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PEDS > lecture 4 [preschooler + respiratory health problems] > Flashcards

lecture 4 [preschooler + respiratory health problems] Flashcards

1
Q

what type of disorder is cystic fibrosis?

A

congenital respiratory

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2
Q

what is cystic fibrosis?

A

increased production of thick mucus in bronchioles and small intestines, & pancreatic and bile ducts

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3
Q

what is the etiology of CF?

A

inherited autosomal recessive trait from both parents

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4
Q

what is the role pancreatic enzymes in the body?

A

they catabolize fats & protein

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5
Q

what is the pathophysiology of CF?

A
  • increased viscosity of secretions
  • atelectasis
  • clogged pancreatic ducts (–> absent enzymes)
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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)
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7
Q

how does a child with CF present?

A
  • coughing
  • dyspnea
  • crackles
  • cyanosis
  • clubbing
  • steatorrhea (frothy, foul smelling)
  • low SpO2
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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
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9
Q

why should pulmonary treatments & procedures be avoided after meals?

A

decrease chances of vomiting

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10
Q

what are the medications for CF?

A
  • mucolytics
  • bronchodilators
  • ABX
  • pancreatic enzymes
  • fat-soluble vitamins
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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
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12
Q

acquired respiratory illnesses

A
  • BPD
  • asthma
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13
Q

what is BPD?

A

chronic obstructive pulmonary disease

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14
Q

what can cause BPD?

A

prolonged oxygen therapy & ventilation

may be genetically predisposed

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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
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16
Q

how can BPD be dianosed?

A
  • CXR
  • ABG
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17
Q

what are the ABG results for a child with BPD?

A
  • hypercapnia
  • respiratory acidosis
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18
Q

what are the s/s of BPD?

A
  • tachypnea
  • tachycardia
  • poor feeding
  • increased WOB
  • retractions
  • wheezing
  • barrel chest
  • pallor
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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
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20
Q

what are the medications for BPD?

A
  • bronchodilators
  • corticosteroids
  • diuretics
  • ABX
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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
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22
Q

what are the characteristics of asthma?

A
  • chronic inflammatory disorder
  • narrow airways
  • hypersenstivity to stimuli/ irritants
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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
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24
Q

what are the diagnostic tests for asthma?

A
  • CXR
  • PFT
  • PEFR
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25
Q

what does the PEFR measure?

A

amount of air that can be forcefully expired in 1 second

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26
Q

what are the s/s for asthma?

A
  • expiratory wheezing, crackles, or diminished
  • dry cough
  • sitting retractions
  • prolonged expiration
  • restlessness
  • fatigue
  • tachypnea
  • cyanosis
  • barrel chest
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27
Q

why do nurses need to avoid giving cold liquids to a pt w/ asthma?

A

avoid bronchospasms

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28
Q

what is the nursing care for a child w/ asthma?

A
  • administer humidified O2
  • high fowler’s
  • monitor pulse ox
  • maintain IV access (hydration, IV steroids)
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29
Q

what are the medications for asthma?

A
  • steroids
  • oxygen
  • IV fluids
  • bronchodilators (beta agonists & anticholinergics)
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30
Q

what is more important for patient and families to know about regulating asthma?

A
  • check peak flow
  • keep rescue inhaler
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31
Q

what are the common infectious respiratory illness among children?

(4)

A
  • acute LTB
  • epiglottitis
  • pneumonia
  • bronchiolitis
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32
Q

what is acute LTB?

A

a viral infection that causes inflammation, edema, & narrowing in LTB

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33
Q

LTB is usually preceded by an upper respiratory infection

RSV most common

A

true

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34
Q

what are the common causative agents of LTB?

A
  • RSV
  • influenzae A & B
  • parainfluenza virus
  • mycoplasma pneumonia
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35
Q

what are the s/s of LTB?

A
  • respiratory acidosis
  • low-grade fever
  • rhinorrhea
  • stridor
  • retractions
  • hypoxia
  • pulmonary edema
  • increased production of mucus
  • airway narrowing
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36
Q

why is diminished or cessation of breathing noise and effort alarming for nurses?

A

sign of impending respiratory failure

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37
Q

why is drooling a major concern in a patient with LTB?

A

closed off airways–meaning they are unable to swallow

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38
Q

what should the nurse administer for LTB?

A
  • humidified O2
  • corticosteroids
  • IV fluids
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39
Q

what is epiglottitis?

A

swelling of epiglottis

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40
Q

why is epiglottitis considered an emergency?

A

airway obstruction & tracheal occlusion

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41
Q

what is epiglottitis usually caused by?

A

Haemophilius influenza

Hib vaccine needed

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42
Q

s/s of epiglottitis

(7)

A
  • dysphonia
  • dysphagia
  • drooling
  • tripoding
  • high fever
  • pain with swallowing
  • edematous epiglottis
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43
Q

how long does it take for the airway to completely obstruct?

