ch 19 PED physical exam, imaging of the RT, inhalation of medications, and Avoidance of environmental hazards Flashcards
________ is the foundation for investigating the pediatric thorax
chest XRAY
The NP suspects pleural fluid within the lungs, what should the NP order?
Lateral decubitus radiograph (determines extent and mobility of the fluid)
Forced expiratory radiographs can be useful to show focal air trapping and shift of the mediastinum to the contralateral side in presence of ________
A suspected foreign body
The NP suspects pleural fluid of the lungs, what should the NP order?
Lateral decubitus radiograph (determines extent and mobility of the fluid)
A lateral neck radiograph with the “thrumbprint sign” indicates?
Epiglottitis – lateral neck XRAY looks at assesses size of adenoids and tonsils; will help differentiate from croup
What type of XRAY should the NP order to differentiate croup from epiglottitis?
Lateral neck XRAY - assesses size of adenoids and tonsils.
“thumbprint” sign indicates epiglottitis
A child with any swallowing dysfunction such as suspected aspiration, tracheoesophageal fistula, vascular rings and slings, and achalasia should be further evaluated. What are three diagnostic tests to evaluate swallowing dysfunction?
Upper gastrointestinal series (UGI)
Esophagram
Videofluoroscopic swallow studies (VFSS)
What imaging can detect paralysis by demonstrating paradoxic movement of the involved hemidiaphragm?
Fluoroscopy or ultrasound of the diaphragm
_________ is recommended for evaluation of congenital lung lesions, pleural disease (effusion or recurrent pneumothorax), complicated pneumonia, mediastinal disorders (lymphadenopathy), interstial lung disease and bronchiectasis.
Volumetric chest CT
A volumetric chest CT with contrast is necessary to evaluate ______and ______.
masses and nodules
When evaluating for interstial lung disease or bronchiectasis, the NP would select ______ because it reduces radiation exposure
High-resolution CT
When the NP suspects vascular malformations or pulmonary embolism, they will order ________ because it assesses for regional ventilation and perfusion.
Ventilation-perfusion scans
__________ is best to delineate vasculature
CT angiography
Physical exam: What will inspection reveal?
respiratory rate work of breathing respiratory effort color movement
Physical exam: What will palpation reveal?
tracheal position
symmetry
vibration
Physical exam: what will auscultation reveal?
intensity and symmetry
quality of breath sounds/presence of abnormal sounds
Physical exam:What will percussion reveal?
tympanic or dull sounds
What are some pediatric respiratory conditions (acute and chronic) that routinely use inhalation medications?
Acute:
Infectious laryngotracheobronchitits (CROUP)
Bronchiolitiss
Chronic:
Cystic fibrosis
Mixed Acute and Chronic TX options:
Bronchopulmonary dysplasia
Asthma
What will short-acting Beta-Agonists and Anticholinergics provide?
acute bronchodilation
What will inhaled corticosteroids and Cromones provide?
Anti-inflammatory effects
What respiratory disease process benefits from nebulized antibiotics?
Cystic fibrosis
What respiratory processes require nebulized mucolytics such as rhDNAse and hypertonic saline?
Cystic Fibrosis
or other conditions with impaired secretion control (non-CF bronchiectasis)
What are three ways to deliver medications to the respiratory tract
(Dr CoP)
DRy powder inhaler (DPI)
Compressed air-driven wet nebulization
Pressurized metered dose inhaler (pMDI)
What is required for pressurized metered dose inhaler (pMDI) use? What age has this technique shown to be effective?
A valved holding chamber or similar spacer
infants as young as 4 months of age
_______ is the device recommended for infants and toddlers receiving either pressurized metered dose inhaler (pMDI) or wet nebulization
face-mask interface
______ is the device recommended for older children that can form a seal
A simple mouth piece
The NP should do what at each clinical visit with a pediatric patient on inhaled medications?
assess and review delivery technique
A shift in the tracheal position from midline indicates:
Pneumothorax or significant unilateral atelectasis
Tachypnea with an equal inspiratory and expiratory time suggests:
Decreased lung compliance
Unilateral crackles found on an ADULT patient on exam is a finding for:
Pneumonia - unilateral crackles on an adult - MOST VALUABLE EXAM FINDING
T/F Respiratory disorders are secondary to disease in other systems
TRUE - fever, metabolic acidosis, congenital heart disease, neuromuscular disease, immunodeficiency, autoimmune disease, and occult malignancy
Wheezing or prolonged expiratory compared to inspiratory time suggests:
Intrathoracic (lower) airway obstruction
What are extrapulmonary manifestations of pulmonary disease? (Acute and Chronic)
Acute:
cyanosis
altered mental status
Chronic:
growth failure
clubbing
osteoarthropathy
What are findings of Cor Pulmonale?
HEL
Hepatomegaly
Elevated neck veins
Loud pulmonic component of the second heart sound
rarely, peripheral edema
Cor Pulmonale signifies _______ and may accompany ________.
Pulmonary hypertension
Advanced lung disease
__________ ____ can aggravate existing lung diseases, impair pulmonary function, and cause lung disease in children
Environmental insults
List all the possible environmental insults
In HoOD
INdoor pollution
HOusehold fungi
Outdoor air pollution (ozone and particulates)
Diesel exhaust
Environmental ______ _____ dramatically increases childhood pulmonary morbidity
tobacco smoke - counsel smoking family members to quit and minimize exposure to those around them
How can ozone exposure be limited?
Avoiding outdoor activities during the height of daily ozone levels - maybe impossible for many families and children
Environmental hazards that trigger children who have asthma includes
pet exposure and infestations such as cockroaches or mice
