Respiratory alterations are ranked as the leading cause of respiratory illnesses in infants and children. Depending on the organs affected, these respiratory disorders can be classified either as upper respiratory disorders or lower respiratory disorders (Huether & McCance, 2012). The former affects organs that include the nose, the ear, the larynx, and the pharynx while the former affects the bronchi, the trachea and the lungs. It is incumbent for advanced practice nurses (APNs) to draw a distinction between severe and moderate respiratory illnesses and offer a proper diagnosis and prescription to patients that seek their professional help. APNs can only execute this mandate after they have a clear understanding of the pathophysiology of different respiratory disorders.
Infants are prone of contacting respiratory disorders. This is because of their immature immune system, underdeveloped supporting cartilages and smaller airways. These expose infants to respiratory illnesses. Their small airways can get obstructed when mucus accumulates in the system. Additionally, their immature immune system can also not withstand some mild attacks that a well developed or mature respiratory system can withstand. In scenario 1, Ms Teel’s baby is brought to the APN and the mother fears that the infant might be suffering from RSV. This is the correct diagnosis because of the chronic nature of the cough. Viral infections do not respond to medication. Again, infants whose immune system was affected by a previous infection are susceptible to such chronic attacks. This is because of the weakened immune system.
Pathophysiology of RSV
The chronic cough exhibited by the infant shows that there is a likelihood that the infant’s lungs might not have developed properly. The infant’s lung might be lacking in surfactant, a material that is responsible for structural support and prevents collapse of the air spaces during the normal course of breathing (McPhee & Hammer, 2012). In a properly functioning lung, the surfactant packed with lamellar bodies which extrude into the air space and folds to form a lining of the air space. This lining helps in reducing the surface tension exerted on the air space by the fluid that lines the cavity of the air sac (Shanley, Wheeler, & Wong, 2007). Approximately two-thirds of the recoil forces that occur inside the air space can be attributed to surface tension.
The reduced surface tension caused by the surfactant prevents the total collapse of the air spaces during exhalation and also causes the air spaces to re-open with a lower amount of force. This shows the important role played by surfactants in ensuring that the air spaces functions as they should (Iannuzzi, Rybicki, &Teirstein, 2007). A lung with insufficient amount of surfactant can be seen microscopically showing expanded area with collapsed air spaces. This results into a reduced gas exchange capacity of the lungs. Positive pressure ventilation and administration of therapeutic oxygen can help remedy the situation.
The Effect of Age and Gender on RSV
RSV is very common in infants. Children under the age of one year are the most affected by this virus. Almost all children get infected with this virus but only a selected few develop a severe respiratory alteration from the viral infection (Frequently Asked Questions, 2008). The virus is can also be found in school going children. Most infants get infected with the virus when their siblings carry the virus home from school. Meaning that the older children contact the virus from their peers in school and bring it home from where they unknowingly infect their younger siblings. Gender does not impact RSV in any significant way. The virus infects both boys and girls in same frequency.
References
Frequently Asked Questions. (2008, October 17). Centers for Disease Control and Prevention. Web.
Huether, S. E., &McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.
Iannuzzi, M. C., Rybicki, B. A., &Teirstein, A. S. (2007). Sarcoidosis. The New England Journal of Medicine, 357(21), 2153–2165.
McPhee, S. J., & Hammer, G. D. (2012). Pathophysiology of disease: An introduction to clinical medicine (Laureate Education, Inc., custom ed.). New York, NY: McGraw-Hill Medical.
Shanley, T. P., Wheeler, D. S., & Wong, H. R. (2007). Pediatric critical care medicine: Basic science and clinical evidence. London: Springer.