Name
Purdue University Globle
NU581 FNP II Clinical – Children and Adolescent Health Focus
Prof. Name
Date
Pediatric eye, ear, nose, throat (EENT), and respiratory infections are common concerns in children, particularly those who attend daycare or school or have frequent contact with siblings. Most uncomplicated infections are viral and improve with supportive care, but clinicians must recognize signs of respiratory distress or other complications. Wheezing, stridor, chest retractions, tachypnea, decreased activity, dehydration, or worsening symptoms warrant prompt clinical assessment. Understanding the distinguishing features of common pediatric infections helps nurses identify conditions that require routine care versus urgent evaluation.
Children experience frequent respiratory and EENT infections because of their developing immune systems and regular exposure to infectious organisms in group settings. Many uncomplicated upper respiratory infections resolve within approximately one to two weeks, although the duration varies according to the illness and individual child.
Common symptoms include nasal discharge, congestion, sore throat, cough, fever, hoarseness, and red or irritated eyes. These symptoms often overlap across different conditions, so the nurse should consider the child’s age, symptom duration, severity, associated findings, vaccination history, and exposure history when assessing the illness.
More concerning findings include:
Increased respiratory rate or work of breathing
Chest retractions
Wheezing or stridor
Persistent or severe coughing
Difficulty feeding or drinking
Decreased activity or unusual lethargy
Signs of dehydration
Increasing or persistent fever
These findings can indicate respiratory compromise or a more serious infection and should prompt additional assessment.
Conjunctivitis, commonly called pink eye, is inflammation of the conjunctiva and is frequently seen in children. The major types include bacterial, viral, and allergic conjunctivitis.
Bacterial conjunctivitis often produces mucopurulent or purulent discharge and may cause the eyelids to stick together. Viral conjunctivitis more commonly causes watery discharge and may occur alongside symptoms of an upper respiratory infection. Allergic conjunctivitis is typically associated with prominent itching, watery eyes, and exposure to allergens.
Because the causes and treatments differ, antibiotics should not automatically be used for every case of conjunctivitis. Clinical assessment helps determine whether supportive care, allergy management, or antimicrobial treatment is appropriate.
A hordeolum, commonly known as a stye, is an acute, localized inflammatory or infectious process involving an eyelid gland or follicle. It usually appears as a painful, red, tender swelling near the eyelid margin.
A chalazion is a chronic, localized inflammatory lesion caused by obstruction of an eyelid gland. It generally appears as a firm, relatively painless nodule. Many chalazia resolve with conservative management, although persistent or recurrent lesions may require further evaluation.
A corneal abrasion is a superficial injury or scratch involving the corneal epithelium. Children may experience eye pain, tearing, redness, photophobia, or a sensation that something is stuck in the eye.
Because untreated corneal injuries can become infected or develop other complications, children with suspected corneal abrasions should receive appropriate eye assessment, particularly when pain, vision changes, or significant trauma is present.
Upper respiratory tract infections (URTIs) are among the most common illnesses affecting children. Viral infections account for many uncomplicated cases, and management is often focused on hydration, rest, symptom relief, and monitoring for complications.
The common cold is caused by numerous respiratory viruses. Typical symptoms include nasal congestion or rhinorrhea, cough, sore throat, and sometimes fever. Most children recover without specific antiviral or antibacterial therapy.
Supportive care may include adequate fluids, rest, and age-appropriate measures for symptom relief. Antibiotics do not treat uncomplicated viral colds.
Influenza is an acute respiratory illness caused by influenza viruses. Influenza A and B are the primary types responsible for seasonal influenza in humans. Influenza A viruses have also been responsible for major pandemics.
Influenza may cause fever, cough, sore throat, headache, myalgia, fatigue, and other systemic symptoms. Young children and children with certain underlying conditions may have a higher risk of complications.
Influenza C generally causes milder disease, while influenza D primarily affects cattle and is not considered a cause of human influenza.
Roseola, also called sixth disease or exanthem subitum, is a common childhood viral infection most often associated with human herpesvirus 6 (HHV-6). It commonly affects infants and young children.
A characteristic pattern is a high fever followed by the sudden appearance of a pink or rose-colored rash as the fever resolves. Most cases are self-limited. Because fever can be high, caregivers should monitor the child for dehydration, altered responsiveness, or other concerning symptoms.
