Care of Child With Respiratory Problems Flashcards
(104 cards)
1
Q
BREATHING SEQUENCE
A
- Phrenic nerve stimulation
- diaphragm and muscles contract; thorax expands
- Intrathoracic and intrapulmonic pressures decrease
- INSPIRATION : air moves from (+) pressure outside to (-)
pressure in alveoli; stretch receptors are stimulated - EXPIRATION : passive expulsion of air as elastic tissue
recoils
2
Q
air moves from (+) pressure outside to (-)
pressure in alveoli; stretch receptors are stimulated
A
INSPIRATION
3
Q
passive expulsion of air as elastic tissue recoils
A
EXPIRATION
4
Q
inspiration stimulates alveolar stretch receptors, which send inhibitory impulses to brainstem to prevent overdistention
A
Hering-Breuer reflex
5
Q
stimulate respiration in response to lowered pH, increased PCO2 and decreased PO2
A
Chemoreceptors
6
Q
control respiration rate and depth
A
Medulla oblongata and pons
7
Q
capacity of chest wall and lung to distend
A
Compliance
8
Q
mostly dependent on airway size, as well as tissue resistance
A
Resistance
9
Q
rapid RR (high metabolism); rate steadily decreases with growth and maturity
A
Neonate
10
Q
hydrogen ion concentration in solution
A
pH
11
Q
measure of acidity and alkalosis
A
pH
12
Q
homeostasis; balance between acidosis and alkalosis
A
Steady pH concentration in the body
13
Q
when pH drops, respirations _______________ to exhale more ________________
A
increase; carbon dioxide
14
Q
when pH rises, respiratory center ________________ rate of respiration
A
decreases
15
Q
excess presence of H+ ions
A
Acidosis
16
Q
deficiency of H+ ions
A
Alkalosis
17
Q
In many disorders, symptoms like ________________________________________________, cause acid-base disturbances that are more hazardous to a child than the primary disorder
A
fever, vomiting or diarrhea
18
Q
RESPIRATION-VENTILATION
Physical Observations
A
- Chest rise-and-fall (child 7 and up)
- Abdominal rise-and-fall (infant and young child)
- Nasal Flaring : indicates respiratory distress
- Skin: mottled, pallor, cyanosis
- Clubbing at fingertips, usually with chronic hypoxia
19
Q
Chest rise-and-fall
A
child 7 and up
20
Q
Abdominal rise-and-fall
A
infant and young child
21
Q
indicates respiratory distress
A
Nasal Flaring
22
Q
Counting Respirations
A
- Abdominal movements in infant to age 7
- Chest movements in age 7 and up
- Count when child is restful and unaware
- Tachypnea
23
Q
rapid respiration often due to awareness, excitement, anxiety, fever, other disorders
A
Tachypnea
24
Q
excessively deep breathing; seen in fever, anemia, etc.
A
Hyperpnea
25
shallow breathing
Hypopnea
26
difficulty breathing
Dyspnea
27
too-shallow, too-slow breathing that fails to meet the body’s needs.
