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ABSN > Peds Exam 2 - Acute Res. > Flashcards

Peds Exam 2 - Acute Res. Flashcards

1
Q

respiratory assessment

A

-LOC
-RR
-respiratory effort
-skin & mucous membrane & cap refill
-breath sounds

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2
Q

RR: infants

A

30-40

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3
Q

RR: child

A

20-24

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4
Q

RR: adolescent

A

16-18

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5
Q

cardinal signs of respiratory distress

A

-tachypnea & cardia
-diaphoresis
-change in LOC restless, anxious, irritable
-possible cyanosis
-increased WOB

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6
Q

breathing levels in early respiratory distress vs later

A

breathing is fast but as they ware out then it will slow

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7
Q

depth & location associated with mild distress

A

isolated intercostal

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8
Q

depth & location associated with moderate distress

A

subcostal, suprasternal & supraclavicular

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9
Q

depth & location associated with severe distress

A

subcostal, suprasternal & supraclavicular + use of accessory muscles in the neck

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10
Q

general nursing interventions for res distress

A

-ease respiratory efforts
-promote comfort & proper position
-prevent spread of infection
-promote hydration & nutrition
need to know

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11
Q

how to ease respiratory efforts / promote rest & comfort

A

-positioning
-warm or cool mist no steam vaporizer
-mist tents
-saline nose drops w/ bulb suctioning
-bedrest or quiet activities
need to know

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12
Q

how to prevent spread of infection

A

-handwashing
-teaching
-judicious pt room assignments
-immunization
-antibiotics
need to know

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13
Q

how to promote hydration & nutrition

A

-high kcal foods
-avoid caffeine
-allow children to self regulate the diet

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14
Q

2nd line nursing interventions for res distress

A

-fever mgt
-family support & teaching
-provide support and plan for home care

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15
Q

specific therapies to improve oxygenation

A

-coughing & deep breathing
-suctioning
-aerosolized nebulizer meds
-percussion & portural draining
-chest physiotherapy
-supplemental oxygen

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16
Q

what makes a CPAP/NHF/Bubble different from the normal oxygen delivery decides

A

it has a seal so the alveoli stay open better and it keeps the kiddos off the vent

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17
Q

clinical manifestations of respiratory infections in infants & children

A

fever, meningismus, anorexia, V/D, abdominal pain, nasal blockage or drainage, respiratory sounds & sore throat

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18
Q

clinical manifestations of nasopharyngitis: younger child

A

-fever
-irritability
-restlessness
-sneezing
-vomiting and/or diarrhea

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19
Q

clinical manifestations of nasopharyngitis: older child

A

-dryness & irritation of nose & throat
-sneezing
-chilling (fever)
-muscular aches
-cough
-edema & vasodilatation of mucosa

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20
Q

how do you treat nasopharyngitis in a child <3 y/o

A

Tylenol & nasal suction & keep them hydrated
no over the counter cough&cold meds

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21
Q

how do you treat nasopharyngitis in a child >3 y/o

A

over the counter cold products (decongestants) cough suppressant, antihistamine & antibiotics should be avoided

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22
Q

tonsillitis

A

a sore throat that is not caused by strep (need to do strep test) viral so no antibiotics

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23
Q

what can untreated strep lead to

A

problems in the heart and kidneys
acute rheumatic fever or acute glomerulonephritis

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24
Q

pharyngitis “strep” (GABHS)

A

a sore throat that is caused by the bacteria group A beta-hemolytic streptococci

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25
Q

strep clinical manifestations

A

sudden onset, sore throat, headache, fever, vomiting, lymphadenopathy, abdominal pain, bad breath & a beefy red tongue

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26
Q

strep treatment

A

antibiotics for 10 days

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27
Q

strep therapeutic mgt & nursing care

A

-seek care & get meds
-pt teaching finish meds
-comfort: ice pack on neck, Tylenol
-go back to school 24 hours after antibiotic start
-very communicable (get new toothbrush & clean/sanitize dental equipment)

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28
Q

tonsillectomy

A

wait until older & be cautious, can lead to death
indicated only if documented recurrent, frequent “strep”, perotonsillar abscess, or sleep apnea

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29
Q

contraindications of a tonsillectomy

A

-cleft palate
-acute infections
-uncontrolled systemic disease or blood dyscrasias
-age <4 y/o

