Respiratory system disorder Bsc nursing, Child heath nursing Unit 5

1. DISORDER
OF
RESPIRATORY
SYSTEM
By-
Mr. M BinandaSingh

2. RESPIRATORY TRACT

3. INTRODUCTION
• Respiratory illness are common in children under 5 years of
age.
• They have 3-8 episodes of cold or respiratory illness in a year.
• Most cases are mild.
• But one by third of all hospitalisation in this age group are due
to respiratory problems including severe asthma and
pneumonia cases.

4. DISORDERS OF RESPIRATORY CAN BE
I. APNEA OF PREMATURITY.
II. ACUTE RESPIRATORY DISORDERS.
a) Upper respiratory disorders
b)Lower respiratory disorders
III. CHRONIC RESPIRATORY DISORDERS
• TB, Asthma, Cystic Fibrosis, Lung Abscess.

5. ACUTE RESPIRATORY DISORDERS.
Upper respiratory disorders Lower respiratory disorders
1. Sinusitis.
2. Nasopharyngitis.
3. Stridor.
4. Pharyngitis/tonsillitis.
5. Croup.
6. Whooping cough(Pertussis).
1. Acute bronchitis.
2. Bronchiolitis.
3. Pneumonia.
4. Respiratory distress
syndrome.

6. I. APNEA OF PREMATURITY.
• Apnea is the cessation of breathing.
• During apnea, there is no movement of the muscles of
inhalation, and the volume of the lungs initially remains
unchanged.
• It is common problem in preterm neonates.
• It occurs in preterm neonates between 2nd – 5th days of life
due to immaturity of the brain.

7. TYPES
1. CENTRAL:
Occurs due to sepsis,
hypoglycaemia, hypocalcaemia,
temperature instability, respiratory
diseases etc…
2. OBSTRUCTIVE APNEA:
Occurs due to blockage of airway
due to secretion, improper position
like hyper flexed neck or
hyperextended neck of baby.
3. MIXED TYPE: May start either as Obstructive or Central. But
involves elements of both and becomes mixed in nature.

8. INCIDENCE
AOP occurs in at least 85% of infants who are born before 34
weeks of gestation.

9. PATHOPHYSIOLOGY
Leading to Apnea.
For premature infants, response to this stimuli is impaired
due to under development of respiratory centre of brain.
Respiratory effort is dependent on response to ↑CO2 and
lactic acid in blood. And another stimuli is hypoxia.

10. MANAGEMENT
1. PHARMACOLOGICAL MANAGEMENT
1. Aminophylline.
2. Theophylline.
3. Caffeine.
4. Doxapram.

11. 2. RESPIRATORY SUPPORT:
a) Tactile stimulation to increase the
infants alertness.
b) Oxygen supply with using oxygen
hood.
c) Continuous positive airway
pressure (CPAP).
MANAGEMENT

12. • It gets better when respiratory centre of brain is mature.
• Usually disappear after 42 weeks of age.
PROGNOSIS

13. II. UPPER RESPIRATORY DISORDERS
a) Sinusitis.
b) Nasopharyngitis.
c) Stridor.
d) Pharyngitis/tonsillitis.
e) Croup.
f) Whooping cough(Pertussis).

14. ASSIGNMENT
Q. Write a short notes on following topic.
1. Sinusitis.
2. Nasopharyngitis.
3. Tonsillitis.
4. Tonsillitis.

15. • Stridor is a noisy or high-pitched sound with
breathing.
• It is a sign that the upper airway is partially
blocked.
• It may involve the nose, mouth, sinuses, voice box
(larynx), or windpipe (trachea).
c. STRIDOR

16. STRIDOR SOUND

17. TYPES OF STRIDOR
1. INSPIRATORY STRIDOR: It suggest obstruction above
the vocal cords.
2. EXPIRATORY STRIDOR: It is present when obstruction is
in distal trachea.
3. BIPHASIC STRIDOR: when stridor is heard during
inspiration and expiration.

18. CAUSES
A. CONGENITAL B. INFECTION C. TRAUMATIC CAUSE
1. Laryngomalacia.
2. Subglottic stenosis.
3. Vascular rings.
1. Croup
2. Epiglottitis
3. Bronchitis
4. Severe tonsillitis
5. Retropharyngeal
abscess.
1. Foreign bodies in ear,
nose, respiratory
tract.
2. Fracture in neck.
3. Swallowing a harmful
substance.

19. DIAGNOSTIC EVALUATION
1. Medical history.
2. Physical examination.
3. Chest x-ray.
4. Bronchoscopy.
5. Pulse oximetry.
6. Sputum culture.

20. MANAGEMENT
The treatment depends on:
1. Age.
2. Causes.
3. Extent of the condition.
4. Child’s tolerance for specific medication, procedure or
therapies.
The treatment may includes:
1. Referral to ENT specialist.
2. Surgery.
3. Medication to reduce the inflammation.

