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Pediatrics > Acute and Chronic Respiratory Illness > Flashcards

Acute and Chronic Respiratory Illness Flashcards

1
Q

What is the diameter of an infant’s airway? Why is it concerning when there is an inflammatory process in the airway?

A

Diameter - 4 mm

- It causes swelling of the airways and airway resistance increases, making it hard to get adequate oxygen

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2
Q

Signs of respiratory distress

A
  • Nasal flaring
  • Substernal retractions
  • Grunting
  • Paradoxical breathing
  • Cyanosis (does crying improve or worsen color?)
  • Weak cough
  • Adventitious sounds
  • Is the child restless, irritable, or lethargic?
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3
Q

Describe the sound of coarse crackles (rales).

A

Crackles are discontinuous, brief, popping sounds. Similar to the sound of a hook and loop fastener being pulled apart.

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4
Q

Describe the sound of wheezes (rhonchi).

A

Wheezes are continuous, musical sounds, high or low pitched. Usually more pronounced on expiration.

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5
Q

Describe the sound of pleural rub.

A

Plural rubs are creaking or grating sounds that have been described as being similar to walking on fresh snow.

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6
Q

Describe the sound of stridor and when is it more prominent in a child?

A

A loud, high-pitched sound heard during inspiration but may also occur throughout the respiratory cycle; crying makes you hear stridor in a child more

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7
Q

Describe Allergic Rhinitis (aka Hay Fever)

A
  • Inflammatory disorder of nasal mucosa and conjunctiva
  • Hypersensitivity reaction mediated by IgE- histamine released
  • Reaction to seasonal allergens
  • Recurrent and rarely seen before age 2
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8
Q

What is the first manifestation you see with someone who is younger than 2 and has allergic rhinitis?

A

Skin changes (eczema and hives)

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9
Q

S/S of Allergic Rhinitis

A
  • Watery rhinnorhea
  • Paroxysmal sneeze
  • Cough that can be unproductive or productive of white sputum
  • Itchy, puffy eyes
  • Itchiness/scratchy throat
  • Pale, boggy nasal mucosa
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10
Q

What lab test is done for Allergic Rhinitis?

A

Nasal smear to look at eosinophil count, blood IgE and skin tests

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11
Q

What antihistamines may be given for Allergic Rhinitis?

A
  • Nasal corticosteroids (Flonase)
  • Mast cell stabilizers (Cromolyn)
  • Leukotriene modifiers (Singulair)
  • Ipratropium (Atrovent) relaxes muscles around the airway and usually given in combo with Albuterol
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12
Q

Describe an Acute Otitis Media

A
  • acute infection
  • bright red drum, distorted landmarks
  • no tympanic movement
  • lymphadenopathy
  • temperature as high as 104 F
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13
Q

Describe an Otitis Media with effusion

A
  • Collection of fluid in the middle ear, no infection
  • grey to amber color
  • drum is usually retracted
  • feeling of fullness
  • transient hearing loss and balance disturbances
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14
Q

What could occur if otitis media becomes a chronic condition?

A

Hearing difficulties and speech delays

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15
Q

Risk factors for Otitis Media

A
  • Eustachian tube placement
  • Passive smoking
  • Daycare attendance
  • Cleft lip and palate
  • Immunization noncompliance
  • Down syndrome
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16
Q

Key preventions for OM

A
  • Breastfeeding (d/t presence of IgA in mom which protects against infections)
  • Vaccines
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17
Q

S/S of OM

A
  • Irritable (first sign we see)
  • Fussiness
  • Hold or pull at ears
  • Roll head side to side
  • Cry while nursing or bottle feeding
  • Unusual night waking
  • Night time screaming
  • Fever
  • Lymphadenopathy
  • Balance disturbances
  • Hearing changes
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18
Q

Nursing care for OM

A
  • Antibiotics (Amoxicillin 80-90 mg/kg/day in two doses) (Azithromycin) (Ceftriaxone)
  • Analgesics (Benzocaine)
  • Antopyretics
  • Encourage oral fluids
  • PE tubes for chronic infection especially when hearing loss is present
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19
Q

