Pain Comm & Resp. Dysfunction Flashcards
What are some Defenses of the Respiratory Tract?
- Lymphoid tissues: adenoids, protective circle at entry point
- Mucous blanket: airborne debris
- Ciliary action: move up and out
- Epiglottis: protective reflex
- Cough: expulsive force
- Position changes: drainage
- Lymphatics: drain bronchi/oles
- Humoral defenses: phagocytosis
What is chest physiotherapy used for?
- To enhance clearance of mucus from the airway
- Includes percussion, vibration, squeezing of the chest, cough, forceful exhalation, and breathing exercises
- ThAIRapy Vest
How do you determine the size of an endotracheal tube?
- Determine ETT size by one of these ways:
- [Age in years + 16] divided by 4
- “Pinky” finger is approximate size for ETT
- Broselow resuscitation tape
What are some Complications of ETT Intubation?
×Hypoxia with accompanying bradycardia
×Aspiration
×Trauma
×Creation of air leaks
×Vagal-mediated changes in vital signs (bradycardia, etc)
×Sore throat
×Traumatic laryngitis
×Infection, glottic edema, and mucosal lesions of larynx
×Subglottic stenosis
What is respiratory failure?
It is the result of an acute obstruction of a major airway or cardiac arrest is sudden are readily apparent.
What is respiratory arrest?
the sudden inability to breathe
What is apnea?
Apnea is defined as the absence of breeding greater than 20 seconds or it can be a shorter. If accompanied with hypoxemia and bradycardia.
What are some predisposing conditions to respiratory failure?
×Obstructive lung disease: Increase resistance to airflow
×Restrictive lung disease: impaired lung expansion, loss of lung volume
×Primary inefficient gas transfer: inefficient gas transfer, insufficient alveolar ventilation
What are the clinical manifestations of respiratory failure?
Cardinal signs:
×restlessness, tachypnea, tachycardia, diaphoresis
Less obvious signs:
×Mood changes, headache, altered depth and pattern, hypertension, dyspnea, anorexia, increased cardiac output and urinary output, nasal flaring, _retractions, _ expiratory grunting, wheezing or prolonged expiration
Severe hypoxia:
× hypotension, depressed respirations, dimness of vision, bradycardia, arrhythmias, somnolence, cyanosis, stupor, coma, dyspnea
What are the commponents of the upper respiratory tract?
×Oronasopharynx, pharynx, larynx, and trachea
What are the components of the lower respiratory tract?
×Bronchi, bronchioles, and alveoli
What are some changes in the immune system as children grow older?
×Infants younger than 3 months—maternal antibodies
×3 to 6 months—infection rate increases
×Toddler and preschool ages—high rate of viral infections
×Older than 5 years—increase in Mycoplasma pneumonia and β-strep infections
×Increased immunity with age
How does a child’s anatomy factor into more respiratory illnesses?
×Diameter of airways plays significant role in respiratory illnesses
×Distance between structures is shorter, allowing organisms to rapidly move down
×Short eustachian tubes, more horizontal. Fluid becomes static and says there
What causes Nasopharyngitis (common cold) and what are the clinical manifestations?
Caused by numerous viruses:
×RSV, rhinovirus, adenovirus, influenza, and parainfluenza viruses
Clinical manifestations:
×Fever—varies with age of child
×Irritability, restlessness
×Decreased appetite and fluid intake
×Nasal inflammation
×Vomiting and diarrhea
What causes pharyngitis, what are the clinical manifestations, and how would you treat it?
-
Caused by GABHS group a beta-hemolytic streptococcal
- Sequelae: rheumatic fever inflammation heart, joints, CNS and Scarlet fever: erythematous sandpaper-like rash
-
Clinical manifestations:
- HA, fever, Abd pain, pharangitis
- Treatment: Penicillin
- Nursing care management: antibiotic education, warm saline gargles, fluid hydration
What are some Pharmacologic Interventions for Strep?
Penicillin
- Oral
- Needs 10-day treatment to decrease risk of rheumatic fever and glomerulonephritis post strep
- Issues with medication compliance
- IM: Penicillin G
- Resolves compliance issue (one injection)
- Painful injection
- Penicillin G procaine is less painful injection
- CANNOT give penicillin G by IV route
- Erythromycin if penicillin allergy
- Other antibiotics
What are some manifestations of bleeding after a Tonsillectomy?
- Observation—frequent swallowing?
What are the clinical manifestations of Infectious Mononucleosis?
manifestations include: tend to six weeks after exposure malaise, sore throat, fever, generalized lymphadenopathy and splenomegaly. Usually symptoms appear insidiously with fatigue, lack of energy and sore throat
What are the clinical manifestations, how would you manage it, and how would you prevent Influenza (Flu)?
- Clinical manifestations: range from subclinical to severe, sore throat and nasal mucosa are dry, dry cough, hoarseness, fever chills flushed face, photophobia; febrile seizure, encephalitis, encephalopathy, myocarditis, otitis media, sinusitis, pneumonia
- **Therapeutic management: ** symptomatic treatment antipyretic’s, who had ration, amantadine hydrochloride is effective in reducing symptoms for type a ministry within the first 24 to 48 hours after onset of symptoms. Rimantadine for patients over one year of age effective against type A. Zanamivir: treat patient seven years of age and older
- Prevention: vaccination for children six months to 18 years
What medication is used to treat otitis media?
Penicillin
What are the clinical manifestations of Otitis Media with Effusion?
persistent middle ear fluid, hearing impairment
Describe the nursing management for a child with Otitis Externa (swimmers ear)
What are the clinical manifestations of croup and how would you manage it?
- **Clinical manifestations: ** occurs in boys more than girls, ages six months to three years rare after six years of age.
- Hoarseness, barking cough, strider, respiratory distress
-
Therapeutic management:
- Airway protection, humidified oxygenation, fluids, nebulized epinephrine, Heliox
- Nursing care management: reassure the patient and parents, decrease anxiety, symptom management
What are Signs of Increasing Respiratory Distress in Children?
- RESTLESSNESS
- Tachycardia
- Tachypnea
- Retractions
- Substernal
- Suprasternal
- Intracostal
What are the clinical manifestations of bronchitis?
persistent dry, hacking cough that is worse at night becoming productive in 2 to 3 days
What are the clinical manifestations of pneumonia?
×Fever, malaise, rapid respiration, and cough
×Chest or abdomen pain, nausea
What are some characteristics of Chlamydial Pneumonia?
×Usually 2-19 weeks after delivery
×Infected mother transmits to fetus via ascending infection or during delivery
×Infant is afebrile with cough, tachypnea, rales
What are some characteristics of Pertussis (Whooping Cough)?
- Highest incidence in spring and summer
- Highly contagious
What are the clinical manifestations of Tuberculosis (TB)?
cough, fever, bloody sputum
What puts a child at risk for Aspiration Pneumonia?
×Oily nose drops and petroleum distillates
×Solvents
×Talcum powder
What are the Clinical Manifestations Hydrocarbon Pneumonia?
- Coughing, vomiting, aspiration
- CNS—agitation, restlessness, confusion, drowsiness, and coma
- Elevated body temperature (37.8° to 40° C)
- Dyspnea, cyanosis, tachycardia, tachypnea, nasal flaring, and retractions
- Hemoptysis, pulmonary edema, severe cyanosis, and death within 24 hours of aspiration
What is ARDS?
Characterized as respiratory distress and hypoxia within 72 hours after serious injury or surgery in person with previously normal lungs
What are the clinical manifestations of a FB Aspiration?
- The child can’t speak
- Becomes cyanotic
- Collapses
What are the clinical manifestation of ARDS?
- Hyperventilations
- tachypnea
- Increasing respiratory effort
- cyanosis
- decreasing oxygenation saturation
What are the characteristics of allergies?
- Allergies occur repeatedly and are often seasonal
- Allergies are seldom accompanied by fever
- Allergies often involve itching in the eyes and nose
- Allergies usually trigger constant and consistent bouts of sneezing
- ×Allergies are often accompanied by ear and eye problems
