Alterations in Oxygenation

• ACUTE STREPTOCOCCAL PHARYNGITIS


  Group A b-hemolytic streptococci infection (GABHS)
• Strep throat


  Risk for serious sequala: Acute Rheumatic fever - 18 days, Acute Glomerulonephritis (AGN) - 10 days
• Diagnostics Examinations


  • Throat culture
• Therapeutic Management


  • Strep sore throat = oral penicillin
  • IM Penicillin G
  • Erythromycin (oral)
• Nursing Care Management

  • Warm saline gargles
  • Avoid sharing drinking or eating utensils
  • Antibiotic full compliance - to prevent the complications (RF and AGN)
  • The child will be non infectious after taking antibiotics for 24 hours
  • Advise to discard toothbrush after 24 hours of taking antibiotics
• TONSILLITIS


  An infection or inflammation (hypertrophy) of the palatine tonsils
• Clinical Manifestation

  • Inflammation
  • Palatine --- Kissing tonsils = no passage of food & air
  • Adenoid --- no air passage = mouth breather, dry oropharynx, impaired smell & taste, voice nasal muffled quality
  • OM/ hearing impaired
• Therapeutic Management

  • Self-limiting & Treatment is symptomatic (Viral)
  • Antibiotics (Bacterial infection)
  • Drug of choice: amoxicillin
  • Surgical Treatment: TONSILLECTOMY
• Tonsillectomy


  • children having 7 bouts of tonsillitis in 12 months, 5 annual bouts for 2 years, or 3 annual bouts for 3 years
  • partial or complete upper airway obstruction during sleep
• Nursing Care Management


  • Soft to liquid diet
  • Cool mist humidifier - soothes inflamed mucous membrane
  • Cool water, crushed ice, Ice chips
  • Allow the child to have diluted juice after the procedure
  • Avoid red juices, citrus, milk, ice cream
  • Opioids - acetaminophen
  • Avoid routine suctioning and coughing
  • Place the child on the abdomen until fully wake
  • NPO until fully alert and no signs of hemorrhage
  • WOF: Continuous swallowing - notify MD
• CROUP SYNDROME


  Heterogeneous group of mainly acute and infectious processes respiratory illness of the trachea, larynx, and bronchi
• CROUP SYNDROME


  • Caused by HAEMOPHILUS INFLUENZA
  • Incidence: Parainfluenza viruses - 80% of cases
• Treatment


  • Cool mist vaporizer at night
  • Corticosteroids
  • Dexamethasone IM - 0.6mg/kg single dose or 0.15mg/kg
  • Budesonide nebulized - 2mg
• Nursing management


  • Allow the parents to stay in the bedside - The parent's presence will reduce anxiety and ease the child's respiratory efforts
  • Do not use tongue depressor to examine the throat - it will cause complete obstruction
  • Priority nursing action if the child is sitting in frog like position, drooling and agitated - nitify the doctor and prepare for tracheostomy
• Acute Conditions


  • ACUTE EPIGLOTTITIS
  • ACUTE LARYNGOTRACHEO-BRONCHITIS
  • ACUTE SPASMODIC LARYNGITIS
  • ACUTE TRACHEITIS
• ACUTE EPIGLOTTITIS


  • 1 - 8 y/o
  • Bacteria: Haemophilus influenza
  • Rapid - medical emergency
  • Dysphagia, stridor - supine, drooling, high fever, toxic appearance
• ACUTE LARYNGOTRACHEO-BRONCHITIS


  • 3 mos - 8 y/o
  • Viral
  • Slowly
  • URI, stridor, hoarseness, dyspnea, restless, irritability, low fever, non-toxic appearance
• ACUTE SPASMODIC LARYNGITIS


  • 3 mos - 3 y/o
  • Viral with allergic components
  • Sudden at night
  • URI, Croupy cough, stridor, hoarseness, dyspnea, symptoms (-) day
• ACUTE TRACHEITIS


  • 1 mo - 6 y/o
  • Bacterial, Staphylococcus Aureus
  • Moderate
  • URI, croupy cough, stridor, purulent secretion, high fever
• Therapeutic Management


  • Antibiotics
  • Airway protection
  • Humidity
  • Racemic epinephrine
  • Humidity
  • Antibiotics
• Iron Deficiency Anemia


  • Most common type of anemia and nutritional deficiency in children
  • Preterm infants - at risk due to reduced fetal iron supply
  • Children 12-36 months: at risk due to cow's milk intake (poor source of iron) and not eating adequate amount of iron-containing food
  • Adolescents - at risk due to rapid growth rate combined with poor eating habits, menses, obesity, or strenuous activities
• Assessment Findings


  • Clinical manifestations are related to a reduction in the amount of oxygen available to tissues
  • Pale skin - pallor
  • Fatigue
  • Muscle weakness
  • Headaches, dizziness, and light-headedness
  • Irritability
  • Slowed thought processes, decreased attention span, apathy, and depression
• Etiology


  • Iron deficiency due to impaired iron absorption
  • Chronic diarrhea
  • Lactose intolerance
  • Inflammatory bowel diseases
  • Gastric alkalinity
  • Presence of phosphates
• Nursing Management


  • Administering liquid iron prerations will turn the stool tarry green color
  • Use straw in giving PO - can discolor the teeth
  • The iron should be given in two divided doses between meals
  • Breast milk or iron-fortified formula should be used for the first 12 months
• Sickle-cell Anemia


  • One of a group of diseases collectively termed hemoglobinopathies in which normal adult hgb is partly or completely replaced by abnormal sickle hgb (HbS)
  • Autosomal recessive disorder (inherited)
  • Each sibling has a 25% chance of having SCA
  • Causes occlusion of small blood vessels, ischemia, and damage to affected organs
• Pathophysiology


  • RBCs change from round to sickle or crescent shaped
  • Increased RBC destruction
  • Clumping, thrombosis, arterial obstruction, increased blood viscosity, hemolysis, and eventually tissue ischemia and necrosis
• Assessment Findings


  • Enlarged spleen from congestion with sickled cells
  • Enlarged and tender liver from blood stasis
  • Hematuria
  • Inability to concentrate urine
  • Enuresis
  • Bone weakness
  • Dactylitis (symmetric swelling of the hands and feet)
• Aims of therapy


  • Prevent the sickling phenomenon which are responsible for the pathologic sequalae
  • Treat the medical emergencies of sickle cell crisis
• Management


  • Rest to minimize energy expenditure and to improve oxygen utilization
  • Hydration through oral and IV therapy
  • Electrolyte replacement because hypoxia results in metabolic acidosis, which also promotes sickling
  • Analgesia for the severe pain from vaso-occlusion - Meperidine (Demerol)
  • Blood replacement to treat anemia and to reduce the viscosity of the sickled blood
  • Antibiotics to treat any existing infection