MCHN Respiratory Diseases

• Respiratory tract infection is a frequent cause of acute illness in infants and children
• Respiratory infections


  • Bacterial pneumonia
  • Viral pneumonia
  • Pneumocystis pneumonia
  • Mycoplasma pneumonia
  • Bronchiolitis
  • Croup
  • Epiglottitis
• Nursing Assessment


  1. Observe respiratory rate and pattern

  2. Observe respiratory rhythm and depth

  3. Auscultate breath sounds

  4. Observe degree of respiratory effort

  5. Document character of dyspnea or labored breathing

  6. Note presence of additional signs of respiratory distress

  7. Observe for head bobbing

  8. Observe the child's color

  9. Observe the presence of cough

  10. Note the presence of sputum

  11. Observe the child's fingernails and toenails for cyanosis and clubbing

  12. Evaluate the child's degree of restlessness, apprehension, and muscle tone

  13. Note the presence or complaint of chest pain

  14. Assess for signs of infection
• Promoting Effective Airway Clearance

  1. Provide a humidified environment enriched with oxygen

  2. Advise the parents to use a jet or ultrasonic nebulizer at home and encourage fluids as tolerated

  3. Keep nasal passages free of secretions
• Improving Breathing Pattern


  1. Place the child in a comfortable position

  2. Provide measures to improve ventilation of the affected portion of the lung

  3. Ensure that the child's oxygen input is not compromised

  4. Administer appropriate antibiotic or antiviral therapy

  5. Administer specific treatment for respiratory syncytial virus (RSV) if ordered

  6. Assist with intubation or tracheostomy and mechanical ventilation for severe respiratory distress
• Promoting Adequate Hydration


  1. Administer I.V. fluids at the prescribed rate

  2. Withhold oral food and fluids if the child is in severe respiratory distress

  3. Offer the child small sips of clear fluid when respiratory status improves

  4. Assist in the control of fever

  5. Record the child's intake and output, and monitor urine specific gravity

  6. Provide mouth care or offer mouth rinse
• Promoting Adequate Rest


  1. Disturb the child as little as possible

  2. Be aware of the age of the child and their level of growth and development

  3. Encourage the parents to stay with the child

  4. Provide opportunities for quiet play
• Reducing Anxiety


  1. Explain procedures and hospital routine to the child

  2. Provide a quiet, stress-free environment

  3. Observe the child's response to the oxygen therapy environment and provide reassurance

  4. Avoid the use of sedatives and opiates

  5. Allow the child to assume a position of comfort
• Strengthening the Parents' Role

  1. Help the parents understand the purpose of the oxygen therapy/humidifier

  2. Discuss their fears and concerns about the child's therapy

  3. Include the parents in planning for the child's care

  4. Recognize that the parents will need rest periods
• Family Education and Health Maintenance

  1. Teach the importance of good hygiene

  2. Teach the family when it is appropriate to keep the child home from school

  3. Teach methods to keep the ill child well hydrated

  4. Teach ways to assess the child's hydration status at home

  5. Teach the parents when to contact their health care provider

  6. Teach about medications and follow-up

  7. If a tracheostomy was required, teach care of the tracheostomy, use of equipment, safety, and referral for home nursing care before discharge
• Tonsillectomy and adenoidectomy are the surgical removal of the adenoidal and tonsillar structures, part of the lymphoid tissue that encircles the pharynx
• The most common disease processes that require tonsillectomy and adenoidectomy are obstructive sleep apnea; chronic, persistent tonsillitis or adenoiditis; and chronic persistent otitis media
• Function of Tonsils and Adenoids

  • They are a first line of defense against respiratory infections
  • Their growth in the first 10 years of life exceeds general somatic growth, making them appear especially large in the child
  • The natural process of involution of tonsillar and adenoidal lymphoid tissue in pre-pubertal years is associated with decreased frequency of throat and ear infections
• Obstructive Sleep Apnea


  • Adenotonsillar hypertrophy causes airway obstruction during sleep leading to persistent hypoventilation
  • Peak incidence in children is between ages 3 and 6 years
  • Incidence is increased in children with Down syndrome
• Tonsillitis and Adenoiditis


