respiratory disorders Flashcards
(66 cards)
1
Q
tonsils
A
- Masses of lymph-type tissue.
- Filter pathogenic organisms (viral and bacterial)
- Contribute to antibody formation.
- Tonsils are highly vascular.
- Palatine and Pharyngeal
2
Q
enlarged tonsils interferes with
A
- Enlarged tonsils can block the nose and throat.
- Interferes with breathing, nasal and sinus drainage, sleeping, swallowing, and speaking.
3
Q
acute tonsillitis
A
occurs when the tonsils become inflamed and reddened.
Can become chronic.
4
Q
tonsillitis risk factors
A
- Exposure to a viral or bacterial agent
- Immature immune systems (younger children)
5
Q
tonsillitis expected findings
how to test for it
A
- Sore throat with difficulty swallowing
- History of otitis media and hearing difficulties
- Mouth odor
- Mouth breathing
- Snoring
- Nasal qualities in the voice
- Fever
- Tonsil inflammation with redness and edema
- Throat culture for group A beta-hemolytic streptococci (GABHS)
6
Q
tonsillits nursing care
A
- Provide symptomatic treatment for viral tonsillitis (rest, warm fluids, warm salt-water gargles).
- Administer antibiotic therapy as prescribed for bacterial tonsillitis.
- Antipyretics/analgesics: acetaminophen
- Hydrocodone is indicated for the child having difficulty drinking fluids.
7
Q
tonsillectomy post op care
A
- Place in position to facilitate drainage.
- Elevate head of bed when child is fully awake.
Assess for evidence of bleeding:
- frequent swallowing
- clearing the throat
- Restlessness
- Bright red emesis, tachycardia, and/or pallor
- Assess the airway and vital signs
- Monitor for difficulty breathing related to oral secretions, edema, and/or bleeding
- Administer liquid analgesics or tetracaine lollipops as prescribed
Provide an ice collar - Offer ice chips or sips of water to keep throat moist
8
Q
tonsillectomy after care
A
- Encourage clear liquids and fluids after a return of the gag reflex, avoiding red‑colored liquids, citrus juice, and milk‑based foods initially.
- Advance the diet with soft, bland foods.
- Discourage coughing, throat clearing, and nose blowing in order to protect the surgical site.
- Avoid straws
- Alert parents that there can be clots or blood‑tinged mucus in vomitus.
- Instruct the family to notify the provider if bright red bleeding occurs.
Encourage the child to rest.
- Instruct the family to notify the provider if bright red bleeding occurs.
9
Q
how many days can you bleed for after tonsillectomy
A
14
10
Q
Tonsillectomy: Parent Education
A
- Instruct the parents to contact the provider if the child experiences difficulty breathing, lack of oral intake, increase in pain, and/or indications of infection.
- Ensure that the child does not put objects in the mouth.
- Administer pain medications for discomfort.
- Encourage fluid intake and diet advancement Instruct the child and family to limit activity to decrease the potential for bleeding.
- Full recovery usually occurs in approximately 14 days.
- Teach manifestations of hemorrhage: Dehydration
Infection
11
Q
manifestations of hemorrhage
A
dehydration
infection
12
Q
tonsillectomy complications
A
hemmorrhage
dehydration
chronic infection
13
Q
tonsillectomy hemorrhage
A
- Use a good light source and possibly a tongue depressor to directly observe the throat.
- Assess for bleeding (tachycardia, repeated swallowing and clearing of throat, hemoptysis).
- Hypotension is a late sign of shock.
- Contact the provider immediately if there is any indication of bleeding.
- Instruct family to report indications of bleeding
14
Q
bleeding s/s tonsillectomy
A
tachycardia, repeated swallowing and clearing of throat, hemoptysis
15
Q
dehydration tonsillectomy nursing care
A
- Encourage oral fluids.
- Monitor I&O.
- Instruct the family to encourage oral fluids.
- Teach the family about manifestations of dehydration.
16
Q
chronic infection tonsillectomy
A
- GABHS can pose a potential threat to other parts of the body.
- Some children who frequently have tonsillitis can develop other diseases, such as rheumatic fever and kidney infection.
- Instruct the family to seek medical attention when the child presents with manifestations of tonsillitis.
17
Q
risk factors for common respiraotry illnesses
A
Disorders can affect both the upper and lower respiratory tracts.
- Age
I- nfants between 3 and 6 months are at increased risk due to the decrease of maternal antibodies acquired at birth and the lack of antibody protection. - Viral infections are more common in toddlers and preschoolers.
- Certain viral agents can cause serious illness during infancy, but only cause a mild illness in older children.
18
Q
Nasopharyngitis (Common Cold)
A
Nasal inflammation, dryness and irritation of nasal passages and the pharynx
- Fever, decreased appetite, and restlessness
19
Q
Nasopharyngitis (Common Cold) interventions
A
- Instruct parents about home management.
