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Peds > Chapter 40: Nursing Care of the Child with an Alteration in Gas Exchange/Respiratory Disorder > Flashcards

Chapter 40: Nursing Care of the Child with an Alteration in Gas Exchange/Respiratory Disorder Flashcards

Exam 2

1
Q

What must be done to prevent life threatening complications?

A

Must detect problems and intervene early to prevent life-threatening complications

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2
Q

The most common causes of illness and hospitalization in children

A

Alterations in gas exchange (respiratory disorders) are the most common causes of illness and hospitalization in children

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3
Q

What accounts for the majority of acute illnesses in children

A

Respiratory infections account for the majority of acute illnesses in children

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4
Q

What can influence both the development of respiratory disorders and the course of the illness?

A

Age, socioeconomic status, and general health status can influence both the development of respiratory disorders and the course of the illness

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5
Q

Age, socioeconomic status, and general health status can influence both the development of respiratory disorders and the course of the illness

What is an example?

A

E.g. low-income children have a higher risk for increased severity or increased frequency of respiratory disease

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6
Q

What is key to solving respiratory problems?

A

Expert assessment skills and early intervention are key

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6
Q

Anatomy and Physiology of the Child’s Nose and Throat:

Infant Nose:

How do infants breath?

How much mucus made?

What are they susceptible to?

What are not developed?

A

Obligate/preferential nose breathers
Produce very little mucus
More susceptible to infections
Sinuses are not developed

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7
Q

Anatomy and Physiology of the Child’s Nose and Throat:

Newborn Nose:

A

Very small nasal passages

More prone to obstruction

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8
Q

Anatomy and Physiology of the Child’s Nose and Throat

Throat- What are children at increased risk for?

A

Increased risk for airway obstruction

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9
Q

Anatomy and Physiology of the Child’s Nose and Throat

Throat- Why are children at increased risk for obstruction?

A

Infants’ tongues larger in relation to oropharnyx

Children have enlarged tonsilar and adenoid tissue

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10
Q

Lower Respiratory Structures include

A

Bifurcation of trachea

Narrower bronchi and bronchioles

Smaller numbers of alveoli

Airway much more compliant

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11
Q

Lower Respiratory Structures:

Bifurcation of trachea

A

Bifurcation of trachea at level of the third thoracic vertebra compared to 6th in adults: important when suctioning or intubating children

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12
Q

Lower Respiratory Structures:

Narrower bronchi and bronchioles increased risk for?

A

Narrower bronchi and bronchioles of infants and children: increased risk for lower airway obstruction

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13
Q

Lower Respiratory Structures:

Smaller numbers of alveoli: puts children at increased risk for ?

A

Smaller numbers of alveoli: higher risk of hypoxemia

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14
Q

Lower Respiratory Structures:

Airway much more compliant- puts children at increased risk for ?

A

Airway much more compliant- making it more susceptible to collapse in presence of airway obstruction.

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15
Q

Chest Wall:

How are infant chest walls? How do they support the lungs?

A

Infants’ chest walls are highly compliant (pliable) and fail to support the lungs adequately.

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16
Q

Chest Wall:

How is functional residual capacity?

A

Functional residual capacity can be greatly reduced if respiratory effort is diminished

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17
Q

Chest Wall:

What does lack of lung support lead to?

A

This lack of lung support also makes the tidal volume of infants and toddlers almost completely dependent upon movement of the diaphragm.

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18
Q

Metabolic Rate and Oxygen Need:

How does children metabolic rate compare to adult?

A

Children have a significantly higher metabolic rate than adults

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19
Q

Chest wall

If diaphragm movement is impaired what happens?

A

If diaphragm movement is impaired (as in states of hyperinflation, such as asthma), the intercostal muscles cannot lift the chest wall and respiration is further compromised.

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20
Q

Metabolic Rate and Oxygen Need:

How RR of children than adult?

A

Resting respiratory rates are faster and their demand for oxygen is higher.

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21
Q

Metabolic Rate and Oxygen Need:

How does child oxygen consumption compare to adult?

A

Adult oxygen consumption is 3 to 4 L/min, while infants consume 6 to 8 L/min.

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22
Q

Metabolic Rate and Oxygen Need:

In respiratory distress how are children compared to adults?

