2Resp/ Gas Exchange Disorders Flashcards
Peds resp illness account for 50% of childrens illness under what age
Predominately what
Under 5
Viral (so usually symptom management)
Peds anatomical differences
Nose
Nose:
-obligate nose breathers first several months of life
-small nasal passages
-sinuses not fully developed
Peds anatomical differences
Ears
Mouth
Ears:
-eustachian tubes are short, wide, straight and lie horizontal (less of an angle) (decreased drainage)
(increase risk for infection)
Mouth:
-large tongues and tonsils
Peds anatomical differences
Lungs
Limited chest volume
Fewer alveoli
Periodic breathing/brief periods of apnea
(Less than 20 secs and asymptomatic)
Peds anatomical differences
Abdominal breathing
Intercostal & accessory muscles
Oxygen consumption
Abdominal breathing:
-diaphragm is main muscle of respirations
Intercostal & accessory muscles: poorly developed
-grunting
-retractions
Oxygen consumption:
-greater due to greater metabolic rate
Peds anatomical differences
Trachea
Shorter/narrower
Bifurcation at 3rd thoracic vertebrae
-higher than adults
Peds respiratory assessment
Ask what
Observe what
Look before what
Ask a good history
Observe physical and behavior
Look before touch
Peds resp assessment
Inspection SSSRAC
Skin color
Shape of chest
Signs of resp distress
Resp: rate, effort, rhythm
Appearance
Clubbing (chronic)
Peds resp assessment
Palpation
Auscultation
P:
-sinuses
-lymph nodes
-pulses
A:
-wheezes
-crackles
-rhonchi
Resp diagnostic SOPRRRBB
Sputum
O2 sats
PFT
Radiology (chest x-rays/CT/MRI)
Rapid flu, strep, covid
RSV, adenovirus, rhinovirua, eterovirus, coronavirus
Blood gases
Bronchoscopy
Where to put pulse ox
Older infants: toe
Best on hand once mobile
Early, subtle signs of resp distress 9
Irritability
Change in depth and pattern of resp
Tahcypnea
Tachycardia
Diaphoretic
Flaring nares
Retractions
Grunt
Wheeze or prolonged expiration
Signs of severe hypoxia
Bradycardia
Cyanosis, peripheral or central
Dyspnea
Hypotension or HTN
Tx of resp disorders
Positioning
Sunction
Saline lavage (only in nose)
Fluids
Oxygen
Aerosol therapy
Chest PT
Tx of resp disorders
Med types
Expectorants
Cough suppressants
Antihistamines
Antibiotics
Bronchodilator
Corticosteroids
Antivirals
Oxygen therapy 4
ALL AIR NEEDS TO BE HUMIDIFIED
Nasal cannula (max 4L)
Oxygen mask (6-10L)
Oxygen hood (10-15L)
Non-rebreather (10-12L)
Oxygen therapy
Highflow (vapotherm/airvo)
Monitoring for O2 toxicity
-high pressure to keep lungs open
If at 100% need to wean bc may be giving them too much oxygen
Nebulized aerosol therapy
Take 10-15 mins
Effective in depositing meds directly into airway
Used with younger pts until they get old enough to get an inhaler
Chest physical therapy
What is it
What is it utilizes
Loosens what
Set of techniques: CPT vest/handheld
-percussion
-vibration
-cough
-breathing exercises
Utilizes postural drainage to enhance the clearance of mucous
Loosens secreations
Where we can suction
Oral suction
Nasal suction
NP(nasopharynx suction)
NT (nasotrachial suction)
Tacheal/endotracheal
Suctioning trachea beyond is called what
What we need to do
How to for NT and OP
Deep suction
Measure
NT: nose to adams apple
OP: corner of mouth to ear lobe
Rules with suctioning
No suction while going in
Once in turn on suction
Twirl on way out
Duration:
Infants = >5 secs
Older children = >10secs
Wait 30-60secs between
Procedures trach care and suction
What to have at bedside
Spedical considerations
Suction is what? We use what?