Hypoventilation
28
seen in preterm infants and children with neuromuscular disorders
Hypoventilation
29
musical breathing, usually on expiration from narrowed airway or foreign body obstruction
Wheezing
30
Auscultation
1.Airway patency
2.Wheezing
3. Stridor
4. Cough
5. Whoop
31
loud, high-pitched breathing; inspiratory or expiratory; usually from narrowed upper airway or foreign body obstruction
Stridor
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inspiratory sound with cough associated with pertussis in small children
Whoop
33
voice sounds while breathing
Fremitus
34
voice sounds while breathing
Fremitus
35
can be used to loosen secretions
Percussion
36
DIAGNOSTIC TESTS
Chest Radiograph
Computed Tomography (CT Scan)
Bronchoscopy
Pulmonary Function Tests
Sputum Culture
Pulse Oximetry
Arterial Blood Gases
37
Use of x-rays passed through the body to record internal structures
Chest Radiograph
38
Protect gonads and thyroid with lead shield
Chest Radiograph
39
Use of x-ray sequences to demonstrate cross-sections of the lung to detect lesions, masses, other abnormalities
Computed Tomography (CT Scan)
40
Use of bronchoscope to directly inspect trachea and bronchi under sedation
Bronchoscopy
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Use of spirometry or pneumotachography to evaluate treatment and course of a disease
Pulmonary Function Tests
42
less useful diagnostically
Pulmonary Function Tests
43
spirometer measures lung volume and inhalation capacity to ascertain amount of air exchanged in breathing
Pulmonary Function Tests
44
Laboratory analysis to assess consistency, color and pathogens in secretions
Sputum Culture
45
Uses a photodetecting sensor clipped to a finger, toe or other small appendage to continuously monitor oxyhemoglobin saturation
Pulse Oximetry
46
helps determine child’s need for O2 administration
Pulse Oximetry
47
Used to assess levels of oxygenation and gas exchange by analyzing blood from an artery or capillary
Arterial Blood Gases
48
Infection and inflammation of the throat
PHARYNGITIS
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signs and symptoms of Viral Pharyngitis
sore throat, fever & general malaise; enlarged regional lymph nodes; erythema at the back of the pharynx & palatine arch
50
Management of Viral Pharyngitis:
- acetaminophen, ibuprofen
- warm heat to the external neck area for comfort
- gargle with warm water
51
signs and symptoms of Streptococcal- caused by GABHS Pharyngitis
erythema at the back of the throat & palatine tonsils, enlarged tonsils, white exudates in tonsillar crypts, petechiae on palate, high fever, extreme sore throat, difficulty swallowing, overall lethargy, headache
52
Management of Viral Streptococcal- caused by GABHS Pharyngitis
- antibiotic treatment for 10 days (Pen G or clindamycin)
- dvise parents to strictly follow course of treatment to prevent hypersensitivity or autoimmune reaction to group A strep causing Rheumatic fever or glumerulonephritis
53
Infection and inflammation of the palatine tonsils
TONSILLITIS
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cause of Tonsillitis in < 3 y.o is?
viral
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cause of Tonsillitis in school age is
GABHS
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Signs and Symptoms of Tonsillitis:
● drooling
● difficulty swallowing
● high fever
● lethargy
● increased ASO titer
● enlarged, bright red palatine tonsils
57
Management of Tonsillitis:
● Antipyretic, analgesic
● Full 10 days antibiotic treatment (Pen G or Amoxicillin)
● Tonsillectomy for chronic tonsillitis; done when organs aren’t infected
58
Tonsillectomy Management
- Avoid red fluids
- Bleeding signs check: increased pulse & RR, frequent
swallowing (cardinal sign of bleeding post tonsillectomy), throat clearing, feeling of anxiety
- Restrict child’s activity until after 7th day
- Offer sips of clear liquid, popsicles or ice chips
- Avoid acid & carbonated drinks
- Do position in prone or side lying position with head lower than the chest
59
Upper respiratory infection (type of croup) usually affecting children under age 5 years; with slow progressive onset
ACUTE LARYNGOTRACHEOBRONCHITIS (LTB)
60
ACUTE LARYNGOTRACHEOBRONCHITIS (LTB) is an ______________ respiratory infection (type of croup) usually affecting children under age ______________; with __________________ onset
