UNIT 7 RESPIRATORY DISORDERS CHAPTER 40

Question 1

Why are pediatrics most likely to get sick?

Answer 1

Narrow nasal passages, glottis, & trachea + large
tongue
2. Fewer functional airway muscles
3.Large amounts of soft tissue & Increase mucus gland
ratio (50x more than adults)
4.Immature thyroid, cricoid, & tracheal cartilages
5.Intercostal and accessory muscles poorly developed
6.Large abdomen
7. Immune system is not mature
8. Patients do not wash hands

Question 2

Is it important for parents to teach their children proper hand washing techniques and coughing and sneezing etiquette?

A. No
B. Yes

Answer 2

B. Yes

• put handsantizer in backpack

Children and families should use a tissue or their elbow to cover their mouth or nose when they cough or sneeze, dispose of the used tissues properly, and wash their hands. Used tissues should be immediately thrown into the wastebasket and not allowed to accu- mulate in a pile. \

Children with respiratory tract infections should not share drinking cups, eating utensils, washcloths, or towels. To decrease respiratory virus contamination, wash hands frequently and do not touch eyes or noses with the hands.

Question 3

What are influences on infection

Answer 3

1. Age
2. Size
3. Decreased Resistance(decrease exacerbation risk )
4. Seasonal Variations like the yearly flu

Question 4

S/S of Respiratory Distress

Answer 4

Respiratory Distress-
*grunting,
*nasal flaring,
*retractions,
*cyanosis(OXYGENATION ISSUE),
*tachypnea
*tachycardia

• Fever- may be absent in NB
• Anorexia – Very common(sick babies do not like to eat)
• Vomiting – small children vomit readily with illness
• Nasal Blockage / Discharge - secretions (keep nasal package clear)
  *babies are mouth breathers

Question 5

What is the golden sign of Chronic Hypoxia?

A. Tachycardia
B. Cyanosis
C. Clubbing
D. Weak cry

Answer 5

C. Clubbing

Question 6

Nursing Management of Respiratory Distress

Answer 6

• Ease respiratory efforts: KEEP BABY CALM decreases oxygen demands.
• Promote rest
  Moisturized air is a common therapeutic measure for symptomatic relief of respiratory discomfort.
• Promote comfort
• Prevent spread of infection: BEST WAY HAND WASHING

Children and families should use a tissue or their elbow to cover their mouth or nose when they cough or sneeze, dispose of the used tissues properly, and wash their hands. Used tissues should be immediately thrown into the wastebasket and not allowed to accu- mulate in a pile.

• Reduce temperature
• Promote hydration/nutrition: Anorexic patient increase IV fluids
• Provide family support: Educate patients

Question 7

What is Transient Tachypnea

Answer 7

a benign, self-limited condition that can present in infants of any gestational age, shortly after birth. It is caused due to delay in clearance of fetal lung fluid after birth which leads to ineffective gas exchange, respiratory distress, and tachypnea.

Question 8

How do you treat viral conditions?

Answer 8

treat the symptoms as you see them

mild headache or pain-use of NSAIDS
dehydration-Increase fluid intake
fever- use antipyretic
stuffy nose- decongestant

Question 9

How do you treat bacterial infections?

Answer 9

use of antibiotics

Question 10

FLUID MAINTENANCE PEDIATRIC FORMULA

Answer 10

4:2:1 RULE

FOR EVERY 0-10KG: 4ml/kg/hr
FOR EVERY 10-20KG: 2ml/kg/hr
FOR EVERY 20KG+: 1ml/kg/hr

Question 11

What is the Fluid maintenance for a patient that weighs 5kg?

Answer 11

20ml/hr

5kg : 5x 4=20ml/hr

Question 12

What is the fluid maintenance for a patient that weights 60kg?

