lower-acute bronchitis,bronchitis,pneumonia,respiratory distress syndrome chronic- tuberculosis,asthma,cystic fibrosis,lung abscess

1. #LOWER RESPIRATORY DISORDER
#CHRONIC RESPIRATORY DISORDER
DISORDER OF RESPIRATORY SYSTEM

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.

3. Lower respiratory disorders
Including:
 Acute bronchitis
 Bronchiolitis
 Pneumonia
 Respiratory distress syndrome

4. Chronic respiratory disorders
Including:
 Tuberculosis
Asthma
Cystic fibrosis
Lung abscess

5. Lower respiratory disorders ACUTE
BRONCHITIS

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

9. Diagnostic evaluation
History collection
Physical examination
Chest auscultation
Chest x-ray

10. Management
Administration of:
Antibiotics
Cough expectorant
Antipyretic
Steam inhalation

11. Bronchiolitis

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

13. CLINICAL FEATURES
 Dyspnea ( rapid shallow breathing )
 Mild to moderate fever
 Nasal flaring
 Cyanosis
 Runny nose
 Cough
 Wheezing
 Intercostal retraction
 Widespread crepitations

14. diagnostic evaluation
Chest x-ray
Viral test- collect a sample of
mucus
Blood test

15. Management
 Oxygen administration
 Maintaining atmosphere well
saturated with water vapour
 Mild sedation
 Postural drainage
 Iv fluid are given to combat
dehydration
 antibiotics

16. Pneumonia

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

22. Pathophysiology

23. Diagnostic evaluation
 History collection
 Chest x-ray
 Blood culture
 Isolation of organism from
nasopharynx by culture or PCR
 Blood test

24. Management
Medical management-
 ANTIBIOTICS;
penicillin,amoxicillin,erythromycin,
azithromycin ,clarithromycin
 ANTIPYRATICS

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

26. COMPLICATION
 Pleural effusion
 Emphysema
 Pneumatocele
 bronchiecasis

27. Prevention
Two vaccine are available to prevent
pneumococcal disease.
 Pneumococcal conjugate vaccine (PCV13)
 Pneumococcal polysaccharide
vaccine(PPSV23); pneumovax

28. Respiratory distress syndrome

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

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

32. Clinical features
 Tachypnea
 Tachycardia
 Chest wall retraction
 Expiratory grunting
 Nasal flaring
 cyanosis

33. Pathophysiology

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.

35. Shake test

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,

37. Chronic respiratory disorders
INCLUDING;
 TUBERCULOSIS
 ASTHMA
 CYSTIC FIBROSIS
 LUNG ABSCESS

38. TUBERCULOSIS

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

48. Bronchial asthma

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.

50. Etiology

53. Pathophysiology

54. Clinical features
 Severe dyspnea
 Bouts of cough
 Wheezing
 Cyanosis
 Sweating
 Restlessness
 Extreme fatigue

55. Diagnostic evaluation
 History collection
 Physical examination
 Pulmonary function test
 Blood examination
 Chest x-ray
 Allergy test

56. Management
 Medical management:
solbutam
ol

57. Nursing management
 Providing emotional support& education
 Administering adequate fluids
 Provide rest and comfort
 Evaluate resipratory status & facilitate
breathing

58. Cystic fibrosis

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.

60. Clinical features

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

64. Lung abscess

65. Lung abscess
Definition
 A localized area of destruction of lung
parenchyma in which infection by pyogenic
organisms results in tissue necrosis &
suppuration .

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

69. Diagnostic evaluation
 History collection
 Physical examination
 Chest x-ray
 CT scan
 Sputum culture
 Pleural fluid and blood culture
 Bronchoscopy

70. Complication
 Brain abscess
 Empyema
 Pneumatocele
 Bronchopleural fistula
 bronchiectasis

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