1. Respiratory Disorders
Gail C. Hoyer
2010-1

3. Foreign Body Aspiration
• Definition
– Inhalation of any object (solid, or liquid, food or
non food) into the respiratory tract
– A major health threat for infants and toddlers due
to their increased tendency to put objects in their
mouth
• Pathophysiology
– Severity depends on size and composition of
object and its location in the respiratory tract

4. Foreign Body Aspiration:
Manifestations
• Manifestations
– Dysphonia (muffled hoarse,
or absent voice sounds)
– Wheezing may also occur and
may last up to hours
depending where object has
lodged
– If a child can not say “P”
words they have diminished
expiratory effort
– If prolonged, s/s of hypoxia
will become evident
• Anxiety, upright position neck
extended
• Irritability and decreased
responsiveness

5. Foreign Body Aspiration:
Nursing Interventions
• Assessment and Diagnosis
– Physiological Assessment
– Psychosocial Assessment
– Developmental Assessment
• Planning and Implementation
– Complete obstruction
• Infant
– Back blows and chest thrusts
• Child
– Abdominal thrusts
– Partial Obstruction
• Resuscitation equipment at bedside
• Avoid anxiety increasing procedures to prevent a complete
obstruction
• Evaluation

7. Croup Syndromes
• Croup- broad group of upper airway illnesses
that result from swelling of the epiglottis and
larynx
• Syndromes
– Laryngotracheobronchitis- most common
– Epiglottitis (Supraglottitis)
– Bacterial Thracheitis
• The initial symptoms of all three conditions
– Stridor, “seal like” barking cough, and hoarseness

9. LTB: Nursing Interventions
• Assessment and Diagnosis
– Respiratory assessment
– Cardio-respiratory monitoring and pulse oximetry
• Planning and Implementation
– Maintaining Airway Patency
• Oxygen
• Position
• Communication
• Medications (beta-agonists and beta adrenergics, and corticosteroids)
• Albuterol, racemic epinephrine, dexamethasone
– Meet Fluid and Nutritional Needs
– Discharge Planning and Home Care Teaching
• Evaluation

10. Epiglottitis (Supraglottitis):
Nursing Interventions
• Assessment and Diagnosis
– Airway management-
• Intubation is the treatment (do not leave the child unattended)
• Position
• Respiratory assessment
– Drug therapy
• Antibiotics to treat infection
– Hydration
– Emotional and Psychosocial support of the child and parents
• Postpone anxiety provoking procedures
• Planning and Implementation
– Pt will be in a critical care setting while intubated
– Teach parents about intubation and prepare for discharge
• Evaluation

11. Bacterial Tracheitis:
Nursing Interventions
• Secondary infection of the upper trachea following a
viral LTB
– Staphylococcus aureus, group a streptococcus, moraxella
catarrhalis, or haemophilis influnzae
• Commonly misdiagnosed for LTB
– Similar symptoms but patient gets worse with therapy
instead of better
– Diagnosed by blood cultures
• Nursing
– Critical care setting
• Intubation
– Frequent suctioning, oxygen or humidified air, antibiotics
– Refer to epiglottitis

12. Bronchiolitis and RSV
• Bronchiolitis
– Lower respiratory tract
infection that occurs when a
viral or bacterial organism
causes inflammation and
obstruction of the
bronchioles
• Etiology
– RSV is the most common
cause
• Occurs in annual epidemics
from October to march
• Transmitted through direct
contact with respiratory
secretions or indirectly
through contaminated
surfaces

13. Bronchiolitis: Manifestations and
Clinical Therapy
• Manifestations
– Mild-rhinitis, cough, low grade fever, wheezing,
tachypnea, poor feeding, vomiting, and diarrhea
– Severe- tachypnea greater than 70bpm, grunting,
increased wheezing, retractions, nasal flaring, irritability,
lethargy, poor fluid intake, and a distended abdomen from
over-expanded lungs
• Clinical Therapy
– No treatment
– Isolation
– Antipyretics
– Ribavirin
• Expensive with marginal benefit and high risk to caregivers

14. Bronchiolitis: Nursing Interventions
• Assessment and Diagnosis
– Physiologic Assessment
– Psychosocial Assessment
• Planning and Implementation
– Maintain Respiratory Function
– Support Physiologic Function
– Reduce Anxiety
– Discharge Planning and Home Care Teaching
• Evaluation

