Oxygenation Flashcards
what are the paths of ventilation on children?
naso trach, oral trach, and direct trach
where does the direct trach enter the body?
Through a stoma created on the lower neck
what infection do you look for when a patient is on a ventilator?
ventilator associated penumonia
what can be done to prevent VAP?
routine oral care, hand washing, gloves, suctioning, semi fowler positioning, and getting off as soon as they are ready
why must the HOB be elevated in a ventilated patient?
doing this helps get rid of secretions in the lungs
what happens to the hospital if a patient gets VAP?
insurance will not cover the cost of the hospital acquired infection
what does DOPE mean for ventilated patients?
Displacement of the tube
Obstruction…secretions
Pneumothorax
Equipment failure
what medications are ventilated patients on to prevent them from extubating themselves?
analgesia, sedation, and paralytic
what are signs someone is ready to come off the vent?
improvement of underlying condition, hemodynamic stability, breathing over vent, and LOC is better
is the upper trachea a upper or lower resp infection?
upper
is the lower trachea a upper or lower resp infection?
lower
why are children under 3 months at low risk of infection?
because they still have their mother antibodies
at what age does the risk of infection go up?
3-6 months
at what age do the mother antibodies leave the baby?
3-6 months
in general who has the greatest risk of infection in kids?
younger children
when is whopping cough the most dangerous?
in infancy
what does size of the child have to do with infection?
then smaller the child the more likely they are to get infectino
why are smaller children more apt to getting infection based on size?
smaller children have smaller airways and a smaller distance for the foreign body to go into the respiratory system
what does resistance have to do with etiology of infection in kids?
the immunes systems ability to fight off the infection
what does seasonal have to do with etiology of infection in kids?
certain times of the year have higher rates of infection
when is the most common time for kids to get resp infections?
september to april
what are the symptoms of respiratory infection in kids?
same as adults but they can have anorexia from not eating
how do sick kids get anorexia?
their body will pick respiratory function over their appetite
what happens to respiratory rate in children sick with a respiratory infection?
then childs RR will increase
what happens to the rhythm of a child with a resp infection?
it will be irregular
what happens to a childs depth/work of breathing?
they will be struggling to breath so they will breath deeper, and also have signs of nasal flaring and retractions
where do retractions typically start?
they usually start low and work their way up
what muscles are working with retractions?
intercostal muscles
are lower or upper retractions worse?
upper
what happens to HR of a child with a resp infection?
increases
what happens to pulse ox of a child with a resp infection?
drops from their normal
is it okay if a childs pulse ox reads low and they are acting normal?
yes
what happens to hydration status of a child with a resp infection?
they become dehydrated due to not wanting to drink fluids and vomitting
how can you check hydration status?
I/O, skin turgor, color of urine, oral mucosa, tear production, skin turgor
what happens to temp of a child with a resp infection?
their temp will increase….if above 100.4 do interventions
what happens to activity level of a child with a resp infection?
they will become lethargic
what type of pain might a child with a resp infection have?
chest pain
what is a good color for a child to be?
pinky
what are bad colors for a child to be?
grey or blue
what happens to LOC of a child with a resp infection?
it is decreased and often correlated with pulse ox
what does stridor sound like?
high pitched
where is stridor auscultated?
in the neck
what does stridor indicate?
narrowing of the airway
what is the rock star?
head bobbing to breath by using the neck muscles
what is nasal flarring?
flarring nose
what should be done during respiratory care management?
easing resp effort, promote rest, promote comfort, prevent spread of infection, reduce temp, promote hydration, provide nutrition, family support
what does easing resp effort mean in resp care?
sit the patient up and give oxygen
what does reduce temp mean for resp care?
look at their clothes, their blankets, and give acetaminophen or ibuprofen depending on age
what medication can you not give before 6 months?
ibuprofen
what age group is most at risk for aspiration?
toddlers
what are some symptoms of choking?
cant speak, cyanotic, coughing, wheezing,
what are some signs of aspiration into the broncioles?
coughing, wheezing, dyspnea, asymmetrical breath sounds
do you do back blow or abdominal thrust on a child over a year?
abdominal thrust
do you do back blow or abdominal thrust in child under a year?
back blow
what should you never do to someone that is choking?
finger sweep in the mouth
what is asthma?
a chronic inflammatory disease that causes airway to swell and have excessive mucus
what are symptoms of asthma?
nonproductive cough, wheezing, restless, tripod, tight chest, and labored breathing
what are the diagnostics for asthma?
signs and symptoms, PFT, and peak expiratroy flow rate
what is done during a pft?
the patient will do some form of exercise while someone monitors their O2 sat, bp, and HR
what is done during a peak expiratory test?
the patient breaths in and then blows as hard as they can into the device
what should you tell a patient to do if they have asthma
control physical activity, take medications, prevent exacerbations, limit smoke and know triggers
what are somethings that can cause exacerbations in asthma patients?
allergens, smoke, sprays, chemicals, exercise, cold air, changes in temp, colds, infections, animals, meds, emotions, pregnancy, thyroid problems
what age must a patient be before diagnosing with asthma?
???
what are the two types of meds used to control asthma?
quick acting and long term
what are the quick-acting meds for controlling asthma?
albuterol and epi+++++++++
when are quick acting meds used?
during exacerbations
when are long term meds used?
used daily to prevent exacerbations
what are the long term meds for asthma?
dexamethasone, budesonide, fluticasone, salmaterol, Cromolyn, Theophylline,
what ages use a breathing chamber for astham?
all children
how many puffs should the child take out of spacer/breathing chamber?
10
what is status asthmaticus?
this occurs when the patient is not responding to treatment for attack
what is respiratory failure?
this occurs when the body cannot maintain adeqaute blood oxygenation
what can respirtroy faiulure lead to in children besides death?
cardiac arrest
what are the cardinal signs of resp failure?
restless, tachypnea, tachycardia, and diaphoresis
what are less obvious signs of resp failrue?
mood changes, headaches, altered resp, hypertension, exertional dyspnea, anorexia, CNS, increased CO and Urine output, nasal flarring, retraction, grunt, wheeze
what should be done if a child is in resp failure?
CPR if needed, O2, suction, high fowlers, cpap, bipap, or vent
what is sickle cell anemia?
this disease occurs when a genetic mutation effects your RBC production shape.
what shape are RBC in a patient with sickle cell?
crescent shaped
what are symptoms of sickle cell anemia?
SOB, fatigue, hand/foot/bone pain, acut chest syndrome, spleen pain, stroke
what causes pain in sickle cell patietns?
ischemia
why is ischemia painful?
due to the tissues not getting oxygenated
how long do sickle cell exacerbations last?
days to weeks
what is used to diagnose sickle cell?
electrophoresis
what should be done during the treatment of sickle cell?
pain meds, oxygen, antibiotics, fluids, immunizations, spleenectomy if needed, heat, MORPHINE, blood
why is morphine given to sickle cell patients
to help with vasodilation to restore blood flow?
what meds are given to sickle cell patients to help with pain?
Nsaids, acetaminophen, morphine, and codones
what pain med should never be given to sickle cell patients?
demmerol/meperidine
what education should be given to sick cell patient?
get vaccines, take antibiotics, child may bed wet, if signs of infection are present come to the ER
what is nasopharyngitis?
a common cold caused by a virus
what med should be avoided in nasopharyngitis?
cough suppressants or diphenhydramine
what are symptoms of nasopharyngitis?
fever, restless, decreased appetite, sneezing, vomit, diarrhea, anorexia, sore throat
what are the interventions for nasopharyngitis?
ibuprofen/acetaminophen, fluids, elevate HOB, nasal suction
what is the minimum fluid intake every 10 minutes to maintain hydration?
5-10ml
when should you do nasal suction?
at bedtime or right before feeding
what are the steps for nasal suciton?
saline in the nose and suction with the bulb
what is acute streptococcal pharyngitis known as?
strep throat
is acute streotoccal pharyngitis viral or bacterial?
bacterial or viral
what is the treatment for acute streptococcal pharyngitis?
treated with penicillin, ibuprofen/acetaminophen, and salt water gargle
what are the symptoms of acute streptoccoal pharyngitis?
sore throat, fever, white exudate, swollen tonsils, headache, vomitting, halitosis
what teaching should be given to patient with acute pharyngitis?
throw toothbrush away 24 hours after starting antibiotics, kid can back to school 24 hours after starting antibiotics, if unmedicated the child must be 24 hours without fever before returning to school cold or warm compress on neck
what is tonsilitis?
inflammation of the tonsils due to virus or bacteria
what are symptoms of tonsillitis?
sore throat, fever, difficulty breathing/swallowing
what is the treatment for tonsilitis?
same treatments as acute pharyngitis but can also have a tonsilectomy
what is a tonsilectomy?
removal of tonsils
what should be done post op for tonsilectomy?
