Acute Respiratory (CH21) Flashcards
The upper respiratory tract is made up of what 4 structures?
-Nose
-Pharynx
-Larynx
-Upper trachea
The lower respiratory tract is made up of what 4 main structures?
-Lower trachea
-Bronchi
-Bronchioles
-Alveoli
Croup Syndromes are infections of the (_________) or the (___________)
Croup Syndromes are infections of the (epiglottis) or the (larynx)
Epiglottitis
Laryngotracheobronchitis (LTB)
Spasmodic Laryngitis
Tracheitis
These conditions are all examples of what acute respiratory syndrome?
Croup Syndrome
What are the 4 general s/s of croup syndrome disease?
(Croup syndrome? BISH please)
-Barking cough
-Inspiratory Stridor
-Swelling of the larynx or epiglottis
-Hoarseness (very noticeable)
What is the trademark sign of a Croup disease?
Steeple Sign: The Airway is so closed it looks like a T, causing a barking cough
When does an infant’s infection rate start to increase and why?
3-6 months of age
The antibodies taken in by mother’s breastmilk start to wane
A main anatomical reason for an increased rate of infections in newborns as opposed to adults is what?
Shorter, straighter Eustachian tubes that connect their ear canal to their airway
Why do an infant’s shorter (____________) tubes cause an increased rate of infection as opposed to adults?
(Eustachian) tube
Since it is shorter and straighter and connects to their airway, infections have less distance to travel to infect
What weather patterns cause an increase in Asthma?
Cold weather patterns
RSV season is in the (_______) and (________)
RSV season is in the (spring) and (winter)
One of the biggest clinical manifestations found in children with an acute respiratory illness is poor (________), aka, (__________)
One of the biggest clinical manifestations found in children with an acute respiratory illness is poor (feeding), aka, (anorexia)
Usually, the 1st sign of change in an infected pediatric patient is the (___________________)
Usually, the 1st sign of change in an infected pediatric patient is the (feeding pattern)
Early s/s of respiratory distress are what 3 things?
-Restlessness
-Tachypnea
-Increase work of breathing
What are the big 3 signs of increased work of breathing?
-Grunting (exhale)
-Flaring (Inhale through nostrils)
-Retractions
A signature sign of respiratory distress in an infant is what?
How does it manifest?
Head bobbing
A subtle nod of the head while the baby is sleeping means they are using accessory muscle retractions to breath
If a patient is experiencing (_____________) in spite of any known cardiac defect, this is a sign of respiratory distress. Why is that?
If a patient is experiencing (cyanosis) in spite of any known cardiac defect, this is a sign of respiratory distress. This is because cardiac defect patients are quicker to become cyanotic
What are 4 nursing interventions that would be given to treat respiratory distress?
-Elevate HOB
-Suctioning
-Increased fluid intake (for mucus)
-Antipyretic for fever
A big factor in treating ARD in children is giving them enough (_____)’s.
A big factor in treating ARD in children is giving them enough (fluid)’s.
Is it wrong to offer anorexic children their food of choice, as opposed to a healthier alternative?
No, at that point its about getting them to eat. Soda and favorite foods are preferred.
What is the most common upper respiratory tract infection?
The common cold/Nasopharyngitis
What are 3 causes for Nasopharyngitis?
-RSV
-Rhinovirus
-Influenza
What are the 2 most common causes for Pharyngitis?
-Strep throat
-Scarlet Fever
What needs to be treated quickly to avoid the risk of Rheumatic Fever and Acute Glomerulonephritis?
GABHS- Streptococcus pyogenes
What are the 4 main symptoms of Pharyngitis?
-Headache
-Fever
-Exudate
-Red/Swollen tongue
How do you dx Pharyngitis?
How do you follow up with test?
