Respiratory+Rounds+1

Pediatrics Respiratory Dysfunction:  The oronasopharynx, the pharynx, the larynx, and the upper part of the trachea is called the upper respiratory tract .

Conversely, the lower respiratory tract  includes the lower trachea, the mainstem bronchi, the segmental bronchi, the bronchioles and the alveoli.

Respiratory infections often spread among these structures due to the continuous nature of the mucosal lining.

Respiratory illnesses account for a lot of childhood illnesses!

Respiratory illnesses can be caused by viruses or bacteria.

Some of the viruses  commonly causing respiratory illness are the respiratory syncytial virus, non-polio enteroviruses (coxsackie A&B), adenoviruses, parainfluenza viruses and metapneumoviruses.

Bacterial agents  causing illness include Group A beta-hemolytic streptococci, staphylococci, Haemophilus influenza, Chlamydia trachomatis, Mycoplasma and pneumococci. Be aware that vaccines have been developed to protect children from Haemophilus influenza (ACT-Hib, Pedvax) and against 13 different strains of the pneumococci (Prevnar 13).

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Full-term infants under 3 months of age experience some protection from infection from maternal antibodies. From 3-6 months this protection begins to wane. From 6 months until five years of age children experience numerous viral infections.

<span style="color: #d61f1f; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Anatomically <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> the airways of children are smaller in diameter and the distances between various respiratory structures short. This can quickly compromise a young child due to swelling of these passages and blockage due to mucous and secretions.

<span style="color: #d61f1f; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Factors <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> which can affect a child’s resistance to respiratory illness include: immune compromise, malnutrition, anemia, allergies, preterm birth, asthma, cystic fibrosis or cardiac anomalies. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Environmental factors such as daycare attendance, environmental smoke can also affect respiratory infection rate.

<span style="color: #d61f1f; display: block; font-family: "Times New Roman"; font-size: 170%; text-align: left;">**Breath Sounds:** <span style="color: #d61f1f; display: block; font-family: "Times New Roman"; font-size: 170%; text-align: left;">media type="youtube" key="O8OC7EiqBKQ" width="560" height="315" <span style="color: #d61f1f; display: block; font-family: "Times New Roman"; font-size: 170%; text-align: left;"> <span style="color: #d61f1f; display: block; font-family: "Times New Roman"; font-size: 170%; text-align: left;">In General - Signs and Symptoms of respiratory tract infection: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Fever <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Poor feeding, anorexia <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Vomiting <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Diarrhea <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Abdominal pain <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Nasal discharge, blockage <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Cough <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Respiratory sounds: cough, stridor, hoarseness, grunting, wheezing, crackles, absence of breath sounds <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Sore Throat <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Meningismus

<span style="color: #d61f1f; display: block; font-family: "Times New Roman",Times,serif; font-size: 18pt; text-align: left;">Nursing Assessment includes: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Rate/Rhythm, depth, ease of respirations, along with breath sounds, as well as, observation of the child’s color and vital signs.

<span style="color: #d61f1f; display: block; font-family: "Times New Roman",Times,serif; font-size: 18pt; text-align: left;">Nursing Actions: Teach parents to be careful with OTC cold medications, as many will have Tylenol included… Ease respiratory efforts – cool mist, shower steam, cool night air Promote rest, decreased activity with illness Promote comfort, saline, bulb syringe, nasal sprays 2 gtts then 10 minutes later repeat, ice or heat Prevent spread – hand washing, cover mouths, tissues, absences Reduce temperature - Motrin, Tylenol, cool liquids Promote hydration – Pedialyte, Gatorade, count diapers Provide nutrition – gelatin, popsicles, soup…

<span style="color: #d61f1f; display: block; font-family: "Times New Roman",Times,serif; font-size: 18pt; text-align: left;">**Complications** of a respiratory illness can include: Earache Respiratory rate >50-60 breaths per minute Fever >101 Listlessness Confusion Increased irritability Persistent cough for 2 days or more Crying Wheezing Restlessness Refusal to eat/drink Low output, fewer wet diapers

<span style="color: #d61f1f; display: block; font-family: "Times New Roman",Times,serif; font-size: 170%; text-align: left;">Breath Sounds: media type="youtube" key="NnuaHGW1cwU" height="342" width="560" align="left"

