FAR EASTERN UNIVERSITY - MANILA
Institute of Health Sciences and Nursing - Department of Nursing
NUR1210: Care of Mother and Child at-risk or with Problem
(Acute and Chronic)
● being around cigarette smoke while in womb
or after being born
MODULE 2
● mothers who smoke or use illegal drugs
Alterations in Oxygenations ● sleeping in same bed as parents
(co-sleeping)
Lecturer: Ma’am Dhonna Cambe, Dr. Wilfredo ● multiple birth babies (twin, triplet, etc)
Quijencio ● prematurity or LBW
Source: Published Module 2 (Canvas), ● having brother or sister who had SIDS
Silbert-Flagg Pillitteri (8th Edition) Book, ● being born to teen mother
PowerPoint
● short time period between pregnancies
● late or no prenatal care
● soft bedding in crib
Topic Outline:
● living in poverty situations
I. Introduction ● lack of breastfeeding
● overheating from excessive sleepwear and
II. Sudden Infant Death Syndrome (SIDS) bedding
● infant with underlying cardiac abnormality
III. Asthma ● infants with abnormality in arcuate nucleus
(part of brain that may help control breathing
IV. Pneumonia and awakening during sleep)
○ if baby is breathing stale air and not
V. Patent Ductus Arteriosus (PDA)
getting enough O2, brain usually
triggers baby to wake up and cry =
movement changes breathing and
I. INTRODUCTION CR - making up for lack of O2
Respiratory Disorders ○ arcuate nucleus can also deprive
- most common causes of illnesses and baby of this involuntary reaction
hospitalization in children and put greater risk for SIDS
- range from minor illnesses, such as ● stomach sleeping – puts pressure on child’s
respiratory tract infection (common cold) to jaw = narrowing airway and hampering
life threatening respiratory tract disease breathing
○ can increase risk of rebreathing his
own exhaled air, particularly if infant
II. SUDDEN INFANT DEATH SYNDROME sleeping on soft mattress or with
(SIDS) bedding, stuffed toys, or pillow near
- Sudden Death Syndrome (SDS) ; cot death ; face
crib death ; Sudden Unexpected Infant ○ soft surface could create small
Deaths (SUID) enclosure around baby’s mouth and
- sudden, unexpected death of infant <1 y.o. trap exhaled air ; as baby breathes
(between 2-4 mos.) exhaled air, O2 level drops and
- may occur during sleep, whilst awake, or just CO2 accumulates - lack of O2
after exercise ; occur between hours of 10 at contributes to SIDS
night and 10 in morning Causes of SIDS:
Risks Factors for SIDS: ● problems with baby's ability to wake up
● affects boys more often than girls (sleep arousal)
● highest for African Americans, Alaska ● inability for baby’s body to detect buildup for
natives, American Indians ; lowest for Asians CO2 in blood
and Hispanics
● increased incidence during cold weather
Faith Angelique D. Rebolledo
Sofiyah G. Dimananal Pedia 2023
FAR EASTERN UNIVERSITY - MANILA
Institute of Health Sciences and Nursing - Department of Nursing
NUR1210: Care of Mother and Child at-risk or with Problem
(Acute and Chronic)
Diagnostic and Laboratory Procedures: III. ASTHMA
● ECG (electrocardiogram) test -
greek word for panting
● hx of any young sudden deaths in family or if -
chronic lung disease with airway obstruction,
young person suffering from s/s of: airway inflammation, and airway hyper
a. chest pain (exercise related) responsiveness or spasm of bronchial
b. breathlessness smooth muscle
c. palpitations Risk Factors for Asthma:
d. dizziness ● among children, more boys have asthma
e. fainting than girls ; after 15 y.o., more women have
Therapeutic Management for SIDS: asthma than men
● educate family re: risk of prone sleeping ● smoking during pregnancy and after delivery
position in infants (birth to 6 mos.) ● low air quality from factors such as traffic
● communicate to parents or care giver re: risk pollution or high ozone levels
factors of SIDS ● use of antibiotics in early life
● avoid any remarks that may suggest ● exposure to bacterial endotoxin in early
responsibility childhood from environmental sources,
● allow parents to say goodbye to their child including tobacco smoke, dogs, and farms
● encourage parents to express emotions ● delivery via cesarean section
