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peds > ch 26 the child with respiratory dysfunction > Flashcards

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

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2
Q

what is included in the lower airway

A

-trachea
-lungs
-bronchi
-alveoli

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3
Q

what is included in assessment of thorax and lungs

A

-inspection
-palpation
-percussion
-auscultation
-adventitious breath sounds

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4
Q

what could a dull sound on percussion indicate

A

fluid (pneumonia)

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5
Q

what might you hear on percussion with a pt with asthma/CF

A

hyper-resonance

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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

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7
Q

what happens to the abdomen in newborns with high RR

A

lots of air (may vomit with food)
-IV fluids

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8
Q

what age do newborns still have maternal antibodies

A

<3 mos

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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

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10
Q

what ages have the highest rate of viral infections

A

toddlers and preschool ages

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11
Q

what infections are common in older than 5 yo (2)

A

-mycoplasma pneumonia
-group a b-hemolytic strep

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12
Q

what time of year are mycoplasma infections (pneumonia) more common

A

fall and winter

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13
Q

what time of year is asthmatic bronchitis more common

A

cold weather (winter) and change of seasons (pollen, dust)

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14
Q

what time of year is considered RSV season

A

winter and spring

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15
Q

Tx for viral infections (general)

A

-suction
-fluids
-tylenol or motrin (if >6 mos)

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16
Q

examples of viral infectious agents

A

-RSV
-rhino
-entero
-parainfluenza
-COVID
-influenza
-adeno
-human metapneumo

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17
Q

infectious agents (non-viral)

A

-group a b-hemolytic strep
-bordetella pertussis
-staph
-mycoplasma
-pneumococcal

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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

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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

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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

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21
Q

meds for URI (not for younger children <4 yo)

A

-OTC cold meds
-cough suppressant
-decongestant nose drops

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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

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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

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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

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25
Q

Tx viral pharyngitis

A

-tylenol/motrin
-popsicles/jello/cold foods or liquid
-avoid juice

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26
Q

S+S bacterial pharyngitis

A

-abrupt onset
-sore throat
-erythema, inflammation pharynx and tonsils
-high fever
-abdominal pain, vomiting
-headache
-cervical lymph nodes tender
-lasts 3-5 days

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27
Q

Dx acute strep pharyngitis

A

-rapid antigen testing
-culture throat swab (to make sure Abx will work)

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28
Q

illness that are potential further complications of strep

A

-acute rheumatic fever
-acute glomerulonephritis
-scarlet fever

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29
Q

Tx acute strep

A

-teach: finish Abx
-teach: throw away toothbrush around 24 hrs after start of Abx
-fever meds
-supportive care (fluids)

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30
Q

meds for strep

A

-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

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31
Q

S+S tonsillitis

A

-“kissing tonsils”
-foul breath
-can result in ear infections

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32
Q

Tx tonsillitis

A

-surgical removal (controversial)

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33
Q

nursing concerns post-op tonsillectomy (3)

A

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

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34
Q

home instructions post-op tonsillectomy

A

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)

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35
Q

cause infectious mono

A

-epstein barre virus
(oral secretions)

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36
Q

Dx mono

A

-CBC
-monospot

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37
Q

emergencies to be prepared for with mono

A

-difficulty breathing
-abdominal pain
-can’t eat/drink
-resp stridor

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38
Q

S+S mono

A

-malaise
-sore throat
-fever
-extreme fatigue
-hepatosplenomegaly

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39
Q

important teaching with mono

A

no playing contact sports for several weeks after mono (bc of hepatosplenomegaly)

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40
Q

possible complications of mono

A

-seizures
-myocarditis
-transverse myelitis
-ruptured spleen
-aseptic meningitis

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41
Q

landmark for enlarged liver

A

2-3 cm below costal margins

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42
Q

meds to treat/prevent flu in children

A

ANTIVIRALS
-oseltamivir (tamiflu)
-zanamivir (relenza)
-*must start within 48 hrs of symptom onset
-still contagious
-NO aspirin

VACCINES
-children >6 mos
-new vaccine annually

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43
Q

risk of taking aspirin with the flu

A

reyes syndrome

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44
Q

contraindications for flu vaccine

A

-egg allergy
-pregnant/nursing
-immunocompromised
-<6 mos

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45
Q

S+S otitis media

A

-pain
-pulling on ears
-fever
-loss of appetite
-*no drainage unless perforated eardrum