30
Q

nursing considerations post tonsillectomy

A

observe for S/s of excessive bleeding -> lots of swallowing
-position on side until awake
-avoid suctioning, drooling is ok Blood tinged sputum is fine
-discourage straws, coughing, laughing, or crying
-diet: soft diet & no red foods & no milk products
-swelling & airway compromise (stridor)
-ice collar and/or cool mist
-pain mgt

31
Q

discharge teaching for a tonsillectomy

A

-around days 8-10 all the white patches on surgical site will peel off and pt is at increased risk for bleeding
-watch for excessive swallowing and clearing the throat

32
Q

External Otitis “swimmers ear”

A

inflammation/infection of outer ear (auricle or canal) -> water gets trapped by ear wax which mediates growth

33
Q

external otitis clinical manifestations

A

-very painful (increases w/ movement)
-drainage (serosangeuineous or purulent)

34
Q

treatment of external otitis

A

antibiotic drops or steroid drop + Tylenol
no oral antibiotics

35
Q

otitis media

A

infection of middle ear (behind the tympanic membrane) associated w/ collection of fluid or pus
true ear infection

36
Q

risk factors for otitis medias

A

-exposure to cigarette smoke and/or many people
-bottles in bed
-non immunized
-winter
-non BF infant
-pacifier use beyond infancy
-fam hx
-immun def
-allergic rhinitis

37
Q

clinical manifestation of otitis media

A

-irritable (infants)
-holds or pulls at ear
-may roll head from side to side
-ruptured tympanic membrane
hearing loss if chronic

38
Q

therapeutic mgt of an ear infection

A

80% of ear infections will go away on its own but causes too much pain & complications to daily life so we treat
-antibiotics
-tylenol/ibuprofen
-warm compress

39
Q

chronic otitis media treatment

A

get tubes in ear once in, no diving, jumping or submerging head in water(can use ear plugs), no lakes or rivers avoid pressure postoperatively

40
Q

croup syndromes

A

swelling or obstruction in region of larynx, can be viral or bacterial which creates a horse, barky cough, stridor & respiratory distress
croup in very important to know (& so brochiolitis)

41
Q

acute laryngotracheobronchitis (LTB)

A

viral croup
-inflammation of the mucosal lining of the larynx, trachea & bronchi causing narrowing of the airways
-children <5
-slowly progressive (may develop w/ influenza or bronchiolitis)
** sound a lot worse then they look**

42
Q

LTB clinical mgt

A

-usually can be managed at home as long as they are not hypoxic or in distress
-harsh, metallic “barky” cough, stridor, hoarseness

43
Q

LTB therapeutic mgt

A

-high humidity (steam shower)
-cool mist
-adequate fluids
-comfort measures
-avoid cough syrups or cold meds
-racemic epinephrine watch for rebound
-corticosteroids
bronchodilators & antibiotics are not helpful

44
Q

LTB nursing considerations

A

-continuous, vigilant observation & accurate assessment of respiratory status
-bed rest to conserve energy
-decrease anxiety
-assess and prevent dehydration
-support the family

45
Q

signs of increasing severity of croup

A

-increase RR, infants >60, keep child NPO
-increased agitation, restlessness, anxiety, decreased LOC
-cyanosis

46
Q

epiglottitis

A

bacterial croup
serious, life threatening obstructive inflammatory process -> lose airway
-usually occurs between 2-5 yrs
-H. influenza B or strep. pneumoniae
vaccine for it so rare now
sounds better than they are

47
Q

epiglottis clinical presentation

A

-abrupt onset, starts w/ sore throat
-high fever
-open mouth, tongue out, drooling, agitated
-looks very sicks & wants to be upright
-sore red inflamed throat, difficulty swallowing
-muffled voice, stridor, no spon. cough

48
Q

epiglottitis interventions

A

maintain the airway
-no tongue blades, do not look in throat
-avoid xray & transport (portal if needed)
-let parents be w/ child & keep everyone calm
-prepare for sedation & intubation -> antibiotic -> extubate

49
Q

bronchiolitis “RSV”

A

acute airway infection resulting in inflammation (edema d/t mucus) of the smaller bronchioles, characterized by thick mucus
-children < 2 yr, peak @ 2-5 mo
RSV is the communicable causative agent in more than half the cases

50
Q

do we test for RSV

A

no -> go based on symptoms, all treatment is the same

51
Q

initial bronchiolitis symptoms

A

-rhinorrhea
-pharyngitis
-couhