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Objectives

Nursing Care of a Family ¬ Understand the anatomy and physiology of the


When a Child has a paediatric respiratory tract.
¬ Identify the functions of the respiratory
Respiratory Disorder system.
¬ Describe the pathophysiology, clinical
General Nursing, 2010 manifestations, treatment and nursing
management of common respiratory
conditions. E.g. asthma, upper respiratory
infection, croup - laryngotracheobronchitis,
pneumonia, bronchiolitis, respiratory distress
and failure, and epiglottitis

Anatomy and Physiology of the Development of the Respiratory


Respiratory System system
¬ Infant (0 to 1 year)
¬ Respiratory rate (30 - 60 bpm average 40 bpm)
¬ Upper respiratory tract - the nose, ¬ Structure and function
paranasal sinuses, pharynx, larynx, ¬ At birth, the lungs contain fluid; this is replaced by air as the infant
begins respiration
trachea and epiglottis ¬ The respiratory tract is small and relatively delicate and it provides
inadequate protection against infection. The close proximity of one
structure to another eases the spread of infection. There is limited
¬ Lower respiratory tract - the bronchi, alveolar surface for gas exchange
bronchioles, alveoli (lungs) ¬ Ethmoidal and maxillary sinuses are present
NOTE:
¬ At birth the chest wall is soft and pliable and the
respiratory muscles underdeveloped resulting in poor
expansion of the chest and decreased lung volumes at
the end of exhalation

In comparison with the adult,


Anatomic differences
in the infant:

¬ The nasal passages are narrower. ¬ Place the infant at higher risk for
¬ The trachea and chest wall are more respiratory compromise.
compliant. ¬ Furthermore, the lack of Ig A in the
¬ The bronchi and bronchioles are mucosal lining of the upper
shorter and narrower. respiratory tract also contributes to
¬ The larynx is more funnel-shaped. the frequent infections that occur in
¬ The tongue is larger. infancy.
¬ There are significantly fewer alveoli.

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Development of the respiratory Development of the respiratory
system system

¬ Toddler/Preschooler (1 to 6 years) ¬ School-age child (6 to 12 years)


¬ Respiratory rate (20 to 30 bpm) ¬ Respiratory rate (15 to 20 bpm)
¬ Structure and function ¬ Structure and function
¬Lung volume increases and susceptibility to ¬Respiratory system achieves adult maturity. The
infection decreases respiratory rate slows as the amount of air
¬After age 2 years the right bronchus is exchanged increases with each breath. Lung
shorter, wider and more vertical capacity becomes proportionate to body size
¬Frontal and sphenoidal sinuses develop between
ages 6 and 8 years.

Development of the respiratory


system Remember

¬ Size of the infant’s trachea and lower


¬ Adolescent (12 to 21 years) airway are approximately 1/3 to 1/2 of
¬ Respiratory rate the an adult’s airway.
¬ Structure and function ¬ The infant and young child’s nose,
¬Inadequate oxygenation occurs as the nasopharynx and pharynx are smaller and
respiratory system grows slowly in proportion more vulnerable to obstruction. Infants
to the rest of the body. Males have greater are obligate nose breathers.
vital capacity due to greater chest size, and ¬ Infants have limited alveolar space for gas
their lung capacity matures later than females exchange (20 million alveoli). By 3 - 8
who reach adult capacity at age 17 or 18. years children’s lungs contain more than
300 million alveoli (same as adult)

Functions of respiratory Nursing Process:


system Respiratory Disorder
¬ The major functions to deliver O2 to arterial blood and
remove CO2 from venous blood (gas exchange). ¬Assessment
¬ Normal gas exchange depends on:
¬
¬
Ventilation
Diffusion
¬Nursing diagnosis
¬
¬ Perfusion
Control of gas exchange involves:
¬Outcome identification and
¬ The neural system planning
¬ Chemical processes
¬ Differences in respiratory response ¬Implementation
¬ Poor tolerance of nasal congestion
¬
¬
Increased susceptibility to ear infection
Increased severity of respiratory symptoms
¬Outcome evaluation
¬ A total body response to respiratory tract infection

