Pediatrics #2: Airway & Breathing Flashcards
Tonsils (4)
Masses of lymph tissue in the pharyngeal area
Filter pathogenic organisms, help protect respiratory and GI tract
Contribute to antibody formation
Highly vascular, help to protect against infection and harmful organisms entering through the mouth
Tonsillitis (4)
Inflammation of palatine and/or pharyngeal (adenoids) tonsils
Palatine tonsils are those removed during tonsillectomy
Pharyngeal (adenoids) are located above palatine tonsils on the posterior wall of the nasopharynx
Removal of the pharyngeal tonsils is called an adenoidectomy
Tonsillitis occurs in ….. (2)
Occurs often in children, rarely in those younger than 2 years of age
Most common in 3-7 year old
Tonsillitis common S/S (8)
Fever
Sore throat
Foul-smelling breath d/t infection
Dysphagia
Odynophagia (painful swallowing)
Tender cervical lymph nodes
Lethargy
Malaise
Treatment (6)
Antibiotics (if d/t bacterial infection)
Liquid acetaminophen (remember: NO aspirin for kids)
Fluid replacement
Rest
Warm saltwater gargles
Surgery (if recurrent or chronic)
Differential: Peritonsillar abscess (if infection spreads behind tonsils) (2)
Severe sore throat, fever, drooling (don’t want to swallow), foul-smelling breath, trismus (lockjaw), muffled voice quality
Tx: drainage of the abscess, antibiotics, hydration, pain management
Tonsillectomy: Pre-op (4)
Medications: No ibuprofen-type medications, herbal supplements (ginkgo, Echinacea) for 2 weeks prior to surgery
Diet - NPO after midnight the day before the procedure
Psychological support
Talk to the child in words that are age-appropriate
Offer a tour of hospital if possible
Tonsillectomy: Post-op 1/2 (4)
Psychological support: regression to cope with surgery
Monitor for frequent swallowing or throat clearing (could indicate bleeding at operative site)
Snoring or breathing trouble may still be present post-op d/t swelling in the throat - subside after swelling does 7 days after surgery
Hydration: water, diluted juice, electrolyte solutions (triple normal fluid intake) (no substances that coat the throat such as milk - can cause cough which causes bleeding)
Tonsillectomy: Post-op 2/2 (5)
Discourage from coughing or blowing nose
Diet: avoid acidic foods (irritating)
Recovery time: 7-10 days (on average)
Activity: return to school when off narcotics, no physical activity/sports for 10 days
Pain medications: acetaminophen, ibuprofen, hydromorphone if warranted
Epiglottitis: Etiology (5)
Bacterial infection
Most common bacteria is Haemophlius influenzae type b (Hib)
Infection causes inflammation and swelling of the epiglottis - supraglottic (laryngitis is subglottic)
Affects breathings by obstructing passage of air to lungs (can turn emergent very quickly)
Commonly affects children between 2-8 years of age
Epiglottitis S/S (8)
Symptoms appear suddenly
Fever and sore throat are usually first symptoms
Dysphagia, muffled voice
Drooling of saliva
Distinctive, large, cherry red edematous epiglottis
Child will likely insist on sitting upright (like tripod)
Restless, frightened, and apprehensive
Possible suprasternal and substernal retractions
Epiglottitis Interventions (4)
NO STRESS! Keep client calm until the airway is stabilized
Allow the child to remain in a position of comfort with a caregiver
Nurse should not attempt epiglottis visualization with tongue depressor, nor should the nurse obtain a throat culture
Maintain droplet precautions until client has received effective antibiotic therapy for 24 hours
Bronchiolitis: Etiology (3)
A lower respiratory tract infection - bronchiolar level (most commonly caused by viral infection, RSV)
Symptoms generally worsen for the first 3-5 days and then gradually improve
Leading cause of hospitalization in infants and young children (mainly affects infants due to immature immune system and lack of developed cilia)
Bronchiolitis: Patho & gen info (4)
Edema and secretions of the lower respiratory tract cause lower airway obstruction with extensive mucus plugging that could lead to atelectasis
Produces small airway obstruction/air trapping
In >90% of cases, pathogen is respiratory syncytial virus (RSV) (Remember: RSV is contact precautions)
Nasal swab will confirm diagnosis
Bronchiolitis: Risk factors (5)
Winter season, male gender, second hand smoke, bottle feeding, daycare
Bronchiolitis: S/S 1/2 (4)
May present like a typical upper respiratory infection
Nasal obstruction (causes decreased ability to feed, dehydration)
Breath sounds are variable (fine inspiratory crackles, high pitched prolonged expiratory wheezes)
Fever over 100.4 degrees F (38 degrees C)
Bronchiolitis: S/S 2/2 (4)
Rhinorrhea (runny nose)
Irritating cough/sneezing
1 to 3 days after onset: Increasing tachypnea and respiratory distress
Increased work of breathing (wheezing with prolonged expiratory phase) (in worse cases, pt may have retractions, nasal flaring, cyanosis, longer episodes of apnea, respirations over 60-80 → all require immediate attention)
Bronchiolitis: Interventions (5)
Oxygen to maintain oxygen saturation 95% during acute phase, preferably humidified
Maintain hydration → IV fluids
Control fever (antipyretics)
Close, frequent assessment to monitor for deterioration
Arterial blood gasses, if necessary
Pneumonia: Etiology & patho (7)
Pneumonia is a lower respiratory tract infection
Inflammation of the lung parenchyma (tissue of the lung that does gas exchange)
Extravasation of fluid to alveoli, causing hypoxia
Caused by a virus, bacteria, chemical irritant, fungi, or parasite
Air sacs fill with exudate
Pneumonia occurs more often in boys than girls
Viral pneumonia occurs more frequently than bacterial pneumonia, but bacterial pneumonia is more serious
Pneumonia: S/S (8)
Dyspnea
Cough, tachypnea, sputum production
Grunting, wheezing, crackles, intercostal retractions
Fever
Pleuritic chest pain
Fatigue
Vomiting, poor feeding
Tachycardia
Pneumonia: Interventions (6)
Monitor breath sounds, oxygen saturation (respiratory status)
Oxygen support
Antibiotic therapy (if bacterial pneumonia is diagnosed)
Rest/conserve energy (don’t increase O2 demand)
Adequate hydration
Family support
Asthma (3)
Chronic inflammatory disorder that is characterized by:
Airway obstruction due to inflammation (triggered by exposure to substances causing an allergic reaction)
Bronchial hyperresponsiveness - bronchospasm
(Swelling and inflammation of the airway, tightening of the muscles = difficulty breathing)
Asthma S/S (6)
Dyspnea
Wheezing
Coughing
Chest tightness, pain
Fatigue and anxiety
Prodromal itch (localized to front of the neck or over the upper part of the back)
Asthma interventions 1/2 (meds) (4)
Corticosteroids (inhaled: long-term asthma med) (IV: rescue med)
Beta-adrenergic agonists (long-acting: long-term asthma med) (short-acting: rescue med [albuterol])
Theophylline (long-term asthma med)
Leukotrienes (long-term asthma med)
Asthma interventions 2/2 (meds) (3)
Ipratropium (rescue med)
Racemic epinephrine (rescue med)
Combined inhalers that contain both a corticosteroid and a long-acting beta-agonist (long-term asthma med)
Peak flow meter: shows maximum volume that can be exhaled in 1 second (L/min). What does green, yellow, and red mean?
Green = > 79% of personal best (airway is ok)
Yellow = 50-79% of personal best (rescue inhaler should be used - suggests exacerbation)
Red = <50% of personal best (emergency - suggests narrowing of airway)
Bronchopulmonary Dysplasia (BPD) (Chronic lung disease) (3)
Chronic lung disease associated with respiratory distress syndrome (long-term respiratory problems)
Usually associated with prematurity (premature infants)
Caused by damage to the lungs from mechanical ventilation and prolonged oxygen treatment that causes scarring in the lung tissue
Specific causes of bronchopulmonary dysplasia (BPD) (6)
Underdeveloped alveoli
Insufficient surfactant
Prolonged use of high concentration oxygen
Pressure from the vent
Suctioning
Trauma of intubation
BPD patho (3)
Diminished respiratory reserve, hyperactive airway, and increased susceptibility to respiratory infections
Classified as mild, moderate, severe based on degree of ongoing oxygen support
Chest x-ray shows spongy appearance of lungs
BPD S/S (8)
Tachypnea
Increased work of breathing
Chest retractions
Nasal flaring
Grunting
Decreased breath sounds, crackles, occasionally expiratory wheezing
Respiratory acidosis on arterial blood gas
Tachycardia
BPD diagnosis (1)
Diagnosis is made when mechanical ventilator and/or oxygen is still necessary after a premature infant has reached the equivalent of 36 weeks gestation
BPD TX (2)
No specific tx exists for BPD except to maintain adequate arterial blood gasses with the administration of oxygen and to avoid progression of disease
Adequate (not over increase!) hydration is extremely important because they lose a lot of fluid thru lungs - however, they’re very susceptible to interstitial edema → Monitor both fluid volume deficit and excess
BPD Interventions 1/2 (4)
Bronchodilators, steroids (maximize airway clearance), diuretics (diminish excess fluid in lungs)
Oxygen therapy
Mechanical ventilation until the lungs mature (several months may be required in most severe cases) (usually weened off by age of 1 year)
