Chapter 45 Respiratory Conditions Flashcards
1
Q
What factors impact the rate and severity of respiratory infections in children?
A
- Type of infectious agent
- Age
- Size
- Resistance
- Seasonal variations
2
Q
What ages are the most susceptible to infections?
A
Between 3-6 months. They are developing their own immunity during this time.
Newborns get passive immunity from birth to 3 months.
3
Q
True or False? Children may get as many as 8-10 colds per year before the age of 2.
A
True
4
Q
How does too much or too little mucous impact respiratory conditions?
A
Too much mucous= risk of airway obstruction
Too little mucous= higher risk of contracting infection
5
Q
How does the size of a child’s respiratory tract impact influence their response to respiratory conditions?
A
Their anatomy is shorter compared to an adult. It is easier for organisms to reach the respiratory tract and cause infection. A smaller airway diameter increases risk of airway obstruction and increased secretions
6
Q
What immune system deficiencies or conditions place a child at risk for infection?
A
Anemia, malnutrition, fatigue, allergies, preterm birth, asthma, previous RSV infection, BPD, cardiac anomalies, CF, crowded places (daycare) and exposure to smoking
7
Q
What seasons increase the rate of respiratory infections?
A
spring and winter
8
Q
Which age range has the most severe reactions to respiratory illness
A
6 months-3 years
9
Q
What is a normal ABG pH range?
A
7.35-7.45
10
Q
What is a normal ABG PaCO2 range?
A
35-45 mmHg
11
Q
What is a normal HCO3 range?
A
22-26 mEq/litre
12
Q
What componenets make up the Upper respiratory tract?
A
Ears, mouth, nose, throat
Oronasopharynx, pharynx
Larynx, upper trachea
Epiglottis
13
Q
What componenets make up the Lower respiratory tract?
A
Lower trachea, bronchi
Bronchioles, alveoli
14
Q
Upper Airway abnormal Breath Sounds
A
Stridor [typically inspiration]
Barking cough
hoarseness
15
Q
Lower Airway abnormal Breath Sounds
A
Wheezing
[typically expiration]
Prolonged expiratory phase
16
Q
Lung Tissue Disease abnormal Breath Sounds
A
Grunting
Crackles
Decreased breath sounds
17
Q
Methods to help ease respiratory effort
A
Increase HOB, chest physio, suction, cool/warm mist humidifier (note that warm has more bacteria transmission), O2, IV fluids if dehydrated, medications to ease breathing effort (no cold meds under age 6, only supportive care)
18
Q
Why is lethargy a concern in respiratory illnesses?
A
lethargy even after resting indicates worsening condition. If the child is cranky and alert (still may be uncomfortable) this is a better sign
19
Q
What is a normal urine output for children?
A
1-2ml/kg/hr
20
Q
Name 6 of the major Upper respiratory infections
A
- Nasopharyngitis (common cold)
- Influenza
- Otitis Media
- Infectious Mononucleosis
- Strep throat
- Tonsillitis
21
Q
What is the common cause of Nasopharyngitis?
A
Virus: RSV, rhinovirus, adenovirus, influenza, and parainfluenza viruses
22
Q
What are the normal symptoms that appear with Nasopharyngitis?
A
Fever varies with the age of the child, irritated, restless, vomiting/diarrhea, dry nose and throat, sneezing, muscle ache, thick green mucous
23
Q
What is the routine management for Nasopharyngitis?
A
- Symptomatic care
- Treated at home: not recommended to medicate with cold products because they are meant to dry out secretions but can have more side effects
- Teach families signs of complications
24
Q
What are signs of respiratory complications and distress in children 3 months or younger?
A
- Trouble breathing,
- Not eating and/or vomiting
– Fever
25
What temperature classifies as a fever?
temperature of 38.5°C or higher
26
What are signs of respiratory complications and distress in children of all ages:?
– tachypnea and increased WOB
– Has blue lips (cyanosis)
- Coughing that leads to choking or vomiting
– Wakes in the morning with one or both eyes stuck shut with dried yellow pus
– Is much sleepier than usual, doesn’t want to feed or play, or is very fussy and cannot be comforted, or
– Has thick or coloured (yellow, green) discharge from the nose for more than 10 to 14 days.
27
What is the most common cause of Strep Throat?
GABHS infection (Group A β-hemolytic streptococcus)
28
What are children with GABHS at risk for developing?
Rheumatic Fever (inflammation of joints, heart, and CNS) and Acute glomerulonephritis (kidney inflammation)
29
What symptoms appear with GABHS
Similar to nasopharyngitis with the addition of rash, abdominal pain, inflamed tonsils, tongue/uvula is edematous and red, pain or difficulty swallowing
30
How is GABHS detected and treated
- Clinical manifestations subside in 3-5 days
- Diagnostic evaluation from throat swab (80-90% are viral)
- Treated with penicillin, Antibiotic for 24 hours (Go to ER if severe symptoms continue).
- Replace anything like toothbrush that has the strep
31
True or False? GABHS is contagious
True. Infectious at the onset of symptoms and 24 hours after antibiotic therapy
32
What is tonsilitis?
Inflammation of the tonsils causing difficulty swallowing and breathing
33
What causes Influenza?
Caused by orthomyxoviruses
Types A, B (epidemic disease) and C (milder disease)
34
What is Otitis Media (OM)?
Inflammation of middle ear with infection (AOM) or without infection (OME, MME)
35
Risks factors for Otitis Media
Cleft palate, upper respiratory infection, being fed laying down (fluids moving in a way that can lead to infection), school or being around lots of people
36
At what ages do most children get Otitis Media?
Most occur in the first 24 months of life
Increase again in the ages of 4-6 when the child goes to school
37
Why does smoking worsen Otitis Media?
Prolong inflammatory response by enhancing the attachment of pathogens that cause otitis to the respiratory epithelium in the middle ear
38
Symptoms, treatment, prevention of OM
- Ear pain, drainage, fever, restless, touches ear often, loss of appetite, Chronic symptom: hearing impairment
- Management: monitoring, antibiotics for severe infection or surgical treatment for drainage or Eustachian tubes
- Prevention: using Pneumococcal 13-valent conjugate vaccine
39
What causes Infectious Mononucleosis and how long does it last?
Epstein-Barr virus (EBV) is the principal cause of infectious mononucleosis
through Contact with saliva (mildly contagious)
- Incubation period roughly 30 days and diagnosed via blood test with no specific treatment
- May last up to 3 months
40
What are the characteristic symptoms of Croup Syndromes?
Hoarseness, resonant “barking” or “brassy” cough, inspiratory stridor, and varying degrees of respiratory distress
41
Names 4 types of Croup Syndromes?
Acute epiglottitis, Acute laryngotracheobronchitits (LTB), Acute spasmodic laryngitis, and Bacterial tracheitis
42
What symptoms are seen in Acute Epiglottitis?
- Sore throat pain
- DROOLING, difficulty swallowing (inability to close their mouth)
- Inspiratory STRIDOR, mild hypoxia, distress
- Thick muffled voice due to inflammation
- Retractions
- TRIPOD positioning
43
How is Acute epiglottitis managed?
- Prevention progress of respiratory obstruction
- Intubation or tracheostomy
- Antibiotics
- Keep child in comfortable position
44
True or False? When a child is suspected to have epiglottitis the nurse should attempt to visualize the epiglottis.
False. Visualization of the epiglottis should not be done by a nurse. Children with suspected epiglottitis should only be examined in a setting where emergency personnel are ready to intubate in case of further obstruction.
45
What is Acute laryngotracheobronchitits (LBT)?
- Most common
- Characterized by GRADUAL onset of:
Low grade fever
Inspiratory stridor
Suprasternal retractions
Barky, brassy “seal-like” cough, hoarseness
Increasing respiratory distress and hypoxia
46
What are complications of Acute laryngotracheobronchitits (LTB)?
Can progress to respiratory acidosis, respiratory failure, and death. The obstruction is severe enough to prevent adequate ventilation and exhalation of carbon dioxide
47
How is treatment for LTB different from epiglottitis?
-Both airway management, fluids, and reassurance
- LBT includes corticosteroids, humidified O2
48
How is acute spasmodic laryngitis different from epiglottitis and LTB?
Paroxysmal (any sudden, uncontrollable outburst; a fit of emotion or action) attacks of laryngeal obstruction
Occur mostly at night- sit outside to breathe cold air to stop the cough
Child usually feels well the following day
49
What is Bacterial tracheitis?
Infection of mucosa of the upper trachea causing airway obstruction and secretions
50
How is Bacterial tracheitis treated?
Antipyretics
Antibiotics
May require intubation
51
What are 3 common lower respiratory conditions?
- RSV and bronchiolitis
- Pneumonias
- Bronchitis
52
What is Bronchitis?
- Inflammation of large airways (trachea and bronchi)
- Symptom management (humidity), No antibiotics since its generally viral \
- Clinical manifestations last 5-10 days
- Can be seen more in Ages 4-5
53
What is bronchiolitis
- Acute viral infection with upper respiratory symptoms and lower respiratory infection of the bronchioles due to inflammation
- Caused by respiratory syncytial virus (RSV)
54
Symptoms of RSV
- Similar to pharyngitis with addition of:
- wheezing, ear/eye drainage, tachypnea, apneic spells, decreased breath sounds
55
What is pneumonia?
Inflammation of the pulmonary parenchyma
Can be caused from virus or a bacteria
56
Manifestations of pneumonia
Productive (white sputum) or non-productive cough;
Tachypnea
Crackles and decreased breath sounds
Dullness with percussion
Abdominal pain with lower lobe involvement
Retractions and nasal flaring
Pallor to cyanosis
Fever of 39.5 C or greater
On chest X-ray there is patchy or diffuse infiltration in the bronchiole distribution area
Lethargy, restless, or irritable,
GI issues (vomiting, diarrhea, nausea)
57
What causes whooping cough?
Caused by Bordetella pertussis
Primarily occurs in children under 4 and not immunized
58
True or False? Whopping cough is not contagious.
False. Whooping cough is highly contagious and lasts 6 to 10 weeks
59
Whopping cough manifestations and care
- Older children's manifestations: fainting, rib fracture from coughing, insomnia, weight loss
- Younger children’s manifestations: Hernia or atelectasis
- Supportive care: hydration, positioning, O2 as needed and antipyretics
- Preventable with vaccines; caregivers should get vaccinated as well
60
Tuberculosis (TB) symptoms
May be asymptomatic or produce a broad range of symptoms:
– Fever, Malaise
– Anorexia, Weight loss (or failure to grow in child)
– Cough (may or may not be present; progresses slowly over weeks to months)
– Aching pain and tightness in the chest
– Hemoptysis (rare)
With progression:
– Tachypnea
– Poor expansion of lung on the affected side
– Diminished breath sounds and crackles
– Dullness on percussion
– Persistent fever
– Pallor, anemia, weakness, and weight loss
61
TB Medical management
Nutrition, hydration
Supportive mesure
Prevention of other infections/reinfection
Pharmacotherapy with antipyretics
Adolescent 6-9 course of iodine
With active TB- sterilize the lesion in the lungs
62
What are signs of Foreign Body Aspiration?
- Produces choking, gagging, wheezing, or coughing
- Laryngotracheal obstruction: stridor, and hoarseness because of decreased air entry.
- In great distress: are unable to speak, can progress to cyanosis and collapse
- Can die within 4 minutes of no air entry
63
What is the difference between Respiratory arrest and apnea?
Respiratory arrest: Cessation of respirations
Apnea:
Cessation of breathing for more than 20 seconds. Cessation of breathing for a shorter period when associated with cyanosis, pallor, hypoxemia or bradycardia. Can be central, obstructive, or both
64
What is a Congenital diaphragmatic hernia?
Abdominal organs are displaced into the thoracic cavity.
- Prenatal ultrasound diagnosis and Surgical repair
65
What is Choanal atresia?
Bone blocking nasal passage wither unilateral or bilateral
- Diagnosed by inability to pass a suction catheter through the nose into the nasopharynx
- Management of the airway often requires a combination of supportive, medical, and surgical care.
66
Nursing Care for aspiration pneumonia
Prevention of aspiration
Get an evaluation from a speech therapist
Feeding techniques (do not prop child up by themselves), positioning
Side-lying if risk of vomiting
Supportive care
67
What is pulmonary edema?
Movement of fluid into the lungs
- cardiogenic or non cardiogenic
68
Pulmonary edema manifestations and management
- Diaphoretic
- Extreme SOB
- Cyanosis
- Tachypnea
- Decreased breath sounds
- Agitated, irritated, confused
- Crackles, expiratory wheezes
- Heart murmur
- Sputum pink and frothy
- Tachycardia, hypertension or hypotension if cardiogenic
- Therapeutic management includes oxygen therapy, CPAP, intubation and ventilator, diuretics, digoxin (monitor intake and output and electrolytes), inotropes and vasodilators
69
What changes occur to the alveoli in Acute Respiratory Distress Syndrome (ARDS)?
In ARDS, the lungs become very stiff (the surfactant that helps the alveoli move, expand and contract is inactive)
Improper gas exchange because alveoli cannot open up
Mucosa starts to swell and atelectasis can occur
70
What are the three types of smoke inhalation injuries?
Heat injury (thermal injury to upper airway)
Chemical injury: found on clothing and furniture, that we breathe in. Carries into the lower airway (insoluble)
Systemic injury: gases that are non-toxic to the airways but are toxic to the lungs and gas exchange (carbon monoxide); it inhibits the ability for cellular respiration
71
What is asthma?
- Most common childhood illness
- Episodic, more at night or early morning
- Chronic inflammatory disorder of airways
- Genetic predisposition
- Can be triggered by allergens, viral infections, exercise, cold air
72
Asthma manifestations
dyspnea, wheezing, and coughing, Shortness of breath with the constriction
73
Asthma therapeutic management
Allergen control
Exercise
Hyposensitization (injection therapy: the patient is given small doses of the allergen to increase their tolerance)
Medication therapy
74
What is cystic fibrosis (CF)?
- Increased viscosity of mucous gland secretion, sweat electrolytes
- Autosomal recessive trait inherited from both parents, with an overall incidence of 1:4
- 1 in 3600 Canadian children are born with CF
75
CF Manifestations
Initial signs:
Wheezing respirations, dry nonproductive cough
Eventually:
Increased dyspnea, paroxysmal cough, obstructive emphysema, atelectasis
Progressive involvement:
Overinflated, barrel-shaped chest; cyanosis; clubbing of fingers and toes; bronchitis and bronchopneumonia
GI:
Meconium ileus
– Large, bulky, loose, frothy, foul-smelling stool (from undigested fats and proteins)
– Voracious appetite (early); loss of appetite (late)
– Weight loss, marked tissue wasting, failure to grow, distended abdomen
– Thin extremities, sallow skin, vitamin deficiency, anemia
76
True or False? CF is a progressive and incurable disease
True. Median age of survival is 52.3 years as it is a progressive and incurable disease. Lung transplant increases life expectancy