● family counseling may be recommended to ● having allergies, eczema (allergic skin
help siblings and all family members cope condition), parents who have asthma
with loss of infant Causes of Asthma:
Prevention Against SIDS: ● genetic factors
● screening family members if there has been ○ atopy is inherited tendency to
heart condition of previous sudden death develop allergies
● infants <1 y.o. should be placed on their ○ parents who have asthma
backs to sleep ; never face-down on their ● environmental factors
stomachs or on sides ○ allergens, air pollution, dust mites,
● place your baby on firm mattress to sleep ; cockroaches, animal dander, mold
never on pillow, waterbed, sheepskin, couch, ○ exposure to some viral infections in
chair, or other soft surface infancy or in early childhood when
● do not put blankets, comforters, stuffed toys, immune system is developing
or pillows near baby - prevent rebreathing ● results from complex interactions and
● make sure baby receives all recommended automatic neural regulation of airways,
immunizations where ff. occurs:
● make sure baby does not get too warm while ○ bronchial smooth muscle
sleeping (it can make it more difficult for contraction
them to be awake) ○ bronchospasm
● do not smoke, drink, or use drugs while ○ mucosal edema from inflammatory
pregnant ; do not expose baby to cells in airways with injury to
second-hand smoke epithelium
● receive early and regular prenatal care ○ increased mucus production
● make sure baby has regular well-baby check ○ mucus plugging
ups ○ air trapped behind occluded or
● breastfeed, if possible narrowed airways
● put baby to sleep with pacifier during first ○ insufficient oxygenation and
year of life ventilation
● keep cribs and bassinets in room where ○ air hunger responses = anxious
parents sleep behavior
Faith Angelique D. Rebolledo
Sofiyah G. Dimananal Pedia 2023
FAR EASTERN UNIVERSITY - MANILA
Institute of Health Sciences and Nursing - Department of Nursing
NUR1210: Care of Mother and Child at-risk or with Problem
(Acute and Chronic)
Pathophysiology of Asthma: ❖ Increased resistance in the airway causes
❖ The airways are tubes that carry air into and forced expiration through the narrowed
out of the lungs lumen
➢ People who have asthma have ➢ The volume of air trapped in the
inflamed airways. The inflammation lungs increases as airways are
makes the airways swollen and functionally closed at a point
very sensitive. The airways tend to between the alveoli and the lobar
react strongly to certain inhaled bronchi
substances ➢ This trapping of gas forces the
➢ When the airways react, it results in individual to breath at higher and
increased contractability of the higher lung volumes
surrounding smooth muscles ❖ Consequently, the person with asthma fights
➢ which thus tightening them. This to inspire sufficient air. This expenditure of
narrows the airways, causing less effort for breathing causes fatigue,
air to flow into the lungs (symptoms decreased respiratory effectiveness, and
of wheezing). increase oxygen consumption
❖ Bronchial constriction is a normal reaction to ➢ The inspiration occurring at higher
foreign stimuli, but in the child with asthma it lung volumes hyper inflates the
is abnormally severe, producing impaired alveoli and reduces the
respiratory function effectiveness of the cough
➢ The smooth muscle arranged in ➢ This chain reaction can result in
spiral bundles around the airway asthma symptoms. Symptoms can
causes narrowing and shortening of happen each time the airways are
the airway, which significantly inflamed
increases airway resistance to ❖ As the severity of obstruction increases,
airflow. Because the bronchi there is a reduced alveolar ventilation with
normally dilate and elongate during carbon dioxide retention, hypoxemia,
inspiration and contract and shorten respiratory acidosis, and eventually
on expiration, the respiratory respiratory failure
difficulty is more pronounced during Classifications of Asthma:
the expiratory phase of respiration a. Atopic (extrinsic)
➢ Typical changes in the airways - occupational asthma - when person
