lecture 4 [preschooler + respiratory health problems] Flashcards
1
Q
what type of disorder is cystic fibrosis?
A
congenital respiratory
2
Q
what is cystic fibrosis?
A
increased production of thick mucus in bronchioles and small intestines, & pancreatic and bile ducts
3
Q
what is the etiology of CF?
A
inherited autosomal recessive trait from both parents
4
Q
what is the role pancreatic enzymes in the body?
A
they catabolize fats & protein
5
Q
what is the pathophysiology of CF?
A
- increased viscosity of secretions
- atelectasis
- clogged pancreatic ducts (–> absent enzymes)
6
Q
what are the diagnostic tests for CF?
A
- sweat chloride test
- CXR
- prenatal DNA testing (from amniotic fluid)
- AXR (meconium ileus)
- PFT
- stool analysis (72 hours fecal fat)
7
Q
how does a child with CF present?
A
- coughing
- dyspnea
- crackles
- cyanosis
- clubbing
- steatorrhea (frothy, foul smelling)
- low SpO2
8
Q
how can a nurse care for a child with CF?
A
- provide high calories & high protein
- administer pancreatic enzymes (w/ meals)
- administer vitamins A, E, D, K (fat soluble)
- increase hydration
9
Q
why should pulmonary treatments & procedures be avoided after meals?
A
decrease chances of vomiting
10
Q
what are the medications for CF?
A
- mucolytics
- bronchodilators
- ABX
- pancreatic enzymes
- fat-soluble vitamins
11
Q
proper education for families with a child with CF
A
- avoid respiratory illness & infection
- chest percussion
- postural drainage
- high calorie & high protein
- physical activity (loosens secretions)
- genetic counseling
12
Q
acquired respiratory illnesses
A
- BPD
- asthma
13
Q
what is BPD?
A
chronic obstructive pulmonary disease
14
Q
what can cause BPD?
A
prolonged oxygen therapy & ventilation
may be genetically predisposed
15
Q
what is the patho for BPD?
(6)
A
- high O2 concentrations
- tissue damage from ventilation
- thick alveolar walls
- scarring & fibrosis
- poor airway patency
- poor gas exhange
16
Q
how can BPD be dianosed?
A
- CXR
- ABG
17
Q
what are the ABG results for a child with BPD?
A
- hypercapnia
- respiratory acidosis
18
Q
what are the s/s of BPD?
A
- tachypnea
- tachycardia
- poor feeding
- increased WOB
- retractions
- wheezing
- barrel chest
- pallor
19
Q
what is the nursing care for a child with BPD?
A
- ICU
- daily weights
- frequent turning (lay on good side)
- mechanical ventilation
- suction
- maintain O2 sats
- monitor for FVE
20
Q
what are the medications for BPD?
A
- bronchodilators
- corticosteroids
- diuretics
- ABX
21
Q
what is most important for familes to learn for their child with BPD?
A
- CPR
- trach care
- use of portable O2 equipment
- proper feeding
- appropriate weight gain
22
Q
what are the characteristics of asthma?
A
- chronic inflammatory disorder
- narrow airways
- hypersenstivity to stimuli/ irritants
23
Q
what happens to the lungs among children with asthma?
A
- bronchial constriction
- alveolar hyperinflation
- air-trapping (unable to exhale properly)
- edema
- increased mucus secretion
24
Q
what are the diagnostic tests for asthma?
A
- CXR
- PFT
- PEFR
25
what does the *PEFR* measure?
amount of air that can be forcefully expired in 1 second
26
what are the s/s for *asthma*?
* expiratory wheezing, crackles, or diminished
* dry cough
* sitting retractions
* prolonged expiration
* restlessness
* fatigue
* tachypnea
* cyanosis
* barrel chest
27
why do nurses need to avoid giving cold liquids to a pt w/ *asthma*?
avoid bronchospasms
28
what is the nursing care for a child w/ *asthma*?
* administer humidified O2
* high fowler's
* monitor pulse ox
* maintain IV access *(hydration, IV steroids)*
29
what are the medications for *asthma*?
* steroids
* oxygen
* IV fluids
* bronchodilators *(beta agonists & anticholinergics)*
30
what is more important for patient and families to know about regulating *asthma*?
* check peak flow
* keep rescue inhaler
31
what are the common *infectious respiratory illness* among children?
| (4)
* acute LTB
* epiglottitis
* pneumonia
* bronchiolitis
32
what is *acute LTB*?
a viral infection that causes inflammation, edema, & narrowing in LTB
33
LTB is usually preceded by an upper respiratory infection
| RSV most common
true
34
what are the common causative agents of *LTB*?
* RSV
* influenzae A & B
* parainfluenza virus
* mycoplasma pneumonia
35
what are the s/s of *LTB*?
