PEDIATRIC NURSING

1. Presented by
Ms ArifaT N
Second year M.Sc Nursing
MIMSCON

2.  Respiratory system
 Upper respiratory parts
 Lower respiratory parts
 Children
 Small
 Not well developed
 Very prone to get respiratory infections
 Bronchiolitis is one of the major infection
affecting to child

3. It is a serious illness, characterized by
inflammation of bronchioles, causing severe
dyspnea.
Bronchiolitis is an acute viral infection with
a maximum effect at the bronchiolar level
 Infants are the most likely candidates

4.  More or less confined to the winter and early
spring
 Primarily a disease of first 2 years of life
 Peak incidence at 6 month of age
 Both epidemic and sporadic forms occurs

5.  The exact etiology is
not clear
 Virus :
 Primary atypical
pneumonia,
 Influenza virus type
(A, B and C)
 Adenovirus
 Respiratory syncytial
virus (RSV)
 Herpes virus and
 Parainfluenza virus.
 Bacteria
 H. influenzae
 Pnenumococcus
 Streptococcus
hemolyticus
 “ Allergy”

6.  Immunosuppression
 Very low birth weight
 Lung disease
 Severe neuromuscular disease
 Complicated congenital heart defects

7. Viruses, acting as parasites, are able to invade the mucosal
cells that line the small bronchi and bronchioles
The invaded cells die when the virus bursts from inside the
cell to invade adjacent cells
The membranes of the infected cells fuse with adjacent
cells, creating large masses of cells or “syncytia”
The resulting cell debris clogs and obstructs the
bronchioles and irritates the airway.
The airway lining swells and produces excessive mucus.

8. Partial airway obstruction and bronchospasms
Air trapping, and hyperinflation of the alveoli
Areas of atelectasis
Normal gas exchange is affected, leading to hypoxemia
The child with severe RSV is at risk for apnea and
respiratory failure as hypoxemia and hypercarbia develop.

10.  Rhinitis
 Nasal flaring
 Low grade fever
 Cough
 Wheezing
 Crackles
 Tachypnea
 Poor feeding
 Vomiting
 Diarrhea
 Dehydration
 Irritability
 Lethargy
 Poor fluid intake
 Distended abdomen
 Cyanosis

11.  History
 Clinical presentation and chest examinations
 X ray :
 Emphysema,
 Prominent bronchiovascular markings and
 Small areas of collapse.
 Overinflated lungs
 wide intercostal space
 ELISA
 ABG analysis
 Virology

12.  Supportive care at home
 Respiratory and contact isolation
 Humidified oxygen therapy
 Hydration : oral or parenteral
 Moderate to severe cases : CPAP
 Medications
 Bronchodilators (Neb: salbutamol or epinephrine (racemic
or levo)
 Corticosteroids
 Epinephrine
 Nebulization with hypertonic saline
 Antibiotics for bacterial origin
 Antiviral agent (ribavarin (Virazid))

13.  Intramuscular palivizumab (Synagis) provides
passive immunity to help protect these high-
risk infants. A dose of 15 mg/kg is given every
30 days for 5 months beginning in October or
November at the onset of the RSV season.

14.  Bronchodialators, Expectorents,
corticosteroids and oxygen administration
 Diet therapy
 Respiratory therapy
 Occupational therapy

15.  Assessment
 Complete health history
 Examination
▪ Rate and character of respirations,
▪ breath sounds (rales, ronchi)
▪ Retractions,
▪ Inspiratory and expiratory efforts,
▪ Use of accessory muscles etc.
▪ Cyanosis
▪ Diaphoresis
▪ Hydration and poor capillary refill
 Psychological assessment

16.  Nursing diagnosis
 Ineffective breathing pattern
 Ineffective airway clearance
 Activity intolerance
 Interrupted family process
 Parental anxiety
 Risk for injury

17.  Planning and implementation
 Maintaining respiratory function
▪ Close monitoring
▪ Saline nasal drops
▪ Elevation of head end
▪ Supplemental oxygen
▪ Medications
 Support physiological function
▪ Promote rest and comfort
▪ Suction nasal passages before feeding
▪ Small and frequent diet
▪ Oral and IV fluids for rehydration

18.  Reduce anxiety
▪ Thorough explanation and daily updation
▪ Reassurance
 Discharge planning and home care teaching
▪ Teach proper administration of medications
▪ Educate about recurrence and how to recognize
symptoms

19.  Evaluation
 The Childs respiratory rate is within normal range
and has no signs of respiratory distress
 Hydration level
 Feeding
 Parents express confidence in caring of the child

21. Asthma is a common chronic disorder in
children characterized by bronchial
constriction, hyperresponsive airways, and
airway inflammation.

22. Bronchial asthma, now regarded as a
chronic inflammatory disorder of the lower
airway is characterized by bouts of dyspnea
(predominantly “expiratory”), as a result of
temporary narrowing of the bronchi by
bronchospasm, mucosal edema and thick
secretions.

23.  Most cases have had its origin in the very first 2
years of life.
 The peak incidence is, however, seen in 5 to 10
years of age group.
 Boys suffer twice as much as the girls. The illness
too is more severe in them.
 Incidence in school-going age is around2%.