-Rapid Strep Test for Pharyngitis
-Follow up with throat culture if test is negative. ABx Amoxicillin if positive
Therapeutic management of Pharyngitis is the use of the Abx (__________) for (___) days
Therapeutic management of Pharyngitis is the use of the Abx (Amoxicillin) for (10) days
How soon can children return to school after being treated for Pharyngitis?
Within 24 hours of Abx administration IF there is no fever present
Are most cases of Otitis Media viral or bacterial?
What are the viruses?
Viral; Self-limiting
Streptococcus pneumonia, H. influenza, Maraxella
The main pathophysiology of Otitis media is a malfunctioning what?
Eustachian tube
How do you dx Otitis Media?
Use a pneumatic otoscope and see how mobile the tympanic membrane is. It will have effusion and be red/swollen (edematous)
How long do you wait to give Amoxicillin to a patient with Otitis Media, typically?
Up to 72 hours if the patient is older than 6 months. It’s often Viral, and self-limiting
List 3 ways you prevent Otitis Media from recurring
-Pneumococcal vaccine
-Keep a child upright
-No bottle propping
Infectious Mononucleosis is caused by what virus?
Epstein barr
What are the s/s of Infectious Mononucleosis?
-Fever
-Exudate
-Pharyngitis
-Fatigue
-Lymph system infection (spleen)
How is Infectious Mononucleosis diagnosed?
With a Monospot test: Response to IgM present in the 1st 2 weeks of infection
Infectious Mononucleosis is a virus, so it is self-limiting, but what should be given to fight swelling, and what should be avoided in infected patients?
Corticosteroid to fight swelling in Infectious Mononucleosis
Avoid contact sports or you could rupture your spleen since it targets the lymph system
What is the trademark of all Croup infections?
Barking, hoarse cough
What is the steeple sign (often seen in Croup infections)?
The steeple sign is seen through an X-ray, and it’s when the airway is so closed off from constriction, that it looks like a “T”.
Acute epiglottitis is always a what?
Acute Epiglottitis is always an emergency!
What are 3 s/s of Acute Epiglottitis?
-Tripod position (to breath)
-Retractions
-Drooling (can’t swallow)
What is the surgical treatment for acute epiglottitis?
Intubation or Tracheostomy
What is inspiratory stridor?
Whistle sound from a blocked airway
If a patient has suspected epiglottitis, what should you NOT attempt to do?
Why?
Do NOT attempt to visualize the epiglottis with a tongue depressor because you can completely block off the airway
Should you suction a patient with acute epiglottitis?
NO, no suctioning
What should you do if you suspect a patient has acute epiglottitis?
Refer them immediately for a medical emergency
What vaccine prevents acute epiglottitis?
Hib vaccine prevents acute epiglottitis
What is the non-surgical tx method for acute epiglottitis?
IV ABx, then oral ABx for 7-10 days
What drug should be given to people who MAY come into contact with people experiencing acute epiglottitis and risk infection?
Rifampin, especially if they are <4 years old
What is the tx for Acute Laryngitis?
Acute Laryngitis is viral and self-limiting. Tx is symptomatic
What is the most common Croup Syndrome?
LTB
Laryngeotracheobronchitis
What is the highest incidence of age for LTB?
6 months to 3 years
Characteristics of LTB are low grade (_____), a (______)/(_________) cough, and a narrowing of the (________) and (________), causing inspiratory stridor, retractions and nasal flaring
Characteristics of LTB are low grade (fever), a (barking)/(hoarse) cough, and a narrowing of the (trachea) and (larynx), causing inspiratory stridor, retractions and nasal flaring
How is LTB assessed?
Mainly by the barking cough, then a Hx of infection and assessing for the big 3
There are 4 types of retractions, and they are based on location. What are they?
Substernal (below the sternum)
-Intercoastal (in-between the ribs)
-Subcoastal (Below the ribs)
-Suprasternal (above the sternum and the clavicle.)
Of the 4 retractions which indicates the highest stress level?
