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NRSG 344 - Nursing of the Family > Lecture 5 > Flashcards

Lecture 5 Flashcards

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1
Q

Upper Airway Infection

A
  • Self-limited irritation and swelling of the upper airways with associated cough and NO SIGNS OF PNEUMONIA

-> Nose
-> Vocal cords in the larynx
-> Sinuses
-> MIDDLE EAR

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2
Q

Lower Airway Infection

A

-> Trachea
-> Bronchi
-> Lungs
-> Alveoli

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3
Q

Most common Upper Respiratory Tract Infections

A

-> Rhinitis
-> Pharyngitis
-> Tonsillitis
-> Laryngitis
-> Otitis media (ear infection)

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4
Q

Most common Lower Respiratory Tract Infections

A

-> Pneumonia
-> Bronchiolitis
-> Bronchitis

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5
Q

Most common serious complications of URI

A
  1. Ear infections
    -> Deafness
  2. Strep Throat (Group A Strep)
    -> Untreated or inadequately treated - Rheumatic fever
    -> Etiology:
    –> Strep tricks the immune system into attacking healthy
    tissues in the body
    –> Inflammation in heart, joints, brain, and skin
    –> Arthritis
    –> Heart inflammation and damage
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6
Q

Differences Btwn Child and Adult Respiratory Systems

A
  1. Chest or thorax shape
    -> Chest wall is round, making lung expansion more difficult
    -> Child’s trachea bifurcates higher (making them more prone to
    choking)
  2. Diaphragm and muscles of respiration
    -> Diaphragms angle is more horizontal
    -> Immature muscle
    -> Fatigues easily
    -> Only way to increase oxygen intake is by increasing
    respiratory rate (Cue)
    -> Normally expiration is passive
  3. Relative internal organ size
    -> Internal organs reduce expansion, d/t relative size in relation
    to lungs
  4. Upper airway structural differences
    -> Cues of respiratory difficulty: Mouth breathing, Nasal flaring,
    increased respiratory rate, Retractions, Use of accessory
    muscles, Leaning forward/Tilting heat back to breathe
  5. Airway diameter (baby has a pinky-sized esophagus)
    -> With edema, 50% reduction in lumen of airway
  6. Bronchial walls
    -> Cues: Chest tightness, Dry cough, Night cough
  7. Cilia
    -> Poorly developed
  8. Surfactant
    -> Insufficient amount in premies
    -> Higher maternal blood sugar levels reduce the production of
    surfactant before birth
  9. Alveoli
    -> Fewer alveoli until age 2
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7
Q

Airway Resistance

A
  • Definition: The effort or force required to move air into the lungs
  • Greater in children than in adults because children’s airways are
    narrower
  • In infants, airway resistance is about 15x that of an adult
  • When there is edema or swelling in the airway d/t an irritant or
    infectious process, the airway is further narrowed, increasing the
    airway resistance even more
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8
Q

Summary of Respiratory Issues

A

-> Due to an immature system, and large organs, infants compensate by increasing their respiratory rate in the setting of respiratory distress

-> Surfactant can be administered to premature babies to help expand the alveoli and prevent atelectasis

-> Important to understand these differences to successfully manage a pediatric patient with a respiratory condition

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9
Q

Pediatric Vital Signs Normal Ranges

A

Age: Newborn
RR: 30-50
HR: 120-160 bpm
Systolic BP: 50-70
Weight kilos: 2-3
Weight lbs: 4-7

Age: Infant (1-12 months)
RR: 20-30
HR: 80-140 bpm
Systolic BP: 70-100
Weight kilos: 4-10
Weight lbs: 9-22

Age: Toddler (1-3 years)
RR: 20-30
HR: 80-130 bpm
Systolic BP: 80-110
Weight kilos: 10-14
Weight lbs: 22-31

Age: Preschooler (3-5 years)

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9
Q

Pediatric Vital Signs Normal Ranges

A

Age: Newborn
RR: 30-50
HR: 120-160 bpm
Systolic BP: 50-70
Weight kilos: 2-3
Weight lbs: 4-7

Age: Infant (1-12 months)
RR: 20-30
HR: 80-140 bpm
Systolic BP: 70-100
Weight kilos: 4-10
Weight lbs: 9-22

Age: Toddler (1-3 years)
RR: 20-30
HR: 80-130 bpm
Systolic BP: 80-110
Weight kilos: 10-14
Weight lbs: 22-31

Age: Preschooler (3-5 years)

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10
Q

Pediatric Vital Signs Normal Ranges

A

Age: Newborn
RR: 30-50
HR: 120-160 bpm
Systolic BP: 50-70
Weight kilos: 2-3
Weight lbs: 4-7

Age: Infant (1-12 months)
RR: 20-30
HR: 80-140 bpm
Systolic BP: 70-100
Weight kilos: 4-10
Weight lbs: 9-22

Age: Toddler (1-3 years)
RR: 20-30
HR: 80-130 bpm
Systolic BP: 80-110
Weight kilos: 10-14
Weight lbs: 22-31