<span style="color: #d61f1f; font-family: 'Times New Roman',Times,serif; font-size: 130%;">This video offers an excellent demonstration of a newborn experiencing retractions and grunting. media type="youtube" key="NBA9iigiDgk" height="468" width="545" <span style="color: #0fab16; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Common, managed at home with mentioned supportive care <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Most frequent complaint <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Average is 6-10/year (adults 2-4) <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Diagnosis based on history <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Better within 48-72 hours
 * <span style="color: #23b017; font-family: 'Times New Roman',Times,serif; font-size: 16pt;">Nasopharyngitis **

<span style="color: #16ab13; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Assessment: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Vitals <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Infants may have trouble eating due to congestion <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Color and amount of secretions

<span style="color: #1c9911; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Nursing diagnosis/Outcomes <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Ineffective airway/ patent airway <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Deficient fluid volume/ output 1ml/kg/hr <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Acute pain/ comfort

<span style="color: #14ad11; font-family: 'Times New Roman',Times,serif; font-size: 18px;">Treatment: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Supportive care, rest, elevate head of bed <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Nonaspirin analgesics (Tylenol, Motrin) <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Humidifiers <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Saline drops, bulb suction <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Fluids - frequent rest periods <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">OTC medications not recommended <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Usually viral so no antibiotics

**<span style="color: #20990c; font-family: 'Times New Roman',Times,serif; font-size: 16pt;">Pharyngitis ** *80-90% are viral! Strep throat at risk for scarlet fever, rheumatic fever, and acute glomerulonephritis Culture <span style="color: #149921; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Clinical Manifestations: Pharyngitis, tonsillar exudate, headache, fever, abdominal pain,  Strawberry tongue, a fine sandpaper rash, clear nasal airways - more indicative of Strep Manifestations subside in 3-5 days but can be complicated with a peritonsillar abscess or sinusitis. Acute glomerulonephritis can follow in 10 days or rheumatic fever in 18. <span style="color: #13ab2b; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Treatment/Management: Supportive care for viral  Warm salt water gargles, Nonsapirin analgesics ( Tylenol and Motrin) for the pain, throat lozenges Soothing liquids for hydration, rest Bacterial rx: Penicillin G, deep IM, make sure parents understand that they may limp after the injection Oral antibiotics preferred for this reason Erythromycin if allergic to PCN. Need to return if not significantly better in 24-48 hours. Change toothbrush!

**<span style="color: #c4061d; font-family: 'Times New Roman',Times,serif; font-size: 16pt;">Tonsillitis ** Tonsils are masses of lymphoid tissue in the pharyngeal area. Children have larger tonsils Tonsillitis often accompanies pharyngitis, most are viral Kissing tonsils makes swallowing difficult Inflammed Adenoids makes breathing through the nose difficult Three or more infections despite adequate therapy Not recommended if cleft palate, current infection or blood disorders  Not recommended for child less than 3 due to possibility of excessive blood loss   Not recommended for child less than 3 also as lymphoid tissue can grow back! Preparation for surgery **<span style="color: #1425ba; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Diagnosis/Outcomes ** Risk for fluid deficit/ adequate hydration   Pain/ minimize pain   Risk for injury (bleeding) due to incision/ observe for bleeding, no tongue blades, rough foods etc. **<span style="color: #111e99; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Interventions: ** Placed **on side** post surgery to promote drainage Soft liquid diet (cool, non carbonated, non-acidic), popsicles or drinks **not red**  Cool mist vaporizer Throat lozenges Tylenol, opioids, zofran No coughing, clearing throat, blowing nose, vigorous toothbrushing **//<span style="color: #1a18a8; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">*Membrane forms over operative site, starts to pull off between 4 and 10 days //**
 * <span style="color: #ba0d41; font-family: 'Times New Roman',Times,serif; font-size: 16pt;">Strep: ** media type="youtube" key="8GucjMGONfI" width="616" height="346"
 * Tonsillectomy **
 * <span style="color: #0e2ac2; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Tonsillectomy Care: **
 * //<span style="color: #1a18a8; font-family: 'Times New Roman',Times,serif; font-size: 14pt;"> Hemorrhage may occur up to 10 days, sloughing of tissue //**
 * //<span style="color: #1a18a8; font-family: 'Times New Roman',Times,serif; font-size: 14pt;"> Frequent swallowing, restlessness, tachycardia can indicate bleeding! //**

media type="youtube" key="TVLo2CtB3GA" height="377" width="504" Types A, B and C School children Can be mild, moderate or severe
 * <span style="color: #1c9c11; font-family: 'Times New Roman',Times,serif; font-size: 16pt;">Influenza **

