Complex Disruptions In Peds Flashcards
1
Q
The exchange of CO2 and O2 between the atmosphere and the alveoli
A
Ventilation
2
Q
The exchange of CO2 and O2 between the alveoli and blood
A
Diffusion
3
Q
The exchange of CO2 and O2 between the blood and tissues
A
Perfusion
4
Q
By ___ week gestation, the rudimentary respiratory system appears
A
4th
5
Q
Respiratory passages elongate between ___ week gestation to birth
A
24th
6
Q
It is not until the ___ to ___ week of life that typical sharply curved alveoli can be identified
A
6-8th
7
Q
Between ___-___ weeks gestation lungs are capable of gas exchange, alveolar cells secrete surfactant, and life becomes possible
A
26-28
8
Q
Postnatal growth of the lungs continues until approximately ___ years of age with an increase in number of alveoli and the dimensions of all the airways
A
8
9
Q
How are children’s respiratory system different from adults’ respiratory system?
A
Smaller air passage, softer, looser tissues, highly vascular, swell more easily, less oxygen reserve, high peripheral airway resistance
10
Q
High peripheral airway resistance and smaller diameter predisposes children to
A
Obstruction until 5 years of age
11
Q
S/S of respiratory distress
A
Tachypnea, nasal flaring, retractions, grunting, see-saw breathing, head-bobbing, stress response, respiratory failure
12
Q
Normal respiratory rate for infants
A
30-60 breaths/min
13
Q
Normal respiratory rate for toddlers (1-3 years)
A
24-40 breaths/min
14
Q
Normal respiratory rate for preschoolers (4-5 years)
A
22-34 breaths/min
15
Q
Normal respiratory rate for school-age children (6-12 years)
A
18-30 breaths/min
16
Q
When is it best to observe a child’s respiration?
A
When they are calm
17
Q
Assessment of respiratory problems: history
A
Health hx, family hx of respiratory disease, smoking in home environment, respiratory disease, current meds
18
Q
Assessment of respiratory problems: physical examination
A
Exercise tolerance, breaths sounds (strider, grunting, wheezing), barrel chest, chest pain, cough
19
Q
Clubbing is not only a sign of HF, but also a symptom of chronic _____ issues in older children
A
Lung
20
Q
Newborns are obligate nose breathers until about ___-___ months of age
A
2-6
21
Q
Respiratory disease seen exclusively in preterm infants characterized surfactant deficiency, underdeveloped and uninflatable alveoli, and highly compliant chest walls that compromise lung expansion
A
Respiratory Distress Syndrome (RDS) (AKA hyaline membrane disease)
22
Q
Function of surfactant
A
Reduces surface tension and increases lung expansion
23
Q
Decreased surfactant production causes the collapse of
A
Alveoli
24
Q
What are the consequences of surfactant deficiency on the infant’s respiratory system?
A
Inability to keep lungs inflated, greater effort to re-expand alveoli with each breath. Risk for inadequate oxygen exchange
25
Final unfolding of alveoli occurs in _____ trimester of pregnancy
Last
26
RDS clinical manifestations
Rapid respirations (>60), retractions, grunting, nasal flaring, color changes, apnea, changes in ABGs, inspiratory rales, flaccid and unresponsive
27
Population at risk for bronchopulmonary dysplasia (BPD)
Extremely low birth weight (ELBW) and very low birth weight (VLBW) infants with RDS
28
BPD or chronic lung disease (CLD) pathophysiology
Pressures of mechanical ventilation damage bronchial epithelium, initial injury leads to chronic inflammatory process resulting in interstitial edema, epithelial swelling, thickened alveolar walls, and airway edema
29
Because BPD causes the alveoli to become thick and fibrotic, these children have _________, _________ airways
Narrowed, scarred
30
BPD incidence
Premature infants, meconium aspiration, CHD, associated w/ younger gestational age and birth weight
31
BPD behaviors
Hyperactive airway, increased susceptibility to infection, borderline respiratory reserve, tachypnea, increased breathing effort, pallor, cyanosis, activity intolerance, weight loss or poor weight gain, restless/irritable, wheezing, pursing lips, arches
32
BPD prevention
Lowest peak inspiratory pressure, lowest O2 required
33
BPD treatment
