Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

n342 peds > resp > Flashcards

resp Flashcards

1
Q

RESP

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the pediatric difference for nasopharynx + implication?

A

o Smaller nasopharynx = easily occluded during infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  • What is the pediatric difference for lymph tissue (tonsil, adenoids)?
A

o Grows rapidly in early childhood, atrophies after age 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
  • What is the pediatric difference for oral cavity + implication?
A

o Small oral cavity and large tongue increase risk for obstruction, especially if unconscious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the pediatric difference for nares + implication?

A

Smaller nares = easily occluded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the pediatric difference for epiglottis + implication?

A

long, floppy epiglottis is vulnerable to swelling with resulting obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the pediatric difference for larynx and glottis + implication?

A

larynx and glottis are higher in the neck = increased risk of aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the pediatric difference for TRACHEA+ implication?

A

because thyroid, cricoid, and tracheal cartilages are immature, they may easily collapse when the neck is flexed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the pediatric difference for AIRWAY + implication?

A

Because fewer muscles are functional in airway= less able to compensate for edema, spasm, and trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the pediatric difference for MUCOUS MEMBRANES + implication?

A

Large amounts of soft tissue and loosely anchored mucous membranes lining airway = increase risk of edema and obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What age and where do infants breathe?

A

infants up to 4-6 months are obligate nose breathers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the pediatric difference for LUNG CAPACITY + implication?

A

Smaller lung capacity and underdeveloped intercostal muscles = less pulmonary reserve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the pediatric difference for RESP RATES and DEMANDS + implication?

A

faster resp rates and higher demands for O2 = easy for hypoxia to happen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the pediatric difference for the CRICOID + implication?

A

airway is smallest at cricoid for children younger than 8 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the pediatric difference for CHEST APPEARANCE?

A

infants and toddlers appear barrel chested

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the pediatric difference for RIBS/CHEST + implication?

A

lack of firm bony structure to ribs/chest = more prone to retractions when in resp distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do children rely heavily on for breathing?

A

Diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CREBS

A

C- cough

R- rate/regularity

E- effort/WOB

B- breath sounds

S- Saturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How would you assess Quality of Respirations?

A

rate, regularity, symmetry, effort, accessory muscles, breath sounds, ability to speak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are associated observations with RESP DISTRESS

A

retractions, nasal flare, head bobbing, tracheal tug, grunting
cough, colour, chest pain, clubbing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

switch order with above

What to assess in assessment of RESP DISTRESS

A

CREBS

Quality of resps

Associated observations (below)

position - sitting, prone, supine, tripod

behaviour change

signs of dehydration

family hx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What comes before resp failure:

A

resp distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

!!!!!What is resp failure? Types of resp failure:

A

can no longer maintain effective gas exchange

Types of resp failure:

-Functional = impaired gas exchange

-Structural = hypoventilation???*****

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Resp failure MANIFESTATIONS

A

hypoxemia

hypercapnia

alveolar hypoventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

3 progressions to resp failure/arrest

A

-5 cardinal signs (during resp distress)
1 restlessness
2 tachypnea
3 tachycardia
4 diaphoresis
5 pallor

-early decompensation (less obvious)
retractions
nasal flaring
grunting (exp)
Head bobbing
exertional dyspnea
increased WOB
wheezing/prolonged exp
headache
CNS symps (and, confusion, restless, irritable, decreased LOC)
mood changes
HTN
Anorexia

-severe hypoxia
cyanosis: ominous late sign
bradycardia
hypotension
decreased resps
bradypnea/dyspnea
stupor and coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the issue with cardinal symptoms?

A

are generalized and can be a lot of other things (ex a child can just be scared)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Do most children have cardiac arrest?

A

No, resp arrest first but then heart eventually fails

Heart failure= poor prognosis

28
Q

physiologic cause of initial resp failure:

A

child attempts to compensate for O2 deficit and airway blockage.
The O2 supply is inadequate= behaviour and VS reflect compensation and beginning hypoxia

29
Q

physiologic cause of early decompensation:

A

child uses accessory muscles to assist O2 intake.
Hypoxia persists and efforts now waste more O2 than obtained

30
Q

physiologic cause of severe hypoxia and imminent resp arrest:

A

O2 deficit is overwhelming and beyond spontaneous recovery.

