Acute otitis media (AOM) is effusion and inflammation in the middle ear that occurs suddently and is

associated with other signs of illness.

Otitis media with effusion (OME) refers to the presence of fluid behind the tympanic membrane
without signs of infection. Otitis media with effusion often follows an episode of AOM and usually
resolves in 1-3 months.

Risk factors: infants younger than 1 year who attend daycare, age (highest in 6-24 months-olds),
exposure to household cigarette smoke, and pacifier use.
Incidence: usually peaks between ages 6 months and 6 years, with most episodes occurring in children
younger than 3 years. Most initial episodes occur at about age 6 months, when maternal antibody
levels decline.

Manifestations: Otalgia (earache); infants may pull their ears or roll their heads; A bulging, opaque
tympanic membrane that usually looks red, with decreased mobility, diffuse light reflex, and obsurged
landmarks; drainage, usually yellowish green, purulent, and foul smelling (indicates perforation of the
tympanic membrane). The child/infant may also display irritibility, sleep disturbances, persistent crying,
fever, vomiting, anorexia, diarrhea.

The tympanic membrane appears retracted and either dull gray or yellow, and an air-fluid level or air
bubbles may be visible through tympanic membrane. The mobility of the tympanic membrane is
decreased, and the landmarks are distorted. Signs and symptoms include: tinnitius, popping sounds,
hearing loss (conductive), mild balance disturbances.
The PE tube falls out spontaneously in 6-12 months.
What are some interventions?
What teaching is needed about antibiotics? Give prescribed abx on time for the prescribed
number of days.
Why is it importatant to complete the antibiotic course? Complete course as prescribed even if
child seems to feel well.
What relationship is there with fluid intake and a child with fever? Childs fluid intake should be
increased if fever is present.
What can the nurse do to help prepare the child scheduled for a myringotomy? Teaching
What post op care is needed following a myringotomy? Monitor for drainage. Report if any
bleeding.
Can water get in the ear if the child has PE tubes? Keep dry. However, shower and chlorinated
swimming pool water may be irritating. Use ear plugs. Avoid baths and lake water.
What might you ask or expect in evaluation? Is the child sleeping OK. Crying decreased? Did
you give all abx? Any fever?

Croup refers to a group of conditions characterized by inspiratory stridor, a harsh (brassy or croupy)
cough, hoarseness, and varying degrees of repiratory distress
Sudden onset of a harsh, metallic barky cough; sore throat; inspiratory stridor; and hoarseness. Use of
accessory muscles; frightened appearance; agitation; cyanosis.
What are some interventions?
Facilitating airway clearance (monitor breathing for distress: tachypnea, stridor, nasal flaring,
retractions, cyanosis, changes in LOC, increased irritibility, adventitious breath sounds).
Maintain fluid balance )tachypnea causes insensible water loss. Difficulty swallowing leads to
decreased intake. Check mucous membranes, skin turgor, present of tears. Weight child daily. Offer
liquids. Tachypnea and aryngospasm often cause dysphagia. Iv fluids. Monitor temp.
Decrease fear
Provide teaching (maintain environmental temp and humidity, hydration, Call physician if:
difficulty breathing, retractons, cyanosis, drooling, dysphagia, fever, lethargy, if breathing cool or warm
mist does not improve symptoms in 20 mintues (such as sitting with child with shower running may help
decrease mucosal swelling) , ect. ; Cough syrups and cold medicines are avoided because they can dry
and thicken secretions.

Epiglotitis
Cardinal signs and symptoms: Drooling, Dysphagia, Dysphonia, Distressed inpiratory efforts. Do not
examine or obtain material for culture from a childs throat if epiglottitis is suspected because any
stimulation with a tongue depressor or culture swab could trigger complete airway obstruction. Clinical
minifestation: tripod position, drooling (because swelling becomes so severe that the child is unable to
swallow and begins to drool), strident cough, irritability, or lethargy Croaking sound on inspiration.
Treatment includes IV antibiotics, artificial airway, IV fluids, emergency hospitalization.
14. Bronchiolitis (p. 500)
Inflammation of the bronchioles. A significant cause of hospitalization in infants under age 1 year.
Respiratory syncytial virus (RSV) is the causitive agen in more than half cases. RSV is higly
communicable.

In bronchiolitis, edema and the accumulation of mucus and cellular debris cause obstruction of the
bronchioles.
Assessment
Observe for S&S of resp distress (tacypnea, dyspnea, retractions, cyanosis, nasal flaring
Intervention
Facilitating gas exchange (O2 administered, position babys head at 30-40 degree upright angle) (give
cool humidified O2
RDS is also known as hyaline membrane disease. It occurs when there is immature development of the
respiratory system or an inadequate amount of surfactant in the lungs.
16. Pneumonia (p. 503)
Pneumonia is an inflammation of the lung parenchyma. Causative agents can be viral or bacterial.
Review table 21-3 p. 503.
Alveoli fill with fluid and cells. Infiltrate can occur causing decrease of lung vial capacity.