Maintain O2, corticosteroids, oral diuretics, bronchodilators
34
Most frequent cause of hospitalizations in children less than 2 years old
Respiratory Syncytial Virus (RSV)
35
RSV strains have 2 subgroups (A&B) and affect _________ cells
Epithelial
36
RSV infections within the first year of life increase risk for development of
Asthma
37
RSV can live for up to ___ days on a surface
5
38
RSV transmission
Direct contact with respiratory secretions
39
RSV behaviors
Upper respiratory infection, otitis media, cough, wheezing, air hunger tachypnea, retractions, rhinorrhea, fever
40
RSV diagnostic tests
ELISA (enzyme linked immunofluorescent antibody), IFA (rapid immunosorbent assay), viral culture
41
RSV treatment
High humidity-mist therapy w/ O2, adequate fluid intake, rest, medications, hospitalization
42
Chronic inflammatory disorder of the airways that may occur in adults or children characterized by recurring symptoms, airway obstruction, and bronchial hyperresponsiveness
Asthma
43
Recurring symptoms of asthma
Wheezing, breathlessness, chest tightness, cough (especially at night)
44
Why is asthma much more serious in children?
Children have smaller tracheas, so inflammation will shut the airway off faster
45
Inhaler should be placed ___ fingers away from mouth
Two (children may use spacer)
46
3 part disease process of asthma
1) edema of mucous membranes, 2) accumulation of tenacious secretions from mucus glands, 3) narrowing of breathing passages
47
Step 1 mild persistent asthma symptoms
Symptoms <2 times/month, nighttime symptoms <2 times/month, brief exacerbations (few hours-days) with varying intensity, asymptomatic and normal PEF between exacerbations
48
Step 1 Mild Intermittent Asthma PEF or FEV1
> 80% of predicted value
49
Step 1 mild intermittent asthma PEF variability
< 20%
50
Step 2 mild persistent asthma symptoms
Symptoms >2 times/week but <1 times/day, nighttime symptoms >2 times/month, exacerbations may affect activity
51
Step 2 mild persistent asthma PEF/FEV
>80 % of predicted value
52
Step 2 mild persistent asthma PEF variability
20-30%
53
Step 3 moderate persistent asthma symptoms
Daily symptoms, daily use of inhaled short active B2 agonists, exacerbations affect activity, exacerbations >2 times/week and may last days, nighttime symptoms >1 times/week
54
Step 3 moderate persistent asthma PEF/FEV
>60% to <80% of predicted value
55
Step 3 moderate persistent asthma PEF variability
>30%
56
Step 4 severe persistent asthma symptoms
Continual symptoms, frequent exacerbations, frequent nighttime symptoms, limited physical activity
57
Step 4 severe persistent asthma Peak flow expiratory flow (PEF) or forced expiratory volume in 1 second (FEV1)
<60%
58
Step 4 severe persistent asthma PEF variability
>30%
59
Medications for severe persistent asthma
Long-acting beta agonists (LABA)
60
Inhaled steroids patient education
Rinse mouth after administration to prevent thrush
61
Medication used as a rescue inhaler for acute asthma attacks
Albuterol
62
Complications of untreated asthma
Respiratory and cardiac arrest
63
Types of asthma
Exercise induced bronchospasm (EIB) and status asthmaticus (medical emergency!)
64
Most common lethal genetic illness among Caucasian children, adolescent, and young adults
Cystic fibrosis
65
Characteristics of cystic fibrosis
Exocrine gland dysfunction, autosomal recessive trait, increased viscosity of mucus gland secretions
66
What systems are primarily affected with CF?
Respiratory, GI, and pancreatic
67
Intervention for CF
Chest percussion therapy
68
CF pathophysiology
Results in failure of chloride conductance of epithelial cells, increased viscosity of secretions in GI, respiratory, and reproductive tracts, and excessive loss of sweat through sweat glands
69
CF results in increased
Sweat, chloride, and sodium
70
CF complications
Chronic HF, DM, chronic infections
71
CF sweat chloride test diagnostic
>60 mEq/L
72
Treatment goals for CF
Prevent/minimize pulmonary complications, ensure adequate nutrition, encourage physical activity, quality of life
73
Cancer incidence
More common in children <15, males, and Caucasians
74
Cancer: increased incidence in what 2 age groups?
