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Peds Exam 1 > Oxygenation > Flashcards

Oxygenation Flashcards

1
Q

Difference between Children and Adult airway

A

children: funnel, smaller and less developed
adult: cylinder

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2
Q

General Physiological Differences Children and Adults

A
  • smaller and shorter airway
  • larger tongue
  • nose breathers
  • belly/diaphragm breathers
  • increased rate and effort
  • retractions
  • vagal nerve
  • eustation tube
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3
Q

Accessory Muscle Use in Children

A

-use of accessory muscles may present as head bobbing in young children

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4
Q

Retractions

A
  • infants and young children have immature chest muscles and cartilagious ribs making the chest wall very flexible
  • negative pressure created by the downward movement of the diaphragm is increased in cases of respiratory distress, and the chest wall is pulled inward causing retractions
  • intercostal retractions are seen in mild respiratory distress
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5
Q

As respiratory distress severity increases…

A

substernal and subcostal retractions are seen

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6
Q

in cases of severe distress…

A

supraclavicular and suprasternal retractions occur as the accessory muscles are used

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7
Q

Normal bpm for infant

A

less than a yr

30-60

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8
Q

Normal bpm for toddler

A

1-3 yrs

24-40

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9
Q

Normal bpm for preschooler

A

4-5 yrs

22-34

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10
Q

Normal bpm for school age

A

6-12 yrs

18-30

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11
Q

Normal bpm for adolescent

A

13-18 yrs

12-16

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12
Q

Oxygenation Assessment Guidelines

A
  • position of comfort (tripod, sitting up, refuse to lay down)
  • vital signs
  • respiratory effort (apnea, decreased RR, retractions)
  • lung auscultation (crackles, wheezing)
  • color (late sign)
  • cough (cough up and swallow is bad)
  • behavior change
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13
Q

Respiratory Distress

A
  • any respiratory condition can progress to respiratory distress
  • if not managed can lead to respiratory failure
  • hypoxemia that persists when supplemental oxygen is given is a sign of respiratory failure
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14
Q

General Care Standards

A
  • Oxygen/O2 sats (greater or equal to 93 percent is ok)
  • CPT/PD and suction (only with mucus, can cause irritation which means more secretions)
  • IS (if 5 or over)
  • saline nose drops (loosens secretions)
  • antibiotics (only for bacterial infections)
  • isolation
  • rest (but let them play, means feeling better)
  • reduce fever (no ibuprofen under 6 mths)
  • hydration
  • nutrition
  • cough medications

-positioning (HOB elevated)

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15
Q

Categorization of Respiratory Tract Infections

A
  • Upper Respiratory Tract
  • Croup Syndromes
  • Lower Respiratory Tract
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16
Q

tonsilitis

A
  • mostly viral infection
  • group A beta hemolytic strep (strep throat)
  • change toothbrush
  • AB 24-48 hrs

**tonsillectomy: bleeding precaution, look for frequent swallowing

  • inspect back of throat
  • no red drinks or foods
  • avoid coughing
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17
Q

Otitis Media

A
  • immobile
  • red or yellow bulding TM
  • symptoms: otalgia, fever, otorrhea, crying, fussy, tendency to pull or rub ear, rolls head from side to side
  • Eustachian tube is flat and can’t drain fluid
  • tx with AB
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18
Q

Therapeutic management of otitis media

A
  • high dose amoxicillin
  • myringotomy: Tympanoplasty/PE tubes
  • pressure equalizing tubes used to put eat drops in ear
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19
Q

Croup Syndromes

A

general term for a group of symptoms characterized by:

  • “barking/brassy” or “seal-like” cough
  • inspiratory stridor, at rest equals bad, with activity equals ok if better at rest
  • respiratory distress
  • swelling/obstruction in the region of the larynx
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20
Q

Croup Syndromes includes…

A
  • laryngotracheobronchitis: subglottic

- epiglottitis: supraglottic

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21
Q

Laryngotracheobronchitis

A

-obstruction (SUBglottic) BELOW VOCAL CORDS

-slower onset, URI symptoms lead to cough and hoarseness
(viral)

  • medical management (steeple sign)
  • airway narrows at top

-nursing management: teaching

  • supportive mainly
  • hydration
  • IVF
  • O2

-Epinephrine…vasoconstriction will reduce edema and decrease inflammation

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22
Q

Epiglottitis

A
  • obstruction (SUPRAglottic)
  • cherry red edematous epiglottis
  • usually caused by Haemophilus influenzae (H.Flu) (bacteria)
  • HIB vaccine
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23
Q

Clinical Manifestations of Epiglottitis

A
  • dyspnea
  • dysphonia
  • stridor aggravated when supine
  • drooling
  • high fever
  • toxic appearance
  • froglike croaking sound
  • agitated/apprehensive
  • tripod sitting

-safety alert: can develop quickly (6 hrs) have intubation ready

24
Q

At risk for epiglottitis

A
  • 2 to 8 year olds
  • teaching: vaccination (HIB vaccine)
  • tx: AB 12-24 hr for improvement
  • O2 if needed, limit activity, hydration
25
Q

Respiratory Syncytial Virus/ Bronchiolitis

A

-inflammation and obstruction of bronchioles

26
Q

Who is at highest risk for Respiratory Syncytial Virus/ Bronchiolitis

A
  • under 2 years
  • chronic lung disease
  • congenital heart disease
  • preterm, less than 35 wks
27
Q

