Acute and Chronic Respiratory Illness Flashcards
(47 cards)
1
Q
What is the diameter of an infant’s airway? Why is it concerning when there is an inflammatory process in the airway?
A
Diameter - 4 mm
- It causes swelling of the airways and airway resistance increases, making it hard to get adequate oxygen
2
Q
Signs of respiratory distress
A
- Nasal flaring
- Substernal retractions
- Grunting
- Paradoxical breathing
- Cyanosis (does crying improve or worsen color?)
- Weak cough
- Adventitious sounds
- Is the child restless, irritable, or lethargic?
3
Q
Describe the sound of coarse crackles (rales).
A
Crackles are discontinuous, brief, popping sounds. Similar to the sound of a hook and loop fastener being pulled apart.
4
Q
Describe the sound of wheezes (rhonchi).
A
Wheezes are continuous, musical sounds, high or low pitched. Usually more pronounced on expiration.
5
Q
Describe the sound of pleural rub.
A
Plural rubs are creaking or grating sounds that have been described as being similar to walking on fresh snow.
6
Q
Describe the sound of stridor and when is it more prominent in a child?
A
A loud, high-pitched sound heard during inspiration but may also occur throughout the respiratory cycle; crying makes you hear stridor in a child more
7
Q
Describe Allergic Rhinitis (aka Hay Fever)
A
- Inflammatory disorder of nasal mucosa and conjunctiva
- Hypersensitivity reaction mediated by IgE- histamine released
- Reaction to seasonal allergens
- Recurrent and rarely seen before age 2
8
Q
What is the first manifestation you see with someone who is younger than 2 and has allergic rhinitis?
A
Skin changes (eczema and hives)
9
Q
S/S of Allergic Rhinitis
A
- Watery rhinnorhea
- Paroxysmal sneeze
- Cough that can be unproductive or productive of white sputum
- Itchy, puffy eyes
- Itchiness/scratchy throat
- Pale, boggy nasal mucosa
10
Q
What lab test is done for Allergic Rhinitis?
A
Nasal smear to look at eosinophil count, blood IgE and skin tests
11
Q
What antihistamines may be given for Allergic Rhinitis?
A
- Nasal corticosteroids (Flonase)
- Mast cell stabilizers (Cromolyn)
- Leukotriene modifiers (Singulair)
- Ipratropium (Atrovent) relaxes muscles around the airway and usually given in combo with Albuterol
12
Q
Describe an Acute Otitis Media
A
- acute infection
- bright red drum, distorted landmarks
- no tympanic movement
- lymphadenopathy
- temperature as high as 104 F
13
Q
Describe an Otitis Media with effusion
A
- Collection of fluid in the middle ear, no infection
- grey to amber color
- drum is usually retracted
- feeling of fullness
- transient hearing loss and balance disturbances
14
Q
What could occur if otitis media becomes a chronic condition?
A
Hearing difficulties and speech delays
15
Q
Risk factors for Otitis Media
A
- Eustachian tube placement
- Passive smoking
- Daycare attendance
- Cleft lip and palate
- Immunization noncompliance
- Down syndrome
16
Q
Key preventions for OM
A
- Breastfeeding (d/t presence of IgA in mom which protects against infections)
- Vaccines
17
Q
S/S of OM
A
- Irritable (first sign we see)
- Fussiness
- Hold or pull at ears
- Roll head side to side
- Cry while nursing or bottle feeding
- Unusual night waking
- Night time screaming
- Fever
- Lymphadenopathy
- Balance disturbances
- Hearing changes
18
Q
Nursing care for OM
A
- Antibiotics (Amoxicillin 80-90 mg/kg/day in two doses) (Azithromycin) (Ceftriaxone)
- Analgesics (Benzocaine)
- Antopyretics
- Encourage oral fluids
- PE tubes for chronic infection especially when hearing loss is present
19
Q
Tympanometry vs. Pneumatic Otoscope
A
Tympanometry - measures air of tympanic membrane mobility with a pulse of air pressure
Pneumatic Otoscope - blasts air and blows it against the ear, if there is an infection the ear will be stiff, if there’s no infection the ear will move
20
Q
Describe Pharyngitis
A
- Inflammation of the pharynx and surrounding tissues
- Peak age: 4-7 years
- 80% to 90% viral
21
Q
Strep vs. Viral Tonsillitis
A
Strep:
- Abrupt onset w/ high fever
- Can lead to rheumatic fever, acute glomerular nephritis
- Caused by group A beta-hemolytic streptococcus
- Occurs more frequently during winter
- Cervical lymphadenopathy
Viral:
- Gradual onset w/ low grade fever
- Self limiting and relatively minor illness
- Caused by: adenovirus, RSV, coxsackie viruses, mycoplasma pneumoniae
- Cervical lymphadenopathy
22
Q
How do you determine if it is strep or viral?
A
Throat culture
23
Q
S/S of pharyngitis
A
- sore throat
- headache
- enlarged tonsils
- difficulty swallowing
- morning breathing w/ bad breath
- snoring
- fever
- enlarged adenoids
24
Q
What is the treatment for strep?
A
- Penicillin (PCN) TID x 10 days (peaks in 60 minutes and is excreted in urine so be careful if renal impairment)
- Amoxicillin x7
- single shot of procaine penicillin/Bicillin
- Allergic to PCN: erythromycin (often causes GI upset and contraindicated in liver disease)
25
Tonsillectomy nursing care: pre-op
- Complete history regarding swallowing and obstruction
- Check for signs of active infection
- Check for loose teeth
- Check for bleeding disorders
- Lab results (PT, PTT, platelet, hgb, hmc, u/s)
- NPO
26
Tonsillectomy nursing care: post-op
- Semi prone, prone or side lying to facilitate drainage; elevation of head
- Assess airway
- Discourage coughing, nasal blowing, throat clearing
- Straws and forks should be avoided
- Comfort measures (analgesics or tetracaine lollipops) Ice chips or ice collars
- Alert parents that there may be clots of mucous in vomitus
- Clear liquids after return of gag reflex
27
What is the primary function of the tonsils?
Filter and protect against invading pathogens
28
Croup vs. Epiglottitis
```
Croup- 1 to 3 years old
- Subglottic
- Viral/Emotional
- Sudden onset, usually at night
- DRY, BARKING COUGH
- Awakens with inspiratory stridor
- Dyspnea
- Agitation
- Symptoms worsen at night
Treatments: Humidity, fluids, racemic epinephrine, possible intubation
```
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Epiglottitis- 3 to 7 years old
- Supraglottic
- Bacterial (haemophyllus influenza)
- Sudden onset
- May rapidly progress to complete airway obstruction
- Dyspnea
- DROOLING
- Tripod positioning (hunching over)
- High fever
- Stridor
- Pallor or cyanosis
- Anxiety
Treatment: IV antibiotics and fluids, artificial airway, emergency hospitalization
```
29
What should you always have available when caring for someone with croup and/or epiglottitis?
Intubation tray
- Droplet precaution
30
Acute laryngotracheobronchitis vs. Acute spasmodic laryngitis
ALTB:
- from RSV, influenza A & B, mycoplasma, parainfluenza 1,2,3
- Low grade fever, Restlessness, Hoarse
- Younger children may have signs of respiratory distress
- Infants and toddlers may be very sick with continuous stridor tachypnea
ASL:
- Self limiting & from allergens
- Usually at night child has paroxysmal attacks of laryngeal obstruction
- Croupy barky cough
- Difficulty breathing
- Restless
31
Bronchitis Tracheobronchitis
- Associated with an upper respiratory infection; viral
- Large airway inflammation
- Dry hacking cough
- Usually lasts 5-7 days
- Symptomatic treatment
32
Bronchiolitis
- caused by RSV, affects the bronchioles
- Bronchioles constrict during EXPIRATORY, not inspiration
- obstruction = air trapping
- Initial starts off with sneezing, coughing, intermittent fever
- Subsequent progression: fever, increase coughing with wheezing, refusal to eat, tachypnea
- Severe: tachycardia, tachypnea, wheezing, crackles, rhonchi, poor feeding, cyanosis
33
Complications of Pneumonia are? Treatments?
Pneumothorax - air inside pleural space
Pleural effusion - fluid inside pleural space
Tx: chest tube
pleural effusion - lower on the chest
pneumothorax - higher up
34
Is RSV viral or bacterial?
Viral
35
Pneumonia tx for viral vs. bacterial
Viral - O2 and oximetry, fever management, I&O, IV therapy
Bacterial - IV antibiotics, I&O, Chest PT, oxygen therapy
36
When is the flu vaccine given for children?
6 months and older
37
Influenza medications:
- Amantadine (type A): shorten the length of illness, administered within 24-48 hours of onset of symptom
- Rimantadine (type A): treats manifestations and given orally 2x for 7 days in children older than 1
- Zanamivir (type A & B): children over 7, inhaled 2x for 5 days, start within 48 hours of manifestations
- Oseltamivir (type A & B): decreases manifestations and given orally for over 1 yr.; within 48 hours of manifestations
38
Bronchodilators: Short acting beta agonists (SABA), Long acting beta agonists (LABA), Cholinergic antagonists
SABA- used for acute exacerbations (albuterol, terbutaline) and to prevent exercise induced asthma
LABA- used to prevent exacerbations and reliance of SABA, does not treat acute episodes (Serevent)
Cholinergic antagonists- block the parasympathetic nervous system which relieves bronchospasm (atropine, ipratoprium)
39
Anti-inflammatory agents: corticosteroids, Leukotriene modifiers, mast cell stabilizers, monoclonal antibodies & nursing considerations?
Corticosteroids - prednisone
Leukotriene modifiers - Montelukast (Singulair)
Mast cell stabilizers- Cromolyn
Monoclonal antibodies- Omalizumab (Xolair)
Considerations: observe oral mucosa for infection, take with food, rinse mouth after use
40
Explain the Pulmonary Function Tests
Non-invasive test that shows how well the lungs are working. It's the most accurate tests for diagnosing asthma and its severity
41
Explain the Peak Expiratory Flow Rate
- "Personal best" of the flow of air in a forced exhalation
- HIGHEST score, not average
- 3 times
42
Explain the Bronchoprovocation tests
Measures lung function after exposure to common asthma symptom triggers
43
Cystic Fibrosis
MULTISYSTEM disorder cause by a defect in a gene
S/S:
- thick, sticky mucus
- very salty sweat
44
Risk Factors of CF
- Both parents carry the recessive gene
- Meconium ileus at birth
- Hx of respiratory infections
- Hx of failure to thrive
45
What does a sweat test detect?
Measures amount of chloride; normal range is less than 40 mEq/LO chloride; Diagnostic is greater than 60 mEq/L for infants less than 3 months and greater than 40 for all others
46
First degree obstruction vs. Second degree obstruction vs. complete obstruction
1st- allows passage of air in both directions
2nd- air able to move past obstruction in one direction only (inspiration)
Complete- air unable to move in either direction
47
What can foreign body aspiration lead to if there is a delay in removal? Nursing management?
Aspiration pneumonia; 1st 12 hours monitor VS, changes in breath sounds, if child cannot say "P" and teach the Heimlich maneuver
