Care of Mother and Child at Risk or with

Problems (Acute and Chronic)

LESSON TITLE: CARE OF A FAMILY OF A CHILDREN Materials:

ALTERATION IN OXYGENATION PART 2
Pen, paper, index card, book, and class List
Learning Targets:
At the end of the module, students will be able to:
1. Define the common respiratory disorders in children and References:
describe these illnesses that occur in children.
2. Integrate the knowledge of the common respiratory Pilliteri, Adele and Silbert-Flagg, JoAnne
disorders in children and describe these illnesses that occur (2018) Maternal and Child Health Nursing, 8th
in these classifications of children in formulating nursing Edition. USA: Lippincott Williams and Wilkins
care plan in giving quality maternal and child health nursing
care.

A. LESSON PREVIEW/REVIEW

Instruction: Identify the disorders of the upper respiratory tract based on its description.

A congenital obstruction of the posterior nares by an Choanal Atresia

obstructing membrane or bony growth.
An abscess can form in these lymph nodes and may Retropharyngeal Abscess
constitute a medical emergency as it may impact the
airway.
Inflammation of the larynx, trachea, and major bronchi. Croup / Laryngotracheobronchitis
Inflammation of the epiglottis, which is the flap of cartilage Epiglottitis
that covers the opening to the larynx to keep out food and
fluid during swallowing.
Inhalation of a foreign object aspirates such as a coin or a Aspiration
peanut into the airway occurs most frequently in infants
and toddlers.

B. MAIN LESSON
The instructor should discuss the following topics. Instruct students to take down notes.

BRONCHITIS
 inflammation of the major bronchi and trachea
 is one of the more common illnesses affecting preschool- and school-age children.
 It is characterized by fever and cough, usually in conjunction with nasal congestion. Causative agents include
the influenza viruses, adenovirus, and Mycoplasma pneumoniae, among others.

ASSESSMENT
 mild upper respiratory tract infection for 1 or 2 days
 fever
 a dry, hacking cough a hoarse and mildly productive and serious enough to wake a child from sleep.
 These symptoms may last for a week, although full recovery sometimes takes as long as 2 weeks.
 On auscultation, rhonchi and coarse crackles (the sound of rales) can be heard.
 A chest X-ray will reveal diffuse alveolar hyperinflation and some markings at the hilus of the lung.

THERAPEUTIC MANAGEMENT
 relieving respiratory symptoms
 reducing fever
 maintaining adequate hydration.
 antibiotic will be prescribed if bacterial infection is suspected.
BRONCHIOLITIS
 inflammation and edema of the fine bronchioles and small bronchi, usually due to a viral illness.

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 Care of Mother and Child at Risk or with
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 The most common cause of bronchiolitis is the Respiratory Syncytial Virus (RSV), although a number of other
viruses may also cause bronchiolitis.
 The most common reason for hospitalization in infancy

ASSESSMENT
 congestion, rhinorrhea, and fever.
 can progress to lower respiratory symptoms, including a cough, wheezing, and retractions.

THERAPEUTIC MANAGEMENT
 Antipyretics
 adequate hydration
 nasal suctioning
 nasal saline
 avoidance of tobacco exposure
 home monitoring are adequate.
 Hospitalization is warranted for children with severe illness, such as apnea, hypoxia, or dehydration,
which may occur due to difficulty feeding.
 Infection control and hand hygiene is important to reduce the risk of transmission
 Palivizumab, a monoclonal antibody, is recommended as prophylactic injection to prevent RSV during RSV
season.
 Injections are given monthly during RSV season.
ASTHMA
PULMONARY FUNCTION STUDIES
 a chronic inflammatory disorder of the respiratory  Pulmonary function studies or spirometry can be
track and is the most common chronic illness in helpful in evaluating children for asthma.
children  In children with asthma, the vital capacity ( the
 derived from the Greek word for “panting,” a air that they are able to exhale) may be low or the
description of the child’s distress. capacity may be normal but because of narrowed
bronchioles as a result of bronchospasm, the
RISK FACTORS expiratory rate will be abnormally long (more than
 Genetics 10 seconds rather than the normal 2 or 3
 environmental exposures seconds).
 allergens  often difficult to perform in young children
 stress because good understanding and effort is needed
 pollution, etc., to effectively perform.

