RESPIRATORY DISORDERS

Acute Pulmonary Disorders

CHOANAL ATRESIA
- back of the nasal passage is blocked
- Unilateral (one nasal passage) persistent nasal drainage & recurrent sinus
infections
- Bilateral (both nasal passages) respiratory distress & cyanosis
- abnormal growth of bony or soft tissue formed during fetal development
- Signs & symptoms: infants manages to get along with one nostril
- Danger sign: Cyanosis during bf, may improve when crying
- Non-insertion of nasogastric tube
- Diagnosis: xray (radiologic imaging) & ct scan (to confirm)
- Treatment: dyspnea (oral airway) & surgical by perforating the atresia to create
nasopharyngeal airway followed by insertion of stent/repetition of dilation to keep
airway patent
- TRANSNASAL ENDOSCOPIC SURGERY
- Nursing care: early screening (pressing the outside of nostril using finger)
- left nostril is occluded (asymptomatic); right is patent
- right nostril is occluded and cries; left nostril needs further investigation
- normal (rapid 30-60, shallow, quiet, synchronised and nasal breathing)

ACUTE SPASMODIC LARYNGITIS (CROUP)

- partial airway obstruction
- cause by viruses or fomites
- higher in children 1-3 yrsold
- parainfluenza viruses & mycoplasma pneumoniae
- bark-like, metallic cough, stridor, retractions (substernal & suprasternal),
dyspnea, cyanosis (late sign)
- 3 S (stridor, subglottic swelling, seal-bark cough)
- inflammation and edema of subglottic larynx, trachea and cricoid cartilage
- decreased mobility of vocal cords due to edema leads to HOARSENESS
- corticosteroids: decrease airway edema
- epinephrine: constricts the precapillary arterioles thus decreasing airway edema
- pulse oximetry: assess need for supplemental oxygen support & monitor for
worsening respiratory compromise
- radiography: confirm diagnosis
- COOL MIST per humidifier / OXYGEN TENT
- SHOWER ROOM FILLED WITH STEAM stay for 15-30 mins to relieve laryngeal
inflammation
 - INEFFECTIVE AIRWAY CLEARANCE RELATED TO PRESENCE OF THICK,
TENACIOUS MUCUS AND SWELLING OR SPASM OF THE EPIGLOTTIS
- DEFICIENT FLUID VOLUME RELATED TO DECREASED ABILITY OR
AVERSION TO SWALLOWING, PRESENCE OF FEVER, AND INCREASED
RESPIRATORY LOSSES
- treat fever with antipyretics (acetaminophen & ibuprofen)
- frozen juice popsicles to ease throat soreness
- avoid smoking at home (worsen child's cough)
- head elevated; extra pillow
- monitor for tachycardia, tachypnea, sternal retractions, hypoxia
- “croup rooms” mist moisten airway secretions decreases viscosity and soothes
inflamed mucosa

ACUTE BRONCHIOLITIS
- inflammation of bronchioles with accumulation of excessive mucus and exudates
causing hyperinflammation
- common in infants 6 months
- paroxysmal hacking cough, fine rales/wheezes, retraction (intercostal/subcostal),
flaring nares, irritability, restlessness, cyanosis (late)
- cool mist tent, chest percussion/vibration (as ordered), postural drainage,
epinephrine or aminophylline for severe cases
- elevate head, mist tent, hood or nasal cath (rx), bronchodilators, expectorants &
antipyretics (rx), monitor parenteral fluids (oral cool fluids)

TONSILLITIS/ADENOIDITIS
- inflammation of lymphoid tissues
- functions: defense against respiratory infections, filter and protect respi and GI
tracts by pathogenic microorganisms. Fast-growing organs of the body
- common cause: Streptococci (beta-hemolytic streptococcus A)
- obstruction of breathing, swallowing, soreness of throat, fever, foul breath,
altered senses of smell, taste and hearing
- antibiotics to control acute infection
- COOL MIST TENT: “flooding” flood tent with oxygen 15 L/min for 5 mins. adjust
flow rate 8-10 L/min for 35% oxygen
- surgical removal/excision 2 to 3 weeks after acute infection to prevent bacterial
spread to other body parts
- Complications: haemorrhage, infection (otitis media, bacteremia), emotional or
psychological sequel, lung abscesses, pneumonia
- administer preoperative med atropine sulphate to reduce oropharyngeal
secretions and prevent aspiration during surgery
 - soft to liquid diet and hydration prior to surgery
- ice collar medications
- intake of cool fluids and ice drops, avoid milk (cruds) and ice cream (thicken
mucus)
- proper positioning: prone, semi-prone or side lying to drain secretions
- avoid suctioning
- danger sign: frequent swallowing, clearing throat and vomiting of blood
- bleeding is common on 5th to 10th day, frequent swallowing indicates bleeding
- offer ice chips 1 to 2 hrs after awakening (rx) fruit juices at first, then popsicles
and cool water for first 12-24 hrs (avoid coloured juices
- apply ice collar to neck (remove if restless)
- analgesics drugs (DO NOT GIVE ASPIRINS)
- rinse mouth with cool water or alkaline solutions