- Give antipyretic for fever.
- Encourage rest.
- Provide vaporized air (cool mist).
- Give decongestants for children older than 6 years.
- Give cough suppressants with caution
- Antihistamines are not recommended.
- Antibiotics are not indicated.
20
Q
Acute Streptococcal Pharyngitis
A
- Infection of the upper airway (strep throat)
- Onset is abrupt and characterized by pharyngitis, headache, fever and abdominal pain.
- can affect kidney and heart
21
Q
Acute Streptococcal Pharyngitis interventions
diagnosed by
A
Throat culture or rapid antigen testing to determine GABHS infection
Administer IV antibiotics as prescribed.
Oral penicillin for at least 10 days.
Amoxicillin once a day for 10 days.
IM penicillin G benzathine is also appropriate.
22
Q
bronchitis
A
- Associated with an upper respiratory infection and inflammation of large airways
- Requires symptomatic relief
- Persistent dry, hacking cough as a result of inflammation
- Resolves in 5 to 10 days
- Test nasopharyngeal secretions
23
Q
bronchitis interventions
A
- Test nasopharyngeal secretions
- Instruct parents about home management.
- Give antipyretics for fever.
- Give a cough suppressant.
- Provide increased humidity (cool mist vaporizer).
24
Q
bronchiolitis
A
Mostly caused by RSV
- Occurs at the bronchiolar level, may be progressive
- Rhinorrhea, intermittent fever, pharyngitis, coughing, sneezing, wheezing, possible ear or eye infection
- Increased coughing and sneezing, fever, tachypnea and retractions, refusal to nurse or bottle feed, copious secretions
- 1Tachypnea (greater than 70/min), listlessness, apneic spells, poor air exchange, poor breath sounds, cyanosis
25
bronchiolitis nursing care
- Supplemental oxygen to maintain oxygen saturation equal to or greater than 90%.
- Encourage fluid intake, otherwise IV fluids until acute phase has passed.
- Maintain airway.
- Medications as prescribed.
- Antibiotics if a coexisting bacterial infection is present
- Nasopharyngeal or nasal suctioning as needed.
- Encourage breastfeeding
- Ng tube for food
- Corticosteroid use is controversial.
- Bronchodilators are not recommended.
26
allergic rhinitis
- Caused by seasonal reaction to allergens most often in the autumn or spring
- Watery rhinorrhea; nasal obstruction; itchiness of the nose, eyes, pharynx and conjunctiva;
- Snoring; fatigue, malaise, headache and poor performance in school.
27
allerguc rhinitis interventions
- Instruct parents about home management.
- Avoid allergens (epi for severe)
- Give nasal corticosteroids (first-line medications used).
- Give antihistamines, beta-adrenergic decongestants, and ipratropium.
28
bacterial pneumomia s/s
- High fever
- Cough that can be unproductive or productive of white sputum
- Tachypnea
- Retractions and nasal flaring
- Chest pain
- Dullness with percussion
- Adventitious breath sounds (rhonchi, fine crackles)
- Pale color that progresses to cyanosis
- Irritability, restless, lethargic
- Abdominal pain, diarrhea, lack of appetite, and vomiting
29
viral pneumonia interventions
- Administer oxygen with cool mist.
- Monitor continuous oximetry.
- Administer antipyretics for fever.
- Monitor I&O.
- CPT and postural drainage
30
s/s of hypoxic
irritabile
| restless
31
bacterial pneumonia interventions
- Encourage rest.
- Administer IV antibiotics.
- Promote increased oral intake.
- Monitor I&O.
- Administer antipyretics for fever.
- CPT and postural drainage can be helpful.
- Administer IV fluids.
- Administer oxygen.
- Monitor continuous oximetry
32
pneuomonia complications
pneumothorax
| pleural effusion
33
pneumonia complication: pneumothorax
- Accumulation of air in the pleural space
| - Dyspnea, chest pain, back pain, labored respirations, decreased oxygen saturations, and tachycardia
34
pneumonia complication: pneumothorax interventions
- Prepare the client for an emergent needle aspiration with insertion of chest tube to closed drainage.
- Provide for chest tube management.
- Assess respiratory status.
- Administer oxygen.
35
pneumonia complication: pleural effusion s/s
Dyspnea, chest pain, back pain,
| labored respirations, decreased oxygen saturations, and tachycardia
36
pneumonia complication: pleural effusion interventions
- Prepare the client for an emergent needle aspiration to remove fluid in the pleural space, with insertion of chest tube to closed drainage.
- Provide for chest tube management.
- Assess respiratory status.
- Administer oxygen as prescribed.