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46
Q

what factors increase risk of developing otitis media

A

-passive smoke inhalation
-crowded living conditions
-socioeconomic

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47
Q

Tx otitis media

A

-Abx
-surgical: myringotomy (ear tubes)

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48
Q

myringotomy

A

ear tubes

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49
Q

what infants have less occurrence of otitis media than others

A

breast-fed
-immunoglobulin A from mom
-position in breastfeeding decreases reflux in eustachian tubes

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50
Q

inflammmation of middle ear without reference to etiology or pathogenesis

A

otitits media

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51
Q

inflammation of middle ear space with rapid onset of S+S of acute infection (fever and ear pain)

A

acute otitis media

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52
Q

fluid in middle ear space w/o symptoms of acute infection

A

otitis media with effusion

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53
Q

meds Tx otitis media

A

->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

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54
Q

Abx for otitis media if highly resistant organism or noncompliant with oral doses

A

cephalosporins (ceftriaxone)
-IM is painful

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55
Q

are steroids, antihistamines, and decongestants recommended with Tx of otitis media

A

no

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56
Q

S+S otitis externa “swimmers ear”

A

-ear pain aggravated with pulling pinna
-edema
-drainage (cheesy, blue-green)
-hearing loss possible

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57
Q

Tx otitis externa

A

-pain meds
-otic drops for 7-10 days

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58
Q

who can’t use otic drops for Tx of otitis externa

A

if have ear tubes
risk of ototoxicity

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59
Q

nursing care management of otitis externa (teaching)

A

-no swimming longer than 1 hr
-dry ears completely
-swimmers drops or white vinegar

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60
Q

S+S croup

A

-“seal barking” cough
-hoarseness
-inspiratory stridor
-often worse at night

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61
Q

severity categories of croup

A

-mild: no stridor at rest
-moderate: mild stridor at rest, mild retractions
-severe: steeple sign/pencil tip on x-ray, severe stridor at rest

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62
Q

what seasons do croup happen most often in

A

fall and winter

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63
Q

Tx coup

A

VIRAL
-humidified air
-fluids
-pain meds
-corticosteroids for severe croup

64
Q

acute epiglottitis S+S

A

-*abrupt onset
-sore throat, pain
-tripod positioning
-retractions
-inspiratory stridor
-mild hypoxia, distress

65
Q

prevention of acute epiglottitis

A

hib vaccine

66
Q

is epiglottitis viral or bacterial

A

bacterial

67
Q

nursing considerations acute epiglottitis

A

-position for comfort
-decrease anxiety
-no tongue blade
-keep suction at bedside
-keep emergency resp equipment at bed

68
Q

Tx epiglottitis

A

-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
Q

who is laryngitis more common in?
virus or bacteria?

A

older children and adolescents
virus

70
Q

S+S laryngitis

A

hoarseness

71
Q

infection of mucosa of upper trachea

A

bacterial tracheitis

72
Q

S+S bacterial tracheitis

A

-thick purulent secretions
-resp distress
-stridor

(appears similar to croup and epiglottitis)

73
Q

Tx bacterial tracheitis

A

-humidified O2
-fever meds
-Abx
-may require intubation if severe distress/resp failure

74
Q

paroxysmal attacks of laryngeal obstruction

A

acute spasmodic laryngitis/spasmodic croup/midnight croup

75
Q

S+S acute spasmodic laryngitis

A

-smasmodic cough
-most often in children 1-3 yo
-inflammation
-wakes up in night with coughing

76
Q

S+S increasing resp distress in children

A

-restlessness
-tachycardia
-tachypnea
-retractions

77
Q

3 lower airway illnesses

A

-asthma
-bronchitis
-bronchiolitis

78
Q

lower airway illness: exaggerated response of bronchi to a trigger such as URI, dander, cold air, exercise

A

asthma

79
Q

age group affected: asthma

A

infancy to adolescence/adulthood

80
Q

S+S asthma

A

-wheezing
-cough
-labored resps

81
Q

Tx asthma

A

-inhaled corticosteroids
-bronchodilators
-leukotriene modifiers
-allergens
-control of triggers

82
Q

lower airway illness: usually occurs in association with URI; seldom an isolated entity

A

bronchitis

83
Q

age group affected: bronchitis

A

first four years of life

84
Q

is bronchitis usually viral or bacterial

A

viral

85
Q

S+S bronchitis

A

-persistent dry hacking cough (worse at night)
-productive cough in 2-3 days

86
Q

Tx bronchitis

A

cough suppressants prn

87
Q

lower airway illness: most common infectious disease of lower airways; max obstructive impact at bronchiolar level