upper; 5 years; slow progressive
61
An inflammation of the mucosa lining the larynx and trachea causing a narrowing the airway
ACUTE LARYNGOTRACHEOBRONCHITIS (LTB)
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Typical patient of ACUTE LARYNGOTRACHEOBRONCHITIS (LTB) is a __________ who develops the classic ______________ and _______________ after several days of _________
toddler; “barking” cough; acute stridor; coryza
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Causes of ACUTE LARYNGOTRACHEOBRONCHITIS (LTB):
parainfluenza virus types 1,2,3, RSV (Respiratory Syncytial Virus), Influenza type A &B, measles, Mycoplasma pneumoniae
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Signs & Symptoms of ACUTE LARYNGOTRACHEOBRONCHITIS (LTB):
- barking (brassy) cough that usually happens at night
- dyspnea
- hoarseness
- inspiratory stridor (produced by the struggle to inhale air past obstruction and into the lungs)
- low-grade fever (gradual onset)
- moderate respiratory distress with mild wheezing
- persistent laryngospasm
- Retractions
- respiratory acidosis and respiratory failure due to
hypoxia and airway obstruction
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Major objective for the therapeutic management of ACUTE LARYNGOTRACHEOBRONCHITIS (LTB)
medical management of infectious process and maintaining an airway for adequate respiratory exchange
66
Therapeutic Management of ACUTE LARYNGOTRACHEOBRONCHITIS (LTB)
1. mild croup without stridor are managed at home
2. cool mist with dexamethasone or racemic epinephrine
3. fluids (oral and intravenous)
4. run shower or hot water tap in bathroom; keep child in warm, moist environment
5. monitoring for signs of respiratory distress
67
Assessment of ACUTE LARYNGOTRACHEOBRONCHITIS (LTB)
✔ vigilant and accurate assessment of respiratory status:
difficulty breathing, low-grade fever, inadequate ventilation,
fatigue from persistent cough
✔ Noninvasive cardiac, respiratory and blood gas monitoring
68
NURSING INTERVENTION
Planning and Implementation
of ACUTE LARYNGOTRACHEOBRONCHITIS (LTB)
✔ Ice chips or physician’s approved agents for irritated throat from brassy cough
✔ Ensure immediate accessibility of intubation equipment
✔ Medications: corticosteroids, heliox (moderate to severe),
nebulized epinephrine
✔ If mist tent is not tolerated, cool moist mist blowing directly toward the patient can be done
✔ Allow parent or caregiver to lie next to the child in the mist tent to lessen anxiety
✔ Patient/ family teaching:
monitor fever
offer comfort and distraction from restlessness
irritability is to be expected
✔ Teach caregivers to monitor intercostal retractions,
tachypnea, nasal flaring, increasing restlessness and/or
continuous stridor (signs of respiratory distress)
69
Life-threatening supraglottic obstructive inflammation requiring emergency medical attention
ACUTE EPIGLOTTITIS
70
Results from bacterial infection of the epiglottis
ACUTE EPIGLOTTITIS
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ACUTE EPIGLOTTITIS occurs in children between ________ years old
2-5
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Causes/ Transmission of ACUTE EPIGLOTTITIS
H. influenzae, pneumococci, streptococci, staphylococci; intake of smoke, hot substances or crack cocaine
73
Signs & Symptoms of ACUTE EPIGLOTTITIS
● A cherry red epiglottis & muffled voice
● Absence of spontaneous cough
● Apprehension & Aggitation
● Bacterial infection
● Causes respiratory Stridor
● Croaking inspiration
● Drooling, Dyspnea, Dysphagia
● Fever
● Hypercapnia
● Muffled voice
● Rapid onset and rapid
progression to distress
● Retractions (Suprasternal and substernal)
74
Respiratory obstruction develops quickly leading to:
✔ Hypoxia
✔ Acidosis
✔ Reduced level of Consciousness
✔ Sudden Death
75
Therapeutic Management for ACUTE EPIGLOTTITIS
1. Immediate airway clearance via nasotracheal tube or
tracheostomy
2. Radiology as needed for rapid visualization
3. With airway opened, administer humdified oxygen
76
Most common in older children and adolescents
CUTE LARYNGITIS
77
in ACUTE LARYNGITIS, causative agents are usually ________ and is almost always ______________ without extended duration or sequelae
virus; self-limiting
78
Signs & Symptoms of ACUTE LARYNGITIS:
Hoarseness
Sore throat
Headache
Coryza
Nasal Congestion
Fever
Malaise
79
