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Undeleted > Acute Respiratory (peds) > Flashcards

Acute Respiratory (peds) Flashcards

0
Q

single most important respiratory infection in infancy and childhood *

A

RSV

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1
Q

single most important respiratory infection in infancy and childhood

A

RSV

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3
Q

Viruses that cause mild symptoms in older children can be severe in…

A

Infants

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4
Q

signs of increased work of breathing (infants) *

A
  • grunting
  • head bobbing
  • increased RR, retractions, flaring
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5
Q

early sign of respiratory distress

A

restlessness

compared to manifestation of confusion in geriatrics

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6
Q

late sign of respiratory distress

A

cyanosis

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7
Q

key for pulmonary auscultation

A

listen to breaths completely: in AND out

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8
Q

RSV symptoms in infants may be preceded by

A

apnea

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9
Q

changes in children are significant, therefore…

A

it is not unusual for one of the vague symptoms to be the initial complaint

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10
Q

signs and symptoms of respiratory infection

A

fever, anorexia, v, d, abd pain, cough, sore throat, nasal discharge, nasal blockage

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11
Q

children, in the absence of cardiac defects have…

A

RESPIRATORY EVENTS! Not cardiac events. (Not a lot of codes, lots of rapid responses)

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12
Q

intervention for impaired gas exchange

A

ease respiratory effort and maximize lung function:

raise head of bed, position of comfort for older child (lap!)

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13
Q

intervention for ineffective airway clearance

A

position, lots of suctioning, increase fluid intake

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14
Q

intervention for fluid volume deficit

A

favorite beverages, offer fluids q1-2h when awake, engage parents in I&O recording

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15
Q

intervention for reducing anxiety/fear

A

parents at the bedside, yo!

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16
Q

intervention for impaired nutrition

A
  • IV fluids if child unable to eat due to tachypnea
  • offer small amounts of food more often with choices
  • DON’T FORCE
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17
Q

intervention for alteration in comfort

A

promote rest: bedtime routines, intentional quiet, lovies, family centered care

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18
Q

intervention for activity intolerance

A

provide diversions with age-appropriate play to decrease boredom but promote rest, cluster care, balance rest and activity

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19
Q

general health promotion foci

A
  • hand washing
  • parent smoking NONO
  • vaccines
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20
Q

croup/laryngotracheobronchitis is…*

A

infection of the larynx/trachea characterized by hoarseness, resonant cough (barky, brassy, seal-like), inspiratory stridor, respiratory distress, non-toxic appearance

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21
Q

croup/laryngotracheobronchitis incidence most common in…

A

6 mo to 3 years (SIZE MATTERS)

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22
Q

croup/laryngotracheobronchitis etiology

A

primarily viral, parainfluenza type 1

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23
Q

croup/laryngotracheobronchitis pathophysiology

A
  • initial portal of entry: nose, nasopharynx
  • inflammation of mucosa lining larynx, trachea
  • leads to subglottic narrowing, obstruction both insp and expiratory
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24
Q

