2. INTRODUCTION
Respiratory illness are common in children under 5
years of age. Most children will develop three to eight
episodes of cold or respiratory illnesses in a year.
Most cases are mild about one-third of all
hospitalizations in this age group are due to
respiratory problems including asthma and
pneumonia.
6. ACUTE BRONCHITIS
DEFINITION
Acute bronchitis is swelling and irritation in
child's air passages.
This irritation may cause him to cough or
have other breathing problems.
Acute bronchitis often starts because of
another illness, such as a cold or the flu.
The illness spreads from your child's nose
and throat to his windpipe and airways
Acute bronchitis lasts about 2 weeks and is
usually not a serious illness
7. Incidence & etiology
Acute bronchitis occure especially in
children less than 4 year of age. It is
usually associated with previous upper
respiratory infection.
Acute bronchitis may be bacterial
(mycoplasma pneumoniae) or viral
(adenovirus, rhinovirus) in origin.
Physical and chemical agent like dust,
allergens , strong fumes etc.
8. Clinical features
Runny nose
Malaise
Chills
Fever
Back and muscle pain
Sore thoroat
Wheezing
The symptoms usually last for 7-14 days
12. Bronchiolitis
Definition
Bronchiolitis is a serious illness characterized by
inflammation of bronchioles, causing severe
dyspnea.
incidence & etiology:
Brochiolitis is common in infants under the age of 6
months. It
Is common in winter and early spring.
The exact etiology is not clear.
The agent may be-
virus-adenovirus, influenza virus, respiratory syncytial
virus
bacteria- H.influenzae, pneumococcus, streptococcus
hemolyticus
15. Management
Oxygen administration
Maintaining atmosphere well
saturated with water vapour
Mild sedation
Postural drainage
Iv fluid are given to combat
dehydration
antibiotics
17. Pneumonia
DEFINITION
It is a inflammatory process
involving lung parenchyma.
It is a inflammation with
consolidation (it is a state of being
solid with exudate) of parenchymal
cells of the lung.
18. INCIDENCE
Occurs most commonly in infants and
young children
30% children are admitted because of
pneumonia
90% of deaths in respiratory illnesses are
due to pneumonia
19. CLASSIFICATION
On anatomical basis-
Lobor or lobular pneumonia:one or more lobes of
lungs are involved
Interstitial pneumonia: interstitial tissue of lungs are
affected
Bronchopneumonia : patchy consolidation of lungs
is known as bronchiopneumonia
ON ETIOLOGIC BASIS-
bacterial pneumonia: pneumococcus, strptococcus,
staphylococcus, H.influenzae and haemophilus
pertusis.
Viral pneumonia: inmfluenza, ,measels, adenovirus,
respiratoy syncytial virus
Fungal
pneumonia:histoplasmosis,coccidioidomycosis
Protozoal pneumonia: pneumocystis
20. MISCELLANEOUS TYPES:
Aspiration pneumonia: it is caused by
aspiration of food, nasal drop, amniotic
fluid by new born.
Loffler pneumonia: eosinophils
accumulate in lungs in response to
parasitic infection.
Hypersensitivity pneumonia: inflammation
of alveoli within the lungs caused by
hypersensitivity to inhaled dust.
Hypostatic pneumonia: collection of fluid
in dorsal region of lungs .
21. Clinical features
Fever with chills
Cough with thick sputum
Increased respiratory rate
Nasal flaring
Running nose
Irritability
Malaise
Sore throat
Anorexia
Late symptoms include:
Convulsions
Wheezing
Hoarseness of voice
cyanosis
25. NURSING MANAGEMENT
ASSESS AND MONITOR THE CHILD’S RESPIRATORY
RATE AND BREATH SOUND.
CONTROL OF FEVER
MAINTAINE PATENT AIRWAY
PROVISION OF HIGH HUMIDIFIED OXYGEN.
MONITOR RESPIRATORY STATUS AND VITAL SIGNS.
ADMINISTRATION OF ANTIBIOTICS
PROMOTION OF REST
PROVISION OF APPROPRIATE AND ADEQUATE
FLUIDS AND NUTRITION
SUPPORT AND EDUCATION TO PARENTS
PREVENTION OF COMPLICATIONS
27. Prevention
Two vaccine are available to prevent
pneumococcal disease.
Pneumococcal conjugate vaccine (PCV13)
Pneumococcal polysaccharide
vaccine(PPSV23); pneumovax
29. Respiratory distress syndrome
Definition
• Respiratory Distress Syndrome (RDS) formerly
known as hyaline membrane disease, is a life
threatening lung disorder that results from
underdeveloped and small alveoli and insufficient
level of pulmonary surfactant that leads to
atelectasis.
• It is the leading cause of death in preterm infants
• Occurs in 50% babies born at26-28 weeks and
25% of babies born at 30-31 weeks
30.
31. CAUSES
RDS occurs as a result of insufficient
production of surfactant which is seen
in:
Prematurity (more common)
Maternal diabetes (Inadequate
utilization of glycogen for surfactant
production)
Meconium aspiration syndrome
34. Diagnostic evaluation
• Details of Antenatal and Prenatal History
• Assessment and Evaluation of Clinical manifestation
• Arterial Blood gas analysis:
PCO2 above 65mmHg(normal:45mmhg)
PO2 of 40mmHg(normal:50mmhg)
pH below 7.15(normal7.35-7.45)
• X-ray shows alveolar atelectasis
• Pulse oximetry: Decreased SPO2
•Shake test
• Prenatal diagnosis of RDS can be made by determining
Lecithin/sphingomyelin ratio in amniotic fluid after 35
weeks of gestation.
36. Management
Neonate should be placed in Newborn Unit (NBU) and
nursed in warm incubator. The infant must be kept
warm (36.50C).
