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NURS 332 > Chapter 21: Respiratory Dysfunction > Flashcards

Chapter 21: Respiratory Dysfunction Flashcards

1
Q

What often occurs in infants age 3 - 6 months?

A

increase in infection rates – maternal antibodies no longer provide enough protection after 3 months

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2
Q

In toddlers and preschoolers, what type of organism causes a high rate of infection?

A

viruses

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3
Q

What are 2 common organisms that cause infections in children older than 5 y.o.?

A
  1. group A beta-hemolytic streptococcus
  2. Mycoplasma pneumoniae
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4
Q

Why does a child’s smaller size make a difference in respiratory infections?

A
  • smaller diameter of airways
  • distance between structures is shorter – organisms rapidly move down to other organs
  • short and open eustachian tubes – more likely to contract otitis media from respiratory infection
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5
Q

What are croup syndromes?

A

infections of the epiglottis or larynx

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6
Q

What is acute nasopharyngitis? What organisms cause it?

5 organisms

A

– common cold
– caused by:
* RSV
* rhinovirus
* adenovirus
* influenza
* parainfluenza

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7
Q

How is acute nasopharyngitis treated?

6 treatments

A
  • because caused by viruses, no abx
  • antipyretics for fever >100.4F
  • fluids
  • rest
  • humidifiers
  • cough suppressants only if cough if non-productive/can’t stop – do NOT use in babies
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8
Q

What is pharyngitis? What organism causes it?

A
  • sore throat
  • caused by GABHS
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9
Q

How does pharyngitis present in children?

5 presentations

A
  • h/a
  • fever
  • abdominal pain
  • tonsil/pharynx inflammation
  • strawberry tongue and sandpaper rash (scarlet fever)

– there is NO cough with pharyngitis

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10
Q

How is pharyngitis diagnosed?

2 diagnostics

A
  • rapid strep tests
  • throat culture
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11
Q

How is pharyngitis treated?

3 treatments

A
  • antibiotics – penicillin, amoxicillin
  • discard toothbrush
  • fluids
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12
Q

What is tonsillitis? What types of organisms cause it?

A
  • inflammation of tonsils
  • caused by viral or bacterial organisms – can occur with pharyngitis
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13
Q

How does tonsillitis usually present in children?

3 presentations

A
  • edema of tonsils (kissing tonsils)
  • difficulty swallowing
  • difficulty breathing
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14
Q

How is tonsillitis treated?

8 treatments

A
  • tonsillectomy if infections are recurrent or affects breathing
  • adenoidectomy if >4x purulent rhinorrhea in 12 months
  • soft/liquid diet
  • avoid irritating foods
  • saltwater gargles
  • lozenges
  • analgesics
  • antipyretics
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15
Q

How does influenza usually present in children?

5 presentations

A
  • dry cough
  • dry throat
  • fever
  • chills
  • fatigue
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16
Q

How is influenza treated?

2 treatments

A
  • medications – Tamiflu, Relenza
  • prevention = flu shots – babies and infants get 2 shots, then annually afterward
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17
Q

What is otitis media? How is it diagnosed?

A
  • otitis media: eustachian tube malfunction d/t fluid in or inflammation of middle ear
  • higher occurrence in winter months
  • often preceded by viral infections
  • diagnosis = otoscope eval and hx
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18
Q

How is otitis media treated?

5 treatments

A
  • wait 72 hours before giving abx if >2 y.o. (can usually resolve on own) – amoxicillin, Augmentin
  • myringotomy
  • tympanostomy tube
  • consider smoking or secondhand smoke – increases OM infections
  • prevention = pneumococcal vaccine
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19
Q

What is infectious mononucleosis?

A
  • AKA kissing disease
  • infection of Epstein-Barr virus
  • common among adolescents
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20
Q

How does mononucleosis usually present in children?

4 presentations

A
  • fever
  • exudative pharyngitis
  • hepatosplenomegaly
  • fatigue
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21
Q

How is mononucleosis diagnosed?

1 diagnostic

A

monospot test (fingerstick)

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22
Q

How is mononucleosis treated?

2 treatments

A
  • self-limiting –> no specific treatment
  • avoid contact sports d/t hepatosplenomegaly
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23
Q

How are croup syndromes characterized?

4 characteristics

A
  • hoarseness
  • barking cough
  • inspiratory stridor
  • varying degrees of respiratory distress d/t swelling or obstruction of airways

– symptoms are usually worse at night

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24
Q

How are croup syndromes treated?

1 treatment

A
  • steroids for inflammation
25
Q

What is acute epiglottitis?

A

inflammation of the epiglottis

26
Q

How does acute epiglottitis usually present in children?

7 presentations

A
  • sore throat
  • pain
  • tripod positioning
  • retractions
  • inspiratory stridor
  • mild hypoxia
  • distress
27
Q

How is acute epiglottitis treated?

3 treatments

A
  • prevention = Hib (haemophilus influenzae type B) vaccine
  • if severe, may need intubation
  • NO throat exams d/t potential respiratory obstruction
28
Q

What type of organism causes acute laryngitis? Which age group more commonly gets it?

A
  • usually caused by viruses
  • more common in older children and adolescents
29
Q

How does acute laryngitis usually present in children?

1 presentation

A

hoarseness

30
Q

How is acute laryngitis treated?

A
  • self-limiting – no long-term sequelae
  • treats symptoms
31
Q

What is acute laryngotracheobronchitis (LTB)? What age group is most commonly affected? Which organisms cause it?

4 organisms

A
  • most common croup syndrome
  • mostly affects children younger than 5 y.o.
  • organisms:
    – RSV
    – parainfluenza
    – Mycoplasma pneumoniae
    – influenza A and B
32
Q

How does LTB usually present in children?

8 presentations

A
  • gradual onset of low-grade fever
  • inspiratory stridor
  • suprasternal retractions
  • barking cough
  • hoarseness
  • increasing respiratory distress and hypoxia
  • nasal flaring
  • respiratory acidosis, failure, or death if not treated
33
Q

How is LTB treated?

4 treatments

A
  • humidified oxygen 4+ L/min
  • face mask or blow-by
  • fluids (oral or IV)
  • nebulizer treatments – epinephrine, steroids, heliox if severe
34
Q

What is acute spasmodic laryngitis? How is it characterized?

3 characteristics

A
  • AKA spasmodic croup or midnight croup
  • characterized by:
    – recurrent paroxysmal attacks
    – occurs mostly at night
    – mild to absent inflammation
35
Q

What is bronchiolitis? What organism typically causes it?

A
  • acute viral infection with upper respiratory infection and lower respiratory infection of bronchioles d/t inflammation
  • RSV most common cause
  • M. pneumonia rarely causes
36
Q

How is bronchiolitis diagnosed?

A

nasal swab (antigen detection)

37
Q

How does bronchiolitis usually present in children?

10 presentations

A
  • upper respiratory infection symptoms
  • rhinorrhea
  • low-grade fever
  • OM
  • conjunctivitis
  • cough
  • infants – poor feeding, lethargy, irritability
  • wheezing
  • crackles
  • dyspnea
38
Q

How is bronchiolitis managed?

2 managements

A
  • prevention = Synagis prophylaxis
  • contact and standard precautions
39
Q

What is pertussis? What organism usually causes it? What age group is most commonly affected?

A
  • AKA whooping cough
  • caused by Bordetella pertussis
  • highest risk to young infants
  • occurs most often in children who haven’t been immunized – for this reason, pregnant women are encouraged to get booster prior to delivery
40
Q

What is aspiration pneumonia?

A
  • inflammation or infection of the lungs d/t aspiration of liquid or solids
41
Q

What are some precautions to prevent aspiration pneumonia?

3 precautions

A
  • prevent aspiration
  • feeding techniques and positioning
  • avoid aspiration risks:
    – oily nose drops
    – solvents
    – talcum powder
42
Q

What is acute respiratory distress syndrome (ARDS)?

A
  • AKA adult respiratory distress syndrome
  • respiratory distress and hypoxia within 72 hours after serious injury or surgery in a person with previously normal lungs
43
Q

How is ARDS treated?

4 treatments

A
  • oxygen
  • fluids
  • medications – vasoconstrictors and BP meds
  • may need intubation
44
Q

What is asthma?