Nutrition through nasogastric tube or orally when tolerated
BPD Interventions 2/2 (4)
Support from family and friends
Regular check-ups and vaccinations
No smoking in home
Avoid other lung irritants
Cystic Fibrosis (3)
Inherited, genetic disease of the exocrine (mucus-producing) glands (mutation in the gene that regulates sweat, digestive enzymes, and mucus)
Thick mucus secretions in pancreas and lungs (excessive sodium absorption in the lungs, turning usually thin secretions into thick. Similarly in GI and reproductive systems) (in pancreas, ducts are plugged, so enzymes to break down fats, proteins, carbs are not made, and these nutrients are not digested)
Electrolyte abnormalities in sweat gland secretions
Cystic fibrosis diagnosis
A sweat chloride test of greater than 60 mEq/L demonstrates a positive value for a diagnosis of CF (salty perspiration)
Cystic fibrosis S/S (4)
Adventitious breath sounds; wheezing and rhonchi
Chronic cough (dry or productive)
Chest hyper-resonant with percussion
Clubbing of fingers (inadequate peripheral tissue perfusion)
Cystic fibrosis Interventions (6)
Avoid exposure to respiratory infections
Chest physiotherapy, postural drainage
Monitor for hemoptysis
Nebulizers, aerosol therapy (meds directly to lungs)
Humidified oxygen
Dental hygiene
Cystic fibrosis: Signs and Symptoms - Nutrition (7)
Failure to regain normal birth weight within 7-10 days after birth
Meconium ileus
Skin breakdown
Rectal prolapse due to weak musculature
Bulk of feces increases - large BMs (undigested food excreted)
The stools are frothy and extremely foul-smelling (steatorrhea)
Fatty stools
Cystic fibrosis Interventions for nutrition (5)
Need up to twice the amount of daily calories
High-protein, high-calorie diet with fat intake as tolerated
Prescribed enzymes; supplemental fat soluble vitamins A, D, E, K; extra calcium
In very hot months, increase sodium intake and monitor for overheating, which leads to excessive chloride and sodium loss
Monitor weight
Tetralogy of fallot (5)
Four defects:
- Ventricular septal defect
- Pulmonary stenosis
- Overriding aorta
- Right ventricular hypertrophy
First 3 are congenital, fourth is acquired
Tetralogy of fallot: S/S (5)
Cyanosis - blue spells or tet spells
Murmur
Clubbing of fingers
Delayed physical growth and development
Squatting
Tetralogy of fallot interventions (6)
Supportive - decrease oxygen demand
Nutrition:
- Feed when hungry
- Soft nipple
- Supplemental gavage feedings
Manage tet spells
Surgical
Foreign body aspiration
Common cause of mortality and morbidity in children 1 - 3 years of age
Foreign body aspiration: risk factors (4)
Putting objects in their mouth
Improving fine motor skills allows child to pick up small objects and put in mouth
Ability to run or play while eating
Lack molars for proper grinding of food
Partial airway obstruction: good airway exchange 1/2 (2)
good airway exchange
Forceful cough, wheezing, crying
Partial airway obstruction: good airway exchange 2/2 (3)
- If coughing effectively, encourage child to continue to cough
- Monitor closely
- Manage child’s anxiety
Partial airway obstruction: Poor air exchange 1/2 (2)
Weak, ineffective cough, high-pitched breath sounds, cyanosis
Clutches throat: Universal distress signal
Partial airway obstruction: Poor air exchange 2/2 (2)
If cough becomes ineffective, call for help
Assess LOC
Choking infant - poor air exchange (3)
If conscious: five back blows, then five chest thrusts
Continue to alternate back blows and chest thrusts
If infant becomes unresponsive, start CPR
Choking child (1 yr to puberty) - poor air exchange (6)
Series of 5 abdominal thrusts
Repeat until obstruction is relieved or child becomes unresponsive
If unresponsive, open mouth and look for obstruction
If visible, attempt to remove with one finger sweep
If not visible, do not use finger sweep
If unsuccessful begin CPR
Nonorganic failure to thrive (1)
Examples of non-organic FTT include lack of food intake due to an inability to afford an appropriate formula, problems with feeding techniques, improperly prepared formula (over-diluting the formula), or an inadequate supply of breast milk (due to the mother being exhausted, under stress or in a poor nutritional state).
Aspirin for a child (3)
Reyes syndrome
Better to never give a kid aspirin
Reye’s syndrome, also known as Reye syndrome, is a rare but serious condition that causes swelling in the liver and brain. Reye’s syndrome can occur at any age but usually affects children and teenagers after a viral infection, most commonly the flu or chickenpox.