Age: Preschooler (3-5 years)
RR: 20-30
HR: 80-120 bpm
Systolic BP: 80-110
Weight kilos: 14-18
Weight lbs: 31-40

Age: School Age (6-12 years)
RR: 20-30
HR: 70-110 bpm
Systolic BP: 80-120
Weight kilos: 20-40
Weight lbs: 41-92

Age: Adolescent (13+ years)
RR: 12-20
HR: 55-105 bpm
Systolic BP: 110-120
Weight kilos: > 50
Weight lbs: > 110

Average Temp: Oral -> 35.5-37.5 C (96-99.5 F)
Average O2: 97-99%
- < 90-92% suggests respiratory or cardiac condition

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11
Q

Deterioration in Children

A
  • May be subtle and non-specific
  • May deteriorate slowly but crash quickly
  • Early intervention is vital
  • Increased respiratory rate is primary cue
  • A suspicion of respiratory failure should be raised when there are
    signs of exhaustion (decreased respiratory work or listlessness),
    recurrent episodes of apnea, or if O2 saturation cannot be
    maintained with O2 supplementation
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12
Q

Adventitious Sounds

A
  • Sounds not normally heard on auscultation of the lungs
  • D/t thinness of chest wall, breath sounds seem louder and
    harsher in infants and young children
  • Sounds may seem to originate in the lungs, when actually they are
    referred from the upper airway in children (there’s mucus in the
    nose or throat)
  • when assessing breath sounds:
    -> Encourage children to breathe deeply (like blowing out
    candles)
    -> Listen with the bell of the stethoscope for low-pitched sounds
    -> Listen with the diaphragm for higher pitched sounds
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13
Q

Sick or Not Sick

A

Cues:
- Not alert
- Retractions
- Nasal flaring

Nursing considerations:
- Positioning to maximize respiration
- Consider effects of feeding/full stomach on respiration,
especially infants

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14
Q

Capillary Refill - Peripheral or Central

A
  • Press and count for 5 seconds
  • Release and count for another 5 seconds
    -> Stop counting when original color returns
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15
Q

Don’t Forget the Carers

A
  • Empower parents with validation and support
  • Keep informed of interventions and pain management options,
    times, etc
  • Keep informed of timeframes and processes
  • Keep informed of your return and reassessments
  • Educate them on the child’s condition
  • Offer play and distraction
16
Q

Chest X-Ray (CXR)

A
  • Bacterial infection such as pneumonia appear
  • Used to rule out:
    -> Foreign body aspiration
    -> Infectious process
    -> Gain information on cardiac size, contour, status of pulmonary
    flow
  • Nursing Considerations:
    -> Explain procedure
    -> Protect child from radiation exposure with lead shields
    -> Ensure child holds still during test
17
Q

Respiratory Treatments and Procedures

A
  • Aerosol therapy
  • Assisted ventilation
  • Chest physiotherapy (CPT)
  • ET intubation
  • O2 administration
  • Tracheotomy
18
Q

Respiratory Equipment

A
  • Pulse Oximeters
    -> Reflect amount of RBC/Hgb saturated by O2 to be delivered to
    tissues (95-99% ok)
    -> Nursing Implications: Assure correct placement of sensor,
    realize excess light in room may skew results, choose correct
    sensor by child’s weight, remove patients dark nail polish
  • Vaporizers
    -> Action is to provide warm or cool mist to moisten air and
    loosen secretions (for croup)
    -> Nursing Implications: Cool mist often preferred as it
    penetrates airways easier and less risk of scald burns.
    Cleaning daily is important
  • Nebulizers
    -> Deliver meds by fine mist deep into lungs for respiratory
    disorders such as asthma
    -> Types: Hand-held (MDI’s) and ultrasonic nebulizer machines
    -> Nursing Implications: See p. 1151 in textbook for Metered-
    Dose inhaler
  • Mist Tents
    -> Specially designed plastic placed over crib and tube carrying
    nebulized water enters “the tent” (used for croup/pneumonia,
    etc)
    -> Nursing Implications: Remember, it may be scary to young
    children, change bedding and clothing frequently
19
Q

Upper Respiratory Infections

A
  • Acute viral infection of upper respiratory tract
  • Causative pathogens:
    -> Most common = rhinovirus
    -> Others: RSV, influenza
  • Transmission:
    -> Nasal secretions
    -> Fingers and hands
  • Symptoms:
    -> Runny nose, nasal congestion, sore throat, cough, sneezing,
    low-grade fever
  • Treatment:
    -> Analgesics (sore throat, muscle aches, fever)
    -> Maintain hydration
    -> NO ANTIBIOTICS!!!
    -> RTC if symptoms persist beyond 7 days or worsens
    -> Prevention: hand washing, hygiene, limit exposure
20
Q

Acute Otitis Media (AOM)