Bedside:
-scissors
-obturator
-trach ties
-xtra trach a size smaller if there is swelling
Special cosiderations:
No inner cannula means:
trach care consists of skin care/ changing trach ties
Premeasure and use saline lavage
Suctioning a peds trach
Premeasure cath
Insert cath
Swirl cath for about 5 sec, suction on
Remove the cath slowly, suction on
Apnea
ALTE vs BRUE
Definition
ALTE: apparent life threatening event
BRUE: brief resolved unexplained event
Cessation of breathing for a period of 20 secs or longer
Or
Short period accompanied by brady cardiac or cyanosis
Apnea of prematurity
vs
infant apnea (not premature)
Premature:
24-32wks (most at risk)
Resolves by week 38wks
Not premature:
R/O: GERD, SZ, Sepsis, hypoglycemia
Apnea diagnostics
CR monitor
Chest xray
Blood chemistry studies (glucose, electrolytes)
ECG/EEG (r/o heart or sz)
Apnea therapeutic management
Apnea of prematurity 5
Vs
Infant apnea (not premature) 1
Premature:
Gentle, cutaneous stimulation (tap foot)
Caffeine (stimulates them)
O2 admin
CPAP
Cr monitor
Not premature:
If no underlying condition like we mentioned previously then:
-home monitoring with meds
Apnea interventions
CR monitor
Tapping foot or trunk
Manintain neutral thermal environment
Avoid suctioning
Monitor closely while feeding (r/o as a problem)
Allergic rhinitis
Caused by
S/s
Seasonal allergies (autumn/spring)
S/s:
-watery rhinorrhea
-nasal stuffiness
-itchy eyes, nose, throat
-HA
-fatigue, malaise
Allergic rhinitis
Tx
Avoid allergen
Meds:
Nasal corticosteriods
Antihistamines
Leukotriene modifiers
Tonsillitis
Risk factors
Exposure to viral or bacterial agent
Immature immune system
Tonsillitis
S/s
Mouth odor
Snoring
Fever
Sore throat
Difficulty eating, drinking, swallowing
Tonsil inflammation w/ redness/edema
(Worried about airway patency)
Tonsilitis
Lab diagnostic
Nursing care
Throat culture for Group-A-beta-hemolytic step
(Viral wont be positive)
Nursing care:
-rest
-warm fluids, salt water gargles
-abx
Tonsilitis
Meds
Procedure
Antipyretics/analgesics
Abx
Tonsillectomy
Post Tonsillectomy
Positioning
Assessment
Comfortmeasures
position:
-facilitate drainage
-elevate HOB when awake
Assessment:
-airway, vitals, WOB
Comfort measures:
-icechips/water/popsicles
-analgesics
Tonsillectomy
Diet
Education
Diet:
-clear liquids
-once tolerating clear liquids go to soft/bland diet
Education:
-avoid straws
-avoid red liquids/citrus/milk(looks like blood)
-rest
-notify of bright red bleeding
Tonsillectomy
Complications
S/s
hemorrhage
dehaydration
S/s:
Frequent swallowing
Clearing throat
Restlessness
Bright red emesis
Tachycardia
Pallor
Hypotension
Nasopharyngitis: common cold
What is it: how long it last
S/s
Self limiting virus: last 4-10 days
S/s:
Nasal inflammation
Dryness/irritation of nasal passages and pharynx
Fever
Decreased appetite
Restlessness, fatigue
Nasopharyngitis: common cold
Nursing care
Rest/oral fluids
Cool mist humidifiers
Meds:
Antipyretics
Cough suppresants
Decongestants (older than 6y/o)!!!!
Bronchitis
Associated with what
What is it
S/s
Resolves how soon
Associated with URIs
Inflammation of large airway
S/s:
-persistent dry/hacking cough
-resolves in 5-10 days (self limiting)
Bronchitis
Nursing care
Rest/oral fluid
Cool mist humidifier
Meds:
antipyretic (fever)
Cough suppressants
Bronchiolitis
Caused by
Affects what part of airway
RSV (resp syncytial virus)
Affects small airway: bronchi and bronchioles
Bronchiolitis
S/s:
Early
Progression
Severe illness
Early: RIPCSEW
-rhinorhhea, intermittent fever, pharyngitis, coughing, sneezing, wheezing
-possible ear infection
Progression: FRITR +
-increased cough and sneezing, fever, tachypnea, retractions, refusal to eat,
Hallmark: copious secretions
Severe illness: CLEPAD
-extreme tachypnea, apneic spells, poor air exchange, diminished breath sounds, cyanosis, listlessness
Bronchiolitis
Diagnostics
Nursing care 6
Test nasopharyngeal secreation (viral test)
Nursing care:
-CR monitor, pulse ox, vitals
-oxygen maintain 90%< sats
-position
-suction/saline lavage
-oral fluids (half strength formula/thinner)
-iv fluids if dont tolerate oral feeding)
Bronchiolitis
Meds
Immunizations (prevent what) (for only who?)
