Exam #2 Respiratory Flashcards Preview

Pediatrics > Exam #2 Respiratory > Flashcards

Flashcards in Exam #2 Respiratory Deck (134)
1

Before born, lungs are not needed.

True

2

Less than 32-33 weeks of age, baby does not have sufficient amount of surfactant.

True

Biggest change in the NICU is the development of surfactant

If less than 34 weeks 1st dose of surfactant is given at birth

3

Fake surfactant = decrease incidence of -

RDS - Respiratory Distress Syndrome

and

BPD- Bronchopulmonary Dysplasia

4

**** Respiratory Distress Syndrome =

Lack of Surfactant

5

Bronchopulmonary Dysplasia

hard alveoli due to constant ventilator causing positive pressure.

lung tissues get pounded until gets tough

6

Treatment for Apnea of Prematurity

Caffeine

Can give through IV or Orally

Monitor for Toxicity

7

What is Apnea of Prematurity?

pause longer than 20 seconds

Apnea spells can last so long that they cause bradycardia

8

Sudden Infant Death Syndrome (SIDS) interventions:

sleep on back

No Bumpers

pacifier after 1 month

9

A + B Spells =

(Apnea and Brady)

How premie tells us they are sick

If alarm goes off, ASSESS FIRST

Infants breathe periodically- breathe, Breathe, Pause
----Happens in Premature babies

10

Preterm babies =

Bronchiolitis

11

**** S/S of Caffeine Toxicity

vomit

Irritable

Tachycardia

Jittery/ excitability

Tremors

12

Toddlers and Preschoolers breathe abdominally

True

use of abdominal muscles to breathe until 5 years old

13

Infants have irregular breathing patterns and are nose breathers.

True

they have smaller, less rigid airways

smaller lung size

horizontal, short eustachian tubes in Infants

Immature immune systems

14

Surfactant was given in clinical trials and had to stop because was unethical.

True….I guess….

15

What is a late sign of respiratory distress?

Cyanosis

16

Assessing Respiratory Status - VISUAL ASSESSMENT =

- work of breathing such as grunting, flaring, retracting

- Rate of breathing

- Chest Movement- is it equal?

- Posture and activity level - Well Flexed alert and awake**

- Sensorium (LOC)

- Level of comfort

- Color- skin and mucus membranes
- pink? sats in the 90's
- Grey? 80's or lower
- Worried about mucus membranes

17

Assessing Respiratory status - AUSCULTATION

Without the stethoscope you can hear grunting, stridor, or wheezing.

With Stethoscope- inspiratory and expiratory- will usually tell us if it is something in the upper or lower airway

Baby- Listen to Axillae and back

Older listen to front and back

18

While grunting- baby uses abdominal muscles to push air out.

True

19

What are the cardinal signs of respiratory distress?

Tachypnea
Restlessness (Huge sign) , Confusion, Anxiety, Irritability
Tachycardia
Diaphoresis

20

What is the earliest sign of respiratory distress?

Tachycardia

21

What are additional signs of respiratory distress?

Wheezing
grunting, flaring, retracting

22

What are the signs of Impending Respiratory Failure?

Depressed or slow respirations (Decreased inspiratory breath sounds)

Dyspnea

Bradycardia

Somnolence

Stupor/coma

Cyanosis (Central (Mucus membranes)

Oxygen desat

23

What are 2 signs that a baby is about to code?

80's o2 sat

and

Bradycardia

Means about to code…,.

24

O2 Sats falling are a sign of respiratory failure….

true

dont wait for them to become cyanotic

25

Why is tachypnea a sign of respiratory distress?

because if you have trouble breathing, you are going to breathe faster to get more air.

26

Acidosis

pH Less than 7.35

27

Respiratory Acidosis causes =

ventilation problem

need to be ventilated with oxygen

28

Metabolic Acidosis causes =

Diarrhea, Kidney failure, DKA

29

Alkalosis =

pH greater than 7.45

30

Respiratory Alkalosis causes =

test taking, any rapid respiratory rate

to little co2, hyperventilating

31

Metabolic Alkalosis causes =

Vomiting

32

Respiratory Acidosis S/S =

Dyspnea
Respiratory Distress
Shallow respirations
Headache
Restlessness
Confusion
Tachycardia
Dysrhythmias

33

Respiratory Alkalosis S/S =

Tachypnea
Light Headedness
numbness and tingling
confusion/ can't concentrate
Blurred Vision
Dysrhythmia
Palpitations / Diaphoresis
Dry Mouth, Tetanic spasms of arms and legs

34

CPAP-

has prongs gives positive pressure to keep stimulus for breathing….

35

Piaget --- FUNCTIONAL

blow balloons and bubbles in place of Incentive Spirometer.

36

Oxygen Safety?

AVOID NYLON AND WOOL
- Avoids materials that generate static electricity, such as wool blankets and synthetic fabrics, Cotton Fabrics and blankets.

- Avoid the use of volatile, flammable materials such as oils, greases, alcohol, ether, and acetone (Nail polish remover) near clients receiving oxygen

- make sure that electric devices (such as razors, hearing aids, radios, TV, and heating pads) are in good working order to prevent the occurrence of short circuit sparks.

- For home oxygen use teach family members to smoke outside away from the client.

37

Respiratory Scoring Sheet

Gives an Idea and can help determine if kids can leave the PICU

38

Inspiratory sounds-

Inspiratory Stridor = Upper airway obstruction (Trachea)

39

Wheezing- Exhalation =

Lower airway obstruction (Asthma, Bronchiolitis)

Bronchioles and alveoli

40

Upper Airway Obstruction causes :

Foreign body aspiration
Swelling of tissues (Croup, tonsils, Epiglotis)
Congenital Narrowing of upper airway

41

Clinical Signs of Upper airway Obstruction :

Tachypnea
Increased Respiratory Effort
Hoarse voice or Cry (seal like cough)
Stridor

42

Croup = 4 types of croup

1. larygotracheobronchitis

2. Acute spasmotic croup

3. Epiglotis

4. Bacterial tracheitis

43

Croup General Info-

late autumn / early winter

6 months to 3 years

Barking cough, hoarseness, inspiratory stridor

respiratory distress

44

What is the most common type of croup?

1. larygotracheobronchitis

45

larygotracheobronchitis LTB

or laryngotracheitis

Most common of the croup syndromes.
- Sound worse than they look
- Abrupt Onset, usually at night

Generally Effects children LESS THAN 3 years

Organisms responsible : Viral
- RSV, Parainfluenza virus, Mycoplasma pneumoniae, Influenza A and B

46

Treatment of Croup LTB - (larygotracheobronchitis)

Dexamethasone - Oral or IM
- 0.6 mg/kg
- Duration of action is 48 - 96 hours***

Nebulized Epinepherine - Racemic Epinepherine
- Used to dilate the airway
- Alpha adrenergic Effects = Mucosal Vasoconstriction
- Duration 1 - 2 hours ***
- Observe the patient for 2 - 4 hours (to make sure
airway doesnt collapse again.)

47

Dexamethasone - Oral or IM

- 0.6 mg/kg

- Duration of action is 48 - 96 hours***

48

Nebulized Epinepherine - Racemic Epinepherine

- Used to dilate the airway

- Alpha adrenergic Effects = Mucosal Vasoconstriction

- Duration 1 - 2 hours ***

- Observe the patient for 2 - 4 hours (to make sure
airway doesnt collapse again.)

49

Croup LTB Info-

Cough medications and decongestant meds are contranindicated because want baby to cry and cough to keep airway patent.

Over the counter medications, esp cough and cold meds should not be administered to CHILDREN UNDER 2 YEARS OF AGE *********

Controversy over whether cool humidified air works. Still may recommend cold water vaporizers, shower vapor, cool night air.

Suction out the child

50

Over the counter medications, esp cough and cold meds should not be administered to CHILDREN UNDER 2 YEARS OF AGE *********

true

51

Epiglottitis -

MEDICAL EMERGENCY

Sudden swelling and about to swell shut

Can't talk

Elective intubation

Dysphagia cannot swallow

52

Epiglottitis Clinical Manifestations:

- Sudden Onset, Fever and sore throat
- Usually in patients 2 - 8 years old

******Drooling, Dysphonia, Dysphagia

- Tripod positioning with retractions and flaring

- Inspiratory Stridor, mild hypoxia, distress

****** Not hoarse, NO COUGH

53

Epiglottitis Diagnostic Testing :

Lateral neck x-ray

Thumb print on x-ray is indicative of swollen epiglottis

54

Epiglottitis positioning =

stay with child and parent can keep child calm. Ask for the people to come to them. Let them stay in whichever position they are in.

55

Therapeutic Management of Epiglottitis

Potential for respiratory obstruction

Nursing Considerations:
- No Tongue Blades
- Maintain calm
- Emergency Intubation Equipment on hand
- No cultures

Do a conscious sedation and intubate them….

