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N353: Practice of Nursing II > Module 2 - Pediatric Respiratory Disorders > Flashcards

Module 2 - Pediatric Respiratory Disorders Flashcards

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1
Q

What are the critical differences between adults and children in regard to repsiration?

A
  1. Nares (infant take 4-6 weeks before breathing via the mouth)
  2. Mouth (smaller mouth and larger tongue/tonsils - so a smaller oral cavity proportion makes it more difficult to swallow)
  3. Faster Respiratory Rate
  4. Bronchioles and Intercoastal Muscles are Immature (Upper airway shorter and narrower in diameter)
  5. Short, Horizontal Eustachian Tubes (so if there is a sinus issue some infection can move and cause ear infection)
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2
Q

Why is ear infection so common in PEDS?

A

their shorter an horizontal eustachian tube makes it easier for infection to move into the ear

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3
Q

Pediatric Assessment Triangle (P.A.T.)

A

A doorway assessment that can be done before even touching the patient w/ 3 things

  1. Appearance
  2. Circulation
  3. Work of Breathing
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4
Q

What things for Appearance need to be looked at in the PAT?

A

TICLS

Tone
Interactiveness
Consolability
Look/Gaze
Speech/Cry

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5
Q

What things for Work of Breathing (WoB) need to be looked at in PAT?

A

Rate of Breathing

Position (are they tripoding?)

Retractions (intercostals, etc)

Anxiety (Hypoxia?)

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6
Q

What things for Circulation need to be looked at in PAT

A

Color (pale cyanosis, ashen, modeled)

Capillary Refill

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7
Q

What things can we look for (Assess) in a Pediatric Respiratory Assessment?

A

Color
Capillary Refill
Irregular or Difficulty Breathing
Feeding/Swallowing Problems
Nasal Congestion
Runny Nose
Cough/Stridor (Insp pull/gasp)
Behavior Changes
Irritability Lethargy
Is the cough wet, productive, dry, etc

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8
Q

Tests that can be done for a Pediatric Respiratory Assessment?

A

CXR

Pulse Ox

Cultures

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9
Q

Example Nursing Diagnosis for Pediatric Respiratory Assessments?

A

Ineffective Breathing Pattern

Ineffective Airway Clearance

Activity Intolerance

Fear and Anxiety

Knowledge Deficit (Re: Condition, Treatment Plan, Self Care, and Discharge Plan)

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10
Q

Nursing Management for Potential Respiratory Distress?

A

*If O2 Sats are less than 94%…

  1. Confirm if the reading is believable (it correlates to heart beat)
  2. Make sure O2 Sat Probe is Fxning (if anxious and moving could get a false reading)
  3. Raise HOB or sit child up –> Open Airway (i.e suctioning if needed and ordered) –> Administer O2 (blow by, n/c or face mask) - [This is the order of stuff IF NEEDED]
  4. Assess for changes in tone, color, VS, etc
  5. Alert to the appropriate person to communicate changes in O2 and responses to treatment, obtain order for O2 and further actions
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11
Q

Signs of Respiratory Distress needs …

A

action and reporting to instructor, RN and MD!

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12
Q

Can we administer O2 on our own?

A

We can, BUT we will eventually need an order on what we had to do and what may need to be done further

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13
Q

What changes should we assess for in children if there is Respiratory Distress?

A

VS - Especially HR, RR, BP

Mentation/Responsiveness

Tone

Color

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14
Q

Who is at risk for Foreign Body Aspiration?

A

Infants, Toddlers, Preschoolers - d/t exploration and imitation (check for them putting things in their mouth)

Older Children and Teens - d/t activities while eating like laughing, going to fast, eating too much, high risk activities (esp if intoxicated)

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15
Q

Severity of Foreign Body Aspiration depends on…

A

Location and Type of Object (ex: popcorn, peanuts, carrots, peanut butter, coins, nails, toys)

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16
Q

Clinical Presentations and Diagnostic Findings of Foreign Body Aspiration

A

Clinical: Chocking, Cough, Gagging, Hoarseness, Wheezing, Stridor, Drooling and/or Asymmetric Breath Sounds

Diagnostic: CXR, Bronchoscopy

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17
Q

Main methods of Clinical Management for Foreign Body Aspiration

A

Assessing S/S, Location and Degree of Obstruction

Chest Thrusts and Back Blows for Infants, Abdominal Thrusts, etc

Bronchoscopy

Passage through the GI Tract

PREVENTION!!

