Pediatric Nursing: Respiratory Problems Flashcards
1
Q
Epiglottitis: description and assessment
A
- bacterial form of croup
- inflammation of the epiglottis occurs, which may be caused by Haemophilus influenzae type b or Streptococcus pneumoniae.
- occurs most frequently in children 2-8y, onset is abrupt, and the condition occurs most often in winter.
- considered an emergency because it can progress rapidly to severe respiratory distress.
Assessment: - high fever, sore, red, and inflamed throat, pain on swallowing. Absence of spontaneous cough, dysphonia, dysphagia, dyspnea, and drooling. Agitation, tachycardia, tachypnea progressing to respiratory distress. Retractions and inspiratory stridor aggravated by the supine position. Tripod positioning (while supporting the body with the hands, the child leans forward, and opens the mouth in an attempt to widen the airway).
2
Q
Epiglottitis: interventions
A
- maintain a patent airway
- assess respiratory status and breath sounds, noting nasal flaring, the use of accessory muscles, retractions, and the presence of stridor.
- do not measure the temp by the oral route, do not leave the child unattended, or restrained, and avoid the supine position.
- monitor pulse oximetry and maintain NPO status.
- prepare the child for radiology.
- adm IV fluids, ATB, analgesics, antipyretics, and corticosteroids as prescribed.
- heliox may be prescribed (it reduces the work of breathing, reduces airway turbulence, and helps relieve airway obstruction).
- provide cool mist oxygen therapy (high humidification cools the airway and decreases swelling).
- have resuscitation equipment available and ensure the child is up to date with immunizations.
3
Q
Laryngotracheobronchitis (croup): description and assessment
A
- inflammation of the larynx, trachea, and bronchi.
- most common type of croup; may be viral or bacterial and most frequently occurs in children younger than 5y.
- common causative organisms include parainfluenza virus type 2 and 3, respiratory syncytial virus (RSV), mycoplasma pneumoniae, and influenza A and B.
- characterized by a gradual onset that may be preceded by an upper respiratory infection.
Assessment: - Stage 1: low-grade fever, hoarseness, seal bark and brassy cough (croup cough), inspiratory stridor, fear, and irritability and restlessness.
- Stage 2: continuous respiratory stridor, retractions, use of accessory muscles , crackels and wheezing, labored respirations.
- Stage 3: continued restlessness, anxiety, pallor, diaphoresis, tachypnea, signs of anoxia and hypercapnia.
- Stage 4: intermittent cyanosis progressing to consistent cyanosis, apneic episodes progressing to cessation of breathing.
4
Q
Laryngotracheobronchitis (croup): interventions
A
- maintain a patent airway
- assess respiratory status, monitor pulse oximetry
- monitor for nasal flaring, sternal retraction, inspiratory stridor, adequate respiratory exchange, pallor or cyanosis.
- elevate the head of the bed and provide rest.
- provide humidified oxygen via a cool air or mist tent as prescribed.
- provide an encourage fluid intake, adm IV fluids, analgesics, ATB, corticosteroids, and heliox as prescribed.
- avoid adm cough syrups or cold medicines, which may dry and thicken secretions.
- have resuscitation equipment available.
- instruct parents to use a cool air vaporizer at home, let the child breathe in the cool night air or the air from an open freezer or taking the child to a cool basement or garage.
5
Q
Bronchitis
A
- inflammation of the trachea and bronchi (may be referred to as tracheobronchitis).
- usually occurs in association with an upper respiratory infection.
- usually a mild disorder; causative agent is most often viral.
- assessment: fever, dry, hacking, and nonproductive cough that is worse at night and becomes productive in 2-3 days.
- interventions: treat symptoms as necessary, monitor for respiratory distress, provide cool, humidified air, encourage increased fluid intake, adm antipyretics and cough suppressant (promote rest) as prescribed.
6
Q
Bronchiolitis and Respiratory Syncytial Virus (RSV): description and assessment
A
- is an inflammation of the bronchioles that causes production of thick mucus that occludes bronchiole tube and small bronchi.
- RSV causes an acute viral infection and is a common cause (other organisms include adenoviruses, parainfluenza viruses, and human metapneumovirus).
- RSV is highly communicable and usually transferred via droplets or by direct contact with respiratory secretions. Is rarer in children older than 2y, with a peak incidence at approx 6m.
- at risk children include chronic or disabling or immunocompromised.
- identification of the virus is done via testing of nasal or nasopharyngeal secretions.
- prevention measures include breast-feeding, avoiding tobacco smoke exposure, and good hand-washing technique.
Assessment: - initial manifestations: rhinorrhea, eye or ear drainage, pharyngitis, coughing, sneezing, wheezing, intermittent fever.
- progressing disease: increased coughing and wheezing, signs of air hunger, tachypnea and retractions, periods of cyanosis.
- severe illness: tachypnea > 70 rpm, decreased breath sounds and poor air exchange, listlessness, apneic episodes.
7
Q
Bronchiolitis and Respiratory Syncytial Virus (RSV): interventions
A
- aimed at treating symptoms and include airway maintenance, cool humidified air and oxygen, adequate fluid intake, and medications.
- children with RSV should be placed in a single room and ensure that nurses caring for the child do not care for other high-risk children.
- use contact, droplet, and standard precautions during care.
- position child at a 30 to 40 degree angle with the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm.
- monitor pulse oximetry, encourage fluids, and periodic suctioning may be necessary.
- antiviral med may be prescribed.
8
Q
Pneumonia
A
- inflammation of the pulmonary parenchyma or alveoli or both, caused by virus, mycoplasmal agents, bacteria, or aspiration of foreign substances. Usually introduced by inhalation or from the bloodstream.
- viral occurs more frequently than bacterial and is often associated with a viral upper respiratory infection.
