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Pediatrics > Peds Final Review - Respiratory > Flashcards

Peds Final Review - Respiratory Flashcards

1
Q

Need to know your normal for age respiratory rates and heart rates!

A

NCLEX HINT: Respiratory disorders are the primary reason most children and their families seek medical care. Therefore, these disorders are frequently tested on the NCLEX.

Knowing the normal parameters of respiratory rates and the key signs of respiratory distress in children is essential.

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2
Q

Neonatal Normal Vital Signs

A

Temp: 36.3oC – 37oC (97.3o – 98.6oF) axillary

Heart rate: 120 – 160

Resp rate: 30 – 60

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3
Q

Normal Infant Vital Signs

A

Temp: 36.5oC – 37.5oC (97.6o – 99.8oF) axillary

Heart Rate: 110 – 160

Respiratory Rate: 30 – 60

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4
Q

Normal Vital Signs for Toddlers

A

Heart Rate: 90 – 140

Respiratory Rate: 24 – 40

Systolic BP: 80 – 112

Diastolic BP: 50 – 80

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5
Q

Normal Vital Signs for Toddlers

A

Heart Rate: 90 – 140

Respiratory Rate: 24 – 40

Systolic BP: 80 – 112

Diastolic BP: 50 – 80

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6
Q

Normal Vital Signs for Preschoolers

A

Heart Rate: 80 – 110

Respiratory Rate: 22 – 34

Systolic BP: 82 – 110
Diastolic BP: 50 – 78

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7
Q

Normal Vital Signs for Preschoolers

A

Heart Rate: 80 – 110

Respiratory Rate: 22 – 34

Systolic BP: 82 – 110
Diastolic BP: 50 – 78

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8
Q

Normal Vital Signs for School Aged Children

A

….

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9
Q

Normal Vital Signs for School Aged Children

A

….

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10
Q

Respiratory distress:

Cardinal signs of respiratory distress:

A

Restlessness

Increased respiratory rate – Tachypnea

Increased pulse rate – Tachycardia

Diaphoresis

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11
Q

Other signs of respiratory distress

A 
Flaring nostrils
Retractions
Grunting
Adventitious breath sounds
Use of accessory muscles, head bobbing
Confusion, anxiety, irritability
Wheezing
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12
Q

Signs of Impending Respiratory Failure

A

Depressed or slow respirations

(decreased inspiratory breath sounds)

Dyspnea
Bradycardia
Somnolence
Stupor/coma
Cyanosis
Oxygen desat
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13
Q

Asthma:

Inflammatory reactive airway disease that is commonly chronic

A

Edematous airways

Airways congested with mucus

Smooth muscles of bronchi and bronchioles constrict

Air trapping occurs in the alveoli

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14
Q

Asthma Nursing Assessment:

A

History of asthma in the family

History of allergies

Home environment containing pets or other allergens

Tight cough (nonproductive cough)

Breath sounds: coarse expiratory wheezing, rales, crackles

Chest diameter enlarges (late sign and symptom)

Increased number of school days missed during past 6 months

Signs of respiratory distress

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15
Q

Asthma Nursing Diagnosis:

A

Impaired gas exchange

Ineffective breathing pattern

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16
Q

Asthma Nursing Interventions:

A

Monitor for increasing respiratory distress

Administer rapid-acting bronchodilators and steroids for acute attacks

Maintain hydration

Monitor blood gas values for signs of respiratory acidosis

Administer oxygen or nebulizer therapy as prescribed

Monitor pulse oximetry as prescribed (usually > 95%)

Administer cromolyn sodium prophylactically to prevent inflammatory response

Teach home care program

Refer child and family for emotional and psychological counseling

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17
Q

Asthma Home Care Program:

A

Identify precipitating factors

Reducing allergens in the home
Use metered-dose inhaler

Monitor peak expiratory flow rate at home

Do breathing exercises

Monitor drug actions, dosages, and side effects

Manage acute episode and when to seek emergency care

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18
Q

Respiratory Distress Syndrome:

A

Surfactant administration to preterm infants at delivery to prevent RDS

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19
Q

Cystic Fibrosis:

Autosomal-recessive disease that causes dysfunction of the exocrine glands

A

Multiple problems:

  1. Lung insufficiency
  2. Pancreatic insufficiency
  3. Increased loss of sodium and chloride in sweat
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20
Q

Cystic Fibrosis Nursing Assessment:

A

Usually found in a white infant or child

Meconium ileus at birth

Recurrent respiratory infection

Pulmonary congestion

Steatorrhea (excessive fat, greasy stools)

Foul-smelling bulky stools

Delayed growth and poor weight gain

Skin that tastes salty when kissed

Later: cyanosis, nail-bed clubbing, congestive heart failure

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21
Q

Cystic Fibrosis Nursing Assessment:

