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Pediatrics > Exam #2 Respiratory > Flashcards

Exam #2 Respiratory Flashcards

1
Q

Before born, lungs are not needed.

A

True

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2
Q

Less than 32-33 weeks of age, baby does not have sufficient amount of surfactant.

A

True

Biggest change in the NICU is the development of surfactant

If less than 34 weeks 1st dose of surfactant is given at birth

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3
Q

Fake surfactant = decrease incidence of -

A

RDS - Respiratory Distress Syndrome

and

BPD- Bronchopulmonary Dysplasia

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4
Q

** Respiratory Distress Syndrome =

A

Lack of Surfactant

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5
Q

Bronchopulmonary Dysplasia

A

hard alveoli due to constant ventilator causing positive pressure.

lung tissues get pounded until gets tough

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6
Q

Treatment for Apnea of Prematurity

A

Caffeine

Can give through IV or Orally

Monitor for Toxicity

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7
Q

What is Apnea of Prematurity?

A

pause longer than 20 seconds

Apnea spells can last so long that they cause bradycardia

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8
Q

Sudden Infant Death Syndrome (SIDS) interventions:

A

sleep on back

No Bumpers

pacifier after 1 month

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9
Q

A + B Spells =

Apnea and Brady

A

How premie tells us they are sick

If alarm goes off, ASSESS FIRST

Infants breathe periodically- breathe, Breathe, Pause
—-Happens in Premature babies

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10
Q

Preterm babies =

A

Bronchiolitis

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11
Q

** S/S of Caffeine Toxicity

A

vomit

Irritable

Tachycardia

Jittery/ excitability

Tremors

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12
Q

Toddlers and Preschoolers breathe abdominally

A

True

use of abdominal muscles to breathe until 5 years old

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13
Q

Infants have irregular breathing patterns and are nose breathers.

A

True

they have smaller, less rigid airways

smaller lung size

horizontal, short eustachian tubes in Infants

Immature immune systems

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14
Q

Surfactant was given in clinical trials and had to stop because was unethical.

A

True….I guess….

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15
Q

What is a late sign of respiratory distress?

A

Cyanosis

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16
Q

Assessing Respiratory Status - VISUAL ASSESSMENT =

A
  • work of breathing such as grunting, flaring, retracting
  • Rate of breathing
  • Chest Movement- is it equal?
  • Posture and activity level - Well Flexed alert and awake**
  • Sensorium (LOC)
  • Level of comfort
  • Color- skin and mucus membranes
    - pink? sats in the 90’s
    - Grey? 80’s or lower
    - Worried about mucus membranes
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17
Q

Assessing Respiratory status - AUSCULTATION

A

Without the stethoscope you can hear grunting, stridor, or wheezing.

With Stethoscope- inspiratory and expiratory- will usually tell us if it is something in the upper or lower airway

Baby- Listen to Axillae and back

Older listen to front and back

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18
Q

While grunting- baby uses abdominal muscles to push air out.

A

True

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19
Q

What are the cardinal signs of respiratory distress?

A

Tachypnea
Restlessness (Huge sign) , Confusion, Anxiety, Irritability
Tachycardia
Diaphoresis

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20
Q

What is the earliest sign of respiratory distress?

A

Tachycardia

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21
Q

What are additional signs of respiratory distress?

A

Wheezing

grunting, flaring, retracting

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22
Q

What are the signs of Impending Respiratory Failure?

A

Depressed or slow respirations (Decreased inspiratory breath sounds)

Dyspnea

Bradycardia

Somnolence

Stupor/coma

Cyanosis (Central (Mucus membranes)

Oxygen desat

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23
Q

What are 2 signs that a baby is about to code?

A

80’s o2 sat

and

Bradycardia

Means about to code…,.

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24
Q

O2 Sats falling are a sign of respiratory failure….

A

true

dont wait for them to become cyanotic

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25
Q

Why is tachypnea a sign of respiratory distress?

A

because if you have trouble breathing, you are going to breathe faster to get more air.

