lOMoARcPSD|22962964
PPN 301 Week 10 Notes: Common Childhood Illness
Respiratory Infection
General Aspects of the Respiratory Infections
- Infection of the respiratory tract are described according to the anatomical area of
involvement.
- The upper respiratory tract or upper airway consists of the oronasopharynx, pharynx,
larynx, and upper part of the trachea.
- The lower respiratory tract consists of the lower trachea, mainstem bronchi, segmental
bronchi, subsegmental bronchioles, terminal bronchioles, and alveoli.
o In this book trachea is considered a lower tract disorder and infection of the
epiglottis and larynx are categorized as croup syndromes.
- Infection can spread from one structure to another because of the adjoining nature of the
mucous membrane lining the entire tract.
Etiology and Characteristics
- Respiratory infection account for most of the acute illness in children.
- The etiology and course of these infections are influenced by the age of the child, season,
living condition and pre-existing medical conditions.
Infectious Agent o The respiratory tract is subject to a wide variety of
infective organisms.
o Most infection are caused by viruses, particularly respiratory syncytial virus
(RSV), rhinovirus, nonpolio enteroviruses A, B, C and D, adenoviruses,
parainfluenza viruses and human meta-pneumoviruses.
Age o Healthy full-term infants younger than 3 months of age are presumed to have a
lower infection rate than that of older children because of the protective function of
maternal antibodies.
o However, infants may be susceptible to specific respiratory tract infections,
namely pertussis during this period.
pg. 1
, o The infection rate increases between 3 and 6 months of age, the time between the
disappearance of maternal antibodies and before the infant’s own antibody
production mature.
o It is not unusual for children to get as many as 8-10 colds each year before they
turn 2 years of age.
o The viral infection rate remains high during the toddler and preschool years.
o By 5 year of age, viral respiratory infections are less frequent but the incidence of
mycoplasma pneumonia and GABHS infection increase.
o The amount of lymphoid tissue increases through middle childhood and repeated
exposure to organisms increase the level of immunity as a child grows older.
Size o Anatomical differences influence the response to respiratory tract infections.
o The diameter of the airway is smaller in young children and subject to
considerable narrowing of the airways form edematous mucous membrane and
increased production of secretions.
o The distance between structures within the respiratory tract is also shorter in the
young child and organisms may move rapidly down the respiratory tract, causing
more extensive involvement.
o Relatively short and open eustachian tube in infants and young children allows
pathogens easy access to the middle ear.
Resistance o Passive immunity is passed on from the mother at birth but diminishes in
the first few weeks and months after birth.
o Infants produce their own antibodies whenever they are exposed to a virus or
bacteria, but it takes times for this immunity to fully develop.
o Children who are breastfed have increased resistance to infections because they
are still receiving immunity from the mother through breast milk.
o Deficiencies of the immune system place the child at risk for infection, other
condition that decrease resistance are malnutrition, anemia, and fatigue.
o Condition that weakens defenses of the respiratory tract and predispose children
to infection include allergies, preterm birth, bronchopulmonary dysplasia (BPD),
pg. 2
, lOMoARcPSD|22962964
asthma, history of RSV infection, cardiac anomalies that cause pulmonary
congestion and cystic fibrosis and daycare attendance and secondhand smoke.
Clinical Manifestations
- Infants and young children especially those between 6 months and 3 years of age react
more severally to acute respiratory tract infection than older children.
o Fever, poor feeding, anorexia, vomiting, diarrhea, abdominal pain, nasal blockage,
nasal discharge, cough, respiratory sounds, sore throat, meningismus.
Nursing Care
- Assessment should include respiratory rate, depth and rhythm, heart rate, oxygenation,
hydration, body temperature, activity level and level of comfort.
- A noninvasive pulse oximeter measurement should be performed on all children as part
of routine physical assessment.
Easing Respiratory Effort o Although children may feel uncomfortable and have a
stuffy nose (congestion) and some mucosal swelling, respiratory distress occurs
infrequently.
o Interventions delivered at home are usually sufficient to relieve minor discomfort
and ease respiratory effort.
o In some cases, the infant or child may require close observation in hospital to
ensure adequate oxygenation and for maintenance of fluid/electrolyte status.
o Warm and cool mist is a common therapeutic measure for symptomatic relief of
respiratory discomfort.
