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Unit 2 68 > ch 19 PED physical exam, imaging of the RT, inhalation of medications, and Avoidance of environmental hazards > Flashcards

ch 19 PED physical exam, imaging of the RT, inhalation of medications, and Avoidance of environmental hazards Flashcards

1
Q

________ is the foundation for investigating the pediatric thorax

A

chest XRAY

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2
Q

The NP suspects pleural fluid within the lungs, what should the NP order?

A

Lateral decubitus radiograph (determines extent and mobility of the fluid)

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3
Q

Forced expiratory radiographs can be useful to show focal air trapping and shift of the mediastinum to the contralateral side in presence of ________

A

A suspected foreign body

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4
Q

The NP suspects pleural fluid of the lungs, what should the NP order?

A

Lateral decubitus radiograph (determines extent and mobility of the fluid)

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5
Q

A lateral neck radiograph with the “thrumbprint sign” indicates?

A

Epiglottitis – lateral neck XRAY looks at assesses size of adenoids and tonsils; will help differentiate from croup

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6
Q

What type of XRAY should the NP order to differentiate croup from epiglottitis?

A

Lateral neck XRAY - assesses size of adenoids and tonsils.

“thumbprint” sign indicates epiglottitis

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7
Q

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?

A

Upper gastrointestinal series (UGI)
Esophagram
Videofluoroscopic swallow studies (VFSS)

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8
Q

What imaging can detect paralysis by demonstrating paradoxic movement of the involved hemidiaphragm?

A

Fluoroscopy or ultrasound of the diaphragm

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9
Q

_________ is recommended for evaluation of congenital lung lesions, pleural disease (effusion or recurrent pneumothorax), complicated pneumonia, mediastinal disorders (lymphadenopathy), interstial lung disease and bronchiectasis.

A

Volumetric chest CT

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10
Q

A volumetric chest CT with contrast is necessary to evaluate ______and ______.

A

masses and nodules

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11
Q

When evaluating for interstial lung disease or bronchiectasis, the NP would select ______ because it reduces radiation exposure

A

High-resolution CT

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12
Q

When the NP suspects vascular malformations or pulmonary embolism, they will order ________ because it assesses for regional ventilation and perfusion.

A

Ventilation-perfusion scans

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13
Q

__________ is best to delineate vasculature

A

CT angiography

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14
Q

Physical exam: What will inspection reveal?

A 
respiratory rate
work of breathing
respiratory effort
color
movement
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15
Q

Physical exam: What will palpation reveal?

A

tracheal position
symmetry
vibration

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16
Q

Physical exam: what will auscultation reveal?

A

intensity and symmetry

quality of breath sounds/presence of abnormal sounds

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17
Q

Physical exam:What will percussion reveal?

A

tympanic or dull sounds

18
Q

What are some pediatric respiratory conditions (acute and chronic) that routinely use inhalation medications?

A

Acute:
Infectious laryngotracheobronchitits (CROUP)
Bronchiolitiss

Chronic:
Cystic fibrosis

Mixed Acute and Chronic TX options:
Bronchopulmonary dysplasia
Asthma

19
Q

What will short-acting Beta-Agonists and Anticholinergics provide?

A

acute bronchodilation

20
Q

What will inhaled corticosteroids and Cromones provide?

A

Anti-inflammatory effects

21
Q

What respiratory disease process benefits from nebulized antibiotics?

A

Cystic fibrosis

22
Q

What respiratory processes require nebulized mucolytics such as rhDNAse and hypertonic saline?

A

Cystic Fibrosis

or other conditions with impaired secretion control (non-CF bronchiectasis)

23
Q

What are three ways to deliver medications to the respiratory tract

(Dr CoP)

A

DRy powder inhaler (DPI)

Compressed air-driven wet nebulization
Pressurized metered dose inhaler (pMDI)

24
Q

What is required for pressurized metered dose inhaler (pMDI) use? What age has this technique shown to be effective?

A

A valved holding chamber or similar spacer

infants as young as 4 months of age

25
Q

_______ is the device recommended for infants and toddlers receiving either pressurized metered dose inhaler (pMDI) or wet nebulization

A

face-mask interface

26
Q

______ is the device recommended for older children that can form a seal

A

A simple mouth piece

27
Q

The NP should do what at each clinical visit with a pediatric patient on inhaled medications?

A

assess and review delivery technique

28
Q

A shift in the tracheal position from midline indicates:

A

Pneumothorax or significant unilateral atelectasis

29
Q

Tachypnea with an equal inspiratory and expiratory time suggests:

A

Decreased lung compliance

30
Q

Unilateral crackles found on an ADULT patient on exam is a finding for:

A

Pneumonia - unilateral crackles on an adult - MOST VALUABLE EXAM FINDING

31
Q

T/F Respiratory disorders are secondary to disease in other systems

A

TRUE - fever, metabolic acidosis, congenital heart disease, neuromuscular disease, immunodeficiency, autoimmune disease, and occult malignancy

32
Q

Wheezing or prolonged expiratory compared to inspiratory time suggests:

A

Intrathoracic (lower) airway obstruction

33
Q

What are extrapulmonary manifestations of pulmonary disease? (Acute and Chronic)

A

Acute:
cyanosis
altered mental status

Chronic:
growth failure
clubbing
osteoarthropathy

34
Q

What are findings of Cor Pulmonale?

HEL

A

Hepatomegaly
Elevated neck veins
Loud pulmonic component of the second heart sound

rarely, peripheral edema

35
Q

Cor Pulmonale signifies _______ and may accompany ________.

A

Pulmonary hypertension

Advanced lung disease

36
Q

__________ ____ can aggravate existing lung diseases, impair pulmonary function, and cause lung disease in children

A

Environmental insults

37
Q

List all the possible environmental insults

In HoOD

A

INdoor pollution

HOusehold fungi
Outdoor air pollution (ozone and particulates)
Diesel exhaust

38
Q

Environmental ______ _____ dramatically increases childhood pulmonary morbidity

A

tobacco smoke - counsel smoking family members to quit and minimize exposure to those around them

39
Q

How can ozone exposure be limited?

A

Avoiding outdoor activities during the height of daily ozone levels - maybe impossible for many families and children

40
Q

Environmental hazards that trigger children who have asthma includes

A

pet exposure and infestations such as cockroaches or mice

Unit 2 68 (32 decks)

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