ch 26 the child with respiratory dysfunction Flashcards
what is included in the upper airway
-nares
-pharynx
-larynx
-ciliated mucous membranes
-tonsils
what is included in the lower airway
-trachea
-lungs
-bronchi
-alveoli
what is included in assessment of thorax and lungs
-inspection
-palpation
-percussion
-auscultation
-adventitious breath sounds
what could a dull sound on percussion indicate
fluid (pneumonia)
what might you hear on percussion with a pt with asthma/CF
hyper-resonance
differences in resp system in newborns
-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
what happens to the abdomen in newborns with high RR
lots of air (may vomit with food)
-IV fluids
what age do newborns still have maternal antibodies
<3 mos
what age do infections increase in newborns
3-6 mos
-lose maternal antibodies
-mom usually goes back to work, kid with babysitter or in daycare
what ages have the highest rate of viral infections
toddlers and preschool ages
what infections are common in older than 5 yo (2)
-mycoplasma pneumonia
-group a b-hemolytic strep
what time of year are mycoplasma infections (pneumonia) more common
fall and winter
what time of year is asthmatic bronchitis more common
cold weather (winter) and change of seasons (pollen, dust)
what time of year is considered RSV season
winter and spring
Tx for viral infections (general)
-suction
-fluids
-tylenol or motrin (if >6 mos)
examples of viral infectious agents
-RSV
-rhino
-entero
-parainfluenza
-COVID
-influenza
-adeno
-human metapneumo
infectious agents (non-viral)
-group a b-hemolytic strep
-bordetella pertussis
-staph
-mycoplasma
-pneumococcal
S+S resp illness in children
-fever
-menigismus
-anorexia
-V/D
-abdominal pain
-nasal blockage and discharge
-cough
-resp sounds (crackles, grunting, wheezing)
-sore throat
nursing care for resp illness in children
-fever management
-promote rest
-infection control and prevent spread
-promote hydration and nutrition
-reassess frequently
-support, teaching and plan for home care
S+S common cold (upper resp tract infection nasopharyngitis) in younger child
-fever
-irritability, restlessness
-decreased appetite and fluid intake
-nasal inflammation
-V/D
-high potential for ear infections
meds for URI (not for younger children <4 yo)
-OTC cold meds
-cough suppressant
-decongestant nose drops
teaching for parents: when to call your hcp for resp complications
-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
what to know about riboviren
(for HESI)
-med for severe RSV
-nebulizer med
-*mom who is pregnant/nursing can’t be around kid receiving med
S+S viral pharyngitis
-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
Tx viral pharyngitis
-tylenol/motrin
-popsicles/jello/cold foods or liquid
-avoid juice
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
Dx acute strep pharyngitis
-rapid antigen testing
-culture throat swab (to make sure Abx will work)
illness that are potential further complications of strep
-acute rheumatic fever
-acute glomerulonephritis
-scarlet fever
Tx acute strep
-teach: finish Abx
-teach: throw away toothbrush around 24 hrs after start of Abx
-fever meds
-supportive care (fluids)
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
S+S tonsillitis
-“kissing tonsils”
-foul breath
-can result in ear infections
Tx tonsillitis
-surgical removal (controversial)
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
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)
cause infectious mono
-epstein barre virus
(oral secretions)
Dx mono
-CBC
-monospot
emergencies to be prepared for with mono
-difficulty breathing
-abdominal pain
-can’t eat/drink
-resp stridor
S+S mono
-malaise
-sore throat
-fever
-extreme fatigue
-hepatosplenomegaly
important teaching with mono
no playing contact sports for several weeks after mono (bc of hepatosplenomegaly)
possible complications of mono
-seizures
-myocarditis
-transverse myelitis
-ruptured spleen
-aseptic meningitis
landmark for enlarged liver
2-3 cm below costal margins
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
risk of taking aspirin with the flu
reyes syndrome
contraindications for flu vaccine
-egg allergy
-pregnant/nursing
-immunocompromised
-<6 mos
S+S otitis media
-pain
-pulling on ears
-fever
-loss of appetite
-*no drainage unless perforated eardrum
what factors increase risk of developing otitis media
-passive smoke inhalation
-crowded living conditions
-socioeconomic
Tx otitis media
-Abx
-surgical: myringotomy (ear tubes)
myringotomy
ear tubes
what infants have less occurrence of otitis media than others
breast-fed
-immunoglobulin A from mom
-position in breastfeeding decreases reflux in eustachian tubes
inflammmation of middle ear without reference to etiology or pathogenesis
otitits media
inflammation of middle ear space with rapid onset of S+S of acute infection (fever and ear pain)
acute otitis media
fluid in middle ear space w/o symptoms of acute infection
otitis media with effusion
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
Abx for otitis media if highly resistant organism or noncompliant with oral doses
cephalosporins (ceftriaxone)
-IM is painful
are steroids, antihistamines, and decongestants recommended with Tx of otitis media
no
S+S otitis externa “swimmers ear”
-ear pain aggravated with pulling pinna
-edema
-drainage (cheesy, blue-green)
-hearing loss possible
Tx otitis externa
-pain meds
-otic drops for 7-10 days
who can’t use otic drops for Tx of otitis externa
if have ear tubes
risk of ototoxicity
nursing care management of otitis externa (teaching)
-no swimming longer than 1 hr
-dry ears completely
-swimmers drops or white vinegar
S+S croup
-“seal barking” cough
-hoarseness
-inspiratory stridor
-often worse at night
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
what seasons do croup happen most often in
fall and winter
Tx coup
VIRAL
-humidified air
-fluids
-pain meds
-corticosteroids for severe croup
acute epiglottitis S+S
-*abrupt onset
-sore throat, pain
-tripod positioning
-retractions
-inspiratory stridor
-mild hypoxia, distress
prevention of acute epiglottitis
hib vaccine
is epiglottitis viral or bacterial
bacterial
nursing considerations acute epiglottitis
-position for comfort
-decrease anxiety
-no tongue blade
-keep suction at bedside
-keep emergency resp equipment at bed
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
who is laryngitis more common in?
