Acute Respiratory Flashcards
1
Q
Interventions to dec spread of respiratory infection
A
Handwashing, teaching, keep infectious patients separate, immunizations up to date, antibiotics (only for bacteria illness)
2
Q
How to promote hydration and nutrition
A
high calories beverages, avoid caffeine, ok if they don’t want to eat but they have to drink, let them pick their own diet
3
Q
Clinical manifestations of nasopharyngitis in younger kids
A
Fever, irritability, restless, sneezing, v/d
4
Q
Clinical manifestations of nasopharyngitis in the older child
A
dryness and irritation in nose and throat, sneeze, chills, muscular aches, cough, edema and vasodilation of mucosa
5
Q
Nasopharyngitis
A
the common cold; from rhinovirus, adenovirus, flue or para-influenza virus
6
Q
Therapeutic management of nasopharyngitis
A
no OTCs under 3Y, antipyretics for high fever and discomfort, rest, older kids can have decongestants, cough suppressants (not ones with high alc content), avoid antihistamines (can make drowsy or stimulated), avoid antibiotics, expectorants, and bronchodilators
7
Q
COLD
A
Comfort symptoms
Offer fluids
Look for complications
Decrease disease spreading
8
Q
Respiratory difference between kids and adults
A
smaller airway, more ab/diaphragmatic breathing, larynx and glottis higher on neck, less distance between body structures, ribs more pliable, eustachian tubes more horizontal, ribs slope downward, fewer alveoli, higher metabolic rate–breathe faster
9
Q
Parts of respiratory assessment
A
LOC, resp rate, resp effort, skin and mucus membrane color, breath sounds
10
Q
Infant resp rate
A
30-40
11
Q
Child resp rate
A
20-24
12
Q
Adolescent resp rate
A
16-18
13
Q
Signs of resp distress
A
tachypnea, tachycardia, diaphoresis, change in LOC–restless, irritable, anxious, cyanotic, inc work of breathing–grunting, nasal flaring, retractions, adventitious or absent breath sounds, cough
14
Q
Locations of retractions for mild distress
A
isolated intercostal
15
Q
Locations of retractions for moderate distress
A
subcostal, suprasternal, supraclavicular
16
Q
Locations of retractions for severe distress
A
subcostal, suprasternal, supraclavicular, use of accessory muscles
17
Q
How often should you change a pulse ox?
A
q4 hours
18
Q
What should oxygen saturation be in kids?
A
95-100
19
Q
general nursing interventions for illness
A
ease respiratory efforts, promote rest, promote comfort, prevent spread of infection, promote hydration and nutrition
20
Q
How to ease resp efforts/promote rest and comfort
A
positioning, warm or cool mist (NO STEAM), mist tent, saline nose drops followed by bulb suctioning before eating, bedrest or quiet activities
21
Q
What to do for fever and fussiness over age 6M
A
give tylenol OR advil
22
Q
Why be wary of OTC meds?
A
Can have acetaminophen as ingredient leading to excess acetaminophen and not recommended for kids under 3
23
Q
Therapies to improve oxygenation
A
cough and deep breathe, suction, aerosolized nebulizer meds, percussion and postural drainage, chest physiotherapy (squeeze, vibrate), supplemental oxygen
24
Q
Where do URIs occur?
A
nose and pharynx, tonsils, paranasal sinuses, larynx, epiglottis
25
Where do LRIs occur?
bronchi, bronchioles, alveoli
26
Causes of resp infections?
virus, B-hemolytic strep A, staphylococci, Haemophilis influenzae B, mycoplasma, pneumococci
27
Why do kids often get sicker from respiratory infections?
internal structures are closer to each other so infection moves faster to multiple areas; haven't built immunity to things like adults have
28
Clinical manifestations of respiratory infection in infants and kids
fever, meningismus, anorexia, v/d, ab pain, nasal blockage and/or discharge, resp sounds, sore throat
29
Risk factors for LRIs
immune sys, allergies, asthma, cardiac anomalies, cystic fibrosis, daycare, second or third hand smoke, sick season, smaller size
30
Why are we not concerned about a low fever in kids?
