peds respiratory Flashcards
(124 cards)
1
Q
Upper respiratory tract
A
Oronasopharynx, pharynx, larynx, and trachea
2
Q
Lower respiratory tract
A
Bronchi, bronchioles, and alveoli
3
Q
Diameter
A
The diameter of the trachea is roughly the size of the child’s pinky finger
4
Q
Distance
A
The structures are shorter
Allows organisms to rapidly move down
Allows fluid to build-up
5
Q
Age - younger than 3 months
A
Immunity increases with age
Infants younger than 3 months Still have maternal antibodies
6
Q
mycoplasmal more common
(my fall and winter)
A
in fall and winter
7
Q
RSV - when does it occur?
(S is for spring)
A
spring and winter
8
Q
Generalized signs and symptoms and local manifestations different in young children - think about the lecture
A
Fever
Anorexia
R/T vomiting, diarrhea, abdominal pain
Cough, sore throat, nasal blockage or discharge
Respiratory sounds
9
Q
obligate nose breathers until when?
A
until about 4 weeks can’t coordinate mouth breathing
10
Q
Infants are abdominal breathers- Diaphragm movement creates what type of pressure?
A
Ribs are primarily cartilage
Very flexible
Inefficient ventilating
Diaphragm movement during inspiration creates negative pressure allowing lungs to expand
11
Q
Assessment with Auscultation
A
Adventitious breath sounds
Stridor
Wheezes
Rhonchi
Crackles
Diminished breath sounds
What if you heard wheezes in a child, then an hour later the wheezes were “quieter” or “softer”?
12
Q
Signs and Symptoms of Respiratory Tract Infections - and the weird one
A
Fever
Nasal discharge
Cough
Adventitious lung sounds
Sore throat
Poor feeding and anorexia
Vomiting
Abdominal pain
Meningismus (headache, neck stiffness and photophobia, often with nausea and vomiting)
13
Q
Signs of Increasing Respiratory Distress in Children
A
RESTLESSNESS
Irritability
Color changes
Tachycardia
Tachypnea
Decreased O2 saturation
Retractions
Supraclavicular/Suprasternal
Intracostal
Substernal
14
Q
Nasal Pharyngeal Culture
(the culture is RIPD)
A
Respiratory Syncytial Virus (RSV)
Influenza Virus
Pertussis Bacteria
Diphtheria Bacteria
15
Q
Sputum Analysis - how to obtain TB?
A
Difficult to obtain from infants and young children
Gastric aspiration to obtain Mycobacterium Tuberculi (TB)
16
Q
Blood Gases- Analysis must include what?
A
Arterial or Capillary
gases (infants- heel stick)
Normal Values are the same as adult (textbook pg. 1192)
Analysis must include: Child’s Temperature
FIO2
Activity (crying/breath holding)
17
Q
Pulmonary Function Tests
A
Evaluate ventilatory function
Normal values change with growth
Serial tests are used to evaluate severity, progression, treatment effectiveness
18
Q
OXYGEN THERAPY - do you need an order?
A
Variety of delivery systems to children
Must have an order
FIO2, Liters/min.
Oxygenation goal
“O2 to keep saturation >…”
Usually nursing discretion how to administer O2
19
Q
Nasal Cannula/Prongs - what O2 amount? and can kids eat with it?
A
Preemie, infant, and child sizes
21 - 40% concentration
Tolerate well
Child able to eat and talk
20
Q
Oxygen Mask - how much O2? and can they eat with it?
A
Variety of sizes to fit
Deliver up to 100% FIO2
Young children afraid to wear mask
Can’t eat or drink while wearing mask
21
Q
“Blow–by” Oxygen - when to use?
A
Humidified Oxygen/Air
No way to measure FIO2 child receives
Use if child won’t tolerate any other modality
22
Q
Oxygen Hood - what percentage of O2?
A
FiO2 up to 100%
High humidity
Easy access to body
23
Q
Oxygen Tent (“Croupette Tent”) - how high is the FIO2?