Answer 12

100ML/HR

60kg: 10x 4=40 ml
10x 2=20ml
40 x 1= 40 ml

TOATAL FLUID MAINTENCE IS 100ML/HR

Question 13

FAMILY EDUCATION IS IMPORTANT

Question 14

What is another name for the common cold

Answer 14

Nasopharyngitis

Question 15

Your pediatric patient has been diagnosed with Nasopharyngitis. What prescriptions would you question for the Health Care Provider? Select all that apply

A. Aspirin
B. IV Assess
C. Antibiotics
D. Intermittent IV Fluid 0.9 NS
E. Varicella vaccine when newly prescribed and administered immunoglobulin therapy.

Answer 15

A. Aspirin
C. Antibiotics
E. Varicella vaccine when newly prescribed and administered immunoglobulin therapy.

The use of aspirin during a viral illness has most commonly been linked to Reye’s syndrome.

Question 16

What viruses cause Nasopharyngitis

Answer 16

RSV,
rhinovirus,
adenovirus,
influenza
parainfluenza viruses

Question 17

Is there a cure for Nasophyrngitis

Answer 17

NO TREAT SYMPTOMS

treat the symptoms as you see them

mild headache or pain-use of NSAIDS
dehydration-Increase fluid intake
fever- use antipyretic
stuffy nose- decongestant

Fluids and rest are recommended.

Question 18

S/S OF NASOPHYRNGITIS

Answer 18

varies with age. May include fever, nasal
mucus, sneezing, Congestion

Nasopharyngitis
Younger Children
* Fever
* Irritability, restlessness
* Decreasedappetiteandfluidintake
* Sneezing
*Nasal mucus(abundant )causing mouth breathing
* Vomiting or diarrhea may be present
* Decreased activity

Older Children
* Dryness and irritation of nose and throat initially *
Nasal discharge causing mouth breathing
* Chilling sensations
* Muscular aches
* Cough or sneezing(occasionally)

Question 19

Your 12-year-old pediatric pt has been prescribed a vasoconstrictive nose drop due to Nasopharyngitis. What is the priority teaching to prevent rebound congestion?

Answer 19

To avoid rebound nasal congestion, vasoconstrictive nose drops or sprays should not be administered for more than 3 days.

Question 20

Nursing Management of Nasopharyngistis

Answer 20

Fluids,
rest, elevation of HOB, suction.
Prevention is key

(handwashing & cough etiquette!)

Children and families should use a tissue or their elbow to cover their mouth or nose when they cough or sneeze, dispose of the used tissues properly, and wash their hands. Used tissues should be immediately thrown into the wastebasket and not allowed to accu- mulate in a pile. \

Children with respiratory tract infections should not share drinking cups, eating utensils, washcloths, or towels. To decrease respiratory virus contamination, wash hands frequently and do not touch eyes or noses with the hands.

Question 21

What Pharyngitis caused by

Answer 21

80-90% of cases are viral; others Group A Beta-Hemolytic
Streptococci (Strep throat)

Question 22

What is the common symptom for Pharyngitis

Answer 22

sore throat

headache, fever, possible rash,
abdominal pain (esp in small children)

Scarlet fever may also occur as a result of a strain of group A strep- tococcus. The clinical manifestations of scarlet fever include pharyngi- tis and a characteristic erythematous sandpaper-like rash; otherwise, scarlet fever shares the same clinical manifestations as those men- tioned for GABHS, and treatment and sequelae are the same. Severe scarlet fever is rarely seen in the United States.

Pharyngitis
Younger Children
* Fever
* General malaise
* Anorexia
* Moderate sore throat
* Headache

Older Children
* Fever(may reach104°F[40°C])
* Headache
* Anorexia
* Dysphagia
* Abdominal pain
* Vomiting
Assessment

• Mild to bright red, edematous pharynx
• Hyperemia of tonsils and pharynx;
• Cervical glands enlarged and tender
• Often abundant follicular exudate that’ spreads and coalesces to form pseudo-
  membrane on tonsils

Question 23

What would suspect the Health Care Provider to prescribe before medications in a patient with suspected Pharyngitis

