Acute respiratory conditions

Question 1

physical difference between adult and child airways

Answer 1

small size
rely on diaphragmatic/abdominal breathing
larynx and glottis higher in neck
eustachian tubes are horizontal
ribs are horizontal r/t downward slope
fewer numbers of alveoli
higher metabolic rate

Question 2

when do we hold bottle feeding in an infant

Answer 2

RR 60 or higher

Question 3

respiratory assessment of child

Answer 3

LOC
RR
Respiratory effort
skin and mucous membranes
breath sounds

Question 4

RR of infant

Answer 4

30-40

Question 5

RR of child

Answer 5

20-24

Question 6

RR of adolescent

Answer 6

16-18

Question 7

what respiratory symptoms are concerning when assessing the respiratory system

Answer 7

nasal flaring 
grunting
retractions
restlessness
irritability
anxiousness

Question 8

cardinal signs of respiratory distress

Answer 8

tachypnea
tachycardia
diaphoresis
change in LOC (restless, irritability, anxiousness)
cyanosis
increased work of breathing ( grunting, nasal flaring, retractions)

Question 9

what about retractions is associated with the severity of the distress?

Answer 9

depth and location

Question 10

other worrisome signs of respiratory diestress

Answer 10

adventitious breath sounds
absent breath sounds
cough (quality: is it dry, wet, productive, brassy, croupy)
expiratory grunting, inspiratory stridor, expiratory wheezing

Question 11

which of the following patients has severe respiratory distress?

a) Jason, 3m old with RR 18
b) Jackson, 3 yr old, RR 22
c) Megan, 13 yr old, RR 24
d) Michelle, 19m old, RR 26

Answer 11

a) Jason, 3m

Question 12

Goals for nursing care of child

Answer 12

normal respiratory effort
adequate rest
not spread infections to others
maintain normal hydration and nutrition

Question 13

how do you ease respiratory efforts and promote rest and comfort

Answer 13

positioning (sit up to help breathe)
no steam vapor- warm or cool mist
mist tents
saline nose drops and bulb suctioning
bed rest and quiet activites

Question 14

how do you prevent the spread of infection?

Answer 14

handwashing
teaching
judicious patient room assignments (cohort similar patients)
immunizations
antibiotics

Question 15

how do you promote hydration and nutrition

Answer 15

high calorie fluids
avoid caffeine
allow children to self regulate their diet

Question 16

specific therapies to improve oxygenation

Answer 16

coughing and deep breathing (make it a game)
suctioning
neb treatments
percussion and postural drainage
chest physiotherapy
supplemental oxygen
ALWAYS humidify air

Question 17

causes of respiratory infections

Answer 17

viruses
b-hemolytic strep a
staphylococci
hemophilic influenzas b
mycoplasma
pneumococci

Question 18

what makes up the upper air way

Answer 18

nose
pharynx
tonsils
paranasal sinuses
larynx
epiglottis

Question 19

what makes up the lower airway

Answer 19

bronchi
bronchioles
alveoli

Question 20

why do infections in children tend to spread faster?

Answer 20

because structures are so close together infections spread more rapidly from structure to structure.

Question 21

clinical manifestations of respiratory infections in infants and children

Answer 21

fever
meningism's ( HA, stiff-necked, photophobia)
anorexia
Vomiting and Diarrhea
Abdominal pain
nasal blockage and or discharge
respiratory sounds
sore throat

Question 22

nasopharyngitis

Answer 22

common cold

Question 23

causes of common cold

Answer 23

rhinovirus, adenovirus, influenza, para-influenza virus

Question 24

clinical manifestations of nasopharyngitis in younger child

Answer 24

fever
irritability
restlessness
sneezing
vomiting/ and or diarrhea

Question 25

clinical manifestations of nasopharyngitis in older child

Answer 25

``` dryness and irritation of nose and throat sneezing chilling muscular aches cough edema vasodilators of mucosa ```

Question 26

at 3 months and less infants are protected by mothers

Answer 26

antibodies

Question 27

infection rates soar at what age

Answer 27

3-6m when moms antibodies are decreasing

Question 28

what is a true temperature in a child?

Answer 28

100.4

Question 29

at what age can you start giving ibuprofen to a child?

Answer 29

6m

Question 30

fever can reduce a viral load by how much?

Answer 30

50% | fever kills virus

Question 31

the nurse in an outpatient center is caring for a 4 month old infant with a URI. The parent asks "what should I do about this fever?" The Childs temperature is 100. How should the nurse respond?

Answer 31

a low grade fever can actually be beneficial

Question 32

The nurse caring for 6-month-old Alexa obtains an axillary temperature of 100.4. What action should the nurse take at this time? a) Administer prn acetaminophen b) assess respiratory and fluid status c) Question the parent about the child's usual temperature status. d) Record the temperature and retake in one hour.

Answer 32

b) assess respiratory and fluid status

Question 33

if you are taking a temperature under the arm do you add or subtract a degree?

Answer 33

add a degree and subtract rectally

Question 34

Therapeutic management of nasopharyngitis

Answer 34

no OTC cough meds less than 3 months antipyretics for high fever and discomfort rest older children- decongestants, cough suppressants

Question 35

what types of meds do you avoid in nasopharyngitis

Answer 35

antihistamines antibiotics expectorants

Question 36

COLD

Answer 36

c- comfort symptoms o- offer fluids l- look for complications d- decrease disease spread

Question 37

common cause of tonsillitis

Answer 37

viral

Question 38

how do you treat tonsilitis

Answer 38

treat symptomatically | no antibiotic necessary

Question 39

what causes step pharyngitis

Answer 39

Group A ( GABHS)

Question 40

clinical manifestations of strep pharyngitis

Answer 40

``` sudden onset sore throat headache fever vomiting lymphadenopathy abdominal pain BEEFY red throat ```

Question 41

what is there a risk of if strep pharyngitis is left untreated?

Answer 41

``` Acute Rheumatic Fever (18 days) Acute Glomerulonephritis (10 days) ```

Question 42

what is the management of strep pharyngitis?

Answer 42

antibiotics for 10 days

Question 43

nursing considerations for strep pharyngitis

Answer 43

severe sore throat seek medical attention obtain swabs teaching

Question 44

When does a child need to get a new toothbrush after strep?

Answer 44

24-48 hours after starting abx

Question 45

when can a child return to school after strep?

Answer 45

24 hours after starting antibiotics

Question 46

when is a tonsillectomy indicated?

Answer 46

only if documented recurrent, frequent strep peritonsillar abscess, or sleep apnea

Question 47

contraindications for tonsillectomy

Answer 47

cleft palate acute infections uncontrolled systemic disease or blood dyscrasias less than 4 years of age

Question 48

#1 sign of hemorrhage after tonsillectomy

Answer 48

excessive swallowing

Question 49

what types of foods do you teach to avoid after tonsillectomy?

Answer 49

red, brown and dairy ( dairy coats the throat)

Question 50

is drooling ok after a tonsillectomy?

Answer 50

Yes

Question 51

what should providers avoid doing after tonsillectomy if possible?

Answer 51

suctioning

Question 52

what should be discouraged after tonsillectomy?

Answer 52

straws coughing laughing crying

Question 53

what should you monitor for when doing a respiratory assessment after tonsillectomy?

Answer 53

stridor, can mean swelling and airway compromise

Question 54

what can be used for comfort after tonsillectomy?

Answer 54

ice collars | cool mist vaporizer

Question 55

when is the second time there is an immediate risk of hemorrhage after a tonsillectomy?

Answer 55

8-10 days after when the scabs fall off

Question 56

the nurse is caring for a 3-year-old child who is 3 hours post tonsillectomy. The child appears restless and is swallowing frequently. The child is quiet. The most appropriate action of the nurse is which of the following? a) allow the child to sleep b) use a tongue blade to assess the surgical site c) perform a focused assessment of the child d) administer analgesia to promote comfort

Answer 56

c) perform a focused assessment of the child