resp part 2

Question 1

what is BRUE

Answer 1

• brief resolved unexplained event
• previously known as a “life threatening event”
• typically lasts less than 1 min and resolves on its own

Question 2

what are some symptoms of BRUE

Answer 2

• pale or cyanotic
• irregular, decreased, or absence of breathing
• changes in muscle tone (hypotonic or hypertonic)
• altered responsiveness

Question 3

with BRUE, when would extensive testing be recommended

Answer 3

• high risk infants
• infants suspected of child abuse/maltreatment
• infection
• recurrent episodes
• fam history of genetic or metabolic conditions

Question 4

someone brings a dead infant into the ED, whats your first priority

Answer 4

• family support

answer their questions, allow time with their baby to grieve, and offer resources

Question 5

what is SIDS

Answer 5

• sudden death of an infant <1yr of age
• leading cause of infant mortality
• peak incidence in 2-4mo of age

Question 6

what are some clinical manifestations of SIDS

Answer 6

• evidence of a struggle or change in position
• presence of frothy blood tinged secretions from the mouth and nares
• parents find the infant dead in the crib in the morning of after a nap
• no cry or disturbance while infant is sleeping

Question 7

theres no definitive cause of SIDS, what are some risk factors?

Answer 7

• abnormality in medulla oblongata with neurotransmitter serotonin
• may interfere with brain stem mediated protective responses during sleep (arousal)
• uderlying vulnerability of infant (cardiac or neuro)
• cerebral oxygenation depressed in healthy infants with prone sleeping
• maternal smoking, alcohol intake, or substance abuse
• preterm or low birth weight
• native americans and black infants are at higher risk

Question 8

what are some environmental risk factors for SIDS

Answer 8

• sleeping prone or side lying
• use of soft bedding
• overheating
• bed sharing
• second hand smoke

Question 9

whats the #1 way to decrease incidence of SIDS

Answer 9

safe sleep practices

Question 10

what are the 2015 AAP recommendations

Answer 10

1. infants should sleep in the same room but not in the same bed, ideally for one year, at least for 6 months
2. parent should spend time in skin-skin contact with newborns

additional:
- breastfeeding
- use of pacifier at naps/bedtime
- complete immunizations
- tummy time
- swaddling: up to 2mo, after sleep in sleep sack

Question 11

what is plagiocephaly

Answer 11

molding of the head by continued pressure against a surface

Question 12

how can plagiocephaly be resolved

Answer 12

rotating the side of the head the infant sleeps and by placing the infant prone while awake and being observed

Question 13

describe SUIDS and how to prevent it

Answer 13

• sudden unexpected infant death
• not due to SIDS
• due to suffocation in pillow, bumpers, blankets
• no pillows, bumpers, or blankets in crib
• no stuffed animals in crib
• high incidence with co sleeping
• swaddling after 2 months, increases risk

Question 14

whats the other name for croup

Answer 14

acute laryngotracheobronchitis

Question 15

what is croup or LBT

Answer 15

• a viral invasion of upper airway extends through larynx, trachea, and bronchi
• inflammation of the mucosal lining of the larynx/trachea: narrowing of the airway
• most common under 6; peak between 7-36mo

Question 16

what clinical manifestations would you expect to see with croup or LBT

Answer 16

• fever
• tachycardia
• barking seal like cough
• hoarseness
• dyspnea
• inspiratory stridor
• possible retractions

Question 17

if a kid is in mild resp distress how are you gonna hydrate

Answer 17

oral fluids

Question 18

if a kid is in moderate to severe resp distress how are you gonna hydrate

Answer 18

IV fluids

Question 19

what are some nursing interventions for croup or LBT

Answer 19

• assessments and vital signs
• hydrations and I+O
• pulse ox and oxygen as ordered
• meds
• parents need to keep the kid calm
• education and discharge planning

priority intervention: do as little as possible
only hands on when necessary

Question 20

describe giving nebulized epi (racemic epi) for croup or LBT

Answer 20

• alpha adrenergic effects causes vasoconstriction and decreases edema of cells
• beta adrenergic acts as bronchodilator

monitor afterwards for rebound symptoms

Question 21

describe giving dexamathasone for croup or LBT

Answer 21

• anti inflammatory corticosteroid
• decreases airway edema

Question 22

when do most kids go home with croup or LBT

Answer 22

• 24-72 hours
• viral illness lasts several days to several weeks

Question 23

describe managing mild croup at home

Answer 23

• take outside and breathe in cold air/freezer; cold temps decrease edema in airway
• hydration and I+O
• calm parents = calm kid
• teach parent signs and symptoms of resp distress and who to call and where to go