(tenting at 40)
A
High humid environment
FIO2 only up to 40%
Separation Anxiety
24
Q
Aerosol Therapy
A
Metered-dose inhalers
Use a spacer
Nebulizers
Used to administer meds such as bronchodilators
Vaporizers
Increases humidity in room
25
FLUIDS
Children with respiratory conditions get dehydrated easily
Fluids thin the sputum/mucous
Encourage PO fluids
Popsicles, jello, juice, electrolyte drinks, breast feeding, water
IV fluids
Humidified O2
26
MEDICATIONS
Bronchodilators
Ipatropium Bromide, Albuterol Sulfate, Epinephrine
Decongestants
Nose Drops (NS), Expectorants
Antipyretics
Acetaminophen, Ibuprofen
Antibiotics
For know bacterial infections
Prophylactic secondary bacterial infections
27
PULMONARY TOILET - 2 things
postural drainage and incentive spirometers
28
ease respiratory effort
Increase humidity, maintain cool environment
Elevate HOB
Promote nasal and pulmonary drainage
Clean nares with bulb syringe
Suction oronasal pharynx
Perform postural drainage and chest physiotherapy
administer o2
29
care of epiglottis - avoid using what?
Avoid using tongue blade
Keep tracheotomy set at bedside
Provide tracheostomy care
30
Infectious Agents
Viruses
RSV
Para-influenza
Others
Group A β-hemolytic streptococci
Staphylococci
Chlamydia trachomatis, Mycoplasma, pneumococci
Haemophilus influenzae
31
OM and Infant Feeding Methods - which immunoglobulin?
Breast-fed infants have less OM than bottle-fed infants
Immunoglobulin A
Position in breast-feeding may decrease reflex in eustachian tubes
32
Acute Otitis Media (AOM) - caused by which organisms? 2 of them
(ears are hemophaliacs w/ strep)
Bacterial Infection in middle ear:
Haemophilus influenza and Streptococcus pneumoniae
33
Diagnosis of AOM
Otoscopy (handheld to look in ear)
Tympanic membrane (measures pressure in ear, not done very often)
Bright red, bulging, may be dull with no visible landmarks or light reflection, diminished mobility
C&S of drainage indicates organism
34
AOM Treament
Antibiotics
“Wait and see approach” (48-72 hrs) for spontaneous resolution
Antipyretics/ Pain relief
Topical
Heat, cold, Benzocaine drops (Rx)
No steroids, antihistamines, decongestants, antibiotic ear drops
35
Treatment for Chronic Otitis Media
Myringotomy
(incise myring)
Incise and Drain accumulated fluid in middle ear
Obtain sample for culture and sensitivity
36
Treatment for Chronic Otitis Media
Pressure Equalizing Tubes- what part of ear do they work for?
Prevent vacuum in middle ear
Temporary treatment
Use earplugs during swimming/bathing
37
Nasopharyngitis
The “common cold”
Caused by
rhinovirus, RSV, adenovirus, influenza virus, parainfluenza virus
Signs and symptoms
Fever, irritability, poor PO intake, sneezing, nasal mucous, vomiting, diarrhea, muscle aches, coughing (sometimes)
38
Acute Streptococcal Pharyngitis (strep throat) - what bacteria?
Group A β-hemolytic streptococci (GABHS)
Manifestations
Onset often abrupt
Varies from no symptoms to toxicity (pharyngitis, headache, fever, abd pain)
Treatment regimen
Risk for serious sequelae
Acute rheumatic fever
Acute glomerulonephritis
Scarlet fever (though rarely seen in United States)
39
Pharmacologic Interventions—Strep
what medicine?
Penicillin
Oral
40
Tonsillitis
Pathophysiology and etiology
Clinical manifestations
Therapeutic management
Medical
Surgical
Controversial
May be indicated with massive hypertrophy
Nursing considerations
41
CROUP SYNDROMES - viral
(Larry has a croup virus)
Viral
Acute laryngitis
Acute spasmodic laryngitis
Acute laryngotracheobronchitis
42
Croup Syndromes - what areas does it affect? 3 of them
(croup loves BLT)
Affect larynx, trachea, bronchi
Described by anatomic area primarily affected
43
Acute Laryngitis - usually common with who?
