children lect 2 Flashcards
What is the narrowest part of the airway
Cricoid cartilage
3 components of work of breathing
- Compliance work
- Resistance work
- Airway resistance
List some examples from an assessment of respiratory distress
- ↑ RR
- ↑ HR
- ↓ saturation
- retractions or nasal flaring
- grunting
- sweating, clammy skin
- auscultate breath sounds— stridor, wheeze, etc
- head bobbing
- croupy cough
- cyanosis
- conscious lvl: drowsy and hypercapnia
- position: tripod position
What are the normal ranges of neonates? (HR, RR and systolic BP)
HR: 120-180bpm
RR: 40-60 min
Systolic BP: 60-80mmHg
Ethiology of:
- Tachypnea
- Hyperpnea
- Dyspnea
- Orthopnea
- Tachypnea— pulmonary disease, metabolic acidosis
- Hyperpnea– diabetic ketoacidosis
- Dyspnea– (acute distress)
- - pneumothorax intermittent distress, asthma chronic lung problem - Orthopnea – asthma, pulmonary edema
Goal of oxygen therapy
- Relieve hypoxemia
- ↓ work of breathing
- ↓ myocardial stress
Average range of vacuum settings for infants and children.
Infant: 75-100mmHg
Children: 100-120mmHg
(Ref: adult is 120-150mmHg)
Symptoms of Laryngomalacia
Stridor and difficulty in breathing
List 3 lower respiratory tract infections.
- Acute laryngotracheobronchitis (Croup)
- Bronchiolitis/ Bronchitis
- Pneumonia
Presentation of Acute laryngotracheobronchitis (Croup)
- fever
- breathing problem at night
- a few days of URTI followed by onset of stridor and harsh barking cough (usually worsen w crying or agitation)
Treatment of Acute laryngotracheobronchitis (Croup)
- Humidified O2; inhaled epinephrine
- Corticosteroids: PO/IV dexamethasone
(if becomes severe, also administer adrenaline & monitor for few hours)
Presentation of bronchiolitis
- starts with URTI, symptoms worsen 3-5 days
- peak 5-7 days; resolve by 2-3 weeks
Treatment of bronchiolitis
- oxygenation aim SaO2 > 95%
- hydration & nutrition (KIV NGT)
- relieve nasal congestion
- bronchodilator if indicated
Causes of pneumonia (5)
- Streptococcus pneumonia (most common)
- Mycoplasma pneumonia (most common in kids)
- Bacterial pneumonia
- Viral pneumonia
- Aspiration pneumonia
Management of pneumonia
- oxygenation aim SaO2 > 95%
- hydration & nutrition (KIV NGT)
- oral antibiotics (1-3months old can start)
- IV antibiotic eg. Ampicillin and Gentamycin for neonates
Causes of bronchial asthma
- bronchospasms
- ↑ mucus secretions
- mucosal oedema
Bronchial asthma’s characteristics
- airway inflammation
- intermittent airflow obstruction
- bronchial hyperresponsiveness
Describe severe persistent asthma
- continual day time symptoms
- frequent night time symptoms
- lung function testing <60% of predicted value
If score is >20 for Asthma Control Test Score (ACT Paed), asthma is well-controlled. T/F?
True
The strongest predictor for wheezing that develops into asthma is atopy. T/F?
True
Management of :
- Acute asthma
- Mild asthma
- Moderate asthma
- (Acute) Pharmacotherapy
- relievers: salbutamol/ipratropium bromide
- preventers: corticosteroids
- O2 - (Mild) Salbutamol MDI/ Nebuliser
- (Moderate)
- O2 to maintain SaO2>95% via nasal prong
- Salbutamol MDI/ Nebuliser
- Oral prednisolone (corticosteroid hormone)
What BP is hypotension in neonate & infant (1-12 months)?
Neonate: 60-80mmHg
Infant (1-12 months): 70-90 mm Hg
Early and late signs of cardiovascular collapse
EARLY:
- tachycardia
- altered perfusion
- skin: prolonged capillary refill
- brain: altered level of consciousness
- kidneys: ↓ urine output
- pulse: weak or thready
LATE:
- skin: cold & clammy; poor capillary refills
- hypotension
- bradypnea (slow breathing rate)
- acidosis
- flaccid tone
- ↓ response to pain
Normal urine output
1-2ml/kg/hr
What are the 3 things required to diagnose congenital heart disease?
- 2D echocardiogram
- cardiac catheterisation
- ECG
What are the 3 types of congenital heart disease?
