Class 4 Respiratory Flashcards by jodi Trethewey

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

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Resiratory assessment

depth
rate
rhythm
effort
mucous membrane retractions
symmetry of breathing
*Look, Listen, Feel

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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

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Otitis Media: Manifestations

drainage
otalgia
bulging, opaque tympanic membrane
irritability
fever
V/D
sleep issues

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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

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Otitis Media: Nursing interventions

antibiotics
acetaminophen
assess ear drainage
keep ears clean/dry
decrease risk
no smoking in house

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Tonsillitis: manifestations

Sore throat
Enlarged, reddened tonsils
Difficulty swallowing
Mouth breathing/foul breath

**bacterial or viral

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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

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Croup: 2 types?

Acute Spasmodic Croup

Laryngotracheobronchitis

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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

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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

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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

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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

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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

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Epiglottits: Therapeutic management

patent airway
O2 monitor
antibiotics
fever management
intubation possible

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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