CHAPTER 40 Flashcards
1
Q
COMPONENTS OF ASSESSING RESPIRATORY FUNCTION RESPIRATIONS:
A
• Rate
• Depth
• Ease
• Labored Breathing
• Rhythm
2
Q
Other observations:
COMPONENTS OF ASSESSING RESPIRATORY FUNCTION’ RESPIRATIONS
A
• Evidence of infection
• Cough
• Wheeze
• Cyanosis
• Chest pain
• Sputum
• Bad breath
3
Q
Respiratory system in kids vs adults
A
• Ethmoidal and maxillary sinuses present at birth
• Frontal (& sphenoidal) sinuses do not develop until 6-8 yrs old
• Normal to have enlarged tonsillar tissue in school age
4
Q
Infant airway
A
• shaped like a funnel narrowest point in cricoid airway
• swelling/obstruction has much higher resistance
• Infants have larger occiputs resulting in obstructed airways
• High risk for airway obstruction due to high laxicity from
underdeveloped cartilage & noncompliant chest wall
5
Q
Infants are nose breathers until…
A
• 6 months old and may result to nasal obstruction which can lead to respiratory distress
6
Q
FIRST SIGN OF RESPIRATORY DISTRESS?
A
- Tachypnea
nasal flaring
grunting
retractions
gasping for breath
7
Q
Assess breath sounds during first part of exam while calm
• Observe for adventitious breath sounds
A
rhonchi
stridor
wheezing
crackles
8
Q
FIRST SIGN OF RESPIRATORY DISTRESS?
A
- HYPOXIA can be seen through
- tachypnea, decreased alertness, & decreased activity
- RETRACTIONS when breathing more forcefully to fill lungs
- Can be defined as suprasternal, supraclavicular, subcostal, substernal, intercostal
9
Q
COUGH ASSESSMENT
A
• productive/nonproductive; helps to clear mucus
• Paroxysmal coughing refers to a series of expiratory coughs after a deep inspiration (common in whooping cough)
• Posttussive emesis (vomit after cough)
10
Q
refers to a series of expiratory coughs after a deep inspiration (common in whooping cough)
A
Paroxysmal coughing
11
Q
vomit after cough
A
Posttussive emesis
12
Q
RESTLESSNESS MIGHT BE FIRST SIGN OF…
A
• Obstruction
• Cyanosis
• late sign of respiratory distress in children
• Clubbing of finger (chronic respiratory illness)
• Elongated anterior-posterior diameter of the chest (alveolar hyperinflation)
13
Q
Lab Tests
- to assess acidosis
A
ABG
14
Q
Lab Tests
A
Nasopharyngeal culture
15
Q
Lab Tests
A
Sputum Culture
16
Q
DIAGNOSTIC PROCEDURES
A
• X-ray for areas of infiltration, foreign body, consolidation
• CT/MRI
• Pulmonary function tests (measures force of airflow and resistance
17
Q
What is the most common respiratory illness in children?
A
Asthma
Common Cold
18
Q
Emphasis on the following:
A
• Importance of hand washing, covering cough
• Flu vaccine if > 6 months
• Reduce exposure to 2nd hand smoke
19
Q
Treatment goal of respiratory illness in kids
A
• maintain or re-establish adequate oxygenation, ventilation, and hydration done by clearing the airway and loosening secretions
• saline spray
• moisten loosen mucus in nose
20
Q
HUMIDIFICATION
A
• warm/cold moisture added to air
• caution parents with warm humidifier can cause harm if child touchers it (burn)
• clean thoroughly (mold or bacterial growth)
• not used for those with asthma
21
Q
Humidification should not be used among?
