[Exam 3] Chapter 40 – Alteration in Gas Exchange/Respiratory Disorder Flashcards
1
Q
Variations in Anatomy - Nose: Newborns are nose breathers until how long
A
4 weeks of age. Breathe through mouth only when crying.
2
Q
Variations in Anatomy - Nose: Frontal sinuses develop by when?
A
6-8 years
3
Q
Variations in Anatomy - Trachea: Infants trachea width compared to adult?
A
4mm versus 20 mm
4
Q
Variations in Anatomy - Trachea: What is underdeveloped here in children?
A
The cricoid crtilage, resulting in laryngeal narrowing and appearing funnel shaped
5
Q
Variations in Anatomy - Lower Respiratory Structure: How are the bronchioles compared to adults?
A
Are narrow in diameter when compared to adults ,placing them at increased risk for lower airway obstruction
6
Q
Variations in Anatomy - Lower Respiratory Structure: When do alveoli develop
A
24 weeks gestation
7
Q
Variations in Anatomy - Lower Respiratory Structure: When do the alveoli stop growing?
A
Until about 7-8 years of age
8
Q
Variations in Anatomy - Lower Respiratory Structure: Smaller amount of alveoli places infant at risk for what?
A
Hypoxemia
9
Q
Variations in Anatomy - Chest Wall: Problems with infants chest walls?
A
They are highly compliant (pliable) and fail to support the lungs adequately
10
Q
Variations in Anatomy - Chest Wall: Oxygen consumption in adult and infants?
A
3-4 L versus 6-8 L / minute
11
Q
Common Medical Treatments, Assessment Health Hx: Health history consists of what
A
past medical history, family history, and history of present illness.
12
Q
Common Medical Treatments, Assessment Health Hx: Past medical history might be cignificant for what?
A
Recurrnet colds or sore throats, atopy, prematurity, and respiratory dysfunction at birth
13
Q
Common Medical Treatments, Assessment Health Hx: Family hx may be important for what?
A
Chronic respiratory disorders such as asthma.
14
Q
Common Medical Treatments, Assessment Health Hx: What should you inquire about when eliciting history of present illness?
A
Inquire about onset, nasal congestion, and noisy breathing
15
Q
Common Medical Treatments, Assessment Health Hx: Why would hihg humidity be presccribed?
A
For the common cold, croup, or tonsillectomy
16
Q
Common Medical Treatments, Assessment Health Hx: Why would chest physiotherapy (CPT) and postural drainage be used?
A
For bronchiolitis, pneumonia, cystic fibrosis
17
Q
Common Medical Treatments, Assessment Health Hx: Why would saline gargles be used?
A
Pharyngitis, tonsillitis
18
Q
Common Medical Treatments, Assessment Health Hx: Why would saline lavage be used?
A
Common cold, flu, bronchiolitis, anything that results in increased mucus production
19
Q
Common Medical Treatments, Assessment Health Hx: Whyw ould chest tube be used
A
for pneumothorax, empyema
20
Q
Common Medical Treatments, Assessment Health Hx: Why would bronchoscopy be used?
A
FOr removal of foreign body, cleansing of bronchial tree
21
Q
Common Medical Treatments, Assessment Physical Exam: Why would expectorant (guaifensein) be used?
A
Reduces viscosity of thickened secretions. Used for common cold, pneumonia
22
Q
Common Medical Treatments, Assessment Physical Exam: Why woul cough suppressents be used?
A
Relieve irritating, nonproductive cough by direct effect. Used for common cold
23
Q
Common Medical Treatments, Assessment Physical Exam: Why ware antihistamines used?
A
Tx of allergic conditiions such as allergic rhinitis
24
Q
Common Medical Treatments, Assessment Physical Exam: Why would antibiotics be used?
A
Treatemnt of bacterial infections of respirtory tract in children with cystic fibrosis
25
Common Medical Treatments, Assessment Physical Exam: Why would Beta2 - Adrenergi Agonists be used?
Relax airway smooth muscle, resulting in bronchodilation
26
Common Medical Treatments, Assessment Physical Exam: Why would Beta 2- Adrenergic Agonists (long acting) be used?
Long-acting bronchodilator used in chronic asthma management
27
Common Medical Treatments, Assessment Physical Exam: Why would racemic epinephrine be used?
Produces bronchodilation indicated for croup
28
Common Medical Treatments, Assessment Physical Exam: Why would anticholinergic be used?
Produdces bronchodilation in asthma or chronic lung disease
29
Common Medical Treatments, Assessment Physical Exam: Why would antiviral agents be used?
Treatment, prevention of influenza A
30
Common Medical Treatments, Assessment Physical Exam: Why would Antiviral (Specific to RSV) be used?
Treatment of severe lower respiratory tract infection with RSV
31
Common Medical Treatments, Assessment Physical Exam: Why would Inhaled Corticosteroids be used?
Exert a potent, locally acting anti-inflammatory effect to decrease frequency and severity of asthma attacks
32
Common Medical Treatments, Assessment Physical Exam: Why would oral, parenteral corticosteroids be used?
Suppress inflammation and normal immune response. Used for acute asthma
33
Common Medical Treatments, Assessment Physical Exam: Why would decongestants be used?
Tx or runny or stuffy nose associated with common cold in children older than 6
34
Common Medical Treatments, Assessment Physical Exam: Why would leukotriene receptor antagonists be used?
To decrease inflammatory response by antagonizing the effects of leukotrienes to control asthma
35
Common Medical Treatments, Assessment Physical Exam: Why are mast cell stabilizers used?
Prevent release of histamine from sensitized mast cells, resulting in decreased frequency and intensity of allergic reactions
36
Common Medical Treatments, Assessment Physical Exam: Why would respiratory stimulant sbe used?
To provide continuous airway relaxation in moderate to severe asthma
37
Common Medical Treatments, Assessment Physical Exam: Why would inhaled pulmonary enzyme be used?
Hydrolyzes the DNA in sputum, reducing sputum viscosity
38
Common Medical Treatments, Assessment Physical Exam: Why would monoclonal antibody be used?
Used to prevent serious lower respiratory RSV disease
39
Common Medical Treatments, Assessment Physical Exam, Inspection/Observation: Why does pallor occur?