Tympanometry vs. Pneumatic Otoscope

A

Tympanometry - measures air of tympanic membrane mobility with a pulse of air pressure

Pneumatic Otoscope - blasts air and blows it against the ear, if there is an infection the ear will be stiff, if there’s no infection the ear will move

20
Q

Describe Pharyngitis

A
  • Inflammation of the pharynx and surrounding tissues
  • Peak age: 4-7 years
  • 80% to 90% viral
21
Q

Strep vs. Viral Tonsillitis

A

Strep:

  • Abrupt onset w/ high fever
  • Can lead to rheumatic fever, acute glomerular nephritis
  • Caused by group A beta-hemolytic streptococcus
  • Occurs more frequently during winter
  • Cervical lymphadenopathy

Viral:

  • Gradual onset w/ low grade fever
  • Self limiting and relatively minor illness
  • Caused by: adenovirus, RSV, coxsackie viruses, mycoplasma pneumoniae
  • Cervical lymphadenopathy
22
Q

How do you determine if it is strep or viral?

A

Throat culture

23
Q

S/S of pharyngitis

A
  • sore throat
  • headache
  • enlarged tonsils
  • difficulty swallowing
  • morning breathing w/ bad breath
  • snoring
  • fever
  • enlarged adenoids
24
Q

What is the treatment for strep?

A
  • Penicillin (PCN) TID x 10 days (peaks in 60 minutes and is excreted in urine so be careful if renal impairment)
  • Amoxicillin x7
  • single shot of procaine penicillin/Bicillin
  • Allergic to PCN: erythromycin (often causes GI upset and contraindicated in liver disease)
25
Q

Tonsillectomy nursing care: pre-op

A
  • Complete history regarding swallowing and obstruction
  • Check for signs of active infection
  • Check for loose teeth
  • Check for bleeding disorders
  • Lab results (PT, PTT, platelet, hgb, hmc, u/s)
  • NPO
26
Q

Tonsillectomy nursing care: post-op

A
  • Semi prone, prone or side lying to facilitate drainage; elevation of head
  • Assess airway
  • Discourage coughing, nasal blowing, throat clearing
  • Straws and forks should be avoided
  • Comfort measures (analgesics or tetracaine lollipops) Ice chips or ice collars
  • Alert parents that there may be clots of mucous in vomitus
  • Clear liquids after return of gag reflex
27
Q

What is the primary function of the tonsils?

A

Filter and protect against invading pathogens

28
Q

Croup vs. Epiglottitis

A 
Croup- 1 to 3 years old
- Subglottic
- Viral/Emotional
- Sudden onset, usually at night
- DRY, BARKING COUGH
- Awakens with inspiratory stridor
- Dyspnea
- Agitation
- Symptoms worsen at night
Treatments: Humidity, fluids, racemic epinephrine, possible intubation
Epiglottitis- 3 to 7 years old
- Supraglottic
- Bacterial (haemophyllus influenza)
- Sudden onset
- May rapidly progress to complete airway obstruction
- Dyspnea
- DROOLING
- Tripod positioning (hunching over)
- High fever
- Stridor
- Pallor or cyanosis
- Anxiety
Treatment: IV antibiotics and fluids, artificial airway, emergency hospitalization
29
Q

What should you always have available when caring for someone with croup and/or epiglottitis?

A

Intubation tray

  • Droplet precaution
30
Q

Acute laryngotracheobronchitis vs. Acute spasmodic laryngitis

A

ALTB:

  • from RSV, influenza A & B, mycoplasma, parainfluenza 1,2,3
  • Low grade fever, Restlessness, Hoarse
  • Younger children may have signs of respiratory distress
  • Infants and toddlers may be very sick with continuous stridor tachypnea

ASL:

  • Self limiting & from allergens
  • Usually at night child has paroxysmal attacks of laryngeal obstruction
  • Croupy barky cough
  • Difficulty breathing
  • Restless
31
Q

