Week 5 - Respiratory

Question 1

Airway diameter of a newborn vs. adult

Answer 1

Newborn: 4 mm

Adult: 20 mm

Question 2

Airway Diameter of a Newborn

KNOW THIS!!!!!

Answer 2

4 mm

Question 3

Airway Diameter of an Adult

Answer 3

20 mm

Question 4

When do alveoli grow & mature in children?

KNOW THIS!!!!!

Answer 4

• Grow by week 36 gestation
• Mature by 5-8 years

Question 5

S/S of Mild Respiratory Distress

KNOW THIS!!!!!

Answer 5

Restlessness, tachypnea, tachycardia, diaphoresis

• Child is trying to compensate for 0-2 deficits & airway blockages
• Vital signs reflect compensation & beginning hypoxia

Question 6

Signs & Symptoms Moderate Respiratory Distress with Early Decompensation

KNOW THIS!!!!!

Answer 6

• Nasal flaring
• Retractions
• Grunting, wheezing
• Anxiety, irritability, mood changes, confusion
• Hypertension

Question 7

Signs & Symptoms of Severe Respiratory Distress: Respiratory Failure / Imminent Arrest

KNOW THIS!!!!!

Answer 7

• Dyspnea
• Bradycardia
• Cyanosis (LATE sign)
• Stupor, coma

Children with severe respiratory distress & a narrowed airway often sit in tripod position, leaning forward with arms on the legs. The head & neck are extended with the jaw thrust forward to help keep the airway open.

• this position may also be seen in a child with an acute asthma flare.

Question 8

Croup

KNOW THIS!!!!!

Answer 8

Broad class of upper airway illnesses that result in inflammation & swelling of the epiglottis & larynx, swelling extends into the trachea & larynx

Cause: can be viral or bacterial

• Common among 3 months - 3 year olds

Dx: CXR with steeple sign

Question 9

Signs & Symptoms of Croup (Laryngotracheitbronchitis / LTB)

KNOW THIS!!!!!

Answer 9

• Fever
• Barking / croupy cough
• Inspiratory stridor
• Retractions
• Hoarse cry
• Cyanosis
• Decreased level of consciousness (LOC)

Question 10

Treatment / Clinical Therapy for Croup (Laryngotracheitbronchitis / LTB)

KNOW THIS!!!!!

Answer 10

• Oral dexamethasone
• Nebulized epinephrine
• Supplemental O2 (if hypoxic)
• Antipyretics PRN
• Hydration
• Continuous observation of respiratory status
• Administer medications
• Quiet environment to promote rest

Question 11

Stridor

KNOW THIS!!!!!

Answer 11

High-pitched sound generated from partially obstructed air flow in the upper airway

Question 12

Epiglottitis

KNOW THIS!!!!!

Answer 12

Inflammation & swelling of the epiglottis & larynx

Cause: bacterial infection often caused by haemophilis influenza

Dx: CXR = thumb sign

Question 13

S/S of Epiglottitis

KNOW THIS!!!!!

Answer 13

• High fever
• Sore throat
• Drooling dysphagia
• Tachycardia
• Tachypnea
• Tripod position

Question 14

Nursing Management of Epiglottitis

KNOW THIS!!!!!

Answer 14

• do NOT upset child
• do NOT put anything in their mouth
• Prep for intubation THEN IV access / labs

Question 15

Tx of Epiglottitis

KNOW THIS!!!!!

Answer 15

• IV antibiotics
• IV dexamethasone
• Nebulized epinephrine
• Antipyretics
• O2
• Intubation
• Hib vaccine (influenza type B)

Question 16

Bronchiolitis

KNOW THIS!!!!!

Answer 16

Inflammation & obstruction of the bronchioles

• lower respiratory infection (viral or bacterial)
• leading cause of hospitalizations in ages 1 year
• RSV = #1 cause

Dx: CXR = reactive airway disease

Question 17

Respiratory Syncytial Virus (RSV)

KNOW THIS!!!!!

