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peds > resp part 2 > Flashcards

resp part 2 Flashcards

1
Q

what is BRUE

A
  • brief resolved unexplained event
  • previously known as a “life threatening event”
  • typically lasts less than 1 min and resolves on its own
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2
Q

what are some symptoms of BRUE

A
  • pale or cyanotic
  • irregular, decreased, or absence of breathing
  • changes in muscle tone (hypotonic or hypertonic)
  • altered responsiveness
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3
Q

with BRUE, when would extensive testing be recommended

A
  • high risk infants
  • infants suspected of child abuse/maltreatment
  • infection
  • recurrent episodes
  • fam history of genetic or metabolic conditions
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4
Q

someone brings a dead infant into the ED, whats your first priority

A
  • family support

answer their questions, allow time with their baby to grieve, and offer resources

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5
Q

what is SIDS

A
  • sudden death of an infant <1yr of age
  • leading cause of infant mortality
  • peak incidence in 2-4mo of age
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6
Q

what are some clinical manifestations of SIDS

A
  • evidence of a struggle or change in position
  • presence of frothy blood tinged secretions from the mouth and nares
  • parents find the infant dead in the crib in the morning of after a nap
  • no cry or disturbance while infant is sleeping
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7
Q

theres no definitive cause of SIDS, what are some risk factors?

A
  • abnormality in medulla oblongata with neurotransmitter serotonin
  • may interfere with brain stem mediated protective responses during sleep (arousal)
  • uderlying vulnerability of infant (cardiac or neuro)
  • cerebral oxygenation depressed in healthy infants with prone sleeping
  • maternal smoking, alcohol intake, or substance abuse
  • preterm or low birth weight
  • native americans and black infants are at higher risk
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8
Q

what are some environmental risk factors for SIDS

A
  • sleeping prone or side lying
  • use of soft bedding
  • overheating
  • bed sharing
  • second hand smoke
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9
Q

whats the #1 way to decrease incidence of SIDS

A

safe sleep practices

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10
Q

what are the 2015 AAP recommendations

A
  1. infants should sleep in the same room but not in the same bed, ideally for one year, at least for 6 months
  2. parent should spend time in skin-skin contact with newborns

additional:
- breastfeeding
- use of pacifier at naps/bedtime
- complete immunizations
- tummy time
- swaddling: up to 2mo, after sleep in sleep sack

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11
Q

what is plagiocephaly

A

molding of the head by continued pressure against a surface

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12
Q

how can plagiocephaly be resolved

A

rotating the side of the head the infant sleeps and by placing the infant prone while awake and being observed

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13
Q

describe SUIDS and how to prevent it

A
  • sudden unexpected infant death
  • not due to SIDS
  • due to suffocation in pillow, bumpers, blankets
  • no pillows, bumpers, or blankets in crib
  • no stuffed animals in crib
  • high incidence with co sleeping
  • swaddling after 2 months, increases risk
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14
Q

whats the other name for croup

A

acute laryngotracheobronchitis

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15
Q

what is croup or LBT

A
  • a viral invasion of upper airway extends through larynx, trachea, and bronchi
  • inflammation of the mucosal lining of the larynx/trachea: narrowing of the airway
  • most common under 6; peak between 7-36mo
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16
Q

what clinical manifestations would you expect to see with croup or LBT

A
  • fever
  • tachycardia
  • barking seal like cough
  • hoarseness
  • dyspnea
  • inspiratory stridor
  • possible retractions
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17
Q

if a kid is in mild resp distress how are you gonna hydrate

A

oral fluids

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18
Q

if a kid is in moderate to severe resp distress how are you gonna hydrate

A

IV fluids

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19
Q

what are some nursing interventions for croup or LBT

A
  • assessments and vital signs
  • hydrations and I+O
  • pulse ox and oxygen as ordered
  • meds
  • parents need to keep the kid calm
  • education and discharge planning

priority intervention: do as little as possible
only hands on when necessary

20
Q

describe giving nebulized epi (racemic epi) for croup or LBT

A
  • alpha adrenergic effects causes vasoconstriction and decreases edema of cells
  • beta adrenergic acts as bronchodilator

monitor afterwards for rebound symptoms

21
Q

describe giving dexamathasone for croup or LBT

A
  • anti inflammatory corticosteroid
  • decreases airway edema
22
Q

when do most kids go home with croup or LBT

A
  • 24-72 hours
  • viral illness lasts several days to several weeks
23
Q

describe managing mild croup at home

A
  • take outside and breathe in cold air/freezer; cold temps decrease edema in airway
  • hydration and I+O
  • calm parents = calm kid
  • teach parent signs and symptoms of resp distress and who to call and where to go
24
Q

