NCM109

• Illnesses that require the attention of health care professionals are outside the usual occurrences of childhood, so most children typically have little knowledge about them
• Helping a child and family prepare for or adjust to such an experience

  A fundamental nursing role
• This role goes well beyond just providing information on what to expect throughout an illness. It involves providing emotional support as well
• Being a pediatric nurse is both a rewarding and challenging career
• A pediatric nurse deals with


  • The child patient
  • The anxieties and demands of the parents
• The joy of watching a sick child recover can be immeasurable but dealing with acutely ill and dying children can take its toll, making it essential that nurses going into pediatrics understand what kinds of issues can arise
• On this module, you will be introduced to common pediatric disorders such as respiratory, cardiovascular, hematologic and gastrointestinal disorders
• You will be equipped with appropriate knowledge, skills and attitude when caring for these children
• Respiratory disorders are among the most common causes of illness and hospitalization in children
• Respiratory dysfunction in children

  • It 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 because 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
• Respiratory assessment


  Includes history taking, physical examination, and possible laboratory testing
• Anatomy and physiology of the respiratory system


  • The respiratory system can be separated into two divisions: the upper respiratory tract, composed of the nose, paranasal sinuses, pharynx, larynx, and epiglottis, and the lower tract, composed of the bronchi, bronchioles, and alveoli
  • Through inspiration (breathing in), the respiratory system 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
  • Through expiration (breathing out), carbon dioxide–filled air is discharged to the outside

  
• Partial pressure of gas


  • Measured in peripheral and systemic circulation
  • Differences in partial pressure of the gases in the different areas causes O2 to move from alveoli to pulmonary capillaries, and O2 to move from tissue capillaries into the tissues while CO2 moves out

  
• Respiratory tract differences in children

  • The ethmoidal and maxillary sinuses are present at birth, but the frontal sinuses and the sphenoidal sinuses do not develop until 6 to 8 years of age
  • There is such rapid growth of lymphoid tissue that tonsillar tissue becomes normally enlarged in early school-age children
  • An infant's airway is shaped like a funnel, with the narrowest portion at the cricoid cartilage rather than the vocal cords, as in an adult
  • Infants have large occiputs when compared with an adult, which can obstruct the airway
  • Infants tongues are large in proportion to the mouth and can more easily obstruct the airway
  • Infants have small nares and are obligate nose breathers until around 6 months of age. Nasal obstruction can contribute to significant respiratory distress
  • Wheezing may not be a prominent finding in infants even when the lumen of the airway is severely compromised
• Physical assessment of respiratory illness in children


  • Cough
  • Rate and depth of respirations
  • Retractions
  • Restlessness
  • Cyanosis
  • Clubbing of fingers
  • Adventitious sounds
  • Chest diameter
• Laboratory tests


  • Pulse oximetry
  • Nasopharyngeal culture
  • Sputum analysis
• Diagnostic procedures


  • Chest radiograph
  • Pulmonary function studies
• Home treatments


  • Humidification
  • Inhalation devices
  • Coughing
  • Mucus-clearing devices
  • Chest physiotherapy
• Therapy to improve oxygenation

  • Oxygen administration
  • Pharmacologic therapy
  • Incentive spirometry
  • Breathing techniques
  • Endotracheal intubation
  • Tracheostomy
  • Assisted ventilation
• Common pediatric respiratory disorders will be covered
• Sterile specimen container


  A container used to collect a sample for medical testing that is free from contamination
• Diagnostic Procedures


  • Chest Radiograph
  • Pulmonary Function Studies
• Chest X-rays


  • Show areas of infiltration or consolidation in the lungs; if a foreign body is opaque, an X-ray study will show its location
  • More limited in infants than in older children because infants cannot take a breath and hold it when instructed, making it difficult to picture the lungs at their most expanded position
• Pulmonary function tests


  Measure the forces of inertia, elasticity, and flow resistance
• Spirometry


  The most common test of lung function in children, can be done in an office or specialty setting
• Home Treatments


  • Humidification
  • Inhalation Devices
  • Coughing
  • Mucus-Clearing Devices
  • Chest Physiotherapy
• Therapy to Improve Oxygenation


  • Oxygen Administration
  • Pharmacologic Therapy
  • Incentive Spirometry
  • Breathing Techniques
  • Endotracheal Intubation
  • Tracheostomy
  • Assisted Ventilation
• Physical Assessment


  • Cough
  • Rate and Depth of Respirations
  • Retractions
  • Cyanosis
  • Clubbing of Fingers
  • Adventitious Sounds
  • Chest Diameters
• Laboratory Tests


  • Pulse Oximetry
  • Blood Gas Studies
  • Nasopharyngeal Syncytial Virus Nasal Washings
  • Sputum Analysis
• Diagnostic Procedures


  • Chest X-ray
  • Bronchography
• Nursing Care


  • Expectorant Therapy
  • Oral Fluid
  • Liquefying Agent
  • Metered-Dose Inhalers
  • Nebulizers
  • Effective Coughing
  • Chest Physiotherapy
  • Mucus–Clearing Device
• Therapy to Improve Oxygenation


  • Oxygen administration
  • Pharmacologic Therapy
  • Nasal sprays
  • Corticosteroid
  • Antihistamines
  • Expectorants
  • Bronchodilators
  • Incentive Spirometry
  • Breathing Techniques
  • Tracheostomy
• Choanal Atresia


  A congenital obstruction of the posterior nares by an obstructing membrane or bony growth, may be unilateral or bilateral, presence of signs of respiratory distress at birth
• Acute Nasopharyngitis (Common Cold)


  Caused by one several viruses, most predominantly by rhinovirus, coxsackle virus, respiratory syncytial virus, adenovirus, parainfluenza and influenza viruses, stress factors also appear to play a role in susceptibility, characterized by dehydration, watery rhinitis, nasal congestion and low grade fever
• Pharyngitis


  Inflammation of the pharynx, may be caused by virus or group A beta hemolytic Streptococcus, characterized by fever, sore throat, enlarged regional lymph nodes and erythematous pharnyx
• Epistaxis


  Bleeding from the nose caused by direct trauma, mucosal inflammation secondary to allergy or URT infection
• Laryngitis


  Inflammation of the larynx, may occur as a spread of pharyngitis or from excessive use of the vocal cords, characterized by brassy voice or inability to make audible sounds