A

In any situation of respiratory distress, infants and children will develop hypoxemia more rapidly than adults

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23
Q

Risk Factors for Respiratory Disorders:

A

Prematurity

Chronic illness (diabetes, sickle cell anemia, cystic fibrosis, congenital heart disease, chronic lung disease)

Developmental disorders (cerebral palsy)

Passive exposure to cigarette smoke

Immune deficiency

Crowded living conditions or lower socioeconomic status

Daycare attendance

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24
Q

Nursing Assessment for Child with Respiratory Distress:

A

Health history

Physical exam

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25
Q

Nursing Assessment for Child with Respiratory Distress:

Health history includes:

A

PMH, FH, Hx present illness, immunization hx, exposure to smoke

Atopy

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26
Q

Atopy

A

genetic tendency to:
Asthma
Allergic rhinitis
Atopic dermatitis

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27
Q

Nursing Assessment for Child with Respiratory Distress

Physical exam

A

Inspection and observation

Palpation

Percussion

Auscultation

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28
Q

Inspection and Observation

A

Anxiety and restlessness
Color: pallor, cyanosis
Hydration status
Clubbing
Breath sounds

Rate and depth of respirations: tachypnea
Respiratory effort
Nose and oral cavity
Cough and other airway noises: stridor

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29
Q

Adventitious Breath Sounds include:

A

Wheezing

Rales

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30
Q

Adventitious Breath Sounds:

Wheezing

A

High-pitched sound usually heard on inspiration; sometimes on expiration

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31
Q

Adventitious Breath Sounds:

Wheezing
What does it occur with?

A

May occur with obstruction in lower trachea or bronchioles

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32
Q

Adventitious Breath Sounds:

Wheezing- What does it occur in?

A

May occur in asthma or viral infections

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33
Q

Adventitious Breath Sounds

Rales

A

Crackling sounds heard when alveoli become fluid filled

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34
Q

Adventitious Breath Sounds

Rales- What does it occur with?

A

May occur with pneumonia

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35
Q

Percussion- What are the things?

A

Normal/resonant

Flat or dull sounds

Tympany

Hyperresonant

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36
Q

Percussion:

Normal=

A

Normal= resonant- low pitched, hollow

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37
Q

Percussion:

Flat or dull sounds might be percussed where?

A

Flat or dull sounds might be percussed over partially consolidated lung tissue, as in pneumonia

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38
Q

Percussion- Tympany

A

Hollow drum sound- might be percussed with a pneumothorax

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39
Q

Percussion- hyperresonance

What may it be apparent for?

A

Note the presence of hyperresonance (as might be apparent with asthma).

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40
Q

Laboratory and Diagnostic Tests :

A

Pulse oximetry:

Chest radiograph

Blood gases:

Nasal-pharyngeal washings:

Rapid strep

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41
Q

Laboratory and Diagnostic Tests :

How is pulse ox?

A

Pulse oximetry: oxygen saturation might be decreased significantly

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42
Q

Laboratory and Diagnostic Tests :

Chest radiograph:

A

might reveal hyperinflation and patchy areas of atelectasis or infiltration

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43
Q

Laboratory and Diagnostic Tests :
Blood gases:

A

might show carbon dioxide retention and hypoxemia

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44
Q

Laboratory and Diagnostic Tests

Nasal-pharyngeal washings:

A

positive identification of RSV or other viral illness via enzyme-linked immunosorbent assay (ELISA) or immunofluorescent antibody (IFA) testing

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45
Q

Laboratory and Diagnostic Tests

Rapid strep

A

testing via throat swab

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46
Q

Common Medical Treatments:

A

Oxygen
High humidity
Suctioning
Chest physiotherapy and postural drainage
Saline gargles or lavage
Mucolytic agents
Chest tubes
Bronchoscopy

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47
Q

Acute Infectious Disorders

A

Common cold
Sinusitis

Influenza

Pharyngitis, tonsillitis

Laryngitis

Croup syndromes

Pneumonia and bronchitis

Infectious mononucleosis

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48
Q

Acute Infectious Disorders

Common cold

A

– viral URI or nasopharyngitis; eg, Respiratory syncytial virus (RSV);

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49
Q

Acute Infectious Disorders:

Sinusitis

A

Sinusitis – bacterial; acute or chronic

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50
Q

Acute Infectious Disorders: Influenza

A

Influenza – viral infection; ‘the flu’; bacterial infections may follow

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51
Q

Acute Infectious Disorders:

Pharyngitis, tonsillitis–

A

often viral

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52
Q

Acute Infectious Disorders:

Laryngitis

A

Laryngitis – inflammation of larynx

53
Q

Acute Infectious Disorders:

Infectious mononucleosis

A

–caused by Epstein-Barr virus;

‘kissing disease’, often in adolescence;

spleen rupture, Guillain-Barre syndrome; meningitis

54
Q

Nursing Management of Epiglottitis:

What is often the cause of Epiglottitis?