(laryngitis in HS)
More common in older children and adolescents
44
Acute Spasmodic Laryngitis
Also called spasmodic croup, midnight croup
Paroxysmal (violent attack) attacks of laryngeal obstruction
45
Acute Laryngotracheobronchitis
(LTB) - who does it affect?
(larry is younger than 5)
Most common of the croup syndromes
Generally affects children younger than
5 years
Organisms responsible
RSV, parainfluenza virus, Mycoplasma pneumoniae, influenza A and B
46
Manifestations of LTB - croup (Laryngotracheobronchitis) - what breath sounds?
(Larry is striding in and out)
Inspiratory and expiratory stridor
47
Acute Epiglottitis - is it serious?
Most life threatening
Serious obstructive, inflammatory process
48
Nursing Considerations—Epiglottitis
Position for comfort
Decrease anxiety
No tongue blade
Keep suction at bedside
Keep emergency respiratory equipment at bedside
49
Bacterial Tracheitis - what does it resemble?
Infection of the mucosa of the upper trachea
Distinct entity, features of croup and epiglottitis
Clinical manifestations similar to those of LTB
May be complication of LTB
50
BRONCHIOLITIS - is it viral or bacterial?
Occurs primarily at the bronchiolar level
Acute viral infection
80% of cases are caused by Respiratory Syncytial Virus (RSV)
20% are caused by Influenza & other virus
51
Bronchiolitis -breath sounds? and RR rate?
(bronx wheezing in the 70s)
Signs of URI
Progresses to more coughing and wheezing
Tachypnea > 70 breaths/min
52
Signs and Symptoms of RSV - Initial - basically a cold w/ conjunctivitis
Initial
Rhinorrhea, pharyngitis, cough, sneezing, wheezing, OM, conjunctivitis, fever
53
Treatment of RSV - keep O2 at what? and how often to assess RR?
Assess respiratory status (1-2 hrs)
Maintain O2 >92%
Humidified O2
Bulb suction
I&Os
Daily weights
Fluids
Small frequent feeds
IV if poor PO
54
Etiology of Pneumonias
Bacterial, viral, aspiration
Histomycosis, coccidioidomycosis, other fungi
Causative agent be introduced into lungs through inhalation or from bloodstream
“Atypical pneumonias”
Caused by pathogens other than most common and readily cultured bacteria
Mycoplasma pneumoniae, chlamydial pneumonia
55
Pneumonitis
(itis not as bad)
Localized acute inflammation of the lung without the consolidation or exudate associated with pneumonia
56
Differential Diagnosis - Pneumonitis
X-ray
Pulmonary infiltrates
Lobar consolidation
Pleural effusion
Lab tests
Cultures—sputum, blood cultures, lung aspiration and biopsy
WBC
57
Bacterial Pneumonia - what causes it? (you know this)
Serious infection
Causes
Aspiration
Hematogenous dissemination (infection in bloodstream)
Strongly influenced by age, underlying illness, and degree of immunocompromise
58
Chlamydial Pneumonia - when does it occur?
Usually 2-19 weeks after delivery
Infected mother transmits to fetus via ascending infection or during delivery
59
Pertussis (Whooping Cough) - when to get booster?
Caused by Bordetella pertussis
In the United States, it occurs most often in children who have not been immunized
Highly contagious
Risk to young infants
Vaccines
DTaP x5 in childhood
“Booster” x1 with TDaP between ages 11 and 64 years
Refer to Vaccine Information Statements (VIS)
60
Tuberculosis (TB)
Caused by Mycobacterium tuberculosis human and bovine varieties
Transmission modes
Clinical manifestations
May or may not have acute respiratory distress (cough, dyspnea)
Weight loss
Fever
Anorexia
Multi system invasion “Miliary TB”
61
TB - what vaccine?
(BPG for TB)
Prognosis
Latent TB infection (LTBI)
Prevention
BCG vaccine usage worldwide and in the United States
Nursing considerations
62
Pharmacologic Management—
Latent TB Infection (LTBI)
Isoniazid (INH)—treat for 9 months
Daily OR alternatively 2-3 x/wk with direct observation of therapy (DOT)
Rifampin—treat for 6 months if INH resistant
Treatment not recommended for children with positive TB test result but no risk factors
Treatment to reduce risk of developing active TB
63
Foreign Body Aspiration- what age?
