NUR2513 Maternal -Child Nursing – Examination Blue Print – Exam 3 Pediatric Respiratory Disorders BRONCHOSCOPY o Procedure that lets the doctor look at your lungs and air passages o Used to diagnose lung issues, tumors, infections and bleeding o Nursing interventions Secure informed consent Check NPO status Assess s/sx of bleeding, monitor vitals, maintaining patent airway Position the client, reinforce diet (NPO), prevent aspiration Do not do in patients with recent head trauma or ICP Monitor for s/sx of pneumothorax - SOB, tachycardia, chest pain, coughing BACTERIAL PNEUMONIA o Nursing assessment Children may appear acutely ill, high fever, tachycardia, chest/abdominal pain, signs of respiratory distress Breath sounds are diminished, crack les in lungs (rales o Interventions IV fluids, antibiotics, antipyretics, humidified air, reposition client Assess O2 sats - administer oxygen as prescribed Possible CT to check secretion and prevent obstruction Maintain airway (sometimes tracheostomy) CYSTIC FIBROSIS o Assessment Autosomal recessive disorder of secretory glands leading to poor nutrition and infections Thick mucus secretions particularly in pancreas and lungs Electrolyte balances Salty tasting sweat/tears, steatorrhea (greasy) stools Diag nostic test - sweat chloride test Pulmonary function tests o Pharmacological management Pancrelipase - enzyme replacement; aids in digestion Adverse effects - nausea, diarrhea, abdominal cramps Nursing Care o Administer with meals, avoid inhaling powder or spitt ing into hands, do not crush tablet ASTHMA o Client education Instruct patient/ parent on s/sx to help monitor effectiveness or treatment and exacerbation Identify and avoid personal triggering agents Provide family with asthma action plan Use peak flow meter at same time each day Promote good nutrition, hand hygiene, and reduce allergens in the home Perform regular exercise as part of asthma therapy (promotes ventilation and perfusion, maintains cardiac health, and enhances skeletal muscle strength) o Assessment Dyspnea, cough, audible wheezing, course lung sounds, wheezing throughout possible crackles, mucus production, restlessness, irritability, anxiety, sweating, use of accessory muscles, decreased oxygen saturation, tripod positioning, sitting retract ions, inaudible breath sounds or crackles (severe obstruction) Exercise intolerance o Pharmacological management Quick relief (rescue drugs) Short -acting bronchodilators - albuterol, levalbuterol Systemic corticosteroids - dexamethasone, prednisone Long term (preventer drugs) Corticosteroids, antiallergy agents (antihistamines), NSAIDs, long -acting bronchodilators, leukotriene modifiers, nebulizers CROUP o Age range= 3months – 5 years, most common at age 2 o Usually only have minimal signs at bedtime o Affects trach ea, larynx, bronchi o URI symptoms (cough, nasal congestion, fever) Barky cough, dyspnea, stridor, retractions o Treatment Diagnosis - soft tissue imaging of the neck shows steeple sign Maintain airway, monitor O2 sats Provide rest, elevate HOB, provide humidified air Systemic corticosteroids: reduce inflammation, dexamethasone @ 0.6 mg/kg Nebulized budesonide Nebulized racemic EPI for more severe cases (stridor at rest) PERTUSSIS o Highly contagious - whooping cough -Bordetella for diagnosis o Assessment Commo n cold manifestations: runny nose/congestion, sneezing, mild fever, mild cough Severe coughing starts in 1 -2 weeks Coughing fits, violent and rapid coughing, loud “whooping” sound upon inspiration Paroxysmal coughing - refers to series of expiratory coughs after a deep inspiration Apnea in infants may be the only symptom o Nursing interventions Educate client to get vaccinated while pregnant Increase fluids, promote coughing, proper positioning, chest physiotherapy Isolation precautions BRONCHIOLITIS o Inflammation of the bronchioles and small bronchi - usually due to viral illness such as RSV o Most common in children younger than 2 o Assessment Initially - rhinorrhea, intermittent fever, pharyngitis, coughing, sneezing, wheezing, possible ear or eye infectio n With illness progression - increased coughing and sneezing, fever, tachypnea and retractions, refusal to nurse or bottle feed, copious secretions
