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Peds > Chapter 40: Nursing Care of the Child with an Alteration in Gas Exchange/Respiratory Disorder > Flashcards

Chapter 40: Nursing Care of the Child with an Alteration in Gas Exchange/Respiratory Disorder Flashcards

Exam 2 (130 cards)

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1
Q

What must be done to prevent life threatening complications?

A

Must detect problems and intervene early to prevent life-threatening complications

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2
Q

The most common causes of illness and hospitalization in children

A

Alterations in gas exchange (respiratory disorders) are the most common causes of illness and hospitalization in children

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3
Q

What accounts for the majority of acute illnesses in children

A

Respiratory infections account for the majority of acute illnesses in children

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4
Q

What can influence both the development of respiratory disorders and the course of the illness?

A

Age, socioeconomic status, and general health status can influence both the development of respiratory disorders and the course of the illness

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5
Q

Age, socioeconomic status, and general health status can influence both the development of respiratory disorders and the course of the illness

What is an example?

A

E.g. low-income children have a higher risk for increased severity or increased frequency of respiratory disease

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6
Q

What is key to solving respiratory problems?

A

Expert assessment skills and early intervention are key

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6
Q

Anatomy and Physiology of the Child’s Nose and Throat:

Infant Nose:

How do infants breath?

How much mucus made?

What are they susceptible to?

What are not developed?

A

Obligate/preferential nose breathers
Produce very little mucus
More susceptible to infections
Sinuses are not developed

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7
Q

Anatomy and Physiology of the Child’s Nose and Throat:

Newborn Nose:

A

Very small nasal passages

More prone to obstruction

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8
Q

Anatomy and Physiology of the Child’s Nose and Throat

Throat- What are children at increased risk for?

A

Increased risk for airway obstruction

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9
Q

Anatomy and Physiology of the Child’s Nose and Throat

Throat- Why are children at increased risk for obstruction?

A

Infants’ tongues larger in relation to oropharnyx

Children have enlarged tonsilar and adenoid tissue

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10
Q

Lower Respiratory Structures include

A

Bifurcation of trachea

Narrower bronchi and bronchioles

Smaller numbers of alveoli

Airway much more compliant

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11
Q

Lower Respiratory Structures:

Bifurcation of trachea

A

Bifurcation of trachea at level of the third thoracic vertebra compared to 6th in adults: important when suctioning or intubating children

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12
Q

Lower Respiratory Structures:

Narrower bronchi and bronchioles increased risk for?

A

Narrower bronchi and bronchioles of infants and children: increased risk for lower airway obstruction

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13
Q

Lower Respiratory Structures:

Smaller numbers of alveoli: puts children at increased risk for ?

A

Smaller numbers of alveoli: higher risk of hypoxemia

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14
Q

Lower Respiratory Structures:

Airway much more compliant- puts children at increased risk for ?

A

Airway much more compliant- making it more susceptible to collapse in presence of airway obstruction.

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15
Q

Chest Wall:

How are infant chest walls? How do they support the lungs?

A

Infants’ chest walls are highly compliant (pliable) and fail to support the lungs adequately.

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16
Q

Chest Wall:

How is functional residual capacity?

A

Functional residual capacity can be greatly reduced if respiratory effort is diminished

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17
Q

Chest Wall:

What does lack of lung support lead to?

A

This lack of lung support also makes the tidal volume of infants and toddlers almost completely dependent upon movement of the diaphragm.

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18
Q

Metabolic Rate and Oxygen Need:

How does children metabolic rate compare to adult?

A

Children have a significantly higher metabolic rate than adults

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19
Q

Chest wall

If diaphragm movement is impaired what happens?

A

If diaphragm movement is impaired (as in states of hyperinflation, such as asthma), the intercostal muscles cannot lift the chest wall and respiration is further compromised.

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20
Q

Metabolic Rate and Oxygen Need:

How RR of children than adult?

A

Resting respiratory rates are faster and their demand for oxygen is higher.