Infancy to 4 years old, 15-19 years old
75
Programmed cell death
Apoptosis
76
Genes that activate tumor growth
Oncogenes
77
Genes that keep tumor growth in check
Tumor suppressor genes
78
Genetic alteration resulting in unregulated proliferation of cells affecting apoptosis, oncogenes, and tumor suppressor genes
Cancer
79
T or F: Unlike in adults, lifestyle related factors have little to no effect on cancer in children
True
80
Pediatric cancer risk factors
Exposure to radiation, carcinogenic drugs, immunosuppression therapy, certain viral infections (EBV, HPV), race/ethnicity, genetic conditions
81
Risk associated with curative treatment for childhood cancer
Risk of developing secondary malignant neoplasms
82
Cancer treatment that mutates and kills cells
Radiation
83
Describe how chemotherapy works
Different chemos target different areas of the cell cycle. Chemo targets all and any cells that are replicating (RBCs, bone marrow, platelets, hair, stomach lining, etc)
84
Cancer is considered “cured” if
Completion of all therapy, no clinical and radiological evidence of diseases, and 5 years since diagnosis
85
Long-term side effects of childhood cancer
Can impact growth and development, organ function, fertility and reproduction, psychosocial, and cancer (recurrent primary cancer and subsequent neoplasms)
86
Cardinal signs of cancer in children
An unusual lump or swelling, unexplained paleness and loss of energy, easy bruising or bleeding, ongoing pain in one area of the body, limping, unexplained fever or illness that does not resolve, frequent headaches often with vomiting, sudden eye or vision changes, sudden and unexplained weight loss
87
Pediatric cancer treatment plan
Multimodal: surgery, radiation, chemotherapy, biological, stem cell transplant
88
Cancer treatment that stimulates antibodies that target cancer cells and stimulate general immune system interfering with tumor growth molecules
Biologic
89
Stem cells derived from compatible donor, often familial
Allogeneic
90
Stem cells derived from self
Autologous
91
Major risk associated with cancer treatment
Infection (most deaths result from sepsis)
92
Managing infection in cancer patients
Monitor S/S of infection/sepsis, IV therapy treatment, prophylaxis common, biologics, prevent infection!
93
Nursing interventions to prevent hemorrhage in cancer patients
Avoid skin puncture when possible, avoid additional trauma, platelet transfusion during bleeding episodes
94
Anemia nursing interventions
RNC transfusions, let child regulate activity
95
Medications for N/V in cancer patients
Pheng, compazine, tigan
96
Interventions for altered nutrition in cancer patients
Assess weight, intake, height; high calorie foods
97
Interventions for mucosal ulceration in cancer patients
Bland food, soft toothbrush or toothsponge, antiseptic mouth washes, warm sitz bath, ointments
98
S/S of neurotoxicity related to cancer treatment
Jaw pain, foot drop, numbness, weakness, constipation
99
Preventing hemorrhagic cystitis as a side effect of chemotherapy
Lots of fluid before, during, and after chemo
100
Broad categories of neoplastic disorders
Blood neoplasms, bone and soft tissue cancers, organ neoplasms
101
Umbrella term for cancers of the blood, bone marrow, and lymphatic system
Leukemias
102
In healthy children, bone marrow makes _______________ which mature into lymphoid or myeloid stem cells
Blood stem cells
103
Myeloid stem cells
RBCs, platelets, WBCs
104
Lymphoid stem cells
Lymphoblasts (become B and T lymphocytes) and natural killer cells
105
Types of leukemias
Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML)
106
Most common form of childhood cancer
Acute Lymphoblastic Leukemia (ALL)
107
Most common solid tumor in children
Tumors of the CNS
108
60% of tumors are
Infratentorial (posterior - primarily brainstem and cerebellum)
109
Manifestations/behaviors of brain tumors
S/S directly related to location and size, headache and vomiting upon waking (increased ICP), behavioral changes, visual disturbances, motor skill disruption, seizures, hemiparesis
110
Pituitary tumors may lead to
Hormonal related disease processes
111
Brain tumors diagnosis
Clinical S/S, imaging, biopsy (usually done during surgery)
112
Brain tumor treatment
