MCN FINALS CHILDREN WITH PHYSIOLOGIC DISORDERS

• PHYSICAL ASSESSMENT (Children with Respiratory Disorder)

  • Cough
  • Rate and depth of respirations
  • Retractions
  • Restlessness
  • Cyanosis
  • Clubbing of fingers
  • Adventitious sounds
  • Chest diameter
• LABORATORY AND DIAGNOSTIC TESTS (CHILDREN WITH RESPIRATORY DISORDERS

  • Blood Gas Analysis
  • Sputum Analysis
  • Chest Radiography or X-ray
  • Pulmonary Function Studies
• GENERAL RESPIRATORY INTERVENTIONS (CHILDREN WITH PHYSIOLOGIC DISORDERS)

  • EXPECTORANT THERAPY
  • THERAPY TO IMPROVE OXYGENATION
  • LUNG TRANSPLANTATION
• EXPECTORANT THERAPY

  • A. LIQUEFYING AGENTS
  • B. HUMIDIFICATION
  • C. COUGHING
  • D. CHEST PHYSIOTHERAPY (CPT)
• THERAPY TO IMPROVE OXYGENATION

  • A. OXYGEN ADMINISTRATION
  • B. PHARMACOLOGIC THERAPY
  • C. INCENTIVE SPIROMETRY
  • D. BREATHING TECHNIQUES
  • E. TRACHEOSTOMY
  • F. INTUBATION WITH VENTILATION
• Lung Transplantation is the last resort for chronic respiratory illnesses such as cystic fibrosis
• RESPIRATORY DISORDERS

  • A. Choanal Atresia
  • B. Upper Respiratory Tract Infections
  • C. Lower Respiratory Tract Infections
  • D. Asthma
  • E. Aspiration of Foreign Objects
  • F. Cystic Fibrosis

  
• Choanal Atresia


  Congenital obstruction of the posterior nares which is either unilateral or bilateral, preventing newborn from drawing air through the nose down to the nasopharynx

  
• Upper Respiratory Tract Infections

  • Acute Nasopharyngitis
  • Pharyngitis
  • Tonsillitis
  • Sinusitis
  • Laryngitis
  • Croup
  • Epiglottitis

  
• Acute Nasopharyngitis


  The common cold, has only a 2 to 3 days incubation period
• Causes of Acute Nasopharyngitis

  • Rhinovirus
  • Coxsackievirus
  • Respiratory syncytial virus
  • Adenovirus
  • Parainfluenza and influenza viruses
• Assessment of Acute Nasopharyngitis


  • Nasal congestion
  • Watery rhinitis, with sore throat if posterior
  • Low-grade fever or none at all
  • Inflamed nasal mucus membranes can lead to congestion
  • Difficulty in breathing
  • Cough, any kind of infection in the respiratory tract can trigger increase mucus production
  • Swollen or painful cervical lymph nodes
  • Thick, purulent nasal discharge if bacterial infection

  
• Therapeutic Management of Acute Nasopharyngitis

  • Antibiotics are not effective, unless with bacterial invasion
  • Acetaminophen (Tylenol) to control fever
  • Saline nose drops and vaporizers to liquify nasal secretions
  • Phenylephrine nose drops constrict the nasal mucus membrane, freeing the airway
  • Suction nasal mucus can be done if coughing is not enough

  
• Pharyngitis

  Infection and inflammation of the throat, which is often painful
• Types of Pharyngitis

  • Viral Pharyngitis
  • Bacterial Pharyngitis
• Viral Pharyngitis

  Causative agent is usually adenovirus
• Assessment of Viral Pharyngitis

  • Sore throat
  • Fever
  • General malaise
  • Enlarged general lymph nodes
  • Erythema at back of pharynx and palatine arch
  • Increased WBCs
• Management of Viral Pharyngitis