<span style="color: #2f9909; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Clinical Manifestations: Dry cough, throat, photophobia, myalgia, chills, fever, exhaustion

<span style="color: #0aa610; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Treatment/Management: Symptomatic care Tylenol, Motrin, fluids, rest Amantadine hydrochloride – Symmetrel within 24-48 hours –for A Zanamivir, Rimantadine, Tamiflu for A or B Flu vaccines injectable or nasal (live) No nasal for asthma, immune compromised, allergy eggs, hx Guillain-Barre Greatest danger secondary infection

<span style="color: #d61f1f; display: block; font-family: "Times New Roman",Times,serif; font-size: 18pt; text-align: left;">Otitis Media media type="youtube" key="UBobShigoFk" height="343" width="616" <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">This video is really cool as you can see the actual infected drum! media type="youtube" key="8keTRPAuvKg" width="560" height="315" Eustachian tubes protect from nasopharyngeal secretions (wider, straighter, shorter in infants)  Promote drainage of middle ear secretions into the nasopharynx,   Ventilation of middle ear and to equalize air pressure One of the most prevalent childhood diseases Often preceded by respiratory infection Most common in first 24 months of life Rare after age 7  Factors affecting: Infections, feeding techniques, smoke exposure, daycare Causes: Streptococcus pneumoniae, H. influenzae, Moraxella catarrhalis
 * <span style="color: #c41025; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Otitis Media (OM), Acute Otitis Media (AOM), **
 * <span style="color: #c41025; font-family: 'Times New Roman',Times,serif; font-size: 150%;"> Otitis Media with Effusion (OME) **

<span style="color: #de3f3f; font-family: 'Times New Roman',Times,serif;">Pneumococcal disease
media type="youtube" key="ij6jMchYyFE?version=3" height="346" width="616" Clinical Manifestations: Infant - fussy, crying, pulls ear, rolls head side to side, no appetite Child – c/o pain, crying, irritability, lethargy, loss of appetite Chronic – 3 or more in 6 months, can cause hearing loss, tinnitus, vertigo Nursing diagnosis/ Outcomes: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Pain/ pain free <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Infection/ afebrile <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Delayed growth and evelopment/ no hearing loss <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Fluid volume deficit/ adequate output Treatment/Management: Therapeutic antibiotics Pain management Prevent complications Education: feeding practices, smoking  Tympanostomy – surgical placement of tubes, grommets, for air equalization Myringotomy – surgical incision for drainage If grommet falls out not an emergency but notify Dr. **<span style="color: #0aa61a; font-family: 'Times New Roman',Times,serif; font-size: 18pt;">Infectious Mononucleosis ** media type="youtube" key="V2QkL9J_pXc" height="439" width="588" Epstein-Barr virus (EBV) Transmitted in saliva Mildly contagious Onset 10 days to 6 weeks after exposure The spot test (Monospot)
 * <span style="color: #10a130; font-family: 'Times New Roman',Times,serif; font-size: 160%;">Infectious Mononucleosis **

<span style="color: #0aad1b; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Clinical Manifestations: Headache, malaise, fatigue, chills, fever, loss of appetite, puffy eyes, sore throat, cervical adenopathy, Pharyngitis, tonsillitis, splenomegaly*, *rash often after antibiotics administered

<span style="color: #08a618; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Therapeutic Management: No specific treatment Rest, maybe activity restriction, analgesics, gargles, hot drinks Antibiotics only in case of strep Corticosteroids only in case of significant inflammation, anemia, thrombocytopenia or neurologic complications Acute symptoms disappear in 7-10 days Fatigue diminishes in 2-4 weeks


 * <span style="color: #1331cc; font-family: 'Times New Roman',Times,serif; font-size: 16pt;">Croup Syndromes: **

It is often caused by Haemophilus influenzae.
 * <span style="color: #d40839; font-family: 'Times New Roman',Times,serif; font-size: 16pt;">Epiglottitis: **
 * *Is a severe life threatening emergency! **

<span style="color: #de3f3f; font-family: 'Times New Roman',Times,serif;">Hib
media type="youtube" key="iy9iywzE0z0?version=3" height="346" width="616"

This is one of the vaccines administered at 2, 4, 6 months and at 15 months. It is known as ACT HIB (4 doses) or Pedvax (3 doses). Sudden onset. Restlessness, high fever, sore throat Dysphagia, drooling, muffled voice and tripoding.
 * Clinical Manifestations: **


 * Nursing Care: **
 * *Do not examine the throat of a child with suspected epiglottitis, this can cause a spasm and close the airway* **