Cerebral oxygenation is dramatically affected = CNS changes are ominous

31
Q

Partial pressure of oxygen. PaO2

A

the pressure of gas the child exerts
like a concentration

Shift LEFT caused by increase pH, decrease temp, decrease PaCO2

Shift RIGHT caused by decrease pH, increase temp, increase PaCO2, increase 2,3 DPG

32
Q

3 groups of Upper resp tract infections (URTI)

A

-Acute streptococcal pharyngitis (ASP)

-Tonsilitis

-Croup syndromes
3 subgroups of croup:

Laryngotracheobronchitis

Epiglottitis

Bacterial tracheitis

33
Q

Acute streptococcal pharyngitis (ASP)

A

aka strep throat

group A B-hemolytic streptococcus

having ASP increases risk of: Acute rheumatic fever and acute glomerulonephritis

rheumatic fever: inflamm disease that inflames body’s joints and heart, CNS. appears 18 days after ASP so ask WHEN it started

Acute glomerulonephritis usually appears 10 days after ASP and can be fatal

ASP onset: abrupt, lasts 3-5 days

ASP manifestations:
tonsils and pharynx inflamed and covered with white exudate

Direct contact or large droplet

Noninfectious to others after 24 hours of antibiotic dosing

Nursing care:
-cold or warm compress
-warm saline gargle
-soft diet

34
Q

Tonsilitis

A

chronic throat infection can lead to acute tonsilitis

tonsilitis manifestations:
-diff swallowing, drooling
-enlarged adenoids
-mouth breathing
-mouth odor
-impaired taste, smell
-muffled and nasal voice
-persistent cough
-otitis media, hearing diff

Tx:
tonsillectomy
adenoidectomy

T&A is needed but controversial at a young age because lymph tissue can regrow.
-needs surgery if airway is blocked

T&A contraindications:
-very young
-blood disorders

Nursing care Post tonsillectomy:
-position upright to facilitate drainage
-careful suctioning prn
-discourage coughing,clearing throat/sneeze
-ice collar
-regular analgesia 24-48hrs
-NPO until alert, able to swallow w/o signs of hemorrhage

*do not give codeine post-op:
it converts to morphine in the body and children either metabolize it too slowly = no effect OR too quickly = can become a high concentration and outcome is unpredictable

*do not give Aspirin post op = risk of bleeding

Signs of hemorrhage:
-frequent clearing of throat, swallowing
-vomit/secretions with bright red blood
-pallor
-tachycardia
-drooling
-coughing up blood

-avoid giving red food because you won’t be able to tell if vomit has blood in it

35
Q

Ear infections

A

the eustachian tube equalizes air pressure and allows for drainage

<2 yrs old, the tube has less angle/ more horizontal = decreased drainage

chronic ear infections = hearing loss

most are viral

tx:
myringotomy(put tubes in ears to equalize pressure)

Nursing care:
supportive instead of surgery
-soft/liquid diet
-cool mist vaporizer
warm saltwater gargle
-throat lozenges
-analgesic-antipyretic drugs

36
Q

Croup syndromes - URTI

A

swelling of epiglottis/larynx, extends to trachea/bronchi

viral or bacterial

characterized by:
hoarseness
barking brassy cough
Stridor (Insp)
resp distress

Mild croup:
occasional barking cough
no stridor at rest
no retractions

Moderate croup:
frequent barking cough
audible stridor at rest
no agitation or distress
no cyanosis

Severe croup:
frequent barking cough
retractions
stridor (Insp)
tachypnea
no cyanosis but lethargic
*beware of quiet child

37
Q

Acute Laryngotracheobronchitis (LTB) - URTI

A

viral: parainfluenza type 1,2,3, RSV, influenza A or B, adenovirus

bacterial: mycoplasma pneumoniea

children <5yrs
boys>girls

LTB manifestations:
-URI for several days, progresses to cough and hoarseness
-low fever
-tachypnea
-barking cough
-stridor (isp)

tx:
-humidification, cool mist
-encourage fluids
-supp. O2, oximetry
-rest, parental reassurance

meds: steroids = usually respond quickly
-epinephrine
-corticosteroids ex dexamethasone

obstruction can still occur in LTB

38
Q

Spasmodic laryngitis

A

cause: parainfluenza virus

signs of inflammation are absent or mild

hx of previous attacks lasting 2-5 days followed by uneventful recovery

1-3 yrs

management: at home, cool mist

39
Q

Epiglottitis (supraglottitis)

A

potentially life-threatening and requires immediate attention

inflammation of epiglottis caused by haemophilus influenza or group A B-hemolytic streptococcus

prevention: vaccines

Sudden onset with high fever >39

4 classic signs (4 D’s) of epiglottitis:
D - drooling
D - dysphagia
D - dysphonia
D- distressed resp effort (tripod)

dx:
lateral neck x-ray

tx:
intubation
Abx
O2
antipyretics for severe and sore throat

Nursing care:
DO NOT INSPECT MOUTH AND THROAT unless prepared to intubate - because the slightest movement or inhale can cause a full obstruction ***!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

