Quiz Unit J Respiratory Dysfunction Flashcards
(112 cards)
1
Q
What do you assess for before drawing an ABG?
A
Respiratory rate, ease, depth, skin color, pain, and do an Allen test prior to drawing
2
Q
When do babies stop being total nose breathers?
A
After the first month
3
Q
Why are kids under the age of 8 more prone to aspiration?
A
Epiglottis is long and floppy, more susceptible to swelling. Trachea is shorter and narrower, and about the size of their pinkie finger (4mm in infants)
4
Q
At what age are the lungs fully developed?
A
12
5
Q
Kids are abdominal breathers until the age of _____.
A
6
6
Q
What are the different croup syndromes?
A
Infections that affect the epiglottis and larynx, and bronchi
7
Q
Most viral URI’s are caused by the _____virus.
A
RSV (Respiratory Syncytial Virus)
8
Q
What are viral infections so common and severe in kids 6 month to 3 years old?
A
The bronchial and Eustachian tubes are short
9
Q
When does RSV season occur?
A
Winter and spring
10
Q
What are some common s/s of a URI?
A
Fever, anorexia, vomiting, diarrhea, abdominal pain, cough, sore throat, nasal discharge/blockage, respiratory sounds
11
Q
At what point is a temperature addressed in children?
A
At 102 degrees
12
Q
How are URI’s managed?
A
Ease respiratory effort, hydration/nutrition, rest/comfort, prevent spread, COMFORT measures only (most of the time)
13
Q
Which symptom needs to be checked further?
A
Sore throat, may be strep, needs antibiotics
14
Q
What is done for pharyngitis?
A
Usually nothing, unless strep. Soft or cool liquid diet (eases swelling and inflammation)
15
Q
Who is a flu shot not recommended for?
A
Asthmatics
16
Q
Who shouldn’t get the nasal mist?
A
Children under 2
17
Q
Why don’t children get aspirin?
A
Reye’s syndrome
18
Q
When can the flu virus be spread?
A
24 hrs before symptoms appear and 24 hrs after symptoms disappear
19
Q
How is the flu spread?
A
By droplet and contact
20
Q
What are the s/s of the flu?
A
Photophobia, exhaustion, red face, dry hacking cough, aches/pains
21
Q
What is done for the flu?
A
Hydration, hydration, hydration
22
Q
What is done for repeated occurrences of otitis media?
A
Tubes in the ears
23
Q
What is usually done pharmacologically for otitis media?
A
Usually nothing
24
Q
How can we prevent otitis media?
A
Reduce tobacco smoke exposure, no pacifier, no bottle propping
25
When is otitis common?
Before age 7 and in the winter months
26
If an antibiotic is needed for otitis media, what is given?
Amoxicillin, 80-90 mg/kg/day, divided into 2 doses, for 5-7 days
27
Describe the average case of mono?
Dx witha spot test (Epstein Barr virus), 30-50 days incubation, usually self-limiting
28
What s/s of epiglottitis is easiest to recognize?
Barking cough (also respiratory stridor)
29
What are some s/s of acute epiglottitis?
Tripod position, drooling, restlessness, sore throat, retractions, spontaneous coughing
30
What is the most important fact to know about acute epiglottitis?
Must be addressed by an MD experienced in this, nothing in the throat for any reason by staff. It is an emergent situation!
31
What is the treatment for acute epiglottitis?
IV antibiotics, steroids, HIB vaccine prevents
32
What do we do for acute epiglottitis?
Comfort, support family, NOTHING in the throat, DON'T even look at the throat, stay with the patient at all times
33
Who gets acute epiglottitis?
Usually kids under 7 yrs of age
34
Who gets LTB?
Age 3 months to 3 years
35
What is a complication of acute LTB?
Respiratory acidosis/failure, death
36
Who gets acute laryngitis?
Older children and teens and is more prevalent in males
37
When are kids with LTB treated in the hospital?
When stridor, retractions, or difficulty breathing is present, others treated at home
38
What does acute spasmodic laryngitis become if it is severe?
LTB
39
What is done for bacterial traceitis?
Humidified O2 (due to secretions), antipyretics, antibiotics, may need intubation
40
What are the s/s of acute bacterial tracheitis?
Stridor, barking cough, thick secretions, but no drooling
41
What is considered the "reactive" portion of the airway?
Bronchi and bronchioles (lower portion)
42
What is RAD and what are it's manifestations?
