IT INCLUDES THE UPPER AND LOWER RESPIRATORY TRACK DISORDERS IN CHILDREN WITH THEIR PREVENTIVE MANAGEMENT. AND IN THIS SLIDE ALSO ENLISTED THE NURSING DIAGNOSIS.

1. SEMINAR ON
RESPIRATORY
DISORDERS
SUBJECT- CHILD HEALTH NURSING
MR. ABHIJIT BHOYAR
M. SC. NURSING
CHILD HEALTH

2. INTRODUCTION

3. Anatomy and physiology of The
Respiratory System

4. Respiratory Tract
Disorders
 Tonsillitis
 Choanal atresia
 Epistaxis
 Aspiration
 Broncheolitis
 Bronchopneumonia
 Asthma
 Cystic fibrosis
Upper respiratory
Tract Disorders
Lower Respiratory
Tract Disorders

5. TONSILLITIS
 Inflammation of the tonsils and especially the
palatine tonsils typically due to viral or
bacterial infection and marked by red enlarged
tonsils usually with sore throat, fever, difficult
swallowing, hoarseness or loss of voice, and
tender or swollen lymph nodes

6. Acute Tonsillitis
 Catarrhal tonsillitis-: it usually present
with URI and measles. It is least severe
form and manifested as redness and
sore throat.
 Follicular tonsillitis-: There is
involvement of crypts with discrete
yellow patches of exudate On tonsils
and enlargement of regional gland.
 Parenchymatous tonsillitis-: There is
congestion and swelling of the entire

7.  Peri – tonsillar abcess-: It may develop in
bacterial tonsillitis.
 The child may present with trismus and muffled
voice with poor oral intake, severe pain on
swallowing and opening of the mouth, high fever,
offensive breath, enlarged cervical lymph glands
and otalgia.
 On examination of the throat, unilateral bulge in
the soft palate and peritonsillar region with vulvar
deviation to the opposite side are scene.

8. Chronic
Tonsillitis
 Chronic follicular tonsillitis-: Here tonsillar crypts are full
of infected cheesy material which shows on the surface as
yellowish spots.
 Chronic parenchymatous tonsillitis-: There is hyperplasia
of lymphoid tissue Tonsils are very much enlarged and may
interfere with speech, deglutition and respiration. Attacks of
sleep apnoea may occur.
 Chronic fibroid tonsillitis-: Tonsils are small but infected,
with history of repeated sore throats.

9. ETIOLOGY
 Viral infection -
includes adenovirus, rhinovirus, influenza, cor
onavirus
 Bacterial infection - Group A β-hemolytic
streptococcus

10. PATHOPHYSIOLOGY
 As with pharyngities, the cause may be viral or bacterial.
 As a result of inflammation, the tonsils, palatine or
faucial, enlarge.
 They may meet in the midline and obstruct the passage
of food and air.
 If the adenoids are also involved, they may block the
posterior nares, resulting in mouth breathing.
 In addition, the Eustachian tubes may be blocked
resulting in otitis media.

11. Clinical Manifestation
 Sore throat
 Red, swollen tonsils
 Pain when
swallowing
 High temperature
(fever)
 Coughing
 Headache
 Tiredness
 Chills
 A general sense of
feeling unwell
(malaise)
 White pus-filled
spots on the tonsils
 Swollen lymph
nodes (glands) in
the neck
 Pain in the ears or
neck

12. Cont......
Less common symptoms
include:
 Nausea
 Stomach ache
 Vomiting
 Furry tongue
 Bad breath (halitosis)
 Voice changes
 Difficulty opening the
mouth (trismus)

13. DIAGNOSIS
 The diagnosis of GABHS tonsillitis can be
confirmed by culture of samples obtained by
swabbing both tonsillar surfaces and the
posterior pharyngeal wall and plating them on
sheep blood agar medium.
 The isolation rate can be increased by
incubating the cultures
under anaerobic conditions and using selective
growth media. A single throat culture has a
sensitivity of 90%-95% for the detection of
GABHS

14. MANAGEMENT
 Warm saline gargles, throat lozenges and analgesics
can relieve discomfort and congestion.
 Nutrition can be supplied by feeding the children with
a soft well cooked, and nonirritating diet.
 Antibiotics if needed, should be given as for the
prescribed period
 If a surgery is needed, the children and parents
should be prepared psychologically, for the operation.