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21
Q

Metabolic Rate and Oxygen Need:

How does child oxygen consumption compare to adult?

A

Adult oxygen consumption is 3 to 4 L/min, while infants consume 6 to 8 L/min.

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22
Q

Metabolic Rate and Oxygen Need:

In respiratory distress how are children compared to adults?

A

In any situation of respiratory distress, infants and children will develop hypoxemia more rapidly than adults

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23
Q

Risk Factors for Respiratory Disorders:

A

Prematurity

Chronic illness (diabetes, sickle cell anemia, cystic fibrosis, congenital heart disease, chronic lung disease)

Developmental disorders (cerebral palsy)

Passive exposure to cigarette smoke

Immune deficiency

Crowded living conditions or lower socioeconomic status

Daycare attendance

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24
Nursing Assessment for Child with Respiratory Distress:
Health history Physical exam
25
Nursing Assessment for Child with Respiratory Distress: Health history includes:
PMH, FH, Hx present illness, immunization hx, exposure to smoke Atopy
26
Atopy
genetic tendency to: Asthma Allergic rhinitis Atopic dermatitis
27
Nursing Assessment for Child with Respiratory Distress Physical exam
Inspection and observation Palpation Percussion  Auscultation
28
Inspection and Observation
Anxiety and restlessness Color: pallor, cyanosis Hydration status Clubbing Breath sounds Rate and depth of respirations: tachypnea Respiratory effort Nose and oral cavity Cough and other airway noises: stridor
29
Adventitious Breath Sounds include:
Wheezing Rales
30
Adventitious Breath Sounds: Wheezing
High-pitched sound usually heard on inspiration; sometimes on expiration
31
Adventitious Breath Sounds: Wheezing What does it occur with?
May occur with obstruction in lower trachea or bronchioles
32
Adventitious Breath Sounds: Wheezing- What does it occur in?
May occur in asthma or viral infections
33
Adventitious Breath Sounds Rales
Crackling sounds heard when alveoli become fluid filled
34
Adventitious Breath Sounds Rales- What does it occur with?
May occur with pneumonia
35
Percussion- What are the things?
Normal/resonant Flat or dull sounds Tympany Hyperresonant
36
Percussion: Normal=
Normal= resonant- low pitched, hollow
37
Percussion: Flat or dull sounds might be percussed where?
Flat or dull sounds might be percussed over partially consolidated lung tissue, as in pneumonia
38
Percussion- Tympany
Hollow drum sound- might be percussed with a pneumothorax
39
Percussion- hyperresonance What may it be apparent for?
Note the presence of hyperresonance (as might be apparent with asthma).
40
Laboratory and Diagnostic Tests :
Pulse oximetry: Chest radiograph Blood gases: Nasal-pharyngeal washings: Rapid strep
41
Laboratory and Diagnostic Tests : How is pulse ox?
Pulse oximetry: oxygen saturation might be decreased significantly
42
Laboratory and Diagnostic Tests : Chest radiograph:
might reveal hyperinflation and patchy areas of atelectasis or infiltration
43
Laboratory and Diagnostic Tests : Blood gases:
might show carbon dioxide retention and hypoxemia
44
Laboratory and Diagnostic Tests Nasal-pharyngeal washings:
positive identification of RSV or other viral illness via enzyme-linked immunosorbent assay (ELISA) or immunofluorescent antibody (IFA) testing
45
Laboratory and Diagnostic Tests Rapid strep
testing via throat swab
46
Common Medical Treatments:
Oxygen High humidity Suctioning Chest physiotherapy and postural drainage Saline gargles or lavage Mucolytic agents Chest tubes Bronchoscopy
47
Acute Infectious Disorders
Common cold Sinusitis Influenza Pharyngitis, tonsillitis Laryngitis Croup syndromes Pneumonia and bronchitis Infectious mononucleosis
48
Acute Infectious Disorders Common cold
– viral URI or nasopharyngitis; eg, Respiratory syncytial virus (RSV);
49
