Guided Lecture Notes/Chapter 18: Nursing Care Of The Child With A Respiratory Disorder

Guided Lecture Notes, Chapter 18, Nursing Care of the Child With a Respiratory Disorder

Learning Objective 1. Distinguish differences between the anatomy and physiology of the respiratory system in children versus adults.

 Teach your students that respiratory disorders are the most common causes of illness and hospitalization in children and account for the majority of acute illnesses in children.  Emphasize the fact that newborns are obligatory nose breathers until at least 4 weeks of age and cannot automatically open their mouths to breathe if the nose is obstructed.  Discuss how the anatomy of the nose and throat differs in infants, making them more prone to acquire infections. (Refer to PowerPoint slide 2.)  Point out that the airway lumen is smaller in infants and children than in adults and when edema, mucus, or bronchospasm is present, the capacity for air passage is greatly diminished. Note that a small reduction in the diameter of a child’s airway will result in an exponential increase in resistance to airflow, causing increased work or breathing. (Refer to PowerPoint slide 3 and Figure 18.1.)  Explain the occurrence of congenital laryngomalacia due to the funnel shape and location of the larynx, increasing the chance of aspiration of foreign material into the lower airways. (Refer to Box 18.1.)  Note that the child's airway is highly compliant, making it quite susceptible to dynamic collapse during airway obstruction.  Discuss the location of the trachea at the third thoracic vertebra in children as opposed to the sixth in adults and how this difference is important when suctioning children and assessing for risk for aspiration. Review the differences in the lower respiratory structures. (Refer to PowerPoint slide 4.)  Point out that children have a significantly higher metabolic rate than adults and how this affects normal oxygen transport.

Learning Objective 2. Identify various factors associated with respiratory illness in infants and children.

 Emphasize the fact that children exposed to environmental smoke have an increased incidence of respiratory illnesses such as asthma, bronchitis, and pneumonia (WHO, 2011).  Discuss what the nurse would inspect and observe when conducting a physical assessment for respiratory disorders. (Refer to PowerPoint slide 5 and Figures 18.4 and 18.5.)  Review the breath sounds heard over the anterior and posterior chest and axillary areas including wheezing and rales. Note that breath sounds should be equal bilaterally, and prolonged expiration is a sign of bronchial or bronchiolar obstruction.  Remind students that when percussing the chest, sounds that are not resonant in nature should be noted. (Refer to PowerPoint slides 6, 7, and 8.) Learning Objective 3. Discuss common laboratory and other diagnostic tests useful in the diagnosis of respiratory conditions.

 Review the laboratory and diagnostic tests most commonly used for a child with a respiratory disorder. (Refer to Common Laboratory and Diagnostic Tests 18.1.)  Discuss the laboratory and diagnostic tests ordered for the assessment of RSV bronchiolitis. (Refer to PowerPoint slide 9.)  Note the common laboratory and diagnostic tests ordered for the assessment of pneumonia. (Refer to PowerPoint slide 10.)  Outline the laboratory and diagnostic tests ordered for the diagnosis and assessment of cystic fibrosis. (Refer to PowerPoint slide 11.)

Learning Objective 4. Describe nursing care related to common medications and other treatments used for management and palliation of respiratory conditions.

 Discuss common medical treatments and medications used to treat respiratory illness in children. (Refer to PowerPoint slides 12, 13, and 14; Common Medical Treatments 18.1; and Drug Guide 18.1.)  Teach your students that therapeutic management of respiratory distress syndrome (RDS) focuses on intensive respiratory care, usually with mechanical ventilation. Note that newer techniques for ventilatory support are also available. (Refer to PowerPoint slide 15 and Table 18.2.)

Learning Objective 5. Recognize risk factors associated with various respiratory disorders.

 Remind your students that acute infectious disorders include the common cold, sinusitis, influenza, pharyngitis, tonsillitis, laryngitis, croup syndromes, respiratory syncytial virus (RSV), pneumonia, and bronchitis. (Refer to PowerPoint slide 16.)  Discuss the risk factors for severe influenza infection, including chronic heart or lung disease (such as asthma), diabetes, chronic renal disease, or immune deficiency or children with cancer receiving chemotherapy.  Teach your students that pneumonia is an inflammation of the lung parenchyma caused by a virus, bacteria, Mycoplasma, or fungus. Point out that respiratory viruses are the most common cause of pneumonia in younger children and the least common cause in older children.  Outline risk factors for tuberculosis. (Refer to PowerPoint slide 17.)  Tell your students that acute respiratory distress syndrome (ARDS) occurs following a primary insult such as sepsis, viral pneumonia, smoke inhalation, or near drowning. Note that respiratory distress and hypoxemia occur acutely within 72 hours of the insult in infants and children with previously healthy lungs.  Review risk factors for acquiring a pneumothorax, including chest trauma or surgery, intubation and mechanical ventilation, or a history of chronic lung disease such as cystic fibrosis.  Discuss the risk factors for apnea and SIDS. (Refer to Box 18.4 and Figure 18.15.)

