ch 26 the child with respiratory dysfunction Flashcards
1
Q
what is included in the upper airway
A
-nares
-pharynx
-larynx
-ciliated mucous membranes
-tonsils
2
Q
what is included in the lower airway
A
-trachea
-lungs
-bronchi
-alveoli
3
Q
what is included in assessment of thorax and lungs
A
-inspection
-palpation
-percussion
-auscultation
-adventitious breath sounds
4
Q
what could a dull sound on percussion indicate
A
fluid (pneumonia)
5
Q
what might you hear on percussion with a pt with asthma/CF
A
hyper-resonance
6
Q
differences in resp system in newborns
A
-lack of/insufficient surfactant
-smaller airways
-nose breather
-brief periods of apnea normal
-faster RR
-eustachian tubes horizontal (more ear infections)
-belly breathers
-larynx susceptible to spasms
7
Q
what happens to the abdomen in newborns with high RR
A
lots of air (may vomit with food)
-IV fluids
8
Q
what age do newborns still have maternal antibodies
A
<3 mos
9
Q
what age do infections increase in newborns
A
3-6 mos
-lose maternal antibodies
-mom usually goes back to work, kid with babysitter or in daycare
10
Q
what ages have the highest rate of viral infections
A
toddlers and preschool ages
11
Q
what infections are common in older than 5 yo (2)
A
-mycoplasma pneumonia
-group a b-hemolytic strep
12
Q
what time of year are mycoplasma infections (pneumonia) more common
A
fall and winter
13
Q
what time of year is asthmatic bronchitis more common
A
cold weather (winter) and change of seasons (pollen, dust)
14
Q
what time of year is considered RSV season
A
winter and spring
15
Q
Tx for viral infections (general)
A
-suction
-fluids
-tylenol or motrin (if >6 mos)
16
Q
examples of viral infectious agents
A
-RSV
-rhino
-entero
-parainfluenza
-COVID
-influenza
-adeno
-human metapneumo
17
Q
infectious agents (non-viral)
A
-group a b-hemolytic strep
-bordetella pertussis
-staph
-mycoplasma
-pneumococcal
18
Q
S+S resp illness in children
A
-fever
-menigismus
-anorexia
-V/D
-abdominal pain
-nasal blockage and discharge
-cough
-resp sounds (crackles, grunting, wheezing)
-sore throat
19
Q
nursing care for resp illness in children
A
-fever management
-promote rest
-infection control and prevent spread
-promote hydration and nutrition
-reassess frequently
-support, teaching and plan for home care
20
Q
S+S common cold (upper resp tract infection nasopharyngitis) in younger child
A
-fever
-irritability, restlessness
-decreased appetite and fluid intake
-nasal inflammation
-V/D
-high potential for ear infections
21
Q
meds for URI (not for younger children <4 yo)
A
-OTC cold meds
-cough suppressant
-decongestant nose drops
22
Q
teaching for parents: when to call your hcp for resp complications
A
-earache
-resps faster than 50-60
fever >101
-listlessness, not interested in play
-increasing irritability w/ or w/o fever
-persistent cough for 2+ days
-wheezing
-crying, uncontrollable
-refusal to eat or drink
-restlessness and poor sleep patterns
23
Q
what to know about riboviren
A
(for HESI)
-med for severe RSV
-nebulizer med
-*mom who is pregnant/nursing can’t be around kid receiving med
24
Q
S+S viral pharyngitis
A
-gradual onset w/ sore throat
-erythema, inflammation of pharynx and tonsils
-vesicles/ulcers on tonsils
-fevers (low or high)
-URI symptoms (hoarseness, cough, rhinitis, conjunctivitis, malaise, anorexia)
-cervical lymph nodes tender
-lasts 3-4 days
25
Tx viral pharyngitis
-tylenol/motrin
-popsicles/jello/cold foods or liquid
-avoid juice
26
S+S bacterial pharyngitis
-*abrupt onset
-sore throat
-erythema, inflammation pharynx and tonsils
-high fever
-*abdominal pain, vomiting
-headache
-cervical lymph nodes tender
-lasts 3-5 days
27
Dx acute strep pharyngitis
-rapid antigen testing
-culture throat swab (to make sure Abx will work)
28
illness that are potential further complications of strep
-acute rheumatic fever
-acute glomerulonephritis
-scarlet fever
29
Tx acute strep
-*teach: finish Abx
-*teach: throw away toothbrush around 24 hrs after start of Abx
-fever meds
-supportive care (fluids)
30
meds for strep
-penicillin PO
*need 10 days Tx to decrease risk of rheumatic fever and glomerulonephritis
-penicillin G (IM admin)
*painful, but works for non-compliance
-erythromycin if penicillin allergy
31
S+S tonsillitis
-"kissing tonsils"
-foul breath
-can result in ear infections
32
Tx tonsillitis
-surgical removal (controversial)
