Exam 2 Respiratory Flashcards
Describe Moderate dehydration in pediatric clients:
Weight loss % infants: Weight loss % child: Pulse: RR: BP: Anterior fontanel: Cap refill: Turgor: Urine: Behavior: Mucous membranes:
Weight loss % infants: 6-9% Weight loss % child: 6-8% Pulse: mildly increased RR: slight tachypnea BP: normal to orthostatic ( > 10mmHg change) Anterior fontanel: Normal to sunken Cap refill: 2-4 seconds Turgor: decreased Urine: Oliguria Behavior: irritable and thirsty Mucous membranes: dry
Acute Laryngealtracheobronchitis Treatment
- Decadron (corticosteroid) *reduces inflammation
- racemic epinephrine *relaxes smooth muscles
Acute Laryngealtracheobronchitis Causes
Virus
Upper respiratory Tract Infection
Acute Laryngealtracheobronchitis Age Group
Infant or Child <5 yrs
Acute Laryngealtracheobronchitis S/S
- barky/seal-like cough
- nighttime exacerbation
- lung sounds: inspiratory stridor
Epiglottis Causes
Bacteria
-H. influenza
Epiglottis Ages
Ages 2-5 yrs
Epiglottis Treatment
- IV corticosteroids
- Antibiotics
Epiglottis Prevention
HIB vaccine
Epiglottis S/S
- muffled voice
- froggy cough
- tripod sitting
- drooling
- Stridor when supine
Epiglottis
MEDICAL EMERGENCY
-rapid/acute onset
Respiratory Syncytial Virus (RSV) Causes
Virus
- At bronchiolar level
- Lower respiratory infection
Respiratory Syncytial Virus (RSV) Assessment
- Premature infants
- Multiples (Twins)
- Ages older than 3 have at it at least once
- Less than 1 month presents as apnea
Respiratory Syncytial Virus (RSV) S/S
- Congestive Cough
- Clear and Cloudy drainage
- Thick layer of mucus in the airway
Respiratory Syncytial Virus (RSV) Treatment
- Suction
- supportive care: antipyretics, fluids, ant
DO NOT GIVE: Corticosteroids, antibiotics, antihistamines, antivirals
Respiratory Syncytial Virus (RSV) Prevention
- Synagis Vaccine
- Kissing babies on lips
- Spit sharing
Pertussis AKA Whooping cough Causes
- Bacterial infection
- Bordatella pertussis
Highly contagious
Pertussis Mechanism
-Bacteria releases toxins which inhibits cilia than increases inflammation, can’t clear lung secretions which leads to congestive coughing
Pertussis S/S
-Frequent congestive cough
-
Pertussis Prevention
- DTap vaccine
- Family vaccination important
Pertussis Treatment
- antibiotics (-mycin)
- antipyretics (ibuprofen, acetaminophen)
- sideline position for aspiration
- fluids
Type 1 Diabetes S/S
Hypoglycemia <60
- Rapid onset
- Skin pallor
- Respiration: low/shallow
- Seizure, shock, coma
- Negative ketones
- Ph normal
Toddler/pre-schoolers <6 yrs
-Blood glucose and A1c Values
Blood glucose before meals: 100-180
Blood glucose at bedtime: 110-200
A1c: 7.5-8.5
*High risk for hypoglycemia
School age 6-12 yrs
-Blood glucose and A1c Values
Blood glucose before meals: 90-180
Blood glucose at bedtime: 100-180
A1c: <8
*High risk for hypoglycemia low risk for complications before puberty
Adolescents >12 yrs
-Blood glucose and A1c Values
Blood glucose before meals: 90-130
Blood glucose at bedtime: 90-150
A1c: <7.5
epiglottis
Prepare for emergency intubation, assess vital signs, and listen to breath sounds
Best way to way monitor weight in a child with dehydration?
Daily weights, same scale, same time
Components of RAPID+
R: Rapid heart rate A: Altered color P: Pee nonexistent I: Inability to interact w/ environment D: Decreased blood pressure
Rapid bolus 20/kg over 5-10 minutes
What patients would you alter how fast to give fluids?
Pt with Cardiac and Renal disease
Oral rehydration
- Formula/breastmilk
- Pedialyte
Determine the severity of asthma
Peak flow meter
The order in which drugs are given via svn to a patient w/ cystic fibrosis
Albuterol 1st and than Dornase Alpha (pulmonary enzyme)
Severe dehydration
Tachycardia, sunken fontanel, and decreased blood pressure, >10% weight loss
What is prodromal(early) symptom for asthma?