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26
Q

Acidosis

A

pH Less than 7.35

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27
Q

Respiratory Acidosis causes =

A

ventilation problem

need to be ventilated with oxygen

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28
Q

Metabolic Acidosis causes =

A

Diarrhea, Kidney failure, DKA

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29
Q

Alkalosis =

A

pH greater than 7.45

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30
Q

Respiratory Alkalosis causes =

A

test taking, any rapid respiratory rate

to little co2, hyperventilating

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31
Q

Metabolic Alkalosis causes =

A

Vomiting

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32
Q

Respiratory Acidosis S/S =

A 
Dyspnea
Respiratory Distress
Shallow respirations
Headache
Restlessness
Confusion
Tachycardia
Dysrhythmias
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33
Q

Respiratory Alkalosis S/S =

A 
Tachypnea
Light Headedness
numbness and tingling
confusion/ can't concentrate
Blurred Vision
Dysrhythmia
Palpitations / Diaphoresis
Dry Mouth, Tetanic spasms of arms and legs
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34
Q

CPAP-

A

has prongs gives positive pressure to keep stimulus for breathing….

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35
Q

Piaget — FUNCTIONAL

A

blow balloons and bubbles in place of Incentive Spirometer.

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36
Q

Oxygen Safety?

A

AVOID NYLON AND WOOL
- Avoids materials that generate static electricity, such as wool blankets and synthetic fabrics, Cotton Fabrics and blankets.

  • Avoid the use of volatile, flammable materials such as oils, greases, alcohol, ether, and acetone (Nail polish remover) near clients receiving oxygen
  • make sure that electric devices (such as razors, hearing aids, radios, TV, and heating pads) are in good working order to prevent the occurrence of short circuit sparks.
  • For home oxygen use teach family members to smoke outside away from the client.
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37
Q

Respiratory Scoring Sheet

A

Gives an Idea and can help determine if kids can leave the PICU

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38
Q

Inspiratory sounds-

A

Inspiratory Stridor = Upper airway obstruction (Trachea)

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39
Q

Wheezing- Exhalation =

A

Lower airway obstruction (Asthma, Bronchiolitis)

Bronchioles and alveoli

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40
Q

Upper Airway Obstruction causes :

A

Foreign body aspiration
Swelling of tissues (Croup, tonsils, Epiglotis)
Congenital Narrowing of upper airway

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41
Q

Clinical Signs of Upper airway Obstruction :

A

Tachypnea
Increased Respiratory Effort
Hoarse voice or Cry (seal like cough)
Stridor

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42
Q

Croup = 4 types of croup

A
  1. larygotracheobronchitis
  2. Acute spasmotic croup
  3. Epiglotis
  4. Bacterial tracheitis
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43
Q

Croup General Info-

A

late autumn / early winter

6 months to 3 years

Barking cough, hoarseness, inspiratory stridor

respiratory distress

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44
Q

What is the most common type of croup?

A
  1. larygotracheobronchitis
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45
Q

larygotracheobronchitis LTB

or laryngotracheitis

A

Most common of the croup syndromes.

  • Sound worse than they look
  • Abrupt Onset, usually at night

Generally Effects children LESS THAN 3 years

Organisms responsible : Viral
- RSV, Parainfluenza virus, Mycoplasma pneumoniae, Influenza A and B

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46
Q

Treatment of Croup LTB - (larygotracheobronchitis)

A

Dexamethasone - Oral or IM

 - 0.6 mg/kg
 - Duration of action is 48 - 96 hours***

Nebulized Epinepherine - Racemic Epinepherine
- Used to dilate the airway
- Alpha adrenergic Effects = Mucosal Vasoconstriction
- Duration 1 - 2 hours ***
- Observe the patient for 2 - 4 hours (to make sure
airway doesnt collapse again.)

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47
Q

Dexamethasone - Oral or IM

A
  • 0.6 mg/kg

- Duration of action is 48 - 96 hours***

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48
Q

Nebulized Epinepherine - Racemic Epinepherine

A
  • Used to dilate the airway
    • Alpha adrenergic Effects = Mucosal Vasoconstriction
    • Duration 1 - 2 hours ***
    • Observe the patient for 2 - 4 hours (to make sure
      airway doesnt collapse again.)
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49
Q

Croup LTB Info-

A

Cough medications and decongestant meds are contranindicated because want baby to cry and cough to keep airway patent.