Acute Infectious Disorders: Sinusitis
Sinusitis – bacterial; acute or chronic
50
Acute Infectious Disorders: Influenza
Influenza – viral infection; ‘the flu’; bacterial infections may follow
51
Acute Infectious Disorders: Pharyngitis, tonsillitis–
often viral
52
Acute Infectious Disorders: Laryngitis
Laryngitis – inflammation of larynx
53
Acute Infectious Disorders: Infectious mononucleosis
–caused by Epstein-Barr virus; ‘kissing disease’, often in adolescence; spleen rupture, Guillain-Barre syndrome; meningitis
54
Nursing Management of Epiglottitis: What is often the cause of Epiglottitis? How common is it and why?
Most often caused by Haemophilus influenza type b; become more rare with Hib vaccine
55
Signs and Symptoms of Bronchiolitis (RSV)
Onset of illness with a clear runny nose (sometimes profuse) Pharyngitis Low-grade fever Development of cough 1 to 3 days into the illness, followed by a wheeze shortly thereafter Poor feeding
56
Nursing Management of Epiglottitis: What should you not do?
Attempt to visualize the throat - larygnospasm Leave the child unattended Place the child in a supine position
57
Nursing Management of Epiglottitis: What should you do?
Provide 100% oxygen in the least invasive manner Ensure tracheostomy tray and emergency equipment readily available
58
Nursing Management of Epiglottitis:       CLINICAL REASONING ALERT! What is Epiglottitis characterized by?
Epiglottitis is characterized by dysphagia, drooling, anxiety, irritability, and significant respiratory distress.
59
Nursing Management of Epiglottitis:       CLINICAL REASONING ALERT! WHat should you prepare for?
Prepare for the event of sudden airway occlusion.
60
Chronic Respiratory Disorders:
Allergic rhinitis Asthma Chronic lung disease Cystic Fibrosis Apnea
61
Chronic Respiratory Disorders: Allergic rhinitis- What is it associated with?
Associated with asthma and atopic dermatitis
62
Chronic Respiratory Disorders: Asthma
Chronic inflammatory airway disorder
63
Chronic Respiratory Disorders: Chronic lung diseases aka bronchopulmonary dysplasia
infants who had RSD and require O2 past 28 days
64
Chronic Respiratory Disorders: Apnea- and what accompanies it?
absence of breathing for more than 20 seconds; may be accompanied by bradycardia
65
Chronic Respiratory Disorders: Apnea-What are the three types
Central Occurs with other illnesses Apnea of prematurity
66
Chronic Respiratory Disorders: Central Apnea
unrelated to another cause
67
Chronic Respiratory Disorders: Apnea of prematurity- What is it a precursor for?
SIDs; caffeine- theophylline
68
Pneumonia—Laboratory and Diagnostic Tests Pulse oximetry:
Pulse oximetry: oxygen saturation might be decreased significantly or within normal range
69
Pneumonia—Laboratory and Diagnostic Tests Chest x-ray
Chest x-ray: varies according to child age and causative agent
70
Pneumonia—Laboratory and Diagnostic Tests WBC count
White blood cell count: might be elevated in the case of bacterial pneumonia
70
Pneumonia—Laboratory and Diagnostic Tests Sputum culture:
may be useful in determining causative bacteria in older children and adolescents
71
Cystic Fibrosis—Laboratory and Diagnostic Tests Sweat chloride test:
considered suspicious if the level of chloride in collected sweat is above 50 mEq/L and diagnostic if the level is above 60 mEq/L
72
Cystic Fibrosis—Laboratory and Diagnostic Tests Pulse oximetry:
oxygen saturation might be decreased, particularly during a pulmonary exacerbation
73
Cystic Fibrosis—Laboratory and Diagnostic Tests Chest Radiograph
Chest radiograph: might reveal hyperinflation, bronchial wall thickening, atelectasis, or infiltration
74
Cystic Fibrosis—Laboratory and Diagnostic Tests Pulmonary function tests:
might reveal a decrease in forced vital capacity and forced expiratory volume, with increases in residual volume
75
Risk Factors for Tuberculosis