Bronchitis Tracheobronchitis

A
  • Associated with an upper respiratory infection; viral
  • Large airway inflammation
  • Dry hacking cough
  • Usually lasts 5-7 days
  • Symptomatic treatment
32
Q

Bronchiolitis

A
  • caused by RSV, affects the bronchioles
  • Bronchioles constrict during EXPIRATORY, not inspiration
  • obstruction = air trapping
  • Initial starts off with sneezing, coughing, intermittent fever
  • Subsequent progression: fever, increase coughing with wheezing, refusal to eat, tachypnea
  • Severe: tachycardia, tachypnea, wheezing, crackles, rhonchi, poor feeding, cyanosis
33
Q

Complications of Pneumonia are? Treatments?

A

Pneumothorax - air inside pleural space
Pleural effusion - fluid inside pleural space

Tx: chest tube
pleural effusion - lower on the chest
pneumothorax - higher up

34
Q

Is RSV viral or bacterial?

A

Viral

35
Q

Pneumonia tx for viral vs. bacterial

A

Viral - O2 and oximetry, fever management, I&O, IV therapy

Bacterial - IV antibiotics, I&O, Chest PT, oxygen therapy

36
Q

When is the flu vaccine given for children?

A

6 months and older

37
Q

Influenza medications:

A
  • Amantadine (type A): shorten the length of illness, administered within 24-48 hours of onset of symptom
  • Rimantadine (type A): treats manifestations and given orally 2x for 7 days in children older than 1
  • Zanamivir (type A & B): children over 7, inhaled 2x for 5 days, start within 48 hours of manifestations
  • Oseltamivir (type A & B): decreases manifestations and given orally for over 1 yr.; within 48 hours of manifestations
38
Q

Bronchodilators: Short acting beta agonists (SABA), Long acting beta agonists (LABA), Cholinergic antagonists

A

SABA- used for acute exacerbations (albuterol, terbutaline) and to prevent exercise induced asthma

LABA- used to prevent exacerbations and reliance of SABA, does not treat acute episodes (Serevent)

Cholinergic antagonists- block the parasympathetic nervous system which relieves bronchospasm (atropine, ipratoprium)

39
Q

Anti-inflammatory agents: corticosteroids, Leukotriene modifiers, mast cell stabilizers, monoclonal antibodies & nursing considerations?

A

Corticosteroids - prednisone
Leukotriene modifiers - Montelukast (Singulair)
Mast cell stabilizers- Cromolyn
Monoclonal antibodies- Omalizumab (Xolair)

Considerations: observe oral mucosa for infection, take with food, rinse mouth after use

40
Q

Explain the Pulmonary Function Tests

A

Non-invasive test that shows how well the lungs are working. It’s the most accurate tests for diagnosing asthma and its severity

41
Q

Explain the Peak Expiratory Flow Rate

A
  • “Personal best” of the flow of air in a forced exhalation
  • HIGHEST score, not average
  • 3 times
42
Q

Explain the Bronchoprovocation tests

A

Measures lung function after exposure to common asthma symptom triggers

43
Q

Cystic Fibrosis

A

MULTISYSTEM disorder cause by a defect in a gene

S/S:

  • thick, sticky mucus
  • very salty sweat
44
Q

Risk Factors of CF

A
  • Both parents carry the recessive gene
  • Meconium ileus at birth
  • Hx of respiratory infections
  • Hx of failure to thrive
45
Q

What does a sweat test detect?

A

Measures amount of chloride; normal range is less than 40 mEq/LO chloride; Diagnostic is greater than 60 mEq/L for infants less than 3 months and greater than 40 for all others

46
Q

First degree obstruction vs. Second degree obstruction vs. complete obstruction

A

1st- allows passage of air in both directions
2nd- air able to move past obstruction in one direction only (inspiration)
Complete- air unable to move in either direction

47
Q

What can foreign body aspiration lead to if there is a delay in removal? Nursing management?

A

Aspiration pneumonia; 1st 12 hours monitor VS, changes in breath sounds, if child cannot say “P” and teach the Heimlich maneuver

Pediatrics (3 decks)

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