Due to immaturity of system.

Have to build up immunity.

eustachian tube starts out straight (prone to a lot of ear infections)

Tonsils grow rapidly then atrophy.

They're belly breathers and nose breathers are first.

Hyaline Membrane Syndrome. Usually in premature babies.

Result of inadequate production of surfactant. Normally release in lung tissue. Keeps alveoli expanded.

Alveoli collapse and eventually hyaline membrane forms.

Decreased O2 levels. 

May develop acutely over time.

Increased respirations (norm 30-60)

Flaring, retractions, grunting

Apneic periods and cyanosis.

Breath sounds diminished.

Ideally prior to delivery by amniocentesis.

Surfactant is produced 7-8th month.

Measure levels of lecithin, which is a major component of surfactant.

If levels are low give glucocorticosteroids if delivery is inevitable. This triggers babies lungs to make surfactant.

Once delivered will be based on symptoms and chest xray. Xray will show dark streaks and ground glass appearance.

Delays lung maturity.

They'll still do the amniocentesis.

Administer sufactant (synthetic/natural) by endotracheal tube right after birth.

Oxygen, IVS, ABGs, pulse ox.

By 1st week of life they'll produce on their own and gradually improve.

 Intrauterine stress/asphyxia usual cause.

Inhalation of meconium in utero or with first breath.

Meconium stained fluid.

Meconium stained baby-green tinge. Stress before labor for long period of time. They have meconium in lungs.

May have green stain to skin.

Tachypnea, dyspnea at birth.

Grunting, flaring, retractions

Hypothermia, hypoglycemia, hypocalcemia

Cyanosis, pallor, hypotonia (very limp)

DX: the fluid breaks. take laryngscope and look into respiratory tract ot see if baby inhaled meconium.

xray-patches/streaks in lungs and atelectasis. Based on symptoms.

TX: suctioning prior to delivery of chest when head is out. Oxygen therapy. Possibly ventilator. IVs. Antibiotics. Corticosteriods.

Sudden Infant Death Syndrome (SIDS)

"Crib Death"
 

Sudden death of basically healthy infant.

Cannot explain why the child died even after autopsy.

Risk factors: 2-4 months, winter months, males, ethnic descent, prematurity, low birth weight, recent mild illness

Brainstem abnormality in regulation of cardiorespiratory control.

Maternal Risk Factors: smoking during pregnancy, poor prenatal care, substance abuse, and exposure to tobacco smoke after birth.

Sudden Infant Death Syndrome (SIDS)

Autopsy

Will show pulmonary edema and evidence of intrathoracic hemorrhages, but there's no conclusive cause of death.

Once one child dies from SIDS it increases any subsequent children dying from SIDS by 4-5 times.

Child not breathing

But unusual sounds/cries prior to episode.

Frothy, blood tinged fluid.

Skin white ashen color, cool.

Autopsy is the only conclusive way to determine.

Preventions: back to sleep.

Apnea monitoring for subsequent children.

Parents deal with guilt, blame self, caregivers.

Extensive support for parents adn siblings.

Infection/inflammation of smaller airways/bronchioles.

Cause: usually RSV (respiratory syncytial virus) or other virus.

Secretions block airways.

Happens to children under age 3. Usually 2-5 months.

They're membranes swell. RSV transmitted by droplet.

Starts with rhinorrhea and low grade fever.

Progresses to deep cough, wheezing, tachypnea, retractions, flaring, cyanosis (alll signs of respiratory distress)

Also have listlessness, anorexia, irritability, dehydration becomes a concern.

DX: ELISA test (enzyme linked immunosorbent assay)-looks for antibodies. CXR may also confirm.

TX: Treat the symptoms b/c it's viral.

Cool humidified O2.

Meds PRN to maintain patent airways, decrease inflamm, and thin secretions.

Adequate fluid intake.

Possible administration of Ribavirin. (antiviral agent for higher risk pts who have other resp issues/cardiac issues. It's expensive and aersol admin. Has toxic effects. Used as last resort)

Contact precautions/isolation

Close respiratory monitoring

Monitor hydration/nutrition status

Term represents group of respiratory illnesses.

Result of inflammation of larynx, trachea, and large bronchi.

Characteristic barking cough (not seen with all types)

Can be a viral/bacterial cause.

Croup Syndrome

Epiglottitis (acute)

Inflammation of the epiglottis

Caused by bacterial infeciton.

Potentially life threatening.

Hib vaccine to decrease incidence.

2-6yrs old get it.

Croup Syndrome

Epiglottitis

S/SX

Symptoms develop rapidly

Sudden high fever, sore throat, dysphagia.

Drooling, tripod position (leaning forward)

Epiglottis is red and edematous.

**Do not use tongue blade/initiate gag reflex!!!**

No cough/struggling to breathe/anxious

Croup Syndrome

Epiglottitis

DX & TX

DX: based on symptoms

TX: have intubation equipment on hand.

Humidified O2.

IV antibiotics.

24-48hrs starts clearing up.

Close repiratory observation.

Croup Syndrome

Acute Laryngotracheaobronchitis LTB

Most common type.

Usually viral cause, follows upper respiratory infection.

Inflammation of mucosa lining, larynx, and trachea.

Children 5 and under.