Depends on type of tumor involved; surgery (survival increases with complete removal), chemotherapy, radiation (shrinks tumors before surgery, kills remaining tumor cells after surgery)
113
Manifestations of bone tumors
Pain in affected site, limping, stops physical activity, unable to hold heave objects, palpable mass, cord compression and respiratory distress (Ewing’s sarcoma)
114
Bone tumor diagnosis
Rule out infection or trauma, imaging, needle or surgical biopsy
115
Most common bone tumor is adolescents and young adults thought to originate during rapid bone growth
Osteosarcoma
116
Osteosarcoma tumor sites
Often in long bones near growth plate (40% in femur)
117
Less common bone tumors predominately in caucasians with more than half the population affected being adolescents
Ewing’s sarcoma
118
Surgery that preserves an arm or leg by replacing cancerous bone with an expandable prosthesis
Limb-salvage surgery
119
Most common extracranial childhood solid tumor that arises from embryonic neural crest cells
Neuroblastoma
120
Median age at diagnosis of neuroblastoma
19 months (disease of infancy and early childhood)
121
Cells that become the adrenal medulla and sympathetic nervous system
Embryonic neural crest cells
122
Neuroblastoma manifestations
Depends on location and extent of disease progression; firm, non-tender, irregular mass that crosses the midline
123
Most common site for neuroblastoma
Abdomen (other sites: head and neck, chest, pelvis)
124
Most common kidney tumor of childhood
Wilms tumor (nephroblastoma)
125
Average age at diagnosis for single kidney wilms tumor
44 months (almost 4 years old)
126
Average age at diagnosis for bilateral wilms tumor
31 months
127
Approximately 10% of children with wilms have
Congenital anomalies (higher rate of bilateral disease)
128
Wilms tumor manifestations
Swelling or mass in abdomen that does not cross midline, mass if firm, non-tender, one sided, deep in flank, pain, hematuria
129
Wilms tumor treatment
Surgery (nephrectomy for unilateral, renal transplant for bilateral/Stage V), chemotherapy, radiation (for advanced disease)
130
Chemotherapy for wilms tumor
Vincristine, dactinomycin, doxorubicin, cyclophosphamide, etoposide
131
Wilms tumor prognosis
5 year survival rates are 90%; worse prognosis with advanced disease or bilateral renal involvement
132
Wilms tumor nursing consideration
Do NOT palpate abdomen! Risk of disseminating cancer cells into abdominal cavity
133
Cancer that arises from striated (rhabdo) tissue originating from muscles, tendons, bursae, and fascia
Rhabdomyosarcoma
134
Most common primary sites of rhabdomyosarcoma
Head and neck (especially the orbit)
135
2/3 of rhabdomyosarcoma cases occur in children under the age of ___ with a smaller peak incidence in early to middle adolescence
10
136
Manifestations of rhabdomyosarcoma
Related to site of tumor and compression of other organs, tend to be vague (frequently suggest a common childhood illness), often not possible to determine primary tumor location
137
Rhabdomyosarcoma treatment
Chemotherapy, surgical resection, radiation in limited cases
138
Chemotherapy for rhabdomyosarcoma
Vincristine, dactinomycin, cyclophosphamide, isofamide
139
Rhabdomyosarcoma prognosis
Related to age, children 1-9 years old have highest survival, poor prognosis if relapse occurs
140
Most common intraocular malignancy of childhood that arises from the retina
Retinoblastoma
141
Characteristics of retinoblastoma
Can be present at birth, unilateral or bilateral, has a heritable form, most cases diagnosed before 3-4 years of age
142
Retinoblastoma manifestations
Whitish glow in the pupil (cats eye reflex); visualization of light as it hits the mass often seen with flash photography; strabismus
143
Retinoblastoma treatment
brachytherapy, photocoagulation, cryotherapy, for advanced disease: chemotherapy, radiation, stem cell transplant, surgical removal of eye
144
Retinoblastoma prognosis
10-year survival rate is 90% for both unilateral and bilateral tumors
145
Pulse oximetry nursing care
Choose probe site that is dry with adequate circulation, compare radial pulse to reading for accuracy, set high/low alarms, rotate probe site q4-8h on infants with impaired skin integrity to prevent pressure necrosis
146
What is the expected O2 range? What level requires nursing intervention?