15. Preoperative Care
 Assessment of the patient should be done for the
other respiratory function.
 History about the bleeding tendency should be
considered.
 Examination for bleeding and clotting time are
necessary.
 Loose teeth should be taken care.

16. Post-operative care
 Proper position should be given to avoid aspiration.
Children are placed in the prone position to help the
drainage of secretion.
 When children become alert, they may like the
sitting position
 Comfort measures are necessary to relieve pain.
Analgesics are helpful.
 Pulse and respiration are checked for four hours.
Especially patient should be observed for
haemorrhage.
 Patient should be discouraged to cough and clear
the throat, to prevent bleeding.

17.  If there are no signs of haemorrhage and if patient
become fully alert, the clear fluids can be started.
 Parents should be explained and advised about the
care to be provided at home.
 Due to sore throat, there may be a discomfort in the
ear, on swallowing, for a few days.
 Diet should be followed for 8-10 days.
 Children should be avoided exposure to infection

18. COMPLICATION
 Peritonsillar abscess.
 Parapharyngeal abscess.
 Intra tonsillar abscess.
 Tonsilloliths.
 Tonsillar cyst.

19. CHOANAL ATRESIA
DEFINITION
 Failure of the nasal
cavities to open
posteriorly into the
nasophrynx (choanae)
during fetal development
is called choanal atresia.

20. CAUSES
 Choanal atresia is a developmental abnormality.
 The anomaly is present at birth and can be associated
with other developmental abnormalities.
 There is no known specific cause of choanal atresia.
 Most believe that choanal atresia occurs when the tissue
that separates the nose and mouth area during fetal
development remains after birth

21. PATHOPHYSIOLOGY
 This condition is congenital obstruction of the
posterior nares at the entrance to the
nasophrynx.
 The obstruction is usually caused by a
membranous septum may be caused by a bony
growth.

22. TYPES
 Unilateral choanal atresia is more common, less
serious, and sometimes appears later in childhood
because the child has been able to manage while
breathing through only one side of the nasal
passage.
 Bilateral choanal atresia is life-threatening
and symptoms appear immediately after
birth. Babies breathe only through their noses
when they are very young, so the blocked nasal
passages will cause extreme difficulty breathing.

23. CLINICAL FEATURES
 Difficulty breathing after birth
 Inability to breath and feed simultaneously
 Persistent one sided nasal blockage or
discharge
 Retraction of the chest when child cries or
breaths through mouth

24. DIAGNOSIS
 CT scan
 Endoscopy of the nose
 Sinus x-ray

25. TREATEMNT
 Treatment of choanal atresia is surgical.
 A variety of approaches available and include
transplatal, transnasal and transseptal techniques.
 Drilling may be required to create a new passage
for bony atresia.

26.  Stents are placed in
the nasal passage
to prevent
resenosis. These
are left in place for 3
to 6 weeks and
require close
nursing care to
prevent blockage.

27. NURSING MANAGEMENT
 The nursing care of infants having choanal
atersia is directed at keeping the nostrils clean
and preventing upper respiratory infections,
 Infants who have bilateral choanal atersia may
need to be gavaged until the defect is corrected.

28. Complications
 Aspiration while feeding and attempting to breathe
through the mouth
 Respiratory arrest
 Renarrowing of the area after surgery

29. EPISTAXIS
 Bleeding from the nose
occurs frequently in
children. Bleeding
occurs usually from
anterior-inferior portion
of the cartilaginous
nasal septum due to rich
capillary vasculature in
this zone known as
little’s area or
kiesselbach’s plexus.

