Respiratory Dysfunction (Part 2) - Unit 2 Flashcards by Andrew Working

What is tonsilitis?

Inflammation of the tonsils

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If a kid has repeated infections (tonsilitis, etc) and sleep apnea - what are they a candidate for? (think throat surgery)

Tonsilectomy/Adenectomy

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Pre-op for tonsilectomy - can have all pain meds, especially ibuprofen - T/F?

FALSE

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Fluids - not important following tonsilectomy. T/F?

FALSE - very important.

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A week after an Adenoectomy/Tonsilectomy, ear pain is NOT normal. T/F?

FALSE - it is.

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Excessive swallowing, vomiting bright red blood (follow A&T)- most common 1st __ hours and __ to __ days.

Because of the blood, kids shouldn’t have anything red after. T/F?

24 hours and 7-10 days

True!

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What are some contraindications for a tonsillectomy?

Clef palate, acute infection @ the time of surgery, uncontrolled systemic disease

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What are the two types of influenza?

A&B

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Influenza - spread by __ contact (____ droplet)

direct contact, large droplet

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Influenza - most infectious __ hours before and __ hours after symptoms 1st appear.

24 hours!

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What are some manifestations of influenza? Complications?

Manifestations = dry cough, sudden onset of fever, croup.

Complications = pneumonia, encephalitis, secondary bacterial infections, etc.

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Should we give acetaminophen/ibuprofen/fluids to influenza patients?

Yes

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Which drug treats which influenza?

Amantadine hydrochloride (Symmetrel) -
Rimantadine -
Zanamivir -
Oseltamivir -

Amantadine hydrochloride (Symmetrel) - A
Rimantadine - A
Zanamivir - A & B
Oseltamivir - A & B

(Antadine’s = A)
(Ivir’s are virus fighters and are stronger so they kill both!)

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What is foreign body aspiration? What ages are at risk? What are they matriculating that they shouldn’t?

Inhalation of any object into the respiratory tract.

Think pincer grasp kids - 9-11 months

Nuts, popcorn, raw veggies, hot dogs, toys, pins, batteries…

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What is the most common site for lower airway obstructions? And where are the obstructions typically at?

Bronchial/Right Bronchi

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What are some manifestations of an airway obstruction?

Coughing, choking, dysphonia (can’t speak), dyspnea, respiratory distress, hypoxia associated behavior changes, Xray changes (hyperinflation, object may be seen),

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How do we treat an obstruction?

Chest thrusts/back blows but DO NOT try to remove the object unless your two eyes see it…or bronchoscopy!

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Apnea is the cessation of respirations lasting longer than ___ seconds. It can also be a pause in ___, associated with cyanosis, hypotonia, pallor, or bradycardia.

20 seconds.

Respirations.

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Apnea with change in color, muscle tone, and/or choking - usually under 4 months, can be caused by reflux, respiratory illness, seizures, etc….should we be on alert for child abuse? Everything else T/F?

Yes - T

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What are the croup syndromes?

Upper airway illness caused by swelling of the larynx and epiglottis, with swelling that usually extends to trachea and bronchi.

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What are the three big croups? Which is the worst? Which one is the one we think of?

Epiglottitis (THE WORST), Laryngotracheobronchitis (LTB - what we think of), Bacterial tracheitis

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Epiglottitis - what is it?

A LIFE THREATENING swelling.

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Epiglottitis - can obstruct airway within minutes to hours. T/F/

Truw

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Epiglottitis - peak age of __ to __ years and it progresses ____

2-6 years

Rapidly

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What are the most common causative organisms for epiglottitis?

Streptococcus, staphylococcus aureus, haemophilus influenza type b (HIB)

Epiglottitis - drooling occurs because why? Should we poke and prod them?

They can't swallow :( | DO NOT TOUCH THEM until a doctor is present to intubate.

Epiglottitis - Lateral X Ray - what's present?

Thumb Sign

Epiglottitis - kids are typically in what position?

Tripod

What is laryngotracheobronchitis?

Viral invasion of the upper airway - extnds to larynx, trachea and bronchi and also inflammation of the submucosa and subglottic area.

laryngotracheobronchitis - stridor worsens in the morning. T/F/

FALSE - night.

laryngotracheobronchitis - large amounts of thin secretions can lead to airway obstruction. T/F?