95-100%; intervention required for 91-92% or lower
147
What is the concentration of O2 in room air?
21%
148
Nasal cannula characteristics
Delivers 24-40% FiO2, safe and tolerated well, child can eat and talk while using
149
Nasal cannula nursing care
Ensure patency of nares, skin intact
150
Oxygen hood for an infant must use a minimum flow rate of __ to __ L/min
4-5
151
Oxygen hood nursing care
Ensure chin, neck, and shoulders do not rub
152
Face mask characteristics
Short-term therapy, flow rate of 5-10 L/min, requires snug fit
153
Inhalation that breaks up medication into minute particles (significantly finer particles compared to inhalers) that can be dispersed throughout the respiratory tract; most effective for getting medication into alveoli
Nebulized aerosol therapy
154
Inhalation therapies that allow child to self-administer medication
MDIs or dry powder inhalers
155
Nursing care for MDIs or dry powder inhalers
Teach at child level, ensure child uses proper technique
156
Set of techniques that aid in the removal of excessive secretions through manual/mechanical percussion, vibration, cough, forceful expiration, and breathing exercises
Chest physiotherapy
157
Chest physiotherapy patient positioning to promote drainage of apical sections of upper lobe
Fowler’s
158
Chest physiotherapy patient positioning to promote drainage of posterior sections of upper lobe
Sitting leaning forward curled over pillows
159
Chest physiotherapy patient positioning to promote drainage of anterior segments of both upper lobes
Supine and slightly rotated away from side being drained
160
Chest physiotherapy patient positioning to promote drainage of superior segments of both lower lobes
Prone with hips elevated
161
Chest physiotherapy nursing care
Medicate prior w/ bronchodilators, remain in position for 20-30 min after (longer if tolerated), assess lungs before and after therapy, assess amount, color, and character of secretions
162
Side effects of cancer treatment
Infection, hemorrhage, anemia, N/V, altered nutrition, mucosal ulceration, neurologic problems, hemorrhagic cystitis
163
With pediatric cancer, between long-term adjustments are associated with parents who:
Are employed, have social support, experience lower levels of parenting stress, view their child’s quality of life positively, have positive expectations from treatment outcome
164
With pediatric cancer, poor long-term adjustments are associated with parents who:
Have low parental expectations for positive outcomes, experience feelings of helplessness, uncertainty, and anxiety, low social support, have negative interactions w/ health care members, negative assessment of child’s quality of life
165
Research has shown that children develop an awareness regarding the seriousness of their diagnosis. Failure to have open and honest discussions result in:
Fear, guilt, misconceptions, pain of grieving alone, psychological problems for surviving siblings
166
Discussing death with children
Be honest and accurate regardless of age, be age-appropriate, identify specific fears and anxiety
167
Preschool children reactions to dying
Have some sense of meaning for the word “death”, may perceive death as temporary and reversible (dead person still eats, breathes, drinks, sleeps, etc.), no understanding of finality of death, may perceive illness as punishment, parents grief may be perceived as a rejection of them, blame disruptions on the ill child, greatest fear is separation from parents
168
School-age children reactions to dying
Deeper understanding of death in concrete sense, curious about what happens after death (be factual!), most have an adult understanding of death by age 7, fear of unknown, fear of death is a tremendous threat to sense of security and ego strength, fear exhibited through verbal uncooperativeness
169
Adolescents reactions to dying
Mature understanding but sense of invincibility, more worried about bodily changes and socialization than possibility of death
170
Nursing care for adolescent reactions to dying
Allow as much independence and control as possible, answer questions honestly, treat them as an individual, be neutral - no alliance with child or parent, allow parents and child to express frustrations w/o judgement
