Acute Respiratory Flashcards
1
Q
do children have a smaller or larger airways compared to adults
A
smaller
2
Q
what type of breathing do infants rely in
A
diaphragmatic / abdominal breathing
3
Q
are the larynx and glottis higher or lower in the neck for children
A
higher
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
5
Q
do children have more or fewer alveoli compared to adults
A
less
6
Q
do children have an increased or decreased metabolic rate compared to adults
A
increased
7
Q
what is the RR for infants
A
30-40
8
Q
what is the RR for children
A
20-24
9
Q
what is the RR for adolescents
A
16-18
10
Q
what are the 8 cardinal signs on respiratory distress
A
- tachypnea
- tachycardia
- diaphoresis
- change in LOC
- cyanosis
- increased work of breathing
- adventitious breath sounds
- cough
11
Q
at what breaths per minute should you not feed an infant
A
60+
12
Q
retractions at isolated intercostal spaces indicates what type of ditress
A
mild
13
Q
retractions at the subcostal, suprasternal, or supraclavicular indicate what type of distress
A
moderate
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
15
Q
what are 5 ways to promote rest and comfort while easing respiratory efforts
A
- positioning
- warm or cool mist
- mist tents
- saline nose drops with bulb suctioning
- quiet activities in bed
16
Q
when using mist is it appropriate to use a steam vaporizer, why
A
no, can cause burns
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
18
Q
would an acute respiratory patient need high or low caloric fluids
A
high
19
Q
name the 6 specific therapies to improve oxygenation
A
- coughing and deep breathing exercises
- suctioning
- aerosolized nebulizer medications
- percussion / postural drainage
- CPT
- supplemental oxygen
20
Q
what things are potentially responsible for the development of nasopharyngitis
A
Rhinovirus, adenovirus, influenza virus, or parainfluenza virus
21
Q
what is nasopharyngitis also referred to as
A
upper respiratory infection (URI)
22
Q
what are clinical manifestations of URI in young children
A
Fever
Irritability
Restlessness
Sneezing
Vomiting and/or diarrhea
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
24
Q
what age group should absolutely not get ibuprofen
A
less then 6 months
25
what is considered a fever in children
100.4
26
how can a low grade fever be beneficial
lower virulence of pathogens
27
when taking axillary temperature, what do you add
1 degree
28
in the therapeutic management of an URI children less than 3 years old should not receive what type of medication
over the counter cough or cold preparations
29
for older children with an URI are antihistamines, antibiotics, and expectorants recommended
no
30
if a patient has tonsillitis how is it treated
based on symptoms
31
should a patient with tonsillitis be prescirbed antibiotics
no
32
strep pharyngitis is caused by what
group A beta-hemolytic streptococci
33
are are the clinical manifestations of strep pharyngitis
Sudden onset, sore throat, headache, fever, vomiting, swollen lymph nodes, and abdominal pain
Beefy red throat
34
what are the 2 primary concerns if step pharyngitis is not treated
acute rheumatic fever and acute glomerulonephritis
35
what is the therapeutic management for strep pharyngitis
antibiotics x 10 days
36
what are 3 teachings the nurse can give to a patient with strep pharyngitis
take all medication, avoid drinking after people, avoid drinking from water fountains
37
how long can a patient return to school after having strep pharygnitis
24 hours after beginning antibiotic
38
step pharyngitis is highly communicable via what
saliva
39
when is a tonsillectomy indicated
recurrent, frequent strep, peritonsillar abscess, or sleep apnea
40
what are the contraindications for a tonsillectomy
Cleft palate
Acute infections
Uncontrolled systemic disease or blood dyscrasias
Age < 4 years
41
after a tonsillectomy what should the nurse be most concerned about
bleeding
42
how will a nurse suspect bleeding after a tonsillectomy
excessive swallowing
43
how should a patient with a tonsillectomy be positioned
initially on their side, but once they wake up they can sit up
44
should a tonsillectomy patient be suctioned to rid of the extra saliva
nope, keep drooling
45
what are 4 specific things the nurse should urge the patient to avoid while they heal from a tonsillectomy
laughing, crying, drinking through a straw, or coughing
46
what are the diet considerations of someone that just had a tonsillectomy
cool, clear liquids
no milk products
avoid red liquids
47
can a patient use a comfort ice collar after a tonsillectomy
yes
48
children are at risk of bleeding initially after a tonsillectomy and when else
10-14 days, when the scabs begin coming off
49
what is external otitis
inflammation / infection of the outer ear
50
what are two potential causes of external otitis
bacteria or dermatitis
51
what are the clinical manifestations of external otitis
pain (can increase with movement and be disproportionate), increased drainage (can even be serosanguinous or purulent)
52
what is the usual therapy for external otitis
antibiotic / steroid ear drops
53
what are the three types of ear infections
acute otitis media, recurrent otitis media, and otitis media with effusion
54
what is otitis media
infection of the middle ear associated with a collection of fluid or pus
55
are boys or girls more at risk of developing otitis media
boys
56
what is the highest incidence age range for otitis media
6 months -2 Y
