ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM  Blood vessels are tubes that carry blood to the lungs and

throughout the body. Tiny blood vessels surround the air

HOW BREATHING WORKS? sacs, allowing an exchange of oxygen and carbon dioxide.

 The pleural space is an area between the lungs and chest

wall, lined on both sides by tissue called pleura.
 The diaphragm is a muscle in the abdomen that helps with
 Breathing in is called inspiration.  breathing.
 When your child breathes in, air fills the airways in the  Mucus is a sticky substance made by cells in the lining of
lungs. the airways. It traps dust, smoke, and other particles from
 Oxygen-rich air reaches the balloon-like air sacs at the air breathed in.
end of the airways.  Cilia are tiny hairs on the cells of the airway lining. They
 These sacs are called alveoli.  sweep mucus up the airways and to the throat. Here,
 Oxygen passes into the blood vessels that surround the mucus gets swallowed or coughed out.
sacs.
 The blood then carries the oxygen to all parts of the body. RESPIRATORY TRACT DIFFERENCES IN CHILDREN
 As the body uses oxygen, it produces carbon dioxide (a  Ethmoidal and maxillary sinuses present at birth
waste gas), which the blood carries back to the lungs.  Frontal sinuses- frequently involved in sinus infection
 When your child breathes out, carbon dioxide leaves the  Sphenoidal sinuses- do not develop until 6 to 8 years of
body through the airways, windpipe, and mouth or nose. age.
 Breathing out is called expiration.  Tonsillar tissue is normally enlarged- early age

PARTS OF THE RESPIRATORY SYSTEM  Due to rapid growth of lymphoid tissue

 A child’s respiratory system is similar to an adult’s.
However, some structures differ in size or position.  Newborns produce little respiratory mucus.
 For example, an infant’s tongue takes up more space in  Excessive production of mucus in children up to 2 years-
the mouth than an adult’s. And an infant’s larynx is located lead to obstruction
in a higher position in the neck than it is in an adult.  Afte2 years, right bronchus is noticeably shorter, wider,
 The mouth and nose are the openings through which air and more vertical in the left
enters and exits the body.  Chest muscle not fully developed
 Sinuses are air-filled chambers within the bones of the
face. They help keep the nose moist and free of dust and  Making them more susceptible to respiratory
bacteria. infection.
 The pharynx is the cavity behind the mouth  Because the bronchial lumens are so small in children
 The larynx is the upper part of the windpipe, which of this age.
contains the vocal cords.  This the reason that inhaled foreign bodies most often
 The windpipe (trachea) provides a pathway for air to enter lodge in the right bronchus
and exit the lungs.  So they use their abdominal muscles to assist
 The lungs are a pair of organs made of spongy tissue. inhalation
They have five sections, or “lobes,” three in the right lung
and two in the left. The lungs allow the body to receive  Change of the thoracic breathing begins 2 to 3 years of
oxygen and get rid of carbon dioxide. age and complete 7 years
 Bronchioles (airways) are stretchy “branches” that  Accessory muscle used more in children
transport air throughout the lungs. Bands of muscles  Walla of airways has less cartilage
surround each bronchiole. Bronchioles get smaller as they  For immature infant, lessened amount of smooth muscle
go deeper into the lungs. in the airway
 Alveoli are clusters of balloon-like air sacs at the ends of
the airways.  advantage- do not develop bronchospasm.
 Therefore, wheezing may not be a prominent finding cold medicines. Saline nasal drops may help alleviate
in infants even when the lumen of the airway is congestion.
severely compromised.

