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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
Q

croup/laryngotracheobronchitis can be preceded by…

A

upper respiratory infection

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26
Q

most croup is managed where?

A

at home!! gotta teach parents what respiratory distress looks like.

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27
Q

croup/LTB interventions

A

(general interventions)

  • cool mist
  • have advanced airway/intubation equipment ready
  • parent education: s/s respiratory distress, when to go to the hospital
28
Q

croup/LTB parent education: when to go to the hospital

A
  • increased stridor
  • decreased responsiveness
  • child needs food but can’t eat therefore needs IV
29
Q

croup/LTB pharm NO NO *

A

NO EXPECTORANTS, may irritate airway

no sedatives (may decrease respiratory functioning)

30
Q

croup/LTB pharm

A
  • racemic epinephrine (often nebulizer, may eliminate need for intubation)
  • O2
  • steroids (anti-inflamm to decrease mucosal edema)
31
Q

croup/LTB prognosis

A

EXCELLENT!!!!

32
Q

croup/epiglottitis is…

A

serious obstructive inflammatory process that requires immediate medical attention;

infection of epiglottis and/or supraglottis

33
Q

croup/epiglottitis incidence in…

A

2 to 5 years

34
Q

croup/epiglottitis etiology

A

bacteria, Haemophilus influenza b

35
Q

why don’t we see hemaeophilus influenza very much anymore?

A

VACCINE!!!!!

36
Q

croup/epiglottitis pathophysiology

A

supraglottic swelling and obstruction

37
Q

croup/epiglottitis s/s: characteristic posturing*

A

sitting upright, leaning forward, chin out, mouth open, tongue protruding and drooling

38
Q

croup/epiglottitis s/s: onset

A

abrupt, often preceded by sore throat

39
Q

croup/epiglottitis s/s: progression

A

rapidly to severe respiratory distress

40
Q

croup/epiglottitis s/s: 4 D’s and significance

A
  • dysphagia
  • dysphonia
  • distress
  • drooling

EMERGENCY!!!!!!!!

41
Q

you should NEVER do this with epiglottitis patients…

A

NEVER EXAMINE THE THROAT (only done if emergent intubation/tracheostomy can be performed, in OR)

42
Q

croup/epiglottitis nursing interventions

A
  • 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
Q

bronchiolitis is…

A

acute viral infection with max effect at bronchial level

44
Q

bronchiolitis incidence most common in and when?

A

winter, spring

2 to 7 months of age (mild in older child, severe in infancy)

45
Q

bronchiolitis etiology

A

respiratory syncytial virus

46
Q

by age 3, what percent of children have had at least 1 RSV infection? *

A

95%

47
Q

RSV bronchiolitis virus is shed when?

A

1 to 2 days BEFORE and 1 to 2 weeks AFTER onset of symptoms

48
Q

RSV bronchiolitis pathophysiology

A
  • 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
Q

bronchiolitis s/s *

A
  • 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
Q

bronchiolitis classic cough

A

machine gun-like taking 1 to 3 weeks to resolve

51
Q

bronchiolitis symptoms improve in…

A

3 to 4 days

52
Q

bronchiolitis/RSV diagnostic evaluation

A

nasal swab ELISA - rapid results with quick diagnosis

53
Q

bronchiolitis/RSV: ribavirin controversy

A

antiviral agent with effectiveness questionable in clinical trials; it doesn’t improve prognosis

54
Q

bronchiolitis/RSV: mode of transmission

A
  • direct contact with respiratory secretions (can live a long time on surfaces)
  • no airborne transmission documented
  • contact precautions only
55
Q

non-RSV bronchiolitis precautions

A

contact AND droplet

56
Q

important protective step when suctioning a child?

A

put a mask on (everything goes into the air!)

57
Q

bronchiolitis interventions *

A
  • 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
Q

most RSV managed where?

A

OUTSIDE hospital, so if they are in the hospital they need some sort of intervention

59
Q

tonsillitis is…

A

inflammation causing difficulty swallowing or breathing with viral OR bacterial cause

60
Q

serious sequelae of strep tonsillitis

A
  • rheumatic heart disease

- acute glomerulonephritis

61
Q

tonsillitis treatment

A

oral penicillin

tonsillectomy if recurrent infection

62
Q

tonsillitis diagnosed how?

A

culture throat with swab

63
Q

tonsillitis post-op care *

A
  • watch for continuous swallowing (a little swallowing is good)
  • sleep on side/abdomen
  • analgesics
  • ice collar
  • don’t gargle!!!!!!!!!!!
64
Q

foreign body aspiration significant in which ages

A

1 to 3 years

65
Q

foreign body aspiration most common causes

A

hot dogs, round candy, peanuts, grapes, cookie, meat, carrot, apples

66
Q

foreign body aspiration s/s

A

choking, gagging, coughing

67
Q

foreign body aspiration REMEMBER

A

CPR * CAB!

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