Over the counter medications, esp cough and cold meds should not be administered to CHILDREN UNDER 2 YEARS OF AGE *******

Controversy over whether cool humidified air works. Still may recommend cold water vaporizers, shower vapor, cool night air.

Suction out the child

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50
Q

Over the counter medications, esp cough and cold meds should not be administered to CHILDREN UNDER 2 YEARS OF AGE *******

A

true

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51
Q

Epiglottitis -

A

MEDICAL EMERGENCY

Sudden swelling and about to swell shut

Can’t talk

Elective intubation

Dysphagia cannot swallow

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52
Q

Epiglottitis Clinical Manifestations:

A
  • Sudden Onset, Fever and sore throat
  • Usually in patients 2 - 8 years old

****Drooling, Dysphonia, Dysphagia

  • Tripod positioning with retractions and flaring
  • Inspiratory Stridor, mild hypoxia, distress

**** Not hoarse, NO COUGH

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53
Q

Epiglottitis Diagnostic Testing :

A

Lateral neck x-ray

Thumb print on x-ray is indicative of swollen epiglottis

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54
Q

Epiglottitis positioning =

A

stay with child and parent can keep child calm. Ask for the people to come to them. Let them stay in whichever position they are in.

55
Q

Therapeutic Management of Epiglottitis

A

Potential for respiratory obstruction

Nursing Considerations:

  • No Tongue Blades
  • Maintain calm
  • Emergency Intubation Equipment on hand
  • No cultures

Do a conscious sedation and intubate them….

56
Q

Epiglottitis Prevention -

A

HIB Vaccine

Influenza Type B

57
Q

Bacterial Tracheitis-

A

Attacks the Trachea

Occurs in the fall and winter months

ages 6 months to 6 years

URI for several days or classic viral croup

Staph aureus, H. Influenzae, Strep

Decompensates: high fever, productive cough, respiratory distress

Endotracheal intubation, mechanical ventilation, IV antibiotics

***Same problem as epiglottitis but not 3 D’s
(Dysphagia, Drooling, Dysphonia)

Treat with elective intubation

58
Q

Lower Airway Obstruction causes:

A

asthma

Bronchiolitis

59
Q

Lower Airway Obstruction clinical Signs:

A

Typically heard on expiration

Wheezing - airway narrows (Rales- crackles)
Rhonchi in larger airway

Tachypnea

Retractions, and nasal flaring

Prolonged expiration phase combined with expiratory effort

Cough

60
Q

Bronchiolitis

A

RSV= Respiratory Syncytial Virus- affects small airways

NO ANTIBIOTICS

#1 Nursing Intervention: Contact Isolation
#2 Assess Respiratory Status
#3 IV Placement
#4 I & O's
61
Q

Bronchiolitis Diagnostics ;

A

Culture secretions

62
Q

Bronchiolitis Therapeutic Management :

A

Hydration
Rest
Humidification
Increased fluid Intake

need pulse ox
bag mask
BP cuff
Bulb Syringe

63
Q

Bronchiolitis and RR Greater than 60, baby is at risk for

A

Aspiration

64
Q

RSV Respiratory Syncytial Virus

A

Born before 33 weeks give synergist -

Prevention of RSV: Prophylaxis- Palivizumab-

Need once a month during RSV period if under 35 weeks gestation… until 2

Ribavirun - antiretroviral med rarely used. Used for life or death situations only….Not typical treatment for RSV anymore.

65
Q

When is RSV Season In TN

A

October - March is RSV season in Tennessee

66
Q

Asthma -

A

Chronic Inflammatory disorder of the airways

limited airflow or obstruction that reverses spontaneously or with treatment

bronchial hyperresponsiveness

Episodic tightening of smooth muscle

67
Q

Trach Care-

A
  • if you go past tip, you are suctioning bronchial tissue
  • Normal saline can wash microbes that are around the mouth area into the lungs. Suction the back of the mouth to get the secretions out.
  • Non- Sterile cath used to suction mouth first then get sterile cath to suction ET Tube.
  • Suction for 3-5 seconds
  • 2 Trachs at bedside.. One same size and one smaller.
  • Mouth care is as important as trach care.
68
Q

Anti Inflammatory Drugs-

A

Inhaled corticosteroids
Oral or Parenteral Corticosteroids
Leukotriene Receptor Antagonists

69
Q

Inhaled corticosteroids Examples

A 
Flucticasone proprionate ( Flonase, Flovent)
Budesonide - (Pulmicort)

Steroids can cause thrush in mouth, use spacer and rinse out mouth with water or brush teeth after use.