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Assessing Respiratory Illness

¬Physical assessment
¬Cough
¬Rate and depth of respirations
¬Retractions
¬Restlessness
¬Cyanosis

Assessing Respiratory Illness

¬Physical assessment
¬Clubbing of the fingers
¬Adventitious sounds
¬Chest diameter

Assessing Respiratory Illness

¬Laboratory tests
¬Blood gas analysis
¬Pulse oximetry

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Assessing Respiratory Illness Assessing Respiratory Illness

¬Laboratory tests ¬Diagnostic procedures


¬Nasopharyngeal culture ¬Chest x-ray
¬Respiratory syncytial virus nasal ¬Pulmonary function studies
washings
¬Sputum analysis

Health promotion and risk


management

¬ Hand washing
¬ Proper disposal of tissues
¬ Covering mouth while coughing
¬ Immunizations (e.g. HIB)

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Therapeutic Techniques Therapeutic Techniques

¬Expectorant therapy ¬Therapy to improve oxygenation


¬Liquefying agents ¬Oxygen administration
¬Humidification ¬Pharmacologic therapy
¬Vaporizers
¬Metered-dose inhalers
¬Nebulizers
¬Incentive spirometry
¬Coughing
¬Chest physiotherapy ¬Breathing techniques

Therapeutic Techniques Therapeutic Techniques

¬Therapy to improve oxygenation ¬Therapy to improve oxygenation


¬Tracheostomy ¬Endotracheal intubation
¬Emergency intubation ¬Assisted ventilation
¬Suctioning technique ¬Lung transplantation

Upper Respiratory Tract


Disorders

¬Acute nasopharyngitis
¬Assessment
¬Therapeutic management

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Upper Respiratory Tract Upper Respiratory Tract
Disorders Disorders

¬Pharyngitis ¬Epistaxis
¬Viral pharyngitis
¬Sinusitis
¬Streptococcal pharyngitis
¬Assessment ¬Laryngitis
¬Therapeutic management ¬Congenital
¬Tonsillitis laryngomalacia/tracheomalacia
¬Assessment
¬Therapeutic management
¬Tonsillectomy

Upper Respiratory Tract


Disorders

¬Croup (laryngotracheobronchitis)
¬Assessment
¬Therapeutic management
¬Epiglottitis
¬Assessment
¬Therapeutic management

Upper Respiratory Tract Lower Respiratory Tract


Disorders Disorders

¬Aspiration ¬Influenza
¬Bronchial obstruction ¬Bronchitis
¬Assessment ¬Bronchiolitis
¬Therapeutic management ¬Respiratory syncytial virus
bronchiolitis

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Lower Respiratory Tract Lower Respiratory Tract
Disorders Disorders

¬Asthma ¬Asthma
¬Mechanism of disease ¬Pulmonary function studies
¬Peak expiratory flow rate monitoring
¬Assessment
¬History
¬Therapeutic management
¬Physical assessment ¬Status asthmaticus
¬Bronchiectasis

Lower Respiratory Tract


Disorders

¬Pneumonia
¬Pneumococcal pneumonia
¬Chlamydial pneumonia
¬Viral pneumonia
¬Mycoplasmal pneumonia
¬Lipid pneumonia

Lower Respiratory Tract


References
Disorders
¬ Leifer, G. (2000). Thompson’s introduction to
¬Atelectasis Maternity and Paediatric Nursing.(4th ed.) St. Louis,
MO: Saunders.
¬Primary atelectasis ¬ Muscari, M. E. (2005). Lippincott's review series:
¬Secondary atelectasis pediatric nursing (4th ed.). Ambler, PA: Lippincott
Williams & Wilkins.
¬Pneumothorax ¬ Pillitteri, A. (2009). Maternal & child health nursing:
care of the childbearing & childrearing family (6th
¬Bronchopulmonary dysplasia ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
¬ Potts, N. L., & Mandleco, B. L. (2002). Pediatric
¬Tuberculosis nursing: Caring for children and their families. NY:
Delmar.
¬Assessment
¬Therapeutic management