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Pediatric Nursing > Altered Respiratory status care of Child > Flashcards

Altered Respiratory status care of Child Flashcards

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1
Q

What is the most common infectious problem in infants and children?

A

Respiratory alterations

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2
Q

What age group has immature immune system?

A

Infants and children less than 3 years which means they are at greater risk for developing respiratory infections

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3
Q

When should the respiratory tract be fully developed?

A

around 12 years of age

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4
Q

How big is an infants trachea?

A

4 mm, size of a straw

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5
Q

How big is an adults trachea?

A

10-20 mm

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6
Q

what is the angle of mainstem bronchi in infants

A

infant 10 degrees on right, 30 degrees left

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7
Q

What is the angle of mainstem bronchi in adult

A

adult 30 degrees right, 50 degrees left

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8
Q

What are structural and functional differences in airways of children?

A
  • smaller oral cavity and larger tongue
  • smaller nares and nasopharynx
  • Long, floppy epiglottis
  • larger amount of soft tissue
  • Fewer alveoli
  • more compliant chest wall
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9
Q

What are early signs of respiratory distress

A 
tachypnea, tachycardia
retractions
nasal flaring
grunting
stridor or wheezing
mottled color
change in responsiveness
hypoxemia, hypercarbia
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10
Q

what are late signs of respiratory distress

A 
poor air entry, weak cry
apnea or gasping
deterioration in systemic perfusion
bradycardia
cyanosis
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11
Q

Tonsillitis/Pharyngitis symptoms

A

viral unless positive strep test

  • sore throat
  • fever, malaise
  • swollen lymph glands
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12
Q

What causes strep?

A

caused by group A Beta Hemolytic Steptococcal bacteria

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13
Q

what are symptoms of strep throat?

A

fever, red & sore throat, exudative tonsil, stomach ache, palatal petechiae, swollen submandibular lymph nodes

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14
Q

what does a red sandpaper rash indicate?

A

scarlet fever

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15
Q

what are treatments of step throat?

A

responds well to antibiotics, PCN (erythromycin if PCN allergy), cephalosporin

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16
Q

What do children with strep have to do before returning to school?

A

They need to take antibiotics for atleast 24 hours in their systems before returning to school

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17
Q

What are indications for a tonsillectomy?

A

frequent strep infections
peritonsillar abscesses
hypertrophy obstructing breathing and/or eating

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18
Q

what are the preoperative measures for a tonsillectomy?

A

teaching and coagulation status

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19
Q

What are the postoperative care for a tonsillectomy?

A
  • positioning for drainage
  • ice collar
  • cool liquids first then soft foods
  • analgesics
  • caution with suctioning, straws
  • refrain from nose blowing 7 coughing
  • observe for constant swallowing
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20
Q

What is emesis

A

swallowed blood

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21
Q

Otitis Externa “Swimmers Ear”

A
  • caused by normal ear flora & excessive wetness or dryness

- causes inflammation, pain and maybe some drainage

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22
Q

what are treatments for otitis externa?

A

clean and dry
analgesics
otic drops: polymyxin, neomycin, corticosteroids

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23
Q

Otitis Media w/Effusion (OME)

A

presence of fluid in the middle ear without signs of acute infection

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24
Q

Acute Otitis Media. (AOM)

A

acute onset MIDDLE ear effusion inflammation

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25
Q

What causes AOM

A

H. flu, step pneumoniae, viral-RSV, or influenza

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26
Q

How do you diagnose AOM?

A
  • acute onset
  • presence of middle ear effusion
  • Distinct TM erythema or otalgia preventing normal activity or sleep
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27
Q

Treatment for AOM

A
  • antibiotics- amoxicillin, amoxicillin clavulanic (Augmentin), ampicillin sulbactam (Unasyn)
  • Cefdinir (omnicef), cefuroxime (ceftin), erythromycin-sulfisoxizole (Peidazole), sulfamethoxazole (Bactrim)
  • make sure to take for the full 10 days in children under 5
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28
Q

In children with AOM or OME, what can you use for pain control?

A
  • Tylenol or Ibuprofen

- Lidocaine/benzocaine topical treatment can help to

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29
Q

Treatment for OME

A

screen hearing/ language

  • follow up
  • antibiotics/ steroids
  • Tympanostomy tubes
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30
Q

Myringotomy with Tympanostomy Tubes

A

Tubes inserted to equalize pressures and facilitate drainage and ventilation of the middle ear

  • This will not prevent all infections
  • will facilitate sound transmission and language development
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31
Q

What are the postop care for Tympanostomy

A
  • analgesia needed
  • finish antibiotics
  • instructions for bathing and swimming
  • tubes will usually fall out on their own within 6 mth to 1 yr
  • follow up for hearing and language
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32
Q

Acute Epiglottits or Supraglottits

A
  • this is acute inflammation and swelling of the epiglottis and surrounding tissue
  • Rapidly progressing upper trachea edema resulting in obstruction of airway
  • life-threatening
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33
Q

What causes acute epiglottits or supraglottis

A

bacterial agent, strep, staph, H-flu

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34
Q

What can decrease the incidence of acute epiglottitis

A

Hib vaccine

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35
Q

How do you diagnose acute epiglottitis

A

lateral neck film and clinical presentation

36
Q

How does acute Epiglottitis present itself?