33
nursing concerns post-op tonsillectomy (3)
1) AIRWAY
-positioning
-note swallowing (may indicate bleeding)
-suction at bedside (in case of vomiting)
2) BLEEDING
-NO suctioning through nose
-bleeding small amount is normal around 7-10 days postop (scab falls off)
3) COMFORT
-pain control: tylenol/motrin
-cool and soft foods and drinks
-avoid fluids/food with red/brown color
-no straws
34
home instructions post-op tonsillectomy
NO:
-spicy and irritating foods
-gargling/vigorous toothbrushing
-coughing/putting objects in mouth
OK:
-pain control (tylenol/motrin alternating)
-stay ahead of pain (esp first 48 hrs)
-limit activity
-avoid dehydration (signs = no tears, no diapers >8 hrs, cracked lips, sunken eyes)
35
cause infectious mono
-epstein barre virus
(oral secretions)
36
Dx mono
-CBC
-monospot
37
emergencies to be prepared for with mono
-difficulty breathing
-abdominal pain
-can't eat/drink
-resp stridor
38
S+S mono
-malaise
-sore throat
-fever
-extreme fatigue
-hepatosplenomegaly
39
important teaching with mono
no playing contact sports for several weeks after mono (bc of hepatosplenomegaly)
40
possible complications of mono
-seizures
-myocarditis
-transverse myelitis
-ruptured spleen
-aseptic meningitis
41
landmark for enlarged liver
2-3 cm below costal margins
42
meds to treat/prevent flu in children
ANTIVIRALS
-oseltamivir (tamiflu)
-zanamivir (relenza)
-*must start within 48 hrs of symptom onset
-still contagious
-NO aspirin
VACCINES
-children >6 mos
-new vaccine annually
43
risk of taking aspirin with the flu
reyes syndrome
44
contraindications for flu vaccine
-egg allergy
-pregnant/nursing
-immunocompromised
-<6 mos
45
S+S otitis media
-pain
-pulling on ears
-fever
-loss of appetite
-*no drainage unless perforated eardrum
46
what factors increase risk of developing otitis media
-passive smoke inhalation
-crowded living conditions
-socioeconomic
47
Tx otitis media
-Abx
-surgical: myringotomy (ear tubes)
48
myringotomy
ear tubes
49
what infants have less occurrence of otitis media than others
breast-fed
-immunoglobulin A from mom
-position in breastfeeding decreases reflux in eustachian tubes
50
inflammmation of middle ear without reference to etiology or pathogenesis
otitits media
51
inflammation of middle ear space with rapid onset of S+S of acute infection (fever and ear pain)
acute otitis media
52
fluid in middle ear space w/o symptoms of acute infection
otitis media with effusion
53
meds Tx otitis media
->6 mos usually "watchful waiting" 72 hrs
-<6 mos: Abx (first line amoxicillin)
-topical relief: heat, cold, or benzocaine drops
-tylenol, motrin if >6 mos
54
Abx for otitis media if highly resistant organism or noncompliant with oral doses
cephalosporins (ceftriaxone)
-IM is painful
55
are steroids, antihistamines, and decongestants recommended with Tx of otitis media
no
56
S+S otitis externa "swimmers ear"
-ear pain aggravated with pulling pinna
-edema
-drainage (cheesy, blue-green)
-hearing loss possible
57
Tx otitis externa
-pain meds
-otic drops for 7-10 days
58
who can't use otic drops for Tx of otitis externa
if have ear tubes
risk of ototoxicity
59
nursing care management of otitis externa (teaching)
-no swimming longer than 1 hr
-dry ears completely
-swimmers drops or white vinegar
60
S+S croup
-"seal barking" cough
-hoarseness
-inspiratory stridor
-often worse at night
61
severity categories of croup
-mild: no stridor at rest
-moderate: mild stridor at rest, mild retractions
-severe: steeple sign/pencil tip on x-ray, severe stridor at rest
62
what seasons do croup happen most often in
fall and winter
63
Tx coup
VIRAL
-humidified air
-fluids
-pain meds
-corticosteroids for severe croup
64
acute epiglottitis S+S
-*abrupt onset
-sore throat, pain
-tripod positioning
-retractions
-inspiratory stridor
-mild hypoxia, distress
65
prevention of acute epiglottitis
hib vaccine
66
is epiglottitis viral or bacterial
bacterial
67
nursing considerations acute epiglottitis
-position for comfort
-decrease anxiety
-no tongue blade
-keep suction at bedside
-keep emergency resp equipment at bed
68
Tx epiglottitis
-lateral neck x-ray
-intubation w/ severe distress
-humidified O2 via mask or blow
-ICU admission
-Abx: ceftriaxone/cefotaxime and vancomycin IV and then PO after 7-10 days
-prophylactic Abx Tx of household
69
who is laryngitis more common in?