Result of peripheral vasoconstriction in effort to conserve oxygen for vital functions
40
Common Medical Treatments, Assessment Physical Exam, Inspection/Observation: What would cyanosis being centrally located indicate?
This si a true sign of hypoxia
41
Common Medical Treatments, Assessment Physical Exam, Inspection/Observation: Often, first sign of respiratory illness in infants and children is?
Tachypnea (increased respiratoryr ate)
42
Common Medical Treatments, Assessment Physical Exam, Cough/Airway Noises: When does grunting occur?
Occurs on expiration and is produced by premature glottic closure. Attempt to preserve or increase functional residual capacity
43
Common Medical Treatments, Assessment Physical Exam, Cough/Airway Noises: Why may grunting occur?
With atelectasis (collapsed portion of lung), pneumonia, and pulmonary edema
44
Common Medical Treatments, Assessment Physical Exam, Cough/Airway Noises: What does stridor indicate?
Sign of upper airway obstruction
45
Common Medical Treatments, Assessment Physical Exam, Clubbing: Why may this occur?
In children with chronic respiratory illness. Result of increased capillary growth as body attempts to supply more oxygen to distal body cells
46
Common Medical Treatments, Assessment Physical Exam, Breathing: Why does Wheezing occur?
Results from obstruction in the lower trachea or bronchioles.
47
Common Medical Treatments, Assessment Physical Exam, Breathing: Wheezing that occurs with coughing is most likely a result of?
Secretions in the lower trachea.
48
Common Medical Treatments, Assessment Physical Exam, Breathing: When does Rales (crackling sound) result?
When the alveoli become fluid filled, such as in pneumonia.
49
Common Medical Treatments, Assessment Physical Exam, Testing: Why would allergy skin testing be done
for allergic rhinitis and asthma
50
Common Medical Treatments, Assessment Physical Exam, Testing: Why would arterial blodo gases be tested?
For severe ilness, the intubated child, or suspected carbon dioxide retention
51
Common Medical Treatments, Assessment Physical Exam, Testing: Why would chest x-ray be done?
Bronchiolitis, pneumonia, tuberculosis, asthma and cystic fibrosis
52
Common Medical Treatments, Assessment Physical Exam, Testing: Why would flurescent antibody testing be done?
Bronchoiolitis, pneumonia
53
Common Medical Treatments, Assessment Physical Exam, Testing: Why would fluroscopy be done?
Identification of masses, abscesses
54
Common Medical Treatments, Assessment Physical Exam, Testing: Why would gastric washings for AFb be done?
Tuberculosis
55
Common Medical Treatments, Assessment Physical Exam, Testing: Why would peak expiratory flow be done?
Daily use can indicate adequacy of sthma control
56
Common Medical Treatments, Assessment Physical Exam, Testing: Why would pulmonary function test be done?
Asthma, cystic fibrosis, chronic lung disease
57
Common Medical Treatments, Assessment Physical Exam, Testing: Why would pulse ox be used?
When child experiencing respiratory distress
58
Common Medical Treatments, Assessment Physical Exam, Testing: Why would rapid flu test be done?
Influenza
59
Common Medical Treatments, Assessment Physical Exam, Testing: Why would rapid strep test be done?
Pharyngitis, tonsillitis
60
Common Medical Treatments, Assessment Physical Exam, Testing: Why would RAST be done?
Asthma (food allergies)
61
Common Medical Treatments, Assessment Physical Exam, Testing: Why would Sinus X-Ray , CT, MRI be done?
Sinusitis, Recurrent Cold
62
Common Medical Treatments, Assessment Physical Exam, Testing: Why would sputum culture be done
Pneumonia, cystic fibrosis, TB
63
Common Medical Treatments, Assessment Physical Exam, Testing: Why would sweat chloride test be done?
Cystic fibrosis
64
Common Medical Treatments, Assessment Physical Exam, Testing: Why would throat culture be done?
Pharyngitis, tonsilitis
65
Common Medical Treatments, Assessment Physical Exam, Testing: Why would TB Skin Test be done?
TB
66
Common Cold: What is this also refeerred as?
Viral Upper Respiratory Infection (URI) or Nasopharyngitis
67
Common Cold: Cold can be caused by what
rhinoviruses, parainfluenza, RSV, enteroviruses, and human metapneumovirus
68
Common Cold: Spontaneous resolution of common cold occurs when
7-10 days
69
Common Cold: Potential complications?
Secondary bacterial infections of ears, throat, sinuses, or lungs
70
Common Cold: Nasal congestion relieved how
via humidity and use of normal saline nasal wash or spray followed by suctioning
71
Common Cold: Why are antihistamines not used?
Because they dry secretions further
72
Common Cold - Nursing Assessment: What will child complain of?
Stuffy nose. Nasal discharge. May compain of sore throat.
73
Common Cold - Nursing Mx, Promoting Comfort: How is nasal congeestion relieved?
With use of normal saline nose drops, followed by bulb suctioning.
74
Common Cold - Nursing Mx, Promoting Comfort: How can you liquefy secretions?
Promotion of adequate oral fluid intake
75
Common Cold - Nursing Mx, Promoting Comfort: What to educate parents about cold medications?
May offer relief, but have not been proven to shorten length of cold symptoms
76
Common Cold - Nursing Mx, Promoting Comfort: Why should acetaminophen not be combined with other cold symptom meds
It may mask a fever in the child who is developing secondary bacterial infection
77
Common Cold - Nursing Mx, Promoting Comfort: Why should aspirin be avoided
Associated with Reye syndrome
78
Common Cold - Nursing Mx, Providing Fam Education: When are antibiotics used
When the child has a bacterial infection, so antibiotics should be reserved for approriate uses.
79
Common Cold - Nursing Mx, Providing Fam Education: Teach parents on how to recognize complication sof common cold which include
Prolonged fever
Increased throat pain
Increased cough
Earache
Skin Rash
80
Common Cold - Nursing Mx, Preventing Common Cold: How to prevent this?
Wash hands, and avoid crowded places
81
Sinusitis: What is this?
Bacterial infection of the paranasal sinuses.