Question 24

what is epiglottitis

Answer 24

• inflammation of the epiglottis; upper airway
• edema is rapid… within minutes/hours
• potentially life threatening condition
• usual age range 3-7yrs

Question 25

what are some symptoms of epiglottitis

Answer 25

- high fever - high RR - dysphagia - dysphonia - drooling - dyspnea - inspiratory stridor (late sign)

Question 26

whats the clinical therapy for epiglottitis

Answer 26

immediate intubation and antibiotics extubated in 1-2days and home for full course of antibiotics

Question 27

what should you most definitely not do for someone with epiglottitis

Answer 27

do not obtain any cultures from throat if epiglottitis is suspect, any stimulation can trigger complete airway obstruction also dont leave em unattended

Question 28

what are some possible causes of epiglottitis

Answer 28

- H. influenzae, but may be staph or strep as well - burning from hot liquids - direct injury to throat

Question 29

describe bronchiolitis

Answer 29

- RSV is the cause in majority of cases - multiple other viruses may also cause - annual epidemic from october to march - particularly dangerous in infants and young children d/t small airway and other differences

Question 30

describe the patho/phys of bronchiolitis

Answer 30

- RSV invades mucosal cells in bronchi and bronchioles - invaded cells die when virus bursts from inside cell - membranes of infected cells fuse with adjacent cells creating large masses - cell debris obstructs bronchioles and irritates airway - airway lining swells and produces excessive amounts of mucus - airway obstruction results during expiration with bronchospasms - air can come in but mucus and edema do not allow air out causing air trapping and hyperinflation of alveoli - interferes with normal gas exchange = hypoxemia

Question 31

what symptoms are associated with bronchiolitis

Answer 31

- wheezing - moist cough - nasal drainage - retractions - poor feeding - dyspnea, tachypnea, tachycardia

Question 32

will albuterol help with wheezing associated with bronchiolitis

Answer 32

nope

Question 33

where are most children with bronchiolitis cared for

Answer 33

home

Question 34

in what situations are children with bronchiolitis usually hospitalized

Answer 34

hx of congenital heart disease, lung disease, bronchopulmonary dysplasia, prematurity, congenital disorder, young age

Question 35

whats used to diagnose bronchiolitis

Answer 35

- history and physical - nasal swab is best practice - CXR

Question 36

will antibiotics help with bronchiolitis

Answer 36

nope

Question 37

whats the plan of care with bronchiolitis

Answer 37

- assessments and vital signs - cardiac/pulmonary monitor/pulse ox - humidified oxygen - nasal suctioning with nose drops - elevate HOB - hydration and I+O - contact isolation for RSV, usually droplet til be know what it is - acetaminophen/ibuprofen - psychosocial care and education

Question 38

whats the first intervention for kids with bronchiolitis

Answer 38

nasal suctioning with nose drops

Question 39

what meds are used for bronchiolitis

Answer 39

nebulized hypertonic saline (3%) Synagis (palivizumab) antipyretics: acetaminophen/ibuprofen corticosteroids, cough suppressants and antibiotics are not recomended for routine use bronchodilators may be tried but there not support in literature

Question 40

what does nebulized hypertonic saline (3%) do for bronchiolitis

Answer 40

- softens secretions, induces cough, reduces edema by absorbing water through mucosa, dislodges materials causing obstruction - research demonstrated effectiveness and shorter hospitalization (AAP)

Question 41

describe synagis (palivizumab)

Answer 41

- monoclonal antibody - reduces RSV related hospitalizations - IG1 antibody that neutralizes and inhibits RSV replication - used for high risk infants - IM (provide atraumatic care) - first dose prior to start of RSV season and monthly IM until season finished (october through march)

Question 42

whats the length of illness with bronchiolitis

Answer 42

- most symptoms abate within 24-72hrs - resolution of all symptoms may take weeks - some infants have repeated occurrences - may increase risk for wheezing and the development of asthma

Question 43

what are some symptoms of pneumonia

Answer 43

- high fever - crackles in the affected lung - dyspnea, tachycardia, tachypnea - abdominal pain - diarrhea

Question 44

describe the difference between bacterial and viral pneumonia

Answer 44

bacterial - get sick super quickly - sudden high fever and rapid breathing viral - more gradual onset and less severe sx

Question 45

what would be included in the plan of care for a child with pneumonia

Answer 45

- assessments and vital signs - assist with lab studies/radiology - oxygen therapy - pulmonary care: cough and deep breathing (bubble bloing, pinwheels) - antibiotics - acetaminophen/ibuprofen for fever or discomfort - hydration and I+O - discharge planning: education regarding meds, signs and symptoms of resp distress