Exam 3: Gas Exchange

Question 1

What puts pediatric patients at a higher risk for hypoxemia?

Answer 1

Smaller numbers of alveoli

Question 2

Respiratory distress syndrome (RDS)

Answer 2

Lung disorder affecting mostly preterm infants, resulting from lung immaturity and deficiency of surfactant

Incidence and severity reduced by giving mother corticosteroids (betamethasone) before birth

Question 3

What is the most common risk factor for RDS?

Answer 3

Premature infants

Incidence is inversely related to gestational age and birth weight

Question 4

Risk factors for RDS

Answer 4

Infants of diabetic birthing mother
Multiple birth
C-section (absence of preceding labor)
Precipitous delivery
Perinatal asphyxia
Cold stress
Previous birth of infant with RDS

Question 5

Clinical manifestations of RDS

Answer 5

GFR (grunting, flaring, retractions)
Tachypnea >60 breaths/min
May see apnea >20 seconds
Cyanosis

Diagnosis: X-ray shows ground glass appearance

Question 6

When does the severity of RDS peak?

Answer 6

Around 6 hours

If untreated = BP may decrease; respiratory failure

Question 7

Nursing interventions/therapeutic management for RDS

Answer 7

Airway
Thermo regulation
Prevent infection (antibiotics)
Nutritional support
Decrease stress
Improve oxygenation and ventilation
Surfactant replacement
Mechanical ventilation
High-frequency ventilation
Inhales nitric oxide
ECMO

Question 8

Croup

Answer 8

Upper airway swelling generally caused by viruses

Acute spasmodic croup = abrupt onset at night
Laryngotracheobronchitis (LTB) = most common

Question 9

LTB Croup

Answer 9

Children 3 months-3 years most at risk

Viral pathogens; starts with URI symptoms, varying degrees of swelling of the larynx that extends to the trachea and bronchi

Symptoms: Hoarseness, inspiratory stridor, bark-y cough, possible low grade fever, tachypnea, restlessness

Steeple sign on x-ray due to swelling in tissue

Priority nursing concern = airway obstruction

Question 10

What type of retractions would you expect to see initially in a child with croup?

Answer 10

Suprasternal
Supraclavicular

Question 11

Croup treatment

Answer 11

Corticosteroids: IV or PO Dexamethasone, Methylprednisone

Bronchodilators: Nebulized epinephrine
Albuterol, Racemic epinephrine (onset: minutes; lasts: 1-2 hours), concern about rebound effect after epinephrine wears off

Question 12

Nursing interventions for Croup

Answer 12

Breathing, air exchange (resp. assessment)
Comfort (HOB elevated)
Positioning
Humidified air or oxygen
Hydration (insensible loss)
Cool mist humidifier at home

Question 13

Parent education for Croup

Answer 13

Hydration
Medications
Cool mist humidifiers

When to call provider:
Red flag syndrome
- Expiratory stridor
- Severe retractions
- Increased RR
- Cyanosis, duskiness

Question 14

Epiglottitis

Answer 14

Bacterial; Ages 2-8 years

Etiology: Haemophilus influenza, strep/staph

Disease process: Inflammation of epiglottis and glottis

Life threatening: edema occurs rapidly

Question 15

Clinical manifestations of epiglottitis

Answer 15

Dystonia (hot potato mouth)
Dysphagia
Drooling
Distress

Tripod position

High fever, restlessness

NEVER attempt to inspect the mouth or throat

Question 16

Nursing interventions for Epiglottitis

Answer 16

NPO
No throat cultures or examinations of the mouth (could precipitate closure)
Prepare for intubation (emergency equipment at bedside, tracheostomy)
Administer antibiotics
Airway and breathing (positioning, resp. assessments, oxygen)
Assess LOC
Comfort (avoid crying, minimize interruptions)
Fluid balance (IV hydration)
Antibiotic therapy (bacterial)

Question 17

Maintenance fluid calculations

Answer 17

100 ml x 1st 10 kg
50 ml x 2nd 10 kg
20 ml x rest of kg

Question 18

What is the most effective primary prevention measure to minimize the incidence of epiglottitis in children?

Answer 18

Haemophilus Influenza B Vaccine

Question 19

Bronchiolitis (RSV)

Answer 19

Acute inflammation and obstruction of the bronchioles and small bronchi

Etiology: Bacterial infection, viral infection (RSV = contact precautions)

Populations at risk: Infants under 6 months, immunocompromised, chronic lung disease

Question 20

Family education for RSV

Answer 20

Prophylactic protection (Synagis)
Strict hand hygiene

Symptoms of worsening distress:
Increased WOB
Unable to eat due to RR
Lethargy
Cyanosis
Decreased respirations

Question 20

Clinical manifestations of RSV

Answer 20

Progresses from URI to lower tract infection

Increased WOB

Cough, runny nose, retractions, nasal flaring, wheezing, crackles, cyanosis

Diagnosis: Nasopharyngeal culture, chest x-ray

Question 20

Therapeutic management of RSV

Answer 20

Supportive treatment
Supplemental oxygen, CPAP
Keep airway patent and clear, suction
Isolation
Bronchodilators (racemic epinephrine)
Hydration, calculate maintenance fluids
Antipyretics
Elevator HOB
Use of bulb syringe before feeds

Question 21

Cystic Fibrosis

Answer 21

Autosomal recessive chronic progressive disease

Patho: Multi-system disease process
Disrupts the sodium-chloride ion cellular transport system
Dysfunction of the exocrine glands
Tenacious amounts of sticky, thick mucus

Must give pancreatic enzymes before eating

Question 22

Clinical manifestations of Cystic Fibrosis

Answer 22

Newborn: Meconium ileus, abdominal distention, vomiting, no stool

Cough, frequent respiratory infections, wheezing
Dyspnea
Paroxysmal cough
Atelectasis
Cyanosis
Barrel-chest
Steatorrhea
Delayed growth
Salty skin
Low Na, glucose instability

Question 23

Diagnostic testing for CF

Answer 23

Genetic testing
Newborn (state) screening
Sweat chloride test

Routine testing: PFTs

Question 24

Therapeutic management for CF

Answer 24

Airway clearance
Chest physiotherapy
High frequency chest oscillation Mucolytics
Bronchodilators (Dilate then vibrate)
Encourage physical activity (swimming)
Prevent infection
Management infection
Flu vaccine
Promote optimal nutrition (infant may need fortification of breast milk)
Family support is key