TB HIV infection Incarceration Positive recent history of latent TB infection Immigration or travel to endemic countries Exposure at home to HIV infected or homeless persons, illicit drug users, persons recently incarcerated, migrant farm workers, or nursing home resident
76
Asthma
Chronic inflammatory airway disorder- most common chronic illness of childhood
77
What is the most common chronic illness of childhood?
Asthma
78
Asthma - symptoms
Airway hyperresponsiveness Airway edema Mucus production Results in airway obstruction that might be partially or completely reversed
79
Asthma- how do symptoms occur in people?
Some have long periods of control with infrequent exacerbations others have presence of persistent daily symptoms
80
Asthma Incidence & severity increasing -is caused by
environment
81
Asthma: Therapeutic Management
Allergens or triggers Comorbid conditions “Stepwise” approach –increasing meds as they worsen, backing off tx as they improve Medications
82
BOX 40.3 Stepwise Approach to Asthma Management How many steps?
6 steps
83
BOX 40.3 Stepwise Approach to Asthma Management What occurs at every step?
All children: child education, environmental control, and management of comorbidities at each step.
84
BOX 40.3 Stepwise Approach to Asthma Management When should you consider referral for asthma specialist?
Consider referral to asthma specialist at step 3.
85
BOX 40.3 Stepwise Approach to Asthma Management Step 2 and above are considered what?
(Step 2 and above are persistent asthma.
86
Slide 24 read if time?
Probs no time
87
Asthma Management: How is management decided?
Tiered system of therapy: based on Asthma Severity Classification
88
Asthma Management What are rescue meds?
Rescue medicine: short-acting bronchodilators
89
Asthma Management What are maintenance meds?
Leukotriene modifiers Inhaled corticosteroids Long-acting bronchodilators
90
Lab and Diagnostic Tests for Asthma Pulse oximetry:
oxygen saturation may be decreased significantly or normal during a mild exacerbation.
91
Lab and Diagnostic Tests for Asthma: Chest radiograph:
Chest radiograph: usually reveals hyperinflation. \
92
Lab and Diagnostic Tests for Asthma Blood gases:
Blood gases: might show carbon dioxide retention and hypoxemia.
93
Lab and Diagnostic Tests for Asthma: Pulmonary function tests (PFTs):
Pulmonary function tests (PFTs): can be very useful in determining the degree of disease but are not useful during an acute attack. Children as young as 5 or 6 years might be able to comply with spirometry.
94
Lab and Diagnostic Tests for Asthma: Peak expiratory flow rate (PEFR):
Peak expiratory flow rate (PEFR): is decreased during an exacerbation.
95
Lab and Diagnostic Tests for Asthma: Allergy testing:
skin test or RAST can determine allergic triggers for the asthmatic child.
96
What is Asthma Action Plan? What does it do?
Education of child and family Management plan Maintenance medications Age-appropriate spacer or holding chamber with meter-dose inhalers It also provides guidance on when to call healthcare provider or when to go to the emergency room
97
Asthma Action Plan: What does it show?
Written, individualized worksheet that shows you the steps to take to keep asthma from getting worse.
98
Cystic Fibrosis: What kind of disorder is it?
Autosomal recessive disorder
99
Cystic Fibrosis: What is the mutation that causes disease?
Cystic fibrosis transmembrane conductance regulator (CFTR) mutation results in problems in exocrine glands
100
Cystic Fibrosis- What occurs during it? What decreases with it?
Excess thick, tenacious mucus lining airways causing decreased resistance to infection and air trapping Decreased pancreatic enzymes and hypersecretion of gastric acids
101
Cystic Fibrosis Treatment
Chest physiotherapy (multiple times daily) Inhaled dornase alfa (pulmonary enzyme) Inhaled antibiotics for exacerbation Pancreatic enzyme supplementation ADEK vitamin supplementation Well-balanced, high-calorie, high-protein diet
102
Providing Oxygen Supplementation: What does it require? Types of ways oxygen is given?
