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Pediatric Nursing > Altered Respiratory status care of Child > Flashcards

Altered Respiratory status care of Child Flashcards

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1
Q

What is the most common infectious problem in infants and children?

A

Respiratory alterations

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2
Q

What age group has immature immune system?

A

Infants and children less than 3 years which means they are at greater risk for developing respiratory infections

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3
Q

When should the respiratory tract be fully developed?

A

around 12 years of age

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4
Q

How big is an infants trachea?

A

4 mm, size of a straw

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5
Q

How big is an adults trachea?

A

10-20 mm

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6
Q

what is the angle of mainstem bronchi in infants

A

infant 10 degrees on right, 30 degrees left

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7
Q

What is the angle of mainstem bronchi in adult

A

adult 30 degrees right, 50 degrees left

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8
Q

What are structural and functional differences in airways of children?

A
  • smaller oral cavity and larger tongue
  • smaller nares and nasopharynx
  • Long, floppy epiglottis
  • larger amount of soft tissue
  • Fewer alveoli
  • more compliant chest wall
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9
Q

What are early signs of respiratory distress

A 
tachypnea, tachycardia
retractions
nasal flaring
grunting
stridor or wheezing
mottled color
change in responsiveness
hypoxemia, hypercarbia
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10
Q

what are late signs of respiratory distress

A 
poor air entry, weak cry
apnea or gasping
deterioration in systemic perfusion
bradycardia
cyanosis
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11
Q

Tonsillitis/Pharyngitis symptoms

A

viral unless positive strep test

  • sore throat
  • fever, malaise
  • swollen lymph glands
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12
Q

What causes strep?

A

caused by group A Beta Hemolytic Steptococcal bacteria

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13
Q

what are symptoms of strep throat?

A

fever, red & sore throat, exudative tonsil, stomach ache, palatal petechiae, swollen submandibular lymph nodes

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14
Q

what does a red sandpaper rash indicate?

A

scarlet fever

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15
Q

what are treatments of step throat?

A

responds well to antibiotics, PCN (erythromycin if PCN allergy), cephalosporin

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16
Q

What do children with strep have to do before returning to school?

A

They need to take antibiotics for atleast 24 hours in their systems before returning to school

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17
Q

What are indications for a tonsillectomy?

A

frequent strep infections
peritonsillar abscesses
hypertrophy obstructing breathing and/or eating

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18
Q

what are the preoperative measures for a tonsillectomy?

A

teaching and coagulation status

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19
Q

What are the postoperative care for a tonsillectomy?

A
  • positioning for drainage
  • ice collar
  • cool liquids first then soft foods
  • analgesics
  • caution with suctioning, straws
  • refrain from nose blowing 7 coughing
  • observe for constant swallowing
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20
Q

What is emesis

A

swallowed blood

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21
Q

Otitis Externa “Swimmers Ear”

A
  • caused by normal ear flora & excessive wetness or dryness

- causes inflammation, pain and maybe some drainage

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22
Q

what are treatments for otitis externa?

A

clean and dry
analgesics
otic drops: polymyxin, neomycin, corticosteroids

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23
Q

Otitis Media w/Effusion (OME)

A

presence of fluid in the middle ear without signs of acute infection

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24
Q

Acute Otitis Media. (AOM)