A

2-6 hours

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44
Q

why is throat examination contraindicated with epiglottitis?

A

could lead to spasm & complete obstruction

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45
Q

what are the diagnostic procedures for epiglottitis?

A
  • portable lateral neck x-ray
  • CBC
  • blood culture (bacteremia)
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46
Q

why is a child with epiglottitis on NPO?

A

they are unable to swallow

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47
Q

what are the medications for epiglottitis?

A
  • ABX
  • corticosteroids
  • antipyretics
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48
Q

what is the ABX regimen for epiglottitis?

A

IV ABX transitioning to oral for 10 days

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49
Q

parents are worried their child is having epiglottitis for the second time, what does the nurse say?

A

recurring epiglottitis is common

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50
Q

what is pneumonia?

A

inflammation of bronchioles and alveolar spaces due to infection

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51
Q

pneumonia is both viral & bacterial

52
Q

what is the most common bacteria that caused pneumonia?

A

mycoplasma pneumoniae

combat with Pneumococcal vaccine

53
Q

what causes bacterial pneumonia?

A

organisms are circulating the bloodstream and reach the lungs

54
Q

common s/s of pneumonia

A
  • fever
  • white sputum
  • coughing
  • CP
  • tachypnea
  • retractions
  • abd pain
55
Q

how is pneumonia diagnosed?

(5)

A
  • CXR
  • pulse O2
  • ABG
  • CBC
  • blood cultures
56
Q

what are the medications for pneumonia?

A
  • antipyretics
  • analgesics
  • IV fluids
  • ABX
  • humidified O2
57
Q

what is the major cause of hospitalizations among infants?

A

bronchiolitis

58
Q

what is bronchiolitis?

A

inflammation of bronchioles with edema & excess accumulation of mucus

59
Q

why does air trapping & atelectasis occur in bronchiolitis?

A

increased airway resistance from obstructed bronchioles

60
Q

what is the primary cause of bronchiolitis?

61
Q

RSV is most prevalent during the first 2 years of life

62
Q

how is bronchiolitis spread?

A

contact with contaminated objects

63
Q

what are the diagnostic procedures for bronchiolitis?

A
  • nasopharyngeal swab
  • CXR
64
Q

what are the symptoms of bronchiolitis?

A
  • worsening upper respiratory infections
  • tachypnea
  • retractions
  • low-grade fever
  • anorexia
  • thick nasal secretions
  • wheezing / crackles
65
Q

how can a nurse care for a child with bronchiolitis?

A
  • encourage feeding
  • suction PRN
  • increase fluid intake
  • daily weights (I&O)
  • pulse ox
  • humidified O2
  • contact precautions
66
Q

medications for bronchiolitis

A
  • ABX
  • fluids
  • steroids
67
Q

what is most important for families to know in caring for their child with bronchiolitis?

A
  • use of bulb syringe
  • notify HCP when anorexic or worsened breathing
68
Q

what is the leading cause of death among infants?

A

foreign body aspiration

69
Q

why do foreign bodies usually lodge in the right main bronchus as compared to the left?

A

shorter & wider

70
Q

how does foreign body aspiration affect the lungs?

(3)

A
  • atelectasis
  • air trapping
  • hyperinflation distal to site of obstruction
71
Q

diagnostic procedures for foreign body aspiration

A
  • fluoroscopy
  • CXR
72
Q

s/s of foreign body aspiration

A
  • wheezing
  • dyspnea
  • cyanotic
  • sudden coughing
  • stridor
73
Q

when are ABXs necessary for aspiration pneumonia?

A
  • purulent secretions are present
  • secondary infection
74
Q

how can a nurse care for a child who aspirated on foreign object?

A
  • NPO
  • prepare for surgery
  • periop monitoring
75
Q

what are the ages of a preschooler?

A

3-6 years old

76
Q

what is the weight gain trajectory of preschoolers?

A

2-3 kg per year

77
Q

by how much do preschoolers grow per year?

78
Q

what are the gross motor skills typically learned during this phase?

A
  • rides tricycle
  • up stairs alternating feet
  • hop on one foot & alternate feet
  • dress independently
  • throws & catches a ball
79
Q

what are fine motor skills preschoolers learn?

A
  • lace shoes up
  • use of scissors & pencils
  • can draw cross, circle, diamond, & triangle
  • count numbers
  • write a few letters
  • names 4-5 colors
80
Q

what type of play are preschoolers engaged in?

A

associative play

81
Q

imaginary friends are common among preschoolers

82
Q

preschoolers are more socially aware with knowledge & less egocentric

83
Q

which phase of Piaget are preschoolers in?

A

preoperational phase

Stage 2

84
Q

what is a hallmark of preschooler’s cognitive development?