include an increase in eosinophils develop asthma due to contact with
and thickening of the lamina certain chemical irritants or
reticularis industrial dusts in workplace
❖ Chronically the airways' smooth muscle may b. Non-atopic (intrinsic)
increase in size along with an increase in the Clinical Manifestations of Asthma:
numbers of mucous glands - dyspnea with prolonged expiration
➢ Other cell types involved include: T - expiratory wheeze (whistling sound when
lymphocytes, macrophages, and you breathe), progressing to inspiratory and
neutrophils expiratory wheezing, progressing to breath
➢ There may also be involvement of sounds becoming audible
other components of the immune - grunting respirations in infancy
system including cytokines, - chest tightness (may feel something is
chemokines, histamine, and squeezing or sitting in your chest)
leukotrienes among others - SOB (cannot catch breath or feel out of
❖ Cells in the airways might make more mucus breath ; cannot get air out of lungs)
than usual - nasal flaring
➢ Mucus is a sticky, thick liquid that - cough occurring at night or early in morning
can further narrow the airways - accessory muscle use
Faith Angelique D. Rebolledo
Sofiyah G. Dimananal Pedia 2023
FAR EASTERN UNIVERSITY - MANILA
Institute of Health Sciences and Nursing - Department of Nursing
NUR1210: Care of Mother and Child at-risk or with Problem
(Acute and Chronic)
- anxiety, irritability, to decreasing level of Therapeutic Management for Asthma:
consciousness - goal of asthma is to control the disease
- cyanosis ● prevent and control asthma symptoms,
- reversible airflow obstruction and reduce frequency and severity of asthma
bronchospasm - airways are very swollen exacerbations, and reverse airflow
that air cannot get through client stops obstruction
wheezing and breath sounds are inaudible ● drug therapy
○ General Categories of Asthma
Exacerbation of Asthma:
Medications:
a. long term control
medications (preventor
medicines) - achieve and
maintain control of
inflammation
i. long acting B2
agonist - open
Diagnostic and Laboratory Procedures: airways
● pattern of symptoms ii. leukotriene
○ wheezing modifiers - help
○ runny nose or swollen nasal block chain
passages reaction that
○ allergic skin conditions (e.g., increases
eczema) inflammation in
● allergy testing - find out wc allergens affect airways
you, if any iii. methylxanthines
○ bronchoprovocation test - measure (5-15mcg/ml)
how sensitive airways are - side effects:
○ spirometry (forced expiratory nausea, vomiting,
volume in 1 sec. (FEV1) and peak irritability,
expiratory flow rate) - check how headache,
lungs are working ; measures how insomnia
much air person can breathe in and - early sign of
out ; measures how fast you can toxicity
blow air out >20mcg/ml:
● chest x-ray or ECG - help find out whether distractibility,
foreign object in airways or another disease irritability, nausea,
might be causing symptoms poor school
● response to therapy over time performance,
● arterial blood gas - initially mild respiratory tachycardia
alkalosis from hyperventilation then
subsequently respiratory acidosis
● eosinophil count - increased blood, sputum
Faith Angelique D. Rebolledo
Sofiyah G. Dimananal Pedia 2023
FAR EASTERN UNIVERSITY - MANILA
Institute of Health Sciences and Nursing - Department of Nursing
NUR1210: Care of Mother and Child at-risk or with Problem
(Acute and Chronic)
b. quick relief medications ● promote pulmonary functions
(rescue medications) - ● assess and monitor child’s hydration status
treat symptoms and ● avoid milk and milk products
exacerbations ● alleviate or minimize anxiety of child and
i. inhaled parents using developmental level
corticosteroids ● assess feelings of child and parents about
ii. cromolyn sodium having asthma and taking medications
and nedocromil - ● assess willingness to participate in education
helps prevent programs and refer family to support groups
body from as needed
reacting to ● ER setting: establish IV line for fluid therapy
asthma triggers and route for emergency drugs
c. asthma medications are Prevention Against Asthma:
given by inhalation by: ● avoid triggers