-quiet environment
-try to minimize crying, emotional support
-fluids
-droplet isolation for 24 hrs after initiation of effect abx
-prophylactic abx tx of household

40
Q

Bacterial Tracheitis

A

Serious cause of airway obstruction with features of both LTB & epiglottitis

cause: staphylococcus aureus

5-7yrs old

tracheitis manifestations:
-croupy cough &stridor
-high fever >39 for several days
-thick purluent secretions - THIS IS THE DIFFERENCE because of the BACTERIAL cause

-requires ventilations support

Differences between bacterial tracheitis and LTB, croup: bacterial cause
-thick purulent secretions
-child prefers lying flat instead of sitting up

41
Q

Bacterial Tracheitis

A

Serious cause of airway obstruction with features of both LTB & epiglottitis

cause: staphylococcus aureus

5-7yrs old

tracheitis manifestations:
-croupy cough &stridor
-high fever >39 for several days
-thick purulent secretions - THIS IS THE DIFFERENCE because of the BACTERIAL cause

-requires ventilation support

Differences between bacterial tracheitis and LTB, croup: bacterial cause
-thick purulent secretions
-child prefers lying flat instead of sitting up

42
Q

3 Lower Resp Tract Infections (LRTI)

A

Bronchitis

Bronchiolitis (RSV)

Asthma

43
Q

Bronchitis

A

inflammation of large airways (trach & bronchi)

usually viral

associate with URTI

Bronchitis manifestations:
-dry, hacking, nonprod. cough
-worse at night
-becomes productive in 2-3 days

mild: self limiting

symptomatic tx

44
Q

Bronchitis

A

inflammation of large airways (trach & bronchi)

usually viral

associated with URTI

Manifestations:
-dry, hacking, nonprod cough
-worse at night
-becomes productive in 2-3 days

mild self-limiting, tx symptoms

45
Q
  1. Bronchiolitis
A

inflammation & obstruction of bronchioles

2-6 months, reinfection in 2nd year of life

most severe in infants <6months

males> females

hyperrinflated airways = O2 can enter but CO2 can’t get out -> pH decreases = resp acidosis

direct contact with resp secretions w/ a eye/nose/mucous membrane

can survive for hours on surfaces and 30 min on skin

incubation 2-8 days; viral shedding can last several weeks

Resp. syncytial virus RSV most common cause

Patho:
-virus invades mucosal cells lining bronchioles
-infected cell membranes fuse to form giant cells with multiple nuclei = creates “syncytia” or streaks at cellular level
-invaded cells die when virus bursts from inside cell to invade adjacent cells
-cell debris clogs and obstructs bronchioles & irritates airway -> cells lining airway swell & produce excessive mucous = partial airway obstruction & bronchospasm

Air can come in but not out = wheezes, crackles, air trapping

Risk for resp failure = beware of quiet breath sounds

High risk groups:

-Premature: dt absence of maternal antibodies and smaller airways

-Bronchopulmonary dysplaaasia (BPD) = chronic lung disease dt bronchial hyper-responsiveness and reduced ling capacity

-Cardiac disease dt pulm. vascular hyper-responsiveness and increased pulm. blood flow

-Neuromuscular disease dt decreased resp muscle strength/endurance and anything that interferes with muscles to breathe

-Immune deficiency dt decreased host defences and impaired capacity to eliminate virus

clinical manifestations:

-initally ill with URTI (nasal stuffiness, +- cough)
-progresses to deeper/more frequent cough
-laboured breathing
-fever >39
-shallow, rapid RR
-nasal flaring
-retractions
-appear sick, not playful, not eating
-infants may spit up thick, clear mucus

dx:

-chest x-ray*
nasopharyngeal wash (NPW) or nasopharyngeal swab (FLOQ swab) - for RSV antigen detections and other viral infections

*chest x-ray not recommended for bronchiolitis because hard to distinguish between RSV and asthma

46
Q

Bronchioolotis con’t

Diagnostics :

Admission criteria for bronchiolitis from CPS (Canadian Pediatric Society)

A

Signs of severe resp distress:
-RR >60, indrawing grunting

-supp O2 to keep sats >90%

-dehydration or hx of poor fluid intake

-cyanosis or hx of apnea

-infant at high risk for severe disease (mentioned above: premature, BPD, hemodynamically signif. cardiopulmonary disease, neuro, immunodeficiency)