56

Epiglottitis Prevention -

HIB Vaccine

(Influenza Type B)

57

Bacterial Tracheitis-

Attacks the Trachea

Occurs in the fall and winter months

ages 6 months to 6 years

URI for several days or classic viral croup

Staph aureus, H. Influenzae, Strep

Decompensates: high fever, productive cough, respiratory distress

Endotracheal intubation, mechanical ventilation, IV antibiotics

*******Same problem as epiglottitis but not 3 D's
(Dysphagia, Drooling, Dysphonia)

Treat with elective intubation

58

Lower Airway Obstruction causes:

asthma

Bronchiolitis

59

Lower Airway Obstruction clinical Signs:

Typically heard on expiration

Wheezing - airway narrows (Rales- crackles)
Rhonchi in larger airway

Tachypnea

Retractions, and nasal flaring

Prolonged expiration phase combined with expiratory effort

Cough

60

Bronchiolitis

RSV= Respiratory Syncytial Virus- affects small airways

NO ANTIBIOTICS

#1 Nursing Intervention: Contact Isolation
#2 Assess Respiratory Status
#3 IV Placement
#4 I & O's

61

Bronchiolitis Diagnostics ;

Culture secretions

62

Bronchiolitis Therapeutic Management :

Hydration
Rest
Humidification
Increased fluid Intake

need pulse ox
bag mask
BP cuff
Bulb Syringe

63

Bronchiolitis and RR Greater than 60, baby is at risk for

Aspiration

64

RSV Respiratory Syncytial Virus

Born before 33 weeks give synergist -

Prevention of RSV: Prophylaxis- Palivizumab-

Need once a month during RSV period if under 35 weeks gestation… until 2

Ribavirun - antiretroviral med rarely used. Used for life or death situations only….Not typical treatment for RSV anymore.

65

When is RSV Season In TN

October - March is RSV season in Tennessee

66

Asthma -

Chronic Inflammatory disorder of the airways

limited airflow or obstruction that reverses spontaneously or with treatment

bronchial hyperresponsiveness

Episodic tightening of smooth muscle

67

Trach Care-

- if you go past tip, you are suctioning bronchial tissue

-Normal saline can wash microbes that are around the mouth area into the lungs. Suction the back of the mouth to get the secretions out.

- Non- Sterile cath used to suction mouth first then get sterile cath to suction ET Tube.

- Suction for 3-5 seconds

- 2 Trachs at bedside.. One same size and one smaller.

- Mouth care is as important as trach care.

68

Anti Inflammatory Drugs-

Inhaled corticosteroids
Oral or Parenteral Corticosteroids
Leukotriene Receptor Antagonists

69

Inhaled corticosteroids Examples

Flucticasone proprionate ( Flonase, Flovent)
Budesonide - (Pulmicort)

Steroids can cause thrush in mouth, use spacer and rinse out mouth with water or brush teeth after use.

70

Leukotriene Receptor Antagonists

Montelukast (Singulair)

71

Corticosteroids-

In low doses for asthma

Side effects: Cough, dysphonia, ORAL THRUSH**,

Monitoring: Every 3-6 months- growth parameters
- Can cause diminished growth

72

Leukotriene Modifiers

Blocks inflammatory and bronchospasm effects of leukotrienes

Zafirlucast (Accolate)- for children 7 years and up

Montelukast sodium (Singulair) for children 1 year and older

***Can cause aggression and anxiety

73

Montelukast (Singulair) Side Effects:

Headache

Can cause increase in SGOT/SGPT- use cautiously in patients with impaired liver function

Patients with PKU- Montelukast contains phenyalanine

Linked with odd psycho effects such as strange mood changes.

74

Beta 2 Adrenergic Agonists-

allow smooth muscle to relax

inhaled form hasa a more rapid onset of action than the oral form

side effects: seen mostly in oral form. irritability, tremor, nervousness, and insomnia


75

Beta 2 Adrenergic Agonists- examples

Albuterol, levabuterol, (Short acting)
Salmeterol - Long acting

Action: Relaxes airway smooth muscle

Indication: Acute and Chronic treatment of Wheezing

Adverse Reactions: Nervousness, tachycardia, jitteriness

Nursing Considerations: Inhalation route has fewer side effects

76

Albuterol

Sympathomimetic Drug

Stimulates beta 2 adrenergic receptors in lungs causing bronchial smooth muscle relaxation

CAUTION: May increase risk of arrhythmias in Digoxin patients

Side Effects: HA, Nausea, Restlessness, Nervousness, Trembling

77

Albuterol Overuse

1. Loss of bronchodilation effects
2. SEVERE paradoxical Bronchoconstriction

78

Nursing Considerations for Albuterol

client family teaching

Wait 2 min before inhaling 2nd puff

79

Salmeterol Servent

long acting - salmeterol (servent)-

Used no more than every 12 hours.

