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AN305 > 2Resp/ Gas Exchange Disorders > Flashcards

2Resp/ Gas Exchange Disorders Flashcards

1
Q

Peds resp illness account for 50% of childrens illness under what age

Predominately what

A

Under 5

Viral (so usually symptom management)

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2
Q

Peds anatomical differences

Nose

A

Nose:
-obligate nose breathers first several months of life
-small nasal passages
-sinuses not fully developed

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3
Q

Peds anatomical differences

Ears

Mouth

A

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

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4
Q

Peds anatomical differences

Lungs

A

Limited chest volume
Fewer alveoli

Periodic breathing/brief periods of apnea
(Less than 20 secs and asymptomatic)

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5
Q

Peds anatomical differences

Abdominal breathing
Intercostal & accessory muscles
Oxygen consumption

A

Abdominal breathing:
-diaphragm is main muscle of respirations

Intercostal & accessory muscles: poorly developed
-grunting
-retractions

Oxygen consumption:
-greater due to greater metabolic rate

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6
Q

Peds anatomical differences

Trachea

A

Shorter/narrower

Bifurcation at 3rd thoracic vertebrae
-higher than adults

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7
Q

Peds respiratory assessment

Ask what
Observe what
Look before what

A

Ask a good history

Observe physical and behavior

Look before touch

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8
Q

Peds resp assessment

Inspection SSSRAC

A

Skin color
Shape of chest
Signs of resp distress
Resp: rate, effort, rhythm
Appearance
Clubbing (chronic)

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9
Q

Peds resp assessment

Palpation

Auscultation

A

P:
-sinuses
-lymph nodes
-pulses

A:
-wheezes
-crackles
-rhonchi

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10
Q

Resp diagnostic SOPRRRBB

A

Sputum
O2 sats
PFT
Radiology (chest x-rays/CT/MRI)
Rapid flu, strep, covid
RSV, adenovirus, rhinovirua, eterovirus, coronavirus
Blood gases
Bronchoscopy

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11
Q

Where to put pulse ox

A

Older infants: toe

Best on hand once mobile

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12
Q

Early, subtle signs of resp distress 9

A

Irritability
Change in depth and pattern of resp
Tahcypnea
Tachycardia
Diaphoretic

Flaring nares
Retractions
Grunt
Wheeze or prolonged expiration

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13
Q

Signs of severe hypoxia

A

Bradycardia
Cyanosis, peripheral or central
Dyspnea
Hypotension or HTN

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14
Q

Tx of resp disorders

A

Positioning
Sunction
Saline lavage (only in nose)
Fluids
Oxygen
Aerosol therapy
Chest PT

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15
Q

Tx of resp disorders

Med types

A

Expectorants
Cough suppressants
Antihistamines
Antibiotics
Bronchodilator
Corticosteroids
Antivirals

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16
Q

Oxygen therapy 4

ALL AIR NEEDS TO BE HUMIDIFIED

A

Nasal cannula (max 4L)

Oxygen mask (6-10L)

Oxygen hood (10-15L)

Non-rebreather (10-12L)

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17
Q

Oxygen therapy

Highflow (vapotherm/airvo)

Monitoring for O2 toxicity

A

-high pressure to keep lungs open

If at 100% need to wean bc may be giving them too much oxygen

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18
Q

Nebulized aerosol therapy

A

Take 10-15 mins

Effective in depositing meds directly into airway

Used with younger pts until they get old enough to get an inhaler

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19
Q

Chest physical therapy

What is it
What is it utilizes
Loosens what

A

Set of techniques: CPT vest/handheld
-percussion
-vibration
-cough
-breathing exercises

Utilizes postural drainage to enhance the clearance of mucous

Loosens secreations

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20
Q

Where we can suction

A

Oral suction

Nasal suction

NP(nasopharynx suction)
NT (nasotrachial suction)

Tacheal/endotracheal

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21
Q

Suctioning trachea beyond is called what

What we need to do
How to for NT and OP

A

Deep suction

Measure

NT: nose to adams apple
OP: corner of mouth to ear lobe

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22
Q

Rules with suctioning

A

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

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23
Q

Procedures trach care and suction

What to have at bedside
Spedical considerations
Suction is what? We use what?

