NLE Paediatric Nursing — Paediatric Respiratory & Cardiac DisordersConcept Map

Concept

Recognising Respiratory Distress in Children

Sub Concepts

• Early compensating signs: restlessness, tachypnea, tachycardia, nasal flaring, mild retractions
• Worsening signs: intercostal/subcostal/suprasternal retractions, grunting, head-bobbing, accessory muscle use, stridor/wheeze
• Late ominous signs: cyanosis, bradycardia, decreased breath sounds, lethargy (impending respiratory failure)
• IMCI fast-breathing thresholds: ≥60/min if <2 mo; ≥50/min if 2-12 mo; ≥40/min if 1-5 yr
• Nursing priority: Early recognition prevents rapid deterioration

Relationship To Central

Foundation for early intervention and triage

Concept

Congenital Heart Defects (CHD)

Sub Concepts

• Acyanotic defects (left-to-right shunt): VSD, ASD, PDA, coarctation of aorta
• Cyanotic defects (right-to-left shunt): Tetralogy of Fallot, TGA, tricuspid atresia, truncus arteriosus, TAPVR
• Heart failure management: detect early signs (feeding difficulty, poor weight gain, hepatomegaly), small frequent feeds, cluster care
• Digoxin therapy: count apical pulse 1 full minute; hold if <90-100 bpm (infant) or <70 bpm (child); watch for toxicity (bradycardia, vomiting, anorexia)

Relationship To Central

Most common cardiac disorder in children; classified by cyanosis

Concept

Specific Respiratory Infections

Sub Concepts

• Croup (laryngotracheobronchitis): viral (parainfluenza), barking cough + inspiratory stridor, steeple sign on X-ray, cool mist + dexamethasone
• Epiglottitis: bacterial (Hib) emergency, 4 D's (Drooling, Dysphagia, Dysphonia, Distress), thumb sign, DO NOT inspect throat, prepare for intubation
• Bronchiolitis (RSV): infants <2 yr, wheezing + retractions, contact precautions mandatory, supportive care + suctioning, palivizumab is prophylaxis not treatment

Relationship To Central

Leading causes of paediatric hospitalisation requiring distinct nursing interventions

Concept

Asthma in Children

Sub Concepts

• Pathophysiology: bronchospasm + mucosal edema + mucus production
• Clinical signs: wheezing (expiratory), cough, chest tightness, prolonged expiration; silent chest = ominous
• Pharmacology: SABA (salbutamol/albuterol) = reliever; ICS (inhaled corticosteroids) = controller
• Management: spacer technique, trigger avoidance, written asthma action plan, mouth rinse after ICS use

Relationship To Central

Chronic reversible airway inflammation with specific pharmacology and management

Concept

Acquired Heart Disease

Sub Concepts

• Rheumatic fever: follows untreated GABHS pharyngitis, Jones criteria diagnosis, carditis causes valve damage (mitral), prevent with full penicillin course + long-term prophylaxis
• Kawasaki disease: vasculitis in children <5 yr, fever >5 days + strawberry tongue + peeling hands/feet, coronary artery aneurysm risk, treat with IVIG + high-dose aspirin

Relationship To Central

Post-infectious or inflammatory cardiac conditions requiring prevention and long-term management

Concept

Cleft Lip and Cleft Palate

Sub Concepts

• Priority nursing problems: feeding difficulty, aspiration risk, speech development, otitis media
• Pre-operative feeding: upright position, special wide/cross-cut nipples, slow feeding, frequent burping
• Surgical timing - Rule of 10s for lip repair: ~10 weeks old, ~10 lb (4.5 kg), Hgb ~10 g/dL; palate ~6-12 months
• Post-operative cleft lip care: supine/side position (never prone), elbow restraints, clean suture line, avoid tension
• Post-operative cleft palate care: nothing hard in mouth (no straws/pacifiers/suction), cup feeding, liquid diet, elbow restraints

Relationship To Central

Congenital facial malformations with feeding and developmental implications

To

Croup

From

Recognising Respiratory Distress in Children

Strength

strong

Relationship

Early signs of respiratory distress help identify croup as the diagnosis; nasal flaring and retractions are present in mild croup

To

Epiglottitis

From

Recognising Respiratory Distress in Children

Strength

strong

Relationship

Late ominous signs (severe distress, potential lethargy) suggest epiglottitis as a medical emergency requiring immediate intervention

To

Bronchiolitis

From

Recognising Respiratory Distress in Children

Strength

strong

Relationship

Retractions, nasal flaring, and wheezing are hallmark early signs of bronchiolitis that guide assessment and intervention priority

To

Asthma

From

Recognising Respiratory Distress in Children

Strength

strong

Relationship

Wheezing and retractions in asthma exacerbation follow the progression pattern of respiratory distress; silent chest indicates severe distress

To

CHF Management

From

Congenital Heart Defects (CHD)