Itching on the back of the neck
Infants and children are more prone to respiratory distress
- Large tongue
- long floppy apiglottis
- short neck
- horizontal face
- funnel shaped airway
- less alveoli
Minimun urine output in 10kg infant over 8 hrs
10x1.5=15
15x8=120ml
120ml!
Acute Laryngealtracheobronchitis
Provide cool mist and observe for signs of respiratory distress
S/S Respiratiry sitress
- Stridor
- head bobbing
- retraxtions
- nasal flaring
- tachycardia
What defect in the cystic fibrosis transmembrane regulating gene cause
Na and H2O are unable to cross the chloride channel causing secretions to become thick
First S/S of cystic fibrosis in an infant
Meconium ileus
-Older children can get rectal prolapse
Nephrotic syndrome
Frothy urine
RSV
Encourage hydration, cluster care, provide oxygen as needed
Breathe sounds that are signs of emergencies
-Inspiratory stridor at rest
Acute Glomerulonephritis
- Tea colored urine
- +RBCs in urine
- +ASO titer (strep infection)
Correct number ml/kg given as oral rehydration in a mildly dehydration
50ml/kg
Mainitance Drugs for Asthma
Bronchodilator:
- morning or at night
- 2 hr before exercise
Who get Synagis
- Prematures
- immunocompromised
- Lung and congenital heart defects
- once a month IM during RSV season
Respiratory Differences from adults and children
- long floppy epiglottis
- large tongue
- short neck
- nose breather
- funnel airway
- diaphragmatic breathers
- Low alveoli
- Alveoli walls thick
- smaller nasopharynx
- immature muscles
- prominent occiput
- premature cilia
Cystic Fibrosis
-Defective/mutated gene on chromosome 7
Cystic Fibrosis Pathophysiology
No CFTR = no Cl pump = no water in secretions = think secretions
Cystic Fibrosis S/S
- Thick mucus
- Clogged airways
- Bacterial growth in airways when mucus in thick leads to infection
- Salty skin
Cystic Fibrosis how it affects Lungs
- thick mucus
- clogged airways
- bacteria loves mucus
- pneumothorax
- pneumonia
- emphysema
Cystic Fibrosis how it affects Pancreas
- insufficiency in enzymes due to ducts blocked with mucus
- treated with pancrelipase (creon)
- CF related DM (insulin resistance and deficiency)
Cystic Fibrosis how it affects GI
Small intestine:
- inspissated meconium
- obstruction of small intestine
- rectal prolaps
Malabsorption issues
- Steatorrhea: bulky stools frothy from undigested fats
- Azortorrhea: foul smell from putrefied stool
Cystic Fibrosis Treatment
-Give fat soluble vitamins (ADEK)
-Give creon within 30 min of eating meals (helps absorb fats)
Airway clearance therapies:
-huffing
-continuous postural
-high frequency chest compressions
-exercise
Cystic Fibrosis Treatment Meds
CFRD: oral glucose tolerance test Maintenance: -bronchodilators -hypertonic saline -Dornase alfa: cough medicine Antibiotics
*Use oxygen cautiously C02 retention
Asthma S/S
- wheezing
- breathlessness
- chest tightness
Early signs of asthma:
-Prodromal itching: front of neck/upper back
Chronic signs:
-coughing w/out infection or expiratory breathing
How to judge Asthma Severity
Peak flow meter *kids older than 5yrs
- Green: good
- Yellow: not well controlled, possible exacerbation
- Red: severe narrowing of airways (give short acting bronchodilator)
Asthma Triggers
control allergens:
- dust mites
- cockroaches
- cat and dog danger
- mouse dropping
- tobacco smoke
- ozone
- cleaning products
Remove allergens:
- carpet
- dehumidifiers
- air conditioners
RDS S/S
Cardinal signs:
- Restlessness
- Tachycardia
- Diaphoresis
- Tachypnea
- retractions
- nasal flaring
- retractions
RDS Intervention
Mild:
-Oxygen via nasal prongs
Moderate:
- oxygen mask
- nonrebreather
- repositioning
- suctioning (mushroom tip/NP)
Severe EMERGENCY
-AMBU bag