A
• COPD patients
22
Q
Inhalation devices
A
• Nebulizer and metered dose inhalers; effective in aerosolized meds like bronchodilators, antibiotics, steroids
• Nebulizer: handheld; provide steam of air into respiratory tract covers nose & mouth
• Metered dose inhaler: mask and nose piece, young children resist due to mask over face (provide distraction)
23
Q
Inhaler Use
A
- Shake cannister
- Exhale deeply
- Activate inhaler
- Place in mouth as begin to inhale
- Take long, slow inhalation
- Hold breath 5-10 seconds
- (only 1 puff at a time w/ 1 min in btwn)
- (Need aerochamber w/ metered dose)
24
Q
• Used to remove mucus from lungs; stainless steel ball that moves when child
breathes in and out to
loosen mucus in
lungs to move up airway (thru vibrations) and expectorate
• Common in those with CF/pneumonia
A
Mucus clearing device (flutter device)
25
• Can relieve breathing distress
• Nasal cannula/Non Rebreather for emergency
• Must be humidified
• Is a drug; if too much is administered there could be negative effects (only provide as much needed, but still make sure they have CO2 drive)
Oxygen administration
26
• Changing child's position to help move mucus to initiate a cough reflex thus preventing mucus from pooling in an area
• Done through postural drainage, percussion, or vibration
• Best done before meals/1hr after meals to prevent vomiting
• What does chest PT help to prevent? Atelectasis and infection
Chest physiotherapy
27
CHEST PHYSIOTHERAPY
POSTURAL DRAINAGE
- position client to have gravity assist with clearing secretions
PERCUSSION
- striking cup or curved palm against chests (causes thumping but no pain)
VIBRATION
- vibrating hand during exhalation to loosen mucus;
- may be done by vibration vest or mechanical vibrator
• most commonly used in those with bronchiolitis & CF
• vibration is done during EXHALATION
28
a very common condition involving inflammation of the nasal passages and throat. It is another name for the common cold
NASOPHARYNGITIS
UPPER RESPIRATORY TRACT INFECTIONS IN CHILDREN
29
UPPER RESPIRATORY TRACT INFECTIONS IN CHILDREN
* NASOPHARYNGITIS
Assessment:
• nasal congestion
• watery rhinitis
• low grade fever
30
UPPER RESPIRATORY TRACT INFECTIONS IN CHILDREN
* NASOPHARYNGITIS
Treatment:
• no specific treatment
• saline nose drops or saline spray
• remove nasal mucus via bulb syringe
• cool mist vaporizer
31
is the inflammation of the mucous membranes of the oropharynx. In most cases, it is caused by an infection, either bacterial or viral. Other less common causes of it include allergies, trauma, cancer, reflux, and certain toxins.
PHARYNGITIS
UPPER RESPIRATORY TRACT INFECTIONS IN CHILDREN
32
Other less common causes of pharyngitis include
• allergies
• trauma
• cancer
• reflux
• certain toxins.
33
❖ Viral Pharyngitis
THERAPEUTIC MANAGEMENT:
• Warm heat applied to the external neck area using warm towel or heating pad
• Children: gargling with warm water
• Sufficient fluid to prevent dehydration for infants
34
• Back of thethroat and palatine tonsils are usually
markedly erytematous (bright red).
• Tonsils are enlarged and there may be white exudates in the tonsillar crypts.
• Petechiae may be present in the palate
• High fever with extremely sore throat
• Difficulty swallowing and overall lethargy
• Headache with swollen abdominal lymph nodes
• Presence of streptococcus bacteria on throat culture
❖ Streptococcal Pharyngitis
35
❖ Streptococcal Pharyngitis
MANAGEMENT:
MANAGEMENT
o Full 10 day course oforal antibiotic such as penicillin G or clindamycin
o Measures for rest, throat pain and maintenance of hydration.
o Cold or warm compress to the neck o warm saline gargles
o Cool liquids or ice chips
36
is inflammation of the tonsils. It's usually caused by a viral infection or, less commonly, a bacterial infection.
is a common condition in children, teenagers and young adults.
TONSILLITIS
37
The symptoms of tonsillitis include:
a sore throat and pain when swallowing.
38
TONSILLITIS
Therapeutic Management:
Therapeutic Management
• Antipyretic for fever, analgesic for pain
• Full 10 day course of antibiotic
• Tonsillectomy and Adenoidectomy
39
is characterized by a sudden onset of fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat and a runny nose.
The cough can be severe and can last 2 or more weeks.
SEASONAL INFLUENZA
40
INFLUENZA
Assessment:
• Assessment
o Dry throat and nasal mucosa, dry coughand hoarseness o Flushed face, myalgia, prostration with
o sudden onset of fever and chills
o Subglottal croup is common especially
o in infants
41
INFLUENZA
Therapeutic Management:
Therapeutic Management
• Symptomatic treatment: antipyretics,analgesic and fluids
• Avoid using aspirin as treatment
42
is inflammation or infection located in the middle ear.
