Nursing Care of Children Who Have Respiratory Disorders
____________________________________________________________________________
Acute and Infectious Respiratory Illness
● Includes:
○ Tonsillitis
○ Nasopharyngitis
○ Pharyngitis
○ Croup syndromes
○ Bacterial tracheitis, bronchitis, bronchiolitis
○ Allergic rhinitis
○ Pneumonia
Tonsils
● Masses of lymph-type tissue at the back of the throat
● Filter pathogens and help create antibodies
● If enlarged, tonsils can:
○ block the nose and throat
○ interfere with breathing, sinus drainage, sleep, swallowing, speaking
● Acute tonsillitis:
○ occurs when the tonsils become inflamed and reddened
○ Can become chronic.
Tonsillitis:
● Risk Factors:
○ Exposure to a viral or bacterial agent
○ Immature immune systems (younger children)
● Expected Findings:
○ Sore throat with difficulty swallowing
○ History of otitis media and hearing difficulties
○ Mouth odor
○ Mouth breathing
○ Snoring
○ Nasal qualities in the voice
○ Fever
○ Tonsil inflammation with redness and edema
○ Throat culture for group A beta-hemolytic streptococci (GABHS)
● Nursing Care
○ Viral tonsillitis- Symptomatic treatment:
○ Rest, warm fluids, warm salt-water gargles.
○ Bacterial tonsillitis: Antibiotic therapy in addition to symptomatic tx.
○ Antipyretics/ analgesics: acetaminophen
○ Hydrocodone if difficulty drinking fluids.
Tonsillectomy:
● Assess airway/VS, raise HOB
● After awake/gag reflex returns:
, ○ Encourage clear liquids
○ avoid red‑colored liquids, citrus juice, and milk‑based foods initially.
○ Provide ice chips
○ No straws
○ Advance diet with soft, bland foods.
● Discourage coughing, throat clearing, and nose blowing in order to protect the surgical
site.
● Encourage rest
● Administer pain medication
○ Ice collar may help
● There may be blood-tinged mucus/vomit or small clots
○ notify provider if bright red bleeding
● Parent Education:
○ Provider should be contacted if child experiences:
■ Difficulty breathing
■ Lack of oral intake
■ Increase in pain
■ Indications of infection
■ Indications of hemorrhage
■ Indications of dehydration
○ Full recovery usually occurs in approximately 14 days.
● Complications:
○ Hemorrhage
■ Use a good light source and possibly a tongue depressor to directly
observe the throat.
■ Assess for bleeding (tachycardia, repeated swallowing and clearing of
throat, hemoptysis).
■ Hypotension is a late sign of shock.
■ Contact the provider immediately if there is any indication of bleeding.
■ Instruct family to report indications of bleeding
○ Dehydration
■ Encourage oral fluids.
■ May need IVF
■ Monitor I&O.
■ Instruct the family to encourage oral fluids.
■ Teach the family about manifestations of dehydration.
● Dry mouth
● Dizziness
● Low or dark colored urine output
○ Chronic infection
■ GABHS can pose a potential threat to other parts of the body.
■ Frequently tonsillitis can lead to:
● rheumatic fever
● kidney infection.
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