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18
Q

Bronchoscopy

A

Sedation/surgery to remove a foreign body obstruction object

Make sure to monitor vitals after and check gag reflex after they wake up

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19
Q

What should be done for object passage through the GI tract for a foreign object?

A

Just giving a normal diet with no laxatives for speeding it up

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20
Q

Abdominal Thrusts are often done on choking adults, what should be done though for infants?

A

Chest thrusts and Back Blows

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21
Q

What is the best clinical management for foreign body aspiration?

A

PREVENTION

ex: clean up small objects/toys, use Mylar Balloons not latex, positive role model, supervised meals, appropriate size bites ….

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22
Q

Apnea

A

cessation of respiration for longer than 10 seconds

not always about color changes or limpness or choking

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23
Q

What may be the first sign of resp distress in infants (ex: for respi. dysfunction, illness, sepsis, etc)?

A

Apnea

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24
Q

What may OR MAY NOT be accompanying Apnea?

A

Cyanosis
Pallor
Hypotonia
Bradycardia

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25
Q

Apnea of Prematurity

A

occurs in preterm infants d/t lack of maturity of neuro/respiratory systems

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26
Q

Apparent Life Threatening Event (ATLE)

A

Episode of apnea accompanied by color change, hypotonia, choking, gagging in infants born >37 weeks and aged >60 days

Occurs more so in full term babies rather than preme

Occurs often

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27
Q

When May ATLE occur?

A

During sleep, wakefulness, feeding - many different times

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28
Q

What is important to do when an ATLE occurs?

A

You NEED TO FIND OUT WHAT HAPPENED

Find the situation it occurred and try to watch a recreation of the moment so we can monitor for later episodes

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29
Q

After admission and monitoring, what do parents often go home with for ATLE?

A

Home Apnea Monitor

CPR Teaching/Training

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30
Q

What is the most common cause of ATLE?

A

GE Reflux (but it could be anything)

It can come up and then take away breath and lead to aspiration

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31
Q

What is a potential abuse cause of ATLE?

A

Shaken Baby Syndrome

They may have been shaken or it may be a neurological problem

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32
Q

Sudden Infant Death Syndrome (SIDS)

A

Sudden death of an infant less than 1 year of age that remained UNEXPLAINED after a complete autopsy, death scene investigation and review of history.

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33
Q

When does SIDS most commonly occur?

A

Death usually occurs during sleep

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34
Q

Etiology of SIDS

A

Unknown

it is an unpredictable and unpreventable thing

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35
Q

Risks for SIDS

A

Prematurity

Drug Exposure

Siblings who have died from SIDS

Prenatal/Postnatal Maternal Smoking

Sleeping prone (be on back not belly)

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36
Q

Nursing Management Technique for SIDS

A
  1. Eval coping and grieving
  2. Provide anticipatory guidance for typical feedings
  3. Allow parents to verbalize; listen and validate feelings
  4. Refer family for counseling if needed
  5. Refer to appropriate community self help groups
  6. Monitor infants for apnea risk
  7. Teach parents how to minimize risk of SIDS!!!!
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37
Q

Things to teach parents to minimize the risk of SIDS?

A

Avoid smoking during and after pregnancy

Encourage putting infants to sleep in supine position unless contraindicated

Avoid soft, moldable mattresses and overheating

Avoid use of pillows

Avoid bed sharing

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38
Q

Obstructive Sleep Apnea

A

Excessive snoring followed by apnea

They are asleep –> airway muscles relax –> decreased tone and obstruction of the lungs occur –> Decreased ventilation, hypoxia, increased CO2

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39
Q

Can only a Heavyset or Older person get Obstructive Sleep Apnea

A

No, children can have decreased tone and airway relaxing leading to apnea at night as well, and it can occur all night too