Manifestations
Fever, cough, crackles, decreased breath sounds, resp distress. Etc.

17. Asthma (p. 512)
Asthma is a reversible obstructive airway disease
Allergens or other trigger substances activate immunoglobulin E (IgE) receptors. Chemical mediators
(histamine, leukotriene, prostaglandins) cause bronchoconstriction. Immune system cells infiltrate the
respiratory tract and also release additional inflammatory substances which eventual lead to airway
edema, mucous plugging of small airways, and inflammation.
Mucous membranes lining the bronchioles become edematous and secrete large amounts of mucus.
The airways narrow, leading to increased airway resistance and respiratory distress. Airways are wider
on inhalation that exhalation. Child can inhale, but wheezing can be heard as air is forced through the
narrow passages during expirations
Triggers:
Cold air, smoke, allergens, viral infection, stress, exercise, odors, medications
First treatment includes a bronchodilator, usually a short-acting beta-adrenergic agonist (SABA) such as
albuterol
Long term management:
Environmental control (irritants and allergens, exercise, infection, emotions)
Monitoring (peak flow meter which measures the flow of air in a forced exhalation in liters per minute.
Used to help identify the start of an asthma episode.
Medications: rescue meds (sort-acting beta-adrenergic agonists such as Albuterol) delivered by MDI or
nebulizer; Anticholinergic (Atrovent); Mast cell inhibitors (Cromolyn sodium/Intal which is an inhaled
nonsteroidal anti-inflammatory drug); Corticosteroids
18. Cystic fibrosis
A chronic multisystem disorder affecting the exocrine glands. The mucus produced by the excocrine
glands (particularly those of the bronchioles, small intestine, and pancreatic and bile ducts) is
abnormally thick, causing obstruction of the small passageways of these organs.

espiratory system abnormally thick, sticky secretions cause obstruction of both the small and large
airways. Causes chronic infection, inflammation, trapping of air, hyperinflation, atelectasis and eventual
fibrosis and destruction of the pulmonary tissue. Increased pulmonary vascular resistance leads to right
side heart enlargement and eventually failure.
Symptoms: wheezing, nonproductive cough, pneumonia, bronchitis, copious sputum, crackles,
wheezes, diminished breath sounds, accessory muscle use, retractions, hypoxia, cyanosis, tachypnea,
spontaneous pneumothorax, hemoptysis. Digital clubbing may be an indication of hypoxia.

Digestive system pancreatic ducts, blocked by thick mucus, are unable to secrete trypsin, amylase, and
lipase into the small intestine thus proteins, carbs, and fats are poorly absorbed. Pancreas undergoes
fibrotic changes. Type 1 diabetes sometimes develops. Gallbladder abnormalities are common.
Symptoms: steatorrhea (frothy, foul smelling stools two to three times bulkier than normal) and flatus.
Malnutrition, growth failure, deficiencies in the fat-soluble vitamins. Children tend to be thin and
underweight. A protuberant abdomen, barrel chest, wasted buttocks, and thin extremities are common.

Meconium ileus (Meconium stool obstruction in the small intestine) is the earliest clinical manifestation
or CF in the neonate.

Segmental percussion and postural drainage with inhalation therapy (called chest physiotherapy or
chest PT) are performed to loosen secretions and move them from the peripheral airways into the
central airways where they can be expectorated. Tend to perform this 2-3 times per day (between
meals).

Digestive: Child may exhibit a huge appetite but not gain weight. Chronic pulmonary infections,
increased work of breathing, and malabsorption place an increased caloric and protein demand on the
child.

Nursing diagnosis and interventions (p. 525) review on own.
Ineffective airway clearance r/t increased pulmonary secretions. Perform chest PT; teach huffing
(forced expiration) to mobilize secretions. Administer medications as directed. Use humidified, low-
flow O2 as ordered.
Why do you think low flow O2 is used? Because in people chronically hypoxic, oxygen can depress
respirations.
Elevate HOB if child is dyspneic.
Impaired gas exchange r/t air trapping within the alveoli secondary to obstruction of the airways by
thick mucus.
Risk of infection r/t tenacious secretions and altered body defenses.
Imbalanced nutrition Well balanced diet high in calories, protein, and carbohydrates. Supplements.
Pancreatic enzymes. G-tube.