steeple sign

A

subglottic narrowing seen on x ray, sign of LTB croup

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25
croup/laryngotracheobronchitis can be preceded by...
upper respiratory infection
26
most croup is managed where?
at home!! gotta teach parents what respiratory distress looks like.
27
croup/LTB interventions
(general interventions) - cool mist - have advanced airway/intubation equipment ready - parent education: s/s respiratory distress, when to go to the hospital
28
croup/LTB parent education: when to go to the hospital
- increased stridor - decreased responsiveness - child needs food but can't eat therefore needs IV
29
croup/LTB pharm NO NO *
*NO EXPECTORANTS*, may irritate airway no sedatives (may decrease respiratory functioning)
30
croup/LTB pharm
- racemic epinephrine (often nebulizer, may eliminate need for intubation) - O2 - steroids (anti-inflamm to decrease mucosal edema)
31
croup/LTB prognosis
EXCELLENT!!!!
32
croup/epiglottitis is...
serious obstructive inflammatory process that requires immediate medical attention; infection of epiglottis and/or supraglottis
33
croup/epiglottitis incidence in...
2 to 5 years
34
croup/epiglottitis etiology
bacteria, Haemophilus influenza b
35
why don't we see hemaeophilus influenza very much anymore?
VACCINE!!!!!
36
croup/epiglottitis pathophysiology
supraglottic swelling and obstruction
37
croup/epiglottitis s/s: characteristic posturing*
sitting upright, leaning forward, *chin out, mouth open, tongue protruding and drooling*
38
croup/epiglottitis s/s: onset
abrupt, often preceded by sore throat
39
croup/epiglottitis s/s: progression
rapidly to severe respiratory distress
40
croup/epiglottitis s/s: 4 D's and significance
- dysphagia - dysphonia - distress - drooling EMERGENCY!!!!!!!!
41
you should NEVER do this with epiglottitis patients...
NEVER EXAMINE THE THROAT (only done if emergent intubation/tracheostomy can be performed, in OR)
42
croup/epiglottitis nursing interventions
- NPO - respiratory isolation - closely monitor (at a distance to decrease anxiety) - calm, professional manner - protect and maintain airway (emergency equipment near) - prepare for lateral neck X-ray - position of comfort: in parent lap
43
bronchiolitis is...
acute viral infection with max effect at bronchial level
44
bronchiolitis incidence most common in and when?
winter, spring | 2 to 7 months of age (mild in older child, severe in infancy)
45
bronchiolitis etiology
respiratory syncytial virus
46
by age 3, what percent of children have had at least 1 RSV infection? *
95%
47
RSV bronchiolitis virus is shed when?
1 to 2 days BEFORE and 1 to 2 weeks AFTER onset of symptoms
48
RSV bronchiolitis pathophysiology
- affects epithelial cells (swell and protrude into lumen, lose cilia) - fusion of infected cell membranes, forming with a giant cell with multiple nuclei - doesn't trigger enough immune response to make children immune (can have RSV once a month for six months, ugh!) - bronchial mucosa swell, frequently obstructed - thick tenacious secretions - hyperinflation leading to air trapping
49
bronchiolitis s/s *
- may present with lethargy or irritability * - upper respiratory: URI symptoms for several days (rhinnorrhea, fever, anorexia, cough, sneezing) UPPER CAN GO LOWER EASILY: SHORT TUBES!!! WHEN IT GOES LOWER, PAY ATTENTION - lower respiratory: tachypnea, dyspnea, retractions, wheezing, crackles, increased seretions - hyperinflation of lungs seen via x-ray (infants usually worst) - poor feeding (refusing) - apnea may precede symptoms in infants - copious thick secretions (clear to white) - croupy cough (may take 1-3 weeks to resolve)
50
bronchiolitis classic cough
machine gun-like taking 1 to 3 weeks to resolve
51
bronchiolitis symptoms improve in...
3 to 4 days
52
bronchiolitis/RSV diagnostic evaluation
nasal swab ELISA - rapid results with quick diagnosis
53
bronchiolitis/RSV: ribavirin controversy
antiviral agent with effectiveness questionable in clinical trials; it doesn't improve prognosis
54
bronchiolitis/RSV: mode of transmission
- direct contact with respiratory secretions (can live a long time on surfaces) - no airborne transmission documented - contact precautions only
55
non-RSV bronchiolitis precautions
contact AND droplet
56
important protective step when suctioning a child?
put a mask on (everything goes into the air!)
57
bronchiolitis interventions *
* high humidity combined with O2 - monitory closely to prevent respiratory failure - adequate fluid intake (IV if tachypneic, fatigued, weak) - intentional, purposeful rest - ease work of breathing - suction prn - NO ANTIBIOTICS
58
most RSV managed where?
OUTSIDE hospital, so if they are in the hospital they need some sort of intervention
59
tonsillitis is...
inflammation causing difficulty swallowing or breathing with viral OR bacterial cause
60
serious sequelae of strep tonsillitis
- rheumatic heart disease | - acute glomerulonephritis
61
tonsillitis treatment
oral penicillin | tonsillectomy if recurrent infection
62
tonsillitis diagnosed how?
culture throat with swab
63
tonsillitis post-op care *
* watch for continuous swallowing (a little swallowing is good) - sleep on side/abdomen - analgesics - ice collar - don't gargle!!!!!!!!!!!
64
foreign body aspiration significant in which ages
1 to 3 years
65
foreign body aspiration most common causes
hot dogs, round candy, peanuts, grapes, cookie, meat, carrot, apples
66
foreign body aspiration s/s
choking, gagging, coughing
67
foreign body aspiration REMEMBER
CPR * CAB!

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