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PAEDS > children lect 2 > Flashcards

children lect 2 Flashcards

1
Q

What is the narrowest part of the airway

A

Cricoid cartilage

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2
Q

3 components of work of breathing

A
  1. Compliance work
  2. Resistance work
  3. Airway resistance
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3
Q

List some examples from an assessment of respiratory distress

A
  • ↑ 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
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4
Q

What are the normal ranges of neonates? (HR, RR and systolic BP)

A

HR: 120-180bpm
RR: 40-60 min
Systolic BP: 60-80mmHg

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5
Q

Ethiology of:

  1. Tachypnea
  2. Hyperpnea
  3. Dyspnea
  4. Orthopnea
A
  1. Tachypnea— pulmonary disease, metabolic acidosis
  2. Hyperpnea– diabetic ketoacidosis
  3. Dyspnea– (acute distress)
    - - pneumothorax intermittent distress, asthma chronic lung problem
  4. Orthopnea – asthma, pulmonary edema
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6
Q

Goal of oxygen therapy

A
  • Relieve hypoxemia
  • ↓ work of breathing
  • ↓ myocardial stress
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7
Q

Average range of vacuum settings for infants and children.

A

Infant: 75-100mmHg
Children: 100-120mmHg
(Ref: adult is 120-150mmHg)

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8
Q

Symptoms of Laryngomalacia

A

Stridor and difficulty in breathing

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9
Q

List 3 lower respiratory tract infections.

A
  1. Acute laryngotracheobronchitis (Croup)
  2. Bronchiolitis/ Bronchitis
  3. Pneumonia
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10
Q

Presentation of Acute laryngotracheobronchitis (Croup)

A
  • 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)
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11
Q

Treatment of Acute laryngotracheobronchitis (Croup)

A
  • Humidified O2; inhaled epinephrine
  • Corticosteroids: PO/IV dexamethasone
    (if becomes severe, also administer adrenaline & monitor for few hours)
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12
Q

Presentation of bronchiolitis

A
  • starts with URTI, symptoms worsen 3-5 days

- peak 5-7 days; resolve by 2-3 weeks

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13
Q

Treatment of bronchiolitis

A
  • oxygenation aim SaO2 > 95%
  • hydration & nutrition (KIV NGT)
  • relieve nasal congestion
  • bronchodilator if indicated
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14
Q

Causes of pneumonia (5)

A
  • Streptococcus pneumonia (most common)
  • Mycoplasma pneumonia (most common in kids)
  • Bacterial pneumonia
  • Viral pneumonia
  • Aspiration pneumonia
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15
Q

Management of pneumonia

A
  • oxygenation aim SaO2 > 95%
  • hydration & nutrition (KIV NGT)
  • oral antibiotics (1-3months old can start)
  • IV antibiotic eg. Ampicillin and Gentamycin for neonates
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16
Q

Causes of bronchial asthma

A
  • bronchospasms
  • ↑ mucus secretions
  • mucosal oedema
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17
Q

Bronchial asthma’s characteristics

A
  • airway inflammation
  • intermittent airflow obstruction
  • bronchial hyperresponsiveness
18
Q

Describe severe persistent asthma

A
  • continual day time symptoms
  • frequent night time symptoms
  • lung function testing <60% of predicted value
19
Q

If score is >20 for Asthma Control Test Score (ACT Paed), asthma is well-controlled. T/F?

A

True

20
Q

The strongest predictor for wheezing that develops into asthma is atopy. T/F?

A

True

21
Q

Management of :

  1. Acute asthma
  2. Mild asthma
  3. Moderate asthma
A
  1. (Acute) Pharmacotherapy
    - relievers: salbutamol/ipratropium bromide
    - preventers: corticosteroids
    - O2
  2. (Mild) Salbutamol MDI/ Nebuliser
  3. (Moderate)
    - O2 to maintain SaO2>95% via nasal prong
    - Salbutamol MDI/ Nebuliser
    - Oral prednisolone (corticosteroid hormone)
22
Q

What BP is hypotension in neonate & infant (1-12 months)?

A

Neonate: 60-80mmHg

Infant (1-12 months): 70-90 mm Hg

23
Q

Early and late signs of cardiovascular collapse

A

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
24
Q

Normal urine output

A

1-2ml/kg/hr

25
Q

What are the 3 things required to diagnose congenital heart disease?

A
  • 2D echocardiogram
  • cardiac catheterisation
  • ECG
26
Q

What are the 3 types of congenital heart disease?

A
  1. Obstruction to blood flow
  2. Left → right shunt (non-cyanotic heart)
  3. Right → left shunt (cyanotic heart)
27
Q

List the diff. defects in each: non-cyanotic and cyanotic heart disease

A

(refer to docs)

28
Q

Ethiology of heart failure in children

A

Majority of heart failure is congestive, resulting from excessive left to right shunting (non-cyanotic)

29
Q

Treatment of congenital heart disease

A
  • 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
30
Q

Specific clinical manifestation of Kawasaki disease

A
  • 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

31
Q

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?

A

d. 7-14 days is false.

7-14 days is the acute phase.

32
Q

Management of Kawasaki disease (3 options)

A
  1. intravenous immunoglobulin (IVIG)
    - pri treatment
    - administered within 1st 10 days
  2. aspirin
  3. 2D echogram
    - during subacute phase to detect cardiovascular changes
33
Q

Nursing management for children w cardio dysfunction

  • promote adequate_________ & _________
  • monitor for signs of _________
  • monitor for signs of _________
  • manage _________
  • reduce _________
  • promote _________
  • evaluate_________ status
  • prevent _________
A
  • 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
34
Q

Ethiology of acute gastroenteritis (Causes)

A
  • 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
35
Q

Signs & symptoms of acute gastroenteritis (severe)

A
  • Numerous stools
  • signs of moderate or severe dehydration
  • drawn appearance
  • weak cry
  • irritability
  • purposeless movements
36
Q

Assessment of severe dehydration

A
  • 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
37
Q

Nursing problems of acute gastroenteritis

A
  • (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)
38
Q

Nursing management of acute gastroenteritis

A
  • reinstate adequate hydation (ORT, adminster IV fluids)
  • ensure adequate nourishment
  • prevent infection
  • skin care (change diaper frequently, apply barrier cream)
39
Q

UTI’s most common bacterial infection, signs & symptoms and treatment.

A

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
40
Q

Clinical presentation of glomerulonephritis & treatment

A
  • 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

41
Q

3 forms of nephrotic syndrome

A
  1. idiopathic (MOST COMMON)
  2. secondary to glomerulonephritis, sickle cells anemia or system lupus erythematous
  3. congenital
42
Q

Characteristics of nephrotic syndrome + treatment

A
  1. proteinuria
  2. oedema
  3. hypoalbuminemia
  4. hyperlipidemia
  5. ascites: pressure on stomach may lead to anorexia or vomiting
  6. diarrhoea

treatment:

  • corticosteroids such as oral prednisolone
  • may need diuretic if child is not responding well to o.p

PAEDS (6 decks)

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