Acute respiratory conditions Flashcards
physical difference between adult and child airways
small size rely on diaphragmatic/abdominal breathing larynx and glottis higher in neck eustachian tubes are horizontal ribs are horizontal r/t downward slope fewer numbers of alveoli higher metabolic rate
when do we hold bottle feeding in an infant
RR 60 or higher
respiratory assessment of child
LOC RR Respiratory effort skin and mucous membranes breath sounds
RR of infant
30-40
RR of child
20-24
RR of adolescent
16-18
what respiratory symptoms are concerning when assessing the respiratory system
nasal flaring grunting retractions restlessness irritability anxiousness
cardinal signs of respiratory distress
tachypnea
tachycardia
diaphoresis
change in LOC (restless, irritability, anxiousness)
cyanosis
increased work of breathing ( grunting, nasal flaring, retractions)
what about retractions is associated with the severity of the distress?
depth and location
other worrisome signs of respiratory diestress
adventitious breath sounds
absent breath sounds
cough (quality: is it dry, wet, productive, brassy, croupy)
expiratory grunting, inspiratory stridor, expiratory wheezing
which of the following patients has severe respiratory distress?
a) Jason, 3m old with RR 18
b) Jackson, 3 yr old, RR 22
c) Megan, 13 yr old, RR 24
d) Michelle, 19m old, RR 26
a) Jason, 3m
Goals for nursing care of child
normal respiratory effort
adequate rest
not spread infections to others
maintain normal hydration and nutrition
how do you ease respiratory efforts and promote rest and comfort
positioning (sit up to help breathe) no steam vapor- warm or cool mist mist tents saline nose drops and bulb suctioning bed rest and quiet activites
how do you prevent the spread of infection?
handwashing teaching judicious patient room assignments (cohort similar patients) immunizations antibiotics
how do you promote hydration and nutrition
high calorie fluids
avoid caffeine
allow children to self regulate their diet
specific therapies to improve oxygenation
coughing and deep breathing (make it a game) suctioning neb treatments percussion and postural drainage chest physiotherapy supplemental oxygen ALWAYS humidify air
causes of respiratory infections
viruses b-hemolytic strep a staphylococci hemophilic influenzas b mycoplasma pneumococci
what makes up the upper air way
nose pharynx tonsils paranasal sinuses larynx epiglottis
what makes up the lower airway
bronchi
bronchioles
alveoli
why do infections in children tend to spread faster?
because structures are so close together infections spread more rapidly from structure to structure.
clinical manifestations of respiratory infections in infants and children
fever meningism's ( HA, stiff-necked, photophobia) anorexia Vomiting and Diarrhea Abdominal pain nasal blockage and or discharge respiratory sounds sore throat
nasopharyngitis
common cold
causes of common cold
rhinovirus, adenovirus, influenza, para-influenza virus
clinical manifestations of nasopharyngitis in younger child
fever irritability restlessness sneezing vomiting/ and or diarrhea
clinical manifestations of nasopharyngitis in older child
dryness and irritation of nose and throat sneezing chilling muscular aches cough edema vasodilators of mucosa
at 3 months and less infants are protected by mothers
antibodies
infection rates soar at what age
3-6m when moms antibodies are decreasing
what is a true temperature in a child?
100.4
at what age can you start giving ibuprofen to a child?
6m
fever can reduce a viral load by how much?
50%
fever kills virus
the nurse in an outpatient center is caring for a 4 month old infant with a URI. The parent asks “what should I do about this fever?” The Childs temperature is 100. How should the nurse respond?
a low grade fever can actually be beneficial
The nurse caring for 6-month-old Alexa obtains an axillary temperature of 100.4. What action should the nurse take at this time?
a) Administer prn acetaminophen
b) assess respiratory and fluid status
c) Question the parent about the child’s usual temperature status.
d) Record the temperature and retake in one hour.
b) assess respiratory and fluid status
if you are taking a temperature under the arm do you add or subtract a degree?
add a degree and subtract rectally
Therapeutic management of nasopharyngitis
no OTC cough meds less than 3 months
antipyretics for high fever and discomfort
rest
older children- decongestants, cough suppressants
what types of meds do you avoid in nasopharyngitis
antihistamines
antibiotics
expectorants
COLD
c- comfort symptoms
o- offer fluids
l- look for complications
d- decrease disease spread
common cause of tonsillitis
viral
how do you treat tonsilitis
treat symptomatically
no antibiotic necessary
what causes step pharyngitis
Group A ( GABHS)
clinical manifestations of strep pharyngitis
sudden onset sore throat headache fever vomiting lymphadenopathy abdominal pain BEEFY red throat
what is there a risk of if strep pharyngitis is left untreated?
Acute Rheumatic Fever (18 days) Acute Glomerulonephritis (10 days)
what is the management of strep pharyngitis?
antibiotics for 10 days
nursing considerations for strep pharyngitis
severe sore throat seek medical attention
obtain swabs
teaching
When does a child need to get a new toothbrush after strep?
24-48 hours after starting abx
when can a child return to school after strep?
24 hours after starting antibiotics
when is a tonsillectomy indicated?
only if documented recurrent, frequent strep peritonsillar abscess, or sleep apnea
contraindications for tonsillectomy
cleft palate
acute infections
uncontrolled systemic disease or blood dyscrasias
less than 4 years of age
1 sign of hemorrhage after tonsillectomy
excessive swallowing
what types of foods do you teach to avoid after tonsillectomy?
red, brown and dairy ( dairy coats the throat)
is drooling ok after a tonsillectomy?
Yes
what should providers avoid doing after tonsillectomy if possible?
suctioning
what should be discouraged after tonsillectomy?
straws
coughing
laughing
crying
what should you monitor for when doing a respiratory assessment after tonsillectomy?
stridor, can mean swelling and airway compromise
what can be used for comfort after tonsillectomy?
ice collars
cool mist vaporizer
when is the second time there is an immediate risk of hemorrhage after a tonsillectomy?
8-10 days after when the scabs fall off
the nurse is caring for a 3-year-old child who is 3 hours post tonsillectomy. The child appears restless and is swallowing frequently. The child is quiet. The most appropriate action of the nurse is which of the following?
a) allow the child to sleep
b) use a tongue blade to assess the surgical site
c) perform a focused assessment of the child
d) administer analgesia to promote comfort
c) perform a focused assessment of the child