* respiratory acidosis
* low-grade fever
* rhinorrhea
* stridor
* retractions
* hypoxia
* pulmonary edema
* increased production of mucus
* airway narrowing
36
why is diminished or cessation of breathing noise and effort alarming for nurses?
sign of impending respiratory failure
37
why is drooling a major concern in a patient with *LTB*?
closed off airways–meaning they are unable to swallow
38
what should the nurse administer for *LTB*?
* humidified O2
* corticosteroids
* IV fluids
39
what is *epiglottitis*?
swelling of epiglottis
40
why is *epiglottitis* considered an emergency?
airway obstruction & tracheal occlusion
41
what is *epiglottitis* usually caused by?
Haemophilius influenza
| Hib vaccine needed
42
s/s of *epiglottitis*
| (7)
* dysphonia
* dysphagia
* drooling
* tripoding
* high fever
* pain with swallowing
* edematous epiglottis
43
how long does it take for the airway to completely obstruct?
2-6 hours
44
why is throat examination contraindicated with *epiglottitis*?
could lead to spasm & complete obstruction
45
what are the diagnostic procedures for *epiglottitis*?
* portable lateral neck x-ray
* CBC
* blood culture *(bacteremia)*
46
why is a child with *epiglottitis* on NPO?
they are unable to swallow
47
what are the medications for *epiglottitis*?
* ABX
* corticosteroids
* antipyretics
48
what is the ABX regimen for *epiglottitis*?
IV ABX transitioning to oral for 10 days
49
parents are worried their child is having *epiglottitis* for the second time, what does the nurse say?
recurring *epiglottitis* is common
50
what is *pneumonia*?
inflammation of bronchioles and alveolar spaces due to infection
51
*pneumonia* is both viral & bacterial
true
52
what is the most common bacteria that caused *pneumonia*?
mycoplasma pneumoniae
| combat with Pneumococcal vaccine
53
what causes *bacterial pneumonia*?
organisms are circulating the bloodstream and reach the lungs
54
common s/s of *pneumonia*
* fever
* white sputum
* coughing
* CP
* tachypnea
* retractions
* abd pain
55
how is *pneumonia* diagnosed?
| (5)
* CXR
* pulse O2
* ABG
* CBC
* blood cultures
56
what are the medications for *pneumonia*?
* antipyretics
* analgesics
* IV fluids
* ABX
* humidified O2
57
what is the major cause of hospitalizations among infants?
bronchiolitis
58
what is *bronchiolitis*?
inflammation of bronchioles with edema & excess accumulation of mucus
59
why does air trapping & atelectasis occur in *bronchiolitis*?
increased airway resistance from obstructed bronchioles
60
what is the primary cause of *bronchiolitis*?
RSV
61
*RSV* is most prevalent during the first 2 years of life
true
62
how is *bronchiolitis* spread?
contact with contaminated objects
63
what are the diagnostic procedures for *bronchiolitis*?
* nasopharyngeal swab
* CXR
64
what are the symptoms of *bronchiolitis*?
* worsening upper respiratory infections
* tachypnea
* retractions
* low-grade fever
* anorexia
* thick nasal secretions
* wheezing / crackles
65
how can a nurse care for a child with *bronchiolitis*?
* encourage feeding
* suction PRN
* increase fluid intake
* daily weights *(I&O)*
* pulse ox
* humidified O2
* contact precautions
66
medications for bronchiolitis
* ABX
* fluids
* steroids
67
what is most important for families to know in caring for their child with *bronchiolitis*?
* use of bulb syringe
* notify HCP when anorexic or worsened breathing
68
what is the leading cause of death among infants?
foreign body aspiration
69
why do foreign bodies usually lodge in the *right main bronchus* as compared to the left?
shorter & wider
70
how does *foreign body aspiration* affect the lungs?
| (3)
* atelectasis
* air trapping
* hyperinflation distal to site of obstruction
71
diagnostic procedures for *foreign body aspiration*
* fluoroscopy
* CXR
72
s/s of *foreign body aspiration*
* wheezing
* dyspnea
* cyanotic
* sudden coughing
* stridor
73
when are ABXs necessary for aspiration pneumonia?
* purulent secretions are present
* secondary infection
74
how can a nurse care for a child who aspirated on foreign object?
* NPO
* prepare for surgery
* periop monitoring
75
what are the ages of a *preschooler*?
3-6 years old
76
what is the weight gain trajectory of *preschoolers*?
2-3 kg per year
77
by how much do *preschoolers* grow per year?
6.5-9cm
78
what are the *gross motor skills* typically learned during this phase?
* rides tricycle
* up stairs alternating feet
* hop on one foot & alternate feet
* dress independently
* throws & catches a ball
79
what are *fine motor skills* preschoolers learn?
* lace shoes up
* use of scissors & pencils
* can draw cross, circle, diamond, & triangle
* count numbers
* write a few letters
* names 4-5 colors
80
what type of play are preschoolers engaged in?
associative play
81
imaginary friends are common among *preschoolers*
true
82
*preschoolers* are more socially aware with knowledge & less egocentric
true
83
which phase of Piaget are *preschoolers* in?
preoperational phase
| Stage 2
84
what is a hallmark of preschooler's cognitive development?
language *(being able to express themselves sufficiently)*
85
how can parents enhance their preschooler's cognitive growth?
