Chapter 18: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder

Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder details the complexities of pediatric respiratory disorders, identifying them as the most frequent cause of illness and hospitalization in children, and highlighting key physiological vulnerabilities such as the infant’s small airway lumen, highly compliant chest wall, and status as a preferential nose breather, which predispose them to rapid clinical decline and severe hypoxemia. Comprehensive nursing assessment is emphasized, focusing on early detection of increased work of breathing (WOB), tachypnea, retractions, stridor, and evaluation of cyanosis and hydration status, supported by critical diagnostic tools like pulse oximetry, chest radiography, and specific laboratory tests. Acute infectious disorders covered range from common viral illnesses, including nasopharyngitis and influenza, to critical airway threats like croup (laryngotracheobronchitis) and epiglottitis, necessitating swift recognition and intervention to prevent occlusion. Supportive management, including high humidity delivery, strategic suctioning, and specialized oxygen administration via hoods or masks, is vital, along with pharmacologic treatments such as bronchodilators, inhaled corticosteroids, and specific antivirals like Palivizumab for high-risk infants. The text further explores chronic conditions, including asthma, which is managed via a stepwise approach based on control levels, requiring rigorous patient and family education on trigger avoidance, medication use, and peak expiratory flow rate (PEFR) monitoring. Detailed attention is given to cystic fibrosis, an autosomal recessive disease affecting exocrine glands and causing tenacious pulmonary secretions and malabsorption, requiring intensive pulmonary hygiene (chest physiotherapy or CPT), pancreatic enzyme replacement therapy, and aggressive nutritional support to maximize quality and length of life. Finally, the chapter addresses acute non-infectious issues like foreign body aspiration and pneumothorax, alongside care requirements for specialized airways such as tracheostomies, underscoring the necessity of skilled nursing intervention and family support in managing chronic pediatric respiratory challenges.