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Peds Exam 2 > Acute Respiratory (CH21) > Flashcards

Acute Respiratory (CH21) Flashcards

1
Q

The upper respiratory tract is made up of what 4 structures?

A

-Nose
-Pharynx
-Larynx
-Upper trachea

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2
Q

The lower respiratory tract is made up of what 4 main structures?

A

-Lower trachea
-Bronchi
-Bronchioles
-Alveoli

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3
Q

Croup Syndromes are infections of the (_________) or the (___________)

A

Croup Syndromes are infections of the (epiglottis) or the (larynx)

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4
Q

Epiglottitis
Laryngotracheobronchitis (LTB)
Spasmodic Laryngitis
Tracheitis

These conditions are all examples of what acute respiratory syndrome?

A

Croup Syndrome

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5
Q

What are the 4 general s/s of croup syndrome disease?
(Croup syndrome? BISH please)

A

-Barking cough
-Inspiratory Stridor
-Swelling of the larynx or epiglottis
-Hoarseness (very noticeable)

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6
Q

What is the trademark sign of a Croup disease?

A

Steeple Sign: The Airway is so closed it looks like a T, causing a barking cough

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7
Q

When does an infant’s infection rate start to increase and why?

A

3-6 months of age

The antibodies taken in by mother’s breastmilk start to wane

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8
Q

A main anatomical reason for an increased rate of infections in newborns as opposed to adults is what?

A

Shorter, straighter Eustachian tubes that connect their ear canal to their airway

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9
Q

Why do an infant’s shorter (____________) tubes cause an increased rate of infection as opposed to adults?

A

(Eustachian) tube

Since it is shorter and straighter and connects to their airway, infections have less distance to travel to infect

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10
Q

What weather patterns cause an increase in Asthma?

A

Cold weather patterns

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11
Q

RSV season is in the (_______) and (________)

A

RSV season is in the (spring) and (winter)

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12
Q

One of the biggest clinical manifestations found in children with an acute respiratory illness is poor (________), aka, (__________)

A

One of the biggest clinical manifestations found in children with an acute respiratory illness is poor (feeding), aka, (anorexia)

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13
Q

Usually, the 1st sign of change in an infected pediatric patient is the (___________________)

A

Usually, the 1st sign of change in an infected pediatric patient is the (feeding pattern)

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14
Q

Early s/s of respiratory distress are what 3 things?

A

-Restlessness
-Tachypnea
-Increase work of breathing

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15
Q

What are the big 3 signs of increased work of breathing?

A

-Grunting (exhale)
-Flaring (Inhale through nostrils)
-Retractions

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16
Q

A signature sign of respiratory distress in an infant is what?

How does it manifest?

A

Head bobbing

A subtle nod of the head while the baby is sleeping means they are using accessory muscle retractions to breath

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17
Q

If a patient is experiencing (_____________) in spite of any known cardiac defect, this is a sign of respiratory distress. Why is that?

A

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

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18
Q

What are 4 nursing interventions that would be given to treat respiratory distress?

A

-Elevate HOB
-Suctioning
-Increased fluid intake (for mucus)
-Antipyretic for fever

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19
Q

A big factor in treating ARD in children is giving them enough (_____)’s.

A

A big factor in treating ARD in children is giving them enough (fluid)’s.

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20
Q

Is it wrong to offer anorexic children their food of choice, as opposed to a healthier alternative?

A

No, at that point its about getting them to eat. Soda and favorite foods are preferred.

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21
Q

What is the most common upper respiratory tract infection?

A

The common cold/Nasopharyngitis

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22
Q

What are 3 causes for Nasopharyngitis?

A

-RSV
-Rhinovirus
-Influenza

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23
Q

What are the 2 most common causes for Pharyngitis?

A

-Strep throat
-Scarlet Fever

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24
Q

What needs to be treated quickly to avoid the risk of Rheumatic Fever and Acute Glomerulonephritis?