MECHANISM OF DISEASE PEAK EXPIRATORY FLOW RATE MONITORING

 primarily affects the small airways.  determine the level of severity of their symptoms
 The relationship of inflammation to airway at home. Each zone (green, yellow, or red) is
hyperresponsiveness associated with treatment recommendations.
 airway obstruction contributes to clinical  These may include options for inhaler use and
symptoms. guidelines for when to call their provider or seek
 This complex interplay of factors presents as emergency care.
recurrent wheezing, breathlessness, chest
tightness, and coughing THERAPEUTIC MANAGEMENT
 history and physical examination and objective
ASSESSMENT testing to determine asthma severity and control
 episode begins with a dry cough  education for home self-management
 difficulty exhaling  control of environmental factors that contribute to
 dyspnea and wheezing (the sound caused by air symptoms (i.e., allergens)
being pushed forcibly past obstructed bronchioles)  Pharmacologic therapy, defined as quick relief
and long acting medications
HISTORY  The primary goal in asthma management is the
 Activity of the child with the time of symptoms prevention of airway inflammation.
began asthma triggers, and what treatments were  A child with mild intermittent asthma may be
given prescribed an inhaled short-acting β-agonist, such

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 Care of Mother and Child at Risk or with
Problems (Acute and Chronic)

 home environment as albuterol, to take as needed

 pets  children with persistent or severe symptoms will
 the child’s bedroom need an inhaled corticosteroid to take daily in
 outdoor play space order to prevent exacerbations
 classroom environment
 type of heating in the house, to see whether more
environmental control could reduce allergen
triggers and future occurrences

PHYSICAL ASSESSMENT
 wheezing is evident only by stethoscope
auscultation; in others, it is so loud it can be heard
by simply listening.
 observe for retractions because children have to
use intercostal accessory muscles to achieve full
breaths.
 More comfortable in a sitting position and standing
position rather than lying on bed
 Children who do agree to lie down are either at
the end of an attack and beginning to feel less
threatened by the dyspnea or are so exhausted by
the paroxysms of coughing that they no longer
have the strength to sit upright.
STATUS ASTHMATICUS
 a severe and prolonged asthma attack that is not THERAPEUTIC MANAGEMENT
responsive to asthma therapy  Continuous nebulization with an inhaled β2
 requires hospital evaluation and close agonist
cardiopulmonary monitoring.  IV corticosteroids may be necessary to reduce
 A child with status asthmaticus is in ARDS symptoms, along with oral or IV steroids
 a child in status asthmaticus has failed to respond  smooth muscle relaxers, and others.
to first-line therapy  In severe attacks, endotracheal intubation and
mechanical ventilation may be necessary to
ASSESSMENT maintain effective ventilation and perfusion.
 heart rate and respiratory rate are elevated.
 level of alertness and responsiveness may be
altered
 may appear anxious.
 Both oxygen saturation and PO2 are low;
 PCO2 is elevated because the bronchi are so
constricted the child cannot exhale, resulting in
CO2 accumulation. The rising PCO2 rapidly leads
to acidosis.
 In contrast to the loud wheezing initially heard in
an asthma attack.
PNEUMONIA
 is an infection and inflammation of alveoli. CHLAMYDIAL PNEUMONIA
 It often has a bacterial or viral origin and is  Chlamydia trachomatis pneumonia, typically seen
categorized as hospital- or community-acquired in newborns up to 12 weeks of age
 Pneumocystis carinii pneumonia, seen almost  is often contracted from contact with the mother’s
exclusively with HIV/AIDS infection. vagina during birth

PNEUMOCOCCAL PNEUMONIA SYMPTOMS

 generally abrupt and follows an upper respiratory  nasal congestion
tract infection.  a sharp cough
 In infants, the infection tends to be  poor weight gain
bronchopneumonia with poor consolidation.  These progress to tachypnea