82
Sinusitis: Where is the site of infection in young children, and after 10 years of age?
Young = Maxillary and Ethmoid sinuses
Older than 10 = Frontal Sinuses
83
Sinusitis: What contributes to bacterial invasion of nose?
Mucosal swelling, decreased ciliary movemenet, and thickened nasal discharge
84
Sinusitis: Complications of this?
Orbital cellulitis and intracranial infections such as subdural empyemas
85
Sinusitis: How long does acute versus chronic last?
```
Acute = < 30 days
Chronic = Longer than 4-6 Weeks
```
86
Sinusitis: How is this managed?
With antibiotic treatment , lasting 14 days
87
Sinusitis: What may be indicated for chronic sinusitis , espeically if recurrent or if nasal polyps present?
Surgical therapy
88
Sinusitis - Nursing Assessment: Most common presentation of this?
Persistent signs and symptoms of cold, but does not improve after 7-10 days.
89
Sinusitis - Nursing Assessment: Explore history for what?
Cough, Fever, Preschoolers
Facial Pain
Eyelid Edemaq
90
Sinusitis - Nursing Assessment: What should you note on physical exam?
Eyelid swelling, extend of nasal drainage, and halitosis (bad breath)
Inspect nose for postnasal drainage
Palpate sinuses
91
Sinusitis - Nursing Assessment: How is diagnosis made?
Based on history and clinical presentation
92
Sinusitis - Nursing Mx: What is recommended for children for tx?
Normal saline drops, cool mist humidifiers, and adequate oral fluid intake
93
Sinusitis - Nursing Mx: What should families be taught?
Importrance of continuing the ful course of antibiotics to eradicate the cause of infection
94
Sinusitis - Nursing Mx: Education family that what txs have not been proven to be successful?
Decongestatns, antihistamines and intranasal steroids
95
Sinusitis - Nursing Mx: What may promote drainage
Normal saline nose spray or nasal washes
96
Pharyngitis: What is this?
Inflammation of the throat mucosa (pharynx). May accompany nasal congestion
97
Pharyngitis: Bacterial sore throat often occurs without what
nasal symptoms
98
Pharyngitis: Complications of Group A Strep Infection?
Peritonsillar or retropharyngeal abscess
99
Pharyngitis: What may peritonsillar abscess be noted by?
Asymmetric swelling of the tonsils, shifting the uvula to one side
100
Pharyngitis: Retropharyngeal abscess may progress to what
point of airway obstruction,
101
Pharyngitis: Treatment with Viral pharyngitis?
Just symptomatic relief.
102
Pharyngitis: What treatment does Group A Streptococcal requie?
Antibiotic therapy, such as penicillin.
103
Pharyngitis: What test is done ehre?
Rapid diagnostic test or throat culture
104
Pharyngitis: Alternative antibiotics incldues what?
Amoxicillin
105
Pharyngitis - Nursing Assesment: History may incldue what?
Its abrupt. Includes fever, sore throat, and difficulty swallowing.
106
Pharyngitis - Nursing Assesment: Inspection may show what?
Inflammation, Exudate. Petechiae onpalate and tongue for strawberry appearance
107
Pharyngitis - Nursing Assesment: How will skin appear?
Will have a sand-paper like rash, partilarly on trunk or abdomen .
108
Pharyngitis - Nursing Mx, Promoting Comfort: What is done to promote comfort?
Saline gargles ,
Acetaminophen and Ibuprogen may ease fever
Throaot lozenges may ease pain
Col mist humidity keps mucosa moist
109
Pharyngitis - Nursing Mx, Providing Fam Education: What to teach parents if this is viral?
Antibitoics are not necessary and will treat itself
110
Pharyngitis - Nursing Mx, Providing Fam Education: What to teach parents for child with streptococcal pharyngitis?
Have child complete entire prescribed course of antibiotics. Throw thoothbrush away
111
Tonsillitis: What is this?
Inflammation of the tonsils that occurs with pharyngitis and may be viral or bacterial
112
Tonsillitis: Treatment for viral infection?
Symptomati treatment
113
Tonsillitis: Treatment for bacterial tonsillitis?
Same as for bacterial pharyngitis.
114
Tonsillitis: When would tonsillectomy be indicated?
May be indicated for for child with recurrent stretococcal tonsillitis or tonsilalr hypertrophy
115
Tonsillitis: What happens when hypotrophied adenoids obstruct breathing?
Adenoidectomy (surgical removal of adenoids) may be indicated
116
Tonsillitis - Nursing Assessment: What to do about fever?
Assess whether it is current or by history
117
Tonsillitis - Nursing Assessment: What history should you inquire about?
History of recurrent pharyngitis or tonsillitis
118
Tonsillitis - Nursing Assessment: What should you note about tonsils and pharynx?
Note for redness and enlarge. If enlarged, may expereince difficulty breathing and swallowing.
119
Tonsillitis - Nursing Mx - Promoting Airway Clearance: What position should they be palced in?
Side-lying or prone position to facilitate safe drainage if not awake. Suction if necessary but careful to avoid trauma
120
Tonsillitis - Nursing Mx - Maintaining Fluid Volume: When can Hemorrhage occur?
Anywhere from immediate postop period to 10 days after surgery.
121
Tonsillitis - Nursing Mx - Maintaining Fluid Volume: Early bleeding may be identified byby?
Continuous swallowing of small amounts of blood while awak or sleeping. May produce tachycardia, pallor, or restlessness.
122
Tonsillitis - Nursing Mx - Maintaining Fluid Volume: How to avoid trauma to surgical site?
Discourage child from coughing, clearing throat, or blowing nose.
123
Tonsillitis - Nursing Mx - Maintaining Fluid Volume: How to maintain fluid volume?
Take any fluids they desire. While avoiding citrus juice and brown/red fluids
124
Tonsillitis - Nursing Mx - Relieving Pain: What may be prescribed after surgery?
Ice collar, as well as analgesics with or without narcotics.
125
Infectious Mononucleosis: What is this?
Self-limited illness caused by Epstein - Barr Virus. Characterized by fever, malaise, sore throat, and lymphadenopathy
126
Infectious Mononucleosis: What is this commonly called
The kissing disease, since its transmited byy oropharyngeal secretions.