  • Structures that are already large become inflamed due to an infectious agent and cause airway obstruction, decreased appetite, and pain
  • Infection is caused by bacterial or viral organisms, with viral organisms most commonly implicated
  • Group A beta-hemolytic Streptococcus is the most common bacterial cause
  • Enlarged adenoids may block nasal passages, resulting in persistent mouth breathing
  • Chronic adenoiditis without tonsillitis is typically seen in children younger than age 4 years
• Otitis Media


  • Bacterial infection caused most commonly by Streptococcus pneumoniae or Haemophilus influenzae
  • Chronic infection may be associated with enlarged adenoids that block drainage from the eustachian tubes
• Clinical Manifestations of Obstructive Sleep Apnea

  • Loud snoring or noisy breathing in sleep
  • Excessive daytime sleepiness
  • Mouth breathing
• Clinical Manifestations of Chronic Infection of Tonsils and Adenoids

  • Mouth breathing or difficulty breathing
  • Frequent sore throat
  • Anorexia, decreased growth velocity
  • Fever
  • Obstruction to swallowing or breathing
  • Nasal, muffled voice
  • Night cough
  • Offensive breath
• Clinical Manifestations of Chronic Otitis Media

  • General irritability in young children
  • Alterations in hearing
  • Enlarged lymph nodes
  • Anorexia
• Diagnostic Evaluation


  1. Thorough ear, nose, and throat examination and appropriate cultures

  2. Preoperative blood studies to determine risk of bleeding
• Indications for Tonsillectomy


  • Recurrent or persistent tonsillitis with documented streptococcal infection four times in 1 year
  • Marked hypertrophy of tonsils, which distorts speech, causes swallowing difficulties, and causes subsequent weight loss
  • Tonsillar malignancy
  • Diphtheria carrier
  • Cor pulmonale due to obstruction
  • Peritonsillar abscess or retrotonsillar abscess
  • Suppurative cervical adenitis with tonsillar focus
  • Persistent hyperemia of anterior pillars
  • Enlarged cervical lymph nodes
• Indications for Adenoidectomy


  • Adenoid hypertrophy resulting in obstruction of airway leading to hypoxia, pulmonary hypertension, and cor pulmonale
  • Hypertrophy with nasal obstruction accompanied by breathing difficulty and severe speech distortion
  • Hypertrophy associated with chronic suppurative or serous otitis media and sensorineural or conductive hearing loss, chronic mastoiditis, or cholesteatoma
  • Mouth breathing due to hypertrophied adenoids
  • Chronic adenoiditis without tonsillitis
• Marked hypertrophy of tonsils, which distorts speech, causes swallowing difficulties, and causes subsequent weight loss


  Indication for tonsillectomy
• Tonsillar malignancy


  Indication for tonsillectomy
• Diphtheria carrier


  Indication for tonsillectomy
• Cor pulmonale due to obstruction

  Indication for tonsillectomy
• Controversial indications for tonsillectomy

  • Peritonsillar abscess or retrotonsillar abscess
  • Suppurative cervical adenitis with tonsillar focus
  • Persistent hyperemia of anterior pillars
  • Enlarged cervical lymph nodes
• Hypertrophy with nasal obstruction accompanied by breathing difficulty and severe speech distortion


  Indication for adenoidectomy
• Hypertrophy associated with chronic suppurative or serous otitis media and sensorineural or conductive hearing loss, chronic mastoiditis, or cholesteatoma

  Indication for adenoidectomy
• Mouth breathing due to hypertrophied adenoids


  Indication for adenoidectomy
• Controversial indications for adenoidectomy

  • Enlarged adenoids
  • Chronic otitis media, and no evidence of complications
• Chronic tonsillitis may result in failure to thrive, peritonsillar or retropharyngeal abscess, difficulty swallowing, and poor eating


  Complication if untreated
• Chronic otitis media may result in hearing loss, scarring of the eardrum (tympanosclerosis), mastoiditis, and meningitis


  Complication if untreated
• Complications of surgery


  • Hemorrhage
  • Reactions to anesthesia
  • Otitis media
  • Bacteremia
• Assess the parents' and child's understanding of the surgical procedure

  Nursing assessment
• Assess psychological preparation of the child for hospitalization and surgery

  Nursing assessment
• The preschool child is especially vulnerable to psychological trauma as a result of surgical procedures or hospitalization
• Obtain thorough nursing history from the child and parents to gather any pertinent information that would impact the child's care

  Nursing assessment
• Obtain the child's baseline vital signs along with his height and weight

  Nursing assessment
• Assess the child's hydration

  Nursing assessment