70
Q

Leukotriene Receptor Antagonists

A

Montelukast (Singulair)

71
Q

Corticosteroids-

A

In low doses for asthma

Side effects: Cough, dysphonia, ORAL THRUSH**,

Monitoring: Every 3-6 months- growth parameters
- Can cause diminished growth

72
Q

Leukotriene Modifiers

A

Blocks inflammatory and bronchospasm effects of leukotrienes

Zafirlucast (Accolate)- for children 7 years and up

Montelukast sodium (Singulair) for children 1 year and older

***Can cause aggression and anxiety

73
Q

Montelukast (Singulair) Side Effects:

A

Headache

Can cause increase in SGOT/SGPT- use cautiously in patients with impaired liver function

Patients with PKU- Montelukast contains phenyalanine

Linked with odd psycho effects such as strange mood changes.

74
Q

Beta 2 Adrenergic Agonists-

A

allow smooth muscle to relax

inhaled form hasa a more rapid onset of action than the oral form

side effects: seen mostly in oral form. irritability, tremor, nervousness, and insomnia

75
Q

Beta 2 Adrenergic Agonists- examples

A

Albuterol, levabuterol, (Short acting)
Salmeterol - Long acting

Action: Relaxes airway smooth muscle

Indication: Acute and Chronic treatment of Wheezing

Adverse Reactions: Nervousness, tachycardia, jitteriness

Nursing Considerations: Inhalation route has fewer side effects

76
Q

Albuterol

A

Sympathomimetic Drug

Stimulates beta 2 adrenergic receptors in lungs causing bronchial smooth muscle relaxation

CAUTION: May increase risk of arrhythmias in Digoxin patients

Side Effects: HA, Nausea, Restlessness, Nervousness, Trembling

77
Q

Albuterol Overuse

A
  1. Loss of bronchodilation effects

2. SEVERE paradoxical Bronchoconstriction

78
Q

Nursing Considerations for Albuterol

A

client family teaching

Wait 2 min before inhaling 2nd puff

79
Q

Salmeterol Servent

A

long acting - salmeterol (servent)-

Used no more than every 12 hours.

Not used in children under 12 years old

NEVER USED FOR ACUTE SYMPTOMS

80
Q

What are triggers for asthma :

A

allergens- dust, animal dander, smoke

Cold air

Weather changes

Infection

Exercise

Fatigue

Emotional Distress

Environmental changes like starting a new school

(ASK ABOUT WHAT THE PATIENTS INDIVIDUAL TRIGGERS ARE)

81
Q

Atopy

A

genetic predisposition for the development of an IgE mediated response to common aeroallergens

Strongest predisposing factor for developing asthma

Born with more IgE

All Children have atopy

Hyperresponsiveness to triggers

82
Q

Antihistimines

A

Loratadine (Claritin) &Cetirizine (Zyrtec)

Fexofenadine (Allegra)

83
Q

Loratadine (Claritin) &Cetirizine (Zyrtec) MOA=

A

competes with histamine on H1 receptor sites

84
Q

Fexofenadine (Allegra) MOA=

A

antagonizes histamine effects

85
Q

What are the side effects of antihistamines?

A

Side effects: headache, dry mouth, drowsiness

(Opposite of muscarinic man)

Children may experience a paradoxical reaction of restlessness, insomnia, nervousness

86
Q

Aspirin Triad

A

A subpopulation of asthmatic patients who react with acute dyspnea within 2 hours after ingestion of aspirin.

Triad: Chronic rhinosinusitis including polyps, severe bronchial asthma, and intolerance to aspirin and other NSAIDs

Client/family education: use acetaminophen

87
Q

Drug Therapy for Asthma

Long-term meds/ Preventive

A 
Corticosteroids
Cromolyn sodium
Albuterol
Salmeterol
Leukotriene modifiers
88
Q

Drug Therapy for Asthma

Quick relief/Rescue meds

A

Albuterol
Ipratropium (anticholinergic)
Magnesium sulfate IV

89
Q

Asthma action plan

A

…..