OTITIS MEDIA
43
can occur as a result of a cold, sore throat, or respiratory infection
OTITIS MEDIA
44
OTITIS MEDIA
Therapeutic Management:
• Therapeutic Management
✓ Antibiotic:oralamoxicillin
✓ Myringotomy and tympanostomy
✓ Polyvalentpneumococcalpolysaccharidevaccine
✓ Bacterial polysaccharide immune globulin (BPIG)
✓ Relieve pain: acetaminophen, Ice compress placed on
affected ear
✓ Facilitatedrainage
✓ Preventcomplication
45
• Congenital obstruction of posterior nares by an obstructing membrane or bony
growth
• Prevents air from flowing through nose to nasopharynx
• unilateral or bilateral
• This is a problem as infants are obligatory nose breathers until 6 months)
CHOANAL ATRESIA
46
• clinical manifestations of choanal atresia:
respiratory distress immediately after birth
47
OTITIS MEDIA
Management:
✓ Management:
• surgical repair of obstruction/removal of bony growth
• IV fluid to maintain glucose levels
48
(nosebleed)
is one of the most common ear, nose, and throat (ENT) emergencies that present to the emergency room or primary care.
EPIXTASIS
49
There are two types of nosebleeds:
• anterior (more common)
• posterior (less common, but more likely to require medical attention).
50
EPIXTASIS
Therapeutic Management
THERAPEUTIC MANAGEMENT:
• place on upright position with head tilted slightly forward
• apply pressure to the sides of the nose with fingers
• epinephrine (1:1000) may be appied to the bleeding site
• nasal pack may be applied
51
is a congenital softening of the tissues of the
larynx (voice box) above the vocal cords. This is the most common cause of noisy
breathing in infancy. The laryngeal structure is malformed and floppy, causing the tissues to fall over the airway opening and partially block it.
CONGENITAL
LARYNGOMALACIA / TRACHEOMALACIA
52
CONGENITAL
LARYNGOMALACIA / TRACHEOMALACIA
Therapeutic Management:
• Feed slowly; provide rest periods as needed
• Assess for signs of upper respiratory infection
• Condition improves as cartilage in the larynx becomes stronger at about 1 year of age
53
is characterized by a "seal-like barking" cough, stridor, hoarseness, and difficulty breathing, which typically becomes worse at night.
CROUP SYNDROMES
54
Other symptoms of CROUP SYNDROMES
Other symptoms include
• fever and dyspnea, but the absence of fever should not reduce suspicion for croup.
55
the most common etiology for hoarseness, cough, and onset of acute stridor in febrile children
CROUP
56
Alternative names of COUP
• Acute laryngotracheitis
• Acute laryngotracheobronchitis,
57
CROUP generally affects the:
croup generally affects the LARYNX and TRACHEA, although this illness may also extend to the bronchi.
58
CAUSES of Croup Syndromes
• Viruses
• Parainfluenza Viruses (types 1, 2, 3)
• Mycoplasma pneumoniae
59
Clinical Manifestations of Croup Syndromes:
• Coryza
• Fever - 38-39C but can exceed to 40C
• Respiratory Symptoms
• Spasmodic Croup
60
CROUP SYNDROMES
Management:
• Corticosteroid
• Epinephrine
61
Nursing treatment for a child with croup must focus on:
• Humidified air
• Antipyretics
• Fluid intake
• Education on smoking
• Head elevation
• Decreasing anxiety
• Vital signs monitoring
• Cool mist administration
62
an inflammation of the vocal fold mucosa and larynx that lasts than 3 weeks.
When the etiologlessy of this disease is infectious, white blood cells remove microorganisms during the healing process. The vocal folds then become more edematous, and vibration is adversely affected.
ACUTE LARYNGITIS
63
Viruses are the usual offending agents and principal complaint is hoarseness, which may be accompanied by an upper respiratory infection (coryza, sore throat, nasal congestion) and systemic manifestations.
ACUTE LARYNGITIS
64
an invasive exudative bacterial infection of the soft tissues of the trachea. In some cases, there is involvement of the subglottic laryngeal structures, extension into the upper bronchial tree, or associated pneumonia.
BACTERIAL TRACHEITIS
65
BACTERIAL TRACHEITIS
s/sx
3-5 yrs old
• fever
• barky cough
• stridor
Look similar to epiglottis/croup BUT toxic appearing
66
Therapeutic Management and Nursing Considerations:
BACTERIAL TRACHEITIS
1. humidified oxygen
2. antipyretics
3. antibiotics
4. severe: endotracheal suctioning
67
happens when the epiglottis — a small cartilage "lid" that covers the windpipe — swells. The swelling blocks the flow of air into the lungs.