It can be beneficial for a short time
31
Tonsilitis
- often viral
- treat symptomatically
32
What if tonsilitis is bacterial?
It is strep--need antibiotics
33
Strep "pharyngitis" (GABHS)
group of A beta-hemolytic streptococci
34
Clinical manifestations of strep
sudden onset, sore throat, headache, fever, vomit, cervical lymphadenopathy, abdominal pain, beefy red throat
35
Risks of untreated strep
acute rheumatic fever or acute glomerulonephritis, impetigo, pyoderma (painful ulcers on leg), scarlet fever, petichae on palette, strawberry tongue
36
Strep treatment
antibiotics for 10 days
37
Is strep common in infants?
No--uncommon
38
Strep nursing considerations
Encourage ppl with severe sore throats to get swabbed, highly communicable with saliva, get new toothbrush after 24h on antibiotics, stay hydrated, cool liquids, warm saliva gargle, warm/cool neck compress, can return to school 24 hours after, need to clean orthodontia very well
39
Indications for tonsillectomy
recurrent, frequent strep, sleep apnea, or abscesses
40
Contraindications for tonsillectomy
cleft palate, acute infections, uncontrolled systemic disease or blood dyscrasias, age under 4 years
41
Nursing considerations for tonsillectomy
observe s/s bleeding like excessive swallowing, position on side for drainage until fully awake, avoid suction and straws, drooling ok, discourage, cough, laugh, cry, inspect secretions and vomit, watch for stridor, ice collar on throat, pain management at regular intervals, cool mist vaporizer
42
Post-tonsillectomy diet
can have freeze pops, cool liquid, no pudding, ice cream, dairy can cause throat clearing and irritation, avoid citrus
43
External otitis
"swimmer's ear"--inflammation/infection of outer ear (auricle or canal), water gets trapped behind cerumen which acts as a growth medium; from bacteria or dermatitis
44
Clinical manifestations of external otitis
pain that inc with movement and hurts when pinna and tragus are pressed, serosanguineous or purulent drainage, antibiotics/steroid drops, prevention; could be hearing loss and drainage
45
Prevention of swimmer's ear
keep ears dry especially 10 days post-diagnosis, 1 drop vinegar and 1 drop rubbing alcohol in ears after bath/swim to restore pH (don't use for ear tubes)
46
Otitis media (OM)
infection of middle ear associated with collection of fluid or pus
47
When are kids most at risk for otitis media
1st 24M, 5-6Y old when entering school
48
Risk factors for otitis media
anatomical structure, age and gender, non-breast fed infant, usual lying down position of infants, exposure to cig smoke, bottles in bed, unimmunized, daycare, winter, craniofacial anomalies, acquired immune deficiencies, allergic rhinitis, fam hx, pacifier use after infancy
49
Protective factor for otitis media
breast feeding
50
Clinical manifestations for otitis media
ear pain, infants get irritable, child pulls ear, roll head from side to side, fever up to 104, ruptured tympanic membrane, hearing loss if chronic
51
Therapeutic management of otitis media
prevention, antibiotic therapy, amoxicillin, analgesia for earache--Tylenol/ibuprofen, topical pain relief with heat or cold or pain relief drops
52
Who gets antibiotic therapy for otitis media
children under 6M, 6-23M if bilateral AOM, over 6M with ear drainage, high fever, ear pain over 48h
53
myringotomy with pressure equalization (PE) tympanostomy tubes precautions
Tx for chronic otitis media--helps fluid drain and dec infection; no diving, jumping, prolonged submersion, no swimming in lakes, rivers bc organisms and bacteria, avoid pressure postoperatively
54
Croup
Swelling or obstruction in region of the larynx
• Hoarseness, barky cough • Inspiratory stridor • Varying degrees of respiratory distress
55
Acute Laryngotracheobronchitis (LTB)
- Viral “Croup”—this is most croup
- Inflammation of the mucosal lining
of the larynx, trachea, & bronchi
causing narrowing of the airway
- Infants and children <5 yrs old
- Slowly progressive –may develop
with influenza or bronchiolitis
56
Croup CM
- Epiglottis becomes edematous, occluding airway
- Trachea swells resulting in restriction of the airway
- Mucosal inflammation and edema narrow airway
- Sudden onset of harsh, metallic “barky” cough,
inspiratory stridor or hoarseness
- Respiratory distress
- Substernal or suprasternal retractions
- Agitation
- Pallor or cyanosis (in serious cases)
- Increased HR, extreme
restlessness, or listlessness • Hypoxia
57
Croup therapeutic goals and tx
AIRWAY AND BREATHING; stay calm, high humidity with cool mist, humidifed oxygen, adequate fluid intake, comforting measures, avoid cough syrups and cold meds, racemic epinephrine (watch for rebound), corticosteroids
58
What meds are not helpful for croup?
