Week 1 Care of Pediatric Clients with Respiratory Dysfunction Flashcards
(125 cards)
1
Q
What is the difference between a child and adults head
A
- A child has a larger head in proportion to body
- Small mandible
- Small short neck
2
Q
What is the difference between a child and adults tongue
A
It is large, floppy, posteriorly placed
3
Q
What is the difference between a child and adults airway
A
- it is smaller and cone-shaped
- more resistance with illness
4
Q
Infants are _____ breathers.
What are the implications of this?
A
Obligatory nose
An infant will not automatically start mouth breathing if the nose is obstructed. Special care need to be provided so that the nasal airways stay unobstructed especially during upper respiratory tract infections and illnesses
5
Q
What is the difference between a child and adults trachea/larynx
A
The cartilage is soft and collapsible
6
Q
What is the difference between a child and adults tonsils and adenoids
A
- Still there
- Bigger and more likely to become inflamed
7
Q
What is the difference between a child and adults respiratory muscles
A
- Children are diaphragm dependent
- More effort to breath when there is resistance = faster exhaustion
8
Q
What is the difference between a child and adults ribcage
A
Less rigid and ribs are more horizontal
9
Q
What is the difference between a child and adults BMR
A
Much higher in children because they are actively growing
-increased O2 consumption
10
Q
What is stridor? What does it indicate?
A
- Lound barking sound upon inspiration
- Obstruction/edema of upper airway
11
Q
What is the most common illness in children?
A
Acute respiratory distress
12
Q
Acute respiratory distress accounts for ____% of illness in kids under 5 and ___ for children 5-12
A
50
30
13
Q
What are the five cardinal signs of respiratory distress for infants
CHART
A
Cyanosis Head Bobbing, Expiratory grunting Abdominal Breating Retractions Tachypnea(neo may be bradycardic)
14
Q
What is watchful waiting?
A
A technique for parents to learn when their child is sick. Know the signs of when you should take the child to the doctor and wait out the illness if they dont show
15
Q
An infants airway is roughly the size of their ____
A
pinky
16
Q
What are the four common upper respiratory tract infections in children?
A
- Nasophryngitis
- Pharyngitis and tonsillitis
- Influenza
- Otitis Media
17
Q
What is Nasopharyngitis?
A
-The common cold
18
Q
frequancy of Nasopharyngitis declines with
A
increasing age
19
Q
What is the most common cause of Nasopharyngitis (think horns/nose)
A
Rhinovirus
20
Q
What are the 4 main Patho aspects of Nasopharyngitis?
INEE
A
- Inflammation
- Nasal airflow Decreased
- Exudate
- Edema/vasodilation
21
Q
What are the main s/s of Nasopharyngitis in younger children
A
- Fever
- Irritable
- Sneeze
- Vomit/diarrhea
22
Q
What are the main S/s of Nasopharyngitis in older children?
A
- Dry nose/throat w/ cough
- Sore throat
- Sneeze
- Muscle ache
23
Q
What is the key intervention in Nasopharyngitis for younger children especially infants?
A
- Remove any nasal airway obstructions
- Lube with saline drops
24
Q
What are the interventions for Nasopharyngitis
A
- Elevate HOB
- Saline Drops
- Vapor/humidify
25
What is the best prevention for Nasopharyngitis?
Hand hygiene and cough etiquette
26
What is the anticipatory guidance for Nasopharyngitis
- It is going to happen
| - Its more likely if child is in daycare
27
What are the outcomes for Nasopharyngitis?
There is no direct treatment since its viral. but with a child in good health recovery should be expected in 1 week
28
What is Pharyngitis/tonsillitis
An infection of the throat.
29
What percentage of Pharyngitis and tonsillitis is viral?