virus or bacteria?
older children and adolescents
virus
S+S laryngitis
hoarseness
infection of mucosa of upper trachea
bacterial tracheitis
S+S bacterial tracheitis
-thick purulent secretions
-resp distress
-stridor
(appears similar to croup and epiglottitis)
Tx bacterial tracheitis
-humidified O2
-fever meds
-Abx
-may require intubation if severe distress/resp failure
paroxysmal attacks of laryngeal obstruction
acute spasmodic laryngitis/spasmodic croup/midnight croup
S+S acute spasmodic laryngitis
-smasmodic cough
-most often in children 1-3 yo
-inflammation
-wakes up in night with coughing
S+S increasing resp distress in children
-restlessness
-tachycardia
-tachypnea
-retractions
3 lower airway illnesses
-asthma
-bronchitis
-bronchiolitis
lower airway illness: exaggerated response of bronchi to a trigger such as URI, dander, cold air, exercise
asthma
age group affected: asthma
infancy to adolescence/adulthood
S+S asthma
-wheezing
-cough
-labored resps
Tx asthma
-inhaled corticosteroids
-bronchodilators
-leukotriene modifiers
-allergens
-control of triggers
lower airway illness: usually occurs in association with URI; seldom an isolated entity
bronchitis
age group affected: bronchitis
first four years of life
is bronchitis usually viral or bacterial
viral
S+S bronchitis
-persistent dry hacking cough (worse at night)
-productive cough in 2-3 days
Tx bronchitis
cough suppressants prn
lower airway illness: most common infectious disease of lower airways; max obstructive impact at bronchiolar level
bronchiolitis
age group affected bronchiolitis
children 2-12 mos of age
*peak incidence 6 mos
S+S bronchiolitis
-labored resps
-poor feeding
-cough
-tachypnea
-retractions
-flaring nares
-emphsema
-increased mucus
-wheezing
-maybe fever
Tx bronchiolitis
-supplemental oxygen if <90%
-bronchodilators prn
-suction
usual cause bronchiolitis
RSV
S+S RSV
-URI
-rhinorrhea
-low grade fever
Dx RSV
nasopharyngeal swab
Tx RSV
-oxygen prn
-airway maintenance
-meds
-adequate fluids
prevention RSV
prophylaxis synagis
-given 1x q30days until end of RSV season
(usually just for premature kids or kids who have lung condition)
transmission precaution for RSV
droplet and contact
3 causes pneumonia
-viral
-bacterial
-atypical
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
complication of pneumonia
-empyema (encapsulated fluid)
-otitis media and pleural effusion
-tension pneumothorax (air trapped in pleural cavity)
Dx pneumonia
chest x-ray
what kids have higher incidence of spontaneous pneumothorax
tall thin teenage boys
S+S spontaneous pneumothorax
-sharp chest pain (worse with deep breath or cough)
-SOB
-chest tightness
-fatigue
-increased HR
-cyanosis
-nasal flaring
-retractions
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
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)
transmission precautions with TB
-airborne precautions (microdroplet transmission)
S+S TB
-fever
-malaise
-night sweats
- unexplained weight loss
Dx TB
-TB sputum test and cultures (if high risk)
-quantiferon (blood or skin test)
-x-ray
if you have a positive TB skin test what do you do next
chest x-ray
Tx latent TB infection
for high risk kids:
-isoniazid (INH) for 9 months
-rifampin for 6 months (if INH resistant)
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
Tx for active TB
-daily INH, rifampin, ethambutol, pyranizamide
-usually direct observation of Tx
-treat family
Tx foreign body aspiration >1 yo and <1 yo
->1 yo: abdominal thrusts (heimlik)
-<1 yo: back blows and chest thrusts
common foreign objects aspirated
-mints
-coins
-hot dogs
-popcorn
-nuts
-grapes
S+S foreign body in nose
-unilateral nasal discharge
-foul smelling
-discomfort
S+S aspiration pneumonia
-coughing
-vomiting
-agitation
-restlessness
-fever
-usually develop 24 hrs after aspiration
Tx aspiration pneumonia
-Abx
-do not induce vomiting
-modify feeding techniques/positions
conditions that increase risk of aspiration pneumonia