A

GABHS- Streptococcus pyogenes

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25
Q

What are the 4 main symptoms of Pharyngitis?

A

-Headache
-Fever
-Exudate
-Red/Swollen tongue

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26
Q

How do you dx Pharyngitis?

How do you follow up with test?

A

-Rapid Strep Test for Pharyngitis

-Follow up with throat culture if test is negative. ABx Amoxicillin if positive

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27
Q

Therapeutic management of Pharyngitis is the use of the Abx (__________) for (___) days

A

Therapeutic management of Pharyngitis is the use of the Abx (Amoxicillin) for (10) days

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28
Q

How soon can children return to school after being treated for Pharyngitis?

A

Within 24 hours of Abx administration IF there is no fever present

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29
Q

Are most cases of Otitis Media viral or bacterial?
What are the viruses?

A

Viral; Self-limiting

Streptococcus pneumonia, H. influenza, Maraxella

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30
Q

The main pathophysiology of Otitis media is a malfunctioning what?

A

Eustachian tube

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31
Q

How do you dx Otitis Media?

A

Use a pneumatic otoscope and see how mobile the tympanic membrane is. It will have effusion and be red/swollen (edematous)

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32
Q

How long do you wait to give Amoxicillin to a patient with Otitis Media, typically?

A

Up to 72 hours if the patient is older than 6 months. It’s often Viral, and self-limiting

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33
Q

List 3 ways you prevent Otitis Media from recurring

A

-Pneumococcal vaccine
-Keep a child upright
-No bottle propping

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34
Q

Infectious Mononucleosis is caused by what virus?

A

Epstein barr

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35
Q

What are the s/s of Infectious Mononucleosis?

A

-Fever
-Exudate
-Pharyngitis
-Fatigue
-Lymph system infection (spleen)

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36
Q

How is Infectious Mononucleosis diagnosed?

A

With a Monospot test: Response to IgM present in the 1st 2 weeks of infection

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37
Q

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?

A

Corticosteroid to fight swelling in Infectious Mononucleosis

Avoid contact sports or you could rupture your spleen since it targets the lymph system

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38
Q

What is the trademark of all Croup infections?

A

Barking, hoarse cough

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39
Q

What is the steeple sign (often seen in Croup infections)?

A

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”.

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40
Q

Acute epiglottitis is always a what?

A

Acute Epiglottitis is always an emergency!

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41
Q

What are 3 s/s of Acute Epiglottitis?

A

-Tripod position (to breath)
-Retractions
-Drooling (can’t swallow)

42
Q

What is the surgical treatment for acute epiglottitis?

A

Intubation or Tracheostomy

43
Q

What is inspiratory stridor?

A

Whistle sound from a blocked airway

44
Q

If a patient has suspected epiglottitis, what should you NOT attempt to do?
Why?

A

Do NOT attempt to visualize the epiglottis with a tongue depressor because you can completely block off the airway

45
Q

Should you suction a patient with acute epiglottitis?

A

NO, no suctioning

46
Q

What should you do if you suspect a patient has acute epiglottitis?

A

Refer them immediately for a medical emergency

47
Q

What vaccine prevents acute epiglottitis?

A

Hib vaccine prevents acute epiglottitis

48
Q

What is the non-surgical tx method for acute epiglottitis?

A

IV ABx, then oral ABx for 7-10 days

49
Q

What drug should be given to people who MAY come into contact with people experiencing acute epiglottitis and risk infection?

A

Rifampin, especially if they are <4 years old

50
Q

What is the tx for Acute Laryngitis?

A

Acute Laryngitis is viral and self-limiting. Tx is symptomatic

51
Q

What is the most common Croup Syndrome?

A

LTB
Laryngeotracheobronchitis

52
Q

What is the highest incidence of age for LTB?

A

6 months to 3 years

53
Q

Characteristics of LTB are low grade (_____), a (______)/(_________) cough, and a narrowing of the (________) and (________), causing inspiratory stridor, retractions and nasal flaring

A

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

54
Q

How is LTB assessed?

