respiratory function pt. 2 (1)

Question 1

what is the old term for brief resolved unexplained event (BRUE)

Answer 1

aparent life-threatening event

Question 2

at what ages do BRUEs occur?

Answer 2

infant-1 yr

Question 3

symptoms of BRUE

Answer 3

• pale or cyanotic
• irregular, dec, absent breathing
• changes in tone
• altered responses

Question 4

how long does a BRUE last

Answer 4

less than a minute, self resolving

Question 5

when is extensive testing reccomended for BRUE?

Answer 5

only for…
* high risk infants
* suspected abuse
* suspected infection
* recurrent episodes of fam hisotry of genetic or metabolic cionditions

Question 6

what would the priority be with the family if an ambulance brought in a 3 m.o. who died in the crib?

Answer 6

• family support
• answer questions
• allow fam time with the baby

Question 7

what is sudden death, during sleep, of an infant less than a year old

Answer 7

SIDS

Question 8

how is SIDS explained after autopsy/death scene investigation?

Answer 8

unexplained

Question 9

what ages is SIDS most common

Answer 9

2-4 months

Question 10

leading cause of infant mortality

Answer 10

SIDS

Question 11

clinical manifestations of SIDS

Answer 11

• evidence of a struggle or change in position (prone)
• presence of frothy blood tinged secretions from the mouth and nares

Question 12

do parents notice disturbance or cry when a baby dies of SIDS

Answer 12

no

Question 13

what is possible etiology and pathophysiology of SIDS

Answer 13

• abnormality of medulla oblongata with serotonin
• may interfere with brainstem mediated protective responses during sleep

Question 14

why can prone sleeping cause SIDS

Answer 14

cerebral oxygenation depressed

Question 15

which of the following are infant risk factors for SIDS?
a) meternal smoking, alcohol or substane use
b) preterm or low birth weight
c) native maerican of black infants at higher risk
d) females at higher risk

Answer 15

a,b,c (males more at risk)

Question 16

which of the following are environmental factors of SIDS
a) sleeping prone or side-lying
b) soft bedding
c) sleeping supine
d) overheating
e) bed sharing
f) second hand smoke

Answer 16

all except sleeping supine!

Question 17

who/when was the back to sleep reccomendation initiated?

Answer 17

american acedemy of pediatrics in 1992

Question 18

when was back to sleep recommendation revised and what did it say

Answer 18

only sleep on back!

Question 19

what did the back to sleep recommendation initially say?

Answer 19

sleep on back or side

Question 20

which campaign involved prevention of all sleep related causes of death?

Answer 20

safe to sleep campaign (2012)

Question 21

what were the 2 main AAP recommendations for safe sleep

Answer 21

1. should sleep in same room, not bed as mom ideally for a year, at least 6 m.o.
2. mothers and fathers should do skin/skin with newborns

Question 22

what is molding of the head by continued pressure against a surface

Answer 22

plagiocephaly

Question 23

how is plagiocephaly resolved?

Answer 23

rotating side of head that infant sleeps on, place the infant prone while awake and supervised (tummy time)

Question 24

what is due to suffocation in pillow, bumpers, or blankets

Answer 24

suddent unexpected infant death (NOT SIDS)

Question 25

how to prevent sudden unexoected infant death?

Answer 25

no pillows, bumpers, blankets, animals sleep alone no swaddle after 2 mo

Question 26

a 6 mo old was admitted with dyspnea, hoarse barky cough, and insp. stridor. what is diagnosis?

Answer 26

acute laryngotracheobronchitis (croup)

Question 27

what is a viral invasion of upper airway and extneds through larynx, trachea, and bronchi. includes inflammation of mucosal lining of larynx/trachea: narrowing of airway

Answer 27

acute laryngotracheobronchitis (croup)

Question 28

what is the most common age group and oeak age group for laryngotracheobrinchitis (croup)

Answer 28

* most common under 6 y.o. * peaks between 7-36 months

Question 29

manifestations of laryngotracheobronchitis (croup)

Answer 29

fever, tachypnea, tachycardia, barky cough!, hoarse voice, dyspnea, insp. stridor, possible retractions

Question 30

what is the priority intervention with laryngotracheobronchitis?

Answer 30

do as little as possible! (touch agitates child, stridor and irritation worsens)

Question 31

assessment includes RR 76, HR 180, pale pink color, severe insp stridor, frequent harsh barky cough, moderate intercostal retractions, POX 93 what is the plan of care? what is priority?

Answer 31

call HCP for nebulized epinephrine (laryngotracheobronchitis)

Question 32

what are alpha adrenergic effects?

Answer 32

vasoconstriction and decrease edema

Question 33

what are beta adrenergic effects

Answer 33

bronchodialtor

Question 34

when and why is dexamethasone given?

Answer 34

laryngotracheobronchitis (croup) given in ED, anti-inflamamtory corticosteroid, decreases edema

Question 35

what is the duration adn peak of dexamethasone

Answer 35

duration= 72 hours peak= 1-2 hours

Question 36

when do most children go home from the hospital after laryngitracheobroncitis (croup)?

