Acute Respiratory Flashcards
(24 cards)
cardinal signs of respiratory distress
T
T
D
C -
C -
I -
tachypnea
tachycardia
diaphoresis
change in LOC: restlessness, irritability, anxiousness
cyanosis - later sign
increased WOB: grunting, nasal flaring, retractions, head bobbing
retractions
infants breathe with their _____ bc ___
they are also obligate ___ breathers bc ____
best thing to do to help:
infants breathe with their bellies bc they do not have the thoracic muscles to breathe
they are also obligate nose breathers bc they do not know how to open their mouths or blow their nose
suction!
other signs of respiratory distress:
A
A
C
what are the worst? and who do we call?
adventitious breath sounds: expiratory grunting, inspiratory stridor, expiratory wheeze
absent breath sounds/diminished breath sounds
cough
absent/diminished breath sounds are the worst bc their is no air exchange happening
we need to call rapid
ease respiratory efforts/promote comfort & rest:
P
W
M
S
B
positioning: does not work as well bc infants do not have muscles to hold themselves up, can use towel under neck
Warm or cool mist * no steam vaporizer
Mist tents - moist environment
Saline nose drops with bulb suctioning!!
Bedrest or quiet activities
prevent spread of infection:
H
T
R
I
A
promote hydration & nutrition
H
A
A
handwashing
teaching
room assignments - separate
immunizations (up to date)
antibiotics - only for bacterial illnesses (not for colds, RSV, or croup)
high calorie fluids (ex: milkshakes)
avoid caffeine (these act like diuretics and dry them out)
allow children to self regulate the diet (hydration is most important, do not care if they do not eat when ill)
other general nursing interventions:
F
F
S
fever management (low grade fevers are the body’s way of fighting off infection)
family support & teaching
provide support & plan for home care
- viral infections (should consult HCP)
- can give ibuprofen/tylenol for fever
- ibuprofen starting at 6M
- tylenol can be give to newborns
- no aspirin (can lead to encephalopathy & liver disease)
specific therapies to improve oxygenation
C & DB
S
A
P & PD
CP
S
coughing & deep breathing (blowing bubbles, pinwheels) - IS is for older kids
suctioning
aerosolized nebulizer medications (inhaler)
percussion & postural drainage (pat on back)
chest physiotherapy (squeezing & vibration) - vibration vest for CF pt; flutter valves can vibrate to move mucous out
supplemental oxygen - PRN hi flow nasal cannula
oxygen delivery methods
Bubble/CPAP
NHF
both use more force to keep alveoli open to improve gas exchange
Bubble/CPAP: increases pressure
NHF: hi flow nasal cannula, less invasive
The common cold is caused by ___
do not need _____
AKA:
clinical manifestations: younger & older child
therapeutic management:
the common cold is caused by a VIRUS
do not need antibiotics
AKA: nasopharyngitis or URI
clinical manifestations:
younger child: fever, sneezing, V/D (d/t mucous going into belly),
older child: dryness & irritation of nose & throat, muscular aches, cough, edema & vasodilation of mucosa
therapeutic management:
no OTC meds for cough/cold if < 3 y.o. (do not help, can be easy to overdose)
do not use cough suppressants if not sleeping well at night
avoid antihistamines, antibiotics, & expectorants (these do not help)
tylenol & ibuprofen are good for: fussiness, fevers, hydration, & to get mucous out
tonsillits
can also be known as:
bacterial or viral?
how to treat?
rapid test postitive or negative?
strep
commonly viral
treat symptomatically: gargling salt water, increase hydration (ex: popsicles)
rapid test is negative to confirm tonsillitis
pharyngitis
aka:
bacterial or viral?
clinical manifestations:
risk if untreated:
can also cause:
management:
aka: strep
bacterial
clinical manifestations: sudden onset, sore throat, h/a, fever, vomiting, lymphadenopathy, abdominal pain, beefy red throat
risk if untreated: acute rheumatic fever or acute glomerulonephritis
can also cause: impetigo & pyoderma (painful ulcers on leg), scarlet fever
management: antibiotics for 10 days
- should not eat/drink after ppl or have other eat/drink after you
- change out toothbrush 24-48 hr after being on antibiotic (can also boil to sterilize it)
tonsillectomy
indicated if documented as a, b, c, & d
must stay ______
do not like this procedure bc…
watching for 2 things specifically:
if these two things are observed, what do we do?
what do we expect to see?
