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Peds > Acute Respiratory > Flashcards

Acute Respiratory Flashcards

1
Q

do children have a smaller or larger airways compared to adults

A

smaller

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2
Q

what type of breathing do infants rely in

A

diaphragmatic / abdominal breathing

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3
Q

are the larynx and glottis higher or lower in the neck for children

A

higher

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4
Q

are the distances between structures shorter or longer in children, and what implications does that have

A

shorter - increased rate of infection spread

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5
Q

do children have more or fewer alveoli compared to adults

A

less

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6
Q

do children have an increased or decreased metabolic rate compared to adults

A

increased

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7
Q

what is the RR for infants

A

30-40

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8
Q

what is the RR for children

A

20-24

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9
Q

what is the RR for adolescents

A

16-18

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10
Q

what are the 8 cardinal signs on respiratory distress

A
  1. tachypnea
  2. tachycardia
  3. diaphoresis
  4. change in LOC
  5. cyanosis
  6. increased work of breathing
  7. adventitious breath sounds
  8. cough
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11
Q

at what breaths per minute should you not feed an infant

A

60+

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12
Q

retractions at isolated intercostal spaces indicates what type of ditress

A

mild

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13
Q

retractions at the subcostal, suprasternal, or supraclavicular indicate what type of distress

A

moderate

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14
Q

retractions at the subcostal, suprasternal, or supraclavicular and the use of accessory muscles in the neck indicate what type of distress

A

severe

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15
Q

what are 5 ways to promote rest and comfort while easing respiratory efforts

A
  1. positioning
  2. warm or cool mist
  3. mist tents
  4. saline nose drops with bulb suctioning
  5. quiet activities in bed
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16
Q

when using mist is it appropriate to use a steam vaporizer, why

A

no, can cause burns

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17
Q

why do we want to avoid caffeine for our acute respiratory patients

A

acts as a diuretic and we need them to stay well hydrated to move secretions / pathogens out

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18
Q

would an acute respiratory patient need high or low caloric fluids

A

high

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19
Q

name the 6 specific therapies to improve oxygenation

A
  1. coughing and deep breathing exercises
  2. suctioning
  3. aerosolized nebulizer medications
  4. percussion / postural drainage
  5. CPT
  6. supplemental oxygen
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20
Q

what things are potentially responsible for the development of nasopharyngitis

A

Rhinovirus, adenovirus, influenza virus, or parainfluenza virus

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21
Q

what is nasopharyngitis also referred to as

A

upper respiratory infection (URI)

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22
Q

what are clinical manifestations of URI in young children

A

Fever
Irritability
Restlessness
Sneezing
Vomiting and/or diarrhea

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23
Q

what are clinical manifestations of URI in older children

A

Dryness and irritation of nose and throat
Sneezing
Chilling
Muscle ache
Cough
Edema and vasodilation of mucosa

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24
Q

what age group should absolutely not get ibuprofen

A

less then 6 months

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25
Q

what is considered a fever in children

A

100.4

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26
Q

how can a low grade fever be beneficial

A

lower virulence of pathogens

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27
Q

when taking axillary temperature, what do you add

A

1 degree

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28
Q

in the therapeutic management of an URI children less than 3 years old should not receive what type of medication

A

over the counter cough or cold preparations

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29
Q

for older children with an URI are antihistamines, antibiotics, and expectorants recommended

A

no

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30
Q

if a patient has tonsillitis how is it treated

A

based on symptoms

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31
Q

should a patient with tonsillitis be prescirbed antibiotics

A

no

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32
Q

strep pharyngitis is caused by what

A

group A beta-hemolytic streptococci

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33
Q

are are the clinical manifestations of strep pharyngitis

A

Sudden onset, sore throat, headache, fever, vomiting, swollen lymph nodes, and abdominal pain
Beefy red throat

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34
Q

what are the 2 primary concerns if step pharyngitis is not treated

A

acute rheumatic fever and acute glomerulonephritis

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35
Q

what is the therapeutic management for strep pharyngitis

A

antibiotics x 10 days

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36
Q

what are 3 teachings the nurse can give to a patient with strep pharyngitis

A

take all medication, avoid drinking after people, avoid drinking from water fountains

