1
Respiratory
Upper Respiratory Tract
• Oronasopharynx, pharynx
• Larynx, upper
trachea Lower Respiratory
Tract
• Lower trachea, bronchi
• Bronchioles, alveoli
General Aspects of Respiratory Infections
• Etiology and characteristics
o Infectious agents
o Age
o Size
o Resistance
o Seasonal variations
Clinical Manifestations
• Vary with age
• Generalized signs and symptoms and local manifestations differ in young children
o Fever and meningismus (stiff neck without meningitis)
o Anorexia, vomiting, diarrhea, and abdominal pain
o Cough, sore throat, nasal blockage or discharge
o Respiratory sounds
Age
• <3 Months: maternal antibodies (exclusively breastfed)
o Helps protect them
• 3-6 Months: infection rate increases
• Toddler and preschool ages: high rate of viral infections (8-10 a year)
o Daycares and preschools
o May have higher fever, cough
• >5 Years: increase in Mycoplasma pneumoniae and β-hemolytic streptococcal
infections- bacterial
o Antibiotics for tx
• Increased immunity with age
Size
• Diameter of airways is smaller
o This is why kids get sicker faster
• Distance between structures is shorter, allowing organisms to move rapidly
• Eustachian tubes are short and open-also angle is more horizontal until 2 years
,1
old, then angles more (otitis media more common in 2yr and under d/t anatomy)
,1
Resistance
• Affected by
o Immune system
o Malnutrition, anemia
o Allergies, asthma
o Preterm birth
▪ Lung development comes late in last trimester of pregnancy
o Cardiac anomalies
o Cystic fibrosis (CF)
o Day care
Symptomatic
-retractions, nasal flaring, abd/tracheal pulling, wheezing, grunting, decreased O2
*can happen abruptly
-infant has additional resistance d/t narrow lumen
Seasonal Variations
• Most common during winter and spring
• Mycoplasmal infections (bacterial): more common in fall (fungal/dust from farmers)
and winter
• Infection-related asthma: more frequent in cold weather
• RSV season: considered winter and spring
Clinical Manifestations
• Vary with age
• Generalized signs and symptoms and local manifestations differ in young children
• Fever and meningismus-(meningial symptoms without meningitis ex) headaches,
stiff neck
• Anorexia, vomiting, diarrhea, abdominal pain
• Cough, sore throat, nasal blockage or discharge
• Respiratory sounds
• Pg: 1128 Box 40.1-symptoms of respiratory difficulty in infants/small children & Pg
1129 Box 40.2 assessing child with respiratory problem
Care Management
• Ease respiratory effort-suction, hydration, cool environment, cool mist
humidification, O2 should be humidified
• Promote rest and comfort-bundle cares to allow rest; decreased noise levels,
decrease stimuli
• Prevent spread of infection-handwashing, considered infectious until fever free 24
hours without fever reducing medication
• Reduce temperature-tylenol/ibuprofen/tepid water bath
, 1
• Promote hydration and nutrition-more insensible fluid loss through resp. tract
with increased resp. rate
• Provide support and reassurance-educate; know plan; ex) signs of
resp. distress/dehydration
Upper Respiratory Tract Infections
• Nasopharyngitis: “common cold”
o Treat at home: child is fussy, cough, may have fever expected sx
• Caused by numerous viruses
o RSV, rhinovirus, adenovirus, influenza and parainfluenza viruses
• Fever: varies with age of the child
• Managed at home
• Suctioning: Saline, bulb, Nasal Frida (can suction longer)
o decreased thickness of secretions
• No specific treatment
• Watch for otitis media symptoms
o Tugging/grabbing ear, not sleeping well, decrease eating/drinking, fussy
o Make sure well hydrated
o Preschool age to tell you how they are feeling/what hurts
Acute Infectious Pharyngitis
*80-90% sore throat viral
• Causes and risks
o Group A β-hemolytic streptococcal infection (bacterial)
o Risk for rheumatic fever and glomerulonephritis
▪ If not treated
• Clinical manifestations
• Diagnostic evaluation
o 5-10% are negative on rapid but culture out +
▪ May want RCR or throat culture
• Therapeutic management
• Care management: Antibiotics, fluids, discard toothbrush (after 24 hours on antibiotics),
handwashing
**Contagious until fever free and on antibiotics for 24 hours
**Halitosis (smelly breath) often comes with strep
Respiratory