A

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

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24
Q

Suctioning a peds trach

A

Premeasure cath
Insert cath
Swirl cath for about 5 sec, suction on
Remove the cath slowly, suction on

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25
Q

Apnea

ALTE vs BRUE

Definition

A

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

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26
Q

Apnea of prematurity
vs
infant apnea (not premature)

A

Premature:
24-32wks (most at risk)
Resolves by week 38wks

Not premature:
R/O: GERD, SZ, Sepsis, hypoglycemia

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27
Q

Apnea diagnostics

A

CR monitor
Chest xray
Blood chemistry studies (glucose, electrolytes)
ECG/EEG (r/o heart or sz)

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28
Q

Apnea therapeutic management

Apnea of prematurity 5
Vs
Infant apnea (not premature) 1

A

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

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29
Q

Apnea interventions

A

CR monitor
Tapping foot or trunk
Manintain neutral thermal environment
Avoid suctioning
Monitor closely while feeding (r/o as a problem)

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30
Q

Allergic rhinitis

Caused by

S/s

A

Seasonal allergies (autumn/spring)

S/s:
-watery rhinorrhea
-nasal stuffiness
-itchy eyes, nose, throat
-HA
-fatigue, malaise

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31
Q

Allergic rhinitis

Tx

A

Avoid allergen

Meds:
Nasal corticosteriods
Antihistamines
Leukotriene modifiers

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32
Q

Tonsillitis

Risk factors

A

Exposure to viral or bacterial agent

Immature immune system

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33
Q

Tonsillitis

S/s

A

Mouth odor
Snoring
Fever
Sore throat
Difficulty eating, drinking, swallowing
Tonsil inflammation w/ redness/edema
(Worried about airway patency)

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34
Q

Tonsilitis

Lab diagnostic

Nursing care

A

Throat culture for Group-A-beta-hemolytic step
(Viral wont be positive)

Nursing care:
-rest
-warm fluids, salt water gargles
-abx

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35
Q

Tonsilitis

Meds
Procedure

A

Antipyretics/analgesics
Abx

Tonsillectomy

36
Q

Post Tonsillectomy

Positioning
Assessment
Comfortmeasures

A

position:
-facilitate drainage
-elevate HOB when awake

Assessment:
-airway, vitals, WOB

Comfort measures:
-icechips/water/popsicles
-analgesics

37
Q

Tonsillectomy

Diet
Education

A

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

38
Q

Tonsillectomy

Complications
S/s

A

hemorrhage
dehaydration

S/s:
Frequent swallowing
Clearing throat
Restlessness
Bright red emesis
Tachycardia
Pallor
Hypotension

39
Q

Nasopharyngitis: common cold

What is it: how long it last
S/s

A

Self limiting virus: last 4-10 days

S/s:
Nasal inflammation
Dryness/irritation of nasal passages and pharynx
Fever
Decreased appetite
Restlessness, fatigue

40
Q

Nasopharyngitis: common cold

Nursing care

A

Rest/oral fluids
Cool mist humidifiers

Meds:
Antipyretics
Cough suppresants
Decongestants (older than 6y/o)!!!!

41
Q

Bronchitis

Associated with what
What is it
S/s
Resolves how soon

A

Associated with URIs
Inflammation of large airway

S/s:
-persistent dry/hacking cough
-resolves in 5-10 days (self limiting)

42
Q

Bronchitis

Nursing care

A

Rest/oral fluid
Cool mist humidifier

Meds:
antipyretic (fever)
Cough suppressants

43
Q

Bronchiolitis

Caused by
Affects what part of airway

A

RSV (resp syncytial virus)

Affects small airway: bronchi and bronchioles

44
Q

Bronchiolitis

S/s:
Early
Progression
Severe illness

A

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

45
Q

Bronchiolitis

Diagnostics

Nursing care 6

A

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)

46
Q

Bronchiolitis

Meds
Immunizations (prevent what) (for only who?)

