube). Miss. kamlah 33

34 Nursing interventions Application of heating pad may reduce the discomfort (over the ear). Put the child on lying down position will facilitate drainage. Give analgesia & antipyretic as order to reduce pain & fever. An ice bag placed over the affected ear may be helpful to reduce edema & pressure Miss. kamlah 34

35 Nursing Diagnosis Risk for imbalanced body temperature, hyperthermia related to infectious process. Fatigue (child & parents) related to sleep deprivation. Disturbed Sensory Perception (auditory) related to chronic ear infections and altered hearing perception. Miss. kamlah 35