The Child with Alterations in Activity Exercise Patterns

Prepared by: Maribeth G. Orio, RN, MN

Respiratory Infections
 Infections of the respiratory tract are Older children
described according to the areas of  dryness and irritation of the nasal
involvement. passages and pharynx
 sneezing
Factors that affects the cause and course of  chilly sensation
infection  muscular aches
- age  irritating nasal discharge
- size  cough
- resistance
- seasonal variations Therapeutic Management
 managed at home
Nursing Care of the Child with a
Respiratory Infection  antipyretics for fever
 Ease Respiratory Effort  rest
 Promote rest  decongestant
 Promote comfort
Nursing Care Management
 Prevent spread of infection
 elevating the head of the bed
 reduce temperature
 maintaining adequate fluid intake
 Promote hydration
 avoiding contact with affected person
 Provide nutrition
 family support and home care 2. Pharyngitis
 viral (streptococcal) infection of the
Upper Respiratory Tract upper airway
Acute Nasopharyngitis (Common colds) –
 affected children are at risk for serious
p.1319
sequelae
Pharyngitis – p.1320
- acute rheumatic fever
Tonsilitis – p. 1321
- inflammatory disease of heart, joints
Epistaxis – p. 1250 (pillitteri)
and CNS
Sinusitis – p. 1250 (pillitteri)
- acute glomerulonephritis
Laryngitis – p. 1332
- kidney infection
Laryngotracheobronchitis (croup) –p.1332
Epiglotitis – p. 1330
Therapeutic Management
Aspiration – p.1348/1345
 oral penicillin
1. Acute Nasopharyngitis (Common colds)
Nursing Care Management
 Caused by a number of viruses, usually
rhinoviruses, RSV, adenovirus, influenza  throat swab
virus, and parainfluenza virus.  encourage bed rest
 cold or warm compress to the neck for
Clinical Manifestations relief
3 mos. to 3 yrs old.
 fever 3. Tonsilitis
 irritability  Inflammation of the tonsils
 restlessness  tonsils are masses of lymphoid tissue
 decreased appetite & fluid intake located in the pharyngeal cavity
- play a role in antibody
 decreased activity
formation
 open mouth breathing - children generally have larger
 vomiting tonsils than adults
 diarrhea
Manifestations
 difficulty swallowing and breathing
 offensive mouth odor

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  impaired senses of taste and smell  Headache
 nasal and muffled quality voice  Tenderness over the affected sinus
 persistent cough
 difficulty hearing Management
Therapeutic Management  Antipyretic for fever
 Viral infection – self-limiting  Analgesic for pain
 streptococcal infection – antibiotic  Antibiotic for specific organism
therapy involved
 tonsilectomy  Warm compresses to the sinus area
 Oxymetazoline hydrochloride (Afrin) –
Nursing Care Management shrinks edematous mucous membranes
 providing comfort and minimizing
activities 6. Laryngitis
 soft to liquid diet  common illness in older children and
 cool-mist vaporizer adolescents
 warm salt water gargles, throat lozenges  viruses are the usual causative agents
and analgesic-antipyretic drugs
Manifestations
4. Epistaxis  hoarseness w/ upper respiratory
 Extremely common in children symptoms
 Usually occurs from trauma, such as  systemic manifestations – fever,
picking at the nose, from falling or from headache, myalgia, malaise
being hit on the nose
 In hot and dry environment, it can cause Nursing Care Management
the mucus membrane dry,  self-limiting
uncomfortable and susceptible to
cracking and bleeding 7. Laryngotracheobronchitis (croup)
 Tends to occur during respiratory  most common type of croup
illnesses experienced by children below 5 years
 May occur after strenuous exercise, and old
it is associated with a number of  parainfluenza virus type 1
systemic diseases such as rheumatic
fever, scarlet fever, measles or varicella Progression of symptoms in
infection (chickenpox). laryngotracheobronchitis
 It can occur with nasal polyps, sinusitis Stage I
and allergic rhinitis - fear
 Familial disposition - hoarseness
- croupy cough
Management - inspiratory stridor when disturbed
 Keep in upright position with head Stage II
tilted slightly forward - continuous respiratory stridor
- lower rib retraction
 Apply pressure to the sides of the nose
- retraction of soft tissue of neck
with your fingers
- use of accessory muscles of
 Make every effort to quiet the child respirations
 Application of epinephrine - labored respiration
 Nasal pack to provide continued Stage III
pressure - signs of anoxia and carbon dioxide
retention
5. Sinusitis - restlessness
 Occurs as a secondary infection in older - anxiety
children when streptococcal, - pallor
staphylococcal or H. influenzae - sweating
organisms spread from the nasal cavity. - rapid respiration
stage IV
Manifestations - intermittent cyanosis
 Fever - permanent cyanosis
 Purulent nasal discharge - cessation of breathing