ASSESSING RESPIRATORY ILLNESS IN CHILDREN PHARYNGITIS

 Pharyngitis is inflammation of the pharynx—the back of
THE CHILD WITH ALTERATION IN OXYGENATION the throat. This can cause a sore throat, as well as
scratchiness in the throat and difficulty swallowing.
UPPER RESPIRATORY TRACT  According to the University of Maryland Medical Center,
pharyngitis is one of the most common reasons for doctor
ACUTE NASOPHARYNGITIS (COMMON COLDS) visits (UMM, 2011).
 is a contagious, viral infectious disease of the  More cases of pharyngitis occur during the colder months
upper respiratory system, primarily. of the year.
 It is the most common infectious disease in humans. 
CAUSES
CAUSES  Individuals who are frequently exposed to colds and flu,
 Picornaviruses such as healthcare workers or children in day care are the
 Rhinoviruses most likely to develop pharyngitis.
 Coronaviruses  Individuals who have allergies, experience frequent sinus
 Human parainfluenza viruses infections, or who have been exposed to second-hand
 Human respiratory syncytial virus smoke are also more likely to develop pharyngitis.
 Adenoviruses  Viral Infection
 Enteroviruses  Bacterial infection
 Metapneumovirus
 Influenza viruses SIGNS AND SYMPTOMS
 Exposure to cold weather  The symptoms that accompany pharyngitis vary
 Lack of sleep depending on the underlying condition.
 Low doses of vitamin D  In addition to a sore, dry, or scratchy throat, a cold or flu
may cause:
SIGNS AND SYPTOMS  sneezing
 runny nose
 Sore throat
 headache
 Runny nose
 cough
 Nasal congestion
 fatigue
 Sneezing  body aches
 Sometimes accompanied by 'pink eye'  chills
 Muscle aches  fever (low grade with cold but higher with flu)
 Fatigue
 Malaise DIAGNOSTICS
 Headaches  Physical exam
 Muscle weakness  Throat Culture
 Uncontrollable shivering  Blood Tests
 Loss of appetite  measles
 chickenpox
TYPES OF NASOPHARYNGITIS  croup (a childhood illness distinguished by a barking
 Respiratory conditions cough
 Inflammatory conditions that may be pathogenic or non-  whooping cough
pathogenic
 Head conditions TREATMENTS
 Throat conditions  Antibiotics
 taking over-the-counter medication such as
DIAGNOSTICS acetaminophen and ibuprofen to ease pain and reduce
 Home Fever Tests fever
 Home Ear Infection Test Kits  drinking plenty of fluids to prevent dehydration
 Home Flu Tests  gargling with warm salt water
 using throat lozenges
TREATMENTS AND INTERVENTIONS  using a humidifier
 Alternative treatments such as vitamin C, and zinc  resting until you feel better
 Conservative treatment - plenty of rest, drinking fluids to
maintain hydration, gargling with warm salt water, using NURSING CARE
cough drops, throat sprays, or over-the-counter pain or  Maintaining proper hygiene can prevent many cases of
pharyngitis
 avoid sharing food, drinks, and eating utensils  Eat smooth foods, such as flavored gelatins, ice cream, or
 avoid individuals who are sick applesauce
 wash your hands often, especially before eating and after  Use a cool-mist vaporizer or humidifier in your room
coughing or sneezing  Gargle with warm salt water
 use alcohol-based hand sanitizers when soap and water
are unavailable EPISTAXIS
 avoid smoking and inhaling second-hand smoke  The purpose of the nose is to warm and humidify the air
that we breathe in. The nose is lined with many blood
vessels that lie close to the surface where they can be
TONSILITIS injured and bleed.
 At the back of your throat, two masses of tissue  Once a vessel starts to bleed, the bleeding tends to recur
called tonsils act as filters, trapping germs that could since the clot or scab is easily dislodged.
otherwise enter your airways and cause infection.  Nosebleeds, called epistaxis, can be messy and even
 They also produce antibodies to fight infection. But scary, but often look worse than they are. Many can be
sometimes the tonsils themselves become infected. treated at home, but some do require medical care.
 Overwhelmed by bacteria or viruses, they swell and
become inflamed, a condition known as tonsillitis. CAUSES
 Tonsillitis is common, especially in children. The condition  Dry, heated, indoor air, which dries out the nasal