Upper Respiratory Tract
• Oronasopharynx, pharynx
• Larynx, upper
trachea Lower Respiratory
Tract
• Lower trachea, bronchi
• Bronchioles, alveoli
General Aspects of Respiratory Infections
• Etiology and characteristics
o Infectious agents
o Age
o Size
o Resistance
o Seasonal variations
Clinical Manifestations
• Vary with age
• Generalized signs and symptoms and local manifestations differ in young children
o Fever and meningismus (stiff neck without meningitis)
o Anorexia, vomiting, diarrhea, and abdominal pain
o Cough, sore throat, nasal blockage or discharge
o Respiratory sounds
Age
• <3 Months: maternal antibodies (exclusively breastfed)
o Helps protect them
• 3-6 Months: infection rate increases
• Toddler and preschool ages: high rate of viral infections (8-10 a year)
o Daycares and preschools
o May have higher fever, cough
• >5 Years: increase in Mycoplasma pneumoniae and β-hemolytic streptococcal
infections- bacterial
o Antibiotics for tx
• Increased immunity with age
Size
• Diameter of airways is smaller
o This is why kids get sicker faster
• Distance between structures is shorter, allowing organisms to move rapidly
• Eustachian tubes are short and open-also angle is more horizontal until 2 years
,1
old, then angles more (otitis media more common in 2yr and under d/t anatomy)
,1
Resistance
• Affected by
o Immune system
o Malnutrition, anemia
o Allergies, asthma
o Preterm birth
▪ Lung development comes late in last trimester of pregnancy
o Cardiac anomalies
o Cystic fibrosis (CF)
o Day care
Symptomatic
-retractions, nasal flaring, abd/tracheal pulling, wheezing, grunting, decreased O2
*can happen abruptly
-infant has additional resistance d/t narrow lumen
Seasonal Variations
• Most common during winter and spring
• Mycoplasmal infections (bacterial): more common in fall (fungal/dust from farmers)
and winter
• Infection-related asthma: more frequent in cold weather
• RSV season: considered winter and spring
Clinical Manifestations
• Vary with age
• Generalized signs and symptoms and local manifestations differ in young children
• Fever and meningismus-(meningial symptoms without meningitis ex) headaches,
stiff neck
• Anorexia, vomiting, diarrhea, abdominal pain
• Cough, sore throat, nasal blockage or discharge
• Respiratory sounds
• Pg: 1128 Box 40.1-symptoms of respiratory difficulty in infants/small children & Pg
1129 Box 40.2 assessing child with respiratory problem
Care Management
• Ease respiratory effort-suction, hydration, cool environment, cool mist
humidification, O2 should be humidified
• Promote rest and comfort-bundle cares to allow rest; decreased noise levels,
decrease stimuli
• Prevent spread of infection-handwashing, considered infectious until fever free 24
hours without fever reducing medication
• Reduce temperature-tylenol/ibuprofen/tepid water bath
, 1
• Promote hydration and nutrition-more insensible fluid loss through resp. tract
with increased resp. rate
• Provide support and reassurance-educate; know plan; ex) signs of
resp. distress/dehydration
Upper Respiratory Tract Infections
• Nasopharyngitis: “common cold”
o Treat at home: child is fussy, cough, may have fever expected sx
• Caused by numerous viruses
o RSV, rhinovirus, adenovirus, influenza and parainfluenza viruses
• Fever: varies with age of the child
• Managed at home
• Suctioning: Saline, bulb, Nasal Frida (can suction longer)
o decreased thickness of secretions
• No specific treatment
• Watch for otitis media symptoms
o Tugging/grabbing ear, not sleeping well, decrease eating/drinking, fussy
o Make sure well hydrated
o Preschool age to tell you how they are feeling/what hurts
Acute Infectious Pharyngitis
*80-90% sore throat viral
• Causes and risks
o Group A β-hemolytic streptococcal infection (bacterial)
o Risk for rheumatic fever and glomerulonephritis
▪ If not treated
• Clinical manifestations
• Diagnostic evaluation
o 5-10% are negative on rapid but culture out +
▪ May want RCR or throat culture
• Therapeutic management
• Care management: Antibiotics, fluids, discard toothbrush (after 24 hours on antibiotics),
handwashing
**Contagious until fever free and on antibiotics for 24 hours
**Halitosis (smelly breath) often comes with strep