24.  Triggers/excitatory factors
 Allergy to certain foreign substances
▪ Inhalants like pollen, smoke, dust* and powder,
▪ Foods like egg, meat, wheat and chocolate,
▪ Food additives, and
▪ Drugs like aspirin and morphine
 Respiratory infection:
 commonly viral
 Emotional disturbances
 Exercise: “exercise-induced asthma”
 Change of climate/weather
 Puberty changes:
 Endocrinal changes

25.  Predisposing Factors
 Heredity: A family history of asthma or some
other allergic disorder is often forthcoming.
 Childhood infections like measles and pertussis.
 Constitution: An asthmatic child is basically
labile, highly stung and over conscientious

26.  Factors ending up with lower airway
obstruction in asthma include:
1. Mucosal inflammation (especially edema)
2. Excessive mucosal secretions (mucus,
inflammatory cells, cellular debris)
3. Bronchial hyperresponsiveness with
bronchospasm

27. Three types of asthma are:
 Extrinsic: This is IgE-mediated and precipitated
by an allergen
 Intrinsic: This is non-IgE-mediated and
precipitated by a respiratory infection (usually,
viral)
 Mixed: This is usually exercise-induced or aspirin
induced

28.  Exposure to an allergen which interacts with
specific mast cell bound IgE, reaction occur in
two phases:
 Early Phase/Reaction
▪ Within minutes, mast cell release histamine, leukotriens C, D
and E, prostaglandins, platelet activating factor and bradykinin
causing mucosal edema, secretion and bronchospasm
 Late Phase/Reaction:
▪ This is characterized by clinical manifestations of asthma. It
follows 3-4 hours later with release of mast cell mediator

29.  Onset of an asthmatic paroxysm is usually sudden and often
occurs at night
 Asthmatic aura
 Tightness in the chest,
 Restlessness,
 Polyuria or itching
 A typical attack consists of
 Marked dyspnea, bouts of cough and chiefly “expiratory
wheezing”.
 Cyanosis, pallor, sweating, exhaustion and restlessness are often
present.
 Pulse is invariably rapid.
 Children with severe bronchial asthma over a prolonged
period may develop a barrel-shaped chest deformity.

30.  Clinical profile
 Detect the responsible allergen.
 A peak expiratory flow (PEFR) meter is very
useful in confirming diagnosis of asthma

31.  Specific Measures
 Acute Mild Exacerbation
▪ Beta2 agonists (oral, inhalation (MDI with spacer) or
nebulization)
▪ Prednisolone, 1-2 mg/kg/day (O) or inhalation steroids
 Acute Moderate Exacerbation
▪ Oxygen inhalation until oxygen saturation > 95%
▪ Nebulization with beta-2 agonists, every 2minutes for one
hour, then 4-6 hourly
▪ Prednisolone, 1-2 mg/kg (O) stat and then daily for 5-7
days

32.  Acute Severe (Life-threatening) Exacerbation
▪ Immediate oxygen inhalation,
▪ Subcutaneous injection of adrenaline
▪ Nebulization with beta-2 agonists (salbutamol, terbutaline),
every 20 minutes and
▪ IV hydrocortisone, every 6-8 hourly.
 Additional Measures
 Mild sedation: Phenobarbital &Tranquilizers
 Expectorants to remove excessive secretions
 Antibiotics
 Maintenance of fluid and electrolyte balance

37.  Status asthmaticus is defined as a state in
which an asthmatic patient continues to suffer
from dyspnea in spite of administration of
sympathomimetic agents as well as
aminophylline/theophylline.
 He is a candidate for receiving treatment in an
intesive care unit.

38. Score 0 to 4 : No immediate danger
Score 5 to 6 : Impending respiratory failure
Score 7 or above : Respiratory failure
Clinical respiratory scoring system

39.  Assessment
 Identify the child’s current respiratory status first by
assessing the ABCs
 Observe the child’s color, and assess the respiratory
and heart rates
 Auscultate the lungs for the quality of breath sounds
 Inspect the chest for retractions
 Attach a pulse oximeter; a SpO2 reading of less than
92% indicates hypoxemia
 Assess skin turgor, intake and output, and urine
specific gravity.
 A spirometry reading may be attempted

40.  Assess Asthma Management

41.  Psychosocial Assessment
 Assess the child’s anxiety or fear
 Parents anxiety
 Concerns about finances, missing work, or other
family members at home

42.  Ineffective airway clearance
 Impaired gas exchange
 Fluid electrolyte imbalances
 Anxiety/ fear
 Ineffective family health management

43.  Maintain airway patency
 Humidified supplemental oxygen
 Sitting position
 Medications
 Meet fluid needs
 Oral and IV fluids
 Intake -output chart
 Avoid ice beverages
 Promote rest and stress reduction
 Group tasks
 Calm environment
 Promote relaxation and rest

44.  Support family participation
 Parents involvement in care
 Reassurance
 Provide frequent updates
 Encourage to take breaks as needed
 Discharge planning and home care teaching
 Educating parents

45.  Community based care
 Promote asthma management skills
 Child focused education
 Health maintenance
 Environmental control
 School management

46.  Reorganization of early symptoms
 Avoid asthma triggers
 Childs response to treatment