Bronchodilator (not proven helpful)
Steriods (help inflammation)
Immunization:
Palivizumab (synagis) IM = prevents RSV
(For high risk only) =premature/ immunocompromised
Otitis media
In peds mostly bc what
Most common complications
S/s
Peds bc anatomical differences
Leads to URI d/t drainage
S/s:
Fussiness
Fever
Pulling at ears
Otitis media
Tx
Rest/ oral fluids
Acetaminophen/ibuprofen
7-10days of abx (amoxicillin, omnicef)
Myringotomy: insertion of tympanostomy tubes
Bacterial pneumonia
S/s
Complications
High fever
Tachypnea/retratctions/nasal flaring
Crackles/rhonchi
Pallor, cyanosis
Irritability, restless
Complications
Pneumothroax
Pleural effusion
Bacterial pneumonia
Diagnostics
Nursing care
Meds
D:
-CXR
Tx:
-I/O monitor, CR monitor
Administer O2
-CPT, potural drainage
Meds:
-IV/PO abx
-antipyretic
Croup: acute laryngotrachneobronchitis
What is it
Common in what ages
Causes by
Inflammation and edema of laynx, teachea, bronchial tubes
3months-3y/o
Causes by:
Para influenza I,II,III virus
Influenza A and B
RSV
Croup: acute laryngotrachneobronchitis
S/s
Hallmark
Normal
May see what in infants and toddlers
Hallmark:
-barky cough
-inspiratory stridor
Normal:
-hoarse cry
-fever
-increased symptoms at night
-increased agitation and crying
May see: (in infants/toddlers)
Nasal flaring
Retractions
Tachypnea
Croup: acute laryngotrachneobronchitis
Tx
Hallmark tx
Normal
Hallmark:
Racemic/nebulized epinephring
Corticosteroids orally (dexamethasone)
Nebulized (budesonide)
Normal:
O2
Oral/IV fluids
Limit suction (stimulated cough)
Epiglottitis (MEDICAL EMERGENCY)
Emergency
Causes
Airway emergency (can be fatal)
Viral or bacteria
(Caused by H. Influenzae(bacteria)
Epiglottitis
S/s:
Hallmark
Normal
4 d’s
Hallmark:
-begins as mild URI, develops high fever, sorethroat with dysphagia
-excessive drooling
Normal:
-inspiratory stridor
-retractions
4d’s:
Dysphagia
Dysphonia
-drooling
-dyspnea/distress
Epiglottitis
Diagnostics
Lateral neck x-ray can show inflammation of soft tissues
Epiglottitis
Precautions
Tx
(Normal)
(Meds)
(Unique)
Droplet
Normal:
CR/O2 monitoring
Humidified o2
Iv fluids
Meds:
Abx
Corticosteroids
Unique:
No deep suctioning
Avoid throat culture or use of tongue blades
Influenza A&B
S/s
Diagnostics
Sudden onset of fever/chills
Fever
Dry throat/nasal mucosa
Dry cough
Myalgia, fatigue
Photophabia
Diagnostics:
Analyze nasopharngeal secretions
Influenza A&B
Tx
Normal
Meds (SEs)
Rest/oral fluids
Meds:
Antipyretics
Antivirals: Tamiflu (oseltamivir)
-start within 48 hrs
SE: N/V, hallucinations
Long term resp disease
Asthma and cystic fibrosis
Asthma facts
What is it
Its the most common what
Chronic inflammatory disorder of the airways characterized by:
-Mast cells released histamine and leukotrienes causing inflammation
-Airway obstruction
-Bronchial hyperresponsiveness
-Mucous production
Most common chronic disease of childhood
Asthma Risk Factors
Family hx of asthma or allergies
Chronic exposure to tobacco smoke
Low birth wt
Overweight
Asthma triggers
Allergens: trees, grass, pollen
Irritants: smoke, sprays
Exposure to chemical
Exercise
Cold air exposure
Animal dander
Asthma exacerbation s/s
Chest tightness
Audible wheezes
Increased WOB
Retractions/accessory muscle use
Tripod positioning
Hypoxia
Inaudible breathsounds (airway obstructed)
Asthma labs and diagnostics
PFTs
PEFR (peak expiratory flow rate)
Allergen testing
CXR
CBC (WBC)
Asthma
Maintence meds
Inhaled anti-inflammatory drugs (everyday drugs)
Long-acting beta 2 agonist
Inhaled anti-inflammatory drugs:
Budesonide (pulmicort)
Beclodmethason dipropionate HFA (QVAR)
Long actions beta 2 agonist: broncho dilators
-salmeterol
-formoterol
Asthma maintence meds
Typically combo inhalers
Systemic leukotriene inhibitors or modifiers
Typical combo inhaler:
-formoterol & budesonide (symbicort)
-formoterol & mometasone (dulera)
-salmerterol & fluticasone (advair)
-Vilanterol & fluticasone (breo)
Systemic leukotriene inhibitors or modifiers:
-montelukast (singulair)
asthma maintence med types
Inhaled anti-inflammatory drugs