Answer 23

throat culture, rapid strep test (antigen detection
test)

TO DETERMINE IF THE CASE IS BACTERIAL OR VIRAL

Question 24

After the throat culture, the patient results came back and showed that the patient has a bacterial case of pharyngitis
What medication would you suspect the health care provider to prescribe

A. Penicillin
B. Aspirin
C. Fluconazole
D.Acyclovir

Answer 24

A. Penicillin

Therapeutic management: PCN

If streptococcal sore throat infection is present, oral penicillin or other antibiotics such as amoxicillin are prescribed for 10 days to control the acute local manifestations and maintain an adequate level to eliminate any organisms that might remain to initiate rheumatic fever symptoms. Penicillin does not prevent the development of acute glomerulonephri- tis in susceptible children.

Question 25

The mother of your pediatric is concerned that her 3 year old toddler will miss activities in daycare due to his pharyngitis diagnosis. What teaching will ease her concerns are penicillin is administered

Answer 25

Nursing care management: * No school/daycare for 24 hrs * Acetaminophen/ibuprofen for pain * Finish full course of antibiotics!

Question 26

Tonsillitis

Answer 26

Causes: often occurs with pharyngitis; causative agent may be viral or bacterial * Clinical manifestations: edema/enlargement of tonsils; difficulty swallowing; mouth breathing * Therapeutic management: antibiotics if bacterial; possible tonsillectomy if criteria met * Nursing management: pain management

Question 27

Tonsillectomy & Adenoidectomy

Answer 27

* Tonsils are removed for usually either frequent strep throat infections and/or airway obstructions (sleep apnea) * Post op care: * Cool, clear liquids (no red liquids) * No milk or milk products *no citrus * Frequent swallowing=bleeding * Vomiting bright red blood=call surgeon/doctor stat! * Avoid coughing, crying, screaming, blowing nose etc post-operatively * Pain meds around the clock

Question 28

What is the cause of Tonsillitis

Answer 28

Causes: often occurs with pharyngitis; causative agent may be viral or bacterial

Question 29

What is your main concern with tonsillitis? A. Serous drainage B. Airway Obstruction C. Barking cough D. peeling of skin

Answer 29

B. Airway Obstruction KISSING TONSILS As the palatine tonsils enlarge from edema, they may meet in the midline (touching or kissing tonsils), obstructing the passage of air or food.

Question 30

S/S of Tonsilitis

Answer 30

* Clinical manifestations: *edema/enlargement of tonsils; *difficulty swallowing; *mouth breathing *the voice may have a nasal and muffled quality, and a persistent cough is also com- mon

Question 31

Contraindications of Tonsillectomy

Answer 31

Contraindications to either tonsillectomy or adenoidectomy are (1) cleft palate, because the tonsils help minimize escape of air during speech; (2) acute infections at the time of surgery, because locally in-flamed tissues increase the risk of bleeding; and ( 3) uncontrolled systemic diseases or blood dyscrasias.

Question 32

Therapeutic management Post Operatively of Tonsillitis

Answer 32

Nursing care of the child with tonsillitis involves providing comfort and minimizing activities or interventions that precipitate bleeding. A soft to liquid diet is generally preferred. Warm saltwater gargles, warm fluids, throat lozenges, and regularly prescribed nonopioids (such as acetaminophen and ibuprofen) are used to promote comfort.

Question 33

What position is most appropriate for a patient post operative of Tonsillectomy A. Supine B. Prone C.High fowlers D. Trensdelenburg

Answer 33

C.High fowlers After the surgery, until they are fully awake, children are positioned to facilitate drainage of secretions. Suctioning is usually avoided, but when performed, it is done carefully to avoid trauma to the orophar- ynx. When alert, the child may prefer sitting up. The child is discouraged from coughing frequently, clearing the throat, blowing the nose, and any activities that may aggravate the operative site.