57
are breast fed or bottle fed babies more at risk for developing otitis media
bottle fed
58
what position are infants more at risk of developing otitis media
laying down
59
what are some risk factors of otitis media (14 total)
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
what can the complication be with chronic otitis media
hearing loss
61
what are the clinical manifestations of otitis media
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
when someone gets pressure equalization (PE) tympanostomy tubes what important teaching points should the nurse communicate
no diving, jumping, or prolonged submersion in water
no swimming in lakes (due to bacteria / viruses)
avoiding pressure after the operation
63
in general what is croup
swelling or obstruction in the region of the larynx
64
what is acute laryngotracheobronchitis
viral croup - Inflammation of the mucosal lining of the larynx, trachea, and bronchi causing the narrowing of the airway
65
who is most at risk for acute laryngotracheobronchitis
infants and children < 5
66
if untreated what can acute laryngotracheobronchitis turn into
influenza or bronchiolitis
67
what are the clinical manifestations of stage 1 croup
Fever
Fear
Hoarseness
Brassy cough
Inspiratory stridor when disturbed
68
what are the clinical manifestations of stage 2 croup
Continuous stridor
Lower lip retraction
Retraction of soft tissue of the neck
Use of accessory muscle of respiration
Labored breathing
69
what are the clinical manifestations of stage 3 croup
Signs of anorexia and CO2 retention
Restlessness
Anxiety
Pallor
Sweating
Rapid respirations
70
what are the clinical manifestations of stage 4 croup
Cyanosis
Cessation of breathing
71
what two types of medications are given in the management of croup and why
racemic epinephrine - for alpha adrenergic effect
corticosteroids - for anti-inflammatory properties
72
in the event of croup are bronchodilators and antibiotics helpful
no use racemic epinephrine and corticosteroids
73
what type of humidity (high or low) and what type of mist (cool or warm) is preferred in the management of croup
high humidity, cool or warm mist
74
what are 6 specific signs that there is an increased severity of croup
increasing respiratory rate, increased agitation, increased restlessness, increased anxiety, decreased LOC, and cyanosis
75
what is epiglottitis
bacterial croup caused by H. influenza B or streptococcus pneumoniae
76
what age group does epiglottitis usually affect
between 2-5Y
77
what are the clinical manifestations of epiglottitis
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
if a child present with bacterial croup what should the nurse prepare for
sedation and intubation
79
should the nurse use a tongue blade to visualize the back of the throat for a child that presents with possible bacterial croup
NO
80
what is bronchiolitis
An acute viral infection resulting in inflammation of the smaller bronchioles, characterized by thick mucus
81
what age range typically develops bronchiolitis, when does it normally peak
<2
peaks 2-5M
82
what three things potentially cause bronchitis
adenovirus, parainfluenza virus, RSV
83
how does a child contract RSV
coming into contact with the respiratory secretions of someone with it
84
how long can RSV survive on surfaces and skin
surfaces - hours
skin - 1/2 hour
85
what is the incubation period for RSV
5-8 days
86
when can it be expected to see a rise in RSV
fall and winter
87
what is usually the first sign of RSV in infants
apnea
88
what are clinical manifestations of RVS
Rhinorrhea
Pharyngitis
coughing/sneezing
Wheezing, crackles, decreased breath sounds
Possible eye and ear infection
Intermittent low-grade fever
Difficult feeding
Irritability
89
what are the 4 things that RSV can progress to
tachypnea, air hunger, retractions, cyanosis
90
what is the most sensitive test for RSV
PCR
91
what is the primary goal for the management of RSV
airway maintenance
92
what precautions does a child with RSV need to be in
droplet
93
what are the typical medications a child with RSV will be prescribed
antivirals, bronchodilators, corticosteroids
94
what is the vaccine that can prevent RSV potentially
synagis
95
what are the clinical manifestations of pneumonia
Fever
Chest pain
Dullness to percussion
Cough (nonproductive early - slight to severe)
Rhonchi or fine rales, decreased breath sounds
Respiratory distress
96
what is the typical treatment for a child with whooping cough
erythromycin
97
when are unimmunized children the most at risk of developing whooping cough
< 4 years and > 10 years
98
is TB hereditary
no
99
when is there a decreased resistance to TB due to age / growth
in infancy, puberty, and adolescence
100
some combination of what 3 things is indicative of apnea of infancy
apnea > 20 seconds
color change
marked change in muscle tone
101
what is the usual observation of apnea of infancy
Continuous cardiorespiratory monitoring until episode free for 6 months
102
what are the 4 most important pieces of information to give to a parent of a child with infancy apnea
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
what is sudden infant death syndrome
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
when does SIDS peak
2-4 onths
105
who has the highest incidence of SIDS
Native americans, african americans, hispanics
Males, lower socioeconomic classes, winter months
106
What is the single most important education point about SIDS
put infants on their back to sleep