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  DYSPHAGIA
Therapeutic Management - Esophageal dysmotility
 maintaining a airway and providing for - neurologic deficit
adequate respiratory exchange - gastroesophageal reflux
 High humidity with cool mist  MECHANICAL DISRUPTION OF
 cool temperature therapy DEFENSIVE BARRIERS
 Nebulized epinephrine - endotracheal tube
- tracheostomy
Nursing Care Management - cleft lip/ palate
 continuous, vigilant observation and  PERSISTENT VOMITING
accurate assessment of respiratory - gastrointestinal infection
status - chemotherapy
 Intubation set, bag and valve mask - postanesthesia
should be available
 encourage to rest Manifestations
 allow parents to remain with the child  Cough
as much as possible  Fever
 Foul-smelling sputum
8. Epiglotitis  Deteriorating chest radiographs
 A serious obstructive inflammatory
process that occurs principally in Nursing Care
children between 2 and 5 years of age  Prevention
but can occur from infancy to - proper feeding techniques
adulthood.

Manifestations Lower Respiratory Tract

 Dysphagia
 Stridor aggravated when supine 1. Influenza – p. 1324
 Drooling 2. Bronchitis – p. 1334
 High fever 3. Bronchiolitis – p. 1334
 Toxic appearance 4. RSV Status Asthmaticus – p. 1355
 Rapid pulse and respiration 5. Bronchiectasis – p. 1264 (Pillitteri)
6. Pneumonia – p. 1337
Treatment 7. Atelectasis – p. 1266 (Pillitteri)
 antibiotics 8. Pneumothorax – p. 1267 (Pillitteri)
9. Bronchopulmonary Dysplasia (BPD) –
 airway protection
p.1268 (Pillitteri)
10. Tuberculosis – p. 1341
Nursing Care
11. Cystic Fibrosis – p. 1373
 Nurses who suspect epiglotitis should
not attempt to visualize the epiglotis
1. INFLUENZA
directly with a tongue depressor or take
 Commonly known as “flu.”
a throat culture but should refer to the
physician immediately.  Caused by three of the
orthomyxoviruses w/c is capable of
9. Aspiration antigenic drift (minor variations of the
same subtypes almost annually)
 Occurs when food, secretions, inert
materials, volatile compounds, or  Can be transmitted by direct contact
liquids enter the lung. (large-droplet infection)
 1 to 3 days incubation period
Conditions that Increase Risk of Aspiration
(box 32-14) Manifestations
 Dry throat and nasal mucosa
ALTERED LEVEL OF CONSCIOUSNESS  Dry cough
- CNS injury or disease  Tendency toward hoarseness
- sedation  Sudden onset of fever and chills
- general anesthesia  Flushed face
- CPR  Photophobia