can occur occasionally or recur frequently. membranes and causes them to become cracked or
crusted and bleed when rubbed or picked or when blowing
CAUSES the nose (more common in winter months)
 Adenoviruses  Dry, hot, low-humidity climates, which can dry out the
 Influenza virus mucus membranes
 Epstein-Barr virus  Colds (upper respiratory infections) and sinusitis,
 Parainfluenza viruses especially episodes that cause repeated sneezing,
 Enteroviruses coughing, and nose blowing
 Herpes simplex virus  Vigorous nose blowing or nose picking
 The insertion of a foreign object into the nose
SIGNS AND SYMPTOMS  Injury to the nose and/or face
 Inflammation and swelling of tonsils  Allergic and non-allergic rhinitis (inflammation of the nasal
 Throat pain or tenderness lining)
 Redness of the tonsils  Use of drugs that thin the blood (aspirin, non-steroidal
 A white or yellow coating on the tonsils anti-inflammatory medications, warfarin, and others)
 Painful blisters or ulcers on the throat  High blood pressure
 Hoarseness or loss of voice  Chemical irritants (e.g., cocaine, industrial chemicals,
 Headache others)
 Deviated septum (an abnormal shape of the structure that
 Loss of appetite
separates the two sides of the nose)
 Ear pain
 Tumors or inherited bleeding disorders (rare)
 Difficulty swallowing or breathing through the mouth
 Facial and nasal surgery
 Swollen glands in the neck or jaw area
 Fever, chills
Under what conditions should I seek physician or emergency
 Bad breath care?
In children, symptoms may also include:
 You cannot stop the bleeding after more than 15 to 20
 Nausea minutes of applying direct pressure.
 Vomiting  You experience repeated episodes of bleeding.
 Abdominal pain  The bleeding is rapid or the blood loss is large (exceeds a
coffee cupful).
DIAGNOSTICS
 The bleeding was caused by an injury, such as a fall or
 Oral exam other blow to the nose or face.
 strep test or throat swab culture.  You feel weak or faint.
 The blood goes down the back of your throat rather than
TREATMENTS
out front through the nose even though you are sitting
 Antibiotics down with body and head leaning slightly forward.
 Acetamenophen
 Ibuprofen TREATMENTS
 Surgery- if very severe  Cauterization – the application of a chemical substance
(silver nitrate) or heat energy (electrocautery) to seal the
NURSING CARE bleeding blood vessel.
 Get enough rest  Nasal packing – the placement of strips of gauze into the
 Drink warm or very cold fluids to ease throat pain nasal cavity to create pressure on the bleeding site.
Alternately, other materials that promote clotting may be  Acute sinusitis: A sudden onset of cold-like symptoms
used. such as runny, stuffy nose and facial pain that does not go
 Medication adjustments – reducing or stopping the away after 10 to 14 days. Acute sinusitis typically lasts 4
amount of blood thinning medications can be helpful. In weeks or less.
addition, medications for controlling blood pressure may  Subacute sinusitis: An inflammation lasting 4 to 8 weeks.
be necessary.  Chronic sinusitis: A condition characterized by sinus
 Foreign body removal inflammation symptoms lasting 8 weeks or longer.
 Repair of nasal fracture  Recurrent sinusitis: Several attacks within a year.
 Correction of a deviated septum
Who Gets Sinusitis?
Are there any steps I can take to prevent nosebleeds?  Nasal mucous membrane swelling as from a common cold
 Use a saline nasal spray or saline nose drops two to three  Blockage of drainage ducts
times a day in each nostril. These products can be  Structural differences that narrow the drainage ducts
purchased over-the-counter or made at home. (To make  Nasal polyps
the saline solution at home: mix 1 teaspoon of salt into 1  Conditions that result in an increased risk of infection such
quart of tap water. Boil water for 20 minutes, cool until as immune deficiencies or taking medications that
lukewarm.) suppress the immune system.
 Add a humidifier to your furnace or run a humidifier in your  In children, common environmental factors that contribute
bedroom at night. to sinusitis include allergies, illness from other children
at day care or school, pacifiers, bottle drinking while lying