virus or bacteria?
older children and adolescents
virus
70
S+S laryngitis
hoarseness
71
infection of mucosa of upper trachea
bacterial tracheitis
72
S+S bacterial tracheitis
-thick purulent secretions
-resp distress
-stridor
(appears similar to croup and epiglottitis)
73
Tx bacterial tracheitis
-humidified O2
-fever meds
-Abx
-may require intubation if severe distress/resp failure
74
paroxysmal attacks of laryngeal obstruction
acute spasmodic laryngitis/spasmodic croup/midnight croup
75
S+S acute spasmodic laryngitis
-smasmodic cough
-most often in children 1-3 yo
-inflammation
-wakes up in night with coughing
76
S+S increasing resp distress in children
-restlessness
-tachycardia
-tachypnea
-retractions
77
3 lower airway illnesses
-asthma
-bronchitis
-bronchiolitis
78
lower airway illness: exaggerated response of bronchi to a trigger such as URI, dander, cold air, exercise
asthma
79
age group affected: asthma
infancy to adolescence/adulthood
80
S+S asthma
-wheezing
-cough
-labored resps
81
Tx asthma
-inhaled corticosteroids
-bronchodilators
-leukotriene modifiers
-allergens
-control of triggers
82
lower airway illness: usually occurs in association with URI; seldom an isolated entity
bronchitis
83
age group affected: bronchitis
first four years of life
84
is bronchitis usually viral or bacterial
viral
85
S+S bronchitis
-persistent dry hacking cough (worse at night)
-productive cough in 2-3 days
86
Tx bronchitis
cough suppressants prn
87
lower airway illness: most common infectious disease of lower airways; max obstructive impact at bronchiolar level
bronchiolitis
88
age group affected bronchiolitis
children 2-12 mos of age
*peak incidence 6 mos
89
S+S bronchiolitis
-labored resps
-poor feeding
-cough
-tachypnea
-retractions
-flaring nares
-emphsema
-increased mucus
-wheezing
-maybe fever
90
Tx bronchiolitis
-supplemental oxygen if <90%
-bronchodilators prn
-suction
91
usual cause bronchiolitis
RSV
92
S+S RSV
-URI
-rhinorrhea
-low grade fever
93
Dx RSV
nasopharyngeal swab
94
Tx RSV
-oxygen prn
-airway maintenance
-meds
-adequate fluids
95
prevention RSV
prophylaxis synagis
-given 1x q30days until end of RSV season
(usually just for premature kids or kids who have lung condition)
96
transmission precaution for RSV
droplet and contact
97
3 causes pneumonia
-viral
-bacterial
-atypical
98
S+S pneumonia
-fever (high)
-cough (whitish sputum)
-tachypnea
-rhonchi/fine crackles
-dullness with percussion
-chest pain
-retractions and nasal flaring
-pallor/cyanosis
-irritable, restless, lethargic
-GI: anorexia, V/D, abdominal pain
-chest x-ray: diffuse/patchy infiltration
99
complication of pneumonia
-empyema (encapsulated fluid)
-otitis media and pleural effusion
-tension pneumothorax (air trapped in pleural cavity)
100
Dx pneumonia
chest x-ray
101
what kids have higher incidence of spontaneous pneumothorax
tall thin teenage boys
102
S+S spontaneous pneumothorax
-sharp chest pain (worse with deep breath or cough)
-SOB
-chest tightness
-fatigue
-increased HR
-cyanosis
-nasal flaring
-retractions
103
Tx spontaneous pneumothorax
-chest tube (water seal drainage system)
-100% O2 using nonrebreather
-safety equipment in case tube dislodges: 2 clamps, vaseline gauze, 4x4 sterile dressing, waterproof tape
104
when would you clamp a chest tube (4 scenarios)
1)drainage system being changed
2)assessing system for air leak
3)chest tube becomes disconnected from chest drainage system
