Respiratory 1

Question 1

are children or adults at a higher risk for respiratory illness

Answer 1

children d/t smaller airway which creates greater resistance and makes the upper airway more prone to obstruction

Question 2

what are some of the other pediatric differences related to lungs/respiratory

Answer 2

• less alveolar surface are (decreased area for gas exchange)
• more diaphragmatic breathing (flexible chest reduces air intake)
• chest wall stiffens w/ age (less retraction with distress)

Question 3

at what age can children start to use intercostals for breathing

Answer 3

about 6 yrs

Question 4

why do children’s chest draw inward or have retractions when breathing

Answer 4

d/t their flexible ribs and chest

Question 5

what is higher in children than adults that increases with respiratory distress

Answer 5

O2 consumption

Question 6

when do tonsils start to atrophy

Answer 6

in teenage years (before that, they cause almost an obstruction in the airway because they are so large in children)

Question 7

how do infants breathe until about 4-6 wks

Answer 7

obligate nose breathers

Question 8

their high respiratory rate are associate with what

Answer 8

risk for heat and fluid volume loss

Question 9

what are some more respiratory differences in pediatric pop

Answer 9

• epiglottis is longer and flaccid (more susceptible to swelling)
• intercostal muscles immature (use diaphragm to breathe)
• aspiration d/t primary bronchus more vertical than left (risk for occlusion

Question 10

what is important to remember about children’s trachea

Answer 10

*biforcation of trachea @ T3 level

in adults biforcation is T6

Question 11

how large is a child’s airway

Answer 11

very small
diameter of airway is about 18 mm while an adult is 20
causes resistance

Question 12

what are the diagnostic tests for resp

Answer 12

• chest x ray
• CT scan
• bronchoscopy
• pulmonary function test
• sputum culture
• arterial blood gases
• pulse ox

Question 13

what is important to consider about diagnostic tests on children

Answer 13

not always east to do these test in children

may need sedation or distraction

Question 14

are OTC meds recommended for kids

Answer 14

no, resp OTC meds are not recommended

Question 15

what is included in the assessment History

Answer 15

birth history: gestational age, on ventilator support?
past med: history
ROS: resp illness, TB (PPD), chest x ray
family hx: asthma, cystic fibrosis
social hx: smoking

Question 16

smoking and day care put children at risk for what

Answer 16

ottis media or other resp issues

Question 17

what is included in resp hx of present illness

Answer 17

• onset
• chronology (progression)
• S/S: nasal congestion, flaring, grunting, SOB, couhg, tightness of chest, retractions, apnea
• current meds
• medical treatment

Question 18

what is the best cough medicine

Answer 18

water

Question 19

if child has a fever what should they be given

Answer 19

acetaminophen

Question 20

what is the physical exam for resp

Answer 20

• vital signs: RR decrease with age (count while child is sleeping NOT cryings/coughing)
• look for s/s of resp illness
• chest: normal shape/symmetry, no increase in AP diameter, no retractions, resp. unlabored
  lungs: clear to auscultation, no adventitious, no diminishes, no dyspnea, tachypnea, cough

Question 21

what is the first sign of resp problem

Answer 21

increased RR

Question 22

describe foreign body aspiration

Answer 22

• <3 yrs (younger)
• lodge in R main bronchus
• hot dogs, candy, nuts, grapes

Question 23

what is the complication you are at risk for if foreign body aspiration

Answer 23

aspiration pneumonia

Question 24

s/s of foreign body aspiration

Answer 24

• sudden coughing/gagging
• hoarseness
• wheezing
• stridor
• croupy cough
• dyspnea
• cyanosis
• difficulty swallowing/speaking

Question 25

treatment of foreign body aspiration

Answer 25

• chest thrusts, back blows and abdominal thrust

- bronchoscopy

Question 26

nursing diagnosis for foreign body aspiration

Answer 26

• ineffective during clearance
• impaired spontaneous ventilation
• anxiety r/t difficulty breathing
• risk for injury

Question 27

what is the key to prevent foreign body aspiration

Answer 27

keep environment safe

Question 28

things stuck in esophagus will show s/s of what

Answer 28

drooling, not eating, and difficulty swallowing

Question 29

if stuck in esophagus what do you do

Answer 29

need chest xray
need bronchoscopy
look for signs of hypoxia (want pulse ox >95)

Question 30

when does respiratory failure occur

Answer 30

when body can no longer maintain effective gas exchange d/t acute/chronic resp. or neuromuscular condition

Question 31

describe hypoventilation

Answer 31

body’s need for O2 exceeds actual O2 intake, leads to hypoxia and beginning of resp failure

Question 32

s/s of respiratory failure

Answer 32

• irritability
• lethargy
• mottled color/cyanosis (cold)
• increased resp effort: dyspnea, tachypnea, nasal flaring, retractions (intercostal)
• grunting

Question 33

if resp failure goes on too long what will happen

Answer 33

get tired and will go into resp arrest eventually