 Place water-soluble nasal gels or ointments in your on one's back, and smoke in the environment.
nostrils with a cotton swab. Bacitracin®, Vaseline®, or  In adults, the contributing factors are most frequently
Ayr Gel®are examples of over-the-counter ointments infections and smoking.
that you can use. Be sure not to insert the swab more
than ¼ inch into your nose. These gels and ointments SIGNS AND SYMPTOMS
can be purchased in most pharmacies. Some of the primary symptoms of acute sinusitis include:
 Facial pain/pressure
 Avoid blowing your nose too forcefully, but you may  Nasal stuffiness
choose to blow your nose after using nasal saline sprays
 Nasal discharge
or drops.
 Loss of smell
 Sneeze through an open mouth.
 Cough/congestion
 Avoid putting anything solid into your nose, including
Additional symptoms may include:
fingers and cotton applicators.
 Fever
 Limit your use of medications that can increase bleeding,
 Bad breath
such as aspirin and ibuprofen.
 Fatigue
 Please remember that any adjustment to medication,  Dental pain
especially prescribed medication such as warfarin  Acute sinusitis may be diagnosed when a person has
(Coumadin®), and non-steroidal anti-inflammatory two or more symptoms and/or the presence of thick,
drugs (NSAIDs), should only be done under you green, or yellow nasal discharge.
physician’s supervision.
DIAGNOSTICS
 See your allergist if your nasal allergy symptoms are not  Looking in the nose for signs of polyps
easily controlled with over-the-counter or prescription  Shining a light against the sinus (transillumination) for
medications. signs of inflammation
 Quit smoking. Smoking dries out your nose and irritates it.  Tapping over a sinus area to find infection
 Nasal endoscopy
 A CT scan of the sinuses to help diagnose sinusitis or
SINUSITIS view the bones and tissues of the sinuses more closely
 an inflammation, or swelling, of the tissue lining  An MRI of the sinuses if there might be a tumor or fungal
the sinuses. infection
 Conditions that can cause sinus blockage include
the common cold, allergic rhinitis (swelling of the lining of TREATMENTS
the nose), nasal polyps (small growths in the lining of the  Nasal decongestant- Be careful with use of over-the-
nose), or a deviated septum (a shift in the nasal cavity). counter spray nasal decongestants. They may help at first,
but using them for more than 3 - 5 days can make nasal
 Normally, sinuses are filled with air, but when sinuses stuffiness worse.
become blocked and filled with fluid, germs (bacteria,  ANTIBIOTICS- may not required but..
viruses, and fungi) can grow and cause an infection. Antibiotics may be prescribed sooner for:
 Children with nasal discharge, possibly with a cough, that
There are different types of sinusitis, including: is not getting better after 2 - 3 weeks
 Fever higher than 102.2° Fahrenheit (39° Celsius)
 Headache or pain in the face  Infections with certain parasites
 Severe swelling around the eyes Other causes of chronic hoarseness include:
 Cancer
NURSING CARE  Vocal cord paralysis, which can result from injury,
The best way to prevent sinusitis is to avoid colds and flu or stroke, a lung tumor or other health conditions
treat problems quickly.  Bowing of the vocal cords in old age
 Eat plenty of fruits and vegetables, which are rich in
antioxidants and other chemicals that could boost your RISK FACTORS
immune system and help your body resist infection. Risk factors for laryngitis include:
 Get an influenza vaccine each year.  Having a respiratory infection, such as a cold, bronchitis or
 Reduce stress. sinusitis
 Wash your hands often, particularly after shaking hands  Exposure to irritating substances, such as cigarette
with others. smoke, excessive alcohol, stomach acid or workplace
 Other tips for preventing sinusitis: chemicals
 Avoid smoke and pollutants.  Overusing your voice, by speaking too much, speaking too
 Drink plenty of fluids to increase moisture in your body. loudly, shouting or singing
 Take decongestants during an upper respiratory infection.
 Treat allergies quickly and appropriately. DIAGNOSTICS
 Use a humidifier to increase moisture in your nose and  Laryngoscopy
sinuses.  Biopsy

