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Peds Exam 1 > Oxygenation > Flashcards

Oxygenation Flashcards

(55 cards)

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1
Q

Difference between Children and Adult airway

A

children: funnel, smaller and less developed
adult: cylinder

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2
Q

General Physiological Differences Children and Adults

A
  • smaller and shorter airway
  • larger tongue
  • nose breathers
  • belly/diaphragm breathers
  • increased rate and effort
  • retractions
  • vagal nerve
  • eustation tube
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3
Q

Accessory Muscle Use in Children

A

-use of accessory muscles may present as head bobbing in young children

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4
Q

Retractions

A
  • infants and young children have immature chest muscles and cartilagious ribs making the chest wall very flexible
  • negative pressure created by the downward movement of the diaphragm is increased in cases of respiratory distress, and the chest wall is pulled inward causing retractions
  • intercostal retractions are seen in mild respiratory distress
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5
Q

As respiratory distress severity increases…

A

substernal and subcostal retractions are seen

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6
Q

in cases of severe distress…

A

supraclavicular and suprasternal retractions occur as the accessory muscles are used

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7
Q

Normal bpm for infant

A

less than a yr

30-60

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8
Q

Normal bpm for toddler

A

1-3 yrs

24-40

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9
Q

Normal bpm for preschooler

A

4-5 yrs

22-34

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10
Q

Normal bpm for school age

A

6-12 yrs

18-30

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11
Q

Normal bpm for adolescent

A

13-18 yrs

12-16

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12
Q

Oxygenation Assessment Guidelines

A
  • position of comfort (tripod, sitting up, refuse to lay down)
  • vital signs
  • respiratory effort (apnea, decreased RR, retractions)
  • lung auscultation (crackles, wheezing)
  • color (late sign)
  • cough (cough up and swallow is bad)
  • behavior change
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13
Q

Respiratory Distress

A
  • any respiratory condition can progress to respiratory distress
  • if not managed can lead to respiratory failure
  • hypoxemia that persists when supplemental oxygen is given is a sign of respiratory failure
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14
Q

General Care Standards

A
  • Oxygen/O2 sats (greater or equal to 93 percent is ok)
  • CPT/PD and suction (only with mucus, can cause irritation which means more secretions)
  • IS (if 5 or over)
  • saline nose drops (loosens secretions)
  • antibiotics (only for bacterial infections)
  • isolation
  • rest (but let them play, means feeling better)
  • reduce fever (no ibuprofen under 6 mths)
  • hydration
  • nutrition
  • cough medications

-positioning (HOB elevated)

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15
Q

Categorization of Respiratory Tract Infections

A
  • Upper Respiratory Tract
  • Croup Syndromes
  • Lower Respiratory Tract
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16
Q

tonsilitis

A
  • mostly viral infection
  • group A beta hemolytic strep (strep throat)
  • change toothbrush
  • AB 24-48 hrs

**tonsillectomy: bleeding precaution, look for frequent swallowing

  • inspect back of throat
  • no red drinks or foods
  • avoid coughing
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17
Q

Otitis Media

A
  • immobile
  • red or yellow bulding TM
  • symptoms: otalgia, fever, otorrhea, crying, fussy, tendency to pull or rub ear, rolls head from side to side
  • Eustachian tube is flat and can’t drain fluid
  • tx with AB
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18
Q

Therapeutic management of otitis media

A
  • high dose amoxicillin
  • myringotomy: Tympanoplasty/PE tubes
  • pressure equalizing tubes used to put eat drops in ear
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19
Q

Croup Syndromes

A

general term for a group of symptoms characterized by:

  • “barking/brassy” or “seal-like” cough
  • inspiratory stridor, at rest equals bad, with activity equals ok if better at rest
  • respiratory distress
  • swelling/obstruction in the region of the larynx
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20
Q

Croup Syndromes includes…

A
  • laryngotracheobronchitis: subglottic

- epiglottitis: supraglottic

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21
Q

Laryngotracheobronchitis

A

-obstruction (SUBglottic) BELOW VOCAL CORDS

-slower onset, URI symptoms lead to cough and hoarseness
(viral)

  • medical management (steeple sign)
  • airway narrows at top

-nursing management: teaching

  • supportive mainly
  • hydration
  • IVF
  • O2

-Epinephrine…vasoconstriction will reduce edema and decrease inflammation

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22
Q

Epiglottitis

A
  • obstruction (SUPRAglottic)
  • cherry red edematous epiglottis
  • usually caused by Haemophilus influenzae (H.Flu) (bacteria)
  • HIB vaccine
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23
Q

Clinical Manifestations of Epiglottitis

Study These Flashcards
A
  • dyspnea
  • dysphonia
  • stridor aggravated when supine
  • drooling
  • high fever
  • toxic appearance
  • froglike croaking sound
  • agitated/apprehensive
  • tripod sitting