80-90%
30
What percentage of Pharyngitis and tonsillitis is bacterial?
around 20%
31
What is an important consideration of bacterial Pharyngitis and tonsillitis
It needs to be indentified because it could be strep.
| If it is bacterial it can migrate and cause more severe complications
32
If Strep is left untreated it can lead to what two major complications
Actue rheumatic fever
| Acute Glomerulonepritis
33
What are the key patho aspects of Pharyngitis and tonsillitis
- Inflammation
- Exudate
- Tender Nodes
- Abrupt onset
34
If a child is under 4 you should not give them OTC ___ medications. Why
Cough Meds.
Because these medications often contain analgesics that are already being given to the children. This will increase the risk of overdose.
Also there is no clear benefit as standard analgesics have the same effect as the cough medications (in children under 4)
35
What are the two considerations for a child taking antibiotics for bacterial Pharyngitis and tonsillitis?
1. Finish the entire course even if feeling better
| 2. Not contagious after 24hours
36
What are the main interventions for a child with Pharyngitis and tonsillitis
- Vapor/humidification
- Analgesics
- Throat culture to rule out strep
- antipyretics
37
What are the s/s for a younger child with Pharyngitis and tonsillitis
- Fever
- Malaise
- Anorexia
- Sore throat
- Headache
- Nasal congestion
38
What are the main s/s for an older child with Pharyngitis and tonsillitis
- Fever
- Anorexia
- Dysphagia
- Headache
- Abd pain and vomiting
- Dry mucus mem.
39
What is the outcome for Pharyngitis and tonsillitis with treatment
should subside in 3-5 days unless it progresses
40
how does influenza transmit
Large droplets direct contact
41
What is the incubation period for influenza?
1-3 days
42
Children with influenza are contagious ____ before the onset of flu Sx
24 hours
43
What is a major source of the spreading of influenza
school-aged children
44
What are the main assessment factors for influenza?
- Dry throat and cough
- Flushed face
- Fever, chills
45
In infants, influenza can transition into.____?
Subglottal croup
46
What are the two main interventions for the flu? which is number one?
- Relieve symptoms
| - Preventions #1
47
What are some flu preventions?
- Immunizations
- hand hygiene
- Cough etiquette
- control of secretions
48
How long do the symptoms of the flu usually last?
4-5 days
49
The biggest risk of influenza is the chance to develop ____?
secondary infections as they can become fatal
50
What are some secondary infections associated with influenza?
- Viral pneumonia
- Encephalitis
- OTM
- Sinusitis
51
What is Otitis Media?
and inflammed middle ear
52
How often is Otitis Media bilateral?
50%
53
93% of Otitis Media patients also have sings and symptoms of ______
URI
54
When do instances of otitis media peak?
6-18 months
55
What is shown to decrease instances of otitis media?
Breastfeeding
56
What virus are responsible for the flu?
Orthomyxoviruses A,B,C
57
What is the patho of otitis media?
Impaired drainage of eustachian tubes causes air to become trapped in the middle ear. This trapping causes pressure to build up. When the tues finally open back up Bacteria can enter the system.
58
What is the assessment for otitis media
-Can be absent of pain
-Look for non-verbal behaviors in the child
these include: Tugging on and rubbing ear, laying on ear, keeping hair over ear, hearing loss.
-If ruptured, dranage will be present
59
What are the three main interventions for otitis media?
- Ammoxicilln/Bactrim
- Address any developmental issues than may have come from the peroid of hearing loss
- Treat the symptoms
60
How do you treat the symptoms of otitis media
- Elevate HOB
- Treat pain
- Give fluids
- Ensure medication compliance
61
What is the anticipatory guidance for Otitis Media?
- Causes temporary hearing loss
- Dont smoke
- Recognize early signs
- Dont prop bottles because the formula can pool and cause blockage
62
How do you pull the ear of a 3yo or under patient?
Back and down
63
How do you pull the ear of a 3yo and older patient?
Back and up
64
What is Otitis Externa?
Infection of the external ear canal
65
How does Otitis Externa present differently than Otitis media?
It is painful
66
How is otitis externa treated?
with drops
67
What are the 5 coup syndromes?
- Acute laryngitis
- Acute Laryngotracheobronchitis (LTB)
- Acute Spasmodic LAryngitis
- Bacterial Tracheitis
- Epiglottitis
68
What is Croup?
