Child with Respiratory Disorder

• Respiratory disorders


  Among the most common causes of illness and hospitalization in children
• Respiratory dysfunction in children tends to be more serious than in adults because the lumens of a child's respiratory tract are smaller and therefore more likely to become obstructed
• Respiratory disorders range from minor illnesses such as a simple upper respiratory tract infection to life-threatening lower respiratory tract diseases, such as pneumonia, and the level of acuity can change quickly
• Respiratory disorders are often difficult for parents to evaluate
• Both a child and parents need a great deal of nursing support when disease interferes with the function of breathing, because even very young children can panic when breathing becomes labored
• Early diagnosis and treatment are essential in preventing a minor problem from turning into a more serious one
• National Health Goals related to children with respiratory disorders


  • Reduce the rate of asthma deaths in children aged 5 to 14 years
  • Reduce the rate of hospital emergency department visits for children with asthma younger than 5 years
  • Reduce the rate of cigarette use by adolescents
  • Reduce the incidence of invasive pneumococcal infections in children younger than 5 years
  • Reduce the incidence of tuberculosis
• Nursing role in helping achieve National Health Goals


  Teaching children to avoid beginning cigarette smoking, including the use of bidis (chocolate-flavored tobacco products), teaching children ways to help avoid respiratory infections such as good handwashing, and reminding parents to come for child health maintenance visits so that children can receive pneumococcal immunization or screening for tuberculosis, as appropriate
• Additional nursing research is needed about the accuracy of parents in self-reading and interpreting tuberculosis screening tests and information required by new parents to better manage respiratory illness in infants and young children
• Nursing Process Overview for a Child With a Respiratory Disorder

  1. Assessment

  2. Nursing Diagnosis

  3. Outcome Identification and Planning

  4. Implementation

  5. Outcome Evaluation
• Respiratory system


  • Upper respiratory tract (nose, paranasal sinuses, pharynx, larynx, epiglottis)
  • Lower respiratory tract (bronchi, bronchioles, alveoli)
• Inspiration


  Breathing in, delivers warmed and moistened air to the alveoli, transports oxygen across the alveolar membrane to hemoglobin-laden red blood cells, and allows carbon dioxide to diffuse from red blood cells back into the alveoli
• Expiration


  Breathing out, discharges carbon dioxide-filled air to the outside
• Respiratory center


  Located in the medulla of the brain, responds to diminished PO2 levels, increased PCO2 levels, body acidity, temperature, and blood pressure
• Children with chronic lung disease such as cystic fibrosis have adapted so well to a chronically high PCO2 level that central receptor sites no longer register this as abnormal, and the main stimulus for respiration is a low oxygen level
• Respiratory tract differences in children


  • Ethmoidal and maxillary sinuses are present at birth, frontal and sphenoidal sinuses develop at 6-8 years of age
  • Tonsillar tissue is normally enlarged in early school-age children
  • Newborns produce little respiratory mucus, making them more susceptible to respiratory infection
  • Excessive mucus production in children up to 2 years can lead to obstruction
  • Right bronchus is shorter, wider, and more vertical than the left after 2 years of age
• Respiratory system in children vs adults


  • Ethmoidal and maxillary sinuses are present at birth, frontal and sphenoidal sinuses develop later
  • Rapid growth of lymphoid tissue leads to enlarged tonsils in early school-age children
• Respiratory mucus in children


  • Newborns produce little respiratory mucus, making them more susceptible to respiratory infection
  • Excessive mucus production in children up to 2 years old can lead to obstruction due to small bronchial lumens
• Airway anatomy in children


  • Right bronchus is shorter, wider and more vertical than left, leading to foreign bodies lodging there more often
  • Infant chest muscles not fully developed, use abdominal muscles for inhalation, transition to thoracic breathing by 7 years old
  • Airway walls have less cartilage in infants, more likely to collapse after expiration
  • Less smooth muscle in infant airways means less bronchoconstriction, so wheezing may not be prominent
• Assessing respiratory illness in children

  1. Interview

  2. Physical examination

  3. Laboratory testing
• Hypoxemia


  Deficient oxygenation of the blood
• Peripheral vasoconstriction, tachypnea, tachycardia are signs of hypoxemia
• Poor feeding can be an early sign of respiratory distress in infants
• Cough


  Reflex initiated by stimulation of respiratory tract mucosa, useful to clear excess mucus or foreign bodies
• Paroxysmal coughing


  Series of expiratory coughs after deep inspiration, can occur in pertussis or aspiration
• Coughing increases chest pressure and can decrease venous return, leading to fainting
• Tachypnea


  Increased respiratory rate, often first indicator of airway obstruction in young children
• Retractions


  Inward movement of non-rigid parts of chest wall due to increased effort to inflate lungs, more common in newborns/infants
• Restlessness


  Sign of hypoxia, not necessarily improvement
• Cyanosis


  Blue tinge to skin indicating hypoxia, may not be apparent with low hemoglobin
• Clubbing of fingers


  Change in angle between fingernail and nailbed due to increased capillary growth, sign of chronic respiratory illness
• Adventitious sounds


  Extra or abnormal breathing sounds caused by pathological conditions, include rhonchi, stridor, wheezing, rales
• Chest diameters


  Hyperinflation can lead to elongated anteroposterior chest diameter ("pigeon breast")
• Blood gas analysis


  Invasive test to determine ventilation effectiveness and acid-base status
• Normal arterial blood gas values are shown in Table 40.1
• Arterial partial pressure of oxygen (PO2)


  Indicates adequacy of oxygenation
• Arterial partial pressure of carbon dioxide (PCO2)


  Measures efficiency of ventilation
• Increased PCO2 indicates hypoventilation, decreased PCO2 indicates hyperventilation
• Respiratory acidosis occurs when CO2 accumulates due to obstruction or hypoventilation
• Acidosis


  A decrease in serum pH or an increase in acidity