EPIGLOTTIS
68
Cause of Epiglottis:
Cause
• Unvaccinated Child (Hemophilus Influenza B
• Defective decision by parents
69
Clinical Picture of EPIGLOTTIS
Clinical Picture
• Dyspnea (Respiratory Distress)
• Muffled Voice
• Dysphagia/Odynophagia – drooling
• Inspiratory Stridor
• Tripod position
• Airway obstruction – detains the CO2 - respiratory acidosis
• It’s an emergency - DEATH
70
Management of EPIGLOTTIS
Management
⃝ Don’t examine the throat
⃝ Don’t give oral fluids
⃝ Do a lateral x-ray
⃝ Delight the kid (keep him/her comfortable and quiet
⃝ Dial the anesthesiologist
⃝ Drive the airway open via endotracheal intubation or
tracheostomy (examine after securing the airway (cherry red
epiglottis
⃝ ThirD generation cephalosporin (Ceftriaxone)
⃝ Dexamethasone
⃝ HumiDified air
⃝ ADminister Oxygen
71
Many factors can cause the epiglottis to swell.
These factors include infections,
• burns from hot liquids and
• injuries to the throat.
72
is an infection of the main airways of the lungs (bronchi), causing them to become irritated and inflamed.
BRONCHITIS
73
Main symptom of BRONCHITIS
cough, which may bring up yellow-grey mucus (phlegm).
74
Bronchitis may also cause
• sore throat
• wheezing
75
BRONCHITIS
Assessment:
Assessment
• Dry hacking cough, nonproductive that worsens at night
• Cough becomes productive in 2 to3 days
76
BRONCHITIS
Therapeutic Management:
Therapeutic Management
• Antipyretics, analgesics and humidity
• Cough suppressants
77
causes infections of the lungs and respiratory tract. It's so common that most children have been infected with the virus by age 2.
RESPIRATORY SYNCYTIAL VIRUS AND BRONCHIOLITIS
78
common respiratory virus that usually causes mild, cold-like symptoms
RESPIRATORY SYNCYTIAL VIRUS
79
RSV
s/sx
• coughing
• sneezing or runny nose
• decrease in appetite
• fever
80
RSV
Assessment:
ASSESMENT:
1. rhinorrhea and low grade fever
2. otitis media and conjunctivitis
3. cough develops:
4. chest radiographs: hyperaeration and areas
ofconsolidation which is difficult todifferentiate from
bacterial pneumonia
5. apnea
6. Severe: rise in arterial carbon dioxide tension(hypercapnia)-respiratory acidosis and hypoxemia
81
RSV
Signs and Symptoms:
Signs and Symptoms
a) INITIAL: rhinorrhea, pharyngitis, coughing/sneezing, wheezing, possible ear or eye drainage, intermittent fever
b) WITH PROGRESSION OF ILLNESS: increased coughing and wheezing, air hunger, tachypnea and retractions, cyanosis
c) SEVERE ILLNESS : tachypnea greater than70 breaths per minute, listlessness, apneic spells, poor air exchange; poor breath sounds
82
RSV
Therapeutic Management and Nursing Considerations:
Therapeutic Management and Nursing Consideration
• High humidity, adequate fluid intake, oxygen mist and rest
• Ribavirin (an oral antiviral medication)
• Prevention: RSV immune globulin (RSV-IGIV), Monoclonal
Antibody, Palivizumab
• 4 Prophylaxis recommendations:
o Infants born 32 and 35 weeks gestation if they are younger
than 6 months of age
o infants who have two or more additional risk factors:
- school-age siblings
- crowding in the home
- day care attendance
• Exposure to tobacco smoke in the home: children who are 24 months of age or younger
• Infection control measures
83
condition in which your airways narrow and swell and may produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when you breathe out and shortness of breath.
ASTHMA
84
an immediate hypersensitivity (type I) response, is the most common chronic illness in children, accounting for a large number of days of absenteeism from school and many hospital admissions each year.
ASTHMA
85
It tends to occur initially before 5 years of age, although in these early years it may be diagnosed
as frequent occurrences of bronchiolitis rather than asthma.
ASTHMA
86
The condition may be intermittent, with symptom- free periods, or chronic, with continuous symptoms.
ASTHMA