nursing considerations:
discharge instructions:
indicated only if documented recurrent (a), frequent strep (b), peritonsillar abscesses (c), or sleep apnea (d)
must stay overnight in hospital for observation
do not like this procedure bc it is hard to tell when child is bleeding out
watching for 1) excessive swallowing - this can indicate swallowing blod
2) stridor - inflammation of airway
if these two things are observed, we call a rapid and call resident
we expect to see blood tinged drooling
nursing considerations: avoid suctioning if possible (drooling is okay), discourage straw, coughing, laughing, or crying (this puts stress on the cauterized area), comfort ice collar around neck, pain management with tylenol/ibuprofen; cool mist vaporizer
discharge instructions: healing starts to slough off 8-10 days post surgery (high risk for bleeding again); if swallowing excessively, bring back to hospital to be cauterized
ear anatomy:
length of eustachian tube
structures are squished together
fluid in ear
length of eustachian tube is shorter in children; this is a common reason for frequent ear infections
structures of the ear are squished together: therefore, drainage from fluid, runny noses, and colds can get trapped in the eustachian tube and does not drain out quickly (stays stationary)
stationary fluid in ear is a breading ground for bacteria - major cause of otitis media
external otitis
infection of canal or tympanic mb?
how can we drain fluid out?
how to treat: nonpharm & pharm
common reaction from kids with this disease
occurs when fluid in canal does not dry well
infection of ear canal
can drain by lying on side, can use fan or hairdryer too
nonpharm: ear plugs, can heal on own
pharm: ear drops, steroid drops, antibiotic drops
common rxn: get fussy and do not sleep well
otitis media risk factors:
age & gender
breast fed or non-breast fed?
positioning
exposure to smoking
should bottles be in bed
immunizations
allergic _____
clinical manifestations:
therapeutic management:
chronic otitis media:
treatment for chronic otitis media:
male in winter months
non-breast fed babies are at risk, breast feeding is protective bc breast milk has lots of antibacterial properties
lying down position is a risk factor
exposure to smoking & cigarettes - can lead to crappy lungs, pneumonia, asthma
bottles should not be in bed within infant
an unimmunized child is at risk
allergic rhinitis
clinical manifestations: irritable, does not sleep well, fevers, do not eat well
- most resolve on own, but can be treated with antibiotics
therapeutic management: finish whole course of antibiotics, amoxicillin is the drug of choice, but tylenol/ibuprofen can be used for pain too
more than 6 ear infections/year
myringotomy with pressure equalization tympanostomy tubes (PE): quick sedation, one way valve to allow fluid to drain out, but no fluid to go in
- no diving, jumping, or prolonged submersion (can cause PE to pop out), no swimming in lakes or rivers (live bacteria live there), avoid pressure post-op (blow their nose, the do not cough)
- they can swim but recommend ear plugs
- PE can also fall out on its own
viral croup symptoms:
clinical manifestations:
when to come back to ER:
treatment:
what treatments are not helpful?
nursing considerations:
signs of increasing severity of croup:
hoarseness, barky cough, inspiratory stridor, usually do not end up in distress, do not look sick, but sound sick
clinical manifestations: epiglottis becomes edematous, occluding airway; mucosal inflammation and edema narrow airway; sudden onset of harsh, metallic cough
- can be managed at home
come back to ER if: retractions occurs, quicker breathing, increased HR, cyanosis, change of consciousness
treatment: adequate fluid intake, corticosteroids, humidified environment (this can soothe the airways - going outside in evening, stand in front of freezer, warm shower)
- not on O2 a lot, bronchodilators & antibiotics NOT helpful
nursing considerations: continuous observation & assessment of resp status; measures to decrease anxiety (parents at bedside!)
