Exam 2 Flashcards
What are the recommended therapies for small children with nasopharyngitis?
Supportive tx with antipyretics, nasal saline irrigation, and adequate fluid hydration. Elevating HOB to drain secretions and suctioning with a bulb syringe.
Why shouldn’t cough suppressants be used for nasopharyngitis?
Because cough is a protective way to clear secretions. They may be prescribed for a dry hacking cough at night.
What do you teach families about URIs?
They usually resolve within 4-10 days. They’re frequent in children younger than 3 and by 5 their children will have developed immunity to many viruses.
What causes strep throat?
Group A Beta-Hemolytic Streptococcus
Children with strep throat are at risk for what for 10 days?
Acute glomerulonephritis
Children with strep throat are at risk for what for 18 days?
Acute rheumatic fever
Incubation period for strep throat
2-4 days
When does strep throat usually subside?
3-5 days
How is strep throat treated?
With oral penicillin for 10 days or IM Pen G (very painful, can cause local skin reactions or rash)
How to care for tonsillectomy patient
Placed on side or abdomen to facilitate drainage, suction cautiously, ice collar to provide relief, prevent coughing/crying/blowing nose
Signs of airway obstruction after tonsillectomy
Stridor, drooling, restlessness
Where is dark brown blood usually found after a tonsillectomy?
Nose, emesis, teeth
Diet for post-tonsillectomy
No fluids with red or brown color, avoid citrus, need soft or liquid diet
Signs of post-op bleeding after tonsillectomy
High HR, frequent clearing of throat or swallowing, vomiting bright red blood
How long will pts have bad breath after a tonsillectomy?
5-10 days
Highest incidence of otitis media
Ages 6-20 months and in winter months
Bacterial OM is usually preceded by what?
A viral respiratory infection (RSV, Influenza)
What causes OM?
Malfunctioning eustachian tube. Obstruction of tube causes accumulation of secretions
Can eventually produce an effusion
Acute OM
Visual inspection shows a purulent
discolored effusion and a bulging
reddened membrane, abrupt onset
OM with effusion
Inflammation and fluid in the middle ear without s/s of acute infection
- immobile membrane or orange discolored
membrane
Symptoms may be absent, nonspecific
symptoms present (rhinitis, cough, diarrhea)
When do pts need hearing evaluations with OM effusion?
Every 3-6 months until resolved
When are antibiotics given for OM?
Less than 6 months, severe s/s of AOM (ear pain for at least 48 hours or temp >102.2F), bilateral AOM without s/s,
Tx for unilateral AOM without severe s/s & for 24 months without s/s
Either give abx or watch for 48-72 hours for improvement
Tx of OME
Abx given if fluid present for > 3mo
What is IM Rocephin for with OM?
Highly resistant bacteria or noncompliance
What is the abx of choice for OM?
Amoxicillin for 10 days (n/v, diarrhea)
Do not give if have PCN allergy
Other abx – augmentin, azithromycin, cephalosporin
Myringotomy
Surgical incision of eardrum to provide drainage and relieve pain
Tympanostomy tube placement
Tx recurrent chronic AOM (3 bouts in 6 mo, 6 in 12 mo, 6 by 6 years old)
Nursing care after a tympanostomy tube placement
Facilitate continued drainage of fluid and allow ventilation of middle ear
Prevention of OM
Pneumococcal vaccine (PCV7), annual flu vaccine reduce risk factors - breast feed for at least 6 mo, avoid propping bottle, decrease pacifier use after 6 months, avoid exposure to tobacco smoke
What to teach family for OM
If tubes in place need earplugs for swimming, avoid getting bathwater and shampoo in ears, show them what tube looks like so can recognize if falls out
Nursing care for OM
Relieve pain, facilitate drainage – clean external canal with cotton swabs and antibiotic ointment and protective barrier if skin breaks down, prevent complications and recurrence – complete abx tx
Croup
Swelling or obstruction in region of the larynx, barking or brassy cough, stridor
Prevention of acute epi
Beginning at two months all children should receive the HIB vaccine
Tx of acute epi
Lateral neck x-ray, elective intubation before any procedures, humidified oxygen, IV antibiotics then oral for 7-10 days, Corticosteriods for reducing edema, Airway swelling decreases after 24 hours of abx tx
S/s of acute LTB
low grade fever, inspiratory stridor, suprasternal retractions
Develops classic barking (seal-like) cough
Worse at night and crying exacerbates
Tx for acute LTB
Maintain airway
High humidity with cool mist (take child outside, stand in front of open freezer, cool basement), cool air vaporizer
Continue fluid intake with mild croup (RR
Nursing management of acute LTB
Continuous, vigilant observation and accurate assessment of respiratory status – pulse ox
What are s/s of respiratory distress and airway obstruction?