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37
Q

how long can a patient return to school after having strep pharygnitis

A

24 hours after beginning antibiotic

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38
Q

step pharyngitis is highly communicable via what

A

saliva

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39
Q

when is a tonsillectomy indicated

A

recurrent, frequent strep, peritonsillar abscess, or sleep apnea

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40
Q

what are the contraindications for a tonsillectomy

A

Cleft palate
Acute infections
Uncontrolled systemic disease or blood dyscrasias
Age < 4 years

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41
Q

after a tonsillectomy what should the nurse be most concerned about

A

bleeding

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42
Q

how will a nurse suspect bleeding after a tonsillectomy

A

excessive swallowing

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43
Q

how should a patient with a tonsillectomy be positioned

A

initially on their side, but once they wake up they can sit up

44
Q

should a tonsillectomy patient be suctioned to rid of the extra saliva

A

nope, keep drooling

45
Q

what are 4 specific things the nurse should urge the patient to avoid while they heal from a tonsillectomy

A

laughing, crying, drinking through a straw, or coughing

46
Q

what are the diet considerations of someone that just had a tonsillectomy

A

cool, clear liquids
no milk products
avoid red liquids

47
Q

can a patient use a comfort ice collar after a tonsillectomy

A

yes

48
Q

children are at risk of bleeding initially after a tonsillectomy and when else

A

10-14 days, when the scabs begin coming off

49
Q

what is external otitis

A

inflammation / infection of the outer ear

50
Q

what are two potential causes of external otitis

A

bacteria or dermatitis

51
Q

what are the clinical manifestations of external otitis

A

pain (can increase with movement and be disproportionate), increased drainage (can even be serosanguinous or purulent)

52
Q

what is the usual therapy for external otitis

A

antibiotic / steroid ear drops

53
Q

what are the three types of ear infections

A

acute otitis media, recurrent otitis media, and otitis media with effusion

54
Q

what is otitis media

A

infection of the middle ear associated with a collection of fluid or pus

55
Q

are boys or girls more at risk of developing otitis media

A

boys

56
Q

what is the highest incidence age range for otitis media

A

6 months -2 Y

57
Q

are breast fed or bottle fed babies more at risk for developing otitis media

A

bottle fed

58
Q

what position are infants more at risk of developing otitis media

A

laying down

59
Q

what are some risk factors of otitis media (14 total)

A

Age and gender
Non-breast fed infant
Usual lying down position of infants
Exposure to cigarette smoke and or many people
Bottles in bed
Unimmunized
Pacifier use beyond infancy
Family hx of ear infections
Allergic rhinitis
Acquired immune deficiencies
Craniofacial anomalies
Winter

60
Q

what can the complication be with chronic otitis media

A

hearing loss

61
Q

what are the clinical manifestations of otitis media

A

ear pain (infants may be irritable, children may pull on ears, may roll head from side to side, spike a fever up to 104)
ruptured tympanic membrane

62
Q

when someone gets pressure equalization (PE) tympanostomy tubes what important teaching points should the nurse communicate

A

no diving, jumping, or prolonged submersion in water
no swimming in lakes (due to bacteria / viruses)
avoiding pressure after the operation

63
Q

in general what is croup

A

swelling or obstruction in the region of the larynx

64
Q

what is acute laryngotracheobronchitis

A

viral croup - Inflammation of the mucosal lining of the larynx, trachea, and bronchi causing the narrowing of the airway

65
Q

who is most at risk for acute laryngotracheobronchitis

A

infants and children < 5

66
Q

if untreated what can acute laryngotracheobronchitis turn into

A

influenza or bronchiolitis

67
Q

what are the clinical manifestations of stage 1 croup

A

Fever
Fear
Hoarseness
Brassy cough
Inspiratory stridor when disturbed

68
Q

what are the clinical manifestations of stage 2 croup

A

Continuous stridor
Lower lip retraction
Retraction of soft tissue of the neck
Use of accessory muscle of respiration
Labored breathing

69
Q

what are the clinical manifestations of stage 3 croup

A

Signs of anorexia and CO2 retention
Restlessness
Anxiety
Pallor
Sweating
Rapid respirations

70
Q

what are the clinical manifestations of stage 4 croup

A

Cyanosis
Cessation of breathing

71
Q

what two types of medications are given in the management of croup and why

A

racemic epinephrine - for alpha adrenergic effect
corticosteroids - for anti-inflammatory properties

