Chapter 21: Respiratory Dysfunction Flashcards
1
Q
What often occurs in infants age 3 - 6 months?
A
increase in infection rates – maternal antibodies no longer provide enough protection after 3 months
2
Q
In toddlers and preschoolers, what type of organism causes a high rate of infection?
A
viruses
3
Q
What are 2 common organisms that cause infections in children older than 5 y.o.?
A
- group A beta-hemolytic streptococcus
- Mycoplasma pneumoniae
4
Q
Why does a child’s smaller size make a difference in respiratory infections?
A
- smaller diameter of airways
- distance between structures is shorter – organisms rapidly move down to other organs
- short and open eustachian tubes – more likely to contract otitis media from respiratory infection
5
Q
What are croup syndromes?
A
infections of the epiglottis or larynx
6
Q
What is acute nasopharyngitis? What organisms cause it?
5 organisms
A
– common cold
– caused by:
* RSV
* rhinovirus
* adenovirus
* influenza
* parainfluenza
7
Q
How is acute nasopharyngitis treated?
6 treatments
A
- because caused by viruses, no abx
- antipyretics for fever >100.4F
- fluids
- rest
- humidifiers
- cough suppressants only if cough if non-productive/can’t stop – do NOT use in babies
8
Q
What is pharyngitis? What organism causes it?
A
- sore throat
- caused by GABHS
9
Q
How does pharyngitis present in children?
5 presentations
A
- h/a
- fever
- abdominal pain
- tonsil/pharynx inflammation
- strawberry tongue and sandpaper rash (scarlet fever)
– there is NO cough with pharyngitis
10
Q
How is pharyngitis diagnosed?
2 diagnostics
A
- rapid strep tests
- throat culture
11
Q
How is pharyngitis treated?
3 treatments
A
- antibiotics – penicillin, amoxicillin
- discard toothbrush
- fluids
12
Q
What is tonsillitis? What types of organisms cause it?
A
- inflammation of tonsils
- caused by viral or bacterial organisms – can occur with pharyngitis
13
Q
How does tonsillitis usually present in children?
3 presentations
A
- edema of tonsils (kissing tonsils)
- difficulty swallowing
- difficulty breathing
14
Q
How is tonsillitis treated?
8 treatments
A
- tonsillectomy if infections are recurrent or affects breathing
- adenoidectomy if >4x purulent rhinorrhea in 12 months
- soft/liquid diet
- avoid irritating foods
- saltwater gargles
- lozenges
- analgesics
- antipyretics
15
Q
How does influenza usually present in children?
5 presentations
A
- dry cough
- dry throat
- fever
- chills
- fatigue
16
Q
How is influenza treated?
2 treatments
A
- medications – Tamiflu, Relenza
- prevention = flu shots – babies and infants get 2 shots, then annually afterward
17
Q
What is otitis media? How is it diagnosed?
A
- otitis media: eustachian tube malfunction d/t fluid in or inflammation of middle ear
- higher occurrence in winter months
- often preceded by viral infections
- diagnosis = otoscope eval and hx
18
Q
How is otitis media treated?
5 treatments
A
- wait 72 hours before giving abx if >2 y.o. (can usually resolve on own) – amoxicillin, Augmentin
- myringotomy
- tympanostomy tube
- consider smoking or secondhand smoke – increases OM infections
- prevention = pneumococcal vaccine
19
Q
What is infectious mononucleosis?
A
- AKA kissing disease
- infection of Epstein-Barr virus
- common among adolescents
20
Q
How does mononucleosis usually present in children?
4 presentations
A
- fever
- exudative pharyngitis
- hepatosplenomegaly
- fatigue
21
Q
How is mononucleosis diagnosed?
1 diagnostic
A
monospot test (fingerstick)
22
Q
How is mononucleosis treated?
2 treatments
A
- self-limiting –> no specific treatment
- avoid contact sports d/t hepatosplenomegaly
23
Q
How are croup syndromes characterized?