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40
Q

Causes for Obstructive Sleep Apnea

A

Craniofacial Abnormalities

Obesity

Large Tonsils/Adenoids

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41
Q

Complications that can occur from Obstructive Sleep Apnea

A

FFT

Cognitive Impairment

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42
Q

Diagnostic/Treatments for Obstructive Sleep Apnea

A

Sleep Study - Diagnostic

Tonsillectomy - Treatment

Craniofacial Repair - Treatment

CPAP Machine - Treatment

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43
Q

FTT

A

Failure to Thrive

Not growing well – this makes you fall behind (you do not eat, then do not grow, dont sleep, etc)

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44
Q

Croup Syndromes

A

Upper Airway Syndromes with multiple possible etiologies

It is like going from breathing through a garden hose to breathing through a coffee straw

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45
Q

Common s/s of Croup Syndromes

A

Swelling of Epiglottis, Trachea, Larynx, and/or Bronchi

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46
Q

Potential Causes of Croup Syndromes?

A

Viral or Bacterial Causes: (more likely to be viral)

Acute Spasmodic Laryngitis

Acute Laryngotracheobronchitis (LTB)

Epiglottitis

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47
Q

The more mild type of Croup Syndrome

A

Acute Spasmodic Laryngitis

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48
Q

The more severe type of Croup Syndrome

A

Epiglottitis

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49
Q

Acute Spasmodic Laryngitis (Croup Syndrome)

A

Viral/Allergic Origin

Sudden Onset

Peaks at night, resolves by morning but often reoccurs - common in the cool fall

Clears with humidity and cool fluids (decrease swelling)

Mild hoarseness and Slight Stridor

More mild symptoms

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50
Q

Laryngotracheo-bronchitis (LTB) (Croup Syndrome)

A

Viral Origin

Usually occurs in winter with quick onset

Barking Cough, Inspiratory Stridor, Retractions, and Low Fever!!!!

Potential for Airway Obstruction

Medium Intensity

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51
Q

Treatment for Laryngotracheo-bronchitis (LTB)

A

Humidity

Steroids

Racemic Epinephrine via Nebulizer

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52
Q

Stridor

A

inspiratory high pitch noise common of upper airway swelling

53
Q

Laryngotracheo-bronchitis can lead to …

A

hospitalization in the ER with a need for steroids to decrease inflammation

54
Q

Steroids decrease ____

A

inflammation

55
Q

With research, which is found more helpful for bronchiolitis: Nebulized Epinephrine or Albuterol

A

Nebulized Epinephrine

56
Q

Epiglottitis (Croup Syndrome)

A

Bacterial origin (Haemophilus influenzae B)

The worst croup syndrome

Incidence decreases with higher immunization of HIB vaccine

Severe, rapid onset, high fever - very sick

Inflammation of epiglottis causing airway obstruction within minutes to hours

57
Q

Treatment for Epiglottitis

A

Maintain the airway - ex: intubate, tracheotomy set at bedside (do not want to lose any minutes)

O2

IV fluids and antibiotics

58
Q

Special Considerations for Epiglottitis

A

It is a rapid, progressive, and life threatening issue

Keep the child calm! - they may want to sit forward, drool, mouth open, leaning all because of difficulty breathing

Absent cough d/t swelling - so swollen that you do not get into the throat easy because of risk of spasms

AVOID throat culture, tongue depressor or palpation of throat area - could cause severe laryngospasms progressing to resp. arrest potentially

59
Q

What is absent in Epiglottitis

A

COUGH

60
Q

Steeple Sign

A

Sign for epiglottitis

In an X Ray the larynx is so tight that it is almost closed and it looks like a steeple/triangle in the throat

61
Q

Nasopharyngitis

A

A “Cold”

One of the most common infections of the respiratory tract

62
Q

What is the principle cause of Nasopharyngitis

A

Rhinovirus

This is spread from person to person by sneezing, coughing or direct contact

63
Q

S/S of Nasopharyngitis

A

Nasal Discharge

Irritability

Sore Throat

Cough

General Discomfort

64
Q

Treatment for Nasopharyngitis

A

Clear Airways (esp BEFORE feedings; ex: suction)

Saline Drops (bulb syringe for infants), Humidifier

Adequate Fluid Intake

Prevention of Fever (ex: Tylenol)

Teach parents how to manage

65
Q

Pharyngitis

A

could be Viral OR bacterial - we need to know which one!

Essentially Strep

MUST be treated because untreated can lead to inflammation attacking the heart, joint, and maybe even the brain

66
Q

Why is it important to differentiate if Pharyngitis is Viral or Bacterial?