A

Mainly by the barking cough, then a Hx of infection and assessing for the big 3

55
Q

There are 4 types of retractions, and they are based on location. What are they?

A

Substernal (below the sternum)
-Intercoastal (in-between the ribs)
-Subcoastal (Below the ribs)
-Suprasternal (above the sternum and the clavicle.)

56
Q

Of the 4 retractions which indicates the highest stress level?

A

Suprasternal (above the sternum and clavicle)

57
Q

Progression of LTB can lead to respiratory (_______), respiratory failure, and (_____).

A

Progression of LTB can lead to respiratory (acidosis), respiratory failure, and (death).

58
Q

Therapeutic management of LTB is oral and IV (___________), followed by high (_________) and (_______) mist to decrease (___________)

A

Therapeutic management of LTB is oral and IV (hydration), followed by high (humidity) and (cool) mist to decrease (secretions)

59
Q

Another method of tx for LTB is the use of a (_________) in combination with epinephrine

A

Another method of tx for LTB is the use of a (nebulizer) in combination with epinephrine

60
Q

If epinephrine is used to treat LTB, what would a nurse need to monitor for?

A

Rebound inflammation after the 2nd dose

61
Q

Inhaled steroids could help with LTB as well. What are two inhaled steroids to fight LTB?

A

-Dexamethasone
-Budesonide

62
Q

What should you NEVER give to treat LTB?
Why?

A

Expectorants. They can irritate the airway and make problems worse with an edema

63
Q

Bacterial Tracheitis is an infection of the (_______) and (_______) tissues

A

Bacterial Tracheitis is an infection of the (mucosa) and (soft) tissues

64
Q

Clinical manifestations of Bacterial Tracheitis are similar to (___) but they are immune to (___) therapy. They will have thick (_________) secretions.

A

Clinical manifestations of Bacterial Tracheitis are similar to (LTB) but they are immune to (LTB) therapy. They will have thick (purulent) secretions.

65
Q

How do you treat bacterial tracheitis?

What age group is most affected by bacterial tracheitis?

A

Abx (Amoxicillin) and fluids for tx

Age group most affected is 5-7 year olds

66
Q

Infections of the lower airways include the (________) and the (__________), which are easier to collapse in children because they arnt fully (__________)

A

Infections of the lower airways include the (bronchi) and the (bronchioles), which are easier to collapse in children because they arnt fully (developed)

67
Q

What is one of the most common infections in youth?

A

RSV
RSV bronchitis

68
Q

What does RSV bronchitis cause swelling of?

A

The Bronchial levels (smallest airways), and also the cilia, and then the cilia fall off and we lose them

69
Q

What is the Dx test for RSV bronchitis?

A

A respiratory panel
or
ELISA test for RSV antigen

70
Q

What happens with a fever in RSV bronchitis?

A

A fever is intermittent, it comes and goes

71
Q

If a CXR is done on a patient suspected of having RSV bronchitis, what is an expected visual result?

A

Hyperinflation (airway trapping)

72
Q

Some infants present wit RSV bronchitis by having (_____), meaning they stop (_______) before they show signs of RSV bronchitis.

A

Some infants present wit RSV bronchitis by having (Apnea), meaning they stop (breathing) before they show signs of RSV bronchitis.

73
Q

What are the typical upper respiratory tract s/s of a bronchitis infection?

What does it develop into with the lower respiratory tract?

A

-Runny nose
-fever
-cough

Develops into:
-Retractions
-Crackles
-wheezing
-Secretions

74
Q

Foreign body aspirations are common in what ages?

A

<3 years old

75
Q

s/s of foreign body aspiration

A

-Sudden choking
-Gagging
-Wheezing
-Cyanosis
-Can’t speak

76
Q

What is the maneuver for a choking patient if they are >1 year old?

What about <1 year old?

A

Greater: Heimlich maneuver

Less than: Back blows and Chest thrusts

77
Q

What at-home risk factor severely increases the risk of SIDS?

