Alteration in Gas Exhange/Respiratory Dx Flashcards
What is the most common cause of illness and hospitalization in children?
Respiratory Disorders
How long are newborns typically obligatory nose breathers?
4 weeks of age
If the newborns nose is obstructed are they able to open their mouths to breath?
No
The Infants Nose
- produce very little mucus which makes them more susceptible to infections
- small nasal passages more prone to obstruction
- sinuses are not developed
The Infants Throat
- tongue relative to oropharynx are larger; placement can lead to obstruction
- enlarged tonsillar and adenoid tissue which can lead to obstruction
Why is the capacity for air passage greatly diminished when edema, mucus, or bronchospasm is present?
Airway lumen is smaller
What results in an exponential increase in resistance to airflow causing increased work or breathing?
small reduction in diameter of the child airway
What increases the chance of aspiration of foreign material into the lower airway?
Congenital laryngomalacia due to funnel shape and location of the larynx
A child’s airway us highly compliant making it more susceptible for what?
dynamic collapse during airway obstruction
Where is the trachea located in children?
third thoracic vertebra
Where is trachea located in adults?
sixth thoracic vertebrae
Children exposed to environmental smoke have an increased risk of what?
Respiratory illnesses such as asthma, bronchitis, and pneumonia
Prolonged expiration is a sign of what?
bronchial or bronchiolar obstruction
Wheezing
high pitched sound on expiration
-may occur w/ obstruction in lower trachea or bronchioles
Rales
crackling sound heard when alveoli become fluid filled
-may occur w/ pneumonia
Lab/Diagnostic Tests ordered for Bronchiolitis
- pulse oximetry
- chest radiography
- blood gases
- nasal pharyngeal washings
A chest radiography may reveal what for bronchiolitis?
hyperinflation and patchy areas of atelectasis or infiltration
Blood Gases test may show what for bronchiolitis?
carbon dioxide retention and hypoxemia
Lab/Diagnostic Tests for Pneumonia
- pulse ox
- chest x-ray
- sputum culture
- white blood cell count
Lab/Diagnostic Tests for Cystic Fibrosis
- sweat chloride test
- pulse ox
- chest radiograph
- pulmonary function test
Common medical treatments for respiratory disorders are?
- oxygen
- high humidity
- suctioning
- chest physiotherapy/postural drainage
- saline gargles/lavage
- chest tubes
- bronchoscopy
Chest Physiotherapy
promotes mucus clearance through percussion and vibration
Suctioning
removes secretions via bulb syringe or suction catheter
Chest Tubes
remove air or fluid through a drain inserted into the pleural cavity
Bronchoscopy
intro of a bronchoscope into the bronchial tree for diagnostic purposes
Acute Infectious Disorders
- common cold, sinusitis
- influenza
- pharyngitis, tonsillitis, laryngitis
- croup syndromes
- RSV (respiratory syncytial virus)
- pneumonia and bronchitis
Nursing Management for the Common Cold
- symptom relief
- promote comfort
- provide family education
- prevent spread of cold
Sinusitis Symptoms
- cough
- fever
- halitosis
- facial pain
- eyelid edema
- irritability
- poor appetite
Severe Influenza Infection
- chronic heart or lung disease
- diabetes
- chronic renal disease
- immune deficiency
- children w/ cancer receiving chemo
Pharyngitis History of Symptoms
- fever
- sore throat
- difficulty swallowing
- headache
- abdominal pain
Nursing Care Post-Tonsillectomy
- promote airway clearance by placing child on side or prone
- encourage fluids
- avoid citrus, brown, or red fluids
- discourage coughing
- pain relief w/ ice collar and analgesics w/ or w/o narcotics
Nursing Management for Mono
- analgesics
- salt water gargles
- bed rest
- rest periods
- avoid contact sports
Croup
- upper airway infection
- barky-seal like cough
- significant stridor at rest
- severe retractions after several hour period of observation
Epiglottitis
- inflammation and swelling of epiglottis
- most often seen b/t ages of 2-7
- life threatening
- maintain patent airway
- IV antibiotics
- ICU
What is Epiglottitis often caused by?
Haemophilus influenzae B
Nursing Management for Epiglottitis
- do NOT attempt to visualize the throat
- do NOT leave unattended
- do NOT place in supine position
- provide 100% oxygen in least invasive manner
- ensure emergency equipment is available
If complete airway occlusion occurs with Epiglottitis what intervention may be necessary?