127
Infectious Mononucleosis: Complictions of this?
Splenic rupture, Gullian-Barre Syndrome, and Aseptic Meningitis
128
Infectious Mononucleosis - Nursing Assessment: What should you assess?
History of exposure. Determine history of fever and onset and progression of sore throat. Observe for periorbial edema.
129
Infectious Mononucleosis - Nursing Assessment: Inspect pharynx and tonsils for what
Inflammation and patches of gray exudate.
130
Infectious Mononucleosis - Nursing Assessment: What happens 3-5 days of illness?
Pharynx becomes more edematous and the tonsillar exudate is more extensive.
131
Infectious Mononucleosis - Nursing Assessment: Definitive diagnosis made how?
By Monospot or Spstein-Barr Virus Titers
132
Infectious Mononucleosis - Nursing Mx: Nursing management is primarily what?
Symptomatic
133
Infectious Mononucleosis - Nursing Mx: What to do if sore throat present?
Use Analgesics and Salt-Water Gargles.
134
Infectious Mononucleosis - Nursing Mx: What to know about rest?
Bed rest if febrile
Rest periods may be necessary for several weeks after illness.
135
Infectious Mononucleosis - Nursing Mx: In acute phase, what to do if tonsillar or pharyngeal edema threatens to obstruct airway?
Corticosteroids given to decrease inflammation.
136
Laryngitis: what is Laryngitis?
Inflammation of the laryn. May occur alone or in conjunction with other respiraotry symtpoms. Characterized by hoarse voice or loss of voice.
137
Laryngitis: Treatment?
Oral fluids may offer relief, but rest the voice for 24 hours to allow inflmmation to subside
138
Croup: What is this?
Is Larynotracheobronchitis because inflammation and edema of the larynx, trachea, and bronchi occur as a result of viral infection.
139
Croup: What is primarily responsible for this?
Parainfluenza is responsible for this. Adenovrisu. Influenza , and RSV also affect this.
140
Croup: Narrowing of subglottic area of treachea results in what
audible inspiratory stridor
141
Croup: Edema of larynx causes what
hoarseness
142
Croup: Inflammation of larynx and trachea causes
Characteristic barking cough of croup
143
Croup: When do symptoms occur?
At night, presenting sudenly with resolution in morning.
144
Croup: How long does this last
3-5 days
145
Croup: Complications of this?
Respiratory distress, Hypoxia, Or Bacterial Superinfection.
146
Croup: What is used for treatment?
Corticosteroids (single dose) used to decrease inflammation, and racemic epinephrine aersols help decrease edema
147
Croup: Children may be hospitialized when?
If they have significant stridor at rest or severe retractions
148
Croup - Nursing Assessment: Waht age will presnt with viral croup?
Between 3 months and 3 years
149
Croup - Nursing Assessment: What may history reveal?
Cough that developed during night, and that sounds like barking. .
150
Croup - Nursing Assessment: Diagnosed how?
based on history and clinical presentaiton, but lacteral neck x-ray may be obtained to rule out epiglottis
151
Croup - Nursing Assessment: Bacterial tracheitis signs?
Fever, toxic appearance, and increased respiraotry distress
152
Croup - Nursing Mx: Instruct parents about what if child care being managed at home
Symptoms of respiratory distress and to seek treatemnt if respiratory condition worsens.
Teach to expose to humdified air
153
Croup - Nursing Mx: What to teach about racemic epinephrine?
Lasts 2 hours and child must be observed because child will occasionally worsen again, requiring another aerosol
154
Epiglottis: What is this?
Inflammation and swelling of the epiglottis, often caused by Haemophilus Influenzae Type B.
155
Epiglottis: What has resulted in decreased incidence of this?
Extensive use of Hib vaccine.
156
Epiglottis: Common age for this?
Children between 2-7 years
157
Epiglottis: What can occur if airway becomes completely occluded?
Respiratory arrest and death.
158
Epiglottis: Complciations fo this?
Pneumothorax and pulmonary edema.
159
Epiglottis: Theraptuc management?
Airway maintenance and support. , with IV antibiotic therapy necessary. Will be in ICU
160
Epiglottis - Nursing Assessment: What should you note?
Sudden onset of symptoms and high fever. Has overall toxic appearance. May sit forward with neck extended. Cough absent.
161
Epiglottis - Nursing Assessment: What test may be performed?
Lateral Neck X-Ray to determine whether epiglottis present.
162
Epiglottis - Nursing Assessment: Why should you not attempt to visualzie the throat?
Reflex laryngospasm may occur, precipitaitng airway occlusion
163
Epiglottis - Nursing Mx: What should you not do?
LEave child unattended. Do not place in supine position
164
Epiglottis - Nursing Mx: What must be done if child experiences complete airway occlusion?
Emergency tracheostomy may be necessary
165
Epiglottis - Nursing Mx: What is this characterized by?
Dysphagia, drooling, anxiety, irritability, and significant respiratory distress
166
Bronchiolitis: What is this?
Acute inflamamtory process of the bronchioles and small bronchi
167
Bronchiolitis: Nearly always caused by waht
viral pathogen, with RSV accounting for majority of bronchiolitis.
168
Bronchiolitis: When does this occur?
During the winter and spring. , often occuring in infants and toddelrs
169
Bronchiolitis - Patho: How is this gotten?
Through direct contact with respiratory secretions or from particles on objects contaminated with the virus.
170
Bronchiolitis - Patho: What does RSV invade?
The nasopharynx, where ir replicates and tehn spreads down to the lwoer airway via aspiration.
171
Bronchiolitis - Patho: What does RSV infection cause to happen to body
necrosis of repsiraotry epithelium. Small airway becomes obstructed. Prevents full expiration leading to hyperinflationa nd atelectasis.
172
Bronchiolitis - Therapeutic Mx: Management of RSV focuses on?
Supportive tx. Supplemental oxygen, nasal suctioing, and inhaled bronchodilator therapy.
173
Bronchiolitis - Therapeutic Mx: Infants with what warrants hospital admision
Tachypnea, significant retractions, poor oral intake, and lethargy
174
Bronchiolitis - Nursing Assessment, Health Hx: Common signs and symptoms reported include?
