Bronchitis

Bronchitis is an infection of the major bronchi that may be referred to as tracheobronchitis.

Signs and Symptoms:

• Fever
• Dry, hacking, and nonproductive cough that is worse at night and becomes productive in 2-3 days

Nursing Interventions:

1. Monitor for respiratory distress
2. Provide cool and humidified air
3. Monitor for any signs of dehydration
4. Increased fluid intake
5. Administer acetaminophen (Tylenol) for fever as prescribed

Laryngotracheobronchitis

Laryngotracheobronchitis is gradual inflammation of the larynx, trachea and bronchi. It is a most common type of croup and may be caused by virus or bacteria.

Sign and Symptoms:

• Irritability and restlessness
• Fever at low to high grade
• Hoarse voice
• Inspiratory striddor and suprasternal retraction
• Seal bark and brassy cough
• Crackles and wheezing
• Use of accessory muscles for breathing
• Anorexia, nausea, and vomiting
• Signs of anoxia and carbon dioxide retention
• Cyanosis

Nursing Interventions:

1. Keep a paten airway
2. Assess respiratory status (nasal flaring, inspiratory stridor, sternal retraction)
3. Monitor for pallor or cyanosis
4. Elevate the head of the bed and provide bed rest
5. Provide humidified oxygen
6. Encourage fluid intake
7. Administer medication as prescribed (antibiotics, analgetics, bronchodilators, corticosteroids)
8. Epinephrine nebulizer may be given for children with severe disease, stridor at rest, retractions, or difficulty breathing
9. Have resuscitation equipment available

Epiglottitis

Epiglottitis is an inflammation on the epiglottitis. It mah be caused by Haemophilus influenzae type B or Streptococcus pneumoniae.

Epiglottitis most frequently occurs in winter in child between age 2 and 5 years. If it is happened, it is consideres as an emergency situation.

Signs and Symptoms:

• High fever
• Sore, red, and inflamed throat
• Drooling
• Absence of spontaneous cough
• Muffled voice
• Difficulty swallowing
• Inspiratory stridor
• Agitation
• Tripod positioning

Nursing Interventions:

1. Maintain a patent airway
2. Assess respiratory status and breath sounds (nasal flaring, stridor, using accessory muscles)
3. Avoid assess body temperature by oral route
4. To prevent spasm of the epiglottis and airway occlusion, no attempts should be made to visualize the posterior pharynx or to obtain a throat culture
5. Prepare for lateral neck films to confirm the diagnosis
6. Keep NPO
7. Do not restrain the child
8. Do not leave the child unattended
9. Do not force the child to lie down
10. Administer fluids and antibiotic intravenously as prescribed
11. Administer analgesics and antipyretics as prescribed
12. Provide high humidification to cool the airway and decrease swelling
13. Provide cool-mist oxygen therapy as prescribed
14. Have resuscitation equipment available
15. Prepare for endotracheal intubation or tracheotomy if there is severe respiratory distress
16. Ensure that the child has up-to-date immunization schedule

Tonsilitis and Adenoiditis

Tonsillitis is an inflammation and infection of the tonsils, while adenoiditis is inflammation and infection of the adenoids. Both of them are usually manage by tonsillectomy and adenoidectomy.

Signs and Symptoms:

• Enlarged, bright red tonsils (may be covered by white exudates)
• Persistent or recurrent sore throat
• Swallowing difficulties
• Fever
• Cough
• Mouth breathing and unpleasant mouth odor
• Enlarge adenoids lead to nasal quality of speech, mouth breathing, hearing difficulties, snoring, or obstructive sleep apnea

Pre-operative Interventions:

• Observe for sign of active infection
• Assess bleeding and clotting studies
• Assess for any loose teeth to decrease the risk of aspiration during surgery

Post-operative Interventions:

• Place patient in prone or side-lying position to facilitate drainage
• Keep suction equipment in reach, however do not suction unless if there is any airway obstruction


• Discourage coughing or clearing the throat
• Avoid milk products initially
• Provide clear, cool, noncitrus and noncarbonated fluid
• Avoid red liquids since will stimulate the appearance of blood if the child vomits
• Do not give child any straws, forks, or sharp objects that can be put in the mouth
• Administer acetaminophen (Tylenol) for sore throat as prescribed
• Notify physician if bleeding, persistent earache, or fever occur
• Instruct parent to keep child away from crowds until heal

Otitis Media

Otitis media is an infection in the middle ear as a result of a blocked Eustachian tube which prevent normal drainage. It is more prone to infants and children because their Eustachian tubes are shorter, wider and straighter. Otitis media also is common complication from an acute respiratory infections.

Signs and Symptoms of Otitis Media:

• Fever
• Irritability and restlessness
• Loss of appetite
• Rolling of head from side to side
• Earache or pain
• Puling on or rubbing the ear
• Signs of hearing loss
• Red, opaque, bulging, or retracting tympanic membrane
• Purulent ear drainage

Nursing Interventions:

1. Encourage fluid intake
2. Teach parent to feed infants in upright position
3. Teach parent about administering ear medication. In a child younger than age 3, pull the pinna down and back, while in a child older than 3 years, pull the pinna up and back
4. Instruct child not to chew during acute episode since it increases pain
5. Provide local heat and have the child lie with the affected ear down
6. Instruct and teach the parent how to clean drainage from the ear with sterile cotton swabs
7. Instruct the parents that screening for hearing loss may be necessary

Myringotomy:
Myringotomy is in insertion of tympanoplasty tubes into the middle ear to equalize pressure and keep the ear aerated.

Post-operative Nursing Intervention for Child with Myringotomy:

• Keep the ear dry
• Instruct patient to wear earplugs when bathing, shampooing, and swimming
• Avoid diving and submerging under water

Conjunctivitis

Conjunctivitis is an inflammation of the conjunctiva and it is usually caused by allergy, infection, or trauma. Conjunctivitis that is caused by bacteria or virus is extremely contagious.

Signs and Symptoms of Conjunctivitis:

• Redness
• Itching, burning, or scratchy eyelids
• Edema
• Discharge

Nursing Interventions:

1. Instruct patient in infection control: good hand washing, not sharing towels, and washcloth
2. Administer antibiotic, antiviral eye drops or ointments or antihistamines as prescribed
3. The child should be kept home from school or day care until antibiotic eye drops have been given for 24 hours
4. Cool compresses can be used to lessen irritation and dark glasses can be worn for photophobia
5. Discontinue wearing contact lenses (if any) and obtain new lenses to eliminate the reinfection
6. Discharge eye makeup (if any)

Strabismus

Strabismus is defined as a condition when the eyes are not aligned because of lack of coordination of the extraocular muscles. It is sometimes called as "squint" or "lazy eyes". Strabismus is normal in the young infant but should disappear after around age 4 months.

The most cause of strabismus come from the muscle imbalance or paralysis of extraocular muscles, however it also may result from brain tumor, myasthenia gravis, or infection.

Signs and Symptoms of Strabismus:
Amblyopia (it comes if not treated early)
Loss of binocular vision
Permanent loss of vision if not treated early
Impairment of depth perception
Squinting or tilting of the head to see
Frequent headaches

Nursing Interventions:
Instruct the parents regarding occlusion therapy (patching) of the good eye to strengthen the weak eye
Corrective lenses may be indicated
Inform the parent that the injection of botulinum toxin wears off in about 2 months, and if successful, the correction will occur
Prepare for surgery. The surgery is performed to realign the weak muscles if non-surgical interventions are unsuccessful. It is performed usually before 2 years
Instruct and encourage parents in regarding the need of follow-up visits