Up the Nose or down the Lungs
High Risk kids:
Any child under the age of 3 years
Neurologically Impaired LOC or Gag reflex
Propped feeding bottles or unattended meals
64
Aspiration Pneumonia
Risk for child with feeding difficulties
Prevention of aspiration
Feeding techniques, positioning
Avoid these aspiration risks:
Oily nose drops
Solvents
Talcum powder
65
Differentiating Between “Allergies” and “Colds” - and what is usually accompanied with allergies?
Allergies occur repeatedly and are often seasonal
Allergies are seldom accompanied by fever
Allergies often involve itching in the eyes and nose
Allergies usually trigger constant and consistent bouts of sneezing
Allergies are often accompanied by ear and eye problems
66
Asthma
Chronic inflammatory disorder of airways
Hyper-reactivity of airway
Bronchial hyper-responsiveness
Episodic
Limited airflow or obstruction that reverses spontaneously or with treatment
Etiology and pathophysiology
67
Factors for Asthma - what about mother?
Age
Heredity
Gender
Mother
68
Asthma Severity Classification in Children 5 Years and Older - steps I through IV
(mild, mild, moderate, severe)
Step I—mild, intermittent asthma
Step II—mild, persistent asthma
Step III—moderate, persistent asthma
Step IV—severe, persistent asthma
Clinical features of each classification
69
Drug Therapy for Asthma - copy slide 131
70
Signs of SEVERE Respiratory Distress in Children with Asthma
Remains sitting upright, refuses to lie down
Sudden agitation
Agitated child who suddenly becomes quiet
Diaphoresis
71
Status Asthmaticus - what meds?
(asthma parties)
Vigorous therapeutic measures
Concurrent infection in some cases
Therapeutic intervention
Emergency treatment—epinephrine
0.01 ml/kg subQ (maximum dose 0.3 ml)
IV magnesium sulfate
IV ketamine
IV corticosteroids
Heliox
72
trees branches twigs and leaves
73
brocholitis
infection in the bronchioles
74
Nursing Considerations
Activate the nursing process to help prioritize both problems and nursing care
Assessment
Nursing diagnosis
Planning
Implementation
Evaluation
75
nasal flaring in baby is
a distress sign
76
if child has wheezing and it suddenly stops
it's a medical emergency. it is filling up with fluid. ex. chlyothorax
77
give 02 for kids with sats less than
92%
78
Nasal Pharyngeal Culture - ignore - repeat
Respiratory Syncytial Virus (RSV)
Influenza Virus
Pertussis Bacteria
Diphtheria Bacteria
79
o2 needs to be
humidified
80
nursing interventions
HOB up, pulmonary toilet, use bulb syringe, increase humidity, fever management, make sure bed linens aren't wet or cold
81
Otitis Media - don't treat
unless temp and something else
82
Acute Otitis Media (AOM) - s/sx
Fever
Ear pain, especially when lying down
Tugging or pulling at ear
Difficulty sleeping
Irritability
Nasal congestion and cough
Loss of appetite
Loss of balance
Headache
Drainage of fluid from the ear
Difficulty hearing or responding to sounds
83
The eustachian tubes
shorter, wider, more horizontal
84
immunity - 3-6 months
3 to 6 months (usually start getting sick around 6 months bc antibodies wear off)
Infection rate increases
Toddler and preschool ages
High rate of viral infections
85
immunity - Older than 5 years - increase in what type of infections? 2 of them - you know this
Increase in Mycoplasma pneumonia and β-strep infections
86
oxygen hood - who is it good for?
Only good for newborn and infants that can’t roll-over
87
acute otitis media - where does the fluid pool?
(otis in the pharynx)
Pooling of fluids posterior pharyngeal area
88
acute otitis media - eustacian tube?
Short, flat, wide eustacian tube
89
acute otitis media - cartilage lining?
Poorly developed cartilage lining
90
acute otitis media - Obstruction of eustacian tube by
Obstruction of eustacian tube by adenoids/lymphoid tissue
91
acute otitis media associated with what?
Associated URI
92
which is the tenting one?