72
Q

in the event of croup are bronchodilators and antibiotics helpful

A

no use racemic epinephrine and corticosteroids

73
Q

what type of humidity (high or low) and what type of mist (cool or warm) is preferred in the management of croup

A

high humidity, cool or warm mist

74
Q

what are 6 specific signs that there is an increased severity of croup

A

increasing respiratory rate, increased agitation, increased restlessness, increased anxiety, decreased LOC, and cyanosis

75
Q

what is epiglottitis

A

bacterial croup caused by H. influenza B or streptococcus pneumoniae

76
Q

what age group does epiglottitis usually affect

A

between 2-5Y

77
Q

what are the clinical manifestations of epiglottitis

A

Abrupt onset, starts with sore throat
DROOLING
High fever, mouth open, tongue protruding, DROOLING, agitation
Looks very sick, insists on sitting upright (tri pod)
Sore red inflamed throat, difficult swallowing
Muffled voice, inspiratory stridor, no spontaneous cough

78
Q

if a child present with bacterial croup what should the nurse prepare for

A

sedation and intubation

79
Q

should the nurse use a tongue blade to visualize the back of the throat for a child that presents with possible bacterial croup

A

NO

80
Q

what is bronchiolitis

A

An acute viral infection resulting in inflammation of the smaller bronchioles, characterized by thick mucus

81
Q

what age range typically develops bronchiolitis, when does it normally peak

A

<2
peaks 2-5M

82
Q

what three things potentially cause bronchitis

A

adenovirus, parainfluenza virus, RSV

83
Q

how does a child contract RSV

A

coming into contact with the respiratory secretions of someone with it

84
Q

how long can RSV survive on surfaces and skin

A

surfaces - hours
skin - 1/2 hour

85
Q

what is the incubation period for RSV

A

5-8 days

86
Q

when can it be expected to see a rise in RSV

A

fall and winter

87
Q

what is usually the first sign of RSV in infants

A

apnea

88
Q

what are clinical manifestations of RVS

A

Rhinorrhea
Pharyngitis
coughing/sneezing
Wheezing, crackles, decreased breath sounds
Possible eye and ear infection
Intermittent low-grade fever
Difficult feeding
Irritability

89
Q

what are the 4 things that RSV can progress to

A

tachypnea, air hunger, retractions, cyanosis

90
Q

what is the most sensitive test for RSV

A

PCR

91
Q

what is the primary goal for the management of RSV

A

airway maintenance

92
Q

what precautions does a child with RSV need to be in

A

droplet

93
Q

what are the typical medications a child with RSV will be prescribed

A

antivirals, bronchodilators, corticosteroids

94
Q

what is the vaccine that can prevent RSV potentially

A

synagis

95
Q

what are the clinical manifestations of pneumonia

A

Fever
Chest pain
Dullness to percussion
Cough (nonproductive early - slight to severe)
Rhonchi or fine rales, decreased breath sounds
Respiratory distress

96
Q

what is the typical treatment for a child with whooping cough

A

erythromycin

97
Q

when are unimmunized children the most at risk of developing whooping cough

A

< 4 years and > 10 years

98
Q

is TB hereditary

A

no

99
Q

when is there a decreased resistance to TB due to age / growth

A

in infancy, puberty, and adolescence

100
Q

some combination of what 3 things is indicative of apnea of infancy

A

apnea > 20 seconds
color change
marked change in muscle tone

101
Q

what is the usual observation of apnea of infancy

A

Continuous cardiorespiratory monitoring until episode free for 6 months

102
Q

what are the 4 most important pieces of information to give to a parent of a child with infancy apnea

A

know CPR
attend to the infant not the monitor (monitor may be wrong)
understand that interference of the monitor is possible
have emergency numbers ready to dial

103
Q

what is sudden infant death syndrome

A

Sudden death of an infant under 1 year of age that occurs during sleep and remains unexplained after a complete postmortem examination, including an investigation of the death scene and a review of the case history

104
Q

when does SIDS peak

A

2-4 onths

105
Q

who has the highest incidence of SIDS

A

Native americans, african americans, hispanics
Males, lower socioeconomic classes, winter months

106
Q

What is the single most important education point about SIDS

A

put infants on their back to sleep

Peds (12 decks)

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