21. CROUP

22. CROUP
‘An upper airway infection that blocks breathing and has a distinctive
barking cough’.
• Croup generally occurs in children.
• In addition to a barking cough, symptoms include fever,
hoarseness and laboured or noisy breathing.
• Most cases clear up with home care in three to five days.
• A doctor may prescribe a steroid for a persistent case.
• Rarely, a severe case may need hospital care.

24. WHOOPING COUGH
• Whooping cough (pertussis) is a highly contagious
respiratory tract infection.
• In many people, it's marked by a severe hacking cough
followed by a high-pitched intake of breath that sounds
like "whoop."
• Before the vaccine was developed, whooping cough was
considered a childhood disease.

25. SIGN AND SYMPTOMS
• Cough: Can Be Chronic Or Severe
• Nasal: Congestion, Runny Nose, Or Sneezing
• Whole Body: Fatigue Or Fever
• Also Common: Cough, Episodes Of No
Breathing, Vomiting, Or Watery Eyes.

26. VACCINES

27. TREATMENT

28. LOWER
RESPIRATORY DISORDERS

29. ACUTE BRONCHITIS

30. INTRODUCTION
“Acute bronchitis is a clinical syndrome produced by inflammation
of the trachea and bronchi.”
• It is a febrile illness, that is characterized by dry cough (worst at
night) and wheezing.
• Involves inflammation of one or more bronchi.

31. INCIDENCE
• Occurs specially in children less than 4 years of age.
• Usually associated with previous upper respiratory infection.

32. ETIOLOGY
• Viral : Adenovirus, Respiratory Syncytial Virus and
Rhinovirus.
• Bacterial: Mycoplasma Pneumoniae
• May occur with Communicable diseases: Pertussis,
Measles, Diphtheria, Typhoid.
• Physical or chemical agents : Dust, allergens, strong
fumes, etc.

33. CLINICAL FEATURES
• Runny nose (usually before cough starts).
• Malaise.
• Chills.
• Fever .
• Back and muscle pain.
• Wheezing.
• Dry non productive cough in earlier stages.
• Excessive mucous filled cough in later stages.
• Symptoms usually lasts for 7 – 14 days.

34. DIAGNOSTIC EVALUATION
• History
• Physical examination
• Chest auscultation reveals Ronchi ( low pitched wheezing
sound like snoring) and Crepitations (bubbling /crackel
sound)
• X ray chest

35. MANAGEMENT
• Antibiotics
• Cough expectorant
• Antipyretics
• Steam inhalation

37. BRONCHIOLIT
IS

38. DEFINITION
“ it is a serious illness characterized by inflammation of bronchioles ,
causing severe dyspnea”

42. ALVEOLI
• The alveoli are where the lungs and
the blood exchange oxygen and
carbon dioxide during the process of
breathing in and breathing out.
• Oxygen breathed in from the air
passes through the alveoli and into
the blood and travels to the tissues
throughout the body.

43. • It is a serious acute lower respiratory
infection of bronchioles.
• Most commonly occurs in infants aged
1 – 6 months.
• More common in winters and spring.

44. Causative organisms
• Respiratory syncytial virus (RSV) – most common
• Parainfluenza virus
• Adenovirus
• Influenza viruses
• M. Pneumoniae - (rarely)

45. CLINICAL FEATURES
A few days following upper respiratory tract infection….
• Dyspnea
• High fever
• Intercoastal retractions
• Prolonged expiration
• Crepitation. (bubbling /crackel sound)
• Ronchi ( low pitched wheezing sound like snoring)
• Nasal flaring

46. In more severe infection
• Dyspnea.
• Cyanosis.
• High fever.
• Increased antero-posterior diameter of chest.
• Faint or inaudible breath sounds.

47. DIAGNOSTIC EVALUATION
• History
• Physical examination
• Chest X ray
• Blood investigations
• Rapid test using monoclonal antibodies on
nasopharyngeal aspirate to identify RSV (Respiratory
syncytial virus).

48. PROGNOSIS
• Usually self limiting
• Symptoms subside in three to seven days.
• Death may occur in 1% of the severely ill patients due to
respiratory failure.

49. MANAGEMENT
The management is usually symptomatic
• Oxygen administration.
• Warm and humid atmosphere.
• Propped up position with head and neck elevated.
• Pulse oximetry
• Fluids and electrolytes balance should be maintained

50. • Bronchodilators (salbutamol with iprotropium and
epinephrine).
• Ribavirin (in severe bronchiolitis resulting from RSV).
• Continuous Positive Airway Pressure (CPAP) or assisted
ventilation, to control respiratory failure.
MANAGEMENT