Reversible, self-limiting, inflammation, mucous, edema, and bronchospasm of the airways that generally responds to supportive care. (ie, croup, asthma, and bronchiolitis)
43
What is the most common cause of hospitalization in kids under 1 yr of age?
RSV
44
What does bronchiolitis lead to?
Epithelial cells are shed into the bronchioles, causing obstruction/over inflation on exhalation (emphysema). This leads to hyperinflation and patchy atelectasis
45
What can RSV lead to?
Asthma
46
What is done for bronchiolitis/RSV? When is it most common?
Rivoviren, Numex, humidified O2, isolation, fluids, no chest therapy or ATB. Winter/spring
47
Where does interstitial pneumonia occur?
Alveoli
48
What is pneumonitis?
Infection of the lung wall
49
How are kids with pneumonia treated?
Postural drainage, antipyretics, fluids, cool mist humidifier. General support
50
What can provide immunity to pertussis?
A single episode, but booster now recommeded btwn 10 and 19 years old, if not given at 10-18, can be given up to age 64
51
What is the 2nd leading cause of death from infectious disease in the US?
TB
52
What is done if person is non-compliant with TB therapy?
DOT therapy (someone watches them take the meds to ensure compliance)
53
What causes resistant strains of TB?
Not completing TB therapy
54
How is TB treated?
Rifampin, INH, and PZA
55
What is done for resistant TB?
Streptomycin IM
56
What are some nursing precautions for TB?
Airborne precautions, negative pressure room, respirator for patient contact
57
How long does it take a child to die from aspiration?
4 minutes
58
What foods should be avoided when considering aspiration in kids?
Grapes, small candy, carrots, BB's, marbles, apple slices, beads/buttons/batteries, coins, hot dogs, PB, grapes, biscuits
59
When are back blows/chest thrusts used for aspiration?
Back blows for >1 year, chest thrusts for <1 year
60
When do you check for gag reflex?
Before and after a procedure
61
How can you prevent aspiration?
Don't feed laying down, frequent burping, no powders
62
What is ARDS?
Increased permeability of the alveolar and capillary membranes causes edema
63
When does ARDS require an ICU stay?
Sepsis, cancer, marrow transplant
64
What nursing measures are needed if a child is in ICU due to ARDS?
Monitor closely, examine skin q2hrs, cardiac output, fluid/electrolyte balance, strict I&O (urometer), ABG's, pulse ox, monitor nutrition (probably enteral/parenteral), ROM/exercise
65
What 3 injuries occur from smoke inhalation?
Heat damages the upper airway, chimical damage occurs deep in the tract, and systemic damage occurs from CO
66
How fast does CO bind to hemoglobin?
230 times faster than O2
67
What are the 3 stages of smoke inhalation and when do they occur?
Pulmonary insufficiency occurs within 12 hrs, pulmonary edema occurs in 6-72 hours, and bronchial pneumonia occurs after 72 hours
68
What CAN'T you use on kids suffering from smoke inhalation?
Pulse ox
69
What are some effects of passive cigarette smoke?
Increased respiratory problems/asthma, otitis media, LBW/preterm/stillborn, SIDS, lung disease as adults, and a decrease in fetal growth
70
What is asthma?
It is a reversible, reactive airway disease
71
What are the most common s/s of asthma in children?
Cough/night time, wheeze, SOB
72
What does it mean if a child is having daily asthma symptoms?
It is not well controlled
73
What 3 things occur during an asthma flareup?
Bronchospasm/constriction, inflammation, mucous production
74
What are some asthma triggers?
Lung/sinus/respiratory/ear infection, tobacco/wood smoke, strong odors, allergens, emotions, GERD, cold air, hard exercise
75
What is the key to treating asthma?
Know the triggers for each individual child
76
What are some warning signs of asthma?
Early: cough/worse at night, expiratory wheezing, listless, itchy eyes/throat/nose, grumpy, decreased appetite, drop in peak flow. Late signs: head bobbing, vomiting, anxiety, rescue med doesn't help, drop in peak flow below 50% of peak
77
What does it mean if your child has blue lips or blue nails?
Call 911
78
Is bronchial constriction normal?
Yes, it is a normal reaction to foreign invasion. Asthma is an abnormally severe reaction
79
What is "Step 1" asthma and what is the treatment?