30. ETIOLOGY
Local factors
 Blunt trauma
 Foreign bodies
 Inflammatory reaction
Other possible factor
 Anatomical deformities
 Insufflate drugs
 Intranasal tumours
 Low relative humidity of inhaled air
 Nasal cannula O2

31.  Nasal sprays
 Surgery
 Vitamin C and vitamin K deficiency

32. PATHOPHYSIOLOGY
 Epistaxis is caused by external trauma, foreign bodies, forcible
blowing of the nose or picking the nose.
 Allergic rhinitis or sinusitis may also lead to nosebleed.
 The strain of emotional excitement or physical exercise may be
enough to start nasal bleeding.
 A circulatory, renal, or emotional condition that produces elevated
blood pressure cause nasal haemorrhage. It may also result from
rheumatic fever, a blood dyscrasia, or an infection.

33. MANAGEMENT

35. Nursing Management
 Details family history and history of illness to be
obtained and necessary investigations to be performed.
 Blood transfusion may be necessary in some children
with epistaxis
 Continues monitoring of vital signs, bleeding, hypoxia,
respiratory difficulty and nasal packing.
 Teaching the parents and family members about
measures to stop epistaxis and immediate medical help
are also important.

36.  Instructions to be given to the parents to apply
lubricant to nasal septum twice daily to reduce
dryness and to avoid nasal blowing or picking nose
after nose bleed
 Preventive measures of foreign body in the nose,
nasal injury and solar radiation to be explained.
 Need for management of local and systemic cause
of epistaxis should be informed and emphasized.

38. CLINICAL
MANIFESTATION
 Atlectasis
 Bronchiectasis
 Pulmonary abcess
 Choacking
 Gaging
 Strider
 Cyanosis

39. TREATMENT
 Laryngoscopic or bronchoscopic removal of the
foreign body may required. If lodged in the larynx,
a tracheostomy may necessary to maintain the
respiration, until further treatment is given.
 Antibiotics may be prescribed to prevent
infection.
 Patients need observation for a further
change in the signs

40. NURSING
MANAGEMENT
 Infants and children many times do not
cough up aspirated foreign bodies, which
should be there for be removed promptly
under direct vision by laryngoscopy or
bronchoscopy.

41.  Prompt removal prevents local tissue
inflammation, which makes later removel
more difficult. If, for instance, a vegetal
foreign body such as a portion of a peanut
remains in a bronchus, the peanut swells,
hampering removal and sometime
necessitating a lobactomy.
 If complication such as secondary infections
occurs, they should be treated with
appropriate antibiotics.

42. PREVENTION
 Provide only sturdy, well constructed rattles for
infants.
 Provide only pacifiers that have a one piece,
durable construction
 Remove small parts that could be aspirated or
swallowed from toys.
 Remove diaper or safety pins, buttons, small whole
or broken parts of toys, and other small objects from
areas where infant can reach

43.  Do not permit infants to play with balloons.
 Remove small objects from the floor
before the infant is placed there and from
the crib when the infant is sleeping.
 Do not give the infants nuts, lozenges,
other hard candies, fruits that contain pits
or seeds.

44. BRONCHEOLITIS
Bronchiolitis is inflammation of the bronchioles,
the smallest air passages of the lungs.

45. ETIOLOGY
 Respiratory syncytial virus is implicated in most
cases.
 Other causative organisms include adenovirus,
influenza, parainfluenza corona virus and
rhinovirus also cause broncheolitis.

46. PATHOGENESIS
The inflammation of the bronchiolar mucosa
edema, thickening, formation of mucus plugs and cellular
derbis. Bronchiolar spasm occurs in some cases.
The bronchial lumen, which is already narrow in the
infants, is further reduced.
Resistance to the airflow is increased both during
inspiration and expiration. During expiration the
bronchioles are partially collapsed

47. This leads to trapping of the air inside the alveoli causing
emphysematous changes. When obstruction becomes
complete, the trapped air in the lungs may be absorbed
causing atelectasis.
Due to diminished ventilation and diffusion, hypoxemia is
produced in almost all of these infants, retention of carbon
dioxide leads to respiratory acidosis

48. CLINICAL
FEATURES
 Difficulty in breathing
 Prolonged expiration
 Persistent dry cough makes children restless and
exhausted
 Fever and dehydration
 Cyanosis
 Inadequate intake of food may be due to cough and
discomfort while swallowing.