Bronchiolitis
Acute viral infection with maximum effect at the bronchiolar level
Occurs in winter and spring – incubation period 2-8 days
RSV responsible for 80% or more of the cases during epidemic periods
RSV makes epithelial cells of resp tract swell, fill with mucus and exudate
Causes obstruction (expiration) and atelectasis
Hyperinflation and progressive overinflation (emphysema)
Transmission is through direct contact with secretions – can live on surfaces for several hours and hands for 30 minutes
Can cause a secondary bacterial infection (OM, pneumonia)
How long does pertussis last?
6-10 weeks
What is the definite dx of a foreign body ingestion?
Bronchoscopy
Tx of foreign body ingestion
-Heimlich Maneuver
1 yo: abdominal thrusts
-No finger sweeps
-Removed through endoscopy under sedation
What do you watch for after endoscopy?
For laryngeal edema afterwards
Peak Expiratory Flow Rate (PEFR)
Used to measure max flow of air forcefully exhaled in 1 second using flow meter
Find child’s best value as a baseline to compare
PFT for asthma
Evaluating the presence and degree of lung disease, response to tx, can be used once child is 5-6 yo
Used on initial dx, after treatment started, and every 1-2 years
MDI
Always attach to a spacer to prevent yeast
Spacer
Helps increase availability of med
Nebulizer
For children who have difficulty using MDI, administers med via compressed air
Patho of CF
Increased viscosity of mucous gland secretions
Elevation of sweat electrolytes
Increase in enzymes in saliva
Abnormalities in autonomic nervous system
Obstruction of the pancreas and bronchioles
How to dx CF
Sweat chloride test – normal 60 mEq/L is diagnostic of CF
Absence of pancreatic enzymes
X-ray – shows patchy atelectasis and obstructive emphysema
Family history
Newborn screening – required by law
DNA ID of gene following + NB screening
Stool analysis for fat and enzyme analysis
GI S/S of CF
Meconium ileus Large, bulky, frothy, foul-smelling stools Wt loss, growth failure Distended abd Vitamin ADEK deficiency
Salty taste to skin occurs with what disorder?
CF
Respiratory S/S of CF
Wheezing respirations Dry, non-prod cough Increased dyspnea Obstructive emphysema and atelectasis Barrel-shaped chest Cyanosis Clubbing of fingers and toes Repeated episodes of bronchitis and bronchopneumonia
Complications of CF
Restricted growth and development - FTT
Cystic-fibrosis related diabetes (CFRD)
Rectal prolapse
Reproductive system – highly viscous cervical secretion can cause infertility in females, 95% of males with CF are sterile
Nursing management of CF
Thorough resp and GI assessment
Maintaining a patent airway
Preventing infection – standard precautions and high alert for hospital acquired infections, avoid contact with other CF patients
Maintaining growth – consult with dietician, may have to teach enteral feeds
Promoting family coping – encourage compliance with complicated regimen
Case management – O2, IV abx, Nebs/Meds, CPT supplies
Preparing family and child for adulthood
Trach care
What do you need to know about the pt’s trach?
Suction prn – when?
Supplies needed??
Steps to suction:
100% O2 before suctioning begins
Sterile at the hospital/ aseptic at home
Each pass only 5 seconds
Rest 30-60 sec after each pass
Parent education- change tubes, ties, suctioning, when to call an MD
Daily care – skin assessment, trach ties changed daily, weekly trach changes (2 hours after meals), use 2 people at all times
How to we give oxygen through trach?
What are the five factors affecting the process of labor and birth?
- Passenger
- Passageway
- Powers
- Position of mother
- Psychological response
Refers to the part of the fetus that enters the pelvic inlet first and leaves through the birth canal during labor
Fetal presentation
Refers to the part of the fetal body first felt by the examining finger
Fetal presentation
The relation of the spine of the fetus to the spine of the mother
Fetal lie
The relation of the fetal body parts to one another
Fetal attitude
The largest transverse diameter and an important indicator of fetal head size
Biparietal diameter
The relationship of a reference point on the presenting part of the fetus to the four quadrants of the mother’s pelvis
Fetal position
First letter of fetal position abbreviation
The location of the presenting part in the right or left side of the mother’s pelvis. (R or L)
Second letter of fetal position abbreviation
The specific presenting part of the fetus (Occiput, sacrum, or mentum..O S or M)
Third letter of fetal position abbreviation
The location of the presenting part of the fetus in relation to the portion of the maternal pelvis (anterior, posterior, transverse… A P or T)
How do you measure the diagonal conjugate?