4 characteristics
A
- hoarseness
- barking cough
- inspiratory stridor
- varying degrees of respiratory distress d/t swelling or obstruction of airways
– symptoms are usually worse at night
24
Q
How are croup syndromes treated?
1 treatment
A
- steroids for inflammation
25
What is acute epiglottitis?
inflammation of the epiglottis
26
How does acute epiglottitis usually present in children?
| 7 presentations
* sore throat
* pain
* tripod positioning
* retractions
* inspiratory stridor
* mild hypoxia
* distress
27
How is acute epiglottitis treated?
| 3 treatments
* prevention = Hib (haemophilus influenzae type B) vaccine
* if severe, may need intubation
* NO throat exams d/t potential respiratory obstruction
28
What type of organism causes acute laryngitis? Which age group more commonly gets it?
* usually caused by viruses
* more common in older children and adolescents
29
How does acute laryngitis usually present in children?
| 1 presentation
hoarseness
30
How is acute laryngitis treated?
* self-limiting -- no long-term sequelae
* treats symptoms
31
What is acute laryngotracheobronchitis (LTB)? What age group is most commonly affected? Which organisms cause it?
| 4 organisms
* most common croup syndrome
* mostly affects children younger than 5 y.o.
* organisms:
-- RSV
-- parainfluenza
-- Mycoplasma pneumoniae
-- influenza A and B
32
How does LTB usually present in children?
| 8 presentations
* gradual onset of low-grade fever
* inspiratory stridor
* suprasternal retractions
* barking cough
* hoarseness
* increasing respiratory distress and hypoxia
* nasal flaring
* respiratory acidosis, failure, or death if not treated
33
How is LTB treated?
| 4 treatments
* humidified oxygen 4+ L/min
* face mask or blow-by
* fluids (oral or IV)
* nebulizer treatments -- epinephrine, steroids, heliox if severe
34
What is acute spasmodic laryngitis? How is it characterized?
| 3 characteristics
* AKA spasmodic croup or midnight croup
* characterized by:
-- recurrent paroxysmal attacks
-- occurs mostly at night
-- mild to absent inflammation
35
What is bronchiolitis? What organism typically causes it?
* acute viral infection with upper respiratory infection and lower respiratory infection of bronchioles d/t inflammation
* RSV most common cause
* M. pneumonia rarely causes
36
How is bronchiolitis diagnosed?
nasal swab (antigen detection)
37
How does bronchiolitis usually present in children?
| 10 presentations
* upper respiratory infection symptoms
* rhinorrhea
* low-grade fever
* OM
* conjunctivitis
* cough
* infants -- poor feeding, lethargy, irritability
* wheezing
* crackles
* dyspnea
38
How is bronchiolitis managed?
| 2 managements
* prevention = Synagis prophylaxis
* contact and standard precautions
39
What is pertussis? What organism usually causes it? What age group is most commonly affected?
* AKA whooping cough
* caused by Bordetella pertussis
* highest risk to young infants
* occurs most often in children who haven't been immunized -- for this reason, pregnant women are encouraged to get booster prior to delivery
40
What is aspiration pneumonia?
* inflammation or infection of the lungs d/t aspiration of liquid or solids
41
What are some precautions to prevent aspiration pneumonia?
| 3 precautions
* prevent aspiration
* feeding techniques and positioning
* avoid aspiration risks:
-- oily nose drops
-- solvents
-- talcum powder
42
What is acute respiratory distress syndrome (ARDS)?
* AKA adult respiratory distress syndrome
* respiratory distress and hypoxia within 72 hours after serious injury or surgery in a person with previously normal lungs
43
How is ARDS treated?
| 4 treatments
* oxygen
* fluids
* medications -- vasoconstrictors and BP meds
* may need intubation
44
What is asthma?