A
  • chronic inflammatory disorder of the airways with recurring episodic symptoms:
    – wheezing
    – breathlessness
    – chest tightness
    – non-productive cough (especially at night)
  • limits of airflow that revereses with treatment or spontaneously
  • bronchial hyperresponsiveness
45
Q

What are the most important things to communicate to patients with asthma?

2 education topics

A
  • avoidance of triggers
  • education on inhaler use:
    – wait 1 minute b/w puffs
    – rinse mouth after use
46
Q

What types of medications are used to treat asthma?

5 medications

A
  • long-term control medications
  • rescue medications – albuterol
  • metered-dose inhaler
  • corticosteroids
  • cromolyn sodium
47
Q

What is status asthmaticus?

A

respiratory distress that continues despite vigorous therapeutic measures

48
Q

How is status asthmaticus treated?

A

emergency epinephrine 0.01 mL/kg subq

49
Q

What are some nursing interventions for pts with asthma?

4 interventions

A
  • calm nursing presence
  • monitor with pulse ox
  • allow older children to sit up if they are comfortable to do so
  • allow parents to remain with children
50
Q

What is cystic fibrosis?

A

exocrine gland dysfunction that produces a thick, sticky mucus that can be found everywhere in the body

51
Q

How is cystic fibrosis inherited?

A

autosomal recessive – can screen for this

52
Q

How does cystic fibrosis usually present in children?

24 presentations

A
  • thick mucus secretions
  • non-productive cough – cannot expectorate the mucus
  • elevation of sweat electrolytes – Na and Cl
  • elevation of several ezymes in saliva – Na and Cl
  • pancreatic enzyme deficiency – mucus plugs block enzymes
  • COPD associated with infection
  • sweat gland dysfunction
  • failure to thrive
  • increased weight loss despite normal appetite
  • respiratory deterioration
  • increased infections – trapped bacteria/viruses in mucus
  • patchy atelectasis
  • cyanosis
  • clubbing of fingers and toes
  • meconium ileus
  • rectal prolapse
  • excretion of undigested stool – bulky, frothy, foul-smelling stool
  • wasting of tissues
  • delayed puberty – females
  • sterility – males
  • dehydration
  • hyponatremia
  • hypochloremia
  • hypoalbuminemia
53
Q

How is CF diagnosed?

A
  • sweat chloride test
  • CXR
  • pulmonary function tests
  • stool fat and/or enzyme analysis
  • barium enema
54
Q

How does CF affect the respiratory system?

11 effects

A
  • gradual deterioration after chronic infection
  • bronchial epithelium destruction
  • infections weaken bronchial walls
  • peribronchial fibrosis
  • decreased exchange of O2 and CO2
  • chronic hypoxemia –> hypertrophy of lung tissue
  • pulmonary HTN
  • cor pulmonale
  • pneumothorax
  • hemoptysis
  • lung transplant(s) may be needed
55
Q

How does CF affect the GI system?

8 effects

A
  • thick secretions block ducts
  • pancreatic enzymes unable to reach duodenum
  • impaired digestion
  • impaired absorption of fat –> steatorrhea
  • impaired absorption of protein –> azotorrhea
  • pancreatic fibrosis develops –> DM
  • biliary obstruction –> cirrhosis
  • impaired salivation
56
Q

What are the 3 treatment goals for CF?

A
  1. prevent/minimize pulmonary complications
  2. adequate nutrition for growth
  3. assist with adaptation to chronic illness
57
Q

How is CF treated?

A
  • bronchodilator meds
  • treatment of pulmonary infections
  • pneumothorax
  • hemoptysis
  • nasal polyps
  • NSAIDs
  • transplants
  • replacement of pancreatic enzymes
  • high-protein, high calorie diet
  • treat constipation
  • reduction of rectal prolapse
  • salt supplements
58
Q

What is respiratory failure, and what are the 3 types?

A
  • respiratory failure: inability of the respiratory system to maintain adequate oxygenation
  • 3 types:
    1. respiratory insufficiency: increased work of breathing, hypoxemia, acidosis
    2. respiratory arrest: complete cessation of respiration
    3. apnea: cessation of breathing for more than 20 seconds
59
Q

How is respiratory failure treated?

4 treatments

A
  • ventilation
  • oxygenation
  • correct hypoxemia and hypercapnia
  • minimize organ failure

NURS 332 (13 decks)

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