closely monitor airway, position on their side, give ondansetron/scopolamine patch, cool fluids
what should not be don post op for tonsilectomy?
avoid suction, avoid coughing, avoid blowing nose, avoid flarring throat, no milk, no warm fluids, dont pust fluids until awake, no brown or red foods
what should you monitor for in post op tonsilectomy?
airway, constant swallowing, hemmorhage, emesis, frequent clearing of throat, increase HR, hypotension
what does constant swallowing or throat clearing mean in a tonsillectomy patient?
bleeding
when is it most common for child to hemmorhage after getting tonsilectomy
5-10 days when the scabs come off
what pain is normal in tonsilectomy?
throat, ear,
is minor bad breath normal in tonsilectomy?
yes
what is RSV
infection caused by virus
is RSV upper or lower resp tract?
lower
when does RSV peak?
3-5 days
how long can RSV last?
weeks
how is RSV diagnosed?
swab test
how to prevent RSV?
hand hygeine or high risk patients take palivizumab
when do high risk patients take palivizumab?
during high risk months
what can RSV lead to?
bronchiolitits
what are symptoms of RSV stage 1?
rhinorhea, coughing, wheezing
what are symptoms of RSV stage 2?
worseinging cough/wheeze, fever tachypnea, poor eating ,and increased secretion
what are symptoms of RSV stage 3?
RR great than 70, listlessness/lethary, and apneic spells
what are treatments for RSV?
hydration, ribavirin, and bulb syringe
when should a child be hospitalized with RSV?
continuous pulse ox less than 90
what are the treatments for hospitalized RSV patient?
humidified o2 in nasal cannula, bulb suction, IV fluids, and bronchodialator
what is cystic fibrosis?
a gland dysfunction that causes the body to increase mucus production and causes problems digesting food
what are symptoms of cysitc fibrosis?
thick secretions, anorexia, clubbing fingers, abdominal distention, failure to pass meconium, vomiting, growth failure, weight loss, thin, wheezing and cough
how is cystic fibrosis diagnosed?
sweat chloride test
what are complications associated with cystic fibrosis?
meconium illeus, loose frothy stool, hypoxia, and diabetes
what vitamins are cystic fibrosis patients deficient in?
vitamin A,D,E,K
why do CF patients have a wheeze but not a productive cough?
their mucus is too thick to get up
what is a meconium illeus?
blockage of the bowel caused by thick mucus
what is steatorrhea
fatty poops
why do CF patients have steatorrhea?
because they cant digest the fats
why are cf patients at risk for malnourishment?
they have bad absorption
what should be given before meals for CF patietns?
pancreatic enzymes
what is the timing needs for pancreatic enzymes?
30 minutes for enteric coats and the open capsule with the meal
what are long term effects of the pulmonary system in cf patients?
dyspnea, cyanosis, barrel chest, and clubbed fingers
what is dornase alpha used for?
to thin the mucus in cf patients
++++how is ripivirn taken?
orally inhaled
why are kids with CF at risk for growth failure?
bad absorption of calories
what kind of diet do CF patietns need?
high cal, high protein, high fat
what is croup?
an umbrella term that involves a barking/brassy cough related to infection
what breath sound do croup patietns have?
inspiratory stridor
what are the symptoms of acute epiglottis?
symptoms that occur at night including drooling, high fever, spontaneous cough, agitatoin, retraction, increased breathing effort
how bad is acute epiglottis?
an urgent emergency
what kind of environment is best for acute epiglottis patients?
calm anxiety free
what should you not do with acute epiglottis patietns?
never inspect the throat
what should be ready at bedside with acute epiglotis patietns?
intubation
what age group typically gets acute epiglottis?
older kids
what is laryngeal bronchitis?
a croup disease that is caused by infection
what are symptoms of laryngeal bronchitis?
stridor, brassy cough, low grade fever, horse,
when should you go to the hospital if your child has laryngeal brochitis?
xx
what helps laryngeal bronchitis?
cold air, o2 by face mask, blow by o2
what should you monitor for when the child gets better with laryngeal bronchitis
rebound of symptoms
what is acute spasmodic laryngitis?
a croup disease that worsens at night
what are symptoms of acute spasmodic laryngitis?
stridor, horse, barky, NO FEVER,
how quickly does acute spasmodic laryngitis get fixed?
few hours
what helps spasmodic laryngitis?
humidified air, cool air, or warms team
what route do you give pain meds in tonsilectomy?
IV or rectal
what do you not give with spirolactone?
no potassium supplement