-family unable to cope

-CBC (generally not helpful in routine cases)

-ABG’s - only if concerned about resp failure

-Bacterial culture (blood, urine, CSF) - not routinely; may be indicated based on clinical judgment

tx:
supp O2

hydration IV or PO

Equivocal therapies:

-epinephrine nebulizer

nasal suction

combined epinephrine and dexamethasone

47
Q

RSV - Palivizumab

A

IM inj, given monthly during RSV season

55% reduction in RSV-related hospital stays

does not interfere with routine immunizations

expensive $5000-9000/infant/year

must be < 2 yrs old

** look in your ppt for more criteria

48
Q

Criteria to discharge w/ bronchiolitis

A

-Tachypnea and WOB improved

-Maintain O2 sats >90% w/o supp. O2
OR stable for home O2 therapy

-adequate oral feeding

-education provided and appropriate follow-up arranged

49
Q

Asthma, 2 types

A

chronic inflammatory disorder of the airways

characterized by:
-recurring symptoms
-airway obstruction (reversible spontaneously or with tx)
-bronchial hyper-responsiveness to stimuli, constriction

most common childhood illness, major cause of school absences, ER visits, and hosp admissions

1/10 children
males>females
80-90% have symptoms before 4-5 yrs old

2 main types:

1) recurrent wheezing in early childhood; RSV cause

2) chronic asthma associated w/ allergy persisting into later childhood and adulthood

50
Q

Asthma classifications

A

ages 5-11

Step 1: intermittent asthma
symps <2days/week

Step 2: mild persistent asthma
symps >2 times/week but <once/day

Step 3 or 4: severe persistent asthma
symps several times a day

step 1 tx: bronchodilator

51
Q

Asthma etiology

A

multifactorial: genetic, immunologic, environmental, infectious, endocrine, psychological, biochemical factors

allergy influences persistence and severity

Strongest identifiable predisposing factor for developing asthma:
-Atopy (IgE-mediated response to common areoallergens => increased propensity to hypersensitivity reactions

Risk factors for asthma:
-atopy (including hx of allergies or atopic dermatitis (eczema)
-heredity (parents, sibling)
-gender (male>female until adolescence)
-smoking or 2nd hand exposure
-maternal smoking during pregnancy
-ethnicity (African-American)
-LBW
-high BMI

Asthma triggers:
-allergens (plants, pollen, air pollution, dust mites, dust, mold, smoke, sprays)
-occupational chemicals
-physical exercise
-cold air
-weather/temp changes
-environmental change
-cold/infections (bacterial or viral)
-animals (cats, dogs, rodents, horses)

52
Q

Asthma patho

A

initial release of inflammatory mediators from bronchial mast cells, macrophages, and epithelial cells

migration and activation of other inflam cells

alterations in epithelial integrity and autonomic neural control of airway tone

Increase in airway smooth muscle responsiveness -> wheezing, dsypnea, eventual obstruction

-inflammation narrows the airway and increases production of mucus
-Alveoli may become hyperinflated or collapse because of obstruction, leading to decreased perfusion of the alveolar capillaries and impaired gas exchange.
Impaired expiration leads to air tapping, hyperinflation, and dyspnea.

-inflammation and edema of mucous membranes

-accumulation of secretions = mucous plug

-spasm of smooth muscle bronchi and bronchioles

-hyperinflation of alveoli, collapse -> impaired gas exchange

53
Q

patho of asthma immunologic factors

A

allergy is the strongest risk factor for chronic morbidity and mortality

IgE is the most active antibody in allergic reactions
IgE mediates hypersensitivity reaction in
bronchial mucosa ->specific tissue binding

Release of chemical mediators
histamine
leukotrienes
prostaglandins
serotonin
platelet-activating factor
major effect of these:
-increased permeability of BV
-contraction of smooth muscle
-stimulation of mucous secretion

54
Q

patho of asthma vagal stimulation

A

balance of vagal (parasymp. rest/digest) & sympathetic nerve influences maintenance of bronchial smooth muscle tone

irritant receptors react to triggers => stimulate reflex bronchospasm (constriction - vagal)

normal response, BUT IN ASTHMA, this is abnormally severe
sympathetic = dilate
vagal (parasymp) = contsrict