Onset of illness, pharyngitis, low-grade fever, and development of cough 1-3 days into illness
175
Bronchiolitis - Nursing Assessment, Health Hx: Explore childs current and past medical hx for risk factors including?
Young age (< 2)
Prematurity
Multiple births
Birth during april to september
History of chronic lung disease
176
Bronchiolitis - Nursing Assessment, Physical ExAM, iNSPECTION: What will you observe?
CHilds general appearance and dcolor. May appear air-hungry and show various degrees of cyanosis, respiratory distress including tachypnea and periods of apnea
177
Bronchiolitis - Nursing Assessment, Physical ExAM, Auscultation: What may be heard earlier in illness and later on?
Earlier = Wheezes might be scattered
Serious = Chest might sound quiet and wihout wheeze
178
Bronchiolitis - Nursing Assessment, Labs: Common labs inlcude?
Pulse Ox, Chest X-Ray, Blood Gases, And Nasal-Pharyngela Washings
179
Bronchiolitis - Nursing Mx: Interventiosn are aimed toward what?
Supporitve care.
180
Bronchiolitis - Nursing Mx: Children with less severe disease might require what
antipyretics, adequate hydration and close observation
181
Bronchiolitis - Nursing Mx: What drug recommended for highest-risk , most severely ill children?
Aerosolized Ribavirin
182
Bronchiolitis - Nursing Mx, Maintaining Patent Airway: How should they be positioned?
Head of bed elevated for open airway.. They have copious secretions.
183
Bronchiolitis - Nursing Mx, Maintaining Patent Airway: What is used to sunction their mouth?
Yankauer or tonsil-tip suction catheter.
184
Bronchiolitis - Nursing Mx, Promoting Adequate Gas Exchange: Assessment should include work of?
breathing, respiratory rate, and oxygen saturation,
185
Bronchiolitis - Nursing Mx, Reducing RF Infection: What precautions should be taken?
Isolate inpatients, since it spreads through droplets.
186
Bronchiolitis - Nursing Mx, Providing Fam Education: Education should be what?
Recognizing signs of worsening distress. Tell parents to call doctor if breathign becomes rapid.
187
Bronchiolitis - Nursing Mx, Providing Fam Education: Teach that cough can lasts for how long?
Several days to weeks after resolution of disease
188
Bronchiolitis - Nursing Mx, Preventing REspiratory Syncytial Virus Disease: What can prevent this?
Palivizumab (Synagis), which is a monoclonal anitbody. Given once a month
189
Pneumonia: What is this?
Inflamamtion of lung parenchyma. Caused by virus, bacteria, or fungus.
190
Pneumonia: Most common cause of this in younger children?
Respiratory viruses.
191
Pneumonia: Most common cause of bacterial pneumonia in all ages of children and most common causative agent in school-age children?
Strep. Pneumoniae
M. Pneumoniae
192
Pneumonia: Why may aspiration pneumonia occur?
From aspiration of foreign material into lower respiratory tract
193
Pneumonia: Chidlren with this reoccuring should be evaluated for?
Chornic lung disease such as asthma or cystic fibrosis.
194
Pneumonia: Potential complications include?
Bacteremia, pleural effusion, empyema, lung abscess and pneumothorax
195
Pneumonia: Excluding bacteremia, complciations often treated how
with thoracentesis and chest tubes
196
Pneumonia: Therapeutic mx of children with less severe disease includes?
Antipyretics, adequate hydrationa dn close observation.
197
Pneumonia: What children may require hospitilization?
Child with tachypnea, significant retractions, poor oral intake, or lethargy
198
Pneumonia - Nursing Assessment, Health Hx: Common S and S include?
Viral URI
Fever
Cough
Increased RR
History of Lethargy
Chills
199
Pneumonia - Nursing Assessment, Health Hx: Risk factors for this include?
Prematurity
Malnutrition
Passive smoke exposure
Low socioeconommic status
200
Pneumonia - Nursing Assessment, Physical Exam: How will their breathing be?
May exhibit substernal, subcostal, or intercostal retractions. Tachypnea and nasal flaring may be present
201
Pneumonia - Nursing Assessment, Physical Exam: Auscultation may reveal what?
Wheezes or rales in younger child.
202
Pneumonia - Nursing Assessment, Physical Exam: Percussion may yield what?
Local dullness over a consolidated area.
203
Pneumonia - Nursing Assessment, Lab Tests: Lab tests performed?
Pulse Ox
Chest X-Ray
Sputum Culture
WBC Count
204
Pneumonia - Nursing Mx, Providing Supportive Care: How to thin secretions?
Ensure adequate hydration and assit in thinning the secretions.
205
Pneumonia - Nursing Mx, Providing Family Education: What to teach family about antibiotics?
Adhere to prescribed antibiotic regimen.
206
Pneumonia - Nursing Mx, Providing Family Education: How can antibioitcs be given?
Iv if hospitalized, or oral if on outpatietn basis
207
Pneumonia - Nursing Mx, Providing Family Education: What to teach parents about bacterial pneumonia?
That for 1-2 weeks, they will tire easily, and infant might continue to need small feedings.
208
Pneumonia - Nursing Mx, Providing Family Education: What to teach about viral pneumonia?
Might not understand their parents dont need antibioitc. May experience a week ro two of weakness or fatigue.
209
Pneumonia - Nursing Mx, Preventing Pneumococcal Infection: Children at high riskf or this should be given what?
Should be immunizaed against it.
210
Bronchitis: What is this?
Inflammation of the trachea and major bronchi. Associated with URI
211
Bronchitis: Bronchitis is usually gotten how?
Virally
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Bronchitis: Recovery occurs in what time frame?
Within 5-10 days.
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Bronchitis: therapeutic management involves?
Mainly supporitve care.
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Bronchitis: What is important for treatment?
Expectorant administrationa dn adequate hydration.
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Bronchitis - Nursing Assessment: Illness might begin with what?
With mild URI. Fever develops, followed by dry, hacking cough that might become productive in older children.
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Bronchitis - Nursing Assessment: Ausculation may reveal what?
Might reveal coarse rales.
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Bronchitis - Nursing Mx: What should parents be taught?