A

Usually found in a white infant or child

Meconium ileus at birth

Recurrent respiratory infection

Pulmonary congestion

Steatorrhea (excessive fat, greasy stools)

Foul-smelling bulky stools

Delayed growth and poor weight gain

Skin that tastes salty when kissed

Later: cyanosis, nail-bed clubbing, congestive heart failure

22
Q

Cystic Fibrosis Nursing Diagnosis:

A

Ineffective airway clearance

Imbalanced nutrition: less than body requirements

23
Q

Cystic Fibrosis Nursing Interventions:

Monitor respiratory status
Assess for signs of respiratory infection

Administer IV antibiotics as prescribed and manage vascular access

Physical activity and exercise loosen secretions and promote lung expansion

A

Administer fat-soluble vitamins (A,D,E,K) in water soluble form

Administer oxygen and nebulizer treatments (Pulmozyme) as prescribed

Evaluate effectiveness of respiratory treatments

Administer pancreatic enzymes with food. In infants with applesauce, rice, or cereal

Provide age appropriate activities

Refer family for genetic counseling

24
Q

Cystic Fibrosis Nursing Interventions:

Teach family percussion and postural-drainage techniques

A

Chest percussion and postural drainage must be performed 3 – 4 times a day.

25
Q

Cystic Fibrosis Nursing Interventions:

Teach dietary recommendations:

A

high in calories, high in protein, moderate to high in fat, and moderate to low in carbohydrates (to avoid an increase in the CO2 drive)

A child with cystic fibrosis needs 150% of the usual calorie intake for normal growth and development.

26
Q

Male cystic fibrosis patients need to be informed at some point that they will probably not be able to produce offspring.

Be sure to emphasize this does not mean they will be impotent.

Normal sexual relationships can be expected.

A

Female cystic fibrosis patients may be able to bear children but should be informed of the possible harmful effects on the respiratory system created by the burden of pregnancy.

27
Q

Cystic Fibrosis Nursing Evaluation of family teaching:

A

Family demonstrates and verbalizes intent to adhere to home care regimen of pulmonary treatments, medications, diet, and exercise;

child gains weight consistently;

participates in self-care and age-appropriate activities,

child demonstrates ability to clear secretions from airway by productive cough;

O2 sat greater than 94%, and decreased respiratory distress.

28
Q

Cystic Fibrosis Nursing Evaluation of family teaching:

A

Family demonstrates and verbalizes intent to adhere to home care regimen of pulmonary treatments, medications, diet, and exercise;

child gains weight consistently;

participates in self-care and age-appropriate activities,

child demonstrates ability to clear secretions from airway by productive cough;

O2 sat greater than 94%, and decreased respiratory distress.

29
Q

Procedure for Chest Physiotherapy (CPT)

A

Child is dressed in a lightweight shirt

Percussion is performed with a cupped hand striking the chest over a portion of the lung; if done properly , a popping sound will be heard

Some children, esp. older children and adolescents, use an oscillating vest to mobilize secretions instead of chest physiotherapy

Postural drainage facilitates removal of secretions that are loosened during percussion; for drainage, various head-down positions drain all lung segments

Positioning for bronchial drainage can be achieved by child standing on his head, hanging upside down on monkey bars and other playground activities that are fun for the child.

Avoid performing CPT immediately after eating.

30
Q

laryngotracheobronchitis

A

Most common of the croup syndromes

  • Sound worse than they look
  • Abrupt onset, usually at night

Generally affects children

31
Q

laryngotracheobronchitis Treatment

A

Dexamethasone – oral or IM
Duration of action is 48 – 96 hours

Nebulized epinephrine – racemic epinephrine
-Duration 1 – 2 hours
-Observe patient for 2 – 4
hours

32
Q

EPIGLOTTITIS

Severe life-threatening infection of the epiglottis

A

Epiglottitis progresses rapidly, causing acute airway obstruction

The organism usually responsible for epiglottitis is Haemophilus influenza

33
Q

EPIGLOTTITIS Nursing Assessment:

A 
Sudden onset
Restlessness
High fever
Sore throat, dysphagia
Drooling
Muffled voice

Child assuming upright position with chin out and tongue protruding (tripod position)

34
Q

EPIGLOTTITIS Nursing Diagnosis

A

Ineffective breathing pattern related to

Anxiety related to

35
Q

EPIGLOTTITIS Nursing Interventions:

A

Employ measures to decrease agitation and crying

Maintain child in upright sitting position

Prepare for intubation or tracheostomy

Administer IV antibiotics as prescribed

Prepare for hospitalization in ICU

Restrain as needed to prevent extubation

Encourage prevention with Hib vaccine

36
Q

DO NOT EXAMINE THE THROAT OF A CHILD WITH EPIGLOTTITIS.