How common is it and why?

A

Most often caused by Haemophilus influenza type b;

become more rare with Hib vaccine

55
Q

Signs and Symptoms of Bronchiolitis (RSV)

A

Onset of illness with a clear runny nose (sometimes profuse)

Pharyngitis

Low-grade fever

Development of cough 1 to 3 days into the illness, followed by a wheeze shortly thereafter

Poor feeding

56
Q

Nursing Management of Epiglottitis:

What should you not do?

A

Attempt to visualize the throat - larygnospasm

Leave the child unattended

Place the child in a supine position

57
Q

Nursing Management of Epiglottitis:

What should you do?

A

Provide 100% oxygen in the least invasive manner

Ensure tracheostomy tray and emergency equipment readily available

58
Q

Nursing Management of Epiglottitis:

CLINICAL REASONING ALERT!
What is Epiglottitis characterized by?

A

Epiglottitis is characterized by dysphagia, drooling, anxiety, irritability, and significant respiratory distress.

59
Q

Nursing Management of Epiglottitis:

CLINICAL REASONING ALERT!

WHat should you prepare for?

A

Prepare for the event of sudden airway occlusion.

60
Q

Chronic Respiratory Disorders:

A

Allergic rhinitis

Asthma

Chronic lung disease

Cystic Fibrosis

Apnea

61
Q

Chronic Respiratory Disorders:

Allergic rhinitis- What is it associated with?

A

Associated with asthma and atopic dermatitis

62
Q

Chronic Respiratory Disorders:

Asthma

A

Chronic inflammatory airway disorder

63
Q

Chronic Respiratory Disorders:

Chronic lung diseases aka bronchopulmonary dysplasia

A

infants who had RSD and require O2 past 28 days

64
Q

Chronic Respiratory Disorders:

Apnea- and what accompanies it?

A

absence of breathing for more than 20 seconds; may be accompanied by bradycardia

65
Q

Chronic Respiratory Disorders:

Apnea-What are the three types

A

Central

Occurs with other illnesses

Apnea of prematurity

66
Q

Chronic Respiratory Disorders:

Central Apnea

A

unrelated to another cause

67
Q

Chronic Respiratory Disorders:

Apnea of prematurity- What is it a precursor for?

A

SIDs;

caffeine- theophylline

68
Q

Pneumonia—Laboratory and Diagnostic Tests

Pulse oximetry:

A

Pulse oximetry: oxygen saturation might be decreased significantly or within normal range

69
Q

Pneumonia—Laboratory and Diagnostic Tests

Chest x-ray

A

Chest x-ray: varies according to child age and causative agent

70
Q

Pneumonia—Laboratory and Diagnostic Tests

WBC count

A

White blood cell count: might be elevated in the case of bacterial pneumonia

70
Q

Pneumonia—Laboratory and Diagnostic Tests

Sputum culture:

A

may be useful in determining causative bacteria in older children and adolescents

71
Q

Cystic Fibrosis—Laboratory and Diagnostic Tests

Sweat chloride test:

A

considered suspicious if the level of chloride in collected sweat is above 50 mEq/L and diagnostic if the level is above 60 mEq/L

72
Q

Cystic Fibrosis—Laboratory and Diagnostic Tests

Pulse oximetry:

A

oxygen saturation might be decreased, particularly during a pulmonary exacerbation

73
Q

Cystic Fibrosis—Laboratory and Diagnostic Tests

Chest Radiograph

A

Chest radiograph: might reveal hyperinflation, bronchial wall thickening, atelectasis, or infiltration

74
Q

Cystic Fibrosis—Laboratory and Diagnostic Tests

Pulmonary function tests:

A

might reveal a decrease in forced vital capacity and forced expiratory volume, with increases in residual volume

75
Q

Risk Factors for Tuberculosis

A

TB

HIV infection

Incarceration

Positive recent history of latent TB infection

Immigration or travel to endemic countries

Exposure at home to HIV infected or homeless persons, illicit drug users, persons recently incarcerated, migrant farm workers, or nursing home resident

76
Q

Asthma

A

Chronic inflammatory airway disorder- most common chronic illness of childhood

77
Q

What is the most common chronic illness of childhood?