bronchodilators and antibiotics
59
Nursing considerations for croup
vigilantly observe respiratory status, measures to conserve energy, measures to dec anxiety (parents at bedside), assess hydration, support family, HIB vax is preventative, droplet precautions
60
Signs of inc severity of croup
- inc resp rate
- over 60/min keep NPO
- cyanosis
- inc agitation, restless, anx, dec LOC
61
When to get emergency care for croup?
*Stridor at rest
*Cyanosis
*Severe agitation or fatigue
*Moderate to severe retractions
*Inability to take oral fluids
62
Epiglottitis
- Bacterial "croup"
- serious, life-threatening obstructive inflammatory process
- usually btwn 2-5Y
- H. influenza B or streptococcus penumoniae
63
CM of epiglottitis
DROOL, DYSPHAGIA, DYSPHONIA, DISTRESSED INSPIRATORY EFFORTS
– Abrupt onset, starts with sore throat
– High fever, mouth open, tongue protruding, drooling, agitation.
– Looks very sick, insists on sitting upright (tripod position)
– Sore red inflamed throat, difficulty swallowing
– Muffled voice, inspiratory stridor, No spontaneous cough
64
Epiglottitis interventions and NC
MAINTAIN AIRWAY
– NO tongue blades! Don’t look in the throat
– Avoid x-ray and transport
– Let parents be with child
– Prepare for sedation & intubation
65
Croup tx after intubation
- Throat and blood specimens are obtained for culture
after the child is intubated.
- Antipyretics
- Antibiotics until extubated (usually 7-10 days usually)
- Discharge occurs in about three to seven days, with a
regimen of oral antibiotics continued at home.
66
Bronchiolitis
acute viral infection resulting in inflammation of the smaller bronchioles, characterized by thick mucus
67
RSV
most common cause of bronchiolitis; usually acquired from older person who has minor resp illness
68
s/s RSV bronchiolitis
* Apnea may be first sign in
infancy
* Rhinorrhea
* Pharyngitis
* Coughing/sneezing
* Wheezing, crackles,
decreased breath sounds
* Possible eye and ear
infection
* Intermittent low-grade
fever
* Difficulty feeding
* Irritability
69
What severe symptoms can bronchiolitis progress to?
tachypnea, air hunger, retractions, cyanosis
70
Bronchiolitis therapeutic tx
Primary goal is airway maintenance, symptomatic tx, meds like ribavirin (preg women can't be in the room when given), bronchodilators like albuterol and racemic epi, corticosteroids (controversial)
71
Bronchiolitis NC
Contact iso, handwash, encourage parental participation, supportive care; keep airway open, saline drops and bulb, inc humidity, adequate fluid, rest, humidifed oxygen, antipyretics, monitor pulse ox, encourage clear fluids, shallow suctioning
72
RSV immunization
Palivizumab (Synagis)- monoclonal antibody vaccine for
at risk infants and children under 2-years-old
– <29 weeks gestation
– Chronic lung disease
– Congenital defects
– Severe immune deficiencies
– IM monthly, November-April,
73
Pneumonias
Inflam of alveoli; viral, bacterial, mycoplasmal, aspiration; inhalation or thru blood stream
74
Penumonia CM
– Fever-mild to high
– Chest pain (may be referred to abdomen)
– Dullness to percussion
– Cough-nonproductive early, slight to severe
– Rhonchi or fine rales, decreased breath sounds
– Respiratory distress
75
Complications of bacterial pneumonias
* Empyema
* Pyopneumothorax
* Tension pneumothorax
* Pleural effusion
76
Pneumonia management
* Humidified Oxygen Therapy, antibiotics, & possibly
bronchodilators.