37
croup syndrome
bacterial apiglottitis
- swelling of airway
- HIB vaccine
- Medical emergency
- Usually caused by Haemophilus influenza
- Absence of cough, drooling, and agitation
- Sitting upright (tripod position)
- Dysphonia/Dysphagia
- Inspiratory stridor (noisy inspirations)
- Suprasternal and substernal retractions
- Sore throat, high fever, and restlessness
- With chin pointing out, mouth opened, and tongue protruding
(thick, muffled voice and froglike croaking sound)
38
croup sundrome interventions
| diagnosed by
- Diagnosed by lateral neck X-Ray
- Protect airway.
- Avoid throat culture or using a tongue blade.
- Prepare for intubation (last resort).
- Provide humidified oxygen (cold).
- Monitor continuous oximetry.
- Administer corticosteroids, and IV fluids as prescribed.
- Administer antibiotics.
- Droplet isolation precautions for first 24 hr after IV antibiotics initiated
39
croup syndrome:Acute laryngotracheobronchitis
Causative agents include RSV, influenza A and B, and Mycoplasma pneumonia, parainfluenza types 1, 2, and 3.
40
croup: Acute spasmodic laryngitis:
- Self-limiting illness that can result from allergens.
| - Characterized by paroxysmal attacks of laryngeal obstruction that occur mainly at night.
41
croup: Acute laryngotracheobronchitis s/s
Low-grade fever, restlessness, hoarseness, barky cough, dyspnea, inspiratory stridor, and retractions.
Nasal flaring, intercostal retractions, tachypnea, and continuous stridor.
42
croup: Acute spasmodic laryngitis: s/s
Croupy barky cough, restlessness, difficulty breathing, hoarseness, and nighttime episodes of laryngeal obstruction
43
croup o2 and meds
- Provide humidity with cool mist.
- Administer oxygen if needed.
- Monitor continuous oximetry.
- Administer nebulized racemic epinephrine as prescribed.
- Administer corticosteroids: oral or IM (dexamethasone), or nebulized (budesonide).
- Encourage oral intake if tolerated.
- Administer IV fluids as prescribed.
44
flu a & b s/s
- Sudden onset of fever and chills
- Dry throat and nasal mucosa
- Dry cough
- Flushed face
- Photophobia
- Myalgia
- Fatigue
45
flu a & b interventions
- Instruct parents about home management.
- Promote increased fluid intake.
Rest.
- Acetaminophen or ibuprofen for fever
- Give medications, as prescribed.
- Amantadine (type A)
- Rimantadine (type A)
- Zanamivir (type A and B)
- Oseltamivir (type A and B)
46
a &B vaccine
- Inactivated influenza vaccine recommended for children 6 months and older.
- Live vaccination should not be used in children who have heart or lung disease, diabetes or kidney failure, are immunocompromised, have respiratory conditions, are pregnant, have a severe allergy to chicken eggs, or have a history of Guillain-Barré syndrome
47
asthma
- A chronic inflammatory disorder of the airways
- most common s/s: wheezing
- Results in intermittent and reversible airflow obstruction of the bronchioles.
- Obstruction occurs either by inflammation or airway hyper-responsiveness.
48
asthma diagnoses categories
Diagnoses are classified into one of four categories based on effects on the child:
- Intermittent
- Mild and moderate persistent
- Severe persistent
49
asthma risk factors
- Family history of asthma and allergies
- Gender
- Exposure to smoke
- Low birth weight
- Being overweight
(boys affected more than girls until adolescence, then the incidence is greater among girls)
50
asthma triggers
- Allergens
- Indoor: mold, cockroach antigen, dust, dust mites
- Outdoor: grasses, pollen, trees, shrubs, molds, spores, air pollution, weeds
- Irritants: Tobacco smoke, wood smoke, odors, sprays
- Exercise
- Cold air
- Environmental change (new home or school)
- Infections/colds
- Animal hair or dander
- Medications: Aspirin, nonsteroidal anti-inflammatory drugs, antibiotics, beta blockers
- Strong emotions: Fear, anger, laughing, crying
- Conditions: Gastroesophageal reflux, tracheoesophageal fistula
- Food allergies or additives (sulfites)
- Endocrine factors: Menses, pregnancy, thyroid disease
51
asthma symptoms
- Chest tightness
- History regarding current and previous asthma exacerbations
- Dyspnea
- Cough
- Audible wheezing
- Coarse lung sounds, wheezing throughout possible crackles
- Mucus production
- Restlessness, irritability, anxiety
- Sweating
- Use of accessory muscles
- Decreased oxygen saturation (low SaO2)
52
asthma diagnostic
pulmonary function test
peak expiraotry flow rate
bronchoprovocation testing
53
asthma: pulmonary function tests
- The most accurate tests for diagnosing asthma and its severity
- Baseline test at time of diagnosis
- Repeat testing after treatment is initiated and child is stabilized
T- est every 1 to 2 years
54
asthma: peak expiratory flow rates
- Measures the amount of air that can be forcefully exhaled in 1 second
- Each child needs to establish personal best
55
asthma: bronchprovoation testing
- Exposure to methacholine, cold air, histamine, exercise
- Skin prick testing: Identify allergens
- Chest x-ray: Showing hyperexpansion and infiltrates
56
asthma nursing care for s/s
- Assess airway patency, respiratory rate, symmetry, effort, and use of accessory muscles.
