CPN Exam Respiratory/ENT Conditions Flashcards
ABG Normal Values
pH: 7.35-7.45
PaCO2: 35-45
HCO3: 22-26
Abnormal ABG Values
pH
-<7.35 - Acidosis
->7.45 - Alkalosis
PaCO2
-<35 - Alkalosis
->45 - Acidosis
HCO3
-< 22 - Acidosis
->26 - Alkalosis
Acidosis Causes
Respiratory distress or arrest
Diarrhea, kidney failure, diabetic ketoacidosis
Alkalosis Causes
Hyperventilation
Vomiting
Respiratory Distress Management
Cluster care
Elevate head of bed
Do not feed orally with tachypnea
Do not hyperextend neck
Asthma
Chronic - Inflammation, hypersensitivity to triggers
Acute - Swelling of airways, mucous production
Bronchospasm
Narrowing of the airways
Asthma Assessment
Cough at night, after physical activity, lasting for > 1 Week
Chest tightness
Shortness of breath
Wheezing
Respiratory Distress
Broncholitis
Lower respiratory infection causing an obstruction of the small airways, called bronchioles
Most cases caused by RSV
Carbon Monoxide Poisoning
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
Mild CO Poisoning
Dull headache (most common early symptom)
Dizziness
Fatigue
Nausea
Severe CO Poisoning
Confusion
Loss of consciousness
Death
CO Poisoning Treatment
100% oxygen via nonrebreathing face mask
May need hyperbaric oxygen if severe
Bronchopulmonary Dysplasia (BPD)
A chronic lung disease thought to be caused by injury to a premature lung
BPD Risk Factors
Gestational age < 30 weeks
Neonatal mechanical ventilation
High inhaled oxygen concentrations
BPD Assessment
Tachypnea
Nasal flaring
Shallow respirations
Wheezing crackles, rhonchi
Grunting respirations
Inability to wean from supplemental oxygen
BPD Treatment
Oxygen
Nasal Positive airway pressure
Small frequent feedings, high calorie formula
Medications
-Corticosteroids
-Bronchodilators
-Diuretics
Laryngotracheobronchitis (LTB) Croup
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
Croup Assessment
Barky, brassy cough
Inspiratory stridor
Respiratory distress
Croup Management
IV Fluid
Antipyretics
Racemic Epi
Corticosteroids
Epiglottitis
A life-threatening infection of the epiglottis
Primarily affects kids under 5 years of age
Etiology = H. Influenzae
Epiglottitis Symptoms
Fever
Painful/difficult swallowing with drooling and tongue protrusion
Refusal to drink
Cough, stridor
respiratory distress
Anxiety/irritability
Epiglottitis Diagnosis
Lateral neck x-ray
NO manual assessment of airway without intubation equipment
Epiglottitis Management
Prepare for intubation
Monitor respiratory status
IV corticosteroids/antibiotics
*Prevention - Hib vaccine
Cystic Fibrosis
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.
CF Assessment
Steatorrhea
Frequent respiratory infections as infant
Failure to Thrive
CF Diagnosis
Sweat Chloride test
CF Respiratory Symptoms
Wet, Chronic cough
Wheezing
Dyspnea
Clubbing of fingernails
Barrel chest - obstructive emphysema, hyperaeration, patchy atelectasis
Secondary Infection with CF
Pseudomonas aeruginosa
Burkholderia cepacia
S. aureus
H. influenzae
E.coli
Klebsiella pneumonia
CF Mechanical Management
Chest percussion
Deep breathing and coughing
Flutter mucous clearance device
ThAIRapy vest
CF Medication Management
CFTR Modulator Therapy
Aerosolized Pulmozyme
Pulmonary Infection with CF Management
Treat Infection Promptly & Aggressively
IV Antibiotics
Airway Clearance
Worrisome Infections with CF
Pseudomonas aeruginos
-Difficult to eradicate
Burkholderia cepacia
-Increases morbidity and mortality
Organs affected by CF
Pancreas - impaired nutrient absorption
Liver - Biliary Obstruction
Small intestine - Meconium blocks ( 7%-10% of cases)
CF Nutrition
High Protein/High Calorie
Pancreatic Enzymes with snacks - in applesauce before meals
CF Reproductive System
Female: delayed puberty, viscous cervical secretions
Male: Sterile
CF Tracheostomy
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
Vision Assessment
Infant: Gross assessment
Preschooler: picture test
School Age: letter test
Hearing Assessment
Newborn: hospital before discharge
Toddler: assessment of speech
Preschooler: hearing acuity testing
Amblyopia (Lazy Eye)
Can result from strabismus (crossed eyes
Can result in vision loss from disuse
Amblyopia Management
Patch healthy eye
Refer for treatment
Bacterial Conjunctivitis
Inflammation of conjunctiva; can also be caused by viruses and allergies
Bacterial Conjunctivitis Management
Antibiotic ophthalmic ointment or drop
Exclude from school for 24 hours after starting antibiotics
Warm compresses
Infection Control
Otitis Media
Common in infants due to shorter, wider and less angled eustachian tube
Otitis Media Assessment
Pull ear down and back 0-3
Up and back >3 years
Bulging/red TM
Pain, Fever, URI
Otitis Media Treatment
Oral Antibiotics
Analgesics
Antipyretics
Tubes
Otitis Media Prevention
Breast feed first 6 mo
Feed in upright position
Discontinue pacifier after 6 mo
Prevnar Vaccine
Avoid passive smoke