49. INVESTIGATION
 X-ray shows
overinfilteration of
lungs
 Throat swab may be
examined for
virology study

50. TREATMENT
 Antibiotics are prescribed to treat the bacterial infection
 Acidosis may corrected by sodium bicarbonates and patient is
monitored with the blood gas studies
 Humidified oxygen is required to relieve hypoxia
 Humid atmosphere can be maintained by placing a vessel of
boiling water in a room to have a warm and humid
atmosphere.
 Maintenance of fluid and electrolyte balance is essential in
severe cases intravenous fluid is required, to maintain
nutrition and hydration

51.  A recent Cochrane review on use of bronchodilators in
bronchiolitis suggests that salbutamol with ipratropium
inhalation may provide some benefit and there may be
some beneficial effect of inhaled epinephrine.
 Continues positive airway pressure (CPAP) or assisted
ventilation may be required to control respiratory
failure.

52. Nursing Management
 The nasal passage of infants should be cleared because
infants are nasal breathers
 The respiration should be monitored and the oxygen
should be administered as required.
 Patients may be placed in a propped up position, with a
pillow under the shoulder and head.

53.  The position should be changed every two
hours.
 In the stage of a dyspnoea, nasogastric
feeding can be given because the infants
refuse oral feeding.

54. BRONCHOPNEUMONIA
 DEFINITION
It is the acute inflammation of the walls of
the bronchioles. It is a type
of pneumonia characterized by multiple foci of
isolated, acute consolidation, affecting one or
more pulmonary lobules.

55.  Most cases of
bacterial pneumonia
are caused by the
bacterium Streptococ
cus pneumonia;
however, it is not
uncommon for
pneumonia to be
caused by more than
one type of bacteria.
 Staphylococcus
aureus
 Haemophilus
influenzae
CAUSES Other possible
culprits include

56. RISK FACTORS
 being age 2 or younger
 having a lung disease,
such as cystic
fibrosis, asthma, or
chronic obstructive
pulmonary disease
(COPD)
 having HIV/AIDS
 having a chronic
 having a weakened
immune system, which
may be caused
by chemotherapy or use
of immunosuppressive
drugs
 being on a ventilator
 smoking
 heavy alcohol use
 trouble coughing or
swallowing
 being malnourished

57. PATHOPHYSIOLOGY
Due to etiological factors
accumulation of mononuclear cells in the submucosa and
perivascular space,
partial obstruction of the airway.
They clinically manifest as wheezing and crackles.
Disease progresses when the alveolar type II cells lose
their structural integrity and surfactant production is
diminished, a hyaline membrane forms, and pulmonary
edema develops.

58. CLINICAL FEATURES
 Fever
 Cough that brings up
mucus
 Shortness of breath
 Chest pain
 Rapid breathing
 Sweating
 Chills
 Headache
 Muscle aches
 Fatigue

59. DIAGNOSIS
 The diagnosis based on history and physical
examination.
 Complete blood count (CBC).
 An elevated number of white blood cells may
indicate a bacterial infection.
 A chest X-ray is one of the best ways to diagnose
this condition. This helps to locate the areas that
are affected by bronchopneumonia

60. Cont......
 A computed tomography (CT) scan produces a
picture similar to an X-ray but in more detail. This
will help to locate the infection is occurring in the
lungs.
 A sputum culture tests a sample of mucus from your
lungs to determine the cause of the infection.
 A bronchoscopy

61. TREATMENT
Specific treatment for pneumonia
includes:
 Rest
 Antibiotics for bacterial
pneumonia
 Inhalers for wheezing
 Albuterol Inhaler
 Proventil Inhaler
 Ventolin Inhaler
 Cough medications
 Dextromethorphan

62. Cont....
 Decongestant medications:
 Only for use in older children and adults
 Pseudoephedrine (Sudafed)
 Phenylephrine (Neo-Synephrine)
 Acetaminophen for pain and fever control
 Nonsteroidal anti-inflammatory medications for pain
and fever control
 Ibuprofen (Motrin, Advil, Nuprin, NeoProfen)
 Ketoprofen (Actron, Orudis, Oruvail)
 Naproxen (Anaprox, Naprosyn, Aleve