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  Myalgia  may be wheezing
 Hyperesthesia
Management
Therapeutic Management  Humidified oxygen
 Symptomatic treatment  Supportive care
 Amantadine hydrochloride (Symmetrel)
 effective in reducing 4. RSV Status Asthmaticus
symptoms  Exaggerated response of bronchi to
 Zamavimir and Rimantadine for infection
treatment of flu symptoms under 18  Bronchospasm, exudation, and edema
years old of the bronchi
 Prevention – influenza vaccine
Nursing Care
Helping the family implement measures to Manifestations
relieve symptoms  Wheezing
 Productive cough
2. BRONCHITIS
Sometimes referred to as trachebronchitis Management
Inflammation of the large airways (trachea  Bronchodilators
and bronchi)  corticosteroids
Viral agents are the primary cause
Age-group affected – first 4 yr of life 5. BRONCHOECTASIS
 Chronic dilatation and plugging of the
Manifestations bronchi
 Persistent dry, hacking cough (worse at  May follow pneumonia, aspiration of
night), becoming productive in 2-3 days foreign body, pertussis, or asthma

Management
 Symptomatic treatment
 Cough suppressants if needed
3. BRONCHIOLITIS
 An acute viral infection with maximum
effect at the bronchiolar level
 Respiratory Syncytial Virus (RSV) is a
paramyxovirus containing a single
strand of ribonucleic acid and related to
parainfluenza virus – accounts to 80%
or more of cases of acute bronchiolitis
during epidemic periods
 RSV is the most frequent cause of
hospitalization in children less than 1
year old and severe RSV infections in
the first year of life represent a
significant risk factor for the
development of asthma up to age 13
 Can be transmitted through direct
contact with respiratory secretions,
fomites or hand to eye, nose or other
mucous membranes
Manifestations
 Dyspnea,
 paroxysmal nonproductive cough,
 tachypnea with retractions
 flaring nares,
 emphysema;
Manifestations
 Develop a chronic cough with
mucopurulent sputum
 Young infants may have accompanying
wheezing or stridor
 If a large area of lung is involved,
children may have cyanosis
 For chronic disease, may develop
clubbing of the fingers and easy
fatigability
 Growth restriction
 Enlarged chest from overinflation of
alveoli
Management
 Chest physiotherapy
 Antibiotic therapy for (+) infection
 Surgery for removal of affected lung
portion
6. PNEUMONIA
 An inflammation of the pulmonary
parenchyma
 Common in childhood, occurring more
frequently in infancy and early
childhood
 Can be classified according to
morphology, etiologic agent, or clinical
form