A

Bronchodilator (not proven helpful)
Steriods (help inflammation)

Immunization:
Palivizumab (synagis) IM = prevents RSV

(For high risk only) =premature/ immunocompromised

47
Q

Otitis media

In peds mostly bc what
Most common complications
S/s

A

Peds bc anatomical differences
Leads to URI d/t drainage

S/s:
Fussiness
Fever
Pulling at ears

48
Q

Otitis media

Tx

A

Rest/ oral fluids

Acetaminophen/ibuprofen
7-10days of abx (amoxicillin, omnicef)

Myringotomy: insertion of tympanostomy tubes

49
Q

Bacterial pneumonia

S/s
Complications

A

High fever
Tachypnea/retratctions/nasal flaring
Crackles/rhonchi
Pallor, cyanosis
Irritability, restless

Complications
Pneumothroax
Pleural effusion

50
Q

Bacterial pneumonia

Diagnostics
Nursing care
Meds

A

D:
-CXR

Tx:
-I/O monitor, CR monitor
Administer O2
-CPT, potural drainage

Meds:
-IV/PO abx
-antipyretic

51
Q

Croup: acute laryngotrachneobronchitis

What is it
Common in what ages

Causes by

A

Inflammation and edema of laynx, teachea, bronchial tubes

3months-3y/o

Causes by:
Para influenza I,II,III virus
Influenza A and B
RSV

52
Q

Croup: acute laryngotrachneobronchitis

S/s

Hallmark
Normal
May see what in infants and toddlers

A

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

53
Q

Croup: acute laryngotrachneobronchitis

Tx

Hallmark tx
Normal

A

Hallmark:
Racemic/nebulized epinephring
Corticosteroids orally (dexamethasone)
Nebulized (budesonide)

Normal:
O2
Oral/IV fluids
Limit suction (stimulated cough)

54
Q

Epiglottitis (MEDICAL EMERGENCY)

Emergency
Causes

A

Airway emergency (can be fatal)

Viral or bacteria
(Caused by H. Influenzae(bacteria)

55
Q

Epiglottitis

S/s:
Hallmark
Normal
4 d’s

A

Hallmark:
-begins as mild URI, develops high fever, sorethroat with dysphagia
-excessive drooling

Normal:
-inspiratory stridor
-retractions

4d’s:
Dysphagia
Dysphonia
-drooling
-dyspnea/distress

56
Q

Epiglottitis

Diagnostics

A

Lateral neck x-ray can show inflammation of soft tissues

57
Q

Epiglottitis

Precautions
Tx
(Normal)
(Meds)
(Unique)

A

Droplet

Normal:
CR/O2 monitoring
Humidified o2
Iv fluids

Meds:
Abx
Corticosteroids

Unique:
No deep suctioning
Avoid throat culture or use of tongue blades

58
Q

Influenza A&B

S/s
Diagnostics

A

Sudden onset of fever/chills
Fever
Dry throat/nasal mucosa
Dry cough
Myalgia, fatigue
Photophabia

Diagnostics:
Analyze nasopharngeal secretions

59
Q

Influenza A&B

Tx

Normal
Meds (SEs)

A

Rest/oral fluids

Meds:
Antipyretics

Antivirals: Tamiflu (oseltamivir)
-start within 48 hrs
SE: N/V, hallucinations

60
Q

Long term resp disease

A

Asthma and cystic fibrosis

61
Q

Asthma facts

What is it
Its the most common what

A

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

62
Q

Asthma Risk Factors

A

Family hx of asthma or allergies
Chronic exposure to tobacco smoke
Low birth wt
Overweight

63
Q

Asthma triggers

A

Allergens: trees, grass, pollen
Irritants: smoke, sprays
Exposure to chemical
Exercise
Cold air exposure
Animal dander