Question 34

What should the patient be discouraged from doing post-operative Tonsillectomy

Answer 34

The child is discouraged from coughing frequently, clearing the throat, blowing the nose, and any activities that may aggravate the operative site.

Question 35

Soft foods being when post-op if patients can tolerate it after a Tonsillectomy

Answer 35

Children often begin soft foods, particularly gelatin, cooked fruits, sherbet, soup, and mashed potatoes, on the first or second postopera- tive day or as the child tolerates feeding. The pain from surgery often inhibits oral intake, reinforcing the need for adequate pain control.

Question 36

What equipment should be readily available post operatively Tonsillectomy

Answer 36

Suction equipment and oxygen should be available after tonsillectomy.

Question 37

Signs of Airway Obstruction

Answer 37

Airway obstruction may also occur as a result of edema or accumulated secretions and is indicated by signs of respiratory distress, such as stridor, drooling, restlessness, agitation, increasing respiratory rate, and progressive cyanosis.

Question 38

What is Otitis Media

Answer 38

An inflammation of the middle ear without reference to etiology or pathogenesis

Question 39

What is Otitis media with effusion(OME)

Answer 39

Fluid in the middle ear space without symptoms of acute infection

Question 40

What can lead to bacterial Otitis media A. Flu B. Varicella C. Streptococcal C D. Hepatitis B

Answer 40

A. Flu Bacterial OM: often proceeded by viral respiratory infections (RSV, flu).

Question 41

What season is Otitis Media prevalent? A. Summer B. Fall C. Spring D. Winter

Answer 41

D. Winter Prevalent in winter; often follows viral respiratory infection

Question 42

Risk factors for OM Otitis Media

Answer 42

*Attending daycare is a significant risk factor for OM. * Children who have siblings or parents with a history of chronic OM also have a higher incidence of OM. *Second hand smoking *A household with many persons * no bottle propping *NON IMMUNE TO FLU VACCINE *

Question 43

Nursing Management

Answer 43

Nursing Management: relieve pain; prevent recurrence: educate family on breastfeeding, no bottle propping, avoid passive smoking, immunize

Question 44

Signs and Symptoms of Otitis Media

Answer 44

* Follows an upper respiratory tract infection * Otalgia(earache) * Fever—may or may not be present * Purulent discharge(otorrhea)—may or may not be present

Question 45

Therapeutic Management Otitis Media

Answer 45

Analgesics (ibuprofen and acetaminophen) are helpful in reducing severe ear pain and controlling fever. Ibuprofen has a longer duration of action (about 6 hours) and is especially beneficial for nighttime comfort but should not be used in children younger than 6 months of age unless directed by a medical provider. Lying on the affected side may reduce pain in some children, as it may facilitate drainage from a ruptured eardrum or myringotomy. Prevention of recurrence requires adequate parent education on antibiotic therapy. Because the symptoms of pain and fever usually subside within 24 to 48 hours, nurses must emphasize that although the child may appear well, the infection is not completely eradicated until all prescribed medication is taken. It is important to stress the potential complications of OM, especially hearing loss, which can be prevented with adequate treatment and follow-up care.

Question 46

What is croup syndrome?

Answer 46

Characterized by hoarseness, “barking” cough, inspiratory stridor, and varying degrees of respiratory distress * Croup syndromes affect larynx, trachea, and bronchi 1. Epiglottitis 2. Laryngitis 3. Laryngotracheobronchitis (LTB)

Question 47

Is Epiglottis a medical emergency? A. No B. Yes

Answer 47

Obstructive inflammatory process: MEDICAL EMERGENCY

Question 48

You notice that your pediatric pt is in a tripod position and drooling severely. What medical emerges diagnoses would you suspect them to have? A. Croup Syndrpme' B. Pharyngitis C.Otitis media D. Epiglottitis

Answer 48

D. Epiglottitis * Clinical Manifestations: abrupt onset, progresses rapidly to obstruction. Tripod position, drooling, inspiratory stridor, retractions, agitation