15. Asthma
• Definition
– Common chronic disorder of the
airways that is characterized by
variable and recurring symptoms,
airflow obstruction, bronchial
hyperresonsiveness, and
underlying inflammation
• Etiology and Pathophysiology
– Caused by an interplay of multiple
factors
• Environmental exposures, viral
illnesses, allergens, and a genetic
predisposition
– Risk factors
• Passive smoke exposure, indoor air
contaminants (pet dander, cockroach
feces), outdoor air pollutants,
recurrent respiratory viral infections,
and allergic disease (atopic eczema,
food allergies)

16. • Manifestations
– asthma attack
– asthma and children
– Sudden cough, wheezing,
shortness of breath is
referred to as an asthma
episode or flare
• Clinical Therapy
– Medications
• bronchodilators
– Hydration
– Education and support of
parents and child

17. Asthma: Nursing Interventions
• Assessment and Diagnosis
– Physiologic
– Assess Asthma Management
– Psychosocial Assessment
• Planning and
Implementation
– Maintain Airway Patency
– Meet Fluid Needs
– Promote Rest and Stress
Reduction
– Support Family Participation
– Discharge Planning and Home
Care Teaching
• Evaluation

18. Cystic Fibrosis
• Definition
– Autosomal recessive disorder of
the exocrine glands that results in
physiologic alterations in the
respiratory, gastrointestinal, and
reproductive systems
• Etiology
– Decreased chloride secretion due
to a defective protein results in
increased sodium absorption,
causing the body to produce
unusually thick, sticky, mucus that
clogs the lungs leading to
infections, and obstructs the
pancreas secretion of natural
enzymes that enable the body to
digest and absorb food

19. CF: Manifestations and Clinical
Therapy
• Manifestations • Clinical Therapy
– Salty taste of skin noticed by – Sweat test
parents first • Seat chloride concentration of
– Newborns- meconium ileus 50 to 60 meq/L is suspicious. If
the chloride is greater than
– Stool- steatorrhea(fat or 60meq/L is diagnosed with
greasy), frothy (bulky and other signs
large quantity), foul smelling,
and floating
– Respiratory-chronic moist,
productive cough and
frequent respiratory
infections
– GI- difficulty gaining weight
because of malabsorption
and increased metabolic rate

23. CF: Nursing Management
• Assessment and Diagnosis
– Physiologic Assessment
– Psychosocial Assessment
• Planning and Implementation
– Provide Respiratory Therapy
• CPT, aerosol treatment with a bronchodilator
– Administer Medications and Meet Nutritional Needs
• Antibiotics for acute exacerbation via PO, inhalation or IV
• Pancreatic enzymes taken with all meals and snacks
• Fat soluble vitamins (ADEK) in water form b/c not easily absorbed from food
• Nutritional supplements or NG/GT feeding to meet high metabolic rate/demands
– Provide Psychosocial Support
– Discharge and Home Care Teaching
• Finances
– Nursing Care in the Community
• Evaluation

24. Pharyngitis
• Acute pharyngitis is an infection that primarily affects the
pharynx including the tonsils
• Major complaint- sore throat
– See page 1303 Clinical Manifestations
• Nursing Management
– Symptomatic relief
• Acetaminophen for pain and fever
• Cool, non-acidic fluids and soft foods, ice chips, or frozen ice pops
• Humidification, chewing gum, warm slat water gargle
• Home remedies more effective than O.T.C. throat sprays
– Teach parents to complete 10-day course of antibiotic is
prescribed for bacterial pharyngitis
• Treating strep infections prevents infections such as rheumatic fever,
cervical adenitis, sinusitis, glomerulonephritis, or meningitis)

25. Pharyngitis: Manifestations

26. Otitis Media
• Inflammation of the middle ear
• Etiology
– Specific cause unknown, but appears to be related to
Eustachian tube dysfunction
– URI precedes the otitis media
– Most common causative organisms of infection are
streptococcus pneumoniae, haemophilus influenzae, and
moraxella catarrhalis
• Manifestations
– Pulling at the ear
– Diarrhea, vomiting and fever
– Acting out and irritability may be a sign of hearing loss

27. Otitis Media: Nursing Management
• Assessment and
Diagnosis
• Planning and
Implementation
– Preventative measures
– Family stressor of
chronic otitis media
– Pain relief Techniques
– Hearing and Language
exams
• Evaluation

28. Otitis Media and
Otitis Media with Effusion
Acute otitis media- characterized by pain Otitis media with effusion-fluid
and a red, bulging non-mobile membrane line or air bubbles