محاضرة pediatrics nursing

Acute Respiratory Infections (ARI)

ARI are worldwide problem in addition to diarrhea and malnutrition and it form the main cause of morbidity and mortality in developing countries.

Viruses causes 80-90% of childhood respiratory infections, the most important are respiratory syncytial virus (RSV), rhinoviruses, parainfluenza, influenza and adenovirus.

The important bacterial pathogens are Streptococcus pneumonia, Haemophilus influenza, Bardetella pertusis and Mycoplasma pneumonia.

 

 

* RISK FACTORS :

1\ malnutrition.

2\ poor socioeconomic status & large family size .

3\ parental smoking.

4\ prematurity & low birth weight.

5\ lack of breast feeding.

6\ Congenital abnormalities of heart or lung.

 

* ANATOMICAL CLASSIFICATIONS :

ARI is classified based on the site of infection as Upper Respiratory Infections (80%)              and Lower Respiratory Infections(20%) .

URI includes common cold , sore throat( pharyngitis & tonsillitis ) ,sinusitis ,laryngitis                          and otitis media.

LRI includes tracheitis, Bronchitis, Bronchiolitis and pneumonia.

 

 

 

 

Case Management

The standard case management of ARI cases includes:

1\ Assessment

2\ Classification

3\ Management

 

1\ Assessment :

1 * assess for feeding.

2 * assess for malnutrition.

3 * assess if child is abnormally sleep or difficult to wake.

4 * does the patient have convulsions during the current illness.

5 * Listen for stridor (harsh sound heard during inspiratory face of respiration due to narrowing of upper respiratory tract (larynx , trachea or epiglottis ). These conditions are often called croup.

6 * Listen for wheeze ( musical sound heard during expiratory face of respiration due to narrowing of the lower air passages in the lunges )

7 * Look for chest indrawing.

8 * assess for cyanosis

9 * assess for fever ,(a temperature of {38“C} or above) or hypothermia, (a temp.{Below35.5“C}

10 * assess for cough & grunting .

11 *Count the respiratory rate (RR) in one minute:

AGE                                                                                     RR\min.

2 months                                                                                    6o  +      >

2 --- 12 months                                                                     50  +

12 months up to 5 years                                                        40  +

 

 

 

2\ Classification :  According to age group

 

A\ 2 months up to 5 years: after the assessment is completed one of the following                          4 classifications is reached:

 

1\ Very sever disease:

Is made when any of the following danger signs is detected:

1* not able to drink

2* severe  malnutrition

3* abnormal sleep or difficult to wake

4* convulsion

5* stridor in calm child

We should act urgently because the child is at high risk of dying.

2\ Sever pneumonia:

1*  cyanosis

2*  chest indrawing

3*  nasal flaring

4*  grunting

Also we should act urgently because the child is at high risk of dying.

 

3\ Pneumonia:

The child has fast breathing (according to his age) without chest indrawing.

 

4\ No pneumonia:(cough and cold )

No chest indrawing & No fast breathing.

B\ Less than2 months: after the assessment is completed one of the following       3 classifications is reached:

 

1\ Very sever disease :

Is made when any of the following danger signs is detected:

1* decreased feeding

2* abnormal sleep or difficult to wake

3* convulsion

4* stridor in calm child

5*  wheeze

6*  fever or hypothermia

7*  cyanosis

8*  grunting

 

2\ Sever pneumonia:

Fast breathing (60+\ min.)

 

3\ No pneumonia ( cough & cold ):

No fast breathing & no chest indrawing.

 

3\ Management:

A\ Very sever disease  OR  Sever pneumonia :

1\  give the 1^st pre-referral dose of paranteral antibiotics.

2\  refer urgently to hospital.

3\ treat fever if present.

 

 

B\ Pneumonia :

 

1\ Give the 1^st dose in health center.

2\ The child is treated with antibiotics at home.

3\ One of the following drugs is given for 5 days( cotrimaxazol , amoxicillin  or procain pencillin ).

4\ Teach the mother how to give the dose, how much and for how many days.

5\ Advice home care.

6\ Reassess in 2 days or sooner if child become worse so return him to hospital.

If child improve so finish 5 days of antibiotics.

 

C \ NO pneumonia ( cough & cold ):

 

1\ no antibiotics

2\ Look for other problems such as cough ( so refer to hospital for further assessment for TB. , asthma , whooping cough) , ear problem or sore throat.

3\ advice for home care:  clear the nose, encourage feeding and fluid intake.

4\ treat fever if present.

5\ treat wheeze if present by bronchodilator.

 

Return child immediately to hospital if child develop :

Breathing becomes difficult or fast

Difficult feeding

Fever

* RISK FACTORS for ARI :

1\ malnutrition.

2\ poor socioeconomic status & large family size .

3\ parental smoking.

4\ prematurity & low birth weight.

5\ lack of breast feeding.

Control of Diarrhoeal Disease ( CDD )

 

DIARRHOEA:  passage of liquid or watery stool for at least 3 times\day.

Consistency is more important than frequency.

 

Diarrhea may be  - acute ……..  Less than 14 days

- persistant …. More than 14 days caused by infections

- dysentery …… mucous with or without blood

- chronic ….. recurrent due to non infectious cause , for more than one month

- paranteral ….. due to infections elsewhere in the body

Acute watery diarrhea

diarrhea that starts acutely and last less than 7 days  without visible blood , might have nausea  and vomiting and fever .

Causes :

Rota virus (50%) , Shigella , Entero invasive E. coli , salmonella , Vibrio cholera , campylobacter jejune , Enteropathogenic E. coli .

Complications and consequence

1-Dehydration                                                                                                                 2-Potassuim depletion                                                                                                  3-Acidosis                                                                                                                       4-Convulsion                                                                                                                   5-Renal failure                                                                                                                6-Cerebral damage

 

 

Dysentery (bloody diarrhea )

diarrhea that is accompanied by mucus with or without blood

Thedanger of this type(complications):

1-Septicemia

 

*Causes of diarrhea :

1\ infectios …..  viral , bacterial or parasitic.

2\ non infectious……. Feeding problem , anatomical , surgical, malabsoption ,endocrine ……

 

 

*Diarrhea can lead to dehydration or malnutrition.

 

DEHYDRATION :    loss of water & electrolytes.

Q\ Why infant more affected by dehydration than adult ?

1\ higher total body fluid

2\ increased metabolic rates

3\ large body surface area

4\decreased fluid intake due to anorexia

5\ increased fluid loss due to fever

6\ frequency of gastroenteritis in infant more than adult.

 

 

Causes of dehydration :*

1\ G.E. ( VOMITTIG & DIARRHEA )

2\ MOUTH DISORDER

3\ D.M.

4\ BURN

5\ INTESTINAL OBSTRUCTION

6\ THYROTOXOCOSIS

 

 

 

Hypokalemia :

-hypotonia

- muscle weakness

- abdominal distention

- paralytic ileus

- arrhythmia

 

 

Assessment of Dehydration

 

* Drugs not to be used in diarrhea :

1\ antibacterials…….. used only when there is lab evidence of bacterial infections.

2\ anti-protozoal …… used only when there is lab evidence of amoebic dysentery or giardiasis.

3\ mycostatin….. given when there is evidence of oral thrush .(monilia is normal inhabitant of G.I.T)

4\ anti-spasmodic & antimotililty…..  can caused paralytic ileus

5\ pectocaolin….. will coat the G.I.T. ,allow colonization of bacteria & lead to persistent diarrh.