Oxygen administration- Adequate, warm and
humidified O2 in high concentration is given through
plastic hood to maintain arterial PO2 between 50-
90mmHg is given.
Ventilator support-Continuous Positive Airway
Pressure (CPAP) is indicated and useful in infant with
decreased lung compliance.
Maintenance of nutrition and hydration by IV route.
Maintenance of acid base balance
Surfactant therapy- Via Endotracheal tube is indicated
in all neonates with RDS and prophylaxis can be given
in all premature infants. Adequate oxygenation,
39. TUBERCULOSIS
Definition
Tuberculosis is a chronic infectious disease
caused by Mycobacterium tuberculosis. Children
are susceptible to both human(mycobacterium
tuberculosis) and bovine(mycobacterium bovis)
organisms.
40. Prevalence
TB is the 8th leading cause of death in
children between 1 and 4 year of age
Children have a lower prevalence rate (5-
10%) as compared o adolescents(10-
35%) and adults(30-50%).
41. Epidemiology
Agent : Mycobacterium tuberculosis, M. bovis
Reservoir : Infected patient
Mode of infection : Droplet infection, dust,
ingestion, skin, mucous membrane, skin
Host Factors
Age : all ages affected, congenital is rare
Sex : Girls > boys at Puberty
Malnutrition : more succeptible
Intercurrent infections : eg measles, whooping
cough
Environment : overcrowding, inadequate
42. Pathophysiology
Pathophysiology
1. Tuberculosis bacillus present in the lungs of infectious person (by
droplet inhalation)
2. Inhaled tubercle bacilli gets lodged in the pulmonary alveoli
3. Cause inflammation with hyperemia & congestion in lungs
4. Cells such as macrophages, histocytes appear in the area of
inflammation
phagocytosis begins
5. Pulmonary alveoli get filled with exudates comprising of fibrin,
leukocytes, phagocytes and tubercle bacilli
6. The central part of inflamed area is necrosed
7. Bacilli may enter the lymphatics and bloodstream and are carried to
different part of body
43. Clinical features
Incubation period varies between 4 and 12 weeks.
fever
Malaise
Weight loss
Coughing
Night sweats
Anorexia
Hemoptysis (rare)
Respiratory rate change
Poor expansion of lungs
Diminished breath sound
Anemia , weakness & weight loss
44. Diagnostic evaluation
History of contact
Mantoux test
Chest x-ray
BCG test
Laboratory investigation
ELISA test to detect mycobacterium
antigen and IgG , IgM , IgA
antibodies
Sputum or laryngeal swab culture
45. Drugs
1 st line anti-tuberculous drugs
Isoniazid (INAH) 5 mg/kg/day H
Rifampicin 10 mg/kg/day R
Pyrazinamide 25 mg/kg/day Z
Ethambutol 20 mg/kg/day E
Streptomycin
2 nd Line drugs
Cycloserine,
ethionamaide,
PAS,
kanamycin
capreomycin
Other drugs Eg. Quinolones, rifamycin, amikacin,
imipenem, ampicillin
46. Phases of Treatment
Intensive Phase:
Eliminate bacterial load
Prevent emergence of drug resistant strains
Atleast 3 Bactericidal Drugs used
Continuation Phase:
Continue and complete therapy
Atleast 2 Bactericidal drugs used
Steroids:
Anti inflammatory effect – millary, peritonitis,
pericarditis
TB meningitis RNTCP Treatment
47. Nursing management
Proper nutritious diet
Adequate res must be provided to
children
Avoidence of infection
Regular immunization
Proper coughing and sneezing technique
by covering the mouth & nose
BCG vaccination should be carried out
for all children at birth or within 3 months
of age
Parents are explained about the need of
49. Bronchial asthma
Definition
Asthma is a chronic inflammatory disease ,
characterized by airway obstruction, airway
inflammation and an increased responsiveness of
trachea and bronchi to various stimuli.
incidence
Most cases have origin in first 2 year of life. Peak
incidence is seen in 5-10 years of age. Boys
suffer twice as much as girls.
59. Cystic fibrosis
Definition
Cystic fibrosis is an autosomal recessive disorder
that affects epithelial cells of the respiratory ,
gastrointestinal and reproductive tracts and leads
to abnormal exocrine gland secretion
Cystic fibrosis is a disease passed down through
families that cause thick, sticky mucus to build up in
the lungs, digestive tract and other areas of the
body.
62. Diagnostic evaluation
Sweat (chloride) test
Genetic test- blood and cheek scraping
cell can tested for mutation in the
CFTR(cystic fibrosis transmembrane
conductance regulator)<cell protein>
Chest x-ray
PFT
Sputum culture
Stool evaluation- tested for fat absorption
63. Management
At present there is no cure for CF.
Treatment may include;
Chest physiotherapy
Exercise
Medications(bronchodialators, anti inflamatory
drugs)
Antibiotics
Management;
Appropriate diet
Vitamin supplements
Psychological support
Newer therapies include lung transplantation
65. Lung abscess
Definition
A localized area of destruction of lung
parenchyma in which infection by pyogenic
organisms results in tissue necrosis &
suppuration .
66.
67. Types
Primary abscess: it occurs in previously
normal lungs and may follow aspiration.
Secondary abscess: it occurs in patient
with an underlying lung abnormality.
68. Clinical features
Cough
Fever
Dyspnea
Chest pain
Vomiting
Sputum production
Weight loss
Hemoptysis
Decrease breath sound
Tachypnea
Crackles
71. Management
IV antibiotics are given usually for about 2-
3 weeks.
Perform surgery( lobectomy,
pneumonectomy)
Supportive measures include:
Analgesics
Oxygen , if required
Rehydration , if indicated
Postural drainage with chest physiotherapy