Not used in children under 12 years old

NEVER USED FOR ACUTE SYMPTOMS

80

What are triggers for asthma :

allergens- dust, animal dander, smoke

Cold air

Weather changes

Infection

Exercise

Fatigue

Emotional Distress

Environmental changes like starting a new school

(ASK ABOUT WHAT THE PATIENTS INDIVIDUAL TRIGGERS ARE)

81

Atopy

genetic predisposition for the development of an IgE mediated response to common aeroallergens

Strongest predisposing factor for developing asthma

Born with more IgE

All Children have atopy

Hyperresponsiveness to triggers

82

Antihistimines

Loratadine (Claritin) &Cetirizine (Zyrtec)

Fexofenadine (Allegra)

83

Loratadine (Claritin) &Cetirizine (Zyrtec) MOA=

competes with histamine on H1 receptor sites

84

Fexofenadine (Allegra) MOA=

antagonizes histamine effects

85

What are the side effects of antihistamines?

Side effects: headache, dry mouth, drowsiness

(Opposite of muscarinic man)

Children may experience a paradoxical reaction of restlessness, insomnia, nervousness

86

Aspirin Triad

A subpopulation of asthmatic patients who react with acute dyspnea within 2 hours after ingestion of aspirin.

Triad: Chronic rhinosinusitis including polyps, severe bronchial asthma, and intolerance to aspirin and other NSAIDs

Client/family education: use acetaminophen

87

Drug Therapy for Asthma

Long-term meds/ Preventive

Corticosteroids
Cromolyn sodium
Albuterol
Salmeterol
Leukotriene modifiers

88

Drug Therapy for Asthma

Quick relief/Rescue meds

Albuterol
Ipratropium (anticholinergic)
Magnesium sulfate IV

89

Asthma action plan

…..

90

Peak Expiratory Flow Rate

80-100% Green
50 – 80 % Yellow
< 50% Red

91

What is red on peak expiratory flow rate?

less than 50%

92

What is green on peak expiratory flow rate?

80 - 100%

93

What is yellow on peak expiratory flow rate?

50 - 80 %

94

What is the patient teaching for a peak expiratory flow rate?

Done in morning. Standing.

Have child “huff and cough” 2 or 3 times to clear airway and set meter gauge on zero before beginning test.

95

Asthma meds and nursing management

Baseline assessment of depth, rate, rhythm, and type of patient respirations

Post-treatment assessment of same

Monitor the quality and rate of patient’s pulse

Assess the patient’s lung sound for crackles, rhonchi, and wheezing

Observe fingernails and lips for signs of cyanosis

96

Client/Family Teaching For Asthma

Instruct patient and family to increase fluid intake to decrease viscosity of lung secretions

Never abruptly discontinue asthma meds

Practice good, oral hygiene

House at 50 – 60 % humidity

No carpet, but if carpet vacuum daily

97

Status Asthmaticus

Respiratory distress continues despite vigorous therapeutic measures

Medical emergency

Humidified oxygen

Aerosolized short-acting Beta 2 –agonist

IV access

Emergency treatment: epinephrine 0.01 ml/kg SC (maximum dose 0.3 ml)

At risk of asphyxia and respiratory arrest

98

Goals of Asthma Management

Avoid exacerbation

Avoid allergens

Relieve asthmatic episodes promptly

Relieve bronchospasm

Monitor function with peak flow meter

Self-management of inhalers, devices, and activity regulation

Participate in sports/exercise when asthma controlled

99

Cystic Fibrosis

Exocrine gland dysfunction that produces multisystem involvement

Most common lethal genetic illness among Caucasian children

Approximately 3% U.S. Caucasian population are symptom-free carriers

Autosomal recessive trait

100

What is the most reliable diagnostic procedure for cystic fibrosis?

Basis of the most reliable diagnostic procedure: sweat chloride test (pilocarpine iontophoresis)

Normal sweat chloride is < 40 mEq/L

A sweat chloride > than 60 mEq/L is diagnostic


Extra salt and fluid required during hot weather

101

What is a normal sweat chloride ?

Normal sweat chloride is < 40 mEq/L

102

What does the level of sweat chloride have to reach in order to be diagnostic for cystic fibrosis?