i. metered dose ○ allergens - dust mites, animal fur,
inhaler cockroaches, mold, pollens from
ii. nebulizer trees, grasses, and flowers
d. hyposensitization - identify ○ irritants - cigarette smoke, air
allergens ; for treatment of pollution, chemicals or dust in
seasonal allergy and when workplace, compounds in home
single substance were decor ; products and sprays
identified as offending (hairspray)
allergen ● medicines, such as aspirin or other
e. oral corticosteroid are nonsteroidal anti-inflammatory drugs and
recommended with 5 days nonselective beta-blockers and use of
of prednisone being same inhaled corticosteroids
2 days of dexamethasone ● sulfites in foods and drinks
f. MgSO4 IV treatment ● viral upper respiratory infections, such as
shown to provide a colds
bronchodilating effect ● physical activity, including exercise
when used in addition to ● limiting smoke exposure both in utero and
other treatment in severe after delivery
acute asthma attacks ● breastfeeding
g. heliox, mixture of helium ● dietary restrictions during pregnancy
and O2, may also be ● smoking bans
considered in severe Prognosis of Asthma:
unresponsive cases ● generally good
● exercise is advantageous for children with ● early tx with corticosteroids seems to prevent
asthma (B-adrenergic or cromolyn sodium or ameliorates decline in lung function
before exercise) ● no cure ; even if you feel fine, you still have
● O2 - alleviate hypoxia if saturations fall disease and can flare up any time
below 92%
● bronchial thermoplasty - involves delivery of
controlled thermal energy to airway wall
during series of bronchoscopies
Nursing Management for Asthma:
● targeted at preventing asthma exacerbations
by avoiding asthma triggers by decreasing
airway obstruction, inflammation, and
reactivity with medications
Faith Angelique D. Rebolledo
Sofiyah G. Dimananal Pedia 2023
FAR EASTERN UNIVERSITY - MANILA
Institute of Health Sciences and Nursing - Department of Nursing
NUR1210: Care of Mother and Child at-risk or with Problem
(Acute and Chronic)
IV. PNEUMONIA Location and Extent:
- inflammation of lung parenchyma a. Lobar pneumonia - involve segment of one
- classified acc. to etiologic agent or more lobe
- classified acc. to location and extent of b. Bronchopneumonia - terminal bronchioles
pulmonary involvement and involve nearby lobules
Etiologic Agent: c. Interstitial pneumonia - confined to alveolar
● <3 mos. - GBS, g (-) bacilli, chlamydia, S. walls, peribronchial, and interlobular tissues
pneumoniae Laboratory and Diagnostic Tests:
● 3 mos. to 5 years - S. pneumoniae, M. ● CXR - diffuse patchy infiltrates, consolidation
catarrhalis or disseminated infiltration
● adolescents - S. and M. pneumoniae, M. ● CBC
catarrhalis ● blood and sputum C/S
● hospital acquired - Pseudomonas, Klebsiella, ● (+) ASO titer
E. coli, Enterobacter sp Management:
● Viral pneumonia - RSV, Parainfluenza, ● assess for respiratory distress
Adenovirus, Influenza ● administer prescribed meds
● Mycoplasma pneumonia - common in more ○ antibiotics (penicillin, macrolides)
than 5 y.o. ● supportive care - viral
S/S of Bacterial Pneumonia: ● promote adequate oxygenation
- high fever, chills
- irritability, restlessness, lethargy
- nausea, vomiting, diarrhea, poor feeding V. PERSISTENT PATENT DUCTUS
- respiratory symptoms - cough, restlessness, ARTERIOSUS (PDA)
tachypnea, retractions, crackles, dullness on - from failure of ductus arteriosus to close
percussion, cyanosis after birth
S/S of Viral Pneumonia: Therapeutic Management:
- mild fever, silent cough ● administer IV therapy cautiously
- high fever, malaise, severe cough and ● indomethacin or ibuprofen - close PDA
prostration ● monitor UO due to oliguria (side effect of
- nonproductive cough to productive cough indomethacin)
with whitish phlegm
- rhonchi and fine crackles
S/S of Mycoplasma Pneumonia:
- sudden and insidious onset
- fever, chills, malaise, headache, anorexia,
myalgia
- hacking cough, rhinitis, anorexia
- nonproductive to productive with
semi-mucoid sputum to mucopurulent or
blood streaked
Faith Angelique D. Rebolledo
Sofiyah G. Dimananal Pedia 2023