Suprasternal (above the sternum and clavicle)
Progression of LTB can lead to respiratory (_______), respiratory failure, and (_____).
Progression of LTB can lead to respiratory (acidosis), respiratory failure, and (death).
Therapeutic management of LTB is oral and IV (___________), followed by high (_________) and (_______) mist to decrease (___________)
Therapeutic management of LTB is oral and IV (hydration), followed by high (humidity) and (cool) mist to decrease (secretions)
Another method of tx for LTB is the use of a (_________) in combination with epinephrine
Another method of tx for LTB is the use of a (nebulizer) in combination with epinephrine
If epinephrine is used to treat LTB, what would a nurse need to monitor for?
Rebound inflammation after the 2nd dose
Inhaled steroids could help with LTB as well. What are two inhaled steroids to fight LTB?
-Dexamethasone
-Budesonide
What should you NEVER give to treat LTB?
Why?
Expectorants. They can irritate the airway and make problems worse with an edema
Bacterial Tracheitis is an infection of the (_______) and (_______) tissues
Bacterial Tracheitis is an infection of the (mucosa) and (soft) tissues
Clinical manifestations of Bacterial Tracheitis are similar to (___) but they are immune to (___) therapy. They will have thick (_________) secretions.
Clinical manifestations of Bacterial Tracheitis are similar to (LTB) but they are immune to (LTB) therapy. They will have thick (purulent) secretions.
How do you treat bacterial tracheitis?
What age group is most affected by bacterial tracheitis?
Abx (Amoxicillin) and fluids for tx
Age group most affected is 5-7 year olds
Infections of the lower airways include the (________) and the (__________), which are easier to collapse in children because they arnt fully (__________)
Infections of the lower airways include the (bronchi) and the (bronchioles), which are easier to collapse in children because they arnt fully (developed)
What is one of the most common infections in youth?
RSV
RSV bronchitis
What does RSV bronchitis cause swelling of?
The Bronchial levels (smallest airways), and also the cilia, and then the cilia fall off and we lose them
What is the Dx test for RSV bronchitis?
A respiratory panel
or
ELISA test for RSV antigen
What happens with a fever in RSV bronchitis?
A fever is intermittent, it comes and goes
If a CXR is done on a patient suspected of having RSV bronchitis, what is an expected visual result?
Hyperinflation (airway trapping)
Some infants present wit RSV bronchitis by having (_____), meaning they stop (_______) before they show signs of RSV bronchitis.
Some infants present wit RSV bronchitis by having (Apnea), meaning they stop (breathing) before they show signs of RSV bronchitis.
What are the typical upper respiratory tract s/s of a bronchitis infection?
What does it develop into with the lower respiratory tract?
-Runny nose
-fever
-cough
Develops into:
-Retractions
-Crackles
-wheezing
-Secretions
Foreign body aspirations are common in what ages?
<3 years old
s/s of foreign body aspiration
-Sudden choking
-Gagging
-Wheezing
-Cyanosis
-Can’t speak
What is the maneuver for a choking patient if they are >1 year old?
What about <1 year old?
Greater: Heimlich maneuver
Less than: Back blows and Chest thrusts
What at-home risk factor severely increases the risk of SIDS?
Passive smoking
The thing to remember about Spasmodic Laryngitis is that you will see recurrent attacks of laryngeal obstruction at (________)
The thing to remember about Spasmodic Laryngitis is that you will see recurrent attacks of laryngeal obstruction at (night)
In Spasmodic Laryngitis, you will see Croup symptoms. What are the Croup symptoms?
-Barking/Hoarse cough
-Inspiratory Stridor
-Flaring of the nostrils
How do you treat Spasmodic Laryngitis?
Also, what is Spasmodic Laryngitis and what is the thing to remember about it?
Spasmodic laryngitis is treated with:
-Cool humidity
-O2 PRN
-Nebulized Steroids
SL is recurrent attacks of laryngeal obstruction AT NIGHT
For Bronchiolitis, what events would cause you to take them to the hospital?