-altered LOC (seizures, sedation)
-dysphagia
-mechanical disruption of defensive barriers (trach, NGT)
-persistent vomiting
Dx congenital diaphragmatic hernia
prenatal at 25th week EGA
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)
Tx congenital diaphragmatic hernia
-fetal surgery
AFTER BIRTH:
-intubation if resp distress
-*bag mask contraindicated
why is bag mask contraindicated in tx of congenital diaphragmatic hernia
blows air into stomach
worsens resp distress
S+S pierre robin squence
-mandibular hypoplasia (small jaw)
-pushes tongue back
-cleft palate
-airway obstruction
-resp distress
-feeding problems
Tx pierre robin squence
-nasal trumpet (opens airway, pushes tongue forward)
-surgical repair of mandible
-early recognition
S+S choanal atresia
-membranous septum located between nose and pharynx
-narrowing of back of nasal cavity
S+S allergic rhinitis
-“allergic shiners”
-eye irritation
risk factors allergic rhinitis
-exposed to tobacco smoke
-given whole milk/solid foods <4 months old
Dx asthma
PFT
peak expiratory flow rate (PEF meter)
ominous sign of indicating resp failure (w/ asthma)
shortness of breath
absent breath sounds
sudden rise in resp rate
chronic inflammatory disorder of airway characterized by:
-recurrent S+S (wheezing, dyspnea, chest tightness, cough)
-airway obstruction
-bronchial hyperresponsiveness
asthma
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
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
S+S intermittent asthma (stage 1)
Tx?
-no interference with normal activity
-S+S <2x/week
tx: use SABA <2x/week
S+S mild asthma (stage 2)
Tx?
-S+S 2-6x/week
-minor interference with normal activity
tx: use SABA 2-6x/week
S+S moderate asthma (stage 3/4)
Tx?
-daily S+S
-some interference with normal activity
Tx: SABA daily
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
meds for asthma (rescue and long term)
RESCUE:
-SABA
-anticholinergic
-systemic corticosteroids
LONG TERM:
-inhaled corticosteroids
-LABA
-methylxanthines
-leukotriene modifiers
-cromolyn sodium and nedocromil
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
Tx status asthmaticus
-frequent admin SABAs
-humidified O2 to keep SpO2 >90%
-IV corticosteroids
Mucus-producing glands dysfunction, causing thickened secretions and resulting in multi-system dysfunction, particularly of the pancreas and lungs
cystic fibrosis
possible complications of endocrine gland dysfunction in CF
-chronic bronchial pneumonia
-generalized obstructive emphysema
-intestinal obstruction of newborn
-malabsorption syndrome
-portal HTN
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
Dx CF
-early infancy screening
-DNA testing
-sweat chloride test
-chest x-ray
-stool for fat
Tx CF
-remove excess mucus secretions (CPT, bronchodilator med, forced expiration)
-Tx pulmonary infections
-steroids and NSAIDs
-lung transplant
impaired digestion/absorption of protein causes..
azotorrhea
impaired digestion/absorption of fat causes..
steatorrhea
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
S+S obstructive sleep apnea
-snoring
-bedwetting
-interrupted sleep patterns
-neurobehavioral problems
Tx OSA
-CPAP
-adenotonsillectomy
most common cause cardiopulmonary arrest in children
resp failure
causes of resp center depression
-cerebral trauma
-intracranial tumors
-CNS infection
-overdose with barbiturates, opioids, benzos
-severe asphyxia
-tetanus
causes pulmonary diffusion defects
-pulmonary edema
-fibrosis
-embolism
-HTN
-collagen disorders
-pneumocytosis pneumonia
-anemia
-hemorrhage
cardinal S+S resp failure
-restlessness
-tachypnea
-tachycardia
-diaphoresis
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
S+S severe hypoxia in resp failure
-hypoTN
-depressed resps
-dim vision
-bradycardia
-arrhythmias
-somnolence
-cyanosis
-stupor
-coma
-dyspnea
Tx resp failure
-supplemental O2
-open airway
-positioning
-stimulation
-suction
-early intubation