* educational TV shows
* music
* stories
* books
86
*preschoolers* cannot reason beyond the observable
true
| literal language, not figurative
87
*preschoolers* have a lack of reversibility
true
88
which stage of *Erikson's* are preschoolers in?
initiative vs. guilt
| Stage 3
## Footnote
exercise autonomy, feeling guilty for unfulfilling tasks
89
what does the nurse tell a preschooler's parent who is worried about their child's stuttering and stammering
it is a normal characteristic of language development
90
when should parents become concerned with their child's language development?
if their child puts undue emphasis on their speech
91
how many calories do *preschoolers* need?
90 calories per kg/ day
92
what can parents do when their child dawdles during meals?
* set time limits
* remove plate when time is over
* offer snacks between meals
* decrease stimulation during meals
* provide small amounts of food
* set regular times for meals or snacks
93
where do most incidents of poisoning occur?
home
94
why are preschoolers much more likely to poison themselves?
* they have increased curiosity & noncompliant behavior
* they are developing autonomy & initiative
95
imitation is a powerful motivator compared to lack of awareness of danger
true
96
what is *tonsilitis*?
a bacterial or viral infection that causes tonsils to be inflamed
97
what are the s/s for *tonsilitis*?
* sore throat *(w/ difficulty swallowing)*
* enlarged tonsils *(w/ redness & edema)*
* fever
* white patches on tonsils
98
diagnostic procedures for *tonsilitis*
* throat culture for GABHS
* CBC for increased WBCs
99
nursing care for *viral tonsilitis*
* warm fluids
* warm salt-water gargles
## Footnote
remember viral infections are not "curable"
100
nursing care for *bacterial tonsilitis*
ABX therapy
101
postop nursing actions for *tonsillectomy*
| (6)
* provide ice collar
* administer liquid analgesics
* assess for frequent swallowing or throat clearing
* advise to avoid coughing and blowing nose
* provide straw for liquids
* avoid red colored food & drink *(masks true bleeding)*
102
what does frequent swallowing & throat clearing a sign of after *tonsillectomy*?
arterial bleeding
103
what are the medications for *tonsillitis*?
* ABX
* acetaminophen
* hydrocodone
* ibuprofen
104
what is *otitis media*?
obstruction of eustachian tube & inflammation of fluid in the middle ear
105
why are babies who are breastfed *less likely* to have otitis media?
they acquire IgA from breasmilk & the semi-vertical positioning while feeding
106
what are the risk factors for *otitis media*?
* secondhand smoke exposure
* daycare
* recent upper respiratory infection
* 24 months or younger
* down syndrome
107
what are the s/s of *otitis media*?
* pulling at affected ear
* fever
* purulent drainage from affected ear
* bulging / red tympanic membrane
* vomiting
* ear pain
108
how can *otitis media* be diagnosed?
pneumatic otoscope
109
what are the medications for *otitis media*?
| (4)
* acetaminophen
* ibuprofen
* amoxicillin
* ceftriaxone *(once; IM)*
110
what is the treatment for recurrent ear infections?
myringotomy *(tube placement)*
111
what are the nursing actions for ABXs?
* administer in high doses orally
* 80-90 mg/kg/day *(two doses)*
112
what is *otitis externa*?
inflammation of ear canal or external structures
113
what causes *otitis externa*?
persistent moisture in the external ear
114
what are the risk factors for *otitis externa*?
* swimming
* foreign object insertion
115
s/s of *otitis externa*
* ear pain
* ear itching
* redness
* tinnitus
* discharge
116
what is the treatment for *otitis externa*?
otic drops *(ABX + steroids)*
117
what is the preventive measure for *otitis externa*?
use solution *(1:1 white vinegar + alcohol)* after showering or swimming
118
what teaching should the nurse include at discharge for ear infections?
proper administration of ear drops
*lie with affected side up for 3-5 minutes*
119
what is *acute streptococcal pharyngitis*?
infection of upper airway with GABHS
120
where are GABHS normally found?
* throat
* skin
121
what are expected findings of *strep throat*?
| (6)
* abrupt onset
* pharyngitis
* HA
* fever
* tonsils & pharynx covered w/ exudate
* pain w/ swallowing
122
how is *strep throat* diagnosed?
* throat culture
* rapid antigen testing
123
what does untreated *strep throat* lead to?
* glomerulonephritis
* rheumatic fever
124
what are the medications to treat *strep throat*?
* ABXs
* antipyretics
* acetaminophen
125
what can the nurse administer to a child with *strep throat* who is allergic to penicillin?
erythromycin
126
what causes *chest retractions*?
there is less air pressure in the lungs due to blockage of small airways & the trachea
