acute respiratory Flashcards
general nursing interventions
ease respiratory efforts, promote rest, comfort, prevent spread of infection, promote hydration and nutrition, manage fever, fam support and teaching, support and plan for home care
ease resp effort
position, warm or cool mist, mist tent, saline nose drops with bulb suctioning, bed rest, quiet activites
tonsilitis
rapid test! strep test - heart and kidneys
treat S
usually viral - no abx
prevent spread of infection
HH, teach, judicious room assingments, immunizations, abx
improve oxygenation
cough and deep breathe, suction, neb meds, percussion and postural drainage, cpt, supplemental o2
hydration and nutrition
high cal fluids, avoid caffeine, allow to self regulate
nasopharyngitis tm
no OTC <3
antipyretics for high fever and discomfort
rest
older: decongestants, cough suppresants - OH
avoid: antihistamines, abx, expectorants
nasopharyngitis
common cold
strep pharyngitis tm
10 day abx - finish
sudden onset, school 24 hrs after being on abx, new tooth brush, dont share drinks, swabs, comfort care, teach
tonsillectomy nc
excessive bleeding, avoid suction - drool ok, position on side for drainage, no straws, cough, laugh, cry; inspect secretions and vomit (blood tinged is ok), swelling and airway compromise - stridor, iced collar, manage pain, cool mist vaporizer, no red or brown food, soft diet, no milk
tonsillectomy discharge
7-11 days
risk of bleeding, watch for excessive swallowing, s/s of hemorrhaging, lots of throat clearing
comfort measures
external otitis
abx/steroid drop - no oral
prevention is key - get water out (peroxide/vinegar, gravity, hair dryer, ear plugs)
otits media tm
teach prevention
abx therapy - amoxicillan
analgesia - heat compress, tylenol, ibuprofen
PE tube
chronic otitis media
sedation - still
no diving, jumping, prolonged submersion; no swimming in lakes/rivers, avoid post op pressure
drainage common after placement
croup - LTB
viral
sound worse than they look
croup - LTB tm
airway and breathing - priority
at home
cool moist env, humidified o2, fluids, comfort, avoid cough syrups and cold medicines, racemic epi, corticosteroids, stay calm
avoid: bronchodilators, abx
croup - LTB nc
resp assessment, conserve E, decrease anx (parents), assess and prevent dehydration, support fam
croup - LTB S of increasing severity
rr increase
agitation, restless, anxiety, decreased LOC, cyanosis
croup - epiglottitis
bacterial croup
serious, life threatening -airway
croup - epiglottitis tm
vaccines
look bad, dont sound bad, no cough, drool
maintain airway, no tongue blades, avoid xray and transport, let parents be there, keep everyone calm, prepare for sedation and intubation
specimens, antipyretics for fever, abx, usually better at 48 hrs, discharge with abx at home
bronchiolitis (RSV) tm/nc
maintain airway - suction
meds: antivirals (ribavirin), bronchodilators (albuterol), corticosteroids (controversial)
treat S (home): contact isolation, HH, parental participation, keep airway open, saline drops and bulb suction, humidity, fluids, rest, humidified O2, antipyretics, pulse ox, monitor hydration and encourage PO intake of clear fluids
bronchiolitis (RSV) vaccine
synagis
at risk <2: <29 weeks, chronic lung disease, congenital defects, severe immune deficiencies
IM monthly - nov - april, expensive
pneumonias tm and nc
humidified o2, abx, bronchodilators, chest tube, postural drainage, cpt, support and symptomatic, elevate HOB, position of comfort, close observation for S of increasing resp distress, continuous pulse ox
pertussis tm/nc
tdap
erythromycin, <6 mo may need vent, oxygen, hydration, watch for and prevent pna
tuberculosis tm/nc
will always test +
rarely need hospital, med adherence, isolation - school once on therapy and s/s reduced, nutrition!!!
ALTE tm/nc
not if in nicu
lots of testing and assessment - continuous monitoring for 6 months episode free
discharge teach: CPR, no extension cords, interference (TV, radio, cell phones, police scanners), emergency # on phones
methylxanthine - caffeine
SIDS tm/nc
back to sleep
compassionate, sensitive, initial approach, ask factual Qs only, allow goodbye, provide lock of hair, foot and hand prints, arrange home visit ASAP
s of resp distress
tachypnea, tachycardia, diaphoresis, change in LOC, restless, irritable, anx, cyanosis, increased WOB (grunt, nasal flare, retractions)
adventitious sounds
cough
general cm of rti in kids
fever, meningismus, anorexia, v/d, abd pain, nasal blockage/discharge, resp sounds, sore throat
nasopharyngitis etiology
common cold - virus
nasopharyngitis cm - younger
fever, irritable, restless, sneeze, v/d
nasopharyngitis cm - older
dryness and irritation of nose and throat, sneeze, chill, muscle aches, cough, edema and vasodilation of mucosa
strep pharyngitis (GABHS) cm
sudden onset, sore throat, HA, fever, v, lymphadenopathy, abd pain, beefy red throat
can lead to RF
impetigo and pyoderma, scarlet dever
exudate on tonsils, petechiae of pharynx
external otitis
water trapped by earwax = growth medium
inflam/infection of outer ear
external otitis cm
pain (disproportionate, increase w movement), drainage (serousanguineous or purulent)
otitis media
middle ear, collection of fluid or pus
non breast fed, cig smoke, bottles in bed, unimmunized, pacifier beyond infancy, allergies, winter
otitis media cm
ear pain, irritable, hold/pull at ear, roll head from side to side, fever up to 104, ruptured tympanic membrane
chronic = hearing loss
LTB cm
slowly progressive
edema of epiglottis, trachea swells, mucosal inflam, harsh mechanic cough, insp stridor, resp distress, agitations, retractions
croup increasing severity
increasing rr, agitation, restless, anx, decreased LOC, cyanosis
epiglottitis cm
abrupt onset - sore throat
hight fever, mouth open, tongue protruding, drool, agitation, looks sick, sit upright (tripod), sore red inflamed throat, difficulty swallowing, muffled voice, insp stridor, no cough
bronchiolitis
viral (RSV) - inflam of broncioles, thick mucus
cm: apnea, rhinorrhea, pharyngitis, cough/sneeze, adventitious or decreased breath sounds, eye/ear infection, low grade fever, difficulty feeding, irritable
progress: tachypnea, air hunger, retractions, cyanosis
pneumonias cm
viral or bacterial
fever, chest pain (abd), dullness to percussion, cough non productive early, ronchi or fine rales, decreased breath sounds, resp distress
whooping cough
persistant cough
too busy coughing, dont want to eat
TB cm
may be asymp with normal CXR
malaise, fever, night sweats, slight cough, weight loss, anorexia, lymphadenopathy
ALTE cm
apnea >20 sec, color change (cyanosis or pallor), marked change in muscle tone, choke or gag
SIDS rf
race and gender, premie or low birth weight, multiple births, low apgar, cns disturbance or resp disorder, later birth order, overheating, unsafe sleeping, bottle fed, maternal age, smoking, substance abusers, poor prenatal care