Moisture soothes inflamed membranes and is beneficial when there is
hoarseness or laryngeal involvement.
Use of hot steam vaporizes in the home is not recommended because a
burn hazard and limited evidence to support their efficacy.
Cool-mist vaporizers and not recommended because of hazard of
contamination from mould and bacteria unless disinfected daily. o A
time-honored method of producing warm steam is the shower.
o Running a shower of hot water into the empty bathtub or open shower stall with
the bathroom door closed produced a quick source of steam.
pg. 3
, o Keep child in this environment for 10-15 minutes humidifies inspired air and can
help relieve symptoms.
Promoting Rest o Children who have an acute febrile illness usually have limited
activity. o One of the cardinal signs that the child is feeling better is their increase
in activity; this may, however, be temporary if a high fever returns after a few hours
of increased activity.
o Children should be encouraged to rest or play quietly to avoid exacerbating
symptoms.
Promoting Comfort
o Older children are usually able to manage nasal secretions with little difficulty. o
For young infants who normally breath through their nose, an infant nasal
aspirator or a bulb syringe is helpful in removing nasal secretions especially
before being put to bed or sleep and before feeding.
o Followed by instillation of saline nose drops as needed, may clear nasal passages,
and promote feeding.
Can be prepared at home by dissolving 5 ml of salt in 1 l warm
water.
o Medicated nose drops or sprays, oral decongestants, cough medication or other
cold products should be administered to children under 6 years of age unless or
over the age of 6 years old or who have chronic illness unless HCP says.
o Medicated nose drops or sprays provide only short-lived relief and should not be
used for more than 2-3 days because they can worsen congestion with a rebound
effect. o Hot or cold application sometimes provide relief for children with
painful cervical adenitis.
Reducing the Spread of Infection o Hand hygiene,
sneezing and coughing into arm. o Hard for children to
remember for frequently wash hands.
o Used tissue should be thrown into wastebaskets immediately and tissues should
not be allowed to accumulate in a pile.
o No sharing drinks cups, utensils, washcloths, towels.
pg. 4
PPN 301 Week 10 Notes: Common Childhood Illness
Respiratory Infection
General Aspects of the Respiratory Infections
- Infection of the respiratory tract are described according to the anatomical area of
involvement.
- The upper respiratory tract or upper airway consists of the oronasopharynx, pharynx,
larynx, and upper part of the trachea.
- The lower respiratory tract consists of the lower trachea, mainstem bronchi, segmental
bronchi, subsegmental bronchioles, terminal bronchioles, and alveoli.
o In this book trachea is considered a lower tract disorder and infection of the
epiglottis and larynx are categorized as croup syndromes.
- Infection can spread from one structure to another because of the adjoining nature of the
mucous membrane lining the entire tract.
Etiology and Characteristics
- Respiratory infection account for most of the acute illness in children.
- The etiology and course of these infections are influenced by the age of the child, season,
living condition and pre-existing medical conditions.
Infectious Agent o The respiratory tract is subject to a wide variety of
infective organisms.
o Most infection are caused by viruses, particularly respiratory syncytial virus
(RSV), rhinovirus, nonpolio enteroviruses A, B, C and D, adenoviruses,
parainfluenza viruses and human meta-pneumoviruses.
Age o Healthy full-term infants younger than 3 months of age are presumed to have a
lower infection rate than that of older children because of the protective function of
maternal antibodies.
o However, infants may be susceptible to specific respiratory tract infections,
namely pertussis during this period.
pg. 1
, o The infection rate increases between 3 and 6 months of age, the time between the
disappearance of maternal antibodies and before the infant’s own antibody
production mature.
o It is not unusual for children to get as many as 8-10 colds each year before they
turn 2 years of age.
o The viral infection rate remains high during the toddler and preschool years.
o By 5 year of age, viral respiratory infections are less frequent but the incidence of
mycoplasma pneumonia and GABHS infection increase.
o The amount of lymphoid tissue increases through middle childhood and repeated
exposure to organisms increase the level of immunity as a child grows older.
