The child with respiratory distress and an acute illness, Study notes of Nursing

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The child with respiratory

distress and an acute illness What

is this child’s problem?

Respiratory Distress

Cyanosed?

Unable to drink? Y Very Severe

Reduced level of consciousness? Pneumonia

Grunting (infants)?

Y

Lower chest wall indrawing? Severe

Pneumonia

RR ≥ 50 aged 2 – 11 months? Y Pneumonia

RR ≥ 40 aged 1 – 4 yrs?

None of the above?

Y

No Pneumonia

How severe is respiratory distress –

Cough or Difficult Breathing 2

Cyanosed?

Unable to drink?

Y

Reduced level of consciousness? Grunting

(infants)?

High Risk of Death

High Risk of Hypoxaemia = Need Oxygen

May need fluid / feeding support

Very Severe

Pneumonia

Observe for improvement / deterioration

How severe is respiratory distress – Cough

or Difficult Breathing 4

RR ≥ 50 aged 2 – 11 months? Y Pneumonia

RR ≥ 40 aged 1 – 4 yrs?

Not severely ill = Outpatient care

Can feed orally

Require Simple Antibiotics = Co-trimoxazole

(Amoxicillin), and

Review in 2-3 days for improvement / deterioration

Cause of Respiratory Distress 1?

12 months Difficult Breathing, AVPU = P RR = 43/min Indrawing +ve Blood Slide

12 months Severe Malaria Difficult with Very Severe Breathing, Respiratory Pneumonia AVPU = P Distress Difficult breathing and RR = 43/min Difficult breathing, AVPU = P Indrawing Indrawing +ve Blood Slide AVPU = P, and +ve Blood Slide

Cause of Respiratory Distress 4?

Very Severe Pneumonia 12 months

Severe Malaria Difficult Difficult with breathing and Breathing, Respiratory AVPU = P AVPU = P Distress Indrawing Difficult breathing, +ve Blood Slide Indrawing, Severe Pallor AVPU = P, and +ve Blood Slide

Cause of Respiratory Distress 5?

Very Severe Pneumonia 12 months Severe Malaria Difficult Difficult with

Pneumonia Cannot drink Difficult Difficult breathing, breathing, Indrawing Indrawing, cannot drink Wheeze ++ Wheeze, and and indrawing Cannot drink.

• ve Blood Slide

Wheeze – how severe is the asthma?

Cyanosed?

Unable to drink? Y

Reduced level of consciousness? Grunting

(infants)?

Very Severe

Asthma

Y

Lower chest wall indrawing?

RR ≥ 50 aged 2 – 11 months? Y Mild Asthma RR ≥

40 aged 1 – 4 yrs?

Causes of respiratory distress

Severe Asthma

Causes of respiratory distress

Pneumonia Malaria Anaemia Asthma Dehydration Acidosis Blood Film Pallor / Hb Acidosis Sunken Eyes, Skin Turogor, Acidosis Wheeze Crackles Difficulty Breathing Indrawing Tachypneoa Consciousness?

Summary

• Key clinical signs define the severity of

respiratory distress

• There are several common causes that are

hard to distinguish

• Define severity and treat appropriately ALL

likely problems.