A

If it is viral and strep then we must prevent rheumatic fever and peritonsillar abscess

67
Q

If someone continuously is getting strep (Viral Pharyngitis) then what might need to be done?

A

Recommendations of Tonsillectomy and Adenoidectomy (T&A)

68
Q

Post Op Care for T&A

A

Observe for bleeding

Prevent bleeding by discouraging coughing and throat clearing

Relieve Pain to get them to drink and encourage fluids (no straws because the sucking pulls on the throat)

Position on the side to facilitate drainage

Patient Teaching

69
Q

What is frequent swallowing an early sign for following T&A?

A

Bleeding

70
Q

Things to Teach Patients following T&A

A

Soft, cold diet: no milk, hot fluids or citrus liquids

Monitor for bleeding, especially 5-10 days post op

Relieve pain, encourage fluids consistently at home

71
Q

A toddler is being admitted to the pediatric unit with epiglottitis. Which intervention would be the most important for the nurse?

Notify the respiratory therapist of the admission.

Have a tracheotomy set available at bedside.

Have antibiotics prepared when the child arrives on the unit.

Make the child NPO.

A

Have a tracheotomy set available at bedside

72
Q

Acute Otitis Media (AOM)

A

Inflammation / Infection of the Middle Ear

Very common in children and can recur often

73
Q

Why are some children anatomically prone to AOM?

A

They have poor Eustachian tube dysfunction with or without a URI (upper resp infection)

74
Q

What causes Acute Otitis Media?

A

Hemophilus influenzae

Streptococcus pneumoniae

Feeding infant in supine position (could get fluid moved on accident)

Passive Smoking (causes resp and ear infections)

75
Q

What two infections often go together?

A

Ear and Respiratory infections

76
Q

Nursing Management for Acute Otitis Media (AOM)

A

Assess Child for Fever and Pain Level

Administer Prescribed Meds (Antibiotics, Antipyretics)

Frequency of AOM may warrant surgery (prepare)

Myringotomy

Assistance with speech and hearing problems if they occurred

77
Q

Myringotomy

A

Small incision in the tympanic membrane where “tubes” placed which allows for proper drainage of fluid

It will relieve symptoms of AOM and restore hearing

78
Q

Things to teach regarding to Myringotomy

A

Sometimes they fall out, or must be removed

Headsets or Wax need to be used to keep the ear dry

79
Q

Bronchiolitis

A

Lower Airway Disorders

inflammation and obstruction of bronchioles

Viral (RSV, influenzas type A and B, etc), Bacteria, or Allergen Cause

80
Q

S/S of Bronchiolitis

A

Rhinorrhea
Pharyngitis
Obstruction and Phlegm
Coughing
Sneezing
Wheezing
Intermittent Fever

Severe: Tachypnea (RR>70) (may stop eating), Listless, Diminished Breath Sounds, Apneic Spells

81
Q

Treatment for Bronchiolitis

A

Supportive Humidified O2

Rest

Push PO Fluids

IVF’s if tachypneic to prevent aspiration

82
Q

Respiratory Syncytial Virus (RSV)

A

Lower airway disorder

RSV is a common cold like virus causing bronchiolitis

transmitted through close or direct contact (day care, shelters, high density group living, older siblings)

83
Q

S/S for Respiratory Syncytial Virus (RSV)

A

Airways swell

Produce excess secretions causing obstruction and bronchospasm

URI

fever

rhinitis

progressing to wheeze and course breath sounds

loss PO intake

less energy

increased sleepiness

84
Q

How to Diagnose RSV

A

viral cultures from nasal secretions

put children on contact precautions

85
Q

Therapy/Managements of RSV

A

Humidified O2, CPT, Isolation Precautions, Handwashing, IVF’s, SUCTION!!!, Family Support

Meds: Bronchodilators (Albuterol, Xopenex)

86
Q

Synagis and Respigam

A

Medications to treat RSV

Synagis is IM and is for Premies and Children with underlying conditioons - provides passive immunity

Respigam gives the same passive immunity but is via IV

87
Q

Pneumonia

A

Viral or Bacterial Causes

Inflammation or infection of the bronchioles and alveolar spaces of lungs

88
Q

S/S of Pneumonia

A

end result is Exudate, creating areas of plugging and consolidation that interferes with gas exchange

Increase cough

SOB with exertion

89
Q

Nursing Management for Pneumonia

A

Frequent, persistent coughing can cause muscle strain and interrupted sleep for both child and parent

Tylenol or Ibuprogen for Fever/Pain control

Cough Suppressants not for children, older children for sleep

Supportive therapy like fluids, nutrition, O2 prn

90
Q

For who with pneumonia is Cough Suppressants for?

