Lower

airway
disorders Patho / Clinical Manifestations / Diagnostics / Treatment meds

*Immature lung *Premature infants high Management

requires morbidity *O2 and ventilator support
mechanical *Direct result of tx provided *Chest physiotherapy
ventilation for: *Bronchodilators, corticosteroids (IV-
barotrauma -Resp distress, CHD, PO-Inhale), diuretics
(strength receptors meconium aspiration, FVO *RSV immune globulin
Broncho- in lungs), O2 in neonate, prematurity *High cal formula (b/c they take less of
pulmonary toxicity, BPD the feed; provides more cals with less
Dysplasia inflammation, cell ** O2 SUPPLEMENTATION fluids b/c they cant take as much)
damage/death
-Chronic Lung fibrosis & edema or S/S Meds
disease bronchioles & *Persistent signs of resp *Bronchodilators= decrease airway
-BPD smooth muscle distress (tachypnea, resistance, stimulate mucous clearance
hypertrophy wheezing, crackles, nasal *Corticosteroids= reduce pulm edema,
prolonged flaring, retractions, maybe decrease inflam response
mechanical vent & cyanosis d/t increase in *Diuretics= remove excess fluid,
O2 requirement, pulmonary pressures decrease pulm resistance (refrigerate
airway *Failure to thrive, delayed spironolactone)
hyperactivity with growth, poor feeding, at risk *KCL replace E lost w/ diuretics
increased mucous for complications and - Palivuzumab = RSV immune
production respiratory compromise globulin
from any viral or bacterial to prevent RSV infection
infections
*Usually viral, RSV, S/S Mgmt.
parainfluenza, *1-3 days URI *Decrease work breathing= humidify, monitor O2
influenza sx= wheezing, sats, may require supp O2, CPT, rarely intubation,
*Bronchiole cough, saline drops and bulb suction
swelling, increased tachypnea, poor *Physiologic funx= may require IV fluids for
mucous PO intake fever hydration, fever control
production d/t dehydration; *Reduce anxiety of parents- usually baby healthy
Bronchiolitis Hyperinflation accessory then this
caused by muscle to
narrowing of breath; Home care
airway, air trapping WHEEZING ALL *Use of bulb syringe
*Transmission- AROUND *Potential for airway relapse and when to call HCP
direct contact, *Rest/fluids
foamites DX
*Prevention- *NP swab or PREVENT
HANDWASHING aspiration of *Synagis/Palivizumab = previously unhealthy baby
**Less likely after 1 nasal secretion *Only Palivizumab= previously healthy baby
years old for culture


*Viral, bacterial, fungal, mycoplasma Bacterial Pneumonia
--usually viral under age of 5 *Community acquired versus hospital
acquired
S/S *Risk Factors include: smoking, decrease LOC,
Pneumonia *Fever, cough, tachypnea, chest pain, chronic lung disease, elderly or infant
retractions, ABD/chest pain, malaise
Management
Assessment *VIRAL= increase fluids, CPT, fever control,
*Breath sounds- fine crackles, dullness, may require O2, antitussive, monitor O2 sats
decreased breath sounds *BACTERIAL= all of the above, ABX, teach
*** Decreased breath sounds usually in splinting for cough, suctioning
one area- not all around **Prevention pneumococcal vaccine

DX UNDER 5 but OVER 1= honey w/ tea/warm
*CXR; sputum culture water

Foreign Body Aspiration:
Most common in children under age of 4

HIGH risk popcorn, peanuts, potato chips, hot dogs, carrots, grapes,
apples, latex balloons, hard candy, coins, batteries

NOTE: If the wheezing doesnt respond to a bronchodilator then do a
CXR because its most likely a foreign body.

Clinical Manifestations Choking, gagging, wheezing, if they cannot talk
it is EMERGENT!

Management -Abdominal thrusts, call 911
-Incomplete obstruction CXR; Bronchoscopy (DONT
GIVE FLUIDS)







Apparent Life Threatening Event:

* Episodes of apnea accompanied by color change, limpness, choking or
gagging in an infant who is >37 weeks gestation
* Peak incidence 1-8 weeks

*Causes GERD, seizure, cardiac arrhythmia, metabolic or endocrine
issue

*Nursing Management CPR, CR monitoring, OSA, parent education
and support, home apnea monitoring


SIDS (Sudden Infant Death Syndrome):

*Risk factors
Prone sleep
Less then 6 months of age
Winter months
Premature infants
Multiple births
Smoke exposure
African Americans; Native Americans; Hispanic; young mothers,
substance abuse, co-sleeping

*Prevention Back to sleep, no toys/pillows, no swaddle/blanket or
bumper bads
*Family support
Teach parents that there is not an increased risk in siblings/future
children
Allow them to hold their infant, stay with family to answer
questions, reinforce explanations, offer resources, DONT JUDGE
Encourage SIDS support groups