Question 49

Signs and Symptoms of Epiglottitis

Answer 49

* Clinical Manifestations: abrupt onset, progresses rapidly to obstruction. Tripod position, drooling, inspiratory stridor, retractions, agitation

Question 50

Nursing management of Epiglottitis

Answer 50

Nursing Management: Stay calm. Allow child to sit in most comfortable position. No visualization of throat

Question 51

Should you visualize the throat to see if the obstruction is getting worser ion a patient with Epiglottitis? A. Yes B. No

Answer 51

B. No No visualization of throat

Question 52

When does swelling tend to decrease after antibiotic medication is administered for Epiglotititis A. 72 HRS B. 30 MINUTES C. 24 HOURS D. 1 HOUR

Answer 52

Therapeutic Management: Swelling decreases after 24 hours of antibiotic therapy

Question 53

You are precepting a new graduate nurse is teaching a patient the cause of Laryngitis. Which statement would need immediate intervention? A. This is a common after-effect with people who have been to lengthy concerts when they sing for long period of time B. This is caused by H. influenza. C. This can be caused by secondhand smoking. D. This is caused by prolonged yelling.

Answer 53

\ CAUSES OF LARYNGITIS URI(upper respiratory infection), cold, overuse of voice (singing, yelling), second hand smoke DEFINITION OF laryngitis- Inflammation of vocal cords

Question 54

What is the S/S of laryngitis

Answer 54

hoarseness, loss of voice, throat pain

Question 55

DEFINITION OF laryngitis-

Answer 55

laryngitis- Inflammation of vocal cords

Question 56

Nursing Managment of Laryngitis

Answer 56

voice rest & humidified air

Question 57

What is Acute Laryngotracheobronchitis

Answer 57

Acute LTB is the most common type of croup syndrome that primarily affects children 6 months to 3 years old. An upper airway infection that blocks breathing and has a distinctive barking cough.

Question 58

Acute Laryngotracheobronchitis cause

Answer 58

Cause: Viral agents- parainfluenza, RSV, rhinovirus, adenovirus

Question 59

Clinical Manifestations Acute Laryngotracheobronchitis

Answer 59

Clinical Manifestations: gradual onset of low grade fever, nighttime awakening with barky cough, inspiratory stridor, retractions

Question 60

Therapeutic and Nursing Management

Answer 60

Therapeutic Management: management of airway, breathing treatments, steroids * Nursing Management: humidified cool air, continuous monitoring, encourage parent presence

Question 61

Where does Bronchiolitis take place A. Upper respiratory B. Lower respiratory C. Larynx D. Nasal passageway

Answer 61

Bronchiolitis B. Lower respiratory Bronchitis (sometimes referred to as tracheobronchitis) is inflamma- tion of the large airways (trachea and bronchi), which is frequently associated with URIs. Viral agents are the primary cause of the disease, including influenza A and B, parainfluenza, coronavirus

Question 62

S/S of Bronchiolitis

Answer 62

begins with URI, rhinorrhea, low grade temp, cough, intercostal retractions, wheezing, crackles, tachypnea, diminished breath sound

Question 63

Nursing management

Answer 63

Therapeutic Management: Supportive: humidified O2, nasal suction, fluids * Nursing Management: Contact precautions, continuous CR/sat monitoring. Prevention: handwashing, breastfeeding, avoidance of passive smoking, vaccine for high-risk preemies Due to the copious nasal secretions associated with RSV infection, infants often have difficulty with breathing and feeding. Breastfeeding mothers are encouraged to continue feeding the infant or, if feedings are contraindicated due to severity of the illness, mothers should pump their milk and store it appropriately for later use. Parents are taught how to instill normal saline drops into the nares and suction the mucus with bulb syringe before feedings and before bedtime so that the child may more easily eat, rest, and sleep.