TREATMENT
LARYNGITIS  Antibiotics
 Laryngitis is an inflammation of the voice box (larynx).  Corticosteroids
 Causes of laryngitis include upper respiratory infection
or cold; overuse of the voice box by talking, singing, or NURSING CARE
shouting; To prevent dryness or irritation to your vocal cords:
 gastroesophageal reflux disease (GERD), reflux laryngitis;  Don't smoke, and avoid secondhand smoke. Smoke dries
chronic irritation of the vocal cords; smoking; exposure to your throat and irritates your vocal cords.
secondhand smoke; or exposure to polluted air.  Limit alcohol and caffeine. These cause you to lose total
 Laryngitis is contagious only if it is caused by an infection. body water.
 The most common symptoms of laryngitis are hoarseness,  Drink plenty of water. Fluids help keep the mucus in your
loss of voice, and throat pain. throat thin and easy to clear.
 Avoid clearing your throat. This does more harm than
SIGNS AND SYMPTOMS good,
  Hoarseness  because it causes an abnormal vibration of your vocal
 Weak voice or voice loss cords and can increase swelling. Clearing your throat also
 Tickling sensation and rawness of your throat causes your throat to secrete more mucus and feel more
 Sore throat irritated, making you want to clear your throat again.
 Dry throat  Avoid upper respiratory infections. Wash your hands
often, and avoid contact with people who have upper
 Dry cough
respiratory infections such as colds.
CAUSES
ACUTE LARYNGITIS
LARYNGOTRACHEOBRONCHITIS
 Viral infections similar to those that cause a cold
 an acute nonspecific inflammation of the mucous
 Vocal strain, caused by yelling or overusing your
membrane of the larynx, trachea and bronchi
voice
characterized by abundant secretion of thick mucus,
 Bacterial infections, such as diphtheria, although this
choking, coughing, cyanosis and high temperature.
is rare
 The most affected groups are children under four years.
CHRONIC LARYNGITIS
 The disease is the result of a viral infection accompanied
 Inhaled irritants, such as chemical fumes, allergens or
by a mixed bacterial infection (Strept, pneumo and
smoke
staphylococci).
 Acid reflux, also called gastroesophageal reflux
 It appears epidemically or sporadically.
disease (GERD)
 Strong swelling of the mucous membrane is an important
 Chronic sinusitis
factor in the disease.
 Excessive alcohol use
 Habitual overuse of your voice (such as with singers SIGNS AND SYMPTOMS
or cheerleaders)
 begins with dry chronic cough that resembles the barking
 Smoking
of a dog. 
Less common causes of chronic laryngitis include:
 voice is hoarse
 Bacterial or fungal infections
 body temperature rises  Having a weakened immune system. If your immune
 difficulties in breathing, system has been weakened by illness or medication,
 cyanosis you're more susceptible to the bacterial infections that
 retraction of the epigastrium jugulum may cause epiglottitis.
 Hypoxia  Lacking adequate vaccination. Delayed or skipped
 together with dehydration immunizations can leave a child vulnerable to Hib and
 general intoxication occur with the cardiovascular system increases the risk of epiglottitis.
weakening.
DIAGNOSTICS
 If the medical team suspects epiglottitis, the first priority is
DIAGNOSTICS to ensure that your or your child's airway is open and that
 Laryngotracheoscopy- which reveals mucous membrane enough oxygen is getting through.
swelling and hyperemia of the larynx with thick yellowish- Initial test
whitish secretion out bursting among vocal cords. A pulse oximeter is a device that estimates blood oxygen
levels. This device:
TREATMENT  Clips onto a finger
 Broad-spectrum of antibiotics  Measures an estimation of the saturation of oxygen in
 Corticosteriods your blood
 a tent with wet oxygen rehydration are applied.  If oxygen saturation levels drop too low, you or your
 Cardiotonics and analeptics  child may need help breathing.
 Bronchial aspiration
 Throat examination
 Acetamenophen
 Chest or neck X-ray.
NURSING CARE  Throat culture and blood tests.
 To prevent croup, take the same steps you use to prevent
TREATMENT
colds and flu.
The first priority in treating epiglottitis is ensuring that you or
 Frequent hand-washing is most important.
your child is receiving enough air. This may mean:
 Also keep your child away from anyone who's sick,
 Wearing a mask. The mask delivers oxygen to the
 encourage your child to cough or sneeze into his or her
lungs.
elbow.
 Having a breathing tube placed into the windpipe
 To stave off more-serious infections, keep your child's
through the nose or mouth (intubation). The tube
vaccinations current. The diphtheria and Haemophilus
must remain in place until the swelling in your or your
influenza type b vaccines offer protection from some of the
child's throat has decreased — sometimes for several
rarest — but most dangerous — forms of upper airway
days.
infection.
 Inserting a needle into the trachea (needle
tracheostomy).In extreme cases or if more
EPIGLOTTITIS
conservative measures fail, the doctor may need to
 is a potentially life-threatening condition that occurs when
create an emergency airway by inserting a needle
the epiglottis — a small cartilage "lid" that covers your
directly into an area of cartilage in your or your child's
windpipe — swells, blocking the flow of air into your lungs.
trachea. This procedure allows air into your lungs
while bypassing the larynx.
CAUSES
 Broad-spectrum antibiotic. Because of the need for
 burns from hot liquids
quick treatment, rather than wait for the results of the
 direct injury to your throat and various infections
blood and tissue cultures, you or your child is likely to
 The most common cause of epiglottitis in children in the be treated with a broad-spectrum drug.
past was infection with Haemophilus influenzae type b  More targeted antibiotic. The drug may be changed
(Hib), the same bacterium that causes pneumonia, later, depending on what's causing the epiglottitis.
meningitis and infections in the bloodstream.
NURSING CARE
SIGNS AND SYMPTOMS
 Immunization with the Hib vaccine is an effective way to
In children, signs and symptoms of epiglottitis may develop
prevent epiglottitis
within a matter of hours, including:
 Don't share personal items.
 Fever
 Wash your hands frequently.
 Severe sore throat
 Use an alcohol-based hand sanitizer if soap and water
 Abnormal, high-pitched sound when breathing in
aren't available.
(stridor)
 Difficult and painful swallowing
ASPIRATION
RISK FACTORS
 Aspiration in children is a serious and common problem.
 Being male. Epiglottitis affects more males than females.
 It usually presents with an initial episode of choking with
subsequent respiratory symptoms. Aspiration occurs
whenever secretions, solid food or liquids "go down the BRONCHIAL OBSTRUCTION
wrong pipe" and enter the airway and lungs.  (AMO LA NAKADTO PPT HAHAHA READ NALA PO HA
 Aspirating material into the lungs can lead to respiratory BOOK PREFERABLY HA EDITION 6 OR 7 THANKS )
problems, such as pneumonia. 
 While there may be observable signs that accompany
aspiration events, such as coughing, choking, eye
reddening during eating, or a gurgly vocal quality after
swallowing, infants and children can also aspirate
"silently," or with no observable symptoms.