Long acting beta 2 agonist (bronchodilators)
Typically combos
Systemic leukotriene inhibitors or modifiers
Asthma
Rescue meds type
Inhaled bronchodilator- short acting beta (1)
Systemic anti-inflammatory (4)
Systemic bronchodilators (4)
Inhaled bronchodilator-short acting beta
-albuterol
Systemic anti-inflammatory
-corticosteroids
-methylprednisolone, predisolone, dexamethasone
Systemic bronchodilator
-mag sulfate, terbutaline, theotphylline, aminophylline
Asthma (pt education)
Identify triggers
Use peak flow meter
Exercise
Learn signs of asthma exacerbation
Immunization (prevent infection leading to exacerbation)
Asthma treatment
Multidose inhaler (MDI)
Dry powder inhaler (DPI)
Nebulized
Spacers
Spacers (how to use inhaler)
Shake inhaler
Attach spacer
Breath out
Place spacer between teeth
Close lips
Slowly breath in as press down on inhaler
Hold breath 10 secs
Slowly exhale out of pursed lips
Rinse mouth
Peak flow meter: education
-Marker at zero
-Upright mouth clear of food
-Close lips around meter and blow out as hard as possible
-Read number
-Usually do 2-3 attampts and accept highest attempt
Do daily
Guidelines peak flows (PEFR)
Green: 80-100%
Yellow 50-80
-call MD
-maintenance therapy be need increase
- take rescue inhaler
Red below 50
-signals medical alert (take rescue meds)
-Go to ER
Cystic fibrosis
RF
Systems it effects
RF:
Genetics (autosomal recessive)
Caucasians
Systems:
-resp
-GI
-integumentary
-endocrine/reproductive
CF Resp s/s
Explained
-Secretions (thick/sticky) obstruct
-Stasis of secretions lead to infection
-Inflammation leads to:
bronchospasm, pneumonia, and obstructive emphysema
CF resp s/s
Early 3
Increased involvement2
Advanced 4
Early:
-Wheezing
-rhonichi
-dry non-productive cough
Increased involvement:
-Dyspnea
-paroxysmal cough
Advanced:
-Cyanosis
-barrel chest
-clubbing
-repeated infections
CF GI/digestive s/s 4
Bowel obstruction (meconium ileus in new borns)
Pancreatic ducts blocked
Unable to secrete pancreatice enzymes
Malaborption of fats/proteins/carbs:
-poor wt gain/growth
-deficiecy of fat-soluble vitamine (A,D,E,K)
-large stools
Bile duct obstruction:
-biliary cirrhosis, portal HTN
CF
Endocrine and reproductive
Integumentary
S/s
E&R:
-vicous cervical mucus (hard to get preg)
-decrease/absent sperm
-decreased insulin production
I:
-sweat,tears and saliva high in sodium and cholride
CF labs and diagnostics
DNA testing (genetic)
Newborn metabolic screen
CXR/abd xray
PFT
Sweat chloride test
Stool analysis (fat and enzymes)
Sputum culture
Serum panel (determine fat vit A,D,E,K deficiency)
CF nursing management
Normal tx
Airway clearance therapy
Aerosol therapy
Others
Resp assessment/vital signs
Oxygen
Sputum collection for culture and sensitivity
Airway clearance therapy (min. 2x a day)
-CPT, postural drainage, cough deep breath, cough assist machine
Aerosol therapy (bronchodilators, dornase alfa)
Tx of lung infections
Lung transplant
CF resp meds
Albuterol-short acting beta2 agonist (bronchodilator)
Atrovent/atrovent HFA (ipratropium bromide)
-anticholinergic (relax airway muscle/reduce mucus)
Route: MDI or nebulizer; rinse mouth
Advair/advair HFA (fluticasone propionate/salmeterol) = bronchodilator + antiinflammatory
Route: MDI;rinse mouth
Pulmozyme (dornase alfa)
Route: aerosol nebulizer
CF
GI/endocrine management
Consult dietician
Diet: high protein/calories
Infants require: breast milk fortification/high calorie
Pancreatic enzyme capsules w/ meals!!!!
Vit supp: A,D,E,K
Monitor blood sugar (hyperglycemia)
Admin insulin if needed
CF GI meds
Daily multivitamin A,D,E,K Monitor
Pancreatic enzymes w/ meals or snacks
-monitor stools: 1-2x day
-monitor wt
increase dosage when eating foods high in fat
route: can swallow or sprinkle on food
Whats a sign a pt is not taking their pancreatic enzymes
Bulky stools
CF interprofession approach
RT
PT pulmonology
Endocrinology
Pediatrician
Dietixian
Pharmacist
CF pt and family education
Education on: nebulizer, CPT vests
Keep immunizations UTD
Monitor for infections
Exercise and diet compliance
Transplantation may be considered