A

bronchiolitis

88
Q

age group affected bronchiolitis

A

children 2-12 mos of age
*peak incidence 6 mos

89
Q

S+S bronchiolitis

A

-labored resps
-poor feeding
-cough
-tachypnea
-retractions
-flaring nares
-emphsema
-increased mucus
-wheezing
-maybe fever

90
Q

Tx bronchiolitis

A

-supplemental oxygen if <90%
-bronchodilators prn
-suction

91
Q

usual cause bronchiolitis

A

RSV

92
Q

S+S RSV

A

-URI
-rhinorrhea
-low grade fever

93
Q

Dx RSV

A

nasopharyngeal swab

94
Q

Tx RSV

A

-oxygen prn
-airway maintenance
-meds
-adequate fluids

95
Q

prevention RSV

A

prophylaxis synagis
-given 1x q30days until end of RSV season
(usually just for premature kids or kids who have lung condition)

96
Q

transmission precaution for RSV

A

droplet and contact

97
Q

3 causes pneumonia

A

-viral
-bacterial
-atypical

98
Q

S+S pneumonia

A

-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
Q

complication of pneumonia

A

-empyema (encapsulated fluid)
-otitis media and pleural effusion
-tension pneumothorax (air trapped in pleural cavity)

100
Q

Dx pneumonia

A

chest x-ray

101
Q

what kids have higher incidence of spontaneous pneumothorax

A

tall thin teenage boys

102
Q

S+S spontaneous pneumothorax

A

-sharp chest pain (worse with deep breath or cough)
-SOB
-chest tightness
-fatigue
-increased HR
-cyanosis
-nasal flaring
-retractions

103
Q

Tx spontaneous pneumothorax

A

-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
Q

when would you clamp a chest tube (4 scenarios)

A

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
Q

transmission precautions with TB

A

-airborne precautions (microdroplet transmission)

106
Q

S+S TB

A

-fever
-malaise
-night sweats
- unexplained weight loss

107
Q

Dx TB

A

-TB sputum test and cultures (if high risk)
-quantiferon (blood or skin test)
-x-ray

108
Q

if you have a positive TB skin test what do you do next

A

chest x-ray

109
Q

Tx latent TB infection

A

for high risk kids:
-isoniazid (INH) for 9 months
-rifampin for 6 months (if INH resistant)

110
Q

risk factors TB

A

-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
Q

Tx for active TB

A

-daily INH, rifampin, ethambutol, pyranizamide
-usually direct observation of Tx
-treat family

112
Q

Tx foreign body aspiration >1 yo and <1 yo

A

->1 yo: abdominal thrusts (heimlik)
-<1 yo: back blows and chest thrusts

113
Q

common foreign objects aspirated

A

-mints
-coins
-hot dogs
-popcorn
-nuts
-grapes

114
Q

S+S foreign body in nose

A

-unilateral nasal discharge
-foul smelling
-discomfort

115
Q

S+S aspiration pneumonia

A

-coughing
-vomiting
-agitation
-restlessness
-fever
-usually develop 24 hrs after aspiration

116
Q

Tx aspiration pneumonia

A

-Abx
-do not induce vomiting
-modify feeding techniques/positions

117
Q

conditions that increase risk of aspiration pneumonia

A

-altered LOC (seizures, sedation)
-dysphagia
-mechanical disruption of defensive barriers (trach, NGT)
-persistent vomiting

118
Q

Dx congenital diaphragmatic hernia

A

prenatal at 25th week EGA

119
Q

S+S congenital diaphragmatic hernia

A

-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
Q

Tx congenital diaphragmatic hernia

A

-fetal surgery

AFTER BIRTH:
-intubation if resp distress
-*bag mask contraindicated

121
Q

why is bag mask contraindicated in tx of congenital diaphragmatic hernia

A

blows air into stomach
worsens resp distress

122
Q

S+S pierre robin squence

A

-mandibular hypoplasia (small jaw)
-pushes tongue back
-cleft palate
-airway obstruction
-resp distress
-feeding problems

123
Q

Tx pierre robin squence

A

-nasal trumpet (opens airway, pushes tongue forward)
-surgical repair of mandible
-early recognition

124
Q

S+S choanal atresia

A

-membranous septum located between nose and pharynx
-narrowing of back of nasal cavity