-If the child stops eating or drinking
-Difficult to wake up from sleep with nighttime wheezing and retractions
What is the only Antiviral medication that is approved to specifically treat Bronchiolitis?
What solution can be nebulized to treat Bronchiolitis?
Ribavirin is the antiviral
3% Saline can be nebulized to treat Bronchiolitis
For Cystic Fibrosis, how often should Chest PT be done? What should be used 1st before beginning chest PT?
Chest PT should be done twice a day, and a Bronchodilator should be used 1st before chest PT
What 2 electrolyte lab values for a sweat chloride test would indicate a negative result for CF?
A sweat chloride of <40mEq
A sweat Sodium of <70mEq
The pancreatic enzymes (______) are given in CF patients to treat (__________), and are typically given (__) minutes prior to food, or (__________) on the meals
The pancreatic enzymes (Creon) are given in CF patients to treat (Steatorrhea), and are typically given (30) minutes prior to food, or (sprinkled) on the meals
CF patients will always be taking a what?
Multivitamin
What H-2 blocker will be given to treat CF, and what will it be given for?
Pepcid is the H-2 blocker given, and it is used for Reflux
What is the drug that targets the mutated gene in CF to slow down the mucosal secretions of CF, and brings back fertility in patients?
Trikafta
Trikafta is a drug that does what for CF patients?
Targets the mutated gene that causes the enhanced mucosal secretions of CF, and brings back fertility
A (_____) transplant in CF patients can add decades to their life expectancy. CF is a terminal disease, and most patients only make it (__) - (__) years.
A (lung) transplant in CF patients can add decades to their life expectancy. CF is a terminal disease, and most patients only make it (20) - (30) years.
Apnea manifests as no (_______) for more than (__) seconds, and is associated with (_________) and (_____)cardia
Apnea manifests as no (breathing) for more than (20) seconds, and is associated with (hypoxemia) and (brady)cardia
What is the primary cause of ARDS?
Infection/Injury to the lungs causing pulmonary edema & surfactant breakdown
A patient is having a dx test within one week of a suspected respiratory infection. Using a CXR it is observed that they have bilateral opacities in the lungs. What is this a sign of?
ARDS
A patient with ARDS will present with (_____)pnea, (____)ventilation, and Increased work of breathing, which manifest as what?
A patient with ARDS will present with (tachy)pnea, (hyper)ventilation, and Increased work of breathing, which manifest as:
-Grunting
-Flaring
-Retractions
-Stridor
The rule for s/s of ARDS is “1st you speed up, then you slow down.” With this in mind, what are 5 s/s of the late adverse effects of ARDS?
-Cyanosis
-Bradycardia
-Bradypnea
-Respiratory acidosis
-Coma
Treatment for ARDS involves opening up the alveoli, killing any bacteria, and getting the fluid out!
What are 4 methods for doing this?
-CPAP/BiPAP for air pressure to open alveoli
-Diuretics to lower pulmonary edema and get fluid out
-Vasodilators to lower lung pressure
-Antibiotics to kill bacteria
Respiratory failure is the most common what?
Most common cause for pulmonary arrest in children
What is a characteristic of Respiratory failure?
The child can’t maintain blood O2 levels (ABG’s)
For Respiratory failure, s/s follow the ARDS rule of “1st you speed up, then you slow down.”
Knowing this, what s/s would you see Early, and what s/s would you see Late?
Early:
-Tachypnea
-Tachycardia
-Diuresis (sweating)
-Restless/Anxiety/Agitation
Late:
-Cyanosis
-Bradycardia/Bradypnea
-Arrythmia’s
-Stupor
What are the 2 treatment methods for respiratory failure in a child?
What O2 level should they be kept at?
-High fowlers position/Tripod
-Supplemental O2 with pressure - CPAP/BiPAP
Keep O2 above 90%