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 Care of Mother and Child at Risk or with
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 In older children, pneumonia often localizes in a  Wheezing

single lobe with full consolidation.  rales on auscultation
 During the initial 24 to 48 hours of infection,
children may have blood-tinged sputum that ASSESSMENT
transitions to a thick, purulent sputum.  elevated levels of IgG and IgM antibodies
 peripheral eosinophilia
ASSESSMENT  antibodies to C. trachomatis
 high fever
 tachycardia THERAPEUTIC MANAGEMENT
 chest or abdominal pain  Antibiotics are often used for pharmacologic
 chills treatment.
 signs of respiratory distress.
 Breath sounds are often diminished, and crackles VIRAL PNEUMONIA
(rales) may be present.  generally caused by viral infections of the upper
 Dullness on percussion indicates total respiratory tract.
consolidation. Chest radiography will often reveal
consolidation SYMPTOMS
 laboratory studies will indicate leukocytosis.  upper respiratory tract infection
 diminished breath sounds
THERAPEUTIC MANAGEMENT  fine rales on auscultation
 IV fluid therapy
 Antibiotics THERAPEUTIC MANAGAMENT
 antipyretics  Antibiotic therapy is not effective against viral
 Oxygen saturation levels should be assessed infections. Rest and antipyretics are used for
frequently. treatment.
 Humidified oxygen may help labored breathing  Similar to bacterial pneumonia, fatigue often
and prevent hypoxemia. occurs following the acute phase of illness.
 CPT may be used to encourage the movement of
mucus and prevent obstruction. MYCOPLASMAL PNEUMONIA
 Repositioning the child will prevent pooling of occurs more frequently in children over 5 years of age
secretions. during winter months.

SYMPTOMS
 Fever
 Cough
 cervical lymphadenopathy
 rhinitis

THERAPEUTIC MANAGEMENT
 Mycoplasmal organisms are generally sensitive to
erythromycin or tetracycline.
ATELECTASIS
the collapse of lung alveoli, may be a primary or SECONDARY ATELECTASIS
secondary condition.  often occurs from a respiratory tract obstruction
that prevents air from entering a portion of the
PRIMARY ATELECTASIS alveoli
seen in preterm newborns with limited surfactant and poor
respiratory strength or mucus or meconium plugs in the CAUSES
trachea  residual air in the alveoli is absorbed, the alveoli
collapse. Causes of obstruction may include
SYMPTOMS mucus plugs associated with chronic respiratory
 Respirations become irregular disease,
 nasal flaring  foreign object aspiration
 apnea  pressure on lung tissue from outside forces, such
 Grunting may also be tiring to the newborn, as compression from a diaphragmatic hernia,
resulting in hypoxemia, hypotonicity, and scoliosis, or enlarged thoracic lymph nodes

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 Care of Mother and Child at Risk or with
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flaccidity.
ASSESSMENT
THERAPEUTIC MANAGEMENT  Asymmetry of the chest may be noticed
 Must be directed at the cause of atelectasis.  diminished breath sounds on the affected side.
 Crying and administration of oxygen may aerate  Tachypnea and cyanosis may be present
the alveoli and may decrease cyanosis.  Chest radiography will show collapsed alveoli
 Children with atelectasis are prone to secondary
infection

THERAPEUTIC MANAGEMENT
 Atelectasis caused by inspiration of a foreign
object will not be relieved until the object is
removed by bronchoscopy.
 Atelectasis caused by a mucus plug will resolve
when the plug clears up.
 The chest of a child with atelectasis should be
kept free from pressure for optimal lung
expansion.
 A semi-Fowler’s position generally allows for the
best lung expansion because it lowers abdominal
contents and increases chest space.
 Suction, Chest Physiotherapy, and increased
humidity may prevent further bronchial plugging.
PNEUMOTHORAX
 the presence of atmospheric air in the pleural THERAPEUTIC MANAGEMENT
space, causing atelectasis  Oxygen therapy to relieve respiratory distress.
 It can occur when external puncture wounds allow  thoracotomy catheter or needle may be placed
air to enter the chest through the chest wall into the pleural space to
 occurs in approximately 1% of newborns often remove accumulated air.
because of rupture of the alveoli from the extreme  symptoms are relieved within 24 hours after
intrathoracic pressure needed to initiate a first suction initiation.
inspiration  If air in the pleural space is from a puncture
wound such as a stab wound cover the chest
ASSESSMENT wound immediately with an impervious material,
 Auscultation reveals absent or decreased breath such as petrolatum gauze, to prevent further air
sounds on the affected side. from entering and to decrease the risk of
 Shift of the apical pulse (mediastinal shift) away atelectasis.
from the site of the pneumothorax.
 Chest radiography will show a darkened area of
the air-filled pleural space.
BRONCHOPULMONARY DYSPLASIA THERAPEUTIC MANAGEMENT
 mild need for increased oxygen, which gradually
 chronic lung condition that can occur in infants. resolves over a few months, to a severe disease
 The condition, frequently found in preterm infants requiring chronic tracheostomy
who received mechanical ventilation for  mechanical ventilation during the first few years of
respiratory distress syndrome at birth life.
 is thought to occur from a combination of  Administration of a corticosteroid to reduce
surfactant deficiency, barotrauma, oxygen toxicity, inflammation
and inflammation.  bronchodilator by nebulizer can improve
respiratory function.
SIGN and SYMPTOMS  Infants need to be monitored carefully for nutrition
 Tachypnea and fluid intake, especially if they are ventilator
 Retractions dependent.
 nasal flaring
 tachycardia
 oxygen dependence.