- Assess breath sounds in all lung fields.
- Monitor for shortness of breath, dyspnea, and audible wheezing.
- An absence of wheezing can indicate severe constriction of the alveoli.
- Monitor vital signs and oxygen saturation.
- Check CBC and chest x-ray results, possible ABGs.
57
asthma nursing care
- Position the child to maximize ventilation.
- Administer oxygen as prescribed.
- Keep intubation equipment nearby.
- Initiate and maintain IV access as prescribed.
- Maintain a calm and reassuring demeanor.
- Encourage appropriate vaccinations and prompt medical attention for infections.
- Administer medications.
- The provider can prescribe antibiotics if a bacterial infection is confirmed.
58
asthma medications: bronchodilators
short acting
long acting
```
Short-acting beta2 agonists (SABA)
- albuterol, levalbuterol, terbutaline
- Used for acute exacerbations
- Prevention of exercised-induced
asthma
```
Long-acting beta2 agonists (LABA)
- formoterol, salmeterol
- Used to prevent exacerbations, especially at night, and reduce use of SABA.
- Must be used along with anti-inflammatory therapy.
- Cannot be used to treat acute exacerbations.
59
asthma meds: cholinergic antagonists
- atropine, ipratropium
- Instruct the child and family in the proper use of metered-dose inhaler or nebulizer.
- Watch the child for tremors and tachycardia when taking albuterol.
- Observe the child for dry mouth when taking ipratropium.
- Encourage older children who are taking ipratropium to suck on hard candies to help with dry mouth.
- Teach children to administer prior to exercise or activity.
60
asthma medications: corticosteroids
- Can be given parenterally (methylprednisolone), orally (prednisone), or by inhalation (fluticasone).
- Oral systemic steroids can be given for short periods (3 or 10 days).
- Inhaled corticosteroids are administered daily as a preventive measure.
- Leukotriene modifiers (zafirlukast, montelukast).
- Mast cell stabilizers (cromolyn)
- Monoclonal antibodies (omalizumab)
61
asthma corticosterioids interventions
- Combination medications contain an inhaled corticosteroid and a LABA (fluticasone/salmeterol)
- Observe the oral mucosa for infection secondary to use of inhaled medication.
- Encourage fluids to promote hydration.
- Encourage taking with food.
- Instruct to rinse mouth
- Instruct to watch for redness, sores, or white patches in the mouth.
- Teach dosage, tapering off medication, length of time to take.
- Assess weight, blood pressure, electrolytes, glucose, and growth with oral corticosteroid use.
62
asthma pt. teaching
- Instruct the family and child to identify personal triggering agents.
- Provide the family and child with an asthma action plan.
- Instruct the child how to properly self-administer medications (nebulizers, inhalers, and spacer).
- Teach the child how to use a peak flow meter. (Use at the same time each day.)
- Teach the family to keep a record of PEFR results. Readings over time show the child’s “best” efforts, and to provide a warning of increased airway impairment.
- Teach the family and child how to recognize an asthma exacerbation
- Teach the family and the child about when to use medications
- Educate the child and family regarding infection prevention techniques.
- Promote good nutrition.
- Encourage prompt medical attention for infections.
- Stress the importance of keeping immunizations, including seasonal influenza and pneumonia vaccines, up to date.
- Encourage regular exercise as part of asthma therapy.
63
asthma promote ventilation and perfusion
◯ Maintains cardiac health
◯ Enhances skeletal muscle strength
● Children can require medication before exercise.
64
asthma complications
status asthmaticus
| respiratory failure
65
status asthmaticus interventions
- Monitor oxygen saturations and continuous cardiorespiratory monitoring.
- Position the child sitting upright, standing, or leaning slightly forward.
- Administer humidified oxygen.
- Administer three nebulizer treatments of a beta2-agonist, 20 to 30 min apart or continuously. Ipratropium bromide can be added to the nebulizer to increase bronchodilation.
- Obtain IV access.
- Monitor ABGs and serum electrolytes.
- Administer corticosteroid.
- Prepare for emergency intubation.
- Magnesium sulfate : moderate to severe asthma when treated in the emergency department or pediatric ICU.
- Heliox (a mixture of helium and oxygen
66
asthma: respiratory failure
- Persistent hypoxemia related to asthma can lead to respiratory failure.
- Monitor oxygenation levels and acid-base balance.
- Prepare for intubation and mechanical ventilation as indicated.