* chronic inflammatory disorder of the airways with recurring episodic symptoms:
-- wheezing
-- breathlessness
-- chest tightness
-- non-productive cough (especially at night)
* limits of airflow that revereses with treatment or spontaneously
* bronchial hyperresponsiveness
45
What are the most important things to communicate to patients with asthma?
| 2 education topics
* avoidance of triggers
* education on inhaler use:
-- wait 1 minute b/w puffs
-- rinse mouth after use
46
What types of medications are used to treat asthma?
| 5 medications
* long-term control medications
* rescue medications -- albuterol
* metered-dose inhaler
* corticosteroids
* cromolyn sodium
47
What is status asthmaticus?
respiratory distress that continues despite vigorous therapeutic measures
48
How is status asthmaticus treated?
emergency epinephrine 0.01 mL/kg subq
49
What are some nursing interventions for pts with asthma?
| 4 interventions
* calm nursing presence
* monitor with pulse ox
* allow older children to sit up if they are comfortable to do so
* allow parents to remain with children
50
What is cystic fibrosis?
exocrine gland dysfunction that produces a thick, sticky mucus that can be found everywhere in the body
51
How is cystic fibrosis inherited?
autosomal recessive -- can screen for this
52
How does cystic fibrosis usually present in children?
| 24 presentations
* thick mucus secretions
* non-productive cough -- cannot expectorate the mucus
* elevation of sweat electrolytes -- Na and Cl
* elevation of several ezymes in saliva -- Na and Cl
* pancreatic enzyme deficiency -- mucus plugs block enzymes
* COPD associated with infection
* sweat gland dysfunction
* failure to thrive
* increased weight loss despite normal appetite
* respiratory deterioration
* increased infections -- trapped bacteria/viruses in mucus
* patchy atelectasis
* cyanosis
* clubbing of fingers and toes
* meconium ileus
* rectal prolapse
* excretion of undigested stool -- bulky, frothy, foul-smelling stool
* wasting of tissues
* delayed puberty -- females
* sterility -- males
* dehydration
* hyponatremia
* hypochloremia
* hypoalbuminemia
53
How is CF diagnosed?
* sweat chloride test
* CXR
* pulmonary function tests
* stool fat and/or enzyme analysis
* barium enema
54
How does CF affect the respiratory system?
| 11 effects
* gradual deterioration after chronic infection
* bronchial epithelium destruction
* infections weaken bronchial walls
* peribronchial fibrosis
* decreased exchange of O2 and CO2
* chronic hypoxemia --> hypertrophy of lung tissue
* pulmonary HTN
* cor pulmonale
* pneumothorax
* hemoptysis
* lung transplant(s) may be needed
55
How does CF affect the GI system?
| 8 effects
* thick secretions block ducts
* pancreatic enzymes unable to reach duodenum
* impaired digestion
* impaired absorption of fat --> steatorrhea
* impaired absorption of protein --> azotorrhea
* pancreatic fibrosis develops --> DM
* biliary obstruction --> cirrhosis
* impaired salivation
56
What are the 3 treatment goals for CF?
1. prevent/minimize pulmonary complications
2. adequate nutrition for growth
3. assist with adaptation to chronic illness
57
How is CF treated?
* bronchodilator meds
* treatment of pulmonary infections
* pneumothorax
* hemoptysis
* nasal polyps
* NSAIDs
* transplants
* replacement of pancreatic enzymes
* high-protein, high calorie diet
* treat constipation
* reduction of rectal prolapse
* salt supplements
58
What is respiratory failure, and what are the 3 types?
* **respiratory failure:** inability of the respiratory system to maintain adequate oxygenation
* 3 types:
1. **respiratory insufficiency:** increased work of breathing, hypoxemia, acidosis
2. **respiratory arrest:** complete cessation of respiration
3. **apnea:** cessation of breathing for more than 20 seconds
59
How is respiratory failure treated?
| 4 treatments
* ventilation
* oxygenation
* correct hypoxemia and hypercapnia
* minimize organ failure