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 Care of Mother and Child at Risk or with
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ASSESSMENT
 Auscultation reveals decreased air movement
 Chest radiography may show areas of
overinflation, inflammation, and atelectasis.
 As inflamed surfaces heal, the infant is left with
fibrotic scarring.
CYSTIC FIBROSIS (CF)
 an inherited disease of the secretory glands. ASSESSMENT
 The disease is characterized by a thick mucus  abnormal chloride concentration in perspiration
secretion, particularly in the pancreas and the  absence of pancreatic enzymes in the duodenum
lungs, as well as electrolyte abnormalities in presence of immunoreactive trypsinogen in the
sweat gland secretions. blood secondary to pancreatic obstruction
 An abnormality of the long arm of chromosome 7  pulmonary involvement
results in the inability to transport small molecules  newborn who fails to regain normal birth weight
across cell membranes, leading to dehydration of within 7 to 10 days after birth
epithelial cells in the airway and pancreas.  inability to absorb milk fat
 inherited from an autosomal recessive trait.  increased hunger and steatorrheic stools because
 Affected males may be unable to reproduce these stool changes are inconsistent with simple
secondary to persistent plugging and blocking of colic.
the vas deferens by tenacious seminal fluid.  Respiratory infections develop around 4 to 6
 Affected females may have thick cervical months of age, and wheezing and rhonchi are
secretions that limit sperm motility. often heard on chest auscultation.
 The chest may be hyper resonant with
PANCREAS INVOLVEMENT percussion.
 An absence of pancreatic enzymes in the  Cough is a prominent finding by preschool
duodenum results in an inability to digest fat,  clubbing of fingers may also be present during this
protein, and some sugars. Bowel movements time
become large, bulky, and greasy (steatorrhea)
 Malnutrition occurs without therapy and may SWEAT TESTING
include emaciated extremities and loose skin folds  Sweat testing detects abnormal salt
on the buttocks. concentrations. content.
 Fat-soluble vitamins, particularly vitamins A, D,  NV sodium chloride in sweat is 20 mEq/L
and E, cannot be absorbed in the absence of fat  more than 60 mEq/L of sodium chloride is
absorption, resulting in vitamin deficiency diagnostic of CF.
 Newborn’s with CF their meconium may be so  Sweat tests are often not necessary because of
thick that it obstructs the intestine, known as advanced chromosomal testing.
meconium ileus.
DUODENAL TESTING
LUNG INVOLVEMENT  This is done by passing a nasogastric tube into
 The anteroposterior diameter of the chest the duodenum;
becomes enlarged in CF.  secretions are then aspirated for analysis.
 Thickened mucus pools in bronchioles and often  The tube placement can be determined by pH
results in frequent infections. levels. Secretions from the duodenum are sent to
 Atelectasis may occur as a result of absorption of the laboratory for analysis of trypsin content, the
air from alveoli behind blocked bronchioles. easiest pancreatic enzyme to assay.
 Clubbed fingers may occur because of inadequate
peripheral tissue perfusion. STOOL ANALYSIS
 Stool may be collected and analyzed for fat
SWEAT GLAND INVOLVEMENT content and lack of trypsin of the stool.
 level of chloride to sodium in perspiration is
increased 2 to 5 times above normal, resulting in PULMONARY TESTING
“salty” perspiration.  A chest X-ray generally confirms the extent of
pulmonary involvement.
 Pulmonary function may be tested to determine
the extent of atelectasis and emphysema.

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 Care of Mother and Child at Risk or with
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THERAPEUTIC MANAGEMENT
 a collaborative process to reduce the involvement
of the pancreas, lungs, and sweat glands.

CHECK FOR UNDERSTANDING

The instructor will prepare 10 questions that can enhance critical thinking skills. Students will work by themselves to
answer these questions and write the rationale for each question.