A

acute onset MIDDLE ear effusion inflammation

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25
What causes AOM
H. flu, step pneumoniae, viral-RSV, or influenza
26
How do you diagnose AOM?
- acute onset - presence of middle ear effusion - Distinct TM erythema or otalgia preventing normal activity or sleep
27
Treatment for AOM
- antibiotics- amoxicillin, amoxicillin clavulanic (Augmentin), ampicillin sulbactam (Unasyn) - Cefdinir (omnicef), cefuroxime (ceftin), erythromycin-sulfisoxizole (Peidazole), sulfamethoxazole (Bactrim) - make sure to take for the full 10 days in children under 5
28
In children with AOM or OME, what can you use for pain control?
- Tylenol or Ibuprofen | - Lidocaine/benzocaine topical treatment can help to
29
Treatment for OME
screen hearing/ language - follow up - antibiotics/ steroids - Tympanostomy tubes
30
Myringotomy with Tympanostomy Tubes
Tubes inserted to equalize pressures and facilitate drainage and ventilation of the middle ear - This will not prevent all infections - will facilitate sound transmission and language development
31
What are the postop care for Tympanostomy
- analgesia needed - finish antibiotics - instructions for bathing and swimming - tubes will usually fall out on their own within 6 mth to 1 yr - follow up for hearing and language
32
Acute Epiglottits or Supraglottits
- this is acute inflammation and swelling of the epiglottis and surrounding tissue - Rapidly progressing upper trachea edema resulting in obstruction of airway - life-threatening
33
What causes acute epiglottits or supraglottis
bacterial agent, strep, staph, H-flu
34
What can decrease the incidence of acute epiglottitis
Hib vaccine
35
How do you diagnose acute epiglottitis
lateral neck film and clinical presentation
36
How does acute Epiglottitis present itself?
- characteristic appearance: edematous, cherry red epiglottis - cardinal S/S: drooling, dysphagia, dysphonia, distressed inspiratory effort
37
How do you manage acute Epiglottits?
- try to maintain patent airway - continuous monitoring of respiratory status and oxygenation - NPO - antibiotics - steroids - Maintain quiet environment - educate
38
Laryngotracheobronchitis (LTB)
- VIRAL - children less than 5 - symptoms worsen at night - inflammation mucosa of larynx and trachea with narrowing of airway - characterized by BARKING COUGH- CROUP cough
39
stage 1 of LTB
fever, hoarseness, croupy cough, inspiratory stridor
40
stage 2 of LTB
increased stridor, use of accessory muscles of respiration, lower costal retractions, labored respirations
41
stage 3 of LTB
hypoxia/hypercabia, restlessness/anxiety, pallor/sweating, tachypnea
42
stage 4 of LTB
intermittent cyanosis, persistent cyanosis, respiratory failure, apnea
43
Management of LTB
- maintain airway and adequate gas exchange - racemic epinephrine (nebulized epi) - Corticosteroids - Oxygen administration as needed, pulse oximetry - heliox
44
Bronchiolitis
- inflammation of the bronchioles - acute viral infection. Most often respiratory syncytial virus-RSV or adenoviruses or parainfluenza - common cause of hospitalization of infants less than a year of age
45
S/S of bronchiolitis
dyspnea, tachypnea with retractions, tachycardia, wheezing, crackles, rhonchi, temperature may vary from hypothermic to febrile, naso-pharyngeal aspirate help diagnosis
46
Management of Bronchiolitis
- pulse oximetry - humidified oxygen - heliox - adequate hydration - suction if needed - education
47
How to prevent RSV
- synagis (palivizumab) monoclonal antibody | - monthly IM injection during season
48
Pneumonia
- viral or bacterial - inflammation of the lung parenchyma - Common VIRAL: adenoviruses, influenza viruses, and RSV - Common BACTERIAL: strep, staph, enteric baccilli, pneumococcal or Hib, mycoplasma pneum
49
S/S pneumonia
- elevated temp - cough - tachypnea - retractions/nasal flaring - cyanosis
50
How to diagnose pneumonia
CXR | Suptum culture
51
Pneumonia management
- assessment of respiratory status and oxygenation - hydration - antibiotics for bacterial pneumonia - elevate HOB and repositioning - coughing and deep breathing - quiet environment to conserve energy
52
Chlamydial Pneumonia
- infants to about 19 weeks - chlamydia trachomatis - ascending infection from mother just before or during birth process - afebrile, persistent cough, tachypnea
53
treatment is chlamydial pneumonia
erythromycin for 2-3 weeks
54
Pertussis (Whooping Cough)
- bordetella pertussis - highly contagious: direct contact or droplet spread; indirect contact with freshly contaminated items - highest incidence in spring and summer - usually lasts 4-6 weeks
55
treatment for pertussis
- antibiotics for all contacts - supportive treatment - prevention with vaccine
56
Catarrhal stage of pertussis
coryza, mild cough, lacrimation, low grade fever
57
Paroxysmal stage of pertussis
increasing cough, whoop
58
Convalescent stage of pertussis