Prepare for hospitalization in the ICU Employ measures to decrease agitation Administer antibiotics as prescribed Maintain the child's positioning for optimum oxygenation (sitting)
 * Be prepared for a possible intubation or tracheostomy **

<span style="color: #d61f1f; font-family: 'Times New Roman',Times,serif; font-size: 22.2px;">Bacterial Tracheitis - similar to epiglottitis **<span style="color: #1fa30a; font-family: 'Times New Roman',Times,serif; font-size: 18pt;">Croup Syndromes: Acute Laryngitis, Acute Spasmodic Laryngitis ** <span style="color: #d61f1f; display: block; font-family: "Times New Roman",Times,serif; font-size: 18pt; text-align: left;">media type="youtube" key="Qbn1Zw5CTbA" height="591" width="491" align="left"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Most common between 6 and 36 months (<7) <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Peaks in Autumn <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Swelling of the trachea, with or without inflammation and mucous
 * <span style="color: #06bd18; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Croup: **

<span style="color: #139c18; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Manifestations: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Hoarse barking cough, sudden onset, often at night <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Stridor, retractions

<span style="color: #2a9110; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Diagnosis: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Based on history, CBC, x-rays

<span style="color: #1c9c19; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Treatment: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Steroids, (dexamethasone) orally or IM <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Nebulized epinephrine <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> O2, hydration, Antipyretics, Anxiety reduction, Humidifier, Cool night air

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Bronchiolitis peaks November to March Factors affecting incidence: prematurity, siblings, exposure to tobacco Narrowing of bronchioles leads to air trapping (hyperinflation) in alveoli and atelectasis (collapse)
 * <span style="color: #19ab16; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Bronchiolitis: **
 * <span style="color: #19ab16; font-family: 'Times New Roman',Times,serif; font-size: 150%;">RSV (Respiratory Syncytial Virus) most common cause of bronchiolitis in children < 1 (75%) **

<span style="color: #13a121; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Manifestations: Present with cold like symptoms then progresses after several days Irritable, coughing, anorexia, nasal congestion, nasal flaring, tachypnea, prolonged expiratory phase, wheezing, rales and a deteriorating respiratory condition. Leading to poor feeding and respiratory fatigue

<span style="color: #0f961d; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Nursing diagnosis/Outcomes: Ineffective airway clearance/ clear lungs Deficient fluid volume/ Output 1ml/kg/hr Knowledge deficit/ educate about management

<span style="color: #0ea30b; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Nursing Actions: Isolate - spread by droplet but contact isolation preferable Monitor respiratory status Bulb syringe O2, raise head of bed *Consolidate care (so frequent rest periods)

Hydrate, IV for hydration or feeding with frquent rest periods (I&O) Mist or nebulized medications as needed Antiviral agent - Ribavirin

<span style="color: #12990f; font-family: 'Times New Roman',Times,serif; font-size: 140%;">*Palivizumab (Synagis) provides passive immunity for high-risk children. This series is generally only offered to children born prematurely with several co-morbidities. It is offered monthly (every 28 days) November to March. It is extremely expensive!*

media type="youtube" key="4yjVD5jNY4Y" height="510" width="507" align="left"

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 * <span style="color: #db1d3f; font-family: 'Times New Roman',Times,serif; font-size: 21px;">Pneumonia **

<span style="color: #d91135; font-family: 'Times New Roman',Times,serif; font-size: 18pt;"> Tuberculosis media type="youtube" key="u7o93nmgp1E" height="362" width="489" align="left"

//<span style="color: #cd2828; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Be aware that Tuberculosis is screened for using the Mantoux test with PPD (tuberculin purified protein derivative). This is an intradermal injection most commonly administered on the left forearm. It is read with in 48-72 hours. A reaction to the PPD indicates exposure to the bacterium. //


 * <span style="color: #1c2aad; font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Foreign Body Aspiration **


 * <span style="color: #1c2aad; font-family: 'Times New Roman',Times,serif; font-size: 140%;"> ARDS - Acute Respiratory Distress Syndrome **

media type="youtube" key="EK8nzKzdnIM" width="560" height="315"
 * <span style="color: #1d2cb5; font-family: 'Times New Roman',Times,serif; font-size: 18pt;"> Asthma **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Characterized by edematous airways clogged with mucous <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Smooth muscles of bronchi and bronchioles constrict <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Air trapping occurs
 * <span style="color: #171dad; font-family: 'Times New Roman',Times,serif; font-size: 23.399999618530273px;"> Inflammatory Reactive Airway Disease/Asthma **