TRUE

Croup - Ap X-ray - what do we look for?

Steeple sign - this is for CROUP, not Epiglottitis - don't get confused.

Should we use cool mist for croup?

Yes

Croup - racemic epinephrine - given how? What does it do? Albuterol.? What does it do? Corticosteroids - what do they do? Heliox - what do they do?

Epi - constrictions capillaries of subglottic mucosa (given throuh inhalation - keep for an hour after because they can have rebound issues - usually done in ER). Albuterol - bronchodilator. Steroids - decrease airway edema. Heliox - helium & O2 - typically in an ICU.

Bacterial tracheitis - secondary infection of the ___ trachea after viral infection.

Upper trachea

What are the typical causative organisms for bacterial tracheitis?

Staphylococcus aurues, MRSA, group A b-hemolytic streptococci, H influenza

airway edema and thick secretions - not a part of bacterial tracheitis. T/F?

FALSE - it is- can lead to obstruction!

Bacterial tracheitis - croupy cough and stridor - T/F/

True

Bronchiolitis - what is it? How is it spread?

Inflammation of lower respiratory tract causing an obstruction of small airways. Spread through direct contact with repsiratory secretions.

Who is at risk for bronchiolitis?

Premies, those not breast fed, those in crowded conditions and those exposed to smoke.

What are the two subtypes of RSV?

Type B (Mild) & type A (more virulent/aggressive)

RSV - infection restricted to respiratory mucosa. T/F/

True

RSV - forms a layer impairing cilia function and causes submucosal edema. T/F/

True

RSV - epithelia cells die and are shed into the bronchioles, causing obstruction (typically on expiration) and leads to hyperinflation and patchy areas of atelectasis) - T/F?

True

how is RSV transmitted?

Direct contact with nasal secretions, contact with contaminated items, no long term immunity so the kids are sunk....etc.

How do we diagnose RSV?

based on clinical picuture - enzyme immune assay (nasal aspirate, results come quick), WBC is slightly elevated, chest x-ray that might show patchy areas or consolidation, airtrapping, etc.

What are some manifestations of bronchiolitis?

History of URI, fever, may progress to lower tract, respiratory distress (tachypnea, retractions, wheezing, prolonged expirations, rales)

For bronchiolitis, should we monitor the respiratory system, suction with a bulb syringe and do CPT (percussion) for selected cases?

Yes

Bronchiolitis - bronchodiolator, corticosteroids, antiviral/antibiotic in severe cases, O2 if needed?

Yes

Bronchiolitis - is it contact isolation?

YES

Brocnhiolitis - handwashing isn't imporatant. T/F?

FALSE

Bronchiolitis - should people/kids who have colds be allowed in?

RSV vaccine - when? What diseases/risk factors?

What is synagis (palivizumab) ?

RSV vaccine - given IM and given monthly during RSV season (about 5 doses) - may not prevent disease but reduces severity!

What is tracheoesaphageal atresia?

Occurs when the trachea and esophagus fail to separate and develop as 2 isolated tubes --- can occur with polyhydramnios (increased amniotic fluid).

What is tracheoesaphageal atresia a component of? (hint - syndrome!)

VATER syndrome - anomolies of vertebrae, anus, trachea, esophagus, radial/renal. VACTERAL includes cardiac and limbs.

What is type A tracheoesaphageal atresia?

missing mid segment - just doesn't connect to stomach.

what is type B tracheoesaphageal atresia?

Risk of aspiration - no connection to stomach but esopaghus and trachea are communicating together.

what is type C tracheoesaphageal atresia?

Stomach is connected to trachea

What is type D tracheoesaphageal atresia?

All connected by esopaghus is improperly connected to the trachea

what is type E tracheoesaphageal atresia?

Almost right, just that the trachea and esophagus have a fistula

What are some manifestations and things to do for tracheoesaphageal atresia?

Frothy saliva, drooling, choking, coughing, NPO, frequent suctioning, antibiotics, surgical correction

The most profound complication of prolonged middle ear disorders is :

loss of hearing.

What is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temp?

Give small amounts of favorite fluids frequently to prevent dehydration