An infection of the airway that often causes upper airway obstruction. It can affect different areas. It can be bacterial or Viral and most often effects children 3 months to 5 years.
69
What is RSV
Human orthopneumovirus
70
What are some viral causes of croup?
RSV, Adeno, Parainfluenza
71
Why is viral croup considered less severe?
The is often a rapid improvment with a normal immune system. BActerial causes rapid deterioration
72
What are some causes of bacterial croup?
HIB, GABHS, Staph, M. Pneumonia
73
what percentage of children with croup have a family history?
+ or - 15%
74
What is the assesment data for croup?
- Edema and obstruction
- Spasm of the vocal cords
- Collapse of the larynx during inspiration
- Steeple sign on chest xray
- Stridor upon inspiration
- respiratory distress
75
What are the interventions for Croup syndromes?
- Warm Humid Air (in the BR with the Shower)
- Treat URI symptoms
- Administer Nubulizer (bronchodilators + steroids)
- Control agitation, Keep them calm
- Prevention
76
How can you prevent croup?
- Immunize for HIB
| - Early recognition
77
If untreated, Croup may evolve into ____
Epiglottitis
78
What is Epiglottitis
Inflammation of the Epiglottis. It is a croup syndrome and is a medical emergency. most often effects 2-5 year olds
79
What is the usual cause of epiglottitis?
HIB possibly Group A strep
80
What are some assessments for acute epiglottitis
- Cherry red epiglottis
- Thumb sign on x-ray
- Tripod positioning
81
What are some signs and symptoms of acute epiglottitis?
- Sudden onset
- Drooling
- High fever
- Horrible sore throat
- Respiratory distress
- Toxic appearance
82
What is it important to keep the child calm and not try to visualize the epiglottis in the case of acute epiglottitis?
Because it can cause a sudden exacerbation and flair up resulting in a complete airway obstruction
83
What are the interventions of acute epiglottitis?
- Oxygen
- Antibiotics
- Keep on parents lap
- Don't stress them out. Keep resp. effort to a min.
84
What are the outcomes of acute epiglottitis
- Life-threatening if not treated
| - Can't intubate may have to trach
85
What are the three main lower respiratory tract infections?
- Bronchitis
- Bronchiolitis(RSV)
- Pneumonias
86
What is bronchitis/tracheobronchitis?
An often viral LRI that causes inflammation of the large airways. It is often associated with a URI
87
What are some assessments of bronchitis/tracheobronchitis?
- Dry, hacking, non-productive cough in beginning
- After 2-3 days may become productive
- Often URI symptoms are present
88
What is the intervention for bronchitis/tracheobronchitis
Treat the symptoms
89
What are the outcomes for bronchitis/tracheobronchitis?
Its self limiting, normally its a watch a wait. Usually clears up in 5-10 days if its not associated with a more severe URI
90
What is Bronchiolitis (RSV)
It is a seasonal LRI that obstructs small airway structures. 80% of cases are caused by RSV and most children get this by 2 years of age
91
What is the patho of Bronchiolitis (RSV)
Airway edema occurs followed by accumulation of mucus. This causes air trapping to occure and causes hyperinflation and atelectasis
92
What are some positive assessments for Bronchiolitis (RSV)
- URI, OTM, conjunctivitis
- Wheezing, crackles, retractions, squeeking
- Apnea
- INtermittent cyanosis
- Tachyepnia
- CXR showing infiltrates/Atelectasis
93
Children who are born with respiratory issues are more likley to get ____
Bronchiolitis (RSV)
94
What are the interventions for Bronchiolitis (RSV)
- Treat symptoms but dont over treat
- Humidity, rest, fluids
- Oxygen, IV's
- Possible anti-viral
95
What is Pneumonia?
A bacterial or Viral LRI that causes inflammation of pulmonary parenchyma. Its more common in infants and ealry childhood. It can be a primary or secondary disease
96
What is the patho. of viral pneumonia?
