Child with a Respiratory Disorder

Question 1

What are the indications of respiratory distress in infants and children.

Answer 1

Nasal flaring 
circumoral cyanosis 
expiratory grunting 
retractions - substernal, lower intercostal
tachypnea- respirations greater than 60.

Question 2

What is otitis media ?

Answer 2

inflammation of the middle ear sometimes accompanied by infection

Question 3

What are the atomic differences in the eustachian tube of adults and small children ??

Answer 3

shorter, wider, more horizontal

Question 4

Which difference do you think could cause more problems for the child and why?

Answer 4

horizontal

Question 5

What are common causes of eustachian tube dysfunction?

Answer 5

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 .

Question 6

Otitis external

Answer 6

swimmer’s ear

no bottles, pacifier after 1 yr - impact on dev, anatomy, speech.

Question 7

Question - considering the contributing factors to this condition, what are group most commonly experiences acute otitis media ?

Answer 7

12-36 months

Question 8

what are the characteristics of acute otitis media?

Answer 8

abrupt onset, pain, middle ear effusion, and inflammation (see reddened altered shape of cone of light )

Question 9

serous otitis media

Answer 9

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.

Question 10

streptococcus pneumoniae is found in

Answer 10

head and neck- resistance has caused medical professional to re evaluate ABX therapy.

Question 11

Many episodes of OM result from ______

Answer 11

viral infections

Question 12

some physicians when treating OT wait up to _____

Answer 12

72 hours for spontaneous resolution in other wise healthy infants.

Question 13

When can immuno-compromised children receive ABX?

Answer 13

immediately

Question 14

what medications are given to children with OM?

Answer 14

oral amoxicillin in high dosages is medication of choice

Question 15

Nursing considerations for antibiotic therapy for OM ?

Answer 15

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

Question 16

Preventative measures with OM?

Answer 16

do not put things in ear
no swimming or submerge head under water
no changes in altitude , change toothbrush after 24 hours on antibiotics

Question 17

What is myringotomy ?

Answer 17

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

Question 18

Nursing care following placement of myringotomy —

Answer 18

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.

Question 19

Mastoiditis

Answer 19

occur with infection that is not treated, bacteria can set in small pockets of the head r/f encephalitis - IV antibiotics txt.

Question 20

mastoiditis

Answer 20

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

Question 21

assessment of mastoiditis includes ?

Answer 21

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