Respiratory Alteration #1

Lucas friend (4 years old) came over to his house for a play date. Lucas mother
noticed that his friend was not acting normal. He was drooling, sittingleaning forward
with his chin thrust out and mouth open. He seemed very anxious and irritable. He felt
very hot with a fever. She immediately was concerned, because she had just been at
the pediatricians office with Lucas; and they had taught her about diseases that can
occur if children do not receive their immunizations. She knows that this friend has not
been vaccinated, because his mother does not believe in vaccinations. What condition
is this child most likely experiencing?
Epiglottitis
Lucas mother calls the friends mother, but is unable to reach her. So she calls Lucas
pediatrician. He says that this condition progresses rapidly, and she should take him to
the emergency department at once. What should the ED physicians not do unless
emergency intubation equipment and qualified personnel are available? Why is this?
Examination, visual observation of the epiglottis, or throat culture; because it
can cause sudden airway obstruction
What nursing interventions should ED and inpatient nurses expect to perform?
Assess for s/s of respiratory distress, monitor oxygenation status closely,
arterial blood gas and pulse oximetry, humidified oxygen, and maintenance of
patent airway. Obtain axillary or tympanic temperature (not oral), and
obtaining throat and blood cultures once child has been intubated, administer
Tylenol (rectal) for fever, enforce NPO status, administer IV antibiotic, and
educate parents about home administration of oral antibiotics once
discharged.

Respiratory Alteration #2
Lucas has a chronic respiratory condition: He has dyspnea with exertion, wheezing, and
a dry cough. What is this condition?
Asthma
What are other manifestations that may have a sudden onset?
Retractions, nasal flaring, stridor, tachypnea, restlessness, apprehension,
diaphoresis, fatigue and difficulty performing simple tasks, feeling of a tight
chest
Lucas has been hospitalized, and you are his nurse. His father is asking why his
condition worsens at night. What would be the best explanation for him?
Increased narrowing of the airway and pooling of secretions at night
How would treatments during hospitalization vary from treatments at home?
Home: Routine--Inhaled corticosteroids, Long acting beta 2-adrenergic
agonists (LABA), combination medication (Symbicort, Advair), Singulair.
Rescue: Albuterol inhaler, Atrovent, oral corticosteroids
Hospital: Humidified oxygen to maintain oxygen saturation great than 95%, IV
methylprednisolone (oral steroids if not in severe respiratory distress),
bronchodilator by nebulizer every 20 minutes to 1 hour initiallyintervals
increasing with improvement
This is a new diagnosis for Lucas, and his father is asking if he will outgrow it?
No, it is a lifelong condition; however the severity of the symptoms may lessen
with age.
You encourage Lucas to maintain a normal lifestyle, but also be adherent to his disease
management. What education would you provide Lucas and his father about the longterm management of his disease? (e.g., environmental control, exercise)
Minimize and control triggers: Allergens, cigarette smoke, smoke from woodburning stove and fireplace, fumes, deodorants, overhumidified air, and
perfume. Minimize sport involvement that requires sustained exertion.
Prevent and quickly treat respiratory infections. Manage asthma symptoms
when emotionally upset.
What is the name of the written plan that will be very important for Lucas. It will have
detailed plans about home management and list of indicators that require physician or
emergency department care?
Asthma action plan

Respiratory Alteration #3
You are Emmas nurse at her pediatricians office. She is two years old, and her mother
has brought her for evaluation. She has been sick for three days with fever, irritability,
and yellow/green foul smelling ear drainage. Her mother says that she has been pulling
on her ears, and not sleeping as well at night. What is most likely her diagnosis?
Otitis Media (or Acute Otitis Media)
Her mother reports that this is the third time she has had this diagnosis in the past 6
months. What explanation could you give as to why infants and toddlers are more at
risk for this illness?
Their eustachian tubes are shorter and more horizontal than older childrens.
Also, their lack of cartilage support causes eustachian tubes to easily collapse.
Both of these manifestations restrict normal middle-ear drainage.
Besides anatomy, what other risk factors could you explain to Emmas mother?
Daycare centers, age (6-24 months), second-hand smoke exposure, pacifier
use, bottle feeding while child is supine.
Emmas mother is confused because the doctor did not prescribe an antibiotic. He said
that he wanted to monitor Emmas condition for 48 hours, and then prescribe antibiotic
if her symptoms have not improved. What explanation would you give her mother, and
what treatment/prevention recommendations can you give her for that time?
A. In 80% of children, AOM resolves spontaneously without antibiotics.
B. Tylenol for pain and/or fever. Increase fluid intake if fever present.
Eliminate any risk factors if possible (second-hand smoke, daycare, supine
feeding). Call the doctor if symptoms not improved after 48 hours.
After 48 hours, if antibiotic is prescribed, what is important information to teach her
mother about antibiotic administration?
Administer antibiotic on time and for the prescribed number of days. Do not
stop giving if child begins to feel better after a few days of treatment.
Since Emma has had many reoccurrences of this this illness, what treatment might the
physician recommend?
Myringotomy with insertion of tympanostomy tubes

Respiratory Alteration #4
Emma is 6 years old, and her father brought her to the pediatrician office because she
has been ill for 4 days. She has a sore throat, hoarseness, cough, and runny nose. Her
father reports that she has not been eating much the past few days and has been acting
very tired. The physician exams her and finds redness and inflammation of her
pharynx. As her nurse, what do you expect her diagnosis is?
Pharyngitis
What will be Emmas treatment for this condition?
Tylenol or Ibruprofen for pain and/or fever, rest, gargling warm salt water,
drinking plenty of cool/bland liquids. Antibiotics only for children who test
positive on antigen detection test/cultures.
Her father states that Emmas brother (Lucas) had tonsillitis and asks if its the same
illness? How would you answer? What are the symptoms for tonsillitis?
No, they are two different conditions. Tonsillitis is inflammation of the tonsils.
Symptoms of tonsillitis include sore throat, redness/irritation of tonsils,
difficulty swallowing, unpleasant mouth odor, and may have white exudate on
tonsils.
Emmas father says that he was hoping Lucas would have his tonsils removed because
he has had tonsillitis twice now. You would explain to their father that tonsillectomies
are now usually reserved for what instances? Also, why should the tonsils not be
removed during an episode of tonsillitis?
A. Upper airway obstruction, peritonsillar abscess, obstructive sleep apnea,
other serious problems.
B. Can result in spread of the infecting organism and sepsis
What is the most serious and life-threatening complication of tonsillectomy?
Postoperative hemorrhage