Requires MD or NP order, exception for emergencies – follow policy Simple mask NC Oxygen tent
103
Providing Oxygen Supplementation:       CLINICAL REASONING ALERT!
Monitor vital signs, color, respiratory effort, pulse oximetry, and level of consciousness before, during, and after oxygen therapy to evaluate its effectiveness.
104
Alternatives to Traditional Mechanical Ventilation
High frequency oscillators Nitric oxide inhalation Perfluorocarbon liquid Extracorporeal membrane oxygenation (ECMO)
105
Alternatives to Traditional Mechanical Ventilation High frequency oscillators
Provide respiratory rates up to 1200 bpm with low tidal volume
106
Alternatives to Traditional Mechanical Ventilation: Nitric oxide inhalation
Inhaled nitric oxide gas, causes vasodilation to increase blood flow to alveoli
107
Alternatives to Traditional Mechanical Ventilation: Per fluorocarbon liquid
Acts like a surfactant; Provides improved gas exchange
108
Alternatives to Traditional Mechanical Ventilation: Extracorporeal membrane oxygenation (ECHO)
Blood is removed from the body, warmed, oxygenated and returned to the patient via pump.
109
Nursing Care Posttonsillectomy What should you do?
Promoting airway clearance: Maintaining fluid volume Relieving pain:
110
Nursing Care Posttonsillectomy How to promote airway clearance?
Promoting airway clearance: place child in side-lying or prone position
111
Nursing Care Posttonsillectomy How to maintain fluid volume
Discourage coughing Encourage fluids; avoid citrus, brown, or red fluids
112
Nursing Care Posttonsillectomy How to relieve pain?
Relieving pain: ice collar and analgesics with or without narcotics
113
Nursing Care Posttonsillectomy: What may indicated bleeding
*Frequent swallowing may indicate bleeding.
114
Acute Noninfectious Respiratory Disorders include:
Epistaxis Foreign body aspiration Acute respiratory distress syndrome Pneumothorax
115
Acute Noninfectious Respiratory Disorders: Epistaxis
Bloody nose
116
Acute Noninfectious Respiratory Disorders: Epistaxis Where does it usually occur? How does it occur?
Often in the anterior portion of the septum Can be recurrent and idiopathic
117
Acute Noninfectious Respiratory Disorders: Foreign body aspiration
solid or liquid substance inhaled in reparatory tract Small objects smaller than diameter of their airway Items smaller than 1.25 inch -Toilet paper roll
118
Acute Noninfectious Respiratory Disorders: Acute Respiratory distress When can it occur?
May follow another illness or insult
119
Acute Noninfectious Respiratory Disorders: Acute Respiratory distress HOw?
Pulmonary edema--> mucosal swelling--> atelectasis --> impaired gas exchange
120
Acute Noninfectious Respiratory Disorders: Pneumothorax
Collection of air in the pleural space
121
Acute Noninfectious Respiratory Disorders: Pneumothorax What occurs in this disorder? What is treatment
Trapped air consumes space in pleural cavity and affected lung may suffer partial or total collapse Needle aspiration or chest tube
122
Pneumothorax: Risk factors:
Chest trauma or surgery Intubation and mechanical ventilation History of chronic lung disease such as cystic fibrosis
123
Pneumothorax: Signs and symptoms
Chest pain Signs of respiratory distress: Tachypnea Retractions Nasal flaring Grunting
124
Pneumothorax: Signs and symptoms of respiratory distress
Signs of respiratory distress: Tachypnea Retractions Nasal flaring Grunting
125
Tracheostomy
Artificial opening in the airway
126
What are tracheostomies performed for?
Tracheostomies are performed to relieve airway obstruction, such as with subglottic stenosis (narrowing of the airway sometimes resulting from long-term intubation)
127
Who are tracheostomies used in?
Used in child who requires chronic mechanical ventilation
128
Tracheostomy: What does it facilitate?
The tracheostomy facilitates secretion removal, reduces work of breathing, and increases the child’s comfort.

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