A

Older children to sleep at night, not routinely advised for children - Robitussin with Codeine

91
Q

Asthma

A

Chronic inflammatory, obstructive airway disease CHARACTERIZED BY WHEEZING

It impacts the large and small airways with increased mucous, swelling and bronchospasm

Inflammation rises up and it is a deeper inflammation than Croup Syndrome

92
Q

Triggers for Astham

A

Exercise

Infection

Allergies and Environmental Irritants (Smoke, weather changes)

93
Q

Most common chronic disease in children is ___

A

asthma

94
Q

Assessment and Management for Asthma in Hospital

A

Assess for degree of Resp Distress (RR, HR, Color/O2 Sat, Cap Refill)

Breath Sounds, Air Movement, Peak Flow

Assess Fluid Status

Monitor Output - Strict I and O (Weight diapers)

Promote Rest to conserve Energy so there is less O2 need

Medicines like MDI and nebulizer inhalation

Teach about prevention and management at home like Peak Flow Machine

95
Q

Why is it important to assess fluid status for Asthma

A

increased RR leads to insensible loss of water, dries out mucous airways and risk of aspiration

96
Q

Nebulizer Inhalation

A

Mask for children that administers B adrenergic agonists, long acting B adrenergic agonists, and Corticosteroids in order to treat asthma by reducing inflammation or bronchodilation for easy breathing

97
Q

MDI

A

metered dose inhaler (with space)

98
Q

Peak Flow Meter

A

a device for asthma management

breath in hard and the tab goes high or low and wherever it lands is your base, and then do again when feeling bad to see difference

Difference determines what action to do next for your asthma plan

Helps find a more objective tidal volume

99
Q

What is the primary at home goal of Asthma Management?

A

PREVENTION of issues!!!

use nebulizers, peak flow meters, keeping a log of tx and events

avoid triggers

determine need for MDi and nebulizer and steroids for maintenance and prevention and emergencies

have a clear follow up plan

100
Q

Triggers for Asthma

A

ice cold drinks

encase pillow/mattresses

no dust collectors in room

no pets

change clothes after being outside

no cockroaches

101
Q

Status Asthmaticus

A

severe, unrelenting respiratory distress with bronchospasm

persists despite medication and supportive interventions

It is a MEDICAL EMERGENCY needing endotracheal intubation with assisted ventilation (may be difficult to intubate since its so tight hard to reverse)

DEATH can be a direct result of poor teaching and mismanagement of medications

102
Q

Fluids offered to the child with asthma should
not be too cold because they may

  1. Increase the chance of dehydration
  2. Trigger reflex bronchospasm
  3. Cause nausea and vomiting
  4. Increase mucus
A

trigger reflex bronchospasm

103
Q

Bronchipulmonary Dysplasia (BPD)

A

Fibrous or thickening of the lung (leathery) caused by persistent oxygen need (O2 toxicity) and ventilation given to newborns for a prolonged period of time

104
Q

What is the main cause of O2 and Vent use leading to BPD?

A

Respiratory Distress Syndrome (RDS) in newborns

105
Q

Main cause of RDS in the newborn is ___

A

prematurity

106
Q

Clinical Symptoms of BPD

A

respiratory distress

tachypnea

wheezing

retractions

cyanosis on exertion

grunting

irritability

long term dyspnea can lead to a barrel chest and clubbing (like COPD)

looks a lot like respiratory distress - so eating becomes difficult and they may need small frequent meals instead - feeding, playing or mild URI, and other things become difficult - so they may become skinny

107
Q

Medical Managements for BPD

A

Respiratory Support - humid O2, mechanical ventilation, suction, CPT 3-4x a day

Med support - bronchodilators, diuretics, anti inflammatory, antibiotics if needed - want to prevent so use respigam or synagis