A
  • characteristic appearance: edematous, cherry red epiglottis
  • cardinal S/S: drooling, dysphagia, dysphonia, distressed inspiratory effort
37
Q

How do you manage acute Epiglottits?

A
  • try to maintain patent airway
  • continuous monitoring of respiratory status and oxygenation
  • NPO
  • antibiotics
  • steroids
  • Maintain quiet environment
  • educate
38
Q

Laryngotracheobronchitis (LTB)

A
  • VIRAL
  • children less than 5
  • symptoms worsen at night
  • inflammation mucosa of larynx and trachea with narrowing of airway
  • characterized by BARKING COUGH- CROUP cough
39
Q

stage 1 of LTB

A

fever, hoarseness, croupy cough, inspiratory stridor

40
Q

stage 2 of LTB

A

increased stridor, use of accessory muscles of respiration, lower costal retractions, labored respirations

41
Q

stage 3 of LTB

A

hypoxia/hypercabia, restlessness/anxiety, pallor/sweating, tachypnea

42
Q

stage 4 of LTB

A

intermittent cyanosis, persistent cyanosis, respiratory failure, apnea

43
Q

Management of LTB

A
  • maintain airway and adequate gas exchange
  • racemic epinephrine (nebulized epi)
  • Corticosteroids
  • Oxygen administration as needed, pulse oximetry
  • heliox
44
Q

Bronchiolitis

A
  • inflammation of the bronchioles
  • acute viral infection. Most often respiratory syncytial virus-RSV or adenoviruses or parainfluenza
  • common cause of hospitalization of infants less than a year of age
45
Q

S/S of bronchiolitis

A

dyspnea, tachypnea with retractions, tachycardia, wheezing, crackles, rhonchi, temperature may vary from hypothermic to febrile, naso-pharyngeal aspirate help diagnosis

46
Q

Management of Bronchiolitis

A
  • pulse oximetry
  • humidified oxygen
  • heliox
  • adequate hydration
  • suction if needed
  • education
47
Q

How to prevent RSV

A
  • synagis (palivizumab) monoclonal antibody

- monthly IM injection during season

48
Q

Pneumonia

A
  • viral or bacterial
  • inflammation of the lung parenchyma
  • Common VIRAL: adenoviruses, influenza viruses, and RSV
  • Common BACTERIAL: strep, staph, enteric baccilli, pneumococcal or Hib, mycoplasma pneum
49
Q

S/S pneumonia

A
  • elevated temp
  • cough
  • tachypnea
  • retractions/nasal flaring
  • cyanosis
50
Q

How to diagnose pneumonia

A

CXR

Suptum culture

51
Q

Pneumonia management

A
  • assessment of respiratory status and oxygenation
  • hydration
  • antibiotics for bacterial pneumonia
  • elevate HOB and repositioning
  • coughing and deep breathing
  • quiet environment to conserve energy
52
Q

Chlamydial Pneumonia

A
  • infants to about 19 weeks
  • chlamydia trachomatis
  • ascending infection from mother just before or during birth process
  • afebrile, persistent cough, tachypnea
53
Q

treatment is chlamydial pneumonia

A

erythromycin for 2-3 weeks

54
Q

Pertussis (Whooping Cough)

A
  • bordetella pertussis
  • highly contagious: direct contact or droplet spread; indirect contact with freshly contaminated items
  • highest incidence in spring and summer
  • usually lasts 4-6 weeks
55
Q

treatment for pertussis

A
  • antibiotics for all contacts
  • supportive treatment
  • prevention with vaccine
56
Q

Catarrhal stage of pertussis

A

coryza, mild cough, lacrimation, low grade fever

57
Q

Paroxysmal stage of pertussis

A

increasing cough, whoop

58
Q

Convalescent stage of pertussis

A

gradually diminishing symptoms

59
Q

Infants less than 6 months with pertussis

A

may not present with typical cough, apnea common

60
Q

Influenza

A
  • VIRUS
  • Type A & B clinically significant
  • most common during winter
  • 1-3 incubation period, most infectious 24 hours before and after onset of symptoms
  • Dry cough, hoarsness, mylagia, fever, chills. young infants may have apnea
61
Q

treatment for influenza

A

fluids and antipyretics

62
Q

Rapivab (peramivir)

A
  • over 2 years
  • type A & B
  • injectable single dose
63
Q

Relenza (zanamivir)

A
  • > 7 years
  • A & B
  • inhaled 2 x daily by 5 days
64
Q

Xofluza (baloxavir marboxil)