A

language (being able to express themselves sufficiently)

85
Q

how can parents enhance their preschooler’s cognitive growth?

A
  • educational TV shows
  • music
  • stories
  • books
86
Q

preschoolers cannot reason beyond the observable

A

true

literal language, not figurative

87
Q

preschoolers have a lack of reversibility

88
Q

which stage of Erikson’s are preschoolers in?

A

initiative vs. guilt

Stage 3

exercise autonomy, feeling guilty for unfulfilling tasks

89
Q

what does the nurse tell a preschooler’s parent who is worried about their child’s stuttering and stammering

A

it is a normal characteristic of language development

90
Q

when should parents become concerned with their child’s language development?

A

if their child puts undue emphasis on their speech

91
Q

how many calories do preschoolers need?

A

90 calories per kg/ day

92
Q

what can parents do when their child dawdles during meals?

A
  • 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
Q

where do most incidents of poisoning occur?

94
Q

why are preschoolers much more likely to poison themselves?

A
  • they have increased curiosity & noncompliant behavior
  • they are developing autonomy & initiative
95
Q

imitation is a powerful motivator compared to lack of awareness of danger

96
Q

what is tonsilitis?

A

a bacterial or viral infection that causes tonsils to be inflamed

97
Q

what are the s/s for tonsilitis?

A
  • sore throat (w/ difficulty swallowing)
  • enlarged tonsils (w/ redness & edema)
  • fever
  • white patches on tonsils
98
Q

diagnostic procedures for tonsilitis

A
  • throat culture for GABHS
  • CBC for increased WBCs
99
Q

nursing care for viral tonsilitis

A
  • warm fluids
  • warm salt-water gargles

remember viral infections are not “curable”

100
Q

nursing care for bacterial tonsilitis

A

ABX therapy

101
Q

postop nursing actions for tonsillectomy

(6)

A
  • 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
Q

what does frequent swallowing & throat clearing a sign of after tonsillectomy?

A

arterial bleeding

103
Q

what are the medications for tonsillitis?

A
  • ABX
  • acetaminophen
  • hydrocodone
  • ibuprofen
104
Q

what is otitis media?

A

obstruction of eustachian tube & inflammation of fluid in the middle ear

105
Q

why are babies who are breastfed less likely to have otitis media?

A

they acquire IgA from breasmilk & the semi-vertical positioning while feeding

106
Q

what are the risk factors for otitis media?

A
  • secondhand smoke exposure
  • daycare
  • recent upper respiratory infection
  • 24 months or younger
  • down syndrome
107
Q

what are the s/s of otitis media?

A
  • pulling at affected ear
  • fever
  • purulent drainage from affected ear
  • bulging / red tympanic membrane
  • vomiting
  • ear pain
108
Q

how can otitis media be diagnosed?

A

pneumatic otoscope

109
Q

what are the medications for otitis media?

(4)

A
  • acetaminophen
  • ibuprofen
  • amoxicillin
  • ceftriaxone (once; IM)
110
Q

what is the treatment for recurrent ear infections?

A

myringotomy (tube placement)

111
Q

what are the nursing actions for ABXs?

A
  • administer in high doses orally
  • 80-90 mg/kg/day (two doses)
112
Q

what is otitis externa?

A

inflammation of ear canal or external structures

113
Q

what causes otitis externa?

A

persistent moisture in the external ear

114
Q

what are the risk factors for otitis externa?

A
  • swimming
  • foreign object insertion
115
Q

s/s of otitis externa

A
  • ear pain
  • ear itching
  • redness
  • tinnitus
  • discharge
116
Q

what is the treatment for otitis externa?

A

otic drops (ABX + steroids)

117
Q

what is the preventive measure for otitis externa?

A

use solution (1:1 white vinegar + alcohol) after showering or swimming

118
Q

what teaching should the nurse include at discharge for ear infections?

A

proper administration of ear drops
lie with affected side up for 3-5 minutes

119
Q

what is acute streptococcal pharyngitis?

A

infection of upper airway with GABHS

120
Q

where are GABHS normally found?

A
  • throat
  • skin
121
Q

what are expected findings of strep throat?

(6)

A
  • abrupt onset
  • pharyngitis
  • HA
  • fever
  • tonsils & pharynx covered w/ exudate
  • pain w/ swallowing
122
Q

how is strep throat diagnosed?

A
  • throat culture
  • rapid antigen testing
123
Q

what does untreated strep throat lead to?

A
  • glomerulonephritis
  • rheumatic fever
124
Q

what are the medications to treat strep throat?

A
  • ABXs
  • antipyretics
  • acetaminophen
125
Q

what can the nurse administer to a child with strep throat who is allergic to penicillin?

A

erythromycin

126
Q

what causes chest retractions?

A

there is less air pressure in the lungs due to blockage of small airways & the trachea

PEDS (11 decks)

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