Strength

strong

Relationship

Acyanotic defects (VSD, PDA, ASD) commonly lead to congestive heart failure, requiring digoxin and diuretic therapy management

To

Patent Ductus Arteriosus

From

Acyanotic defects

Strength

strong

Relationship

PDA-specific therapy: indomethacin/ibuprofen closes the duct; prostaglandin E1 keeps it open in duct-dependent lesions

To

Tetralogy of Fallot

From

Cyanotic defects

Strength

strong

Relationship

TOF is the most common cyanotic CHD; tet spells require immediate knee-chest positioning and morphine therapy

To

Tet Spell Management

From

Tetralogy of Fallot

Strength

strong

Relationship

Tet spells are acute episodes of deep cyanosis in TOF patients; knee-chest position is the priority nursing intervention

To

Digoxin Therapy

From

CHF Management

Strength

strong

Relationship

Digoxin is a key drug for CHF; apical pulse count and toxicity monitoring are essential nursing responsibilities

To

Croup

From

Respiratory Infections

Strength

strong

Relationship

Croup is a viral respiratory infection managed with cool mist, dexamethasone, and racemic epinephrine

To

Epiglottitis

From

Respiratory Infections

Strength

strong

Relationship

Epiglottitis is a bacterial airway emergency; airway examination must be avoided to prevent laryngospasm

To

Bronchiolitis

From

Respiratory Infections

Strength

strong

Relationship

Bronchiolitis (RSV) requires contact precautions and supportive care; palivizumab is prophylaxis for high-risk infants

To

Contact Precautions

From

Bronchiolitis

Strength

strong

Relationship

RSV spreads via droplet/contact; contact precautions are mandatory to prevent nosocomial spread

To

SABA Pharmacotherapy

From

Asthma in Children

Strength

strong

Relationship

Salbutamol/albuterol is the reliever drug for acute asthma exacerbations; acts quickly on beta-2 receptors in airways

To

ICS Controller Therapy

From

Asthma in Children

Strength

strong

Relationship

Inhaled corticosteroids are used for long-term asthma control; mouth rinse after use prevents oral thrush

To

Silent Chest Sign

From

Asthma in Children

Strength

strong

Relationship

Silent chest (no audible wheeze) in an asthmatic child indicates severe obstruction and impending respiratory failure

To

Rheumatic Fever

From

Acquired Heart Disease

Strength

strong

Relationship

Rheumatic fever follows untreated GABHS pharyngitis and causes carditis with permanent valve damage; prevention via full penicillin course is key

To

Kawasaki Disease

From

Acquired Heart Disease

Strength

strong

Relationship

Kawasaki disease is a vasculitis with coronary artery aneurysm risk; treated with IVIG and high-dose aspirin (exception to no aspirin in children)

To

Pre-operative Feeding

From

Cleft Lip and Palate

Strength

strong

Relationship

Pre-operative feeding challenges include aspiration risk; upright positioning and special nipples are essential

To

Post-operative Lip Care

From

Cleft Lip and Palate

Strength

strong

Relationship

After cleft lip repair: side/supine position, elbow restraints, and protection of suture line are priorities

To

Post-operative Palate Care

From

Cleft Lip and Palate

Strength

strong

Relationship

After cleft palate repair: nothing hard in mouth (no straws, pacifiers, or suction), cup feeding only

To

Rule of 10s

From

Cleft Lip and Palate

Strength

strong

Relationship

Cleft lip repair timing: ~10 weeks old, ~10 lb weight, Hgb ~10 g/dL; palate repair at 6-12 months

To

Penicillin Therapy

From

Rheumatic Fever Prevention

Strength

strong

Relationship

Complete penicillin course for strep throat is the single most important prevention strategy; incomplete treatment allows rheumatic fever development

To

IVIG and Aspirin

From

Kawasaki Disease

Strength

strong

Relationship

IVIG and high-dose aspirin are the treatments for Kawasaki disease; aspirin is used here despite typical avoidance in children due to Reye syndrome risk

To

Airway Emergency Preparation

From

Epiglottitis

Strength

strong

Relationship

Epiglottitis is a medical emergency; preparing for intubation/tracheostomy with emergency equipment at bedside is essential

To

Duct-Dependent Lesions

From

Patent Ductus Arteriosus

Strength

moderate

Relationship

In duct-dependent cyanotic lesions (TGA, interrupted aortic arch), prostaglandin E1 keeps the ductus open to maintain systemic circulation

To

Hypokalemia

From

Digoxin Toxicity

Strength

strong

Relationship

Hypokalemia increases digoxin toxicity risk; diuretics like furosemide lower potassium and require monitoring

To

Environmental Control

From

Asthma Trigger Avoidance

Strength

moderate

Relationship

Identifying and avoiding triggers (smoke, dust, cold, allergens) is part of comprehensive asthma management

To

Airway Clearance

From

Bronchiolitis Suctioning

Strength

strong

Relationship

Gentle suctioning (bulb or nasal) maintains airway patency in bronchiolitis with copious secretions