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  The most useful classification is based
on the etiologic agent (i.e., viral,
bacterial, mycoplasmal, or aspiration of
foreign substances)
Manifestations
 Vary depending on the etiologic agent,
the child’s age, the child’s systemic
reaction to the infections, the extent of
lesions, and the degree of bronchial and
bronchiolar obstruction
General Signs:
 Fever, usually quite high
 Cough: unproductive to productive with
whitish sputum
 Breath sounds: rhonchi or fine crackles
 Dullness with percussion
 Chest pain
 Retractions
 Nasal flaring
 Pallor to cyanosis (depends on severity)
Management
 Nursing care of the child with
pneumonia is primarily supportive and
symptomatic
 It necessitates thorough respiratory
assessment and administration of
oxygen and antibiotics
 Frequent assessment of the child’s
respiratory rate and status
 Institute isolation procedures according
to hospital policy
 Encouragement of rest and conservation
of energy
 Use of antitussives for disturbing cough
 Administration of intravenous fluids
during acute phase
 Increase in oral fluids if allowed and
should be given cautiously to prevent
aspiration
 Oxygen by nasal cannula if needed
 High or Low fowler’s position
7. ATELECTASIS
 The colapse of the lung alveoli
 Occurs in children as a primary or
secondary condition
Primary Atelectasis
 Occurs in newborn who do not breathe
with enough respiratory strength at birth
to inflate lung tissue
 or whose alveoli are so immature
 or so lacking surfactant that they cannot
expand
Manifestations of primary Atelectasis
 Irregular respirations
 Nasal flaring and apnea
 After a few minutes, respiratory
grunting (because of closing of glottis
upon expiration) and cyanosis occurs
 This closure is tiring and will result to
becoming hypotonic and flaccid
newborn
Secondary Atelectasis
 Occurs in children when they have a
respiratory tract obstruction that
prevents air from entering a portion of
the alveoli
 As the residual air in the alveoli is
absorbed, the alveoli collapse
 The cause of obstruction include mucus
plugs that may occur with chronic
respiratory disease or aspiration of
foreign objects.
Manifestations of secondary atelectasis
 Depend on the degree of collapse
 Asymmetry of the chest
 Decreased breath sound of the affected
side
 If the process is extensive, tachypnea
and cyanosis will occur
 Chest x-ray will show the collapsed
alveoli ( a “whiteout”)
Management
 Removal of foreign object by
bronchoscopy
 Resolves, moved or expectorate mucus
plug
 Assisted ventilation to maintain
adequate respiratory function
 Keep the chest free from pressure for
optimum lung expansion
 semi-fowler’s position
 Increase humidity of the environment
 Suctioning
 Chest physiotherapy
8. PNEUMOTHORAX
 The presence of atmospheric air in the
pleural space
 Usually occurs when air seeps from
ruptured alveoli and collects in the
pleural cavity.
 It can also occur when external
puncture wounds allow air to enter the
chest.
Manifestations
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  Tachypnea
 Grunting respirations
 Flaring of the nares
 Cyanosis
 Absent or decreased breath sound
 Hyperresonant
 Shift of apical pulse (mediastinal shift)
away from the site of pneumothorax
 Chest film will show the darkened area
of the air-filled pleural space
Management
 Oxygen therapy
 Thoracotomy catheter or needle may be
placed in the pleural space
 atmospheric air aspirated or low
pressure suction with water-seal
drainage
 For puncture wound, cover the chest
wound immediately with an impervious
material, such as petrolatum gauze to
prevent air from entering.
9. BRONCHOPULMONARY DYSPLASIA
(BPD)
 Chronic pulmonary involvement that
occurs in 10% to 40% of infants who
are treated for acute respiratory distress
in the first days of life.
 Thought to occur from a combination of
surfactant deficiency (decreased from
lung trauma), barotrauma (lung damage
from ventilator pressure), oxygen
toxicity and continuing inflammation.
Manifestations
 Tachypnea
 Retractions
 Nasal flaring
 Tachycardia
 Oxygen dependence
 Abnormal x-ray findings – areas pf
overinflation and atelectasis
Management
 Administration of corticosteroid and
bronchodilator
10. TUBERCULOSIS
 highly contagious pulmonary disease
 Causative agent is Mycobacterium
tuberculosis (tubercle bacillus)
 Mode of transmission is inhalation of
infected droplets
 Incubation period is 2 to 10 weeks
Manifestations
Primary inflammation
Slight cough
Anorexia
Weight loss
Night sweats
Low grade fever
Management
 Rifampin – gastrointestinal disturbance
 Isoniazid (INH) – peripheral neurologic
sx
 Pyridoxine
 Ethambutol – optic neuritis
11. CYSTIC FIBROSIS
 Generalized dysfunction of the exocrine
glands
 Mucus secretions of the body,
particularly in the pancreas and the
lungs are so tenacious that they have
difficulty flowing through gland ducts.
 There is marked electrolyte change in
the secretions of the sweat glands (2-5x
above normal chloride concentration)
 The cause of the disorder is an
abnormality of the long arm of
chromosome 7.
 Inherited as autosomal resessive trait
 Common in whites, rare in blacks and
asians
 Boys with CF may not be able to
reproduce because they have persistent
plugging and blocking of the vas
deferens from tenacious seminal fluid.
 Girls may have thick cervical secretions
that sperm penetration is limited.
Management
 Lung transplantation
 Measures to reduce the involvement of
the pancreas, lungs and sweat glands.
 Pancrelipase (Cotazym) – used to aid
digestion