63. Cont......
 Oxygen therapy
 Respiratory therapy for pneumonia
Mechanical ventilation:
 Use of a ventilator to support breathing in severe
pneumonia

64. NURSING MANAGEMENT
 The observation of the respiration for the pattern,
respiratory rate and nasal flaring and for cyanosis.
Patient should be observed for any strider and
wheezing.
 Sufficient humidified oxygen should be provided.
 The behavioural changes or restlessness should be
notified.
 Position should be changed every two hours.
Comfortable semi sitting position may help to relieve

65. Cont.....
 The accurate intake and output record should be
maintained. If children are in respiratory distress,
they should not be given anything by mouth. They
should be observed for vomiting, and distension.
 Intravenous fluid may be prescribed and it should
be monitored.
 Nutritional status should be maintained
 Children should not be disturbed unnecessary.
 The body temperature should be maintained within
the normal limits.
 In some cases postural drainage and breathing
exercise during convalescent period.

66. ASTHMA
 Definition Asthma is a
condition of the lungs in
which there is a airway
obstruction due to
spasms of the bronchial
smooth muscle, edema
of the mucosa and
increased mucus
secretion in the bronchi
and bronchioles brought
on the various stimuli.

67. Types
MILD INTERMITTENT ASTHMA
 Symptoms ≤2 times a week
 Night time symptoms ≤2 times a month
 Peak expiratory flow(PEF) or forced
expiratory volume(FEV1)≥80% of predicted
value

68. MILD PERSISTENT ASTHMA
 Symptoms >2 times a week, but <1 time a
day
 Night time symptoms >2 times a month
 Peak expiratory flow(PEF) or forced
expiratory volume(FEV1)≥80% of predicted
value

69. MODERATE PERSISTENT ASTHMA
 Daily symptoms
 Night time symptoms >1 night/wk
 Peak expiratory flow(PEF) or forced
expiratory volume(FEV1)>60% and <80%
of predicted value
 PEF variability >30%

70. SEVER PERSISTENT ASTHMA
 Continual symptoms
 Frequent night time symptoms
 Peak expiratory flow(PEF) or forced
expiratory volume(FEV1) in one second is
≤60% predicted value
 PEF variability >30%

71. CAUSES
 Allergy to pollens, foods, and
antigen antibody reaction
 Infection
 Physical factors such as cold,
humidity, sudden changes in
temperature and sudden
changes in barometric
pressure
 Irritants such as dust,
chemicals, and air pollutants.
 Psychological or emotional
stress

72. PATHOPHYSIOLOGY
Asthma is the result of
chronic inflammation of
the airways which
subsequently results in
increased contractibility
of the
surrounding smooth
muscles.
This among other factors
leads to narrowing of the
airway and the classic
symptoms of wheezing.

73. Typical changes in the airways include an
increase in eosinophils and thickening of
the lamina reticularis.
Chronically the airways' smooth muscle may
increase in size along with an increase in the
numbers of mucous glands. Other cell types
involved include: T lymphocytes, macrophages,
and neutrophils
There may also be involvement of other
components of the immune system
including: cytokines, chemokines, histamine,

74. MANIFESTATIONS
 Onset may be
gradual with nasal
congestion and
sneezing
 Wzeezing
 Anxiety
 Apprehension
 Diaphoresis
 Uncontrollable
cough
 Dyspnoea
 Flaring of the
nostrils
 Cyanosis
 Hyperapnoea
 Increased pulse
 Increased
respiratory rate
 Vomiting

75. DIAGNOSTIC
EVALUATION
 Eosinophlia in the peripheral blood
 Examination of nasal secretions and sputum
 Pulmonary function studies may reveal
diminished maximum breathing capacity, tidal
volume, and forced expiratory volume.
 Blood gas and pH
 Chest X-ray

76. TREATMEN
T
Fast–acting
 Short-acting beta2-adrenoceptor
agonists (SABA), such
as salbutamol (albuterol USAN) are the first line
treatment for asthma symptoms. They are
recommended before exercise in those with
exercise induced symptoms
 Anticholinergic medications, such as ipratropium
bromide, provide additional benefit when used in
combination with SABA in those with moderate
or severe symptoms.