64
Q

Asthma exacerbation s/s

A

Chest tightness
Audible wheezes
Increased WOB
Retractions/accessory muscle use
Tripod positioning
Hypoxia

Inaudible breathsounds (airway obstructed)

65
Q

Asthma labs and diagnostics

A

PFTs
PEFR (peak expiratory flow rate)
Allergen testing
CXR
CBC (WBC)

66
Q

Asthma
Maintence meds

Inhaled anti-inflammatory drugs (everyday drugs)
Long-acting beta 2 agonist

A

Inhaled anti-inflammatory drugs:

Budesonide (pulmicort)
Beclodmethason dipropionate HFA (QVAR)

Long actions beta 2 agonist: broncho dilators
-salmeterol
-formoterol

67
Q

Asthma maintence meds

Typically combo inhalers

Systemic leukotriene inhibitors or modifiers

A

Typical combo inhaler:
-formoterol & budesonide (symbicort)
-formoterol & mometasone (dulera)
-salmerterol & fluticasone (advair)
-Vilanterol & fluticasone (breo)

Systemic leukotriene inhibitors or modifiers:
-montelukast (singulair)

68
Q

asthma maintence med types

A

Inhaled anti-inflammatory drugs
Long acting beta 2 agonist (bronchodilators)
Typically combos
Systemic leukotriene inhibitors or modifiers

69
Q

Asthma
Rescue meds type

Inhaled bronchodilator- short acting beta (1)
Systemic anti-inflammatory (4)
Systemic bronchodilators (4)

A

Inhaled bronchodilator-short acting beta
-albuterol

Systemic anti-inflammatory
-corticosteroids
-methylprednisolone, predisolone, dexamethasone

Systemic bronchodilator
-mag sulfate, terbutaline, theotphylline, aminophylline

70
Q

Asthma (pt education)

A

Identify triggers
Use peak flow meter
Exercise
Learn signs of asthma exacerbation
Immunization (prevent infection leading to exacerbation)

71
Q

Asthma treatment

A

Multidose inhaler (MDI)
Dry powder inhaler (DPI)
Nebulized
Spacers

72
Q

Spacers (how to use inhaler)

A

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

73
Q

Peak flow meter: education

A

-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

74
Q

Guidelines peak flows (PEFR)

A

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

75
Q

Cystic fibrosis

RF
Systems it effects

A

RF:
Genetics (autosomal recessive)
Caucasians

Systems:
-resp
-GI
-integumentary
-endocrine/reproductive

76
Q

CF Resp s/s
Explained

A

-Secretions (thick/sticky) obstruct

-Stasis of secretions lead to infection

-Inflammation leads to:
bronchospasm, pneumonia, and obstructive emphysema

77
Q

CF resp s/s
Early 3
Increased involvement2
Advanced 4

A

Early:
-Wheezing
-rhonichi
-dry non-productive cough

Increased involvement:
-Dyspnea
-paroxysmal cough

Advanced:
-Cyanosis
-barrel chest
-clubbing
-repeated infections

78
Q

CF GI/digestive s/s 4

A

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

79
Q

CF
Endocrine and reproductive
Integumentary
S/s

A

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

80
Q

CF labs and diagnostics

A

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)

81
Q

CF nursing management

Normal tx
Airway clearance therapy
Aerosol therapy
Others

A

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

82
Q

CF resp meds

A

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

83
Q

CF
GI/endocrine management

A

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

84
Q

CF GI meds

A

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

85
Q

Whats a sign a pt is not taking their pancreatic enzymes

A

Bulky stools

86
Q

CF interprofession approach

A

RT
PT pulmonology
Endocrinology
Pediatrician
Dietixian
Pharmacist

87
Q

CF pt and family education

A

Education on: nebulizer, CPT vests

Keep immunizations UTD

Monitor for infections

Exercise and diet compliance

Transplantation may be considered

AN305 (15 decks)

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