A

Do not put a tongue blade or any object into the throat because of the risk of obstructing the airway completely.

37
Q

BRONCHIOLITIS

Viral infection of the bronchioles that is characterized by thick secretions

A

Bronchiolitis is usually caused by respiratory syncytial virus (RSV) and is found to be readily transmitted by close contact with hospital personnel, families, and other children.

Bronchiolitis occurs primarily in young infants, and is more common in infant born preterm or infants with congenital heart disease.

Prevention of RSV – Synagis (palivizumab)—monthly IM injection during RSV season

38
Q

BRONCHIOLITIS Nursing Assessment:

A

History of upper respiratory symptoms

Irritable, distressed infant

Paroxysmal coughing

Poor eating

Nasal congestion

Nasal flaring

Prolonged expiratory phase of respiration

Wheezing, rales can be auscultated

Deteriorating condition that is often indicated by shallow, rapid respirations

39
Q

BRONCHIOLITIS Nursing Diagnosis:

A

Impaired gas exchange related to ……..

Ineffective airway clearance related to ………

40
Q

BRONCHIOLITIS Nursing interventions:

A

Isolate child – Contact isolation for RSV

Assign nurses to clients with RSV who have no responsibility for any other children

Monitor respiratory status; observe for hypoxia

Clear airway of secretions using a bulb syringe for suctioning

Provide care in mist tent; administer oxygen as prescribed

Maintain hydration

Monitor antiviral agent, ribavirin aerosol, if prescribed  
      – Ribavirin is rarely used, 
        but if used can not have 
        pregnant care taker as it 
        is teratogenic.

Evaluate response to respiratory therapy treatments

Administer palivizumab (Synagis) to provide passive immunity against RSV in high-risk children (those less than 2 years of age with a history of prematurity, lung disease, or congenital heart disease).

41
Q

BRONCHIOLITIS

A

NCLEX HINT: In planning and providing nursing care, a patent airway is always the priority of care, regardless of age!

42
Q

OTITIS MEDIA

Inflammatory disorder of the middle ear

A

Otitis media may be suppurative or serous

Anatomic structure of the ear predisposes young child to ear infections – horizontal position

There is a risk for conductive hearing loss if untreated or incompletely treated

43
Q

OTITIS MEDIA Nursing Assessment

A

Fever, pain; infant may pull at ear

Enlarged lymph nodes

Discharge from ear (if drum is ruptured)

Upper respiratory symptoms

Vomiting, diarrhea

44
Q

OTITIS MEDIA Nursing Diagnosis

A

Risk for infection related to

Acute pain related to

45
Q

OTITIS MEDIA Nursing Interventions:

A

Administer antibiotics if prescribed

Reduce body temperature
-Tepid baths
- Acetaminophen is
prescribed

Position child on affected side

Provide comfort measure: warm compress on affected ear

Teach home care:
-Teach to finish all prescribed
antibiotics

- Encourage follow-up visit
- Monitor for hearing loss
    - Teach preventive care 
      (smoking and bottle 
      feeding when child is in 
      supine position are 
      predisposing factors)
46
Q

TONSILLITIS

Inflammation of the tonsils

A

Tonsillitis may be viral or bacterial

Tonsillitis may be related to infection by a Stretococcus species

If related to strep, treatment is very important because of the risk for developing acute
Glomerulonephritis or rheumatic heart disease.

47
Q

TONSILLITIS Nursing Assessment:

A

Sore throat

Fever

Enlarged tonsils, with possible purulent discharge on tonsils

Breathing may be obstructed

Tonsils may be touching (called “kissing tonsils”)

Need throat culture to determine bacterial or viral cause

48
Q

TONSILLITIS

A

The nurse should be sure that a PT and PTT have been determined prior to a tonsillectomy.

More important, the nurse should ask whether there has been a history of bleeding, prolonged or excessive, and whether there is a history of any bleeding disorders in the family.

49
Q

TONSILLITIS Nursing Diagnosis:

A

Impaired swallowing related to…..

Risk for injury related to …….

50
Q

TONSILLITIS Nursing Interventions:

Collect throat culture if prescribed

Instruct parents in home care

Encourage warm saline gargles

Provide ice chips

Administer antibiotics if prescribed

Manage fever with acetaminophen

Provide surgical care if indicated

Provide preoperative teaching and assessment

A

Monitor for signs of postoperative bleeding

 - Frequent swallowing
 - Vomiting fresh blood
 - Clearing throat

Encourage soft foods and oral fluids. Avoid red fluids, which mimic signs of bleeding.

Do not use straws

Provide comfort measures: Ice collar helps with pain and with vasoconstriction

Teach that the highest risk for hemorrhage is during the first 24 hours and 5 – 10 days after surgery

Pediatrics (24 decks)

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