Erythema infectiosum, commonly known as fifth disease, is caused by parvovirus B19. A classic clinical finding is a facial rash that gives the cheeks a “slapped-cheek” appearance, followed by a more generalized rash in some children.
The illness is generally mild in otherwise healthy children. However, parvovirus B19 can have important implications for certain populations, so appropriate clinical assessment is necessary when risk factors are present.
Pityriasis rosea is a self-limited skin eruption that often begins with a single herald patch, followed days or weeks later by additional lesions, typically on the trunk. The exact cause is not fully established, although viral mechanisms have been proposed.
Because several childhood rashes can look similar, clinical assessment is important when the diagnosis is uncertain or when systemic symptoms accompany the rash.
Pharyngitis refers to inflammation of the pharynx, whereas tonsillitis involves inflammation of the tonsils. Both can result from viral or bacterial infections.
Common manifestations include:
Sore throat
Fever
Pain or difficulty with swallowing
Enlarged or inflamed tonsils
Tender cervical lymph nodes
A careful history and physical examination help determine whether additional testing, such as testing for group A Streptococcus, is appropriate.
Infectious mononucleosis is most commonly associated with Epstein-Barr virus (EBV). It occurs frequently among adolescents and young adults and may cause pronounced fatigue, fever, sore throat, and cervical lymphadenopathy.
Some patients develop hepatosplenomegaly. When splenic enlargement is present or suspected, activity restrictions may be necessary because of the risk of splenic injury.
Rhinosinusitis involves inflammation of the nasal passages and paranasal sinuses. Viral upper respiratory infections can produce congestion and nasal discharge without representing bacterial sinusitis.
A bacterial cause may be considered when symptoms are persistent without improvement, become severe, or initially improve and then worsen. Clinical evaluation should consider the child’s overall presentation rather than relying on symptom duration alone.
Pertussis, or whooping cough, is a highly contagious bacterial respiratory infection caused by Bordetella pertussis. It can begin with symptoms resembling a common cold and progress to severe coughing episodes.
Infants are particularly vulnerable to serious complications. Young children may develop apnea, cyanosis, feeding difficulties, or respiratory distress, making early recognition and appropriate treatment especially important.
Croup is generally a viral infection involving inflammation and narrowing of the upper airway. It is characterized by a barking cough, hoarseness, and, in more significant cases, inspiratory stridor.
Symptoms may become more noticeable at night. Children with stridor at rest, significant respiratory distress, or worsening airway obstruction require prompt medical evaluation.
Epiglottitis is a potentially life-threatening inflammation of the epiglottis and surrounding upper airway structures. Routine childhood vaccination against Haemophilus influenzae type b (Hib) has substantially reduced Hib-associated epiglottitis.
A child with suspected epiglottitis may develop sudden respiratory distress, drooling, difficulty swallowing, muffled voice, and a preference for sitting upright. Suspected epiglottitis is an airway emergency. The child should be kept calm, and unnecessary examination or manipulation of the throat should be avoided while emergency airway management is arranged.
Acute otitis media (AOM) is one of the most common pediatric infections. It involves acute inflammation and infection of the middle ear and frequently follows an upper respiratory infection.
Common symptoms and findings include:
Ear pain
Fever
Irritability
Difficulty sleeping
Reduced appetite
Changes in hearing or responsiveness
Common bacterial pathogens include Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis. Viral respiratory infections may also contribute to the development of AOM.
Diagnosis requires appropriate examination of the tympanic membrane and middle ear rather than relying on symptoms alone. Treatment depends on the child’s age, severity, laterality, diagnostic certainty, and risk of complications.
Lower respiratory tract infections involve structures below the upper airway and can produce more significant respiratory symptoms. Assessment should focus on respiratory rate, oxygenation, work of breathing, hydration, and the child’s ability to feed or maintain normal activity.
Acute bronchitis is generally viral and causes inflammation of the larger airways, often following an upper respiratory infection.
Bronchiolitis primarily affects infants and young children and involves inflammation and obstruction of the small airways. Respiratory syncytial virus (RSV) is a common cause, although other respiratory viruses can also be responsible.
Typical bronchiolitis findings include:
Wheezing
Tachypnea
Increased work of breathing
Nasal flaring or retractions
Cough
Difficulty feeding
Management is primarily supportive. Infants who develop significant respiratory distress, hypoxemia, dehydration, or difficulty feeding may require urgent evaluation or hospitalization.
Pneumonia is an infection or inflammation involving the lung parenchyma. It may be caused by viruses, bacteria, or other infectious organisms.