A sweat chloride > than 60 mEq/L is diagnostic

103

Respiratory Manifestations of CF

Present in almost all CF patients but onset and extent are variable

Stagnation of mucus and bacterial colonization result in destruction of lung tissue

Tenacious secretions are difficult to expectorate, obstruct bronchi and bronchioles

Decreased O2-CO2 exchange

Results in hypoxia, hypercapnia, acidosis

Compression of pulmonary blood vessels and progressive lung dysfunction lead to pulmonary hypertension, cor pulmonale, respiratory failure, and death

104

Management of CF

Percussion and postural drainage

Mucolytic agents

Antibiotics – Vancomycin, Tobramycin

Pancreatic enzymes

Supplement fat soluble vitamins

105

Pulmozyme (dornase alfa)

Action: Enzyme that hydrolyzes the DNA in sputum

Indications: Cystic fibrosis

Nursing indications:
--Given by nebulizer

--Monitor for dysphonis and pharyngitis

106

CF Diet

Children with CF have an energy intake of 100% to 200% of standards for healthy persons

High protein, high caloric, with unrestricted fat

107

Azotorrhea =

increased protein in stool

108

Steatorrhea =

increased fat in stool – greasy stools

109

Otitis Media

Otitis Media is primarily a result of a dysfunctioning eustachian tube.

110

AOM

Acute otitis media

111

OME

Otitis media with effusion

112

CSOM

Chronic suppurative otitis media

113

Mastoiditis

...

114

Risk factors for developing AOM or OME

Less than 2 years of age – peak incidence between 6 and 18 mo
Atopy

Bottle propping

Chronic sinusitis

Cleft palate

Child care attendance

Down syndrome

Immunocompromising conditions

115

Risk factors for developing AOM or OME


“Passive smoking increases the risk of persistent middle ear effusion by enhancing attachment of the pathogens that cause otitis to the respiratory epithelium in the middle ear space, prolonging the inflammatory response, and impeding drainage through the eustachian tube.”

True or false?

True

116

Signs and symptoms of AOM

Holding or pulling at ears

Rolling head side to side

Pain

Fever

Enlarged postauricular, cervical lymph glands

117

Diagnosis of AOM

Acute onset of symptoms

Evidence of middle ear effusion

Signs and symptoms of middle ear inflammation

118

Treatment of AOM

Spontaneous resolution in 80% children

Wait up to 72 hours for spontaneous resolution while providing pain control

Amoxicillin 90 mg/kg/day divided bid for 10 days

Second-line antibiotic: Augmentin (amoxicillin/clavulanate)

Third-line: ceftriaxone (Rocephin)

119

What is the second line treatment for AOM?

Second-line antibiotic: Augmentin (amoxicillin/clavulanate)

120

What is the 1st line treatment for AOM?

Amoxicillin 90 mg/kg/day divided bid for 10 days

121

What is the 3rd line treatment for AOM?

Third-line: ceftriaxone (Rocephin)

122

True or False?

Steroids, decongestants, and antihistamines are not recommended for treatment of AOM

True

123

True or False?


Tonsillectomy does NOT reduce incidence of otitis

true

124

Nursing Care of AOM

Relief of pain

----Acetaminophen, Ibuprofen, acetaminophen with codeine

----Topical --topical benzocaine

----Local heat over ear while child lies on affected side

125

Management of OME

75% of cases resolved within 3 months

Temporary hearing deficit

Persistent OME past 3 months with hearing or language delays may benefit from tympanostomy tubes

126

Myringotomy and tubes


“Placement of tympanostomy tubes is recommended after a total of 4 – 6 months of bilateral effusion with a bilateral hearing deficit.”

True or False

True

127

Nursing Care For draining ears:

Sterile cotton in ears, still allowing drainage

Moisture barrier on skin


Speech and hearing evaluation

128

Nursing Care For tubes–

keep bath water and shampoo out of ears – ear plugs


Speech and hearing evaluation

129

Pneumococcal immunization

Pneumococcal conjugate vaccine --PCV7-- and currently PCV 13

Reduced the number of otitis media cases dramatically

S pneumoniae in 50% of children in daycare

130

Tonsillectomy

Post-op Nursing care:

Observe for bleeding (7 – 10 da)

Position side-lying

Strict intake and output

Oral fluids, or popcicles

Nothing scratchy or salty

131

Pharyngitis

Gargle with warm saline three times a day

Ice chips/popcicles

Tylenol q 4 – 6 hours

132

Strep throat

Gargle with warm saline three times a day

Ice chips/popcicles

Tylenol q 4 – 6 hours

Penicillin for 10 days

133

What is the difference in treatment for strep throat vs pharyngitis?

treatment is the same for both but strep throat requires Penicillin for 10 days.

134

Acute Streptococcal Pharyngitis

Treat with Penicillin – usually oral for 10 days
-----Erythromycin is allergic to
PCN

May return to school or day care after have been taking antibiotics for a full 24 hour period

Need to discard toothbrush and replace with new one after being on antibiotics for 24 hours