* May need chest tube for purulent drainage.
* May require postural drainage or CPT
* Supportive & symptomatic-rest, hydration
* Elevate HOB & allow child to assume a position of comfort
* Close observation for increased signs of respiratory distress
* Monitor pulse ox
* Drainage tube should be below chest tube
77
Pertussis (whooping cough)
* Unimmunized children< 4 yrs. & > 10 yrs.
* Infants < 6-mos present with apnea, > 6-mos.
Have paroxysmal cough
* Older people have a persistent cough but it may not whoop
* cough
78
Pertussis tx and NC
* Treatment: Erythromycin
* Infants < 6-mos may need ventilator support.
* Humidified oxygen
* Maintain Hydration
* Watch for and prevent pneumonia
79
Tuberculosis cause and transmission
* Caused by mycobacterium tuberculosis
* Source in children is usually an infected
member of the household, or a frequent
visitor to the household
* Transmission occurs by micro-droplet
inhalation when an infected person coughs
or sneezes or through infected milk (bovis
form of disease)
80
TB risk factors
infancy, puberty and adolescence (esp girls), stress states--injury, illness, steroids, nutritional deficits, concurrent infection (HIV, MMR), immunodeficiency
81
Mantoux skin test for TB
Signals presence of TB antibodies (does not confirm active disease)
82
TB CM
* May be
asymptomatic with
normal chest x-rays
* Malaise,
* Fever,
* Night sweats,
* Slight cough,
* Weight loss,
* Anorexia,
* Lymphadenopathy
83
TB exposure vs infection vs disease
- Exposure--recent contact with ind with contagious TB
- Infection--lack s/s but skin test is pos; give prophylactic tx
- Disease--s/s of disease and pos test
84
TB nursing care
- rarely need hospitalization
- medication adherence
- isolation until clinical s/s dec and on therapy
- adequate nutrition very important--protein, fruit, veg
85
Apparent life threatening event (ALTE)
happens to infant over 37W gestation; frightening to the observer; combination of apnea over 20 seconds, color chx (cyanosis or pallor), chx in muscle tone, choking or gagging
86
ALTE diagnostic evaluation
– Cardiopneumogram or pneumocardiogram- 4 channel; HR,
RR, nasal airflow, O2 sat.
– Polysomnography (sleep study)- HR, RR, nasal airflow, O2
sat brain waves, eye & body movement, esophageal
manometry (pH), end tidal CO2 measurements
87
ALTE etiology
50% idiopathic, 50% are sx of other dx
88
ALTE tx
- continuous cardioresp monitoring until episode free for
- methylxanthine use (caffeine) to give heart a little oomf
89
ALTE NC
support fam, education caregivers on CPR, no extension cords, emergency # on phone, interference like TV, radio, cell phones, police scanners, attend infant not monitor
90
SIDS
Leading cause of infant death; sudden death of an infant that occurs during sleep & remains unexplained after postmortem exam, including an investigation of the death scene and a review of the case history
91
What age does SIDS most often occur?
2-4M (90% by 6M)
92
SIDS risk fx
Native Americans, AfrAm, Hispanic, males, lower SES, winter months, LBW or premature, multiple births, low apgar, CNS/resp prob, later birth order, overheating, unsafe sleeping arrangement, bottle-fed, older maternal age, prenatal and postnatal smoking, sub abusers, poor prenatal care
93
SIDS NC
teach SLEEP on BACK, compassionate approach to fam, ask only factual Qs, not leading, allow fam to say goodbye, prove lock of hair, foot and handprints, arrange home visit ASAP