Clinical manifestations can include fever, cough, tachypnea, chest pain, abnormal breath sounds, and increased work of breathing. The presentation varies according to the child’s age and the causative organism.
Pneumonia may occur in the community or healthcare setting, and treatment depends on the suspected cause and severity. Children with hypoxemia, significant respiratory distress, dehydration, altered mental status, or other severe findings may require hospital-based care.
Asthma is a chronic respiratory disease characterized by variable respiratory symptoms and airway inflammation and narrowing. Children with asthma may experience recurrent episodes of wheezing, coughing, shortness of breath, or chest tightness.
Symptoms may be triggered or worsened by viral respiratory infections, allergens, exercise, environmental irritants, or other individual triggers.
Effective asthma management includes identifying triggers, using prescribed controller and reliever medications appropriately, monitoring symptoms, and following an individualized asthma action plan. Families should also understand how to recognize worsening symptoms and when emergency care is necessary.
Recognizing respiratory distress is a critical pediatric nursing skill. A child who is struggling to breathe may show increased respiratory effort before oxygen levels become severely abnormal.
Important warning signs include tachypnea, nasal flaring, grunting, intercostal or substernal retractions, persistent wheezing, stridor, cyanosis, difficulty speaking or feeding, altered responsiveness, and exhaustion.
Stridor generally indicates upper-airway obstruction, whereas wheezing is more commonly associated with lower-airway narrowing. However, respiratory sounds must always be interpreted alongside the child’s overall clinical condition.
Parents and caregivers should seek prompt medical assessment when a child develops difficulty breathing, persistent or severe respiratory symptoms, significant dehydration, unusual sleepiness or decreased responsiveness, or rapidly worsening illness.
Urgent evaluation is particularly important when the child has:
Stridor or severe wheezing
Chest retractions or markedly increased work of breathing
Bluish or gray discoloration
Apnea or pauses in breathing
Difficulty swallowing with drooling
Inability to maintain adequate fluid intake
Signs of significant dehydration
A rapidly worsening condition
For infants, young children, and children with chronic medical conditions, the threshold for seeking medical advice may be lower because respiratory illnesses can progress more quickly.
Pediatric EENT and respiratory infections range from uncomplicated viral illnesses to conditions that can rapidly compromise the airway or breathing. Nurses should distinguish common findings from red flags and assess the child’s respiratory effort, hydration, activity level, and overall appearance.
The most important clinical distinctions include recognizing watery versus purulent eye discharge in conjunctivitis, differentiating a painful hordeolum from a typically painless chalazion, identifying the barking cough and possible stridor of croup, recognizing the drooling and respiratory distress associated with suspected epiglottitis, and identifying wheezing and increased work of breathing in bronchiolitis or asthma.
Early recognition of respiratory distress and timely escalation of care are essential components of safe pediatric assessment.
Common pediatric conditions include viral upper respiratory infections, conjunctivitis, acute otitis media, pharyngitis, croup, bronchiolitis, influenza, and pneumonia. The specific diagnosis depends on the child’s symptoms, age, physical findings, and clinical course.
Warning signs include tachypnea, retractions, nasal flaring, grunting, stridor, persistent wheezing, cyanosis, difficulty feeding or speaking, unusual lethargy, and exhaustion. Significant or rapidly worsening breathing difficulty requires urgent medical evaluation.
Symptoms alone do not always reliably distinguish viral from bacterial infections. Clinicians consider the child’s history, physical examination, symptom pattern, duration, severity, and, when indicated, diagnostic testing. Antibiotics should be used when a bacterial infection is diagnosed or strongly suspected rather than for uncomplicated viral illnesses.
Croup commonly causes a barking cough, hoarseness, and sometimes stridor because of upper-airway inflammation. Epiglottitis is a medical emergency that may cause drooling, difficulty swallowing, muffled voice, and severe respiratory distress. Suspected epiglottitis requires immediate emergency assessment.
Urgent assessment is appropriate when an infant or young child has significant difficulty breathing, persistent hypoxemia, apnea, severe retractions, inability to feed adequately, dehydration, or marked lethargy.
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Centers for Disease Control and Prevention. (2025). Pertussis (whooping cough). https://www.cdc.gov/pertussis/
Centers for Disease Control and Prevention. (2025). Respiratory syncytial virus (RSV). https://www.cdc.gov/rsv/
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