Class 4 Respiratory Flashcards
Pediatric differences in respiratory system
- lacking surfactant
- smaller lower airway
- under developed cartilage
- obligatory nose breather
- increase O2 needs
- alveolar development
- Eustachian tubes are horizontal
- trach size
- larynx flex subject to spasm
- tonsillar tissue is enlarged
Resiratory assessment
- depth
- rate
- rhythm
- effort
- mucous membrane retractions
- symmetry of breathing
- *Look, Listen, Feel
Lung sounds
Crackles- popcorn sound on inspiration
Rhonchi-low pitch, snoring sound. Have pt deep breath coughing
Wheezes- high pitch, musical sound
Pleural friction rubs
Otitis Media: Manifestations
- drainage
- otalgia
- bulging, opaque tympanic membrane
- irritability
- fever
- V/D
- sleep issues
Otitis Media: Treatment
- symptom management
- watch/wait 48-72 hours
- Amoxicillin or cephalosporin for penicillin allergy
- reduce risk factors (daycare, smoking in house, bottle feeding)
- surgical: recurrent infections (4x in one year) tube placement in ears
Otitis Media: Nursing interventions
antibiotics acetaminophen assess ear drainage keep ears clean/dry decrease risk no smoking in house
Tonsillitis: manifestations
Sore throat
Enlarged, reddened tonsils
Difficulty swallowing
Mouth breathing/foul breath
**bacterial or viral
Tonsillectomy: pre-op and post-op period
Pre-op: complete history (allergies, etc)
assess swallowing and airway obstruction
active infection (fever, increased WBC)
deficient knowledge r/t surgery and procedures
Post-op: monitor respiration, v/s, examine mouth/throat, hemorrhage, swallowing
Croup: 2 types?
Acute Spasmodic Croup
Laryngotracheobronchitis
Croup: Acute spasmodic Croup
Age: 1-3 years
Cause: viral, genetic predisposition
Assessment: sudden onset, usually at night harsh cough inspiratory stridor dyspnea hoarseness
Treatment:
increase fluids
can treat at home
Croup: Laryngotracheobronchitis
Age: 3 mo - 3 years
Cause: usually vial
Assessment:
gradual onset usually at night
harsh cough
inspiratory stridor
Treatment:
Racemic Epi
IV fluids
Hospitalization
Croup: nursing intervention
Airway clearance maintain fluid balances I/O decrease fever cluster nursing care Teaching: recognize s/s of resp. distress, pain reliever, adequate fluids
Epiglottitis: info, what is it?
Inflammation/swelling of epiglottis and surrounding tissue Life threatening Abrupt onset usually within hours Rapid progression Complete airway block possible
Epiglottits: Manifestations
- high fever
- child insists on sitting upright
- sore throat
- drooling
- dysphagia
- dysphonia
- distress inspiration effort
- nasal flare
- use of accessory muscles
- acute resp distress possible
Epiglottits: Therapeutic management
- patent airway
- O2 monitor
- antibiotics
- fever management
- intubation possible
Bronchiolitis: info and what is it?
- inflammation and swelling of the bronchioles (small)
- RSV is most likely cause
- highly contagious
- *droplet isolation precautions
Bronchiolitis: manifestations
- tachycardia
- tachypnea
- wheezing/crackles/rhonchi
- retractions
- cyanosis
Bronchiolitis: therapeutic management
- fluids
- humid air
- comfort
- antibiotics
- prevent: synagis (immunization)
- maintain airway
- medication: nebs, corticosteriods
- O2
Bonchitis: info, manifestations, therapeutic management
Inflammation and swelling of the bronchi (large) usually occurs with other URI or LRI condition
viral
Manifestations: couch, rhinitis, lung sounds, fatigue, low fever
Therapeutic: symptomatic, rest, OTC med, encourage fluids
Pneumonia: viral? bacterial?
Can be viral or bacterial
Viral- cell destruction, debris in lumen
Bacterial- alveoli fill with cells/fluid
Pneumonia: nursing care
Frequent assessment q 2hr Aid breathing Humidified O2 Fluids, IV or oral Conserve energy, rest Medications HOB raised up Deep breathing to induce cough I/O Weight Assess for dehydration
Foreign body aspiration: age, common items, assessment
Most often 6 mo to 5 years old
Common items: small today, foods such as grapes, popcorn.
Assessment: sudden violent coughing, gagging, wheezing, cyanosis, vomiting, apnea
Sudden Infant Death Syndrome (SIDS): age, prevention
Most occur between 2-4 months of age, 95% before 6 months
Prevention: always place baby on back to sleep, keep crib free of blankets and toys, keep baby at comfortable temperature, safe swaddling, firm mattress
Asthma: cause?
bronchospasms
bronchoconstriction
inflammation and edema of mucous membrane of airways
Asthma: triggers
cold air smoke allergens environmental pollutants weather stress exercise odors respiratory infection
Asthma: manifestation
dry cough wheezing retraction nasal flaring tachycardia tri pod position
Asthma: medications, how long wait between meds, which one first?
Wait time: 1 min between puffs of same medication, 5 min between different medications
First med: albuterol (proventil) should be taken first before other inhaled medications, rescue inhaler
Asthma: peak flow meter, how to use it and what is it?
measures how fast air comes out of the lungs when you exhale forcefully after inhaling fully
makes sure meter is at 0, sit/stand up, take deep breath in, place mouth around mouth piece, exhale forcefully and as hard as possible. record number. repeat 2x. record the highest number out of the 3, that is the peak expiratory flow (PEF).
**have action plan
Asthma: nursing care
frequent assessment air breathing oxygenation fluids conserve energy medication education
Cystic Fibrosis: what is it?
Genetic disorder, usually detected w/in first year
Exocrine glands are not working properly
Lethal disease, life expectancy about 40 years
Thick, sticky mucus produced by exocrine gland causes obstruction
Cystic Fibrosis: manifestations of lungs
Crackles Wheezing Diminished breath sounds Use of accessory muscles Dry non productive cough Frequent lung infections
Cystic Fibrosis: diagnostic
Sweat test
<39 mmol/L = neg
40-59 mmol/L = further testing needs to be done
>60 mmol/L = pos
Most US states test for CF as part of routine newborn screening
Cystic Fibrosis: nursing care
Facilitate airway clearance and gas exchange
Prevent infections
Providing optimal nutrition (high cal/protein/carbs)
Promote increase exercise tolerance
Meet emotional needs
Home care
Cystic Fibrosis: symptoms
Fatigue Chronic cough Recurrent URI's Thick, sticky mucus Chronic hypoxia= barrel chest, nail clubbing Decreased absorption of vit and enzymes Abdominal distention Decrease digestive enzymes Rectal prolapse Fatty, stinky stools Meconium ileus in NB
Asthma action plan GREEN ZONE
Doing well:
No coughing, wheezing, chest tightness or difficulty breathing
Can work, play, exercise, perform usual activities without symptoms
OR
Peak flow: 80-100% of personal best
Asthma action plan YELLOW ZONE
Caution/Getting worse:
Coughing, wheezing, chest tightness or difficulty breathing
Symptoms with daily activities, work, play or exercise
nighttime awakenings with symptoms
OR
Peak flow: 50-80% of personal best
Asthma action plan RED ZONE
Alert!:
Difficulty breathing, coughing, wheezing not helped with medications
Trouble walking or talking due to asthma symptoms
Not responding to quick relief medication
OR
Peak flow is less than: 50% of personal best