- Obstruction to blood flow
- Left → right shunt (non-cyanotic heart)
- Right → left shunt (cyanotic heart)
List the diff. defects in each: non-cyanotic and cyanotic heart disease
(refer to docs)
Ethiology of heart failure in children
Majority of heart failure is congestive, resulting from excessive left to right shunting (non-cyanotic)
Treatment of congenital heart disease
- TAPVR will require surgery at birth
- Transposition of great arteries: surgery within a few days
Ideally, cardiac surgery is done when child is >10kg as it increases success rate.
Nursing care:
- ventilator
- intravenous catheters
- extracorporeal membrane oxygenation (ECMO)
- arterial line
- nasogastric tube
- chest tubes…etc
Specific clinical manifestation of Kawasaki disease
- high fever persisting for at least 5 days
- rash: polymorphous exanthema, never vesicular or bullous
- red eyes w/o discharge
- erythema & cracking of lips, strawberry tongue
- cervical lymphadenopathy (abnormal lymph node adjustment)
also can refer to docs
Kawasaki disease in a subacute phase:
a. Desquamation of fingers & toes
b. May have arthritis and arthralgia
c. May have thrombocytosis
d. 7-14 days
Which sentence is false?
d. 7-14 days is false.
7-14 days is the acute phase.
Management of Kawasaki disease (3 options)
- intravenous immunoglobulin (IVIG)
- pri treatment
- administered within 1st 10 days - aspirin
- 2D echogram
- during subacute phase to detect cardiovascular changes
Nursing management for children w cardio dysfunction
- promote adequate_________ & _________
- monitor for signs of _________
- monitor for signs of _________
- manage _________
- reduce _________
- promote _________
- evaluate_________ status
- prevent _________
- promote adequate cardiac output & oxygenation
- monitor for signs of altered cardiac output
- monitor for signs of respiratory distress
- manage electrolyte balance
- reduce cardiac demand
- promote adequate nutrition
- evaluate fluid status
- prevent infection
Ethiology of acute gastroenteritis (Causes)
- Rotavirus– most common acute non-bacterial diarrhea
- bacterial infections causing vomiting and diarrhea: Escherichia coli, salmonella, shigellosis, staphylococcal food poisoning
Other causes:
- antibiotics
- irritable bowel syndrome
- lactose-intolerance
Signs & symptoms of acute gastroenteritis (severe)
- Numerous stools
- signs of moderate or severe dehydration
- drawn appearance
- weak cry
- irritability
- purposeless movements
Assessment of severe dehydration
- Drowsy, floppy, unconscious
- Eyes: very sunken and dry
- Tears: absent
- Capillary refill: > 2 secs
- Skin turgor: recoil in >2secs
- Skin: cold, clammy and mottles
- Urine: anuria/severe oliguria
- Pulse rate: rapid, feeble
- BP: low
Nursing problems of acute gastroenteritis
- (IMPT!!! ADRESS THIS FIRST) Deficient fluid vol.– diarrhea loss, inadequate intake
- Imbalanced nutrition
- Risk of infection— microorganisms invading GIT
- Impaired perineum skin integrity– irritation cause by frequent loose stools (acidic)
Nursing management of acute gastroenteritis
- reinstate adequate hydation (ORT, adminster IV fluids)
- ensure adequate nourishment
- prevent infection
- skin care (change diaper frequently, apply barrier cream)
UTI’s most common bacterial infection, signs & symptoms and treatment.
Common bacterial infection: E coli
S.S:
- Lower tract: dysuria, frequent voiding, suprabubic pain
- Upper tract: generally <2 yrs old, fever, loin pain
Treatment: (antibiotics)
- 1st line: ampicillin &/or gentamycin
- 2nd line: ceftriaxone or cefotaxime
Clinical presentation of glomerulonephritis & treatment
- child typically has history of URTI (within 1-2 weeks) – streptococci infection
- proteinuria (total 24hr urine) > 1gm
- urine sediment
- oliguria
- hypertension from hypervolemia
- hypoalbuminemia
treatment:
symptomatic– strict assessment of intake and output
3 forms of nephrotic syndrome
- idiopathic (MOST COMMON)
- secondary to glomerulonephritis, sickle cells anemia or system lupus erythematous
- congenital
Characteristics of nephrotic syndrome + treatment
- proteinuria
- oedema
- hypoalbuminemia
- hyperlipidemia
- ascites: pressure on stomach may lead to anorexia or vomiting
- diarrhoea
treatment:
- corticosteroids such as oral prednisolone
- may need diuretic if child is not responding well to o.p