4)tube ready for removal (dr orders)
105
transmission precautions with TB
-airborne precautions (microdroplet transmission)
106
S+S TB
-fever
-malaise
-*night sweats
-* unexplained weight loss
107
Dx TB
-TB sputum test and cultures (if high risk)
-quantiferon (blood or skin test)
-x-ray
108
if you have a positive TB skin test what do you do next
chest x-ray
109
Tx latent TB infection
for high risk kids:
-isoniazid (INH) for 9 months
-rifampin for 6 months (if INH resistant)
110
risk factors TB
-contact with infected adults
-chronic illness, immunosuppression, HIV infection, malnutrition
-age (infancy, adolescence)
-non-white; immigrants from areas with high TB rates
-low income living conditions
-incarcerated adolescents
111
Tx for active TB
-daily INH, rifampin, ethambutol, pyranizamide
-usually direct observation of Tx
-treat family
112
Tx foreign body aspiration >1 yo and <1 yo
->1 yo: abdominal thrusts (heimlik)
-<1 yo: back blows and chest thrusts
113
common foreign objects aspirated
-mints
-coins
-hot dogs
-popcorn
-nuts
-grapes
114
S+S foreign body in nose
-unilateral nasal discharge
-foul smelling
-discomfort
115
S+S aspiration pneumonia
-coughing
-vomiting
-agitation
-restlessness
-fever
-usually develop 24 hrs after aspiration
116
Tx aspiration pneumonia
-Abx
-do not induce vomiting
-modify feeding techniques/positions
117
conditions that increase risk of aspiration pneumonia
-altered LOC (seizures, sedation)
-dysphagia
-mechanical disruption of defensive barriers (trach, NGT)
-persistent vomiting
118
Dx congenital diaphragmatic hernia
prenatal at 25th week EGA
119
S+S congenital diaphragmatic hernia
-acute resp distress in newborn
-may have scaphoid abdomen (flat/sunken in bc stomach contents are in chest)
-impaired cardiac output (signs of shock, hypoTN)
120
Tx congenital diaphragmatic hernia
-fetal surgery
AFTER BIRTH:
-intubation if resp distress
-*bag mask contraindicated
121
why is bag mask contraindicated in tx of congenital diaphragmatic hernia
blows air into stomach
worsens resp distress
122
S+S pierre robin squence
-mandibular hypoplasia (small jaw)
-pushes tongue back
-cleft palate
-airway obstruction
-resp distress
-feeding problems
123
Tx pierre robin squence
-nasal trumpet (opens airway, pushes tongue forward)
-surgical repair of mandible
-early recognition
124
S+S choanal atresia
-membranous septum located between nose and pharynx
-narrowing of back of nasal cavity
125
S+S allergic rhinitis
-"allergic shiners"
-eye irritation
126
risk factors allergic rhinitis
-exposed to tobacco smoke
-given whole milk/solid foods <4 months old
127
Dx asthma
PFT
peak expiratory flow rate (PEF meter)
128
ominous sign of indicating resp failure (w/ asthma)
shortness of breath
absent breath sounds
sudden rise in resp rate
129
chronic inflammatory disorder of airway characterized by:
-recurrent S+S (wheezing, dyspnea, chest tightness, cough)
-airway obstruction
-bronchial hyperresponsiveness
asthma
130
risk factors asthma
-genetic predisposition
-Heredity (parent/sibling with asthma)
-Gender
-Smoking or exposure to 2nd hand smoking
-Maternal smoking during pregnancy
-Ethnicity (African-Americans at greatest risk)
-Low birth weight
-Being overweight
131
S+S asthma
-worse at night/during exercise
-infancy: usually follows resp infection
-begins with feeling of restlessness
-hacking nonproductive cough that becomes productive
-tripod position
132
S+S intermittent asthma (stage 1)
Tx?