Answer 17

• Highly contagious viral respiratory infection
• major cause of bronchiolitis
• form syncytia or large masses of cells that clog & irritate the airway

Question 18

S/S of Bronchiolitis / RSV

KNOW THIS!!!!!

Answer 18

• Nasal symptoms
• Cough
• Fever
• Wheezing
• Tachypnea
• Retractions / nasal flaring / grunting
• ↓ activity level
• ↓ oral intake
• Dehydration (dry lips, tachycardia, lethargy)
• Wheezing & crackles in airways

Question 19

Nursing Management for Bronchiolitis

Answer 19

• Nasal swabs
• Suction
• IV fluids
• O2 (NC or high flow NC)

Question 20

Tx of Bronchiolitis / RSV

KNOW THIS!!!!!

Answer 20

• Supportive care
• Antibiotics
• Nebulized albuterol
• Chest physiotherapy (CPT)
• Synagis: Immunoglobulin for high risk children less than 32 weeks old; administerd q30 days for 5 months (winter months)

Question 21

High Flow Nasal Cannula (HFNC)

KNOW THIS!!!!!

Answer 21

Continuous positive airway pressure (CPAP)

• up to 60 L/min

Question 22

Pneumonia

KNOW THIS!!!!!

Answer 22

Inflammation of the bronchioles & alveoli

• community or hospital acquired or from aspiration
• TYPES: viral, bacterial, mycoplasmal (atypical)

Question 23

S/S of Pneumonia

KNOW THE BOLD!!!!!

Answer 23

• cough
• crackles / rhonchi
• congestion
• fever
• chest pain
• Retractions / nasal flaring / grunting / SOB / lethargy
• abdominal pain
• poor appetite

Question 24

Tx for Pneumonia

Answer 24

Antibiotics for Bacterial
* ampicillin or amoxicillin for outpatient
* azithromycin for atypical
* ceftriaxone for high risk or unvaxxed

Pain / fever control

Question 25

**Asthma** | **KNOW THE BOLD!!!!!**

Answer 25

**Persistent inflammation of the airway causing hyper responsiveness leading to excess mucous, swelling, & muscle contraction** Triggers: environmental, exercise, viruses, or allergens, smoke, dander, feces, air pollutants

Question 26

**S/S of Asthma** | **KNOW THE BOLD!!!!!**

Answer 26

* **sudden onset of SOB** * cough * **inspiratory or expiratory wheezing** * tachypnea * **retractions**

Question 27

**Tx for Asthma**

Answer 27

**Short-acting beta agonist (SABA)** * albuterol **Corticosteroids** * decadron, prednisone, solumedrol **Anticholinergics** * ipatropium **Adjuncts** * duoneb: albuterol/ipatropium, magnesium sulfate

Question 28

**Rule of Twos for Asthma** | **KNOW THIS!!!!!**

Answer 28

* Do you use your quick-relief inhaler more than **2 times per week?** * Do you awaken at night due to ashtma more than **2 times per month?** * Do you refill a quick-relief inhaler prescription more than **2 times per year?**

Question 29

**5-10-5 Rule** (asthma) | **KNOW THIS!!!!!**

Answer 29

**How to use a Spacer:** * Tilt head back & breath in for **5 seconds** * Hold breath for **10 seconds** * breathe out for **5 seconds**

Question 30

**Cystic Fibrosis (CF)** | **KNOW THE BOLD!!!!!**

Answer 30

**Reduced water movement across cell membranes = blocked airways** * Inherited disorder, **CFTR gene mutation;** autosomal **recessive** trait * Causes damage to the lungs, pancrease, gallbladder, & liver * 30,000 in the US * 10 million carriers **Dx: sweat test** (gold standard)

Question 31

**Tx for Cystic Fibrosis (CF)**

Answer 31

* Short-acting beta agonist (SABA) for airway inflammation * inhaled (tobramycin) & IV antibiotics (Cefepime) for flare ups * Hypertonic saline nebulizer tx * Pulmozyme (liquifies secretions) * pancreatic supplements * Vit ADEK (fat soluble)