Size o Anatomical differences influence the response to respiratory tract infections.
o The diameter of the airway is smaller in young children and subject to
considerable narrowing of the airways form edematous mucous membrane and
increased production of secretions.
o The distance between structures within the respiratory tract is also shorter in the
young child and organisms may move rapidly down the respiratory tract, causing
more extensive involvement.
o Relatively short and open eustachian tube in infants and young children allows
pathogens easy access to the middle ear.
Resistance o Passive immunity is passed on from the mother at birth but diminishes in
the first few weeks and months after birth.
o Infants produce their own antibodies whenever they are exposed to a virus or
bacteria, but it takes times for this immunity to fully develop.
o Children who are breastfed have increased resistance to infections because they
are still receiving immunity from the mother through breast milk.
o Deficiencies of the immune system place the child at risk for infection, other
condition that decrease resistance are malnutrition, anemia, and fatigue.
o Condition that weakens defenses of the respiratory tract and predispose children
to infection include allergies, preterm birth, bronchopulmonary dysplasia (BPD),
pg. 2
, lOMoARcPSD|22962964
asthma, history of RSV infection, cardiac anomalies that cause pulmonary
congestion and cystic fibrosis and daycare attendance and secondhand smoke.
Clinical Manifestations
- Infants and young children especially those between 6 months and 3 years of age react
more severally to acute respiratory tract infection than older children.
o Fever, poor feeding, anorexia, vomiting, diarrhea, abdominal pain, nasal blockage,
nasal discharge, cough, respiratory sounds, sore throat, meningismus.
Nursing Care
- Assessment should include respiratory rate, depth and rhythm, heart rate, oxygenation,
hydration, body temperature, activity level and level of comfort.
- A noninvasive pulse oximeter measurement should be performed on all children as part
of routine physical assessment.
Easing Respiratory Effort o Although children may feel uncomfortable and have a
stuffy nose (congestion) and some mucosal swelling, respiratory distress occurs
infrequently.
o Interventions delivered at home are usually sufficient to relieve minor discomfort
and ease respiratory effort.
o In some cases, the infant or child may require close observation in hospital to
ensure adequate oxygenation and for maintenance of fluid/electrolyte status.
o Warm and cool mist is a common therapeutic measure for symptomatic relief of
respiratory discomfort.
Moisture soothes inflamed membranes and is beneficial when there is
hoarseness or laryngeal involvement.
Use of hot steam vaporizes in the home is not recommended because a
burn hazard and limited evidence to support their efficacy.
Cool-mist vaporizers and not recommended because of hazard of
contamination from mould and bacteria unless disinfected daily. o A
time-honored method of producing warm steam is the shower.
o Running a shower of hot water into the empty bathtub or open shower stall with
the bathroom door closed produced a quick source of steam.
pg. 3
, o Keep child in this environment for 10-15 minutes humidifies inspired air and can
help relieve symptoms.
Promoting Rest o Children who have an acute febrile illness usually have limited
activity. o One of the cardinal signs that the child is feeling better is their increase
in activity; this may, however, be temporary if a high fever returns after a few hours
of increased activity.
o Children should be encouraged to rest or play quietly to avoid exacerbating
symptoms.
Promoting Comfort
o Older children are usually able to manage nasal secretions with little difficulty. o
For young infants who normally breath through their nose, an infant nasal
aspirator or a bulb syringe is helpful in removing nasal secretions especially
before being put to bed or sleep and before feeding.
o Followed by instillation of saline nose drops as needed, may clear nasal passages,
and promote feeding.
Can be prepared at home by dissolving 5 ml of salt in 1 l warm
water.
o Medicated nose drops or sprays, oral decongestants, cough medication or other
cold products should be administered to children under 6 years of age unless or
over the age of 6 years old or who have chronic illness unless HCP says.
o Medicated nose drops or sprays provide only short-lived relief and should not be
used for more than 2-3 days because they can worsen congestion with a rebound
effect. o Hot or cold application sometimes provide relief for children with
painful cervical adenitis.
Reducing the Spread of Infection o Hand hygiene,
sneezing and coughing into arm. o Hard for children to
remember for frequently wash hands.
o Used tissue should be thrown into wastebaskets immediately and tissues should
not be allowed to accumulate in a pile.
o No sharing drinks cups, utensils, washcloths, towels.
pg. 4