A
  • Most commonly diagnosed illness in childhood
  • Inflammation of middle ear with rapid onset of symptoms/clinical
    signs
  • AOM occurs most commonly in children btwn 6 months-3 years.
    Uncommon after age 8
  • Incidence higher in winter months
  • Breastfed infants have lower incidence than formula-fed infants because breast milk provides increase immunity that protects the eustachian tube and middle ear mucosa from pathogens
  • Infants more predisposed because:
    -> Short, horizontally positioned eustachian tubes
    -> Enlarged lymphoid tissue, which obstructs the eustachian
    tube opening
  • When swelling or other predisposing factors cause eustachian
    tube dysfunction secretions are retained in the middle ear
  • Bottle feeding infant in the supine position increases risk as
    position promotes pooling of milk in the pharyngeal cavity =
    infection
21
Q

Treatment for AOM

A
  • Analgesics (Ibuprofen[Motrin]) and acetaminophen (Tylenol) to
    relieve pain/fever in first 24 hours of infection
  • Wait and see
    -> 48-72 hours
    -> 6-24 months old
    -> Non-severe otitis media
  • Antibiotics
    -> Younger than 6 months
    -> Fever > 102.2F
    -> Ages 2 and older with severe symptoms
  • Encourage prevention by breastfeeding/non-propping of bottle,
    eliminate child’s exposure to tobacco smoke
  • After antibiotic therapy completed, child re-evaluated that tx was
    effective
  • If not, other tx:
    -> Myringotomy - Incision in tympanic membrane
    -> Tympanoplasty - Ventilating tubes equalize pressure
  • Severe cases:
    -> Prophylactic antibiotics
    -> Assess for hearing loss
    -> Refer for audiology testing
22
Q

Influenza

A
  • Highly contagious viral illness
  • Seasonal: Mid-October to February
  • Transmissible
  • Incubation of 2-7 days
  • Infectious 24 hours before onset of symptoms
  • Diagnostic:
    -> Nasopharyngeal culture obtained within the first 72 hours of
    illness
    -> Diagnosis usually based on clinical signs
  • Treatment:
    -> Supportive therapy
    -> Antiviral prophylaxis such as Oseltamivir (Tamiflu)
    -> Immunization
23
Q

Croup

A
  • Acute upper airway obstruction caused by a viral infection of the
    larynx
  • Symptoms:
    -> Barky cough, inspiratory stridor, hoarseness, fever, URI
    symptoms
  • Diagnostics:
    -> Pulse oximetry shows hypoxia in children with severe disease
  • Treatment:
    -> Mild: Outpatient care
    -> Hydration
    -> Humidified air
    -> Family education regarding worsening respiratory distress

Most cases are self-limiting for 3-5 days
- Moderate-Severe:
-> Hospitalize for supportive care (O2 supplementation, IV fluids)
-> Medication:
-> Dexamethasone and nebulized epinephrine (Adrenaline)
–> Nebulized epinephrine reduces swelling in the
airway and begins to work faster than
dexamethasone alone
-> Budesonide –> Corticosteroid
–> Decreases swelling and irritation in the airways to
allow for easier breathing
–> Begins working within 6 hours of first use

24
Q

Principles of Client Care

A
  1. Maintain or achieve stability
25
Q

Possible Clinical Judgment Pathway

A

Diagnosis: Flu -> Acute Issue

O2 per mask at 2L/min

  1. Recognize Cues: (What’s not right?)
    • Rapid breathing
    • Increased respiratory effort
    • Lethargic
    • GOAL: ADEQUATE OXYGENATION
  2. Analyze Cues: (What could be happening?)
    • Airway:
      -> Swelling?
      -> Blockage?
      -> Position?
    • Breathing:
      -> Decreased oxygen intake
      -> Poor gas exchange
      -> Color of lips, nailbeds –> pink
      -> Oximeter 88-90%
  3. Prioritize Hypothesis (What’s going on?)
    • Decreased O2 intake r/t position and O2 flow rate
  4. Generate Solutions (What can I do to fix this?)
    • Offer warm blankets
    • Emotional support to reduce anxiety
    • Notify provider after 15 minutes
  5. Take Action (Where will I start?)
    • Assist to upright position
    • Increase O2 rate (if PRN order to adjust rate)
  6. Evaluate and notify provider after 15 minutes
  7. Anticipate nebulizer treatment
26
Q

Bronchitis

A
  • Acute: Transient inflammation of the larger lower airways
  • Chronic: Poorly defined in children -> Rarely an isolated entity in
    children
  • Most commonly occurs after viral infections
  • Symptoms:
    -> Mild URI symptoms
    -> Dry hacking cough that becomes productive
    -> Older kids may complain of chest pain, worse with cough
    -> As disease progresses -> More generalized illness
    -> Normal temperature or mild elevation
  • Diagnostic tests:
    -> Diagnosis based on H&P
    -> CXR not routinely ordered
    -> Elevated neutrophil or CRP is suggestive of bacterial etiology
  • Treatment:
    -> Supportive if viral
    -> Avoidance of respiratory irritants
    -> Increase fluid intake and rest
    -> Bronchodilators??
    -> Inhaled steroids
    -> Antibiotics useful if bacterial infection is suspected
    -> Pain meds for chest pain
    -> Humidification of air promotes comfort
    -> Cough meds?
    -> No antihistamines

NRSG 344 - Nursing of the Family (5 decks)

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