Clinical Manifestations of Respiratory Syncytial Virus/ Bronchiolitis

A
  • rhinorrhea
  • increased cough and wheezing
  • tachypnea
  • unstable O2 sats
  • full of snot, rhonchi and wheezing

*Begins as URI

28
Q

Diagnosis of Respiratory Syncytial Virus/ Bronchiolitis

A
  • Rhinorrhea
  • increasing respiratory distress
  • chest x-ray
  • **positive RSV swab of nasopharyngeal seretions

-can cause pneumonia

29
Q

Treatment of Respiratory Syncytial Virus/ Bronchiolitis

A

-ribavirin aerosol (controversial)

  • RSV immunoglobulin (Synagis) *prevention not treatment
  • can’t use AB
  • only for high risk (PT, lung dz, less than 2)

-given every 28-30days

30
Q

Pulmonary Dysfunctions not caused by infectious agents

A
  • foreign body aspiration
  • asthma
  • cystic fibrosis
31
Q

Foreign Body Aspiration

A
  • symptoms: choking, cyanotic, can’t talk, cough
  • heimlich and back blows (less than 1 yr)
  • bronchoscopy
  • teaching
  • lay on side
  • monitor for breathing
  • wait for swallow and gag reflex to come back
32
Q

Asthma

A
  • reactive airway disease: for kids less than 3 happens only when sick
  • pathophysiology: chronic inflammatory disorder of airways
  • classification for children 5 years and older
33
Q

Primary Prevention: Whos ar risk?

A
  • infants
  • usually starts between 3-8 years
  • atopy (allergies)
  • ALLERGY TRIAD: asthma, eczema, rhinitis
  • complex disorder
  • genetic predisposition
34
Q

Cystic Fibrosis

A
  • autosomal recessive trait
  • exocrine gland dysfunction that produces multisystem involvement
  • mutated gene on chromosome 7
  • greatest effect in lung
35
Q

Pathophysiology of CF

A
  • CFTR: cystic fibrosis transmembrane regulator

- abnormal chloride movement leads to increased viscosity of mucous gland secretion

36
Q

Diagnosis of CF

A
  • history
  • quantitative sweat chloride test
  • chest xray
  • stool fat and/or enzyme analysis
  • salty sweat
37
Q

Goals of CF

A
  • prevent/minimize pulmonary complications
  • adequate nutrition for growth
  • assist in adapting to chronic illness
38
Q

Signs of distress

A
  • increased RR
  • retractions
  • head bobbing
39
Q

Clinical Manifestations of Mild distress and initial signs of failure (compensating)

A
  • increased HR

- increased RR

40
Q

Clinical Manifestations of moderate distress/early decompensation

A
  • retractions
  • nasal flaring
  • anxiety
  • irritability
  • head bobbing
  • grunting
41
Q

Clinical Manifestations of severe distress/imminent failure or arrest

A
  • cyanosis
  • bradycardia
  • apnea
42
Q

Nursing care of RSV/Bronchiolitis

A
  1. nutrition, hydration, small and frequent feeds
  2. handwashing to prevent spread
  3. duration of illness lasts 3-4 days peak 3-4 days
43
Q

Goal of asthma treatment

A
  • open airway
  • symptoms helped with meds
  • decrease of attacks
  • chronic remodeling and changes in airways
44
Q

Short term asthma meds

A
  • bronchodilator (albuterol)
  • ipotropium bromide
  • corticosteroids
  • IV Mag (bronchodilator)
45
Q

Long term asthma meds

A
  • advair (combo med)
  • long acting bronchodilators
  • allergy med (singulair)
  • NSAID
  • cromolyn sodium
46
Q

Secondary Prevention of Asthma

A
  • MDI: younger kids
  • aerochamber/spacer: take 6 breaths in and out
  • nebulizer: easiest to use for child
47
Q

Peak flow meters

A

shows how well they are

  • establish personal best
  • blow into
  • shows if they are getting worse
48
Q

Oxygenation assessment for CF: Bronchi

A
  • chronic pneumonia
  • generalized obstructive emphysema
  • clubbing
  • infections

**isolation

49
Q

Collaborative care for CF

A
  • prevent colonization of pathogens and move secretions
  • aerosol: bronchodilators
  • daily CPT/PD
  • flutter valve (PEP therapy, vibrating vests
  • AB
  • resp tx is given before food because they get nauseated from tx
50
Q

Elimination assessment for CF

A
  • meconium illeus

- bowel obstruction

51
Q

Nutrition assessment for CF

A
  • pancreatic ducts: malabsorption and fibrosis, eventual CFRD
  • bile ducts: decreased bile, decreased ADEK, portal HTN
52
Q

CF Tx

A
  • ursodiol/actigall
  • supplemental tube feedings
  • ADEK vitamins
  • increase calories and protein
  • insulin?
  • *Pancreatic enzymes
53
Q

-ursodiol/actigal

A

improves bile flow and prevents gallstones

54
Q

pancreatic enzymes

A
  • take with meals/snacks
  • can open capsule and sprinkle on food
  • enzyme can burn, irrtate teeth and mouth
  • take as directed
55
Q

Alternative to IS

A
  • blowing bubble
  • pin wheel
  • blowing out birthday candles

Peds Exam 1 (6 decks)

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