Answer 36

24-72 hr

Question 37

how long does laryngotracheobronchitis last?

Answer 37

several days to weeks

Question 38

how can mild croup be managed at home?

Answer 38

* take child outside to breathe in cold air (wear jacket) (decreases edema) * maintain hydration and I&O * calm the parents by educating * teach s/sx of resp distress

Question 39

can epiglottitis be life threatening?

Answer 39

true

Question 40

how can epiglottitis be life threatening?

Answer 40

inflammation of upper airway, edema is rapid (mins/hrs) can obstruct

Question 41

non resp symptoms of epiglottitis

Answer 41

muffled voice, dysphagia, drooling

Question 42

resp symptoms of epiglottitis

Answer 42

dyspnea, insp stridor, high fever, high RR

Question 43

clinical therapy of epiglottitis

Answer 43

immediate intubation and antibiotics

Question 44

when is a child with epiglottitis extubated

Answer 44

1-2 days

Question 45

what is a child sent home with after being extubated for epiglottitis

Answer 45

full course of antibiotics

Question 46

if youre working in february, a large percent of infants have the same resp diagnosis, what is it? does it occur every year?

Answer 46

bronchiolitis, annual outbreak

Question 47

when does bronchiolitis anually outbreak?

Answer 47

octiber-march

Question 48

what is the main cause of bronchiolitis?

Answer 48

RSV, other viruses too

Question 49

how does bronchiolitis airway obstruction occur

Answer 49

virus invades bronchi and bronchioles, cells die inside, fuse and collect cells, obstructing bronchioles, airway swells

Question 50

describe ibstruction in bronchiolitis

Answer 50

air allowed in but mucus and edema does not allow air out, air trapping and hyperinflation of alveoli

Question 51

which symptoms are in bronchiolitis? 1. wheezing 2. stridor 3. dry cough 4. nasal drainage 5. retractions 6. poor feeding 7. dyspnea, tachypnea, tachycardia

Answer 51

1, 4,5,6,7

Question 52

what is always a characteristic of brinchiolitis?

Answer 52

moist cough

Question 53

describe when a child is hospitalized for bronchiolitis?

Answer 53

* most not hospitalized * if they have a history of congenital heart disease, lung disease, BPD, prematurity, congenital disorder, young age

Question 54

how is bronchiolitis diagnosed?

Answer 54

history and physical, nasal swab for isolation

Question 55

what is not recommended to diagnose bronchiolitis and why?

Answer 55

CXR, nonspecific lung inflammation

Question 56

acetaminophen vs. ibuprofen use

Answer 56

acetaminophen at any age, ibuprofen only if older than 6 mo old

Question 57

what meds are used for brinchiolitis?

Answer 57

nebulized hypertonic saline!!! antipyretics corticosteroids bronchodilators (not as much)

Question 58

why is nebulized hypertonic saline used?

Answer 58

* softens secretions, induce cough, reduces edema, dislodges material * can lead to shorter hospitalization

Question 59

what is an IG1 antibody that neutralizes and inhibits RSV replication and reduces hospitalization

Answer 59

synagis (palivizumab)

Question 60

how is synagis given?

Answer 60

IM, use emla cream to numb

Question 61

when is the first synagis dose given and how is it given after that

Answer 61

first dose prior to start of RSV season and then monthly IM until season finishes (october through march)

Question 62

how is bronchiolitis transmitted?

Answer 62

direct contact with secretions

Question 63

how long does brinchilitis last on surfaces and on stethoscopes?

Answer 63

12h surfaces, 6h steth

Question 64

what is the main major source of transmission for bronchiolitis, and how long does it live on that surface

Answer 64

hands, 30 min

Question 65

what is the incubation period for bronchiolitis and how long does it take to shed it

Answer 65

incubation 2-8 days, shed in 3-8 days

Question 66

how long does it take for bronchiolitis symptoms to abate?

Answer 66

24-72 hours, full resolution may take weeks

Question 67

which of the following are symptoms of pneumonia? a) high fever b) crackles in effected lung c) dyspnea and tachycardia d) abdominal pain e) diarrhea

Answer 67

all

Question 68

what is a rating scale based on behavior, cardiovascular status, and resp status. the score determines intervention

Answer 68

pediatric early warning scale

Question 69

which of the following are risk factors for SIDS 1. prone sleeping 2. maternal smoking 3. breast feeding 4. bed sharing 5. use of pacifier 6. premature infant

Answer 69

1,2,4,6

Question 70

what is the cause of SIDS?

Answer 70

suffocation

Question 71

laryngotracheobronchitis (croup) has which of the following symptoms? a) bilateral inspiratory and expiratory wheezing b) insp stridor and hoarse barky cough c) crackles in effected lung d) copious nasal secretions

Answer 71

b

Question 72

what is the benefit of taking a child outside to breathe in cold air when they have croup?

Answer 72

decrease edema in the airway

Question 73

what isolation is used for bronchiolitis?

Answer 73

contact isolation