-no interference with normal activity
-S+S <2x/week
tx: use SABA <2x/week
133
S+S mild asthma (stage 2)
Tx?
-S+S 2-6x/week
-minor interference with normal activity
tx: use SABA 2-6x/week
134
S+S moderate asthma (stage 3/4)
Tx?
-daily S+S
-some interference with normal activity
Tx: SABA daily
135
S+S severe asthma (stage 5/6)
Tx?
-continual S+S throughout day
-extremely limited normal activity
Tx: SABA several times a day, maybe oral corticosteroids
136
meds for asthma (rescue and long term)
RESCUE:
-SABA
-anticholinergic
-systemic corticosteroids
LONG TERM:
-inhaled corticosteroids
-LABA
-methylxanthines
-leukotriene modifiers
-cromolyn sodium and nedocromil
137
S+S severe resp distress in child with asthma
-remains sitting upright (won't lay down)
-sudden agitation
-agitated child who suddenly becomes quiet
-diaphoresis
-pale
138
Tx status asthmaticus
-frequent admin SABAs
-humidified O2 to keep SpO2 >90%
-IV corticosteroids
139
Mucus-producing glands dysfunction, causing thickened secretions and resulting in multi-system dysfunction, particularly of the pancreas and lungs
cystic fibrosis
140
possible complications of endocrine gland dysfunction in CF
-chronic bronchial pneumonia
-generalized obstructive emphysema
-intestinal obstruction of newborn
-malabsorption syndrome
-portal HTN
141
S+S of cystic fibrosis
-resp
-GI
-repro
-integumentary
RESP:
-early: wheezing, dry nonproductive cough
-repeated episodes bronchitis and bronchiopneumonia
-later: cyanosis, clubbing of fingers
GI:
-early: meconium ileus
-later: pancreatic ducts obstructed, bulky stools of fats and proteins
-growth failure (inability to absorb foods)
REPRO:
-delayed puberty in girls
INTEGUMENTARY:
-"salty" tasting
142
Dx CF
-early infancy screening
-DNA testing
-sweat chloride test
-chest x-ray
-stool for fat
143
Tx CF
-remove excess mucus secretions (CPT, bronchodilator med, forced expiration)
-Tx pulmonary infections
-steroids and NSAIDs
-lung transplant
144
impaired digestion/absorption of protein causes..
azotorrhea
145
impaired digestion/absorption of fat causes..
steatorrhea
146
management of GI S+S with CF
-replacement pancreatic enzymes
-high protein high calorie diet
-prevention/early management intestinal obstruction
-oral glucose-lowering agents/insulin prn
-diet and exercise
147
S+S obstructive sleep apnea
-snoring
-bedwetting
-interrupted sleep patterns
-neurobehavioral problems
148
Tx OSA
-CPAP
-adenotonsillectomy
149
most common cause cardiopulmonary arrest in children
resp failure
150
causes of resp center depression
-cerebral trauma
-intracranial tumors
-CNS infection
-overdose with barbiturates, opioids, benzos
-severe asphyxia
-tetanus
151
causes pulmonary diffusion defects
-pulmonary edema
-fibrosis
-embolism
-HTN
-collagen disorders
-pneumocytosis pneumonia
-anemia
-hemorrhage
152
cardinal S+S resp failure
-restlessness
-tachypnea
-tachycardia
-diaphoresis
153
early but less obvious S+S resp failure
-mood changes (euphoria or depression)
-headache
-altered depth and pattern resps
-HTN
-exertional dyspnea
-anorexia
-increased cardiac output and urinary output
-CNS symptoms
-nasal flaring
-retractions
-expiratory grunting
-wheezing/prolonged expiration
154
S+S severe hypoxia in resp failure
-hypoTN
-depressed resps
-dim vision
-bradycardia
-arrhythmias
-somnolence
-cyanosis
-stupor
-coma
-dyspnea
155
Tx resp failure
-supplemental O2
-open airway
-positioning
-stimulation
-suction
-early intubation
