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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
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
26
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
27
Apnea diagnostics
CR monitor Chest xray Blood chemistry studies (glucose, electrolytes) ECG/EEG (r/o heart or sz)
28
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
29
Apnea interventions
CR monitor Tapping foot or trunk Manintain neutral thermal environment Avoid suctioning Monitor closely while feeding (r/o as a problem)
30
Allergic rhinitis Caused by S/s
Seasonal allergies (autumn/spring) S/s: -watery rhinorrhea -nasal stuffiness -itchy eyes, nose, throat -HA -fatigue, malaise
31
Allergic rhinitis Tx
Avoid allergen Meds: Nasal corticosteriods Antihistamines Leukotriene modifiers
32
Tonsillitis Risk factors
Exposure to viral or bacterial agent Immature immune system
33
Tonsillitis S/s
Mouth odor Snoring Fever Sore throat Difficulty eating, drinking, swallowing Tonsil inflammation w/ redness/edema (Worried about airway patency)
34
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
35
Tonsilitis Meds Procedure
Antipyretics/analgesics Abx Tonsillectomy
36
Post Tonsillectomy Positioning Assessment Comfortmeasures
position: -facilitate drainage -elevate HOB when awake Assessment: -airway, vitals, WOB Comfort measures: -icechips/water/popsicles -analgesics
37
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
38
Tonsillectomy Complications S/s
hemorrhage dehaydration S/s: Frequent swallowing Clearing throat Restlessness Bright red emesis Tachycardia Pallor Hypotension
39
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
40
Nasopharyngitis: common cold Nursing care
Rest/oral fluids Cool mist humidifiers Meds: Antipyretics Cough suppresants Decongestants (older than 6y/o)!!!!
41
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)
42
Bronchitis Nursing care
Rest/oral fluid Cool mist humidifier Meds: antipyretic (fever) Cough suppressants
43
Bronchiolitis Caused by Affects what part of airway
RSV (resp syncytial virus) Affects small airway: bronchi and bronchioles
44
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
45
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)
46
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
47
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
48
Otitis media Tx
Rest/ oral fluids Acetaminophen/ibuprofen 7-10days of abx (amoxicillin, omnicef) Myringotomy: insertion of tympanostomy tubes
49
Bacterial pneumonia S/s Complications
High fever Tachypnea/retratctions/nasal flaring Crackles/rhonchi Pallor, cyanosis Irritability, restless Complications Pneumothroax Pleural effusion
50
Bacterial pneumonia Diagnostics Nursing care Meds
D: -CXR Tx: -I/O monitor, CR monitor Administer O2 -CPT, potural drainage Meds: -IV/PO abx -antipyretic
51
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
52
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
53
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)
54
Epiglottitis (MEDICAL EMERGENCY) Emergency Causes
Airway emergency (can be fatal) Viral or bacteria (Caused by H. Influenzae(bacteria)
55
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
56
Epiglottitis Diagnostics
Lateral neck x-ray can show inflammation of soft tissues
57
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
58
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
59
Influenza A&B Tx Normal Meds (SEs)
Rest/oral fluids Meds: Antipyretics Antivirals: Tamiflu (oseltamivir) -start within 48 hrs SE: N/V, hallucinations
60
Long term resp disease
Asthma and cystic fibrosis
61
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
62
Asthma Risk Factors
Family hx of asthma or allergies Chronic exposure to tobacco smoke Low birth wt Overweight
63
Asthma triggers
Allergens: trees, grass, pollen Irritants: smoke, sprays Exposure to chemical Exercise Cold air exposure Animal dander
64
Asthma exacerbation s/s
Chest tightness Audible wheezes Increased WOB Retractions/accessory muscle use Tripod positioning Hypoxia Inaudible breathsounds (airway obstructed)
65
Asthma labs and diagnostics
PFTs PEFR (peak expiratory flow rate) Allergen testing CXR CBC (WBC)
66
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
67
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)
68
asthma maintence med types
Inhaled anti-inflammatory drugs Long acting beta 2 agonist (bronchodilators) Typically combos Systemic leukotriene inhibitors or modifiers
69
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
70
Asthma (pt education)
Identify triggers Use peak flow meter Exercise Learn signs of asthma exacerbation Immunization (prevent infection leading to exacerbation)
71
Asthma treatment
Multidose inhaler (MDI) Dry powder inhaler (DPI) Nebulized Spacers
72
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
73
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
74
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
75
Cystic fibrosis RF Systems it effects
RF: Genetics (autosomal recessive) Caucasians Systems: -resp -GI -integumentary -endocrine/reproductive
76
CF Resp s/s Explained
-Secretions (thick/sticky) obstruct -Stasis of secretions lead to infection -Inflammation leads to: bronchospasm, pneumonia, and obstructive emphysema
77
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
78
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
79
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
80
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)
81
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
82
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
83
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
84
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
85
Whats a sign a pt is not taking their pancreatic enzymes
Bulky stools
86
CF interprofession approach
RT PT pulmonology Endocrinology Pediatrician Dietixian Pharmacist
87
CF pt and family education
Education on: nebulizer, CPT vests Keep immunizations UTD Monitor for infections Exercise and diet compliance Transplantation may be considered

N305 (17 decks)

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