- Commonly cause by RSV, viral pneumonia often comes from a URI.
- The infection invades the bronchioles and alveoli leaving cellular debris
97
What is the patho of bacterial pneumonia?
- Often caused by strep and M. Pneumonia that travels through the blood and into the lungs
- The alveoli fill with fluid and exudate causing loss of surface area for gas exchange
98
What are the assessments for viral Pneumonia
- A low fever
- Wheezes
- Tachycardia
- Resp. Distress
- Non productive cough
- Normal WBC
99
What are the assessments for bacterial Pneumonia?
- High fever
- Retractions and grunting
- Chest pain
- Resp. Distress
- Productive cough
- Increased WBC/Neutrophils
- GI symptoms
100
What are the interventions for Pneumonia? Which one is number 1?
- Elevate HOB
- Chest physiotherapy
- O2 and fluids
- ABO if bacterial
- Treat symptoms
- Hydration
- Humidification
- REST #1
101
What is Pertussis?
*Aka whooping cough* It is a serious and highly contagious acute bacterial respiratory infection.
Caused by the Bordetella Pertussis bacteria.
102
What are the assessments for pertussis
- URI with severe Paroxysms of coughing
- INspiratory Whoop then vomiting from swallowing air
- Apnea if under 6 months
103
What are the interventions for pertussis? which one is number one
- Erythromycin
- Immunizations
- Prevent exposure
- Preventions #1
104
What causes TB
Mycobacterium Tuberculosis both human and bovine
105
What is the patho of TB?
The body reacts to the bacteria by encapsulating the bacilli.
106
What are the assessments for TB
- Positive PPD
- Fever, Malaise, Weightloss
- Anorexia, pain/tightness in the chest
- Hemoptysis
107
If a patient has LTB infection, What assessment data can be seen?
- positive PPD
- Negative CXR
- No symptoms
108
What is case finding?
It is when someone contracts a disease like TB and the case finder needs to locate where the disease was contracted so that they can find those who were exposed
109
WHat is the most common pediatric illness?
Asthma
110
What is the leading cause of pediatric hospital stays and ER visits?
Asthma
111
What is the leading cause of missed school days?
Asthma
112
When is the most common first asthma attack?
between 3-8 years
113
WHat are the two trigger categories for asthma?
Atopic (allergic) or non-atopic (non-allergic)
| 50/50
114
What is asthma?
Chronic inflammatory disorder of the airway
115
What is the patho of asthma?
Asthma is triggered and causes inflammation of the mucus membranes and the airways
- Mucus and secretions begin to accumulate in response to the inflammation
- Spasms of the smooth muscles occur
116
What are some assessments of asthma?
- Cough
- Wheeze
- Chest tightness
- Respiratory distress during exacerbations
117
What are the interventions for asthma?
- Prevention is Key
- No smoking
- Beta 2 agents, anti-cholinergics
- use peak flow and spacers
- ID the trigger
118
What are the goals of asthma interventions
- Prevent disability
- Minimize morbidity
- Assist living a normal happy life
119
How is asthma treatment sucess measured?
With PEF monitoring
120
What is status asthmaticus?
an asthma attack that is non-responsive to beta-2's
| -Requires intubation and mechanical vent.
121
What is Cystic Fibrosis?
A multi system disorder of the endocrine glands
122
What is the patho of Cystic Fibrosis?
- Thick mucus accumulates in broncioles (atelectasis)
- Pancreatic ducts clog( prevent release of digestive enzymes)
- Small intestines cant absorb fat and protein (Growth retardation)
123
How is Cystic Fibrosis diagnosed?
Sweat test
124
What is the assesment for Cystic Fibrosis?
- Diabetes
- Sweat test
- Clubbing, cyanosis
- Steatorrhea
- Failure to thrive
- Fat soluble vitamin deficiency
125
What are the four main interventions for Cystic fibrosis?
1. Prevent and minimise pulmonary complications
2. Ensure adequate nutrition
3. Encourage activity
4. Promote reasonable quality of life