Insert 2 fingers into the vagina until they reach the sacral promontory.
How long should the diagonal conjugate be?
Greater than 11.5 cm
The distance from the sacral promontory to the exterior portion of the symphysis
The diagonal conjugate
The bony pelvis is divided into what?
True and false portions
The upper flared parts of the two iliac bones and the base of the sacrum
The false portions
Bony passageway through which the fetus must travel
True portions
Allows entrance into the true pelvis
Pelvic inlet
Occupies the space between the inlet and the outlet
Mid-pelvis
Bound by the ischial tuberosities and lower rim of the symphysis pubis and the tip of the coccyx
Pelvic outlet
Classic female pelvic shape
Gynecoid
Resembles the male pelvis
Android
Resembles the pelvis of anthropoid apes, adequate for vertex birth, oval shape
Anthropoid
Flat pelvis, rectangular
Platypelloid
The relation of the presenting part of the fetus to an imaginary line drawn between the maternal ischial spines
Station
A measure of the degree of descent of the presenting part of the fetus through the birth canal
Station
How to measure the placement of the presenting part of the fetus?
In cm above or below the ischial spines
The largest transverse diameter of the presenting part that has passes through the maternal pelvic brim or inlet into the true pelvis and usually corresponds to 0 station
Engagement
The presenting part of the fetus is usually which diameter?
Biparietal
The fetal head is positioned in the pelvic cavity at an angle
Asynclitism
Soft tissues include what?
Distensible lower uterine segment, cervix, pelvic floor muscles, vagina, and introitus
After labor begins uterine contractions cause the uterine body to have what?
A thick muscular upper segment and a thin-walled, passive, muscular lower segment
Primary contractions
Involuntary, responsible for effacement, dilation, and descent
Secondary contractions
Augment the force of the involuntary contractions, mother bears down, have no effect on dilation or expulsion
When the presenting part of the fetus descends into the true pelvis
Lightening
Hormones at onset of labor
Increasing estrogen and prostaglandin and decreasing progesterone
First stage of labor phases
Latent, active, transition
When does the 1st stage of labor occur
From the onset of regular uterine contractions to full dilation of the cervix
Latent phase
0-3 cm dilated
Active phase
3-7 cm dilated
Transition phase
8-10 cm dilated
When does the 2nd stage of labor occur
Begins with full cervical dilation and complete effacement and eggs with the baby’s birth
When does the 3rd stage of labor occur
From the birth of the baby until the placenta is expelled
Placental separation is indicated by what?
Firmly contracting fundus, changing uterus from discoid to globular shape, placenta moves into the lower uterine segment, a gush of dark blood, lengthening of the cord
When does the 4th stage of labor occur
Begins with the delivery of eh placenta to the first 1-2 hours after birth
How should the uterus be during the 4th stage of labor
Firm and well contracted, hypotonic bladder
What to monitor for with hemodynamic changes
Blood loss ranging to 250-500mL, blood redistributed into venous beds, moderate drop in both systolic and diastolic BP, increase pulse pressure, moderate tachycardia
The turns and other adjustments necessary in the human birth process
Mechanism of labor (cardinal movements)
Cardinal movements
- Engagement
- Descent
- Flexion
- Internal rotation
- Extension
- External rotation
(restitution) - Expulsion
Bradley Method
?
Sedatives given during labor
Seconal, phenergan, valium, vistaril
Narcotics given during labor
Demreol, dilaudid, fentanyl, nubain, stadol
Pudendal block
Injected directly into the pudendal nerve
When is the pudendal block used?
Second stage of labor, birth, forceps or vacuum assisted delivery, episiotomy repair
When is a spinal block used?
For C-sections or difficult forceps delivery
Disadvantages to spinal blocks
Hypotension, total spinal block, drug reaction, spinal HA
Epidural contraindications
Infection, coagulation dx, drug allergy
How do you treat epidural induced maternal hypotension?
IV bolus and ephedrine
Disadvantages to epidurals
Pruritus, slowed pushing efforts, increased use of vacuum and forceps, delay in return of bladder sensation
Combined spinal and epidural
Involves inserting the epidural needle into the epidural space and subsequently inserting a smaller gauge spinal needle through the epidural needle into the subarachnoid space, rapid onset and duration of pain relief, allows motor function and pushing efforts to remain active