Question 64

Pertussis, what sound is related to this disorder A. Stridor B. Whooping cough C. Crackles D. Wheezing

Answer 64

B. Whooping cough

Question 65

What is the cause of Pertussis

Answer 65

Cause: by Bordetella pertussi

Question 66

Treatment and nursing management oof pertussis

Answer 66

Therapeutic Management: antibiotics Nursing Management: Highly contagious; remain isolated for 5 days after antibiotics started

Question 67

When can a pediatric pt go back to school after starting their antibiotic medications that has been diagnosed with Pertussis

Answer 67

* Nursing Management: Highly contagious; remain isolated for 5 days after antibiotics started

Question 68

Foreign Body Aspiration

Answer 68

small items (toys, food) aspirated into trachea

Question 69

With foreign body aspiration, should you do a blind sweep A. Yes B. No

Answer 69

B. No

Question 70

S/S foreign body aspiration

Answer 70

diagnosis based on S/S- choking, gagging, wheezing, drooling, coughing. Confirmed with xraY When an object is lodged in the larynx, the child is unable to speak or breathe.

Question 71

Nursing Intervention for Foreign Body aspiration

Answer 71

Therapeutic Management: abdominal thrusts and back slaps; removal by bronchoscopy * Nursing Management: teach prevention: “fun” foods often the culpri Back blows or abdominal thrusts performed by both health professionals and prop- erly instructed lay persons can save lives. NO BLIND SWEEPING CHIN TILT

Question 72

Teaching for foreign body aspiration(PREVENTION)

Answer 72

Nurses are able to teach prevention in a variety of settings. They can educate parents singly or in groups about the hazards of aspiration in relation to the developmental level of their children and encourage them to teach their children safety. Caution parents about behaviors that their children might imitate (e.g., holding FBs such as pins, nails, and toothpicks between their lips or in the mouth). Educate parents on age-appropriate toys and how older siblings’ toys could be hazardous for younger siblings.

Question 73

Asthma

Answer 73

Chronic inflammatory disorder of the airways resulting in airway obstruction

Question 74

cause of asthma

Answer 74

Cause: atopy, exposure to allergens, previous RSV exposure

Question 75

S/S of Asthma

Answer 75

Clinical Manifestations: Wheezing, breathlessness, chest tightness, cough (especially at night

Question 76

Therapeutic management of Asthma

Answer 76

Therapeutic Management: allergen control, drug therapy * Corticosteroids, bronchodilators, mast cell stabilizers, etc

Question 77

Asthma teaching . education for parents

Answer 77

Nursing Management: teach prevention of exacerbations * Avoid allergens * Relieve bronchospasms * Exercise * Asthma teaching plan- identify respiratory deterioration

Question 78

Which of the following drugs is a rescue drug? A. Enoxaparin B. Heparin C. Prednision D. Albuterol

Answer 78

Short Term * Short acting beta-agonists-Albuterol (#1) * rescue inhaler for symptomatic treatment

Question 79

Asthma Pharmacologic

Answer 79

Short Term * Short acting beta-agonists-Albuterol (#1) * rescue inhaler for symptomatic treatment * Long Term/Preventative * Corticosteroids (inhaled form is the anti-inflammatory drug of choice for persistent asthma.) * Mast cell stabilizers (anti-inflammatory drugs) * Long acting beta-agonists (bronchodilators often used along with an anti-inflammatory drug) * Theophylline (a bronchodilator used along with an anti-inflammatory drug to prevent nighttime symptoms) * Leukotriene modifiers (an alternative to steroids and mast cell stabilizers) * Xolair (an injectable asthma medication used when inhaled steroids for asthma failed to control asthma symptoms in people with moderate to severe asthma who also have allergies)

Question 80

1. A nurse is reviewing the diagnostic findings for a preschool age child who is suspected of having cystic fibrosis. Which of the following findings should the nurse identify as an indication of cystic fibrosis? A. Sweat chloride content 85 mEg/L B. Increased blood levels of fat-soluble vitamins C. 72 hr stool analysis sample indicating hard, packed stools D. Chest x-ray negative for atelectasis

