PEDI | Respiratory

The pediatric respiratory system differs significantly from adults, making children prone to rapid decompensation.

• Airway Size: An infant's trachea is approximately 4 mm wide (vs. 20 mm in adults). Even 1 mm of edema can reduce the airway diameter by 50%, significantly increasing resistance and work of breathing.

• Physiology: Children have higher metabolic rates and oxygen consumption (6–8 L/min vs. 3–4 L/min in adults), causing hypoxemia to develop more rapidly during distress.

• Assessment Priorities: The first sign of respiratory illness is often tachypnea. Other critical signs include retractions (suprasternal, intercostal), nasal flaring, grunting, and head bobbing. Quiet chests in asthmatics can indicate severe obstruction (lack of air movement) rather than improvement.

Croup (Laryngotracheobronchitis)

Barking/seal-like cough, inspiratory stridor, low-grade fever.

Cool mist humidity, corticosteroids (dexamethasone), nebulized racemic epinephrine.

Monitor for rebound bronchospasm after racemic epinephrine wears off.

Epiglottitis

Medical Emergency. Drooling, agitation, tripod positioning, frog-like croaking, high fever.

Protect the airway immediately. Prepare for intubation. IV antibiotics and humidified oxygen.

NEVER visualize the throat (tongue blade) or obtain a culture; this may trigger complete airway occlusion.

Bronchiolitis (often RSV)

Copious thick secretions, wheezing, tachypnea, poor feeding.

Suctioning (especially before feeds), hydration, and supplemental oxygen if sat <90%.

Bronchodilators and corticosteroids are generally not recommended. Use contact precautions.

Chronic Management Priorities

1. Asthma Asthma is characterized by inflammation, bronchoconstriction, and mucus. Management is tiered:

• Rescue: Short-acting beta2-agonists (SABA) like albuterol are used for acute exacerbations to relax airway smooth muscle.

• Maintenance: Inhaled corticosteroids (e.g., fluticasone) and leukotriene modifiers (e.g., montelukast) suppress inflammation and prevent attacks.

• Monitoring: Use a peak flow meter to establish a "personal best." A reading in the Red Zone (<50%) requires immediate bronchodilators and medical attention.

2. Cystic Fibrosis (CF) An autosomal recessive disorder causing thick, tenacious mucus that blocks alveoli and pancreatic ducts.

• Respiratory Care: Airway clearance is mandatory. Techniques include Chest Physiotherapy (CPT) and high-frequency chest oscillation vests, often preceded by bronchodilators or dornase alfa (to thin mucus).

• Nutritional Care: Patients require pancreatic enzymes with all meals and snacks to digest food. The diet must be high-calorie and high-protein, with fat-soluble vitamin supplementation (A, D, E, K).

Critical Nursing Safety Alerts

• Tonsillectomy: The most common complication is hemorrhage. Monitor for frequent swallowing (a sign of trickling blood), tachycardia, and bright red emesis. Discourage coughing or clearing the throat.

• Foreign Body Aspiration: Most common in ages 6 months to 3 years. Avoid latex balloons, peanuts, and popcorn. If obstruction occurs, use back blows/chest thrusts (infant) or abdominal thrusts (older child).

• Oxygen Therapy: Oxygen is a drug. In chronic hypercapnia (like CF), indiscriminate oxygen use can suppress the respiratory drive. Use the lowest liter flow to correct hypoxemia.