55
Q

patho of asthma ventilation

A

Increased airway resistance:
-forced expiration -> air trapping,

air trap -> WOB, fatigue

WOB, fatigue -> ineffective resps, increased O2 consumption

decreased O2 avail-> ineffective cough

dysnpea, cyanosis, tachypnea

56
Q

patho of asthma gas exchange

A

depends on ratio of poorly ventilated/hyperextended alveoli VS. well-ventilated alveoli

as severity of obstruction increases -> reduced alveolar ventilation

CO2 retention, resp acidosis, hypoxemia, resp failure

57
Q

patho of asthma exacerbations

A

episodes of progressively worsening SOB, cough, wheezing, chest tightness

Decreases in expiratory airflow
-airways narrow because of bronchospasm
-mucosal edema and mucous plugging -> air trapping behind narrowed airways

Hyperinflation: keeps airways open and permits gas exchange

Hypoxemia: ventilation/perfusion mismatch

58
Q

classic manifestations of asthma

A

classic: dyspnea (SOB), wheezing, coughing

other:

prodromal itching (front neck, upper back)

mood changes like irritability, restlessness

feeling tired

headache

chest tightness

hacking, paroxysmal, irritative, nonproductive cough which becomes productive as secretions accumulate

coughing at night

59
Q

symptoms of worsening asthma

A

SOB
increased RR, HR, shallow
prolonged expiratory resps
pallor -> cyanosis
anxious
diaphoresis
position - tripod
retractions
VOICE CHANGES - short, panting, broken phrases

60
Q

PRAM resp assessment

A

air entry
wheezing
O2 sat
Suprasternal retractions
scalene muscle contraction

61
Q

Asthma complications

A

-increased susceptibility to infections - dt break in mucosal membrane

-Atelectasis: deflated alveoli, filled w/ fluid

-Emphysema: damaged alveoli, inner walls of alveoli weaken and rupture = creating large spaces instead of small ones
appear barrel-chested

-Status asthmatics (rare): long-lasting severe asthma attack that does not respond to normal tx

-Pneumothorax (rare): air leaks into lung and compresses

62
Q

When educating families, how would you explain how to use a peak expiratory flow meter?

A

Green zone (PEFM rate) 80-100%
-good asthma control, relatively free from symptoms
-follow asthma management plan and take usual meds

Yellow zone (PEFM rate) 50-80%
-caution
-asthma is worsening
-contact HCP to adjust tx

Red zone (PEFM rate) <50%
-danger
-management plan is not controlling symptoms
-use inhaled bronchodilator
-if peak flow readings do not return to at least yellow, contact HCP

figure out triggers, track with diary
allergen control: house dust mites, cockroaches
drug therapy
breathing exercises
hypo-sensitization
exercise

63
Q

What to include in a detailed health hx for asthma

A

current symptoms
medications
triggers
family hx of asthma or allergies

compare attack, look at differences

chest assessment:

1) Observation:
color
rythym, tachypnea
accessory muscles
indrawing
posture
fever/cold s&s
cough, wheeze

2) Auscultation:
air entry
breath sounds
movement of air
wheezing, crackles
changes w/ coughing, meds

3) Tests:
CXR
PEFR
ABG’s
O2 sats

64
Q

Supportive care for asthma

A

maintain patent airway
humidified O2
positioning - raise HOB to sit upright
rest and stress reduction
quiet environment, group care tasks
fluid - warm, may need IV fluids
avoid triggers
reassurance
discharge planning and teaching

MEDICATIONS

1) Beta-2 agonists - “rescuers” “relievers”
-Salbutamol (Ventolin), salmeterol (severvent), terbutaline(bricanyl)

2) Corticosteroids - anti-inflammatories
-inhaled: “preventors”
ex. fluticasone (Flovent), budesonide, beclomethasone

-oral: prednisone (relieve swelling), prednisolone, dexamethasone

-IV: methylprednisolone

3) Anticholinergics -prevent constriction but not as fast acting
ex Ipratropium (Atrovent)

4) Magnesium sulfate “rescuer”
-bronchodilator
-used in severe/life-threatening exacerbations
-immediate effects, given IV

5) Methylzanthines “rescuer”
-used primarily in emerg when unresponsive to other tx

6) Mast cell inhibitors “preventor”
-cromolyn sodium (intal), nedocromil (tilade)

7) Leukotriene receptor antagonists “preventor”
-accolate, singular
-more for kids with allergic response

65
Q

more tid bits

A

-if using puffer >2x/week = need preventative meds
preventor meds stop inflammation

-After taking steroids, rinse mouth to prevent thrush

-best way to admin is MDI with spacer
better than a nebulizer because lots gets wasted

66
Q

end resp

A

moo

n342 peds (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions