acute respiratory

Question 1

general nursing interventions

Answer 1

ease respiratory efforts, promote rest, comfort, prevent spread of infection, promote hydration and nutrition, manage fever, fam support and teaching, support and plan for home care

Question 2

ease resp effort

Answer 2

position, warm or cool mist, mist tent, saline nose drops with bulb suctioning, bed rest, quiet activites

Question 3

tonsilitis

Answer 3

rapid test! strep test - heart and kidneys
treat S
usually viral - no abx

Question 3

prevent spread of infection

Answer 3

HH, teach, judicious room assingments, immunizations, abx

Question 3

improve oxygenation

Answer 3

cough and deep breathe, suction, neb meds, percussion and postural drainage, cpt, supplemental o2

Question 4

hydration and nutrition

Answer 4

high cal fluids, avoid caffeine, allow to self regulate

Question 4

nasopharyngitis tm

Answer 4

no OTC <3
antipyretics for high fever and discomfort
rest
older: decongestants, cough suppresants - OH
avoid: antihistamines, abx, expectorants

Question 5

nasopharyngitis

Answer 5

common cold

Question 5

strep pharyngitis tm

Answer 5

10 day abx - finish
sudden onset, school 24 hrs after being on abx, new tooth brush, dont share drinks, swabs, comfort care, teach

Question 6

tonsillectomy nc

Answer 6

excessive bleeding, avoid suction - drool ok, position on side for drainage, no straws, cough, laugh, cry; inspect secretions and vomit (blood tinged is ok), swelling and airway compromise - stridor, iced collar, manage pain, cool mist vaporizer, no red or brown food, soft diet, no milk

Question 7

tonsillectomy discharge

Answer 7

7-11 days
risk of bleeding, watch for excessive swallowing, s/s of hemorrhaging, lots of throat clearing
comfort measures

Question 8

external otitis

Answer 8

abx/steroid drop - no oral
prevention is key - get water out (peroxide/vinegar, gravity, hair dryer, ear plugs)

Question 9

otits media tm

Answer 9

teach prevention
abx therapy - amoxicillan
analgesia - heat compress, tylenol, ibuprofen

Question 10

PE tube

Answer 10

chronic otitis media
sedation - still
no diving, jumping, prolonged submersion; no swimming in lakes/rivers, avoid post op pressure
drainage common after placement

Question 11

croup - LTB

Answer 11

viral
sound worse than they look

Question 12

croup - LTB tm

Answer 12

airway and breathing - priority
at home
cool moist env, humidified o2, fluids, comfort, avoid cough syrups and cold medicines, racemic epi, corticosteroids, stay calm
avoid: bronchodilators, abx

Question 13

croup - LTB nc

Answer 13

resp assessment, conserve E, decrease anx (parents), assess and prevent dehydration, support fam

Question 14

croup - LTB S of increasing severity

Answer 14

rr increase
agitation, restless, anxiety, decreased LOC, cyanosis

Question 15

croup - epiglottitis

Answer 15

bacterial croup
serious, life threatening -airway

Question 16

croup - epiglottitis tm

Answer 16

vaccines
look bad, dont sound bad, no cough, drool
maintain airway, no tongue blades, avoid xray and transport, let parents be there, keep everyone calm, prepare for sedation and intubation
specimens, antipyretics for fever, abx, usually better at 48 hrs, discharge with abx at home

Question 17

bronchiolitis (RSV) tm/nc

Answer 17

maintain airway - suction
meds: antivirals (ribavirin), bronchodilators (albuterol), corticosteroids (controversial)
treat S (home): contact isolation, HH, parental participation, keep airway open, saline drops and bulb suction, humidity, fluids, rest, humidified O2, antipyretics, pulse ox, monitor hydration and encourage PO intake of clear fluids

Question 18

bronchiolitis (RSV) vaccine

Answer 18

synagis
at risk <2: <29 weeks, chronic lung disease, congenital defects, severe immune deficiencies
IM monthly - nov - april, expensive

Question 19

pneumonias tm and nc

Answer 19

humidified o2, abx, bronchodilators, chest tube, postural drainage, cpt, support and symptomatic, elevate HOB, position of comfort, close observation for S of increasing resp distress, continuous pulse ox

Question 20

pertussis tm/nc

Answer 20

tdap
erythromycin, <6 mo may need vent, oxygen, hydration, watch for and prevent pna

Question 21

tuberculosis tm/nc

Answer 21

will always test + rarely need hospital, med adherence, isolation - school once on therapy and s/s reduced, nutrition!!!

Question 22

ALTE tm/nc

Answer 22

not if in nicu lots of testing and assessment - continuous monitoring for 6 months episode free discharge teach: CPR, no extension cords, interference (TV, radio, cell phones, police scanners), emergency # on phones methylxanthine - caffeine

Question 23

SIDS tm/nc

Answer 23

back to sleep compassionate, sensitive, initial approach, ask factual Qs only, allow goodbye, provide lock of hair, foot and hand prints, arrange home visit ASAP

Question 24

s of resp distress

Answer 24

tachypnea, tachycardia, diaphoresis, change in LOC, restless, irritable, anx, cyanosis, increased WOB (grunt, nasal flare, retractions) adventitious sounds cough

Question 25

general cm of rti in kids

Answer 25

fever, meningismus, anorexia, v/d, abd pain, nasal blockage/discharge, resp sounds, sore throat

Question 26

nasopharyngitis etiology

Answer 26

common cold - virus

Question 27

nasopharyngitis cm - younger

Answer 27

fever, irritable, restless, sneeze, v/d

Question 28

nasopharyngitis cm - older

Answer 28

dryness and irritation of nose and throat, sneeze, chill, muscle aches, cough, edema and vasodilation of mucosa

Question 29

strep pharyngitis (GABHS) cm

Answer 29

sudden onset, sore throat, HA, fever, v, lymphadenopathy, abd pain, beefy red throat can lead to RF impetigo and pyoderma, scarlet dever exudate on tonsils, petechiae of pharynx

Question 30

external otitis

Answer 30

water trapped by earwax = growth medium inflam/infection of outer ear

Question 31

external otitis cm

Answer 31

pain (disproportionate, increase w movement), drainage (serousanguineous or purulent)

Question 32

otitis media

Answer 32

middle ear, collection of fluid or pus non breast fed, cig smoke, bottles in bed, unimmunized, pacifier beyond infancy, allergies, winter

Question 33

otitis media cm

Answer 33

ear pain, irritable, hold/pull at ear, roll head from side to side, fever up to 104, ruptured tympanic membrane chronic = hearing loss

Question 34

LTB cm

Answer 34

slowly progressive edema of epiglottis, trachea swells, mucosal inflam, harsh mechanic cough, insp stridor, resp distress, agitations, retractions

Question 35

croup increasing severity

Answer 35

increasing rr, agitation, restless, anx, decreased LOC, cyanosis

Question 36

epiglottitis cm

Answer 36

abrupt onset - sore throat hight fever, mouth open, tongue protruding, drool, agitation, looks sick, sit upright (tripod), sore red inflamed throat, difficulty swallowing, muffled voice, insp stridor, no cough

Question 37

bronchiolitis

Answer 37

viral (RSV) - inflam of broncioles, thick mucus cm: apnea, rhinorrhea, pharyngitis, cough/sneeze, adventitious or decreased breath sounds, eye/ear infection, low grade fever, difficulty feeding, irritable progress: tachypnea, air hunger, retractions, cyanosis

Question 38

pneumonias cm

Answer 38

viral or bacterial fever, chest pain (abd), dullness to percussion, cough non productive early, ronchi or fine rales, decreased breath sounds, resp distress

Question 39

whooping cough

Answer 39

persistant cough too busy coughing, dont want to eat

Question 40

TB cm

Answer 40

may be asymp with normal CXR malaise, fever, night sweats, slight cough, weight loss, anorexia, lymphadenopathy

Question 41

ALTE cm

Answer 41

apnea >20 sec, color change (cyanosis or pallor), marked change in muscle tone, choke or gag

Question 42

SIDS rf

Answer 42

race and gender, premie or low birth weight, multiple births, low apgar, cns disturbance or resp disorder, later birth order, overheating, unsafe sleeping, bottle fed, maternal age, smoking, substance abusers, poor prenatal care