1. Which of the following nursing diagnoses would be most appropriate for a child with pneumonia during the acute phase
of illness?
A. Activity intolerance related to poor oxygen-carbon dioxide exchange
B. Altered urinary elimination related to hypervolemic state
C. Pain related to swelling of abdominal lymph nodes
D. Excess fluid volume related to excessive mucus production

2. The nurse is administering medications to a child with cystic fibrosis. Which of the following methods would the nurse
most likely use to give medications to treat the pancreatic involvement seen in this disease?
A. Open capsule and sprinkle on food
B. Pour in medication cup and have child drink
C. Shake inhaler and hold close to mouth
D. Draw up in syringe and administer subcutaneously

3. The nurse is examining a 4-year-old who is injured and crying. What might the nurse document about the child's
breathing?
A. Tachypnea
B. Tachycardia
C. Respirations are slow and shallow
D. Respirations are regular

4. You see a 3-year-old boy in an ambulatory setting for localized wheezing on auscultation. Which statement by his
mother would be most important to report?
A. She gives the child hard candy as an afternoon treat.
B. The child has two cousins who have allergies.
C. She likes the child to play by himself for 15 minutes every afternoon.
D. The child was eating peanuts yesterday.

5. A 4-year-old girl has been admitted to the hospital with a diagnosis of pneumococcal pneumonia. Her parents are
extremely distraught over her condition and the fact she has not wanted to eat anything for the past 2 days. Which nursing
approach would be most important to take to help alleviate the high anxiety level of these parents?
A. Allow the parents to remain with the child as much as possible.
B. Encourage the parents to return home and get some rest.
C. Tell the parents that their child is receiving the best care possible.
D. Avoid telling the parents unnecessary facts regarding her prognosis.

6. To help meet the nutritional needs of a child with pneumonia, you would:
A. Encourage reducing fluid intake
B. Offer small, frequent feedings
C. Encourage intake of three large meals daily
D. Suggest feeding by enteral tube feedings.

7. Which of the following nursing diagnoses would be most appropriate for a child with pneumonia during the acute phase
of illness?
A. Excess fluid volume related to excessive mucus production.
B. Activity intolerance related to poor oxygen-carbon dioxide exchange
C. Altered urinary elimination related to hypovolemic state

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 Care of Mother and Child at Risk or with
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D. Pain related to swelling of abdominal lymph nodes

8. A patient with asthma is prescribed to take inhaled Salmeterol and Fluticasone for long-term management of asthma.
You observe the patient taking these medications. Which option below best describes the correct order in how to take
these medications?
A. The patient inhales the Salmeterol first and then waits 5 minutes before inhaling the Fluticasone.
B. The patient inhales the Fluticasone first and then waits 5 minutes before inhaling the Salmeterol.
C. The patient inhales the Salmeterol first and then waits 1 minute before inhaling the Fluticasone.
D. The patient inhales the Fluticasone and immediately inhales the Salmeterol.

9. You’re assisting your patient who has asthma to bed. The patient is experiencing a frequent cough and chest tightness.
You auscultate the patient’s lung fields and note expiratory wheezes. The patient’s peak flow rate is 78% less than their
best peak flow reading. Which medication will provide the patient with the fastest relief from these signs and symptoms of
an asthma attack?
A. Theophylline
B. Tiotropium
C. Albuterol
D. Cromolyn

10. You assist your patient with using their inhaler. The inhaler contains the medication Budesonide. Before administering
the inhaler, you will want to connect what device to the inhaler to help decrease the patient from developing ?
A. Peak flow meter; pneumonia
B. Incentive spirometer; thrush
C. Spacer; thrush
D. Peak flow meter; mouth sores

C. LESSON WRAP-UP

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 Care of Mother and Child at Risk or with
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AL Activity: Minute Paper

Instruction:
1. Reserve a few minutes at the end of class session. Leave enough time to ask the questions, to allow students to
respond, and to collect their responses.
2. Pass out slips of paper on index cards for students to write on. You may also ask students to bring out and write on a
half sheet of paper instead.
3. Collect the responses as or before students leave. One way is to station yourself at the door and collecting “minute
papers” as student file out.
4. Respond to students’ feedback during the next class meeting or as soon as possible.

1) What was the most useful or the most meaningful thing you have learned this session?

2) What question(s) do you have as we end this session?

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