Answer 80

A. Sweat chloride content 85 mEg/L

Question 81

2. A nurse is admitting a child who has cystic fibrosis. Which of the following medications should the nurse expect to include in the plan of care? (Select all that apply.) A. Tobramycin B. Loperamide C. Fat-soluble vitamins D. Albuterol

Answer 81

A. Tobramycin C. Fat-soluble vitamins D. Albuterol

Question 82

3. A nurse is performing an admission assessment for a child who has cystic fibrosis. Which of the following findings should the nurse expect? (Select all that apply.) A.Wheezing B. Clubbing of fingers and toes C. Barrel-shaped chest D. Thin, watery mucus E. Rapid growth spurts

Answer 82

C. Barrel-shaped chest B. Clubbing of fingers and toes A.Wheezing

Question 83

4. A nurse is providing discharge teaching for a child who has cystic fibrosis. Which of the following instructions should the nurse include? A. Provide a low-calorie, low-protein diet. B. Administer pancreatic enzymes with meals and snacks. C.Implement a fluid restriction during times of infection. D.Restrict physical activity.

Answer 83

B. Administer pancreatic enzymes with meals and snacks. before a meal for snack (30 minutes)

Question 84

Oral care metered dose inhalers

Answer 84

It's important to rinse your mouth out after using a steroid inhaler, such as your preventer inhaler. This is so that any medicine that is stuck in your mouth or throat is cleaned away. This will prevent side effects such as oral thrush. Young children and those who are unable to manipulate the MDI or hold their breath for 10 seconds should use a spacer. A spacer is a 4- to 8-inch tube that fits on the end of the MDI mouthpiece. These devices allow the parent or child to deliver the medication from the MDI into the spacer, from which the child then inhales the medication while taking slow, steady breaths at his or her own pace. Spacers also help prevent yeast infections in the mouth when corticosteroids are inhaled via an MDI.

Question 85

Cystic fibrosis

Answer 85

Exocrine gland dysfunction that produces multisystem involvement * Inherits defective gene from both parents with an overall incidence of 1:4 * Increased viscosity of mucous gland secretion * Thick mucous accumulates in glands and ducts * Respiratory tract and pancreas are predominantly affect

Question 86

Respiratory Manifestations of Cystic fibrosis

Answer 86

Stagnation of mucus and bacterial colonization result in destruction of lung tissue * Tenacious secretions are difficult to expectorate—obstruct bronchi/bronchioles * Compression of pulmonary blood vessels and progressive lung dysfunction lead to pulmonary hypertension, cor pulmonale, respiratory failure, and death

Question 87

GI ma infestations of Cystic fibrosis

Answer 87

* Pancreatic enzyme deficiency * Failure to thrive * Increased weight loss despite increased appetite * Steatorrhea * Eventual diabetes from pancreatic fibrosis * Eventual cirrhosis from focal biliary obstruction

Question 88

Is Steatorrhea a common finding in cystic fibrosis?

Answer 88

yes

Question 89

Is weight gain a common finding in Cystic fibrosis ?

Answer 89

No

Question 90

What is the best diagnostic test to rule in Cystic fibrosis

Answer 90

sweat CHLORIDE test infant 3 months or less 40 mEQ/L - POSITIVE 3 months or greater 60 mEQ/L - POSITIVE

Question 91

S/S OF CYSTIC FIBROSIS

Answer 91

*Wheezing respiration, * dry nonproductive cough * Generalized obstructive emphysema * Patchy atelectasis * Cyanosis * Clubbing of fingers and toes * Repeated bronchitis and pneumonia * Wasting of tissues * Delayed puberty in females * Dehydration * Sterility in males * Parents report children taste “salty” * Hyponatremic/hypochloremic alkalosis * Hypoalbuminemia * Meconium ileus * Distal intestinal obstruction syndrome * Excretion of undigested food in stool; increased bulk, frothy, and foul * Prolapse of the rectum