  • Give acetaminophen or ibuprofen for comfort
  • Encourage to gargle warm water to reduce pain
  • Apply warm heat to external neck to soothe area
  • Ensure sufficient fluid, as they prefer liquid than solid foods
• Bacterial Pharyngitis

  Caused by group A beta-hemolytic streptococcus, must be taken seriously as they can lead to cardiac and kidney damage
• Assessment of Bacterial Pharyngitis

  • Bright red and enlarged palatine tonsils
  • White exudates in tonsillar crypts
  • Extreme sore throat, difficulty swallowing
• ASSESSMENT


  • Sore throat
  • Fever
  • General malaise
  • Enlarged general lymph nodes
  • Erythema at back of pharynx and palatine arch
  • Increased WBCs

  
• MANAGEMENT


  1. Give acetaminophen or ibuprofen for comfort

  2. Encourage to gargle warm water to reduce pain

  3. Apply warm heat to external neck to soothe area

  4. Ensure sufficient fluid, as they prefer liquid than solid foods
• Bacterial pharyngitis

  Caused by group A beta-hemolytic streptococcus
• Streptococcal infection is generally more severe than viral infections
• ASSESSMENT of bacterial pharyngitis

  • Bright red and enlarged palatine tonsils
  • White exudates in tonsillar crypts
  • Extreme sore throat, difficulty swallowing
  • Petechiae on palate
  • Fever as high as 40ºC
  • Lethargy, headache
  • Swollen and painful abdominal lymph nodes

  
• MANAGEMENT of bacterial pharyngitis

  1. Full 10-day course of an oral antibiotic such as penicillin G or clindamycin

  2. Measures for rest, relief of throat pain, and maintaining hydration
• Recommended treatment days are very necessary to ensure that streptococci are eradicated quickly
• If not, the child may develop hypersensitivity or autoimmune reaction to streptococcus, either Rheumatic fever or Glomerulonephritis
• Retropharyngeal abscess


  Infected lymph nodes that drain the nasopharynx located just behind the posterior pharynx wall, caused by group A beta-hemolytic streptococcus
• ASSESSMENT of retropharyngeal abscess

  • Sore throat, refuses to eat
  • Drooling because unable to swallow saliva
  • Snoring with respirations
  • Hyperextends head, very unusual position
  • High fever
  • Enlarged regional lymph nodes
  • X-ray reveals bulging tissue in pharynx
  • Leukocytosis
• THERAPEUTIC MANAGEMENT of retropharyngeal abscess


  1. Give benzathine penicillin G or penicillin V for the infection

  2. Suction to remove secretions

  3. Position side-lying to allow difficult-to swallow mouth secretions to drain forward

  4. Limit oral intake to fluids as hard foods could rupture abscess
• Although some resolve on their own, some recommend incision surgery to promote drainage, although some post-pharyngeal abscess resolve on their own
• Tonsillitis


  Infection and inflammation of the palatine tonsils, a lymphoid tissue on both sides of the pharynx that filters pathogenic organisms from the head and neck area
• Adenitis is the infection and inflammation of the adenoid or pharyngeal tonsils
• Tonsils in Waldeyer's Ring

  • Palatine (orange)
  • Adenoid (red)
  • Tubal tonsils (blue)
  • Lingual tonsils (green)
• ASSESSMENT of tonsillitis


  • Enlarged red tonsils, fever
  • Sore throat, difficulty swallowing, mouth breathing, snoring
  • White patches of exudates on tonsillar pillars
  • Enlarged cervical lymph nodes
• MANAGEMENT of tonsillitis


  1. Measures to provide comfort and reduce fever

  2. Antipyretic for fever

  3. Analgesics for pain

  4. Full 10-day course of penicillin or amoxicillin, if bacterial
• Tonsillectomy


  Removal of palatine tonsils
• Adenoidectomy


  Removal of the pharyngeal tonsils
• INDICATIONS for tonsillectomy/adenoidectomy


  • Recurrent tonsillitis
  • Peritonsillar abscess
  • Airway or esophageal obstruction