<span style="color: #2b28cd; font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;"> Nursing Actions: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Monitor for respiratory distress <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Administer bronchodilators and steroids as ordered, everyday meds, (maintanence meds) or emergency meds (rescue meds) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Maintain hydration <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">O2 and nebulizer therapy <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Monitor blood gases and O2 sats, should be greater than 95% <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Teach! Triggers, Allergens, use of metered dose inhaler (MDI), management

media type="youtube" key="A7DhGX0p1KY" height="396" width="534"

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media type="youtube" key="l0dDhKFk2HU" height="412" width="520"
 * <span style="color: #181eb5; font-family: 'Times New Roman',Times,serif; font-size: 18pt;"> Cystic Fibrosis **

media type="youtube" key="AlOIKzMWqcQ" width="560" height="315"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Characterized by dysfunction of the exocrine glands impacting the lungs, pancreas, sodium and chloride levels. <span style="font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Meconium ileus at birth approximately 10-20% of the time <span style="font-family: 'Times New Roman',Times,serif; font-size: 14pt;">recurrent respiratory infection characterized by copious mucous <span style="font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Steatorrhea (fatty, greasy stools), foul smelling <span style="font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Delayed growth, poor weight gain <span style="font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Skin tastes salty <span style="font-family: 'Times New Roman',Times,serif; font-size: 14pt;">Cyanosis, CHF, nail bed clubbing appear later due to continued compromise
 * <span style="color: #1530bd; font-family: 'Times New Roman',Times,serif; font-size: 14pt;"> Autosomal recessive disorder **

<span style="color: #1933bd; font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;"> Nursing Actions: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Monitor respiratory status, observe for infection and distress <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Administer antibiotics, pancreatic enzymes, and O2 treatments as ordered <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Administer vitamins <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Teach family about dietary needs - high calories, high protein, moderate to high fat, and low carbohydartes <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Teach postural-drainage, percussion <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Note the need for 'tune-ups'

media type="youtube" key="36Ndn0UZWgg" height="315" width="560"
 * <span style="color: #0f1fab; font-family: 'Times New Roman',Times,serif; font-size: 130%;">*What is Bronchopulmonary dysplasia (BPD)? **

<span style="color: #cc1319; font-family: 'Times New Roman',Times,serif; font-size: 130%;">References:

// Hockenberry, M. J., & Wilson, D. (2009). // Wong's essentials of pediatric nursing //(8th ed.). St. Louis, MO: Mosby Elsevier.//

Potts, N. L., & Mandleco, B. L. (2012). //Pediatric nursing: Caring for children and their families// (3rd ed.). New York, NY: Delmar Cengage Learning.

<span style="color: #cc1319; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Videos:

Respiratory picture with captions []

Breath sounds by Adam https://youtu.be/O8OC7EiqBKQ

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Breath Sounds by cararose17 http://youtu.be/NnuaHGW1cwU

Grunting/retractions by Jeremy Spangle http://youtu.be/NBA9iigiDgk

Strep https://youtu.be/8GucjMGONfI

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px; line-height: 25px;">Flu Attack by National Geographic <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/TVLo2CtB3GA

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Otitis Media by theedexitvideo http://youtu.be/UBobShigoFk

Otitis media/ruptured ear drum https://youtu.be/8keTRPAuvKg

Mono by Children's Physician Medical Group http://youtu.be/V2QkL9J_pXc

Stridor by Juliette Anderson http://youtu.be/Qbn1Zw5CTbA

Croup https://youtu.be/cUo-I-3DmXA RSV at St. Joseph's Children's Hospital by ABC http://youtu.be/4yjVD5jNY4Y

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Pertussis Cough by Paul Gallagher http://youtu.be/wuvn-vp5InE

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Pneumonia <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">http://youtu.be/cWQ14x1URXo

TB by the CDC uploaded by Paul Cochrane http://youtu.be/u7o93nmgp1E

Asthma by Bupa http://youtu.be/vlZ7R07OrR4

Inhalers by Children's Hospital St. Louis http://youtu.be/A7DhGX0p1KY

Asthma meds by Medicine Coach http://youtu.be/hyahVlGISvc

Cystic Fibrosis by MedRise http://youtu.be/l0dDhKFk2HU

Cystic Fibrosis http://youtu.be/GGbuXM1ScSg https://youtu.be/AlOIKzMWqcQ <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">BPD <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/36Ndn0UZWgg