Chapter 40: Respiratory Disorders in Children Nursing Care

Respiratory Disorders in Children Nursing Care examines respiratory disorders, which are primary causes of illness and hospitalization in the pediatric population, detailing the drastic physical and psychosocial effects on children and their families. It emphasizes critical anatomical differences in children, such as their narrower, funnel-shaped airways, compliant chest walls, and obligate nose-breathing capacity, which heighten their vulnerability to obstruction. Core nursing responsibilities include adhering to Healthy People 2030 goals, which aim to reduce the initiation of smoking, limit secondhand smoke exposure, and increase immunization rates. The nursing process focuses on immediate recognition and response to respiratory compromise, utilizing assessment findings like retractions, tachypnea, adventitious sounds (such as rales, rhonchi, wheezing, and stridor), and objective measures such as pulse oximetry (SpO2) and systematic arterial blood gas analysis (ABG). Management techniques range from supportive home care, like humidification and saline drops, to advanced interventions, including chest physiotherapy (CPT), oxygen administration, inhaled medications delivered via nebulizers or metered-dose inhalers (MDIs with spacers), endotracheal intubation, and long-term tracheostomy care. The chapter explores upper respiratory conditions such as acute nasopharyngitis, pharyngitis (including streptococcal infections requiring antibiotics to prevent complications like rheumatic fever), tonsillectomy post-operative care (focusing on hemorrhage monitoring), and life-threatening disorders like croup (laryngotracheobronchitis) and epiglottitis, stressing that one must never attempt to visualize the throat in a child suspected of having epiglottitis unless prepared for emergency artificial airway placement. Lower respiratory tract disorders include influenza, COVID-19, bronchiolitis (frequently caused by Respiratory Syncytial Virus or RSV), and bacterial or viral pneumonia. Chronic conditions highlighted include asthma, a diffuse and obstructive airway disease managed by environmental control and pharmacologic therapy to reduce inflammation and bronchoconstriction, and cystic fibrosis (CF), an inherited secretory gland disease resulting in abnormally tenacious mucus in the lungs and pancreas. CF requires collaborative management, including high-calorie nutrition, pancreatic enzyme replacement (Pancrelipase) to address malabsorption (steatorrhea), and frequent CPT to mobilize pulmonary secretions. Advanced options like assisted ventilation and lung transplantation are discussed for severe, chronic respiratory failure.