Chapter 21: Respiratory Dysfunction Flashcards
What often occurs in infants age 3 - 6 months?
increase in infection rates – maternal antibodies no longer provide enough protection after 3 months
In toddlers and preschoolers, what type of organism causes a high rate of infection?
viruses
What are 2 common organisms that cause infections in children older than 5 y.o.?
- group A beta-hemolytic streptococcus
- Mycoplasma pneumoniae
Why does a child’s smaller size make a difference in respiratory infections?
- 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
What are croup syndromes?
infections of the epiglottis or larynx
What is acute nasopharyngitis? What organisms cause it?
5 organisms
– common cold
– caused by:
* RSV
* rhinovirus
* adenovirus
* influenza
* parainfluenza
How is acute nasopharyngitis treated?
6 treatments
- 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
What is pharyngitis? What organism causes it?
- sore throat
- caused by GABHS
How does pharyngitis present in children?
5 presentations
- h/a
- fever
- abdominal pain
- tonsil/pharynx inflammation
- strawberry tongue and sandpaper rash (scarlet fever)
– there is NO cough with pharyngitis
How is pharyngitis diagnosed?
2 diagnostics
- rapid strep tests
- throat culture
How is pharyngitis treated?
3 treatments
- antibiotics – penicillin, amoxicillin
- discard toothbrush
- fluids
What is tonsillitis? What types of organisms cause it?
- inflammation of tonsils
- caused by viral or bacterial organisms – can occur with pharyngitis
How does tonsillitis usually present in children?
3 presentations
- edema of tonsils (kissing tonsils)
- difficulty swallowing
- difficulty breathing
How is tonsillitis treated?
8 treatments
- 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
How does influenza usually present in children?
5 presentations
- dry cough
- dry throat
- fever
- chills
- fatigue
How is influenza treated?
2 treatments
- medications – Tamiflu, Relenza
- prevention = flu shots – babies and infants get 2 shots, then annually afterward
What is otitis media? How is it diagnosed?
- 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
How is otitis media treated?
5 treatments
- 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
What is infectious mononucleosis?
- AKA kissing disease
- infection of Epstein-Barr virus
- common among adolescents
How does mononucleosis usually present in children?
4 presentations
- fever
- exudative pharyngitis
- hepatosplenomegaly
- fatigue
How is mononucleosis diagnosed?
1 diagnostic
monospot test (fingerstick)
How is mononucleosis treated?
2 treatments
- self-limiting –> no specific treatment
- avoid contact sports d/t hepatosplenomegaly
How are croup syndromes characterized?
4 characteristics
- hoarseness
- barking cough
- inspiratory stridor
- varying degrees of respiratory distress d/t swelling or obstruction of airways
– symptoms are usually worse at night
How are croup syndromes treated?
1 treatment
- steroids for inflammation
What is acute epiglottitis?
inflammation of the epiglottis
How does acute epiglottitis usually present in children?
7 presentations
- sore throat
- pain
- tripod positioning
- retractions
- inspiratory stridor
- mild hypoxia
- distress
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
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
How does acute laryngitis usually present in children?
1 presentation
hoarseness
How is acute laryngitis treated?
- self-limiting – no long-term sequelae
- treats symptoms
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
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
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
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
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
How is bronchiolitis diagnosed?
nasal swab (antigen detection)
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
How is bronchiolitis managed?
2 managements
- prevention = Synagis prophylaxis
- contact and standard precautions
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
What is aspiration pneumonia?
- inflammation or infection of the lungs d/t aspiration of liquid or solids
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
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
How is ARDS treated?
4 treatments
- oxygen
- fluids
- medications – vasoconstrictors and BP meds
- may need intubation
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
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
What types of medications are used to treat asthma?
5 medications
- long-term control medications
- rescue medications – albuterol
- metered-dose inhaler
- corticosteroids
- cromolyn sodium
What is status asthmaticus?
respiratory distress that continues despite vigorous therapeutic measures
How is status asthmaticus treated?
emergency epinephrine 0.01 mL/kg subq
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
What is cystic fibrosis?
exocrine gland dysfunction that produces a thick, sticky mucus that can be found everywhere in the body
How is cystic fibrosis inherited?
autosomal recessive – can screen for this
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
How is CF diagnosed?
- sweat chloride test
- CXR
- pulmonary function tests
- stool fat and/or enzyme analysis
- barium enema
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
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
What are the 3 treatment goals for CF?
- prevent/minimize pulmonary complications
- adequate nutrition for growth
- assist with adaptation to chronic illness
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
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
How is respiratory failure treated?
4 treatments
- ventilation
- oxygenation
- correct hypoxemia and hypercapnia
- minimize organ failure
