Chapter 45: The Child With a Respiratory Alteration

Upper respiratory conditions are distinguished from lower respiratory involvement, with upper airway disorders encompassing allergic rhinitis presenting with characteristic physical signs, along with infectious processes including sinusitis and otitis media that may necessitate fluid management and surgical placement of tympanostomy tubes for recurrent middle ear infections. Acute infectious conditions such as pharyngitis and tonsillitis require identification of bacterial pathogens, particularly Group A streptococcus, to prevent serious sequelae including rheumatic fever and acute glomerulonephritis. Obstructive airway disorders are detailed extensively, covering laryngomalacia as a common cause of stridor and multiple presentations of croup syndrome, with particular attention to laryngotracheobronchitis and its distinctive barking cough pattern. The chapter emphasizes epiglottitis as a life-threatening emergency, identifying the classic warning signs of drooling, difficulty swallowing, dysphoria, and distressed breathing patterns that demand immediate airway intervention and hospitalization. Lower respiratory tract infections include bronchiolitis predominantly caused by respiratory syncytial virus in infants and various pneumonia presentations across pediatric age groups. Chronic respiratory conditions receive substantial coverage, including asthma as a reversible inflammatory airway disease managed through rescue and controller medications, peak flow monitoring, and environmental trigger avoidance, and cystic fibrosis as a genetic disorder causing thick mucus production affecting pulmonary and pancreatic function, requiring lifelong enzyme supplementation and intensive airway clearance techniques. Environmental and safety considerations address smoke inhalation injury, foreign body aspiration risks, apnea monitoring, and Sudden Infant Death Syndrome prevention through evidence-based safe sleep positioning and environmental modifications. Throughout the chapter, nursing assessment, intervention, family education, and advocacy are highlighted as essential components of pediatric respiratory care that support adequate oxygenation, ventilation, and developmental growth.