A

Asthma

78
Q

Asthma - symptoms

A

Airway hyperresponsiveness
Airway edema
Mucus production
Results in airway obstruction that might be partially or completely reversed

79
Q

Asthma- how do symptoms occur in people?

A

Some have long periods of control with infrequent exacerbations others have presence of persistent daily symptoms

80
Q

Asthma Incidence & severity increasing -is caused by

A

environment

81
Q

Asthma: Therapeutic Management

A

Allergens or triggers
Comorbid conditions
“Stepwise” approach –increasing meds as they worsen, backing offtx as they improve
Medications

82
Q

BOX40.3Stepwise Approach to Asthma Management

How many steps?

A

6 steps

83
Q

BOX40.3Stepwise Approach to Asthma Management

What occurs at every step?

A

All children: child education, environmental control, and management of comorbidities at each step.

84
Q

BOX40.3Stepwise Approach to Asthma Management

When should you consider referral for asthma specialist?

A

Consider referral to asthma specialist at step 3.

85
Q

BOX40.3Stepwise Approach to Asthma Management

Step 2 and above are considered what?

A

(Step 2 and above are persistent asthma.

86
Q

Slide 24 read if time?

A

Probs no time

87
Q

Asthma Management: How is management decided?

A

Tiered system of therapy: based on Asthma Severity Classification

88
Q

Asthma Management

What are rescue meds?

A

Rescue medicine: short-acting bronchodilators

89
Q

Asthma Management

What are maintenance meds?

A

Leukotriene modifiers
Inhaled corticosteroids
Long-acting bronchodilators

90
Q

Lab and Diagnostic Tests for Asthma

Pulse oximetry:

A

oxygen saturation may be decreased significantly or normal during a mild exacerbation.

91
Q

Lab and Diagnostic Tests for Asthma:

Chest radiograph:

A

Chest radiograph: usually reveals hyperinflation.
\

92
Q

Lab and Diagnostic Tests for Asthma

Blood gases:

A

Blood gases: might show carbon dioxide retention and hypoxemia.

93
Q

Lab and Diagnostic Tests for Asthma:

Pulmonary function tests (PFTs):

A

Pulmonary function tests (PFTs): can be very useful in determining the degree of disease but are not useful during an acute attack. Children as young as 5 or 6 years might be able to comply with spirometry.

94
Q

Lab and Diagnostic Tests for Asthma:

Peak expiratory flow rate (PEFR):

A

Peak expiratory flow rate (PEFR): is decreased during an exacerbation.

95
Q

Lab and Diagnostic Tests for Asthma:

Allergy testing:

A

skin test or RAST can determine allergic triggers for the asthmatic child.

96
Q

What is Asthma Action Plan? What does it do?

A

Education of child and family

Management plan
Maintenance medications
Age-appropriate spacer or holding chamber with meter-dose inhalers

It also provides guidance on when to call healthcare provider or when to go to the emergency room

97
Q

Asthma Action Plan:

What does it show?

A

Written, individualized worksheet that shows you the steps to take to keep asthma from getting worse.

98
Q

Cystic Fibrosis: What kind of disorder is it?

A

Autosomal recessive disorder

99
Q

Cystic Fibrosis: What is the mutation that causes disease?

A

Cystic fibrosis transmembrane conductance regulator (CFTR) mutation results in problems in exocrine glands

100
Q

Cystic Fibrosis- What occurs during it?

What decreases with it?

A

Excess thick, tenacious mucus lining airways causing decreased resistance to infection and air trapping

Decreased pancreatic enzymes and hypersecretion of gastric acids

101
Q

Cystic Fibrosis Treatment

A

Chest physiotherapy (multiple times daily)

Inhaled dornase alfa (pulmonary enzyme)

Inhaled antibiotics for exacerbation

Pancreatic enzyme supplementation

ADEK vitamin supplementation

Well-balanced, high-calorie, high-protein diet

102
Q

Providing Oxygen Supplementation:

What does it require?

Types of ways oxygen is given?