Question 92

DAISPLINARY CARE MANAGMEMNT FOR CYSTIC FIBROSIS

Answer 92

* CPT- Chest physiotherapy * Bronchodilator medication * Forced expiration * Prevention/aggressive treatment of pulmonary infections * Aerosolized antibiotics * Steroid/NSAID * Transplantation

Question 93

Family and patient teaching for Cystic Fibrosis

Answer 93

Family support * Coping with lifelong illness; affects on family * Maximize health potential- 30 years old maximum. survival age * Nutrition- high calories , high protein, low fat , cannot break down fat * Prevention of infection- avoid large crowds, wash hands * New research * New pharmacologic agents * Transplantation- survival rate 55% at 3-yrs post bilateral lung transplant

Question 94

1. A 10-year-old child with asthma is treated for acute ex- acerbation in the emergency department. The nurse car- ing for the child would monitor for which sign, know- ing that it indicates a worsening of the condition? 1. Warm, dry skin 2. Decreased wheezing 3. Pulse rate of 90 beats per minute 4. Respirations of 18 breaths per minute

Answer 94

2. Decreased wheezing Asthma is a chronic inflammatory disease of the airways. Decreased wheezing in a child with asthma may be interpreted incorrectly as a positive sign when it may actually signal an inability to move air. A “silent chest” is an ominous sign during an asthma episode. With treatment, increased wheezing actually may signal that the child’s condition is improving. Warm, dry skin indicates an improvement in the child’s condition, because the child is normally diaphoretic during exacerbation. The normal pulse rate in a 10-year-old is 70 to 110 beats per minute. The normal respiratory rate in a 10-year-old is 16 to 20 breaths per minute.

Question 95

3. A new parent expresses concern to the nurse regard- ing sudden infant death syndrome (SIDS). The par- ent asks the nurse how to position the new infant for sleep. In which position would the nurse tell the parent to place the infant? 1. Side or prone 2. Back or prone 3. Stomach with the face turned 4. Back rather than on the stomach

Answer 95

4. Back rather than on the stomach

Question 96

The clinic nurse is providing instructions to the parent of a child with cystic brosis regarding the immunization schedule for the child. Which state- ment would the nurse make to the parent? 1. “The immunization schedule will need to be al- tered.” 2. “The child should not receive any hepatitis vaccines.” 3. “The child will receive all of the immunizations except for the polio series. 4. “The child will receive the recommended basic series of immunizations along with a yearly inFLuenza vaccination.”

Answer 96

4. “The child will receive the recommended basic series of immunizations along with a yearly inFLuenza vaccination.”

Question 97

5. The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse would monitor for which indication that the child may be experiencing airway obstruction? 1. The child exhibits nasal flaring and bradycardia. 2. The child is leaning forward, with the chin thrust out. 3. The child has a low-grade fever and complains of a sore throat. 4. The child is leaning backward, supporting self with the hands and arms

Answer 97

2. The child is leaning forward, with the chin thrust out. Epiglottitis is a bacterial form of croup. A pri- mary concern is that it can progress to acute respiratory dis- tress. Clinical manifestations suggestive of airway obstruction include tripod positioning (leaning forward while supported by arms, chin thrust out, mouth open), nasal flaring, the use of accessory muscles for breathing, and the presence of stridor. Option 4 is an incorrect position. Options 1 and 3 are incor- rect because epiglottitis causes tachycardia and a high fever.

Question 98

A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The parent becomes con- cerned because the child is frightened, consistently crying, and trying to climb out of the tent. Which is the most appropriate nursing action? 1. Tell the parent that the child must stay in the tent. 2. Place a toy in the tent to make the child feel more comfortable. 3. Call the pediatrician and obtain a prescription for a mild sedative. 4. Let the parent hold the child and direct the cool mist over the child’s face.

Answer 98

4. Let the parent hold the child and direct the cool mist over the child’s face.