PNEUMONIA
- inflammation of lung parenchyma
- pneumonitis: inflammatory of lung tissue (risk for microbial invasion)
- inflammation of lung tissue and alveoli filled with exudate
- Gram-positive bacteria (streptococcus pneumonia, beta-hemolytic streptococcus
grp A, and streptococcus pyogenes & staphylococcus aureus
- Gram-negative bacteria (haemophilus influenzae, klebsiella pneumonia)
- Viruses-causing pneumonia: respiratory syncytial virus [RSV] (influenza viruses)
- Community-acquired pneumonia (CAP) first 48 hrs hospitalisation (streptococcus
pneumoniae, H. influenza, legionella & pseudomonas aeruginosa)
- Hospital-acquired pneumonia (HAP) more than 48 hrs, most lethal nosocomial
infection (enterobacter species, escherichia coli, influenza, klebsiella species,
proteus, serratia marcescens, S. aureus and S. pneumonia)
- immunocompromised host PNEUMOCYSTIS PNEUMONIA., fungal pneumonias,
mycobacterium TB
- ASPIRATION PNEU: entry of endogenous or exogenous substances into lower
airway (S. pneumonia, H. influenza, S. aureus)
 - fever, chills, fast breathing (tachypnea), nasal flaring, dyspnea, intercostal
retractions (chest indrawing), pleuritic chest pain, crackles,
- atypical signs: anorexia (refusal to at), vomiting, diarrhea, fatigue, malaise
- RUSTY SPUTUM (greenish)
- collected for 3 consecutive days, in the morning upon waking up; no mouth
washing before sputum collection
- Arterial blood gases (ABG): hypoxemia
- antibiotics: penicillins, ampicillin, amoxicillin, cephalosporins (keflex, keflin);
aminoglycosides (kanamycin, gentamicin); tetracyclines
- non-antibiotics drugs; bronchodilators (theophylline), expectorants (guaifenesin
[robitussin])
- assess for dehydration (sunken fontanels, thirst, dry skin & mucous membrane,
poor skin turgor/non elastic skin, rapid, thread/pulse, dehydration fever, lethargy)

BRONCHIAL ASTHMA
- reversible obstructive condition of bronchi/bronchioles in response to certain
biochemical, immunological & psychological factors
- intrinsic/extrinsic triggering factors (allergens) that cause bronchospasm
- activation, perpetuation, bronchoconstriction, progression
- hacking cough, rales & wheeze expirations, dyspnea, tightness in chest, change
in LOC, restless, diaphoresis, anxiety
- PULMONARY FUNCTION TEST (PFT)
CYSTIC FIBROSIS (MUCOVISCIDOSIS)
- dysfunction of exocrine or mucus-producing glands, causing excessive
secretions and leading to obstruction and fibrotic changes
- etiology: autosomal recessive trait
- SWEAT TEST (pilocarpine iontophoretic test) reveals excessive sodium chloride
in sweat. (Chloride: 60mEq/L or over) (Sodium: 70mEq/L or over)
- stool examination and fat absorption studies
- Newborn signs: meconium ileus, wheezing breathing, weight loss
- respiratory signs: barrel chest, clubbing of fingers/toes, distended neck veins,
possible atelectasis (collapse of lungs)

TUBERCULOSIS
- ongoing (chronic) infection, kidney, spine and brain may be affected.
- mycobacterium tb (acid-fast aerobic rod)
- transmitted other parts of body (meninges, kidneys, bones and lymph nodes)
- fever, weight loss, poor growth, cough, swollen glands, chills
- TB skin test: bump develops 2 - 3 days
- Purified protein derivative (PPD) test after initial infection, 2-10 wks to develop.
always be positive