(just flu)
Haemophilus influenzae
93
strep - how long for antibiotics?
Needs 10-day treatment to decrease risk of rheumatic fever and glomerulonephritis post strep
Issues with medication compliance
94
strep IM: Penicillin G
Resolves compliance issue (one injection)
Painful injection
Penicillin G procaine is less painful injection
95
strep - what about penicillin G?
CANNOT give penicillin G by IV route
96
strep - what if penicillin allergy? (close)
Erythromycin if penicillin allergy
Other antibiotics
97
croup syndrome - mainly affects what areas?
Epiglottitis [or supraglottitis], laryngitis, laryngotracheobronchitis [LTB], and tracheitis
98
croup - what type of retractions?
(croup is above stern)
Suprasternal retractions
Decreased O2 sats
Barking or “seal-like” cough
Increasing respiratory distress and hypoxia
99
croup can progress to...
(croup on acid)
respiratory acidosis, respiratory failure, and death
100
acute epiglottitis - Clinical manifestations - what about fever?
High fever, sore throat, pain, tripod positioning, retractions, open mouth, drooling,
101
acute epiglottitis - lung sounds? and O2?
(a cute epi inspires my stride)
inspiratory stridor, mild hypoxia, may become cyanotic
102
acute epiglottitis - what should be available?
Potential for complete respiratory obstruction
Emergency airway equipment must be available
103
acute epiglottitis - vaccine
(a cutie with hibs)
Hib vaccine
104
acute laryngitis - caused by virus or bacteria?
Usually caused by virus
Chief complaint is hoarseness
Generally self-limiting and without long-term sequelae
Treatmentc—symptomatic
105
croups bacterial - just two
(croup bacteria can trach the epi)
Bacterial tracheitis
Acute epiglottitis
106
acute spasmodic larnygitis - when does it occur?
(spaz at night)
Occur chiefly at night
Inflammation—mild or absent
107
acute spasmodic larnygitis - who does it affect?
(spaz from age 1 to 3)
Most often affects children ages 1 through 3
Therapeutic management
108
diagnosis of AOM - Tympanometry
Tympanometry measures air pressure in ear canal
Audiometric testing establishes baseline hearing
109
RSV - with progression
(progress to blue retractions)
Increased coughing and wheezing, tachypnea, retractions, cyanosis
110
RSV - severe illness
Tachypnea, listlessness, apneic spells, poor air exchange, poor breath sounds
111
bacterial tracheitis - what are secretions like? and is it serious?
(the trach is purulent)
Thick, purulent secretions = respiratory distress
May cause upper airway obstruction, respiratory failure, ARDS, and multiple organ dysfunction
112
LBT usually occurs after what?
Typically preceded by URI
113
whooping cough - what time of year?
(whooping in the summer)
Highest incidence in spring and summer
114
croups syndromes - what type of lung sounds?
(croup also inspires my stride)
Characterized by hoarseness, “barking” cough, inspiratory stridor, and varying degrees of respiratory distress
115
chlaymadial pneumonia - symptoms
(clap with no fever and crackles)
Infant is afebrile with cough, tachypnea, crackles
X-ray
Antibiotic treatment
116
asthma - longterm maintanence - Inhaled corticosteroids ex.
(becla on steroids)
Beclomethasone
117
asthma - quick relief
B-Adrenergic agonist (short acting)
Albuterol Sulfate
118
asthma - anticholenergics
(anti is appropriate)
Ipratropium
119
acute otitis media - don't use
antibiotic ear drops bc the infection is on the inside not the outside of the ear. they would need oral antibiotics
120
OTC cold remedies - what age?
not under 2 bc they can contain alcohol or tylenol or dyes
121
cough suppresants for cold?
no, you want to get the congestion out
122
post tonsilectomy
don't want them to swallow their secretions, don't medicate w/ red medicine bc it will look like blood, offer cold treats, gum is good, gargle w/ salt water and baking soda
123
asthma - longterm maintanence - Inhaled mast cell stabilizers ex.
(chrom mast)
Cromolyn
124
asthma - longterm maintanence - Oral Leukotriene Modifiers ex.
(luke is single)
Singulair