Expectorants will help loosen secretions and antipyretics will help reduce the fever, making child comfortable.
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Epistaxis: What is this?
Nosebleed, occuring from the anterior portion of the sputum
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Epistaxis - Nursing Assessment: Explore childs history for what?
Initiating factors such as local inflammation, mucosal drying, or local traumaq
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Epistaxis - Nursing Management: How should child be positioned?
Should sit up and lead forward. Apply conitnuous pressure to the anterior portion of the nose by pinching it closed.
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Epistaxis - Nursing Management: Bleeding stops when
Within 10-15 minutes.
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Foreign Body Aspiration: What is this?
Occurs when any solid or liquid substance is inhaled into the respiratory tract.
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Foreign Body Aspiration: Items smaller than what size can be aspirated easily?
1.25 in
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Foreign Body Aspiration: Occurs most frequently in what age?
Between 6 months to 4 years
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Foreign Body Aspiration: What happens if foreign body reaches bronchus?
May need to be surgically removed via bronchoscopy
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Foreign Body Aspiration - Nursing Assessment: Infant or young child may present with history of ?
sudden onset of cough, wheeze, or stridor
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Foreign Body Aspiration - Nursing Assessment: Stridor suggets what
That foreign body is lodged in the upper airway.
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Foreign Body Aspiration - Nursing Mx: Most important nursing intervention?
Prevention. Tell parents to avoid letting their children play with toys with small parts
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Allergic Rhinitis: What is perennial allergic rhinitis?
Occurs year-round and is associated with indoor environments. This includes dust mites, pet dander
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Allergic Rhinitis: What is season allergic rhinitis?
Typically caused by pollens, trees, weeds, , fungi.
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Allergic Rhinitis: Complications from this?
Exacerbation of asthm symptoms, recurrent sinusitis, and otitis media
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Allergic Rhinitis - Patho: What immunoglobin causes this?
IgE
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Allergic Rhinitis - Patho: How is IgE activated?
In response to contact with airborne allergic protein. Releases chemical mediators of histamine. Results in acute tissue edema and mucus production.
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Allergic Rhinitis - Patho: Histamine and other factors cause what?
Nasal vasodilation, watery rhinorrhea (runny nose) and nasal congestion
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Allergic Rhinitis - Nursing Assessment, Health Hx: Common signs of this?
Mild chronic nasal stuffiness
Thin, runny nasal discharge
Sneezing
Itching of nose, eyes, palate
Mouth breathing
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Allergic Rhinitis - Nursing Assessment, Health Hx: Explore history for presence of risk factors including?
Family history of atopic disease
Known allergy to dust mites
Early childhood exposure to indoor allergens
Exposure to tobacco smoke
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Allergic Rhinitis - Nursing Assessment, Physical Exam, Inspection/Observation: What will you observe for?
Red-rimmed eyes or tearing, mild eyelid edema, allergic shiners (bluish cast beneath eyes) and allergic salute
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Allergic Rhinitis - Nursing Assessment, Physical Exam, Auscultation: How do lungs usually sound?
Has exacerbation with wheezing often occuring with alergic rhinitis
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Allergic Rhinitis - Nursing Assessment, Physical Exam, Labs: Common labs?
Nasal smear (+ for eosinophilia), positive allergy skin test, and positive radioallergoserbent test (RAST)
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Allergic Rhinitis - Nursing Mx, Maintaining Patent Airway: How to prevent mucus from becoming thickened?
Nasal washes with normal saline.
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Allergic Rhinitis - Nursing Mx, Maintaining Patent Airway: What can anti-inflammatory (corticosteroid) nasal sprays do?
Decrease the inflammatory response to allergens.
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Allergic Rhinitis - Nursing Mx, Maintaining Patent Airway: What may a mast cell stabilizing nasal spray do?
May decrease the intensity and frequency of allergic responses
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Allergic Rhinitis - Nursing Mx, Providing Family education: Most important way to treat this?
Learning to avoid known allergens
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Asthma: What is this?
Chronic inflammatory airway disorder characterized by airway hyperresponsiveness, airway edema, and mucus production
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Asthma: How doe sseverity range?
FRom symptoms associated only with vigorous acticity (exercise induced) to daily symptoms that interfere with quality of life
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Asthma: Intermittent symptoms?
1-2 times a week, Nighttime symptoms 1-2x per month
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Asthma: Mild Persistent Symptoms?
Symptoms more than twice a week, but less than once a day
Nighttime symptoms 3-4x a month
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Asthma: Moderate persistent symptoms?
Daily symptoms
Nighttimem symptoms > 1 time a week
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Asthma: Severe persistent symptoms?
Throughout the day, nighttime symptoms often 7x per week
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Asthma: Acute complications?
Status asthmaticus and respiratory failure
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Asthma Patho: How does this processs begin?
Mast cells, T Lympho, Macrophages, and Epithelial cells involves in release of inflammatory mediators. Eosinophils and neutrophils migrate and cause injury.
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Asthma Patho: Why does airway remodeling occur?
As a result of chronic inflammation of the airway. Influx to airway continues resulting in changes that are irreversible.
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Asthma Patho: Irreversible changes causes what to happen?
Thickening of sub-basement membrane, subepithelial fibrosis, airway smooth muscle and blood vessels proliferation.
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Asthma Therapeutic Mx: Current goals of medical therapy include?
Avoidance of asthma triggers and reduction or control of inflammatory episdoes.
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Asthma Therapeutic Mx: Stepwise appraoch to asthma treatment?
Increasing medications as child's condition worsens, then backing off treatment as theyimprove
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Asthma Therapeutic Mx: Why may short-acting bronchodilators be used?
In acute treatment of bronchoconstriction and long-acting may be used to prevent bronchospasm.
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Asthma Therapeutic Mx: How can children avoid exercise-induced bronchospasm?
By using a longer warm-up period prior to vigorous exercise and inhalaing a short-acting bronchodilator
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Asthma Therapeutic Mx: Long term prevention usually involves?
Inhaled steroids.
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Asthma Nursing Assessment, Health Hx: Common sign and symptoms?
Cough, particularly at night.