A

Passive smoking

78
Q

The thing to remember about Spasmodic Laryngitis is that you will see recurrent attacks of laryngeal obstruction at (________)

A

The thing to remember about Spasmodic Laryngitis is that you will see recurrent attacks of laryngeal obstruction at (night)

79
Q

In Spasmodic Laryngitis, you will see Croup symptoms. What are the Croup symptoms?

A

-Barking/Hoarse cough
-Inspiratory Stridor
-Flaring of the nostrils

80
Q

How do you treat Spasmodic Laryngitis?

Also, what is Spasmodic Laryngitis and what is the thing to remember about it?

A

Spasmodic laryngitis is treated with:
-Cool humidity
-O2 PRN
-Nebulized Steroids

SL is recurrent attacks of laryngeal obstruction AT NIGHT

81
Q

For Bronchiolitis, what events would cause you to take them to the hospital?

A

-If the child stops eating or drinking
-Difficult to wake up from sleep with nighttime wheezing and retractions

82
Q

What is the only Antiviral medication that is approved to specifically treat Bronchiolitis?

What solution can be nebulized to treat Bronchiolitis?

A

Ribavirin is the antiviral

3% Saline can be nebulized to treat Bronchiolitis

83
Q

For Cystic Fibrosis, how often should Chest PT be done? What should be used 1st before beginning chest PT?

A

Chest PT should be done twice a day, and a Bronchodilator should be used 1st before chest PT

84
Q

What 2 electrolyte lab values for a sweat chloride test would indicate a negative result for CF?

A

A sweat chloride of <40mEq
A sweat Sodium of <70mEq

85
Q

The pancreatic enzymes (______) are given in CF patients to treat (__________), and are typically given (__) minutes prior to food, or (__________) on the meals

A

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

86
Q

CF patients will always be taking a what?

A

Multivitamin

87
Q

What H-2 blocker will be given to treat CF, and what will it be given for?

A

Pepcid is the H-2 blocker given, and it is used for Reflux

88
Q

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?

A

Trikafta

89
Q

Trikafta is a drug that does what for CF patients?

A

Targets the mutated gene that causes the enhanced mucosal secretions of CF, and brings back fertility

90
Q

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

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.

91
Q

Apnea manifests as no (_______) for more than (__) seconds, and is associated with (_________) and (_____)cardia

A

Apnea manifests as no (breathing) for more than (20) seconds, and is associated with (hypoxemia) and (brady)cardia

92
Q

What is the primary cause of ARDS?

A

Infection/Injury to the lungs causing pulmonary edema & surfactant breakdown

93
Q

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?

A

ARDS

94
Q

A patient with ARDS will present with (_____)pnea, (____)ventilation, and Increased work of breathing, which manifest as what?

A

A patient with ARDS will present with (tachy)pnea, (hyper)ventilation, and Increased work of breathing, which manifest as:
-Grunting
-Flaring
-Retractions
-Stridor

95
Q

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?

A

-Cyanosis
-Bradycardia
-Bradypnea
-Respiratory acidosis
-Coma

96
Q

Treatment for ARDS involves opening up the alveoli, killing any bacteria, and getting the fluid out!

What are 4 methods for doing this?

A

-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

97
Q

Respiratory failure is the most common what?

A

Most common cause for pulmonary arrest in children

98
Q

What is a characteristic of Respiratory failure?

A

The child can’t maintain blood O2 levels (ABG’s)

99
Q

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?

A

Early:
-Tachypnea
-Tachycardia
-Diuresis (sweating)
-Restless/Anxiety/Agitation

Late:
-Cyanosis
-Bradycardia/Bradypnea
-Arrythmia’s
-Stupor

100
Q

What are the 2 treatment methods for respiratory failure in a child?

What O2 level should they be kept at?

A

-High fowlers position/Tripod
-Supplemental O2 with pressure - CPAP/BiPAP

Keep O2 above 90%

Peds Exam 2 (4 decks)

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