77. Long–term control
 Corticosteroids are generally considered the most
effective treatment available for long-term
control. Inhaled forms such as beclomethasone are
usually used except in the case of severe persistent
disease, in which oral corticosteroids may be
needed. It is usually recommended that inhaled
formulations be used once or twice daily, depending
on the severity of symptoms.

78. For emergency management other options include:
 Oxygen to alleviate hypoxia if saturations fall below
92%.
 Magnesium sulfate intravenous treatment has been
shown to provide a bronchodilating effect when used
in addition to other treatment in severe acute asthma
attacks.

79. NURSING MANAGEMENT
 The severity of attack and the degree of
respiratory distress should be observed
 Breathing pattern should be noted for expiratory
dyspnoea. It should be observed, whether the
patients use their accessory respiratory muscles
and has nasal flaring.
 The level of children anxiety should be noted.
 The patients should be observed for cyanosis.

80.  The patient should be placed fowler’s position, to
help in maximum lung expansion
 The sing of air hunger are observed, the oxygen
should be administered.
 Reassurance may help to reduce the anxiety.
 The dehydration should be treated by providing
adequate fluid.
 The normal diet can be started when the patient
can take it.

81. CYSTIC FIBROSIS
 Cystic fibrosis (CF), also known
as mucoviscidosis, is an
autosomal recessive genetic disorder that
affects most critically the lungs, and also the
pancreas, liver, and intestine. It is characterized
by abnormal transport
of chloride and sodium across an epithelium,

82. CAUSES
 GENETIC

83. CLINICAL MANIFESTATION
 Intestinal obstruction
 Chronic diarrhea
 Steatorrhea
 Recurrent respiratory tract infection
 Failure to thrive
 Rectal prolapsed
 Biliary cirrhosis of liver

84. DIAGNOSIS
 The diagnosis is suspected from the onset of
diarrhea early in infancy, usually associated with
recurrent respiratory infections. D-xylose absorption
test is normal as this monosaccharide does not
need hydrolysis before absorption. X-ray film of the
chest shows pulmonary involvement. Analysis of
the sweat for chlorides is a reliable diagnostic test.
Level of chlorides above 60mEq/L in sweat
obtained by pilocarpine iontophoresis is suggestive

85. TREATMENT
 Pancreatic supplement is given in a dose of 5 to
10 tablets daily depending on the patients
clinical response.
 Use of antacids, sodium bicarbonate and
antihistamine along with the enzyme is desirable.

86.  Taurine supplements should be given to
provide substrate for increased hepatic
synthesis of bile acids.
 In resistant cases misoprostol a
prostaglandin analogue had been used to
inhibit gastric acid secretion and stimulate
bicarbonate secretion in upper gut.
Antibiotics are administered to prevent
infection.

87. NURSING
MANAGEMENT
 Assessment of the child with CF involves both
pulmonary and gastrointestinal observations.
 Gastrointestinal assessment primarily involves
observing the frequency and nature of the stools
and abdominal distension.

88.  Periodical weighing and check up are
necessary.
 Family members are interviewed to determine
the child’s eating and eliminating habits and to
confirm a history of frequent repiratory infections
or bowel obstruction in infancy.

89. COMPLICATION
S
Respiratory system complications
 Bronchiectasis
 Chronic infections
 Nasal polyps
 Cough up blood
 Pneumothorax
 Collapsed lung

90. Digestive system complications
 Nutritional deficiencies.
 Diabetes
 Blocked bile duct
 Rectal prolapse

91. Nursing diagnosis:
 1) Impaired Gas Exchange Related To
Disease Conditions.
 2) Ineffective Thermoregulation Related To
Prematurity And Low Birth Weight; As
Evidenced By Poor Flexion And Lack Of
Subcutaneous Fat Stores Needed For Non
Shivering Thermogenesis
 3) Altered Nutrition: Less Than Body
Requirements Related To Respiratory
Distress; As Evidenced By Confinement Under
Oxyhood, Oral Gastric Tube To Drainage.