- primary atypical pneumonia, usually caused by mycoplasma pneumoniae or chlamydia pneumoniae, occurs most often in the fall and winter, more commen in crowed living conditions, in children between 5-12y.
- bacterial is often a serious infection requiring hospitalization when pleural effusion or empyema accompanies the disease. Also necessary with staphylococcal pneumonia.
- aspiration pneumonia occurs when food, secretions, liquids, or other materials enter the lung and cause inflammation and a chemical pneumonitis.
- prevention of viral and bacterial includes immunization.
9
Q
Viral Pneumonia
A
Assessment:
- acute or insidious onset.
- symptoms can range from mild fever, slight cough, and malaise to high fever, severe cough, and diaphoresis.
- nonproductive or productive cough of small amounts of whitish sputum.
- wheezes or fine crackles.
Interventions:
- treatment is symptomatic, adm oxygen with cool humidified air as prescribed.
- increase fluid intake, adm antipyretics, chest physiotherapy and postural drainage as prescribed.
10
Q
Primary Atypical Pneumonia
A
Assessment:
- acute or insidious onset
- fever (lasting several days to 2 weeks), chills, anorexia, headache, malaise, and myalgia.
- rhinitis, sore throat, dry hacking cough.
- nonproductive cough initially, progressing to production of seromucoid sputum that becames mucopurulent or blood-streaked.
Interventions:
- treatment is symptomatic and recovery generally occurs in 7-10 days.
11
Q
Bacterial pneumonia
A
Assessment:
- acute onset.
- infant: irritability, lethargy, poor feeding, abrupt fever, respiratory distress.
- older child: headache, chills, abd pain, chest pain, meningeal symptoms.
- hacking, nonproductive cough.
- diminished breath sounds or scattered crackles.
- with consolidation, decreased breath sounds are more pronounced.
- as the infection resolves, the cough becomes productive and the child expectorates purulent sputum; coarse crackles and wheezing are noted.
Interventions:
- blood cultures are taken and ATB therapy initiated.
- monitor for weight loss and signs of dehydration.
- adm oxygen and monitor pulse oximetry, place the child in a cool mist tent, suction mucus as prescribes.
- adm chest physiotherapy and postural drainage every 4h, promote bed rest.
- encourage child to lie on the affected side (if unilateral) to splint the chest and reduce the discomfort caused by pleural rubbing.
- encourage fluid intake, adm antipyretics, cough suppressant as prescribed.
- institute isolation precautions.
- continuous closed chest drainage and thoracentesis (also used for instilling ATB directly into the pleural cavity) may be done.
12
Q
Asthma: description
A
- a chronic inflammatory disease of the airways.
- classified on the basis of disease severity; management includes medications, environmental control of allergens, and child and family education.
- allergic reaction in the airways caused by the precipitant can result in an immediate reaction with obstruction occurring, and it can result in a late bronchial obstructive reaction several hours after the initial exposure.
- mast cells release of histamine leads to a bronchoconstrictive process, bronchospasm, and obstruction.
- diagnosis is made on the basis of the child’s symptoms, history and physical examination, chest rx, and lab tests.
- status asthmaticus is the most severe form of an asthma attack that is unresponsive to repeated courses of beta-agonist therapy (a medical emergency that can result in respiratory failure and death).
13
Q
Asthma: assessment
A
- episodes of dyspnea, wheezing, breathlessness, chest tightness, and cough, particularly at night or in the early morning or both.
- acute asthma attacks: episodes include progressively worsening shortness of breath, cough, wheezing, chest tightness, decreases in expiratory airflow secondary to bronchospasm, mucosal edema, and mucus plugging; air is trapped behind occluded or narrow airways, and hypoxemia can occur.
- just before the attack, child may present with itching at the front of the neck or over the upper part of the back, then attack begins with irritability, restlessness, headache, feeling tires, or chest tightness.
- accumulated secretions stimulate the cough, and becomes rattling and there is a production of frothy, clear, gelatinous sputum.
- child experiences retractions and hyperresonance on percussion of the chest is noted.
- breath sounds become coarse and loud with crackles, coarse rhonchi, wheezing, and expiration is prolonged. Child speaks in short, broken phrases.
- younger child assume the tripod position and older children sit upright.
- severe spasm or obstruction: silent chest and cough is ineffective.
- ventilatory failure and asphyxia: air movement is restricted to the point of absent breath sounds accompanied by a sudden increase in RR.
14
Q
Asthma: Interventions
A
- assess airway patency and respiratory status.
- adm humidified oxygen (cannula or mask)
- adm quick-relief/rescue meds (corticosteroids, short-acting B2 agonists, and anticholinergics).
- initiate IV line
- prepare child for chest rx and fiberoptic nasal laryngectomy is prescribed.
- obtain blood sample (arterial blood gas levels).
- chest physiotherapy is not recommended during acute exacerbation.
- testing may be done to identify allergens.
- instruct on long-term control medications (inhaled corticosteroids, antiallergy meds, AINES, long-acting B2 agonists, leukotriene modifiers, monoclonal antibody).
- instruct cleaning devices and preventing yeast infection. Annual influenza vac are recommended.
15
Q
Cystic Fibrosis: description
A
- chronic multisystem disorder (autosomal recessive trait disorder) characterized by exocrine gland dysfunction.
- mucus produced by the exocrine glands is abnormally thick, tenacious, and copious, causing obstruction of the small passageways of the affected organs.
- common symptoms are associated with pancreatic enzyme deficiency and pancreatic fibroses caused by duct blockage, progressive chronic lung disease as a result of infection, and sweat gland dysfunction resulting in increased sodium and chloride sweat concentrations.
- is a progressive and incurable disorder, and respiratory failure is a common cause of death.
