ch 19 PED physical exam, imaging of the RT, inhalation of medications, and Avoidance of environmental hazards

Question 1

________ is the foundation for investigating the pediatric thorax

Answer 1

chest XRAY

Question 2

The NP suspects pleural fluid within the lungs, what should the NP order?

Answer 2

Lateral decubitus radiograph (determines extent and mobility of the fluid)

Question 3

Forced expiratory radiographs can be useful to show focal air trapping and shift of the mediastinum to the contralateral side in presence of ________

Answer 3

A suspected foreign body

Question 4

The NP suspects pleural fluid of the lungs, what should the NP order?

Answer 4

Lateral decubitus radiograph (determines extent and mobility of the fluid)

Question 5

A lateral neck radiograph with the “thrumbprint sign” indicates?

Answer 5

Epiglottitis – lateral neck XRAY looks at assesses size of adenoids and tonsils; will help differentiate from croup

Question 6

What type of XRAY should the NP order to differentiate croup from epiglottitis?

Answer 6

Lateral neck XRAY - assesses size of adenoids and tonsils.

“thumbprint” sign indicates epiglottitis

Question 7

A child with any swallowing dysfunction such as suspected aspiration, tracheoesophageal fistula, vascular rings and slings, and achalasia should be further evaluated. What are three diagnostic tests to evaluate swallowing dysfunction?

Answer 7

Upper gastrointestinal series (UGI)
Esophagram
Videofluoroscopic swallow studies (VFSS)

Question 8

What imaging can detect paralysis by demonstrating paradoxic movement of the involved hemidiaphragm?

Answer 8

Fluoroscopy or ultrasound of the diaphragm

Question 9

_________ is recommended for evaluation of congenital lung lesions, pleural disease (effusion or recurrent pneumothorax), complicated pneumonia, mediastinal disorders (lymphadenopathy), interstial lung disease and bronchiectasis.

Answer 9

Volumetric chest CT

Question 10

A volumetric chest CT with contrast is necessary to evaluate ______and ______.

Answer 10

masses and nodules

Question 11

When evaluating for interstial lung disease or bronchiectasis, the NP would select ______ because it reduces radiation exposure

Answer 11

High-resolution CT

Question 12

When the NP suspects vascular malformations or pulmonary embolism, they will order ________ because it assesses for regional ventilation and perfusion.

Answer 12

Ventilation-perfusion scans

Question 13

__________ is best to delineate vasculature

Answer 13

CT angiography

Question 14

Physical exam: What will inspection reveal?

Answer 14

respiratory rate
work of breathing
respiratory effort
color
movement

Question 15

Physical exam: What will palpation reveal?

Answer 15

tracheal position
symmetry
vibration

Question 16

Physical exam: what will auscultation reveal?

Answer 16

intensity and symmetry

quality of breath sounds/presence of abnormal sounds

Question 17

Physical exam:What will percussion reveal?

Answer 17

tympanic or dull sounds

Question 18

What are some pediatric respiratory conditions (acute and chronic) that routinely use inhalation medications?

Answer 18

Acute:
Infectious laryngotracheobronchitits (CROUP)
Bronchiolitiss

Chronic:
Cystic fibrosis

Mixed Acute and Chronic TX options:
Bronchopulmonary dysplasia
Asthma

Question 19

What will short-acting Beta-Agonists and Anticholinergics provide?

Answer 19

acute bronchodilation

Question 20

What will inhaled corticosteroids and Cromones provide?

Answer 20

Anti-inflammatory effects

Question 21

What respiratory disease process benefits from nebulized antibiotics?

Answer 21

Cystic fibrosis

Question 22

What respiratory processes require nebulized mucolytics such as rhDNAse and hypertonic saline?

Answer 22

Cystic Fibrosis

or other conditions with impaired secretion control (non-CF bronchiectasis)

Question 23

What are three ways to deliver medications to the respiratory tract

(Dr CoP)

Answer 23

DRy powder inhaler (DPI)

Compressed air-driven wet nebulization
Pressurized metered dose inhaler (pMDI)

Question 24

What is required for pressurized metered dose inhaler (pMDI) use? What age has this technique shown to be effective?

Answer 24

A valved holding chamber or similar spacer

infants as young as 4 months of age

Question 25

_______ is the device recommended for infants and toddlers receiving either pressurized metered dose inhaler (pMDI) or wet nebulization

Answer 25

face-mask interface

Question 26

______ is the device recommended for older children that can form a seal

Answer 26

A simple mouth piece

Question 27

The NP should do what at each clinical visit with a pediatric patient on inhaled medications?

Answer 27

assess and review delivery technique

Question 28

A shift in the tracheal position from midline indicates:

Answer 28

Pneumothorax or significant unilateral atelectasis

Question 29

Tachypnea with an equal inspiratory and expiratory time suggests:

Answer 29

Decreased lung compliance

Question 30

Unilateral crackles found on an ADULT patient on exam is a finding for:

Answer 30

Pneumonia - unilateral crackles on an adult - MOST VALUABLE EXAM FINDING

Question 31

T/F Respiratory disorders are secondary to disease in other systems

Answer 31

TRUE - fever, metabolic acidosis, congenital heart disease, neuromuscular disease, immunodeficiency, autoimmune disease, and occult malignancy

Question 32

Wheezing or prolonged expiratory compared to inspiratory time suggests:

Answer 32

Intrathoracic (lower) airway obstruction

Question 33

What are extrapulmonary manifestations of pulmonary disease? (Acute and Chronic)

Answer 33

Acute: cyanosis altered mental status Chronic: growth failure clubbing osteoarthropathy

Question 34

What are findings of Cor Pulmonale? | HEL

Answer 34

Hepatomegaly Elevated neck veins Loud pulmonic component of the second heart sound rarely, peripheral edema

Question 35

Cor Pulmonale signifies _______ and may accompany ________.

Answer 35

Pulmonary hypertension | Advanced lung disease

Question 36

__________ ____ can aggravate existing lung diseases, impair pulmonary function, and cause lung disease in children

Answer 36

Environmental insults

Question 37

List all the possible environmental insults | In HoOD

Answer 37

INdoor pollution HOusehold fungi Outdoor air pollution (ozone and particulates) Diesel exhaust

Question 38

Environmental ______ _____ dramatically increases childhood pulmonary morbidity

Answer 38

tobacco smoke - counsel smoking family members to quit and minimize exposure to those around them

Question 39

How can ozone exposure be limited?

Answer 39

Avoiding outdoor activities during the height of daily ozone levels - maybe impossible for many families and children

Question 40

Environmental hazards that trigger children who have asthma includes

Answer 40

pet exposure and infestations such as cockroaches or mice