Nutritional support - NG tube feedings to conserve energy (calorie time)

108
Q

Nursing Management for BPD

A

support safe weaning from oxygen

promote normal growth and development

prepare family for home care needs

teach close monitoring of RR, HR, color and behavioral changes, and how the family unit is coping with caring for this child with special needs

discuss clear parameters for follow up in an acute illness - re admission to the hospital is common and they become ill very quickly

Want to wean them off management and teaching is important for home care needs

109
Q

Cystic Fibrosis

A

Exocrine gland releasing thick fluid that affects functioning of the respiratory, GI, endocrine, skin and reproductive systems

110
Q

Cystic Fibrosis is a major cause of what?

A

serious chronic lung disease in children, inherited from both parents carrying a gene for the disease (autosomal recessive)

111
Q

What population is cystic fibrosis most found in?

A

White Population

Equal Distribution among gender

112
Q

Median Life Span for Cystic Fibrosis is __ ___

A

30 years

113
Q

What glands are important to cystic fibrosis occurring?

A

Exocrine Glands

114
Q

How is the Resp System impacted by Cystic Fibrosis

A

lungs plugged with thick mucous that cannot be easily expectorated, causing atelectasis, air trapping, fibrosis and frequent infections

115
Q

Respiratory S/S of Cystic Fibrosis

A

wheezing
dyspnea
cough
cyanosis
Thick mucus in lungs

generalized obstructive emphysema produces characteristic features like barrel chest and finger clubbing – from lack of oxygen

116
Q

How is the Digestive System impacted by Cystic Fibrosis

A

secretions prevent digestive from flowing to GI tracts, thus resulting in poor absorption of food

117
Q

Digestive S/S of Cystic Fibrosis

A

great appetite
weight loss
FTT
bulky and foul smelling stools are frothy d/t undigested food

rectal prolapse

pancreatic ducts blocked so insulin dependent diabetes may occur

118
Q

How is the Reproductive System impacted by Cystic Fibrosis

A

Female will have delayed puberty and decreased fertility (thick cervical mucus)

Males also have decreased fertility (decreased sperm motility, blockage of vas deferens)

119
Q

How is the Cardiovascular System impacted by Cystic Fibrosis?

A

right sided heart enlargement and CHF from obstruction of pulmonary blood flow

120
Q

How is the Integumentary System impacted by Cystic Fibrosis?

A

Increased concentrations of sodium and chloride in sweat: salty skin surface, tears, and saliva

121
Q

Primary Presentation of Cystic fibrosis

A

Meconium ileus in the new born (small bowel obstruction occurs after - not just in elderly this means)

Meconium leads to small bowel obstruction as a young infant

fecal impaction and/or intussusception

steatorrhea (bulky fatty stools)

productive cough, frequent URI, weight loss

122
Q

Diagnosis of Cystic Fibrosis

A

Elevated chloride on a sweat test (>50-60)

123
Q

Steatorrhea

A

bulky fatty stools

124
Q

Intussusception

A

where the intestine folds in on itself because stuck and bulky stool

125
Q

Nursing Management for Cystic Fibrosis

A

Therapy - oxygen prn, antibiotics, aerosols and MDIs, postural draining, breathing exercise, prevention of infection

Dietary

Other - general hygiene, dentition may be in poor condition d/t dietary deficiencies, promote growth and development, assist family to adjust to chronic disease and long term implications

126
Q

What sort of dietary supplements are needed with cystic fibrosis?

A

Supplemental Pancreatic Enzymes (to help food absorption)

127
Q

Postural Drainage

A

chest PT (pound) but in different positions

moves the mucus to make them cough it up or potentially vomit the mucus up

you do it at certain times each day, not when they are full, and it is done BEFORE EACH MEAL

breathing exercises then help aerate as well

128
Q

Suzie Q., a 3 month old, has cystic fibrosis(CF). The parents want to know how their child got the disease, because no one in the family has CF. The nurse understands that with CF

1.  Only one parent carries the CF gene
2.  Both parents are carriers of the CF gene
3.  The inheritance pattern is multifactoral
4.  Was probably the result of a genetic mutation
A
  1. both parents are carriers of the CF gene

N353: Practice of Nursing II (14 decks)

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