Difficulty breathing,: SOB, chest tightness or pain
Wheezing
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Asthma Nursing Assessment, Health Hx: Risk factors include?
Hx of allergic rhinitis
Family history of atopy
Known allergies
Seasonal response to pollen
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Asthma Nursing Assessment, Physical Exam, Inspection: How can color change?
Cyanosis might result.
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Asthma Nursing Assessment, Physical Exam, Inspection: Children with persistent sever asthma may have what appearance on chest?
Barrel chest and routinely demonstrate midly increased work of breathing
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Asthma Nursing Assessment, Physical Exam, Auscultation/Percussion: Wheezing is a hallmark sign of what?
Airway obstruction.
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Asthma Nursing Assessment, Lab Tests: Which ones are done?
Pulse OX
Chest X-Ray
Blood Gases (CO2 Retention)
Pulmonary Function Tests
Peak Expiratory Flow Rate
Allergy Testing
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Asthma Nursing Mx, Educating Pt and Family: Educate family on appropriate use of what?
Nebulizers, metered-dose inhalers, spacers, dry-powder inhalers and Diskus
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Asthma Nursing Mx, Educating Pt and Family: For those with more severe asthma, PEFR is recommended to determine daily control. what is this?
Measurement sobtained via a home peak flow meter and can be very helpful as long as the meter is used appropriately.
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Asthma Nursing Mx, Educating Pt and Family: Young children with asthma receivign inhaled medications via a nebulizer should use what mask
A snugly fitting mask to ensure accurate deposition of medication to the lungs
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Asthma Nursing Mx, Educating Pt and Family: Education about asthma should include what?
Patho, asthma triggers, and prevention and treatment strategies.
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Asthma Nursing Mx, Promoting Child's Self-Esteem: How can we improve this?
Through education and support. Child needs to learn to master their disease.
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Cystic Fibrosis: What is this?
Autosomal recessive disorder. Complications include hemoptysis, pneumothorax, bacterial colonization, cor pulmonale and intestinal obstruction
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Cystic Fibrosis - Patho: What mutation occurs here?
CFTR mutation, resulting in generalized dysfunction of the exocrine glands.
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Cystic Fibrosis - Patho: What happens to epithelial cells?
Fail to conduct chloride and water transport abnormalities occur. Results in thickened , tenacious secretions ins weat glands.
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Cystic Fibrosis - Patho: What probolems does this viscious mucus cause on other organs?
Pancreas, intrahepatic bile ducts, gallbladder and submaxillary glands become obstruction.
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Cystic Fibrosis - Patho: What happens to pancreatic activity?
Enzyme actiity is lost and malabsorption of fats, proteins, and carbohydrates occurs, resulting in poor growth.
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Cystic Fibrosis - Patho: What happens with excess mucus produced by the tracheobronchial glands?
Abnormally thick mucus plugs the small ariway , and then chonchiolitis and further plugging of airway occurs.
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Cystic Fibrosis - Patho: The risk for secondary bacterial infection leads to what risks?
Obsturction and inflammation, leading to chronic infection, tissue damage, and respiratory failue.
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Cystic Fibrosis - Patho: What can this specifically cause to boys?
Blocks vas deferens, making them infertile
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Cystic Fibrosis - Patho: What specifically happens to girls?
Thick cervical secreions limit penetraiton of sperm
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Cystic Fibrosis - Therapeutic Mx: This is aimed toward what
| ?
Minimizing pulmonary complications, maximizing lung function, preventing infection and facilitating growth
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Cystic Fibrosis - Therapeutic Mx: Child with this require what therapy?
Chest physiotherapy and postural drainage several times a day to mobilize secretions.
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Cystic Fibrosis - Therapeutic Mx: What is given daily using a nebulizer?
Recombinant Human DNase (Pulmozyme) to decrease sputum viscosity and help clear secretions
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Cystic Fibrosis - Therapeutic Mx: What is prescribed to promtoe adequate digestion?
Pancreatic enzymes and supplemental fat-soluble vitamins. `
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Cystic Fibrosis -Nursing Assess, Health Hx: Common signs of this include?
Salty taste to childs skin
Difficulty passing meconium stool
Abdominal pain or difficulty passing stool
Bulky, greasy stools
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Cystic Fibrosis -Nursing Assess, Health Hx: Health Hx should have questiosn related to what?
Respiratory status
Appetite/WEight Gain
Activity Tolerance
Increased need for pulmonary meds
Presence of bone pain
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Cystic Fibrosis -Nursing Assess, Health Hx, Physical Exam - Inspection: What do you note about respiratory?
RR, Work of breathing, use of accessory muscles, position of comfort, frequency adn severity of cough.
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Cystic Fibrosis -Nursing Assess, Health Hx, Physical Exam - Auscultation: May reveal what?
Adventitious breath sounds. Fine or coarse crackles and scattered wheezing. If advanced, breth sounds diminished
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Cystic Fibrosis -Nursing Assess, Health Hx, Physical Exam - Percussion: What does this normally yield?
Hyperresonance due to air trapping.
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Cystic Fibrosis -Nursing Assess, Health Hx, Physical Exam - Palpation: This yields what?
Asymmetric chest excursion if atelectasis is present. Tactile fremitus may be decreased
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Cystic Fibrosis -Nursing Assess, Labs: ;what tests can be done?
Sweat Chloride Test (>60)
Pulse Ox
Chest X Ray
Pulmonary Function TEsts
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Cystic Fibrosis -Nursing Mx, Maintaining PAtent Airway: What therapy is often done?
Chest physiotherapy.
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Cystic Fibrosis -Nursing Mx, Maintaining PAtent Airway: What may be done for older children or adolescents?
FLutter-valve decice, positive expiratory pressure therapy, or a high-frequency chest compression vest
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Cystic Fibrosis -Nursing Mx, Maintaining PAtent Airway: What does flutter valve device do?
Provides high-frequency oscillation to airway as child exhales into mouthpiece that contains a steel ball
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Cystic Fibrosis -Nursing Mx, Maintaining PAtent Airway: What is positive expiratory pressure therapy?
Exhaling through a flow resistor, which creates positive expiratory pressure.
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Cystic Fibrosis -Nursing Mx, Maintaining Growth: What nutrient is given?