90
Q

Peak Expiratory Flow Rate

A

80-100% Green
50 – 80 % Yellow
< 50% Red

91
Q

What is red on peak expiratory flow rate?

A

less than 50%

92
Q

What is green on peak expiratory flow rate?

A

80 - 100%

93
Q

What is yellow on peak expiratory flow rate?

A

50 - 80 %

94
Q

What is the patient teaching for a peak expiratory flow rate?

A

Done in morning. Standing.

Have child “huff and cough” 2 or 3 times to clear airway and set meter gauge on zero before beginning test.

95
Q

Asthma meds and nursing management

A

Baseline assessment of depth, rate, rhythm, and type of patient respirations

Post-treatment assessment of same

Monitor the quality and rate of patient’s pulse

Assess the patient’s lung sound for crackles, rhonchi, and wheezing

Observe fingernails and lips for signs of cyanosis

96
Q

Client/Family Teaching For Asthma

A

Instruct patient and family to increase fluid intake to decrease viscosity of lung secretions

Never abruptly discontinue asthma meds

Practice good, oral hygiene

House at 50 – 60 % humidity

No carpet, but if carpet vacuum daily

97
Q

Status Asthmaticus

A

Respiratory distress continues despite vigorous therapeutic measures

Medical emergency

Humidified oxygen

Aerosolized short-acting Beta 2 –agonist

IV access

Emergency treatment: epinephrine 0.01 ml/kg SC (maximum dose 0.3 ml)

At risk of asphyxia and respiratory arrest

98
Q

Goals of Asthma Management

A

Avoid exacerbation

Avoid allergens

Relieve asthmatic episodes promptly

Relieve bronchospasm

Monitor function with peak flow meter

Self-management of inhalers, devices, and activity regulation

Participate in sports/exercise when asthma controlled

99
Q

Cystic Fibrosis

A

Exocrine gland dysfunction that produces multisystem involvement

Most common lethal genetic illness among Caucasian children

Approximately 3% U.S. Caucasian population are symptom-free carriers

Autosomal recessive trait

100
Q

What is the most reliable diagnostic procedure for cystic fibrosis?

A

Basis of the most reliable diagnostic procedure: sweat chloride test (pilocarpine iontophoresis)

Normal sweat chloride is < 40 mEq/L

A sweat chloride > than 60 mEq/L is diagnostic

Extra salt and fluid required during hot weather

101
Q

What is a normal sweat chloride ?

A

Normal sweat chloride is < 40 mEq/L

102
Q

What does the level of sweat chloride have to reach in order to be diagnostic for cystic fibrosis?

A

A sweat chloride > than 60 mEq/L is diagnostic

103
Q

Respiratory Manifestations of CF

A

Present in almost all CF patients but onset and extent are variable

Stagnation of mucus and bacterial colonization result in destruction of lung tissue

Tenacious secretions are difficult to expectorate, obstruct bronchi and bronchioles

Decreased O2-CO2 exchange

Results in hypoxia, hypercapnia, acidosis

Compression of pulmonary blood vessels and progressive lung dysfunction lead to pulmonary hypertension, cor pulmonale, respiratory failure, and death

104
Q

Management of CF

A

Percussion and postural drainage

Mucolytic agents

Antibiotics – Vancomycin, Tobramycin

Pancreatic enzymes

Supplement fat soluble vitamins

105
Q

Pulmozyme (dornase alfa)

A

Action: Enzyme that hydrolyzes the DNA in sputum

Indications: Cystic fibrosis

Nursing indications:
–Given by nebulizer

–Monitor for dysphonis and pharyngitis

106
Q

CF Diet

A

Children with CF have an energy intake of 100% to 200% of standards for healthy persons

High protein, high caloric, with unrestricted fat

107
Q

Azotorrhea =

A

increased protein in stool

108
Q

Steatorrhea =

A

increased fat in stool – greasy stools

109
Q

Otitis Media

A

Otitis Media is primarily a result of a dysfunctioning eustachian tube.

