Alterations in Respiratory System (Peds) Flashcards
tonsillectomy
The surgical removal of tonsils
Monitoring for postop bleeding is most important, Watch for: Excessive swallowing, frequent throat clearing, elevated pulse, decreasing BP, signs of fresh bleeding in back of throat vomiting bright red blood, restlessness not associated with pain, . Have suction equipment available
Also: Position prone or side-lying to facilitate drainage, provide clear cool liquids once awake to keep throat moist (when gag reflex returns) , provide ice collar, provide pt. teaching, no straws or forks, bad mouth odor is normal, notify MD for temp 101F or greater, bleeding, or persistent earache.
mmr
Live attunuated comination vaccine. Can be given the same day as other live attenuated virus vaccines such as Varicella. If not given on the same day the vaccines should be spaced 28 days apart. Anaphylactic reactions associated with neomycin.
The first shot is given at 12 to 15 months of age. The second shot is given at 18 months OR between ages 4 to 6 years
bronchitis
Associated with URI and inflammation of large airways, self-limiting
Findings: persistent, dry hacking cough as a result of inflammation, resolves in 5-10 days
Treatment: Antipyretics, cough suppressant, provide humidity (cool mist vapor)
tracheostomy
Artificial opening in the airway to relieve airway obstruction. Facilitates secretion removal, reduces work of breathing, and increases child’s comfort. Can be permanent or temporary.
Complications after surgery: Hemorrhage, air entry, pulmonary edema, anatomic damage, and respiratory arrest, as well as, infection, cellulitis and formation of granulation tissue.
Site should be pink without bleeding or drainage, tube should be free from secretions, trach tie should fir securely with one finger being able to slide between ties. Watch for infections, measure pulse ox, perform trach care Q8 hr. Have suction and emergency equipment at bedside.
Perform trach care
bronchiolitis
Mostly caused by RSV, primarily affects the bronchi and bronchioles.
Preceded by mild URI followed by acute onset or respiratory distress: Dec. HR, Inc. RR, wheezing, crackles, rhonchi, retractions with or without nasal flaring, cyanosis, feeding difficulties.
Interventions: Can be treated at home (infants with respiratory distress should be treated at hospital), cool humidified O2, suction with bulb syringe, IVF if not feeding, HOB elevated, maintain airway, meds as prescribed
mucomyst
Acetylcysteine: Helps to loosen and thin mucous in the airway
Antidote for acetaminophen overdose
Asthma
A reversible obstructive airway disease. Inflammation and edema of the mucous membranes that lines the airways and the subsequent accumulation of thick secretions in the airways
Triggers: Allergens, exercise, cold air and weather changes, environmental change, infections/cold, animal hair or dander, meds, strong emotions, medial conditions, endocrine factors.
Risk Factors: Family history of allergies or asthma, gender, smoke exposure, low birth weight, obesity
Physical Findings: Chest tightness, dyspnea, cough, Audible wheezing, coarse lung sounds, accessory muscle use, Restlessness, irritability, anxiety, sweating, history of current and previous asthma attacks, Inc RR and HR, Dec O2 saturation
Nursing Care: Focus on airway maintenance, position to maximize ventilation, administer O2 therapy, maintain IV access and keep intubation equipment close by, maintain calm and reassuring demeanor, administer meds as prescribed.
Treatment: Managed by step-wise approach, asthma action plan
Life threatening airway obstruction that respond to conventional treatment methods: Worsening wheeze, cough or SOB, difficulty breathing, NO improvement after bronchodilator use, trouble walking or talking, discontinuation of play, inability to resume activity, Listlessness, weak cry in infant, refusal to suck, Grey or blue lips or fingernails
cystic fibrosis
Characterized by widespread dysfunction of the exocrine glands. Thick and tenacious mucus. Obstruction and dysfunction of the pancreas, lungs, salivary and sweat glands, and reproductive organs. Autosomal recessive trait. Symptoms worsen as disease progresses and is eventually fatal.
Diagnosis: Sweat Chloride test, >60 is positive for CF
Symptoms: Fatigue, chronic cough, recurrent URI’s, Thick, sticky mucus, chronic hypoxia: Clubbing, barrel chest, Dec. absorption of vitamins and enzymes, abd distention, Dec. digestive enzymes, rectal prolapse, smelly fatty stools (steatorrhea), meconium ileus in newborn.
Treatment: Inc Ca. and Protein diet, CPT (postural drainage), breathing exercises, aerosol therapy, Vitamins A,D,E and K
Meds: Antibiotics, supplemental vitamins, bronchodilators, mucolytic, pancreatic enzymes (each meal)