A
  • > 12 years

- tablet PO x1

65
Q

Tamiflu (oseltamivir)

A
  • 2 wks & older
  • A & b
  • PO 2 x daily by 5 days
66
Q

Influenza prevention

A

vaccines

67
Q

Asthma

A
  • most common chronic disease of childhood
  • chronic inflammatory disorder of airway contributing to increased airway reactivity
  • narrowing of airways in response to triggers
  • air trapping- prolonged expiratory phase
  • wheezing, tachypnea, retractions, hypoxia
68
Q

How to diagnose asthma

A
  • standardized questioning
  • spirometry
  • peak flow measurement
69
Q

Asthma Therapy Goals

A
  • prevent symptoms
  • <2 days/wk use of short acting Beta agonist (SABA)
  • maintain normal pulmonary function
  • maintain normal activity levels
  • prevent recurrent exacerbations and ED visits
  • prevent progressive loss of lung function/growth
  • provide optimal pharmacotherapy with minimal or no adverse effects
70
Q

Asthma management

A
  • regular visits
  • education
  • environment-reduction in exposure to possible and known triggers
  • medication
71
Q

Short-acting Beta-agonists for asthma

A
  • bronchodilators: releive intermittent symptoms, “rescue”
  • Do not treat inflammation
  • Should include in therapy anyone with symptoms > 1 per month
  • Albuterol and levalbuterol
72
Q

Inhaled Corticosteroids

A
  • standard of care
  • inhaled steroids
  • inhibit inflammatory process
  • beclomethosone, budesonide, fluticasone, mometasone
  • few side effects: cough, dysphonia, oral thrush
73
Q

Long-acting Beta-agonists

A
  • product may be only LABA or combination with ICS
  • improve lung function, reduce use of SABA
  • Salmeterol, formoterol, terbutaline
  • Combinations-Advair, Symbicort
74
Q

Beta agonist side effects

A
  • decreased diastolic and mean arterial pressure
  • tachycardia
  • jitteriness
  • myocardial ischemia
  • Terbutaline-hypokalemia
75
Q

Anticholinergics

A
  • Ipratropium Bromide (atrovent)
  • oldest form of bronchodilator
  • used for relief of acute bronchospasm
  • blocks acetylcholine preventing smooth muscle contraction
  • SE drying resp secretions, blurred vision, cardiac & CNS stimulant
76
Q

HELIOX

A
  • combination of helium and oxygen
  • comes 70:30 or 80:20
  • lightness of gas carries oxygen
  • decreases CO2 retention
  • low toxicity
77
Q

Immunotherapy

A

-allergy shots

78
Q

status asthmaticus

A
  • continuation of acute distress
  • medical emergency
  • prolonged hypoventilation leads to resp acidosis
  • treatment include maintain airway and oxygenation
79
Q

Cystic Fibrosis

A
  • autosomal recessive transmission. Long arm chromosome 7. CFTR protein
  • exocrine gland disfunction-inc. mucous viscosity with multisystem effects- pancreas, lungs, GI
  • abnormal transport of chloride- sweat contains 2- 5x more Na and Cl
  • small passages blocked (bronchi, pancreas)
  • early or late symptoms
  • median age of CF is 37
80
Q

S/S of CF

A
  • newborn- meconium ileus (7-10%)
  • failure to thrive-continuing weight loss despite inc appetite
  • frequent pulmonary infections
  • bulky loose stools
  • inability to absorb fat soluble vitamins: A,D,E,K
  • delayed puberty in females: may have difficulty with conception due to cervical mucous
  • Males: often sterile by adulthood due to blockage of vas deferens and/or decreased/absent sperm production
81
Q

Treatment of CF

A
  • airway clearance therapies
  • percussion & postural drainage, PEP, HF, chest compressions
  • aerosolized bronchodilators, hypertonic saline, dornase alfa
  • long-term tx ibuprofen helps reduce inflammation and protect pulmonary function
  • adequate nutrition
  • promote reasonable quality of life
82
Q

Endocrine with CF

A

insulin resistance & insulin deficiency

-bone health with pancreatic insufficiency & steroid use

83
Q

Nursing care of CF

A
  • usually require long-term IV access
  • teaching
  • support
  • promote normal G & D
  • Genetic counseling
  • Reproductive issues
  • anticipatory grieving
84
Q

SIDS

A
  • Third leading cause of infant death
  • decline in incident since 1994
  • highest risk
    • 2-3 months; 95% by 6 months
    • increased in winter
    • african american, native american, alaskan native
  • causes are most likely pre-existing conditions and initiating events
85
Q

What are the AAP recommendations for reducing SIDS?

A
  • supine for sleep side lying is not acceptable
  • sleep surfaces firm with no soft materials
  • no smoking during pregnancy or 2nd hand smoke
  • sleep in separate crib or bassinet
  • consider a pacifier when sleeping
  • avoid overheating

Pediatric Nursing (4 decks)

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