Learning Objective 6. Distinguish different respiratory disorders based on their signs and symptoms.

 Review the common signs and symptoms of sinusitis, including cough, fever, halitosis, facial pain, eyelid edema, irritability, and poor appetite.  Note that onset of pharyngitis is often quite abrupt and the history may include fever, sore throat and difficulty swallowing, headache, and abdominal pain. (Refer to Figure 18.7.)  Note the signs and symptoms of bronchiolitis (RSV). (Refer to PowerPoint slide 18.)  Discuss the signs and symptoms of a pneumothorax. (Refer to PowerPoint slide 19 and Figures 18.9 and 18.10.)  Note the signs and symptoms of the following chronic respiratory disorders: allergic rhinitis, asthma, chronic lung disease (bronchopulmonary dysplasia), cystic fibrosis, and apnea. (Refer to PowerPoint slide 20 and Figure 18.11.)  Discuss the characteristics (airway hyperresponsiveness, airway edema, and mucus production) and signs and symptoms of asthma. (Refer to PowerPoint slides 21, 22, and 23; Figures 18.12 to 18.14; and Table 18.3.)  Point out that cystic fibrosis is the most common debilitating disease of childhood among those of European descent. Then, discuss the signs and symptoms of, and risk factors for, the disease. (Refer to PowerPoint slide 24 and Table 18.5.)

Learning Objective 7. Discuss nursing interventions commonly used for respiratory illnesses.

 Discuss the variety of methods that oxygen may be delivered to a child. (Refer to PowerPoint slide 25 and Figure 18.6.)  Point out that therapeutic management of the common cold is directed toward symptom relief and includes promoting comfort, providing family education, and preventing spread of the cold. (Refer to Comparison Chart 18.1, Box 18.2, and Teaching Guidelines 18.1.)  Teach your students that nursing management of mononucleosis is primarily symptomatic and includes analgesics, salt water gargles, bed rest, rest periods, and avoiding contact sports.  Note that children with croup may be hospitalized if they have significant stridor at rest or severe retractions after a several-hour period of observation. (Refer to Comparison Chart 18.2.)  Warn your students not to under any circumstance attempt to visualize the throat of a child with epiglottis as reflex laryngospasm may occur, precipitating immediate airway occlusion. (Refer to PowerPoint slide 26.)  Review the procedure for maintaining a patent airway. (Refer to Nursing Procedure 18.1.)  Emphasize the fact that the most important nursing intervention related to foreign body aspiration is prevention. (Refer to Figure 18.8.)  Note that the stepwise approach to asthma treatment involves increasing medications as the child’s condition worsens, then backing off treatment as he or she improves. (Refer to Box 18.3.)

Learning Objective 8. Devise an individualized nursing care plan for the child with a respiratory disorder.

 Review the postoperative care of a child following tonsillectomy. (Refer to PowerPoint slide 27.)  Discuss the nursing management of pneumonia including diagnoses, goals, and interventions. (Refer to Nursing Care Plan 18.1.)  Ask your students to prepare a nursing care plan for a child who has one of the following acute noninfectious disorders: epistaxis, foreign body aspiration, respiratory distress syndrome, acute respiratory distress syndrome, or pneumothorax. (Refer to PowerPoint slide 28.)  Discuss the education provided to families of children with allergic rhinitis. (Refer to Teaching Guidelines 18.4.)  Teach your students that anti-inflammatory inhaled medications are used for maintenance of chronic lung disease, and short-acting bronchodilators are used as needed for wheezing episodes. Further, note that supplemental long-term oxygen therapy may be required in some infants.  With the class participating, develop a nursing care plan for a child with a tracheostomy. (Refer to Nursing Procedure 18.3.)

Learning Objective 9. Develop child/family teaching plans for the child with a respiratory disorder.

 Discuss teaching guidelines for a child with croup. Brainstorm with the class to develop a teaching plan for a child with croup. (Refer to Teaching Guidelines 18.2.)  Review safety measures to teach parents of children with aspiration pneumonia to prevent recurrent or further aspiration. (Refer to Teaching Guidelines 18.3.)  Tell your students that children with asthma and their families need a teaching plan focused on the appropriate use of nebulizers, metered-dose inhalers, spacers, dry-powder inhalers, and Diskus, as well as the purposes, functions, and side effects of the medications they deliver. Point out that the teaching requires a return demonstration of equipment. (Refer to PowerPoint slide 29, Table 18.4, and Teaching Guidelines 18.5.)

Learning Objective 10. Describe the psychosocial impact of chronic respiratory disorders on children.

 Remind your students that fear of an exacerbation and feeling “different” from other children can harm a child’s self-esteem. Brainstorm with the class to devise of list of interventions to promote self-esteem in children with respiratory disorders.  Point out that transferring control of asthma care to the child is an important developmental process that will increase the child’s feeling of control over the illness.  Emphasize the fact that a nurse who understands the family’s issues and concerns and provides culturally sensitive education and interventions is better able to plan for support and education regarding chronic respiratory disorders. (Refer to PowerPoint slide 30.)