Nursing Care of Pediatric Patient With Respiratory Illness

Question 1

How is the pediatric respiratory system different from the adults?

Answer 1

Nares, infants are obligate nose breathers for up to 4-6 weeks.
Mouth-oral cavity out of proportion to large tongue and tonsils.
Faster respiratory rate 30-60 RR for infant.
Bronchioles and intercostal muscles are immature.

Question 2

Pediatric Assessment Triangle

Answer 2

Appearance, Circulation, Work of Breathing

Question 3

TICLS

Answer 3

Tone, Interactiveness, Console-ability, Look/gaze, Speech

Question 4

Visual Circulation Cues

Answer 4

Color, Pallor, cyanosis, ashen, mottled.

Question 5

Pediatric Respiratory Assessment

Answer 5

Color, Cap Refill, Feeding/swallowing problems, Nasal congestion, runny nose, cough,. stridor, behavior changes, irritability, lethargy.

Question 6

Respiratory tests

Answer 6

CXR, Pulse ox, cultures.

Question 7

Nursing Management of Respiratory Distress

Answer 7

02 sat below 95%, Confirm if accurate, determine if probe is functioning, Raise HOB or sit up, open airway with suction, administer O2 by blow by, mask, nasal cannula, then bag if O2 drops. Report to PCP or instructor.

Question 8

Assessment of changes

Answer 8

VS, HR, RR, BP, mentition, tone, color

Question 9

Foreign body aspiration risk

Answer 9

Infants toddlers, preschoolers, young adults, teens

Question 10

Location of most foreign body aspiration

Answer 10

right bronchus

Question 11

Foreign body aspiration - clinical presentation

Answer 11

choking, cough, gagging, hoarseness, wheezing, stridor, drooling, asymmetrical breath sounds.

Question 12

Foreign body aspiration - clinical diagnostics

Answer 12

xray, bronchoscopy

Question 13

Foreign body aspiration - clinical management

Answer 13

assess S&S, location and degree of obstruction.
chest thrusts and back blows for infant
abdominal thrusts
bronchoscopy: sedation/surgery to remove object.
pass through GI tract - NO LAXATIVES
Best approach is prevention

Question 14

Apnea

Answer 14

cessation of respiration greater than 20 seconds, first sign of infant in distress

Question 15

Apnea of prematurity

Answer 15

occurs in preterm infants due to immature neurological and respiratory systems.

Question 16

ALTE - Apparent Life Threatening Event

Answer 16

Episode of apnea accompanied by color change, hypotonia, chocking, gagging in infant >37 weeks
May be GERD or shaken baby syndrome

Question 17

SIDS

Answer 17

< 1 year of age, death occurs during sleep. leading cause of infant death 1 month-1 year.

Question 18

SIDS Risks

Answer 18

Prematurity, drug exposure, siblings who have dies of SIDS, prenatal/postnatal maternal smoking, sleeping in prone position.

Question 19

SIDS assessment

Answer 19

no characteristic findings, found dead

Question 20

Obstructive Sleep Apnea

Answer 20

Apnea following excessive snoring. infant is asleep, airways relaxxed, decrased tone or obsruction, decreaseed ventilation and hypoxia.

Question 21

Obstructive Sleep Apnea causes

Answer 21

facial malformations, obesity, large tonsils and tongues

Question 22

Obstructive Sleep Apnea complications

Answer 22

failure to thrive, cognitive impairment, systemic HTN

Question 23

Obstructive Sleep Apnea Diagnostic

Answer 23

sleep study

Question 24

Obstructive Sleep Apnea treatment

Answer 24

tonsilectomy, craniofacial repair, CPAP machine

Question 25

Croup

Answer 25

upper airway syndrome, can have swelling of epiglottis, larynx, trachea

Question 26

3 types of croup

Answer 26

acute spasmodic laryngitis, acute laryngotracheobronchitis LTB, epiglotitis (most dangerous).

Question 27

acute spasmodic laryngitis (croup)

Answer 27

viral/allergic, sudden onset, peaks at night and resolves by morning and reoccurs, mild hoarseness and slight stridor.

Question 28

acute spasmodic laryngitis treatment (croup)

Answer 28

humidity, cold foods

Question 29

laryngotracheobronchitis LTB (croup)

Answer 29

viral, usually in winter, barking cough, inspiratory stridor, retractions, low fever. Potential for airway obstruction!

Question 30

laryngotracheobronchitis LTB treatment (croup)

Answer 30

humidity, steroids, racemic epinephrine nebulizer.

Question 31

epiglotitis (croup) DEFINITION

Answer 31

inflammation of epiglottis causing airway obstruction within minutes to hours.

Question 32

epiglotitis (croup) s&s

Answer 32

bacterial HIB, incidence decrease with immunization, always sudden severe rapid onset, high fever, child may lean forward and drool, cough is usually not present.

Question 33

epiglotitis (croup) treatment

Answer 33

maintain airway, be ready to intubate, have tracheotomy kit at bedside, O2, IV fluids, antibiotics. avoid throat culture and keep child calm. NO THROAT CULTURE, they cause laryngospasms and respiratory arrest.

Question 34

Nasopharyngitis (upper airway disorder)

Answer 34

A cold, caused by rhinovirus, nasal discharge, irritability, sore throat, cough, general discomfort

Question 35

Nasopharyngitis (upper airway disorder) treatment

Answer 35

clear airways, saline drops, bulb syringe, humidifier, adequate fluid intake, prevention of fever

Question 36

Pharingitis (upper airway disorder)

Answer 36

strep throat, treat all to prevent consequences, T&A

Question 37

Tonsillectomy and adenoidectomy post op care.