125
Q

S+S allergic rhinitis

A

-“allergic shiners”
-eye irritation

126
Q

risk factors allergic rhinitis

A

-exposed to tobacco smoke
-given whole milk/solid foods <4 months old

127
Q

Dx asthma

A

PFT
peak expiratory flow rate (PEF meter)

128
Q

ominous sign of indicating resp failure (w/ asthma)

A

shortness of breath
absent breath sounds
sudden rise in resp rate

129
Q

chronic inflammatory disorder of airway characterized by:
-recurrent S+S (wheezing, dyspnea, chest tightness, cough)
-airway obstruction
-bronchial hyperresponsiveness

A

asthma

130
Q

risk factors asthma

A

-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
Q

S+S asthma

A

-worse at night/during exercise
-infancy: usually follows resp infection
-begins with feeling of restlessness
-hacking nonproductive cough that becomes productive
-tripod position

132
Q

S+S intermittent asthma (stage 1)
Tx?

A

-no interference with normal activity
-S+S <2x/week
tx: use SABA <2x/week

133
Q

S+S mild asthma (stage 2)
Tx?

A

-S+S 2-6x/week
-minor interference with normal activity
tx: use SABA 2-6x/week

134
Q

S+S moderate asthma (stage 3/4)
Tx?

A

-daily S+S
-some interference with normal activity
Tx: SABA daily

135
Q

S+S severe asthma (stage 5/6)
Tx?

A

-continual S+S throughout day
-extremely limited normal activity
Tx: SABA several times a day, maybe oral corticosteroids

136
Q

meds for asthma (rescue and long term)

A

RESCUE:
-SABA
-anticholinergic
-systemic corticosteroids

LONG TERM:
-inhaled corticosteroids
-LABA
-methylxanthines
-leukotriene modifiers
-cromolyn sodium and nedocromil

137
Q

S+S severe resp distress in child with asthma

A

-remains sitting upright (won’t lay down)
-sudden agitation
-agitated child who suddenly becomes quiet
-diaphoresis
-pale

138
Q

Tx status asthmaticus

A

-frequent admin SABAs
-humidified O2 to keep SpO2 >90%
-IV corticosteroids

139
Q

Mucus-producing glands dysfunction, causing thickened secretions and resulting in multi-system dysfunction, particularly of the pancreas and lungs

A

cystic fibrosis

140
Q

possible complications of endocrine gland dysfunction in CF

A

-chronic bronchial pneumonia
-generalized obstructive emphysema
-intestinal obstruction of newborn
-malabsorption syndrome
-portal HTN

141
Q

S+S of cystic fibrosis
-resp
-GI
-repro
-integumentary

A

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
Q

Dx CF

A

-early infancy screening
-DNA testing
-sweat chloride test
-chest x-ray
-stool for fat

143
Q

Tx CF

A

-remove excess mucus secretions (CPT, bronchodilator med, forced expiration)
-Tx pulmonary infections
-steroids and NSAIDs
-lung transplant

144
Q

impaired digestion/absorption of protein causes..

A

azotorrhea

145
Q

impaired digestion/absorption of fat causes..

A

steatorrhea

146
Q

management of GI S+S with CF

A

-replacement pancreatic enzymes
-high protein high calorie diet
-prevention/early management intestinal obstruction
-oral glucose-lowering agents/insulin prn
-diet and exercise

147
Q

S+S obstructive sleep apnea

A

-snoring
-bedwetting
-interrupted sleep patterns
-neurobehavioral problems

148
Q

Tx OSA

A

-CPAP
-adenotonsillectomy

149
Q

most common cause cardiopulmonary arrest in children

A

resp failure

150
Q

causes of resp center depression

A

-cerebral trauma
-intracranial tumors
-CNS infection
-overdose with barbiturates, opioids, benzos
-severe asphyxia
-tetanus

151
Q

causes pulmonary diffusion defects

A

-pulmonary edema
-fibrosis
-embolism
-HTN
-collagen disorders
-pneumocytosis pneumonia
-anemia
-hemorrhage

152
Q

cardinal S+S resp failure

A

-restlessness
-tachypnea
-tachycardia
-diaphoresis

153
Q

early but less obvious S+S resp failure

A

-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
Q

S+S severe hypoxia in resp failure

A

-hypoTN
-depressed resps
-dim vision
-bradycardia
-arrhythmias
-somnolence
-cyanosis
-stupor
-coma
-dyspnea

155
Q

Tx resp failure

A

-supplemental O2
-open airway
-positioning
-stimulation
-suction
-early intubation

peds (28 decks)

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