-safety alert: can develop quickly (6 hrs) have intubation ready

24
Q

At risk for epiglottitis

Study These Flashcards
A
  • 2 to 8 year olds
  • teaching: vaccination (HIB vaccine)
  • tx: AB 12-24 hr for improvement
  • O2 if needed, limit activity, hydration
25
Respiratory Syncytial Virus/ Bronchiolitis
-inflammation and obstruction of bronchioles
26
Who is at highest risk for Respiratory Syncytial Virus/ Bronchiolitis
- under 2 years - chronic lung disease - congenital heart disease - preterm, less than 35 wks
27
Clinical Manifestations of Respiratory Syncytial Virus/ Bronchiolitis
- rhinorrhea - increased cough and wheezing - tachypnea - unstable O2 sats - full of snot, rhonchi and wheezing *Begins as URI
28
Diagnosis of Respiratory Syncytial Virus/ Bronchiolitis
- Rhinorrhea - increasing respiratory distress - chest x-ray * ****positive RSV swab of nasopharyngeal seretions -can cause pneumonia
29
Treatment of Respiratory Syncytial Virus/ Bronchiolitis
-ribavirin aerosol (controversial) - RSV immunoglobulin (Synagis) *prevention not treatment * can't use AB * only for high risk (PT, lung dz, less than 2) -given every 28-30days
30
Pulmonary Dysfunctions not caused by infectious agents
- foreign body aspiration - asthma - cystic fibrosis
31
Foreign Body Aspiration
- symptoms: choking, cyanotic, can't talk, cough - heimlich and back blows (less than 1 yr) - bronchoscopy - teaching - lay on side - monitor for breathing - wait for swallow and gag reflex to come back
32
Asthma
- reactive airway disease: for kids less than 3 happens only when sick - pathophysiology: chronic inflammatory disorder of airways - classification for children 5 years and older
33
Primary Prevention: Whos ar risk?
- infants - usually starts between 3-8 years - atopy (allergies) - ALLERGY TRIAD: asthma, eczema, rhinitis - complex disorder - genetic predisposition
34
Cystic Fibrosis
- autosomal recessive trait - exocrine gland dysfunction that produces multisystem involvement - mutated gene on chromosome 7 - greatest effect in lung
35
Pathophysiology of CF
- CFTR: cystic fibrosis transmembrane regulator | - abnormal chloride movement leads to increased viscosity of mucous gland secretion
36
Diagnosis of CF
- history - quantitative sweat chloride test - chest xray - stool fat and/or enzyme analysis - salty sweat
37
Goals of CF
- prevent/minimize pulmonary complications - adequate nutrition for growth - assist in adapting to chronic illness
38
Signs of distress
- increased RR - retractions - head bobbing
39
Clinical Manifestations of Mild distress and initial signs of failure (compensating)
- increased HR | - increased RR
40
Clinical Manifestations of moderate distress/early decompensation
- retractions - nasal flaring - anxiety - irritability - head bobbing - grunting
41
Clinical Manifestations of severe distress/imminent failure or arrest
- cyanosis - bradycardia - apnea
42
Nursing care of RSV/Bronchiolitis
1. nutrition, hydration, small and frequent feeds 2. handwashing to prevent spread 3. duration of illness lasts 3-4 days peak 3-4 days
43
Goal of asthma treatment
- open airway - symptoms helped with meds - decrease of attacks - chronic remodeling and changes in airways
44
Short term asthma meds
- bronchodilator (albuterol) - ipotropium bromide - corticosteroids - IV Mag (bronchodilator)
45
Long term asthma meds
- advair (combo med) - long acting bronchodilators - allergy med (singulair) - NSAID - cromolyn sodium
46
Secondary Prevention of Asthma
- MDI: younger kids - aerochamber/spacer: take 6 breaths in and out - nebulizer: easiest to use for child
47
Peak flow meters
shows how well they are - establish personal best - blow into - shows if they are getting worse
48
Oxygenation assessment for CF: Bronchi
- chronic pneumonia - generalized obstructive emphysema - clubbing - infections **isolation
49
Collaborative care for CF
- prevent colonization of pathogens and move secretions - aerosol: bronchodilators - daily CPT/PD - flutter valve (PEP therapy, vibrating vests - AB - resp tx is given before food because they get nauseated from tx
50
Elimination assessment for CF
- meconium illeus | - bowel obstruction
51
Nutrition assessment for CF
- pancreatic ducts: malabsorption and fibrosis, eventual CFRD - bile ducts: decreased bile, decreased ADEK, portal HTN
52
CF Tx
- ursodiol/actigall - supplemental tube feedings - ADEK vitamins - increase calories and protein - insulin? * *Pancreatic enzymes
53
-ursodiol/actigal
improves bile flow and prevents gallstones
54
pancreatic enzymes
- take with meals/snacks - can open capsule and sprinkle on food - enzyme can burn, irrtate teeth and mouth - take as directed
55
Alternative to IS
- blowing bubble - pin wheel - blowing out birthday candles

Peds Exam 1 (6 decks)

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