Child with a Respiratory Disorder Flashcards
What are the indications of respiratory distress in infants and children.
Nasal flaring circumoral cyanosis expiratory grunting retractions - substernal, lower intercostal tachypnea- respirations greater than 60.
What is otitis media ?
inflammation of the middle ear sometimes accompanied by infection
What are the atomic differences in the eustachian tube of adults and small children ??
shorter, wider, more horizontal
Which difference do you think could cause more problems for the child and why?
horizontal
What are common causes of eustachian tube dysfunction?
Previous URI causes mucous membranes of the eustachian tube to become edematous and blocks tube
Enlarged adenoids - predispose to otitis media
allergic rhinitis - predispose to otitis media
Exposure to cigarette smoke - airborne pollutants
pacifier use may raise soft palate and alter dynamics in the eustachian tube.
prop- feeding or horizontal feeding with bottle .
Otitis external
swimmer’s ear
no bottles, pacifier after 1 yr - impact on dev, anatomy, speech.
Question - considering the contributing factors to this condition, what are group most commonly experiences acute otitis media ?
12-36 months
what are the characteristics of acute otitis media?
abrupt onset, pain, middle ear effusion, and inflammation (see reddened altered shape of cone of light )
serous otitis media
note effusion on otoscopy by fluid line and air bubbles- note that the light reflex is not in the expected position du to a change in tympanic membrane shaped from air bubbles.
streptococcus pneumoniae is found in
head and neck- resistance has caused medical professional to re evaluate ABX therapy.
Many episodes of OM result from ______
viral infections
some physicians when treating OT wait up to _____
72 hours for spontaneous resolution in other wise healthy infants.
When can immuno-compromised children receive ABX?
immediately
what medications are given to children with OM?
oral amoxicillin in high dosages is medication of choice
Nursing considerations for antibiotic therapy for OM ?
safety- use as directed and finish course
comfort measures - ibuprofen , tylenol - alternate
parents be aware of allergic reactions with medication administration such as hives, itching, etc.
parents- assess if child is not responding in 24-48 hrs, contact HCP
FU visit with PCP - possible ROM and infection
Preventative measures with OM?
do not put things in ear
no swimming or submerge head under water
no changes in altitude , change toothbrush after 24 hours on antibiotics
What is myringotomy ?
purpose is to drain
air exchange by-passing Eustachian tube
prevent further scarring and head ring loss
used for chronic ear infections
candidate if 3 ear infections in 6 months
4 ear infections in 1 year
Nursing care following placement of myringotomy —
Comfort measures - alt ibu and tylenol
Assess imm. post-op and ongoing for fever,c/o pain, childs demeanor , odor, tubes not working
notify dr when theres an increase in temperature, odor present.
Prevent- head submersion , keep child steady, no changes in pressure.
Mastoiditis
occur with infection that is not treated, bacteria can set in small pockets of the head r/f encephalitis - IV antibiotics txt.
mastoiditis
can have hearing loss, extension of infectious process beyond the mastoid system , results in intracranial complications.
Ages affected- parallels otitis media, affects mostly young children and peaking in those aged 6-13 months
assessment of mastoiditis includes ?
assess pain and tempature
additional concerns when there is a elevation in CBC, ERS inflammation- check progression - CSF lumbar puncture.
IF bacteria spreads to to mastoid- treat aggressively because it is so close to brain.
ABX- garamycin or gentamycin or ticarcillin (Timentin)
assess for complications - hearing loss, tinnitus