SIGNS AND SYMPTOMS

 Any child with a history of recurrent pneumonia or chronic
respiratory illness.
 Any child with neuromuscular disorders, both structural © sheramaeisobelsilvano/dyosa
and functional (i.e., cerebral palsy, etc.).
 Children with excessive drooling, especially if seen to
cough or gag on their own secretions.
 Infants/children with history of gastroesophageal reflux
disease.
 Children who have acquired brain damage secondary to
open or closed head injuries, with particular importance on
those withbrainstem/cranial nerve involvement.
 Infants who are born prematurely.
 Infants/children with chronic heart disease.
 Infants/children with craniofacial anomalies (i.e., cleft
palate, etc.).
 Infants/children with congenital syndromes.
 Children with upper airway anomalies (i.e., congenital
defects of the larynx, trachea, and
esophagus; tracheoesophageal fistulas).
 Children who exhibit failure to gain weight or poor weight
gain; diagnosis of failure to thrive.
 Sucking and swallowing incoordination or weak suck.
 Breathing disruption or apnea during feeding.
 Children with behavioral feeding problems (i.e., refusal to
eat new foods or unexplained food refusal; rigid feeding
behaviors;irritablilty during or after feeding).
 Children with feeding periods longer than 30 to 40
minutes.
 Children receiving enteral/tube feedings, especially under
the age of 2.
 Children who exhibit aversive responses to oral
stimulation

TREATMENT AND MANAGEMENT

 Conservative therapy is the initial treatment of choice to
prevent aspiration syndromes and often results in
significant improvement in respiratory symptoms.
 Position infants in the prone or upright position.
 Avoid placing infants younger than 6 months in a seated
position for approximately 90 minutes after a feed.
 Do not feed the infant within 90 minutes before bedtime.
 Elevation of the head of the bed approximately 30° may
help, although young infants may slide down the bed
during the night.
 Broad spectrum antibiotic
 Second or third generation cephalosporins