CPN Exam Respiratory/ENT Conditions

Question 1

ABG Normal Values

Answer 1

pH: 7.35-7.45
PaCO2: 35-45
HCO3: 22-26

Question 2

Abnormal ABG Values

Answer 2

pH
-<7.35 - Acidosis
->7.45 - Alkalosis
PaCO2
-<35 - Alkalosis
->45 - Acidosis
HCO3
-< 22 - Acidosis
->26 - Alkalosis

Question 3

Acidosis Causes

Answer 3

Respiratory distress or arrest
Diarrhea, kidney failure, diabetic ketoacidosis

Question 4

Alkalosis Causes

Answer 4

Hyperventilation
Vomiting

Question 5

Respiratory Distress Management

Answer 5

Cluster care
Elevate head of bed
Do not feed orally with tachypnea
Do not hyperextend neck

Question 6

Asthma

Answer 6

Chronic - Inflammation, hypersensitivity to triggers
Acute - Swelling of airways, mucous production

Question 7

Bronchospasm

Answer 7

Narrowing of the airways

Question 8

Asthma Assessment

Answer 8

Cough at night, after physical activity, lasting for > 1 Week
Chest tightness
Shortness of breath
Wheezing
Respiratory Distress

Question 9

Broncholitis

Answer 9

Lower respiratory infection causing an obstruction of the small airways, called bronchioles
Most cases caused by RSV

Question 10

Carbon Monoxide Poisoning

Answer 10

RBCs pick up CO quicker than they pick up O2. If there is a lot of CO in the air, the body will pick up only CO and this interferes with O2 getting into the body and leads to tissue damage and death. CO is odorless/colorless

Question 11

Mild CO Poisoning

Answer 11

Dull headache (most common early symptom)
Dizziness
Fatigue
Nausea

Question 12

Severe CO Poisoning

Answer 12

Confusion
Loss of consciousness
Death

Question 13

CO Poisoning Treatment

Answer 13

100% oxygen via nonrebreathing face mask
May need hyperbaric oxygen if severe

Question 14

Bronchopulmonary Dysplasia (BPD)

Answer 14

A chronic lung disease thought to be caused by injury to a premature lung

Question 15

BPD Risk Factors

Answer 15

Gestational age < 30 weeks
Neonatal mechanical ventilation
High inhaled oxygen concentrations

Question 16

BPD Assessment

Answer 16

Tachypnea
Nasal flaring
Shallow respirations
Wheezing crackles, rhonchi
Grunting respirations
Inability to wean from supplemental oxygen

Question 17

BPD Treatment

Answer 17

Oxygen
Nasal Positive airway pressure
Small frequent feedings, high calorie formula
Medications
-Corticosteroids
-Bronchodilators
-Diuretics

Question 18

Laryngotracheobronchitis (LTB) Croup

Answer 18

Primarily affects toddlers
Usually viral-induced inflammation of the larynx (large airway)
Most cases occur in autumn or winter
Etiology– Most cases are caused by Parainfluenza virus

Question 19

Croup Assessment

Answer 19

Barky, brassy cough
Inspiratory stridor
Respiratory distress

Question 20

Croup Management

Answer 20

IV Fluid
Antipyretics
Racemic Epi
Corticosteroids

Question 21

Epiglottitis

Answer 21

A life-threatening infection of the epiglottis
Primarily affects kids under 5 years of age
Etiology = H. Influenzae

Question 22

Epiglottitis Symptoms

Answer 22

Fever
Painful/difficult swallowing with drooling and tongue protrusion
Refusal to drink
Cough, stridor
respiratory distress
Anxiety/irritability

Question 23

Epiglottitis Diagnosis

Answer 23

Lateral neck x-ray
NO manual assessment of airway without intubation equipment

Question 24

Epiglottitis Management

Answer 24

Prepare for intubation
Monitor respiratory status
IV corticosteroids/antibiotics
*Prevention - Hib vaccine

Question 25

Cystic Fibrosis

Answer 25

An inherited autosomal recessive disorder of the exocrine (mucus-producing) glands causing increase viscosity of mucous gland secretions. The most common genetic disease in the U.S.

Question 26

CF Assessment

Answer 26

Steatorrhea Frequent respiratory infections as infant Failure to Thrive

Question 27

CF Diagnosis

Answer 27

Sweat Chloride test

Question 28

CF Respiratory Symptoms

Answer 28

Wet, Chronic cough Wheezing Dyspnea Clubbing of fingernails Barrel chest - obstructive emphysema, hyperaeration, patchy atelectasis

Question 29

Secondary Infection with CF

Answer 29

Pseudomonas aeruginosa Burkholderia cepacia S. aureus H. influenzae E.coli Klebsiella pneumonia

Question 30

CF Mechanical Management

Answer 30

Chest percussion Deep breathing and coughing Flutter mucous clearance device ThAIRapy vest

Question 31

CF Medication Management

Answer 31

CFTR Modulator Therapy Aerosolized Pulmozyme

Question 32

Pulmonary Infection with CF Management

Answer 32

Treat Infection Promptly & Aggressively IV Antibiotics Airway Clearance

Question 33

Worrisome Infections with CF

Answer 33

Pseudomonas aeruginos -Difficult to eradicate Burkholderia cepacia -Increases morbidity and mortality

Question 34

Organs affected by CF

Answer 34

Pancreas - impaired nutrient absorption Liver - Biliary Obstruction Small intestine - Meconium blocks ( 7%-10% of cases)

Question 35

CF Nutrition

Answer 35

High Protein/High Calorie Pancreatic Enzymes with snacks - in applesauce before meals

Question 36

CF Reproductive System

Answer 36

Female: delayed puberty, viscous cervical secretions Male: Sterile

Question 37

CF Tracheostomy

Answer 37

Catheter should be ½ size of trach diameter Instill catheter to a pre-measured length NOT until resistance is met.– 0.5 cm (0.2 inch) beyond the end of tracheostomy tube Normal Saline should NOT be used - removes normal flora and promotes infection

Question 38

Vision Assessment

Answer 38

Infant: Gross assessment Preschooler: picture test School Age: letter test

Question 39

Hearing Assessment

Answer 39

Newborn: hospital before discharge Toddler: assessment of speech Preschooler: hearing acuity testing

Question 40

Amblyopia (Lazy Eye)

Answer 40

Can result from strabismus (crossed eyes Can result in vision loss from disuse

Question 41

Amblyopia Management

Answer 41

Patch healthy eye Refer for treatment

Question 42

Bacterial Conjunctivitis

Answer 42

Inflammation of conjunctiva; can also be caused by viruses and allergies

Question 43

Bacterial Conjunctivitis Management

Answer 43

Antibiotic ophthalmic ointment or drop Exclude from school for 24 hours after starting antibiotics Warm compresses Infection Control

Question 44

Otitis Media

Answer 44

Common in infants due to shorter, wider and less angled eustachian tube

Question 45

Otitis Media Assessment

Answer 45

Pull ear down and back 0-3 Up and back >3 years Bulging/red TM Pain, Fever, URI

Question 46

Otitis Media Treatment

Answer 46

Oral Antibiotics Analgesics Antipyretics Tubes

Question 47

Otitis Media Prevention

Answer 47

Breast feed first 6 mo Feed in upright position Discontinue pacifier after 6 mo Prevnar Vaccine Avoid passive smoke