Croup Syndrome

Acute Laryngotracheaobronchitis LTB

S/SX

Gradual onset of low fever, barking seal like cough usually worse at night.

Inspiratory stridor, retractions, nasal flaring, tachypnea, tachycardia, restlessness, irritability. (signs of resp distress)

Croup Syndrome

Acute Laryngotracheaobronchitis LTB

DX & TX

DX: Clinical findings. CXR to rule out certain things.

TX: maintain patent airway.

Mild cases managed at home.

High humidity & cool air.

Nebulized epinephrine if needed.

Possible corticosteroids.

Antibiotics if bacterial.

Close monitoring of respiratory status.

Bedrest, fluids as tolerated.

Croup Syndrome

Acute Spasmodic Layrngitis

Attacks of laryngeal obstruction

Occur mainly at night. "Midnight Croup"

Mild to no signs of inflammation

Child usually between ages of 1-3 yrs.

Cause: Unknown, possible infectious or allergen origin.

Acute Spasmodic Layrngitis

S/SX

Child awakens with barking cough, hoarseness, respiratory difficulty, restlessness increases

S/SX subside in a few hours.

Acute Spasmodic Layrngitis

TX

Managed at home with cool air or warm mist.

Disease is self limiting. Parents should be instructed to seek help if S/SX worsen or persist.

Croup Syndrome

Tracheitis

Bacterial infection of upper trachea.

Most often kids under 3 yrs.

It's serious. Can cause respiratory arrest.

It's a possible complication of LTB (acute laryngotracheaobroncitis).

Causes: Staph aureus or H influenza

Tracheitits

S/SX & TX

S/SX: Similiar to LTB, but doesn't respond to TX (cool air).

They have HX of upper respiratory infections, cough, stridor, high fever.

Major sign: thick purulent secretions. 

This can lead to respiratory arrest by obstructing airways.

TX: Aggressive and may include intubation, antibiotics, antipyretics, O2.

Tonsils are lymphoid tissue that filters and protects respiratory and GI tracts and have a role in antibody formation.

3 sets

pharyngeal: adenoids

palatine: faucial (visible and enlarge, come out with tonsillectomy) Inflamm of the palatine tonsils can be viral/bacterial.

lingual

Tonsillitis & Adenoiditis

S/SX

Difficulty swallowing and breathing. 

Sore throat, mouth breathing (adenoids inflammed)

Halitosis, cough.

Occasionally otitis media.

Tonsillitis and Adenoiditis

DX & TX

DX: Culture

TX: Antibiotics if bacterial

Analgesics and antipyretics. Encourage fluids.

Surgical intervention only if causing difficulty breathing or eating or repeated episodes. Don't usually do before age 3-4 because they can grow back. Tonsils also can shrink when they get older and that may solve they problem.

Tonsillitis and Adenoiditis

Post OP Care

Bleeding is a BIG concern. Especially when they're older.

Provide comfort, minimize activity.

Side lying/prone until fully awake to prevent aspiration.

Discourage coughing, clearning throat, or blowing nose b/c it causes irritation.

Watch for hemmorhage. They'll have frequent swallowing, be restless and tachycardiac, vomit bright red blood. Can happen 5-7 days after surgery.

Need liquids and soft food. Avoid red liquid, milk and spicy foods up to 2 weeks after surgery.

Inherited disorder of the exocrine/mucous producing glands.

Effects primarily caucasians.

Defective chloride ion and water transport across cell membranes.

Thick mucous produced obstructs organs: pancreas, liver, reproductive system, lungs.

They'll have an increase in sodium and chloride levels in both saliva and sweat sometimes 2-5 times higher than normal.

Cystic Fibrosis

S/SX

Meconium ileus because of the thickness and stickiness. Distention and possible vomitting.

Salty taste on skin. Steatorrhea (fatty stools with mucuos)

Respiratory system biggest problem:

Increase thick mucous & resistance to ciliary action

Frequent upper respiratory infections

Altered gas exchange

Cystic Fibrosis 

Long Term Effects

Clubbing of Fingers & barrel chest

Atelectasis

Emphysema

Pulmonary fibrosis

Eventually pneumothorax

Right ventricular hypertrophy

Cystic Fibrosis

DX

Based on family HX

Symptoms of failure to thrice

Stool analysis for fat and enzymes

Sweat test analyze and CXR

Cystic Fibrosis

TX

Primary Goal: Improve quality of life and provide long term survival.

Pancreatic enzymes help improve digestion of fats and proteins.

Diet changes: increased carbs & proteins and low fat.

Salt and vitamin supplements: ADEK (fat soluble)

Meds as needed: bronchodilators to thin secretions

Chest physiotherapy & exercise program as tolerated.

Chronic inflammation disorder of airways.

Edema of bronchial mucosa.

Increased mucus production

Bronchial muscle spasms

Often triggered by allergic reaction, stress, cold, and exercise. The cells release histamine.

Periods of exacerbations and remission.

Asthma

S/SX & DX

S/SX: Suddenly or over several days dry, hacking cough

Tightness in chest

Wheezing, dyspnea

DX: Based on hx, symptoms, sometimes CXR

Asthma

TX

Focus on preventing symptoms and reoccurence and attacks.

Avoid triggers.

Keep diary, clean carpets, get rid of pets, stop smoking.

Regulation of meds: bronchodilators, antinflmmatories, and other as ordered.