110
Q

AOM

A

Acute otitis media

111
Q

OME

A

Otitis media with effusion

112
Q

CSOM

A

Chronic suppurative otitis media

113
Q

Mastoiditis

A

…

114
Q

Risk factors for developing AOM or OME

A

Less than 2 years of age – peak incidence between 6 and 18 mo
Atopy

Bottle propping

Chronic sinusitis

Cleft palate

Child care attendance

Down syndrome

Immunocompromising conditions

115
Q

Risk factors for developing AOM or OME

“Passive smoking increases the risk of persistent middle ear effusion by enhancing attachment of the pathogens that cause otitis to the respiratory epithelium in the middle ear space, prolonging the inflammatory response, and impeding drainage through the eustachian tube.”

True or false?

A

True

116
Q

Signs and symptoms of AOM

A

Holding or pulling at ears

Rolling head side to side

Pain

Fever

Enlarged postauricular, cervical lymph glands

117
Q

Diagnosis of AOM

A

Acute onset of symptoms

Evidence of middle ear effusion

Signs and symptoms of middle ear inflammation

118
Q

Treatment of AOM

A

Spontaneous resolution in 80% children

Wait up to 72 hours for spontaneous resolution while providing pain control

Amoxicillin 90 mg/kg/day divided bid for 10 days

Second-line antibiotic: Augmentin (amoxicillin/clavulanate)

Third-line: ceftriaxone (Rocephin)

119
Q

What is the second line treatment for AOM?

A

Second-line antibiotic: Augmentin (amoxicillin/clavulanate)

120
Q

What is the 1st line treatment for AOM?

A

Amoxicillin 90 mg/kg/day divided bid for 10 days

121
Q

What is the 3rd line treatment for AOM?

A

Third-line: ceftriaxone (Rocephin)

122
Q

True or False?

Steroids, decongestants, and antihistamines are not recommended for treatment of AOM

A

True

123
Q

True or False?

Tonsillectomy does NOT reduce incidence of otitis

A

true

124
Q

Nursing Care of AOM

A

Relief of pain

—-Acetaminophen, Ibuprofen, acetaminophen with codeine

—-Topical –topical benzocaine

—-Local heat over ear while child lies on affected side

125
Q

Management of OME

A

75% of cases resolved within 3 months

Temporary hearing deficit

Persistent OME past 3 months with hearing or language delays may benefit from tympanostomy tubes

126
Q

Myringotomy and tubes


“Placement of tympanostomy tubes is recommended after a total of 4 – 6 months of bilateral effusion with a bilateral hearing deficit.”

True or False

A

True

127
Q

Nursing Care For draining ears:

A

Sterile cotton in ears, still allowing drainage

Moisture barrier on skin

Speech and hearing evaluation

128
Q

Nursing Care For tubes–

A

keep bath water and shampoo out of ears – ear plugs

Speech and hearing evaluation

129
Q

Pneumococcal immunization

A

Pneumococcal conjugate vaccine –PCV7– and currently PCV 13

Reduced the number of otitis media cases dramatically

S pneumoniae in 50% of children in daycare

130
Q

Tonsillectomy

A

Post-op Nursing care:

Observe for bleeding (7 – 10 da)

Position side-lying

Strict intake and output

Oral fluids, or popcicles

Nothing scratchy or salty

131
Q

Pharyngitis

A

Gargle with warm saline three times a day

Ice chips/popcicles

Tylenol q 4 – 6 hours

132
Q

Strep throat

A

Gargle with warm saline three times a day

Ice chips/popcicles

Tylenol q 4 – 6 hours

Penicillin for 10 days

133
Q

What is the difference in treatment for strep throat vs pharyngitis?

A

treatment is the same for both but strep throat requires Penicillin for 10 days.

134
Q

Acute Streptococcal Pharyngitis

A

Treat with Penicillin – usually oral for 10 days
—–Erythromycin is allergic to
PCN

May return to school or day care after have been taking antibiotics for a full 24 hour period

Need to discard toothbrush and replace with new one after being on antibiotics for 24 hours

Pediatrics (24 decks)

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