signs of increasing severity of croup:
- increasing RR: if > 60/min, keep NPO (may need an NG)
- increased agitation, restlessness, anxiety, decreased LOC
- cyanosis
epiglottitis
aka:
can be caused by flu B or streptococcus penumoniae, but ___
clinical presentation:
main intervention:
further treatment:
bacterial croup
serious, life-threatening obstructive inflammatory process = PEDs EMERGENCY
not as common d/t vaccines ; unimmunized pt are at higher risk
clinical presentation: high fever, drooling, looks very sick, tripod position, difficulty swallowing, trouble talking, in distress
main intervention: maintain the airway
- DO NOT ASSESS
- no tongue blades, do not look in throat
- let parents be with child
- prepare for sedation & intubation
- if at home, let 911 come to them (do not want to lose airway)
further treatment:
- remain calm, crash cart position, prepare for intubation
- with antibiotics, child improves and can be extubated (7-10 days long)
- discharge occurs 3-7 days with regimen of oral antibiotics for home
bronchiolitis
aka:
RSV season:
patho:
syangis vaccine:
diagnostic evaluation fo RSV:
therapeutic management:
nursing considerations:
aka: RSV
RSV season: november -april
patho: hard time eating & breathing (lots of mucous), leads to resp distress, can crash on you
vaccine: used for kids with CHD, asthma, born prematurely, a twin, chronic lung probs
- monthly injection
diagnostic evaluation of RSV: routine testing is no longer recommended (too much room for error)
- use supportive care by going off of S&S
therapeutic management:
- primary goal: airway maintenance
- symptomatic treatment (most can be managed at home)
- medications:
a. antivirals: ribavirin (aerosolized, do not give to prego)
b. bronchodilators - albuterol, xopenex, racemic epi
c. corticosteroids - do not help as much
d. use O2 and IV support
nursing considerations:
- contact isolation
- consistent hand washing
- encourage parental participation
- saline drops & bulb sx (FIRST)
- increased humidity (mist tent or vaporizer)
- adequate fluid intake (NPO if RR > 60)
- rest
- humidified O2
- antipyretics
- monitor pulse ox
- monitor hydration & encourage PO intake of clear fluids
pneumonias
clinical manifestations:
issue with children with this disease:
if viral, what do we need?
therapeutic management & nursing care:
- fever: mild to high
- cough: nonproductive early, slight to severe (can do x-rays and sputum cultures)
- rhonchi or fine rales, decreased breath sounds
- resp distress & need O2 support
- coarseness in lungs
cannot localize pain well
if viral, we need a sputum culture to tell, x-ray is not sufficient
- if sputum culture is not done, child will be treated with antibiotic
therapeutic management & nursing care:
- humidified O2 therapy & BRONCHIODIALTORS
- many need chest tube for purulent drainage
- may require postural drainage or CPT (to get mucous up and out)
- rest & HYDRATION
pertussis
aka:
not seen much d/t:
frequent coughing, therefore…
when pregnant at 27 wk, pt gets ___- to protect infants when they are born
therapeutic management/nursing considerations:
aka: whooping cough
not seen much d/t vaccine
frequent coughing, therefore, pt cannot catch their breath or eat
TDaP
therapeutic management/nursing considerations:
- treatment: ERYTHROMYCIN/zythromycin
- infants < 6M may need ventilator support
tuberculosis
not as common
source:
in this disease, what is as important as medications?
nursing care:
source: usually an infected member of house, or frequent visitor to house
nutrition!
nursing care:
- medication adherence (check nutrition as well)
- adequate nutrition is as necessary as adherence to medications
- not as common in the US
two disorders of unknown etiology
apnea of infancy
sudden infant death syndrome
apnea of infancy
ATLE:
infants < ___ wk gestation
symptom combo of:
do premies do this?
50% are ___
50% are ___
therapeutic management:
ATLE: apparent life threatening event (they stop breathing)
infants < 37 wk gestation
symptom combo of:
- apnea > 20 seconds
- color change: cyanosis/pallor
- marked change in muscle tone (floppy)
- choking or gagging
premies do not do this - they stop breathing and need stimulation
50% are idiopathic
50% are symptoms of other disorders like undetected CHD or infection
therapeutic management:
- continuous cardioresp monitoring until episode free for 6M
- methylxanthine use: caffeine (reminds infant to breathe)
- teach CPR
sudden infant death syndrome (SIDS)
epidemiology of SIDS:
- could be d/t:
- peak age:
- increased incidence in what gender?
- cause of death:
infant & maternal characteristics:
nursing considerations:
sudden death of an infant under 1 yr of age that occurs during sleep & remains unexplained after a complete postmortem examination & investigation of death scene
- leading cause of death in infants
epidemiology of SIDS:
- could be d/t underdeveloped neuro-respiratory drive
- peak age 2-4 months
- males
- unknown
infant & maternal characteristics:
- premature or low birth weight infants
- low apgar score
- overheating
- unsafe sleeping arrangements (co-sleeping, pillows, things in crib, bumper pads) - they need their own space, put on tummy and soft place
- bottle fed (breast feeding is protective)
- second degree smoking
- hot environment (need 70-72 degrees)
nursing considerations:
- teach back to sleep: once they roll over, they can stay rolled over
- compassionate, sensitive, initial approach to fam
- only ask factual questions
- allow fam to say goodbye
- provide lock of hair, foot & hand prints
- arrange home visit ASAP