A

Requires MD or NP order, exception for emergencies – follow policy

Simple mask
NC
Oxygen tent

103
Q

Providing Oxygen Supplementation:

CLINICAL REASONING ALERT!

A

Monitor vital signs, color, respiratory effort, pulse oximetry, and level of consciousness before, during, and after oxygen therapy to evaluate its effectiveness.

104
Q

Alternatives to Traditional Mechanical Ventilation

A

High frequency oscillators

Nitric oxide inhalation

Perfluorocarbon liquid

Extracorporeal membrane oxygenation (ECMO)

105
Q

Alternatives to Traditional Mechanical Ventilation

High frequency oscillators

A

Provide respiratory rates up to 1200 bpm with low tidal volume

106
Q

Alternatives to Traditional Mechanical Ventilation: Nitric oxide inhalation

A

Inhaled nitric oxide gas, causes vasodilation to increase blood flow to alveoli

107
Q

Alternatives to Traditional Mechanical Ventilation: Per fluorocarbon liquid

A

Acts like a surfactant;

Provides improved gas exchange

108
Q

Alternatives to Traditional Mechanical Ventilation:

Extracorporeal membrane oxygenation (ECHO)

A

Blood is removed from the body, warmed, oxygenated and returned to the patient via pump.

109
Q

Nursing Care Posttonsillectomy

What should you do?

A

Promoting airway clearance:

Maintaining fluid volume

Relieving pain:

110
Q

Nursing Care Posttonsillectomy

How to promote airway clearance?

A

Promoting airway clearance: place child in side-lying or prone position

111
Q

Nursing Care Posttonsillectomy

How to maintain fluid volume

A

Discourage coughing

Encourage fluids; avoid citrus, brown, or red fluids

112
Q

Nursing Care Posttonsillectomy

How to relieve pain?

A

Relieving pain: ice collar and analgesics with or without narcotics

113
Q

Nursing Care Posttonsillectomy:

What may indicated bleeding

A

*Frequent swallowing may indicate bleeding.

114
Q

Acute Noninfectious Respiratory Disorders include:

A

Epistaxis

Foreign body aspiration

Acute respiratory distress syndrome

Pneumothorax

115
Q

Acute Noninfectious Respiratory Disorders: Epistaxis

A

Bloody nose

116
Q

Acute Noninfectious Respiratory Disorders: Epistaxis

Where does it usually occur? How does it occur?

A

Often in the anterior portion of the septum

Can be recurrent and idiopathic

117
Q

Acute Noninfectious Respiratory Disorders: Foreign body aspiration

A

solid or liquid substance inhaled in reparatory tract

Small objects smaller than diameter of their airway

Items smaller than 1.25 inch -Toilet paper roll

118
Q

Acute Noninfectious Respiratory Disorders: Acute Respiratory distress

When can it occur?

A

May follow another illness or insult

119
Q

Acute Noninfectious Respiratory Disorders: Acute Respiratory distress

HOw?

A

Pulmonary edema–> mucosal swelling–> atelectasis –> impaired gas exchange

120
Q

Acute Noninfectious Respiratory Disorders: Pneumothorax

A

Collection of air in the pleural space

121
Q

Acute Noninfectious Respiratory Disorders: Pneumothorax

What occurs in this disorder? What is treatment

A

Trapped air consumes space in pleural cavity and affected lung may suffer partial or total collapse

Needle aspiration or chest tube

122
Q

Pneumothorax: Risk factors:

A

Chest trauma or surgery

Intubation and mechanical ventilation

History of chronic lung disease such as cystic fibrosis

123
Q

Pneumothorax: Signs and symptoms

A

Chest pain

Signs of respiratory distress:
Tachypnea
Retractions
Nasal flaring
Grunting

124
Q

Pneumothorax: Signs and symptoms of respiratory distress

A

Signs of respiratory distress:
Tachypnea
Retractions
Nasal flaring
Grunting

125
Q

Tracheostomy

A

Artificial opening in the airway

126
Q

What are tracheostomies performed for?

A

Tracheostomies are performed to relieve airway obstruction, such as with subglottic stenosis (narrowing of the airway sometimes resulting from long-term intubation)

127
Q

Who are tracheostomies used in?

A

Used in child who requires chronic mechanical ventilation

128
Q

Tracheostomy: What does it facilitate?

A

The tracheostomy facilitates secretion removal, reduces work of breathing, and increases the child’s comfort.

Peds (15 decks)

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