what is epiglottitis

A
  • inflammation of the epiglottis; upper airway
  • edema is rapid… within minutes/hours
  • potentially life threatening condition
  • usual age range 3-7yrs
25
Q

what are some symptoms of epiglottitis

A
  • high fever
  • high RR
  • dysphagia
  • dysphonia
  • drooling
  • dyspnea
  • inspiratory stridor (late sign)
26
Q

whats the clinical therapy for epiglottitis

A

immediate intubation and antibiotics

extubated in 1-2days and home for full course of antibiotics

27
Q

what should you most definitely not do for someone with epiglottitis

A

do not obtain any cultures from throat if epiglottitis is suspect, any stimulation can trigger complete airway obstruction

also dont leave em unattended

28
Q

what are some possible causes of epiglottitis

A
  • H. influenzae, but may be staph or strep as well
  • burning from hot liquids
  • direct injury to throat
29
Q

describe bronchiolitis

A
  • RSV is the cause in majority of cases
  • multiple other viruses may also cause
  • annual epidemic from october to march
  • particularly dangerous in infants and young children d/t small airway and other differences
30
Q

describe the patho/phys of bronchiolitis

A
  • RSV invades mucosal cells in bronchi and bronchioles
  • invaded cells die when virus bursts from inside cell
  • membranes of infected cells fuse with adjacent cells creating large masses
  • cell debris obstructs bronchioles and irritates airway
  • airway lining swells and produces excessive amounts of mucus
  • airway obstruction results during expiration with bronchospasms
  • air can come in but mucus and edema do not allow air out causing air trapping and hyperinflation of alveoli
  • interferes with normal gas exchange = hypoxemia
31
Q

what symptoms are associated with bronchiolitis

A
  • wheezing
  • moist cough
  • nasal drainage
  • retractions
  • poor feeding
  • dyspnea, tachypnea, tachycardia
32
Q

will albuterol help with wheezing associated with bronchiolitis

A

nope

33
Q

where are most children with bronchiolitis cared for

A

home

34
Q

in what situations are children with bronchiolitis usually hospitalized

A

hx of congenital heart disease, lung disease, bronchopulmonary dysplasia, prematurity, congenital disorder, young age

35
Q

whats used to diagnose bronchiolitis

A
  • history and physical
  • nasal swab is best practice
  • CXR
36
Q

will antibiotics help with bronchiolitis

A

nope

37
Q

whats the plan of care with bronchiolitis

A
  • assessments and vital signs
  • cardiac/pulmonary monitor/pulse ox
  • humidified oxygen
  • nasal suctioning with nose drops
  • elevate HOB
  • hydration and I+O
  • contact isolation for RSV, usually droplet til be know what it is
  • acetaminophen/ibuprofen
  • psychosocial care and education
38
Q

whats the first intervention for kids with bronchiolitis

A

nasal suctioning with nose drops

39
Q

what meds are used for bronchiolitis

A

nebulized hypertonic saline (3%)

Synagis (palivizumab)

antipyretics: acetaminophen/ibuprofen

corticosteroids, cough suppressants and antibiotics are not recomended for routine use

bronchodilators may be tried but there not support in literature

40
Q

what does nebulized hypertonic saline (3%) do for bronchiolitis

A
  • softens secretions, induces cough, reduces edema by absorbing water through mucosa, dislodges materials causing obstruction
  • research demonstrated effectiveness and shorter hospitalization (AAP)
41
Q

describe synagis (palivizumab)

A
  • monoclonal antibody
  • reduces RSV related hospitalizations
  • IG1 antibody that neutralizes and inhibits RSV replication
  • used for high risk infants
  • IM (provide atraumatic care)
  • first dose prior to start of RSV season and monthly IM until season finished (october through march)
42
Q

whats the length of illness with bronchiolitis

A
  • most symptoms abate within 24-72hrs
  • resolution of all symptoms may take weeks
  • some infants have repeated occurrences
  • may increase risk for wheezing and the development of asthma
43
Q

what are some symptoms of pneumonia

A
  • high fever
  • crackles in the affected lung
  • dyspnea, tachycardia, tachypnea
  • abdominal pain
  • diarrhea
44
Q

describe the difference between bacterial and viral pneumonia

A

bacterial
- get sick super quickly
- sudden high fever and rapid breathing

viral
- more gradual onset and less severe sx

45
Q

what would be included in the plan of care for a child with pneumonia

A
  • assessments and vital signs
  • assist with lab studies/radiology
  • oxygen therapy
  • pulmonary care: cough and deep breathing (bubble bloing, pinwheels)
  • antibiotics
  • acetaminophen/ibuprofen for fever or discomfort
  • hydration and I+O
  • discharge planning: education regarding meds, signs and symptoms of resp distress

peds (15 decks)

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