Pancreatic enzyme supplements given with meals to promote digestion of nutrients.
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Cystic Fibrosis -Nursing Mx, Maintaining Growth: Dose of pancrelipase adjusted until when?
Stools is consistent at one or two a day
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Cystic Fibrosis -Nursing Mx, Promoting Family Coping: What is Ivacaftor?
Resultins in thinning of lung mucous, resulting in easier airway clearance via coughing. First drug to act directly on defective gene
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Cystic Fibrosis -Nursing Mx, Promoting Family Coping: What is being used with children to help extend life expectancy?
Lung transplantation.
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Cystic Fibrosis -Nursing Mx, Promoting Family Coping: Who carries this gene?
All children of parents withcystic fibrosis
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Apnea: What is this?
Absence of rbeathing for longer than 20 seconds, and may be accompanied by bradycaria.
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Apnea: Sometimes Apnea presents in form of an Acute Life-Threatening Event (ALTE), event that does what?
Child exhibits some combination of apnea, color change, muscle tone alteration, coughing or gagging.
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Apnea: Apnea in newborn may be associated with what?
hypothermmia, hypoglycemia, infection, or hyperbilirubinemia
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Apnea: In event of apnea, what may help infant take a breath?
Stimulation.
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Apnea: What is sometimes administered in premature infants to sitmulate respirations?
Caffeine or theophylline
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Apnea - Nursing Assessment: Questions to ask parents?
Did infant experience color change? Did the infant self-stimulate? Assess RF for apnea.
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Apnea - Nursing Mx: What must be done to help infant breathe?
Gently sitmulate them to take a breath again. If unsuccessful, resue breahting or bag valve mask must be started.
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Apnea - Nursing Mx: How to avoid apnea in newborn?
Maintain a neutral theraml environemnt. Avoid excessive vagial sitmulation.
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Apnea - Nursing Mx: Infants with recurrent apnea or ALTE may be dischaged on a what
home apnea monitor. Discontinued after 3 months of no significant event of apnea.
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Tracheostomy: what is this?
Artifical opening in the airway. Performed to relieve airway obstruction.
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Tracheostomy: This facilitates what?
Secretion removal, reduces work of breathing, and increases childs comfort.
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Tracheostomy: What to knwo for silastic tracheostomy?
Tube are soft and flexible. Available with a single lumen or may have a nouter and inner lumen.
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Tracheostomy: What tube used more often in pediatric population?
Uncuffed tubes
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Tracheostomy: COmplications after surgery include?
Hemorrhage, air entry, pulmonary edema, and respiratory arrest.
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Tracheostomy: Complications of chronic tracheostomy include?
Infection , cellulitis and fomration of graulation tissue
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Tracheostomy - Nursing Assess: What to do when getting history?
Note reason for tracheostomy, as well as size/type. Inspect site. .Should be pink without bleeding or drainage.
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Tracheostomy - Nursing Assess: How should tube appear when checking?
Clean and free from secretions. One finger should fit under ties.
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Tracheostomy - Nursing Assess: Wht must be done when caring for an infant or child with a tracheostomy?
Respiratory assessment is necessary.
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Tracheostomy - Nursing Mx: What may need to be done in the immediate postoperative period of the infant?
They may require restraints to avoid accidental dislodgment of tracheostomy tube.
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Tracheostomy - Nursing Mx: What happens since there is no humidifcatio?
Mucuous plug can occur resulting in hypoxia.
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Tracheostomy - Nursing Mx: What must be done for suctioning?
Place sign at head of bed indicating suction catheter size and length.
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Tracheostomy - Nursing Mx: Many pediatric tracheostomy tubes do not have inner cannula, meanin gwhat
periodic removal and replacement of chronic tracheostomy is required. Clean with half-strength hydrogen peroxide. Rinse with distilled water and allow to dry
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Tracheostomy - Nursing Mx: Tracheostomy care performed how often
Every 8 hours
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A 5-month-old infant with RSV bronchiolitis is in respiratory distress. The baby has copious secretions, increased work of breathing, cyanosis, and a respiratory rate of 78. What is the most appropriate initial nursing intervention?
Attempt to calm the infant by placing him in his mother’s lap and offering him a bottle.
Alert the physician or nurse practitioner to the situation and ask for an order for a stat chest x-ray.
Suction secretions, provide 100% oxygen via mask, and anticipate respiratory failure.
Bring the emergency equipment to the room and begin bag-valve-mask ventilation.
Suction secretions, provide 100% oxygen via mask, and anticipate respiratory failure.
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A toddler has moderate respiratory distress, is mildly cyanotic, and has increased work of breathing, with a respiratory rate of 40. What is the priority nursing intervention?
Airway maintenance and 100% oxygen by mask
100% oxygen and pulse oximetry monitoring
Airway maintenance and continued reassessment
100% oxygen and provision of comfort
Airway maintenance and 100% oxygen by mask
324
The nurse is caring for a child with cystic fibrosis who receives pancreatic enzymes. Which statement by the child’s mother indicates an understanding of how to administer the supplemental enzymes?
“I will stop the enzymes if my child is receiving antibiotics.”
“I will decrease the dose by half if my child is having frequent, bulky stools.”
“Between meals is the best time for me to give the enzymes.”
“The enzymes should be given at the beginning of each meal and snack.”
“The enzymes should be given at the beginning of each meal and snack.”
325
Which of these factors contributes to infants’ and children’s increased risk for upper airway obstruction as compared with adults?
Underdeveloped cricoid cartilage and narrow nasal passages
Small tonsils and narrow nasal passages
Cylinder-shaped larynx and underdeveloped sinuses
Underdeveloped cricoid cartilage and smaller tongue
Underdeveloped cricoid cartilage and narrow nasal passages
326
Which is the most appropriate treatment for epistaxis?
With the child lying down and breathing through the mouth, apply pressure to the bridge of the nose.
With the child lying down and breathing through the mouth, pinch the lower third of the nose closed.
With the child sitting up and leaning forward, apply pressure to the bridge of the nose.
With the child sitting up and leaning forward, pinch the lower third of the nose closed.
With the child sitting up and leaning forward, pinch the lower third of the nose closed.