Step system used in kids 5 and older. Step 1 = mild intermittent asthma; defined as s/s occurring 2 days per wk (only 1 per day), and 2 nights per nomth. It is treated with rescue meds only
80
What is "Step 2" asthma and what is the treatment?
This is mild persistent asthma, and is defined as s/s 2 days per wk (1 per day at most) and more than 2 times a month at night. It is treated with low dose inhaled steroids
81
What is "Step 3" asthma and what is the treatment?
This is moderate persistent asthma, and is defined as daily symptoms, with symptoms at night greater than 1 per week. It is treated with low to medium dose inhaled steroids and long acting Beta 2
82
What is "Step 4" asthma and what is the treatment?
This is severe persistent asthma and is defined as continual symptoms during the day and frequently at night. Treatment is high dose inhaled steroids and long acting Beta 2
83
What is done after a treatment involving steroids?
Brush teeth, rinse/spit, wash face if mask used
84
What are some risk factors for asthma?
More common in boys before puberty, girls after puberty. Exposure to chemicals, parent with asthma, silicon exposure, LBW, obesity, GERD
85
What is usually used for long term asthma control?
Prednisone, methylprednisone
86
What meds is normally used as a rescue med for asthma?
Short acting Beta 2 like Proventyl, Ventalyn, Maxiair
87
What are some examples of long acting Beta 2's?
Formoterol and Budesonide = Symbicort, Salmeteraol and Fluticasone = Advair Formoterol and mometason = Dulera
88
What is done for exercise induced asthma?
Use a rescue inhaler before exercise
89
What does status asthmaticus require and what is it?
Ventilation. It is an asthma attack that does not subside with treatment
90
What is done for status asthmaticus?
Epinephrine (Epi Pen) 0.01 mL/kg SubQ - Max dose is 0.03 mL/kg
91
Why use a spacer with inhaled steroids?
With a spacer, only 22% of the med reaches the lungs. Without it, only 9%
92
How long do you wait between puffs on an inhaler?
1 minute
93
What is CF?
Cystic fibrosis is an exocrine gland dysfunction that produces multisystem involvement. It is the most common genetic illness in children
94
How does CF affect the sexes differently?
Delayed puberty in females and sterility in males
95
CF is an _____ _____ trait that affects 1 in 4 of the offspring if both parent have the defect.
Autosomal recessive
96
What does CF cause (respiratory), and what is the treatment for it?
CF causes mechanical obstruction of the airways and is treated with giving the child a thumping
97
What else does CF affect besides the respiratory tract?
Pancreatic, reproductive, and digestive tracts
98
Why do CF patients develop anemia?
Lack of vitamins A, D, E, K (fat soluble)
99
What does inspissated mean?
To thicken or congeal (mucous).
100
What are some respiratory manifestations of CF?
Infection, difficulty expectorating secretions, decreased O2 exchange, hypoxia, pulmonary hypertension, cor pulmonale, failure and death
101
What is cor pulmonale?
Hypertrophy or dilation of the right ventricle
102
What pathogen can't alveolar microphages destroy in CF patients?
Pseudomonas
103
How does CF affect the GI tract?
It impairs the absorption of proteins and fats, causing steatorrhea and azotorrhea
104
What test is used to determine if a child has CF?
Sweat test
105
What drug is used to stimulate sweating for the sweat test?
Pilocarpine
106
What are some manifestations of CF?
COPD, sweat gland dysfunction, FTT, weight loss, wheezing, dry cough, patchy atelectasis, clubbing repeated bronchitis/pneumonia, bulky/frothy/foul smelling stools, rectal prolapse, dehydration, alkalosis, hypoalbuminemia
107
How is CF managed?
CPT, bronchodilator, home IV antibiotics therapy, transplantation, steroids, replace pancreatic enzymes, high protein diet, salt
108
What is the prognosis for kids with CF?
Life expectancy of 36.5 years. Lung transplant = 75% at 1 year and 55% at 3 years
109
What is sleep apnea and what are the treatments for it?
Cessation of breathing for more than 20 seconds due to mechanical obstruction of the airway while sleeping. It is treated with CPAP/BIPAP or surgery
110
What are the classic s/s of respiratory failure?
Restlessness, tachypnea, tachycardia, diaphoresis
111
What happens if tachycardia turns into bradycardia?
Bradycardia is s/s of severe hypoxia, so you better act fast
112
What is a major cause of cardiac arrest in children?
Drowning