Answer 37

nothing warm, observe for bleeding, frequent swallowing, relieve pain and encourage fluids. position on side to facilitate drainage, soft cold diet, no dairy, bleeding 5-10 days.

Question 38

Acute Otitis Media `

Answer 38

inflammation of inner ear, children prone, caused by HIB, strep, feeding in supine position.

Question 39

Acute Otitis Media `nursing care

Answer 39

assess for fever and pain level, administer meds, frequency may warrant surgery myringotomy - incision and tube. keep ear dry, will fall out by themselves or taken out by provider.

Question 40

Bronchiolitis (Lower Air Way) cause

Answer 40

viral RSV and influenza A and B, can be bacterial

Question 41

Bronchiolitis (Lower Air Way) S&S

Answer 41

rhinorrhea, pharyngitis, coughing, sneezing, wheezing, intermittent fever. can become tachypnic >70 R

Question 42

Bronchiolitis (Lower Air Way) treatment

Answer 42

supportive humidified O2, rest, push po fluids or IV if aspiration risk,

Question 43

Respiratory Syncytial Virus (RSV)

Answer 43

Transmitted through close or direct contact.

Question 44

Respiratory Syncytial Virus (RSV) S&S

Answer 44

Airways swell and produce excess secretions causing obstructions and bronchospasm. URI, fever, rhinitis, progessing to wheezing and coarse breath sounds, less PO intake, less energy, less sleep.

Question 45

Respiratory Syncytial Virus (RSV) Diagnosis

Answer 45

Culture done on nasal secretion, child put on contact.

Question 46

Respiratory Syncytial Virus (RSV) treatment

Answer 46

Humidified O2, CPT, isolation precautions, handwashing, IVF’s, suction, family support. Bronchodialators, inhaled steroids, Synagis immunoglobin for preemies.

Question 47

Pneumonia

Answer 47

Viral or bacterial, inflammation of the bronchioles and alveolar spaces of lung resulting in exudate, areas of plugging and consolidation interfering with gas exchange. Cough, SOB with exertion.

Question 48

Pneumonia nursing management

Answer 48

Tylenol and ibuprofen, cough suppressants not advised for younger children, but expectorants are good, fluids, nutrition, O2 PRN.

Question 49

Asthma definition

Answer 49

chronic inflammatory obstructive airway disease characterized by wheezing. Affects large and small airways with increased mucous, swelling, and bronchospasm. Triggered by cold weather, allergies, infection,environment.

Question 50

Asthma nursing management

Answer 50

assess RR, HR, color, O2, cap refill. breath sounds, air movement, peak flow movement, assess fluid status, high risk of aspiration, STRICT I&O, promote rest to conserve energy.

Question 51

Asthma medications

Answer 51

Nebulizer inhalation with MASK for children. B adrenergic short acting albuterol and lezabuterol. B andrenergic long acting salumeterol. Corticosteroid (pulmicort, advair). MDI metered dose inhaler with spacer.

Question 52

Asthma home management

Answer 52

goal is prevention. peak flow to monitor, home log of treatments, avoid triggers, determine need for nebulizer, determine need for steroid maintenance, have clear follow up plan with PCP.

Question 53

Status asthmaticus

Answer 53

severe unrelenting respiratory distress with bronchospasm, persists even with meds, medical emergency. Death can result from poor teaching and mismanagement of disease.

Question 54

Broncho Pulmonary Dysplasia (BPD) definition

Answer 54

a fibrioud or thikenining of lung caused by excessive oxygenation of premature babies for a prolonged period of time. RDS main reason for oxygenation. COPD in little people

Question 55

Broncho pulmonary Dysplasia (BPD) S&S

Answer 55

respiratory distress, tachypnea, wheezing, retractions, grunting, irritability, barrel chest, clubbing, cardiac anomalies, heart failure, jugular vein distention, Normal activities can increase demand for O2 and distress.

Question 56

Broncho pulmonary Dysplasia (BPD) medical management

Answer 56

Respiratory support, humidified O2, mechanical ventilation, suction, CPT 3x a day. Bronchodilators, diuretics, anti-inflammatories, antibiotics when needed. Prevention is key. nutritional support via NG to conserve energy.

Question 57

Broncho pulmonary Dysplasia (BPD) nursing management

Answer 57

support safe weaning from O2, promote normal growth and development, prepare family for home care needs, teach about monitoring of RR, HR, color, and behabioral changes. discuss clear parameter in acute illness.

Question 58

Cystic Fibrosis

Answer 58

major cause of serious lung disease in children, inherited from autosomal recessive. involves exocrinne glands excreeting thick fluid.

Question 59

Cystic Fibrosis assessment

Answer 59

wheezing, dyspnea, cough, cyanosis, generalized obstructive emphysema (clubbing barrrel chest). Right sided heart failure

Question 60

Cystic Fibrosis presentations

Answer 60

generalized obstructive emphysema (clubbing barrrel chest). Right sided heart failure, salty sweat, steatorrhea bulky floating stools, productive cough, frequent URI, weight loss. meconium ileus in the new born, small bowel obstruction as young infant, fecal impaction/intussesception, elevated chloride on sweat test.

Question 61

Cystic Fibrosis nursing management

Answer 61

Therapy, O2 PRN, antibiotic, aerosol and MDI’s, postural drainage, breathing exercises, prevention of infection. pancrease with meals, hygiene, teeth, promote growth and development, assist with families adjustment.