Tracheostomy
S/S of Bronchiolitis (RSV)
- onset of illness w/ a clear runny nose
- pharyngitis
- low grade fever
- development of cough 1-3 days into the illness, followed by a wheeze shortly after
- poor feeding
Pneumonia
inflammation of the lung parenchyma caused by a virus, bacteria, Mycoplasma, or fungus
What is the most common cause of pneumonia in younger children?
Respiratory virus
What is the most common type of bacterial pneumonia in all ages?
Streptococcus pneumoniae
What is the most common type of bacterial pneumonia specifically for school-age and adolescents?
M. pneumoniae
Risk factors for Tuberculosis
- HIV infection
- incarceration or institutionalization
- positive recent history of latent TB infection
- immigration or travel to endemic countries
- exposure at home to HIV-infected or homeless persons, illicit drug users, persons recently incarcerated, migrant farm workers, nursing home residents
Acute Non-infectious Disorders
- epistaxis
- foreign body aspiration
- RDS
- ARDS
- Pneumothorax
What is the most important nursing intervention for foreign body aspiration?
Prevention
Respiratory Distress Syndrome (RDS)
- respiratory disease specific to neonates
- immature lungs/deficiency in surfactant
- intensive respiratory care
- mechanical ventilation
- new techniques for ventilator support
Acute Respiratory Distress Syndrome (ARDS)
- sepsis
- viral pneumonia
- smoke inhalation
- drowning
- ICU
What occurs acutely w/in 72 hours of the insult of ARDS in infants/children w/ previously healthy lungs?
Respiratory distress and hypoxemia
Pneumothorax
- collection of air in the pleural space
- chest trauma or surgery
- intubation and mechanical ventilation
- history of chronic lung disease such as cystic fibrosis
S/S for a Pneumothorax
- chest pain
- respiratory distress
- tachypnea
- retractions
- nasal flaring
- grunting
Risk Factors for a Pneumothorax
- chest trauma or surgery
- intubation and mechanical ventilation
- hx of chronic lung disease such as cystic fibrosis
Chronic Respiratory Disorders
- allergic rhinitis
- asthma
- chronic lung disease
- cystic fibrosis
- apnea
Medications
- anti-inflammatory inhaled meds
- short-acting bronchodilators
- supplemental long-term oxygen therapy may be required
Asthma
chronic inflammatory airway disorder characterized by hyperresponsiveness, airway edema, and mucus production
Teaching for Asthma
- nebulizers
- metered-dose inhalers
- spacers
- dry-powder inhalers
- diskus
Cystic Fibrosis
- autosomal recessive disorder
- thickened, tenacious secretions in the seat glands, GI tract, pancreas, resp tract, etc
What is the most common debilitating disease of childhood among those of European descent?
Cystic Fibrosis
S/S of Cystic Fibrosis
- salty taste to the skin
- meconium ileus
- abdominal pain
- bulky, greasy stools
- poor weight gain
- chronic cough
Apnea
absence of breathing for longer than 20 seconds
How often do you perform tracheostomy care?
8 hours
What is the life expectancy for someone with cystic fibrosis?
30
Epiglottitis S/S
- high fever
- toxic appearance
- may refuse to speak or speak softly
- refuses to lie down
- sits forward w/ neck extended
Allergic Rhinitis
common chronic condition in childhood, associated w/ atopic dermatitis and asthma
-intermittent or persistent inflammatory state
What is treatment for Allergic Rhinitis aimed at?
decreasing response to allergic mediators as well as treating inflammation
S/S of Allergic Rhinitis
- red-rimmed eyes or tearing
- mild eyelid edema
- “allergic shiners” (blue/grayish cast below eyes)
- “allergic salute” (nasal crease from rubbing)
What is therapeutic management of cystic fibrosis aimed at?
minimizing pulmonary complications
maximizing lung function
preventing infection
facilitating growth
All children with cystic fibrosis who have pulmonary involvement require what?
chest physiotherapy and postural drainage several times daily to mobilize secretions from the lungs
Nursing Management for Cystic Fibrosis
- maintain patent airway
- prevent infection through vigorous pulmonary hygiene
- maintain growth
- promote family coping