gradually diminishing symptoms
59
Infants less than 6 months with pertussis
may not present with typical cough, apnea common
60
Influenza
- VIRUS - Type A & B clinically significant - most common during winter - 1-3 incubation period, most infectious 24 hours before and after onset of symptoms - Dry cough, hoarsness, mylagia, fever, chills. young infants may have apnea
61
treatment for influenza
fluids and antipyretics
62
Rapivab (peramivir)
- over 2 years - type A & B - injectable single dose
63
Relenza (zanamivir)
- >7 years - A & B - inhaled 2 x daily by 5 days
64
Xofluza (baloxavir marboxil)
- >12 years | - tablet PO x1
65
Tamiflu (oseltamivir)
- 2 wks & older - A & b - PO 2 x daily by 5 days
66
Influenza prevention
vaccines
67
Asthma
- most common chronic disease of childhood - chronic inflammatory disorder of airway contributing to increased airway reactivity - narrowing of airways in response to triggers - air trapping- prolonged expiratory phase - wheezing, tachypnea, retractions, hypoxia
68
How to diagnose asthma
- standardized questioning - spirometry - peak flow measurement
69
Asthma Therapy Goals
- prevent symptoms - <2 days/wk use of short acting Beta agonist (SABA) - maintain normal pulmonary function - maintain normal activity levels - prevent recurrent exacerbations and ED visits - prevent progressive loss of lung function/growth - provide optimal pharmacotherapy with minimal or no adverse effects
70
Asthma management
- regular visits - education - environment-reduction in exposure to possible and known triggers - medication
71
Short-acting Beta-agonists for asthma
- bronchodilators: releive intermittent symptoms, "rescue" - Do not treat inflammation - Should include in therapy anyone with symptoms > 1 per month - Albuterol and levalbuterol
72
Inhaled Corticosteroids
- standard of care - inhaled steroids - inhibit inflammatory process - beclomethosone, budesonide, fluticasone, mometasone - few side effects: cough, dysphonia, oral thrush
73
Long-acting Beta-agonists
- product may be only LABA or combination with ICS - improve lung function, reduce use of SABA - Salmeterol, formoterol, terbutaline - Combinations-Advair, Symbicort
74
Beta agonist side effects
- decreased diastolic and mean arterial pressure - tachycardia - jitteriness - myocardial ischemia - Terbutaline-hypokalemia
75
Anticholinergics
- Ipratropium Bromide (atrovent) - oldest form of bronchodilator - used for relief of acute bronchospasm - blocks acetylcholine preventing smooth muscle contraction - SE drying resp secretions, blurred vision, cardiac & CNS stimulant
76
HELIOX
- combination of helium and oxygen - comes 70:30 or 80:20 - lightness of gas carries oxygen - decreases CO2 retention - low toxicity
77
Immunotherapy
-allergy shots
78
status asthmaticus
- continuation of acute distress - medical emergency - prolonged hypoventilation leads to resp acidosis - treatment include maintain airway and oxygenation
79
Cystic Fibrosis
- autosomal recessive transmission. Long arm chromosome 7. CFTR protein - exocrine gland disfunction-inc. mucous viscosity with multisystem effects- pancreas, lungs, GI - abnormal transport of chloride- sweat contains 2- 5x more Na and Cl - small passages blocked (bronchi, pancreas) - early or late symptoms - median age of CF is 37
80
S/S of CF
- newborn- meconium ileus (7-10%) - failure to thrive-continuing weight loss despite inc appetite - frequent pulmonary infections - bulky loose stools - inability to absorb fat soluble vitamins: A,D,E,K - delayed puberty in females: may have difficulty with conception due to cervical mucous - Males: often sterile by adulthood due to blockage of vas deferens and/or decreased/absent sperm production
81
Treatment of CF
- airway clearance therapies - percussion & postural drainage, PEP, HF, chest compressions - aerosolized bronchodilators, hypertonic saline, dornase alfa - long-term tx ibuprofen helps reduce inflammation and protect pulmonary function - adequate nutrition - promote reasonable quality of life
82
Endocrine with CF
insulin resistance & insulin deficiency | -bone health with pancreatic insufficiency & steroid use
83
Nursing care of CF
- usually require long-term IV access - teaching - support - promote normal G & D - Genetic counseling - Reproductive issues - anticipatory grieving
84
SIDS
- Third leading cause of infant death - decline in incident since 1994 - highest risk - 2-3 months; 95% by 6 months - increased in winter - african american, native american, alaskan native - causes are most likely pre-existing conditions and initiating events
85
What are the AAP recommendations for reducing SIDS?
- supine for sleep side lying is not acceptable - sleep surfaces firm with no soft materials - no smoking during pregnancy or 2nd hand smoke - sleep in separate crib or bassinet - consider a pacifier when sleeping - avoid overheating

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