Chapter 45: The Child with a Respiratory Alteration (Part 1- Upper Airway) Flashcards
Croup patients with these four symptoms should be taken to the emergency room immediately
stridor at rest
cyanosis
retractions
inability to take PO fluids
pink, sandpaper rash on trunk indicates this
scarlet fever
peritonsillar abscess has a higher risk for ____________________ and _________________
airway obstruction, dehydration
most common cause of neonatal stridor
laryngomalacia
two drugs of choice to treat sinusitis
amoxicillin
amoxicillin-potassium clavulanate
viral or bacterial pharyngitis: abrupt onset (may be gradual in children younger than 2 years)
bacterial
four cardinal signs of epiglottitis
drooling, dysphagia, dysphonia, distressed respiratory efforts
When treating sinusitis, _____________ can be used to treat allergic rhinitis but tend to _____________ secretions and impair ______________.
antihistamines, thicken, sinus drainage
viral or bacterial pharyngitis: fever usually high (39.4 to 40 degrees C)
bacterial
Care for pharyngitis/tonsillitis includes ____________, gargling _______________, ________ and ________ foods and liquids, and _______________ applied to the neck.
antipyretics, warm salt water, cool, bland, warm compress
treatment for bacterial pharyngitis includes these antibiotics of ______ doses orally daily over a course of ______ days
penicillins, 2-3, 10
The tonsillectomy patient is most at risk for postoperative hemorrhage in these two time periods after surgery
first 24 hours
days 7-10
these two openings in the fetal heart must close shortly after birth to establish effective pulmonary and circulatory systems
foramen ovale, ductus arteriosus
After a tonsillectomy, avoid the use of ___________________ unless absolutely necessary, when they should be __________.
tongue depressors, sterile
pharyngitis/tonsillitis peaks between the ages of _________
4-7 years
to help relieve mucus buildup in nares, teach parents how to use these
saline drops and bulb syringe for suction
ideal treatment for allergic rhinitis
remove the allergen
In the postoperative period after a tonsillectomy, the child should be placed in a _________ or _____________ position to facilitate drainage
prone, side-lying
infants <6 months are obligatory ________ breathers
nose
these children will always test positive for strep throat even if there is not an active infection
carriers/colonized
viral or bacterial pharyngitis: usually low grade fever but may be high
viral
a child with croup should be monitored in the emergency room for about ________ in case of ______________.
3 hours, rebound stridor
surfactant starts to be produced at this point in pregnancy
mid pregnancy
viral or bacterial pharyngitis: manifestations include abdominal pain, headache, vomiting
bacterial
In a child with croup, __________ can aggravate symptoms and make respiratory distress worse
crying
rapid strep antigen tests have a false negative rate of this
20%
viral or bacterial pharyngitis: sometimes accompanied with a pink, sandpaper rash on trunk
bacterial
For treating croup, a single dose of this drug is also indicated to reduce airway inflammation and reduce necessity for hospitalization
dexamethasone
_____________ occur more likely in pediatrics with respiratory distress
retractions
crease across the bridge of the nose from wiping the nose upward with the palm of the hand
allergic salute
viral or bacterial pharyngitis: usually lasts 3-5 days
bacterial
untreated strep throat increases the risk of developing this inflammatory heart condition
rheumatic fever
sudden onset of harsh, metallic, barky cough; sore throat; inspiratory stridor; hoarseness
croup
Parents of children with laryngomalacia should be educated about signs of ________________ and ___________________, which can make symptoms worse.
respiratory distress, respiratory infections
epiglottitis is typically caused by this pathogen
H. influenza
allergic rhinitis onset is _________________ but rarely occurs before the age of _____
during childhood, 2 years
eustachian tubes are relatively _______________ and ____________ in pediatric patients
horizontal, shorter
the average age of occurrence of epiglottitis
3-7 years
incidences of epiglottitis decreased substantially since the introduction of this vaccine
Hib
pulmonary function tests can sometimes be difficult on young children for this reason
inability to follow commands
Parents of children with laryngomalacia should use a (smaller, larger) nipple if bottle feeding and may tolerate (small, large) and (less, more) frequent feedings better.
smaller, small, more
___________________ emesis is common, but emesis that contains ____________________ is a sign of postoperative hemorrhage (tonsillectomy)
Coffee-ground, bright red blood
pediatric patients have __________________ intercostal muscles, which can cause ____________ breathing and (increased, decreased) respiratory rate
underdeveloped, abdominal, increased
croup typically occurs in this age group
6 months to 6 years
In a patient with laryngomalacia, the nurse should assess for __________________, __________ difficulties, and pattern of _____________ and ________.
respiratory distress, feeding, weight gain, growth
viral or bacterial pharyngitis: vesicles or ulcers on tonsils
viral
viral or bacterial pharyngitis: early manifestations include hoarseness, cough, rhinitis, conjunctivitis, malaise, anorexia
viral
viral or bacterial pharyngitis: cervical lymph nodes may be enlarged, tender
viral and bacterial
this test measures vital capacity and expiratory flow rate
pulmonary function test (via spirometry)
In the postoperative period after a tonsillectomy, the nurse should assess the child for excess __________ and the ability to __________________.
bleeding, swallow secretions
caused by immature neuromuscular development of the airway
laryngomalacia
manifestations include cold-like symptoms that do not improve after 10-14 days, low grade fever, nasal congestion with purulent drainage, halitosis, and cough that worsens when lying flat, headache
sinusitis
only reliable and accurate diagnostic for bacterial pharyngitis
throat culture
children have (more, less) flexible larynx, (decreasing, increasing) susceptibility to spasms and their complications
more, increasing
pediatric patients have __________ airways and ____________ cartilage, increasing the risk for these three things
smaller, undeveloped
foreign body aspiration, edema, mucus obstruction
these drugs are not recommended for treatment of respiratory disorders due to adverse side effects
decongestants
tonsillectomies should not be performed under ________ of age and are contraindicated in _________________ and those with a ____________.
3 years, active infection, cleft palate
manifestations include refusal to talk, swallow, or eat due to severe pain, which may radiate up to the ear
peritonsillar abscess
pediatric patients have a(n) _________ respiratory rate due to ______________ metabolic needs
faster, increased
end tidal carbon dioxide, used with the pulse oximeter, is useful in the patient in these three conditions
intubated
under procedural sedation
evaluating asthma severity
newborns can have brief periods of _________ which can last up to 15 seconds; this is normal until ___________
apnea, 1 month
croup occurs most often during the _______ (time of day) in the __________ (season)
night, winter
symptoms of laryngomalacia usually resolve spontaneously between _____________________ of age.
18-24 months
_________________ studies and a thorough history should be done prior to a tonsillectomy because the tonsils are a highly ___________ area.
Bleeding, vascular
sinusitis often follows a(n) ____________________________ but may also occur after ______________ or _________________
upper respiratory infection, allergic rhinitis, otitis media
viral or bacterial pharyngitis: usually lasts 3-4 days
viral
if the child is not responsive to treatments for allergic rhinitis, this therapy may be used
immunotherapy
noisy, crowing, respiratory sounds with or without retractions in the neonatal period
laryngomalacia
assessment findings include stridor with or without retractions, acyanotic, and worsening symptoms with laying down or crying
laryngomalacia
unilateral abscess that displaces the uvula to the opposite side
peritonsillar abscess
ABGs are more reliable for patients with these two problems
chronic pulmonary alteration
decreased peripheral perfusion
diagnosis of pharyngitis
rapid antigen test and throat culture
In a patient with laryngomalacia, stridor can be reduced by placing the child’s neck in this position
hyperextended
characterized by flaccidity of epiglottis and weakness along airway walls
laryngomalacia
most effective drug treatment for allergic rhinitis
antihistamines, intranasal corticosteroids
alveoli are expanded within the first ________ after birth
hour
manifestations include clear rhinorrhea; itching of nose, eyes, and ears; and paroxysmal sneezing
allergic rhinitis
inflammation and infection of the sinuses
sinusitis
After a tonsillectomy, after the child is fully awake, provide _____________ liquids and avoid ___________, ____________, and extreme ______ or ______ liquids.
clear cool, carbonated, citrus, hot, cold
this medication is given to decrease laryngeal swelling and bronchospasms in croup
nebulized racemic epinephrine
tonsils in children are naturally (smaller, larger) than in adults
larger
dark circles under the eyes caused by edema
allergic shiners
pediatric patients have __________ surfactant
decreased
Interventions and teaching for sinusitis include increasing _____________ intake, using a bedside ___________, placing a ______________ on the face for pain relief, and _________________ for pain and fever control.
clear fluid, humidifier, warm compress, acetaminophen
viral or bacterial pharyngitis: erythema, inflammation of pharynx and tonsils
viral and bacterial
After a tonsillectomy, have ____________ equipment available, but do not use unless there is a(n) __________________.
suction, airway obstruction
diagnostic test that checks oxygen and carbon dioxide levels through electrodes on the patient’s skin
transcutaneous monitoring
children with strep throat are infectious until this
24 hours after antibiotics are started
Before a tonsillectomy, teach the child and parents of the presence of a ______________ after the procedure and the importance of _____________________.
sore throat, drinking fluids
most cases of sinusitis are ___________________, but some cases may require _____________
self-limiting, antibiotics
Treat epiglottitis with ______________, the drugs _______________ and ______________, and place child on _______ status.
intubation, antipyretics, IV antibiotics, NPO
diagnostic test that assesses acid base balances
arterial blood gas (ABG)
four common viruses that cause pharyngitis
adenovirus
coronavirus
enterovirus
respiratory syncytial virus (RSV)
tonsillectomies should be reserved in cases of upper airway ____________, ____________________, ____________ sleep apneas, or other serious problems.
obstruction, peritonsillar abscesses, obstructive
pulmonary function tests are used to assess the _________ of disease, response to _____________, or presence of ______________________ pulmonary disease
degree, therapy, restrictive or obstructive
If epiglottitis is suspected, do not do these two things
leave child unattended
examine or attempt to obtain culture
viral or bacterial pharyngitis: gradual onset with sore throat
viral
may be preceded by several days of symptoms of upper respiratory tract infection
croup
electrodes in transcutaneous monitoring must be changed every ___________, and the machine must be ____________ each time they are changed
3-4 hours, recalibrated
seasonal, recurrent inflammatory disorder of the nasal mucosa
allergic rhinitis
total inflation of a normal lung is complete within the first _____________________
few breaths of life
viral or bacterial pharyngitis: usually severe sore throat
bacterial