An acute common self-limiting infectious disease among young people <25 years of age
MONONUCLEOSIS
80
Signs & Symptoms of MONONUCLEOSIS
✔ Fatigue
✔ Malaise
✔ Sore throat
✔ Fever with: Generalized lymphadenopathy, splenomegaly,
skin rash on trunk, enlarged and reddened tonsils, enlarged spleen, jaundice
81
is the principal causing agent of MONONUCLEOSIS
Epstein-Barr (EB) virus
82
in MONONUCLEOSIS, incubation period following exposure is __________ weeks
4-6
83
to determine blood agglutination of significant agglutinins
Spot test
84
Fluid and inflammation in the middle ear
OTITIS MEDIA
85
Otitis Media is most frequently caused by ______________________ which may become bacterial
RSV and influenza viruses
86
Transmission of Otitis Media:
airborne and direct contact
87
Clinical Manifestations of Otitis Media
✔ middle ear pain and inflammation
✔ fever and otalgia (AOM)
✔ fluid in middle ear without infectious symptoms (OME)
✔ Eardrum perforation and tympanosclerosis (eardrum scarring)
✔ Cervical or preauricular lymph gland enlargement
✔ Rhinorrhea (nasal drainage), vomiting, diarrhea
✔ Loss of appetite
✔ Labyrinthitis (infection of inner ear) and mastoiditis (infection of
mastoid sinus) could occur
88
Therapeutic Management of Otitis Media
✔ Observation
✔ Treat fever and ear pain
✔ Analgesic-antipyretics
✔ Heat or cold application
✔ Topical pain relief
✔ Tympanostomy tubes (recurrent & with bilateral hearing loss)
✔ Myringotomy (eardrum incision) to alleviate pain or drain fluid
89
Nursing Interventions of Otitis Media
✔ Observation
✔ Treat fever and ear pain
✔ Heat pack application over ear
✔ Position child on affected side
✔ Assist in removal of drainage: wicks inserted loosely and
frequent cleansing of outer ear
✔ Parent teaching on prophylactic care: upright position
when feeding ; avoid smoking around infants
✔ Provide emotional support by explaining the process for
management of drainage and encourage follow up
evaluation of hearing
90
Acute viral infection of the bronchioles which frequently occurs in children <2 years of age
RSV (RESPIRATORY SYNCYTIAL VIRUS) BRONCHIOLITIS
91
is responsible for most cases of RSV (RESPIRATORY SYNCYTIAL VIRUS) BRONCHIOLITIS
RSV or Respiratory Syncytial Virus
92
Signs & Symptoms of SV (RESPIRATORY SYNCYTIAL VIRUS) BRONCHIOLITIS
✔ Rhinorrhea, low-grade fever, sneezing, decreased appetite
and dry and persistent coughing
✔ Wheezing, retractions, crackles, nasal flaring, dyspnea,
prolonged expiratory phase and intermittent cyanosis
✔ Extremely shallow respirations and air hunger
✔ Barrel-shaped chest
✔ Dehydration
93
Nasal and nasopharyngeal secretions testing by:
- enzyme-linked immunosorbent assay (ELISA)
- Rapid immunofluorescent antibody (IFA)
94
a specific aerosol antiviral medication for RSV bronchiolitis (for severely ill)
Ribaviri
95
Drug for preventio for RSV bronchiolitis
RSV immune globulin intravenou
96
Nursing Interventions for SV (RESPIRATORY SYNCYTIAL VIRUS) BRONCHIOLITIS
Airway- neck slightly extended
Bed- head elevated 30-45 degrees
Cool humidified O2
Dehydration Monitoring
Encourage handwashing
For contact precaution
Globulin immunization
97
A chronic inflammatory bronchial response of airway obstruction, bronchospasm, hyperexudation, and bronchial edema in response to patient-specific triggers
ASTHMA
98
Signs & Symptoms of Asthma
● Breathlessness
● Dyspnea
● Long expiratory rate
● Wheezing
● Tight chest
● Cough,
● Weakness from work of breathing due to limited airflow,
● Copious w/ white cast mucus,
● Dehydration
99
maximum volume of air released during a forced expiration
Peak Expiratory Flow Rate (PEFR
100
age 5 and older; measures both expired and inspired air through a mouthpiece; promotes maximum effort (with visual feedback); loosens secretio
Spirometr
101
Acute inflammation of the pulmonary parenchyma associated with alveolar consolidation
PNEUMONIA
102
1. Pneumococcal Signs and Symptoms
● Blood tinged sputum before 24 hours
● Crackles
● Thick purulent sputum after 24-48 hours
● Dullness on percussion
● High fever
● Retractions
● Chest pain
● Chills
● Nasal flaring
● Dyspnea
● Tachypnea
103
1. With generalized dysfunction of the exocrine glands
2. Autosomal recessive trait
CYSTIC FIBROSIS
104
inability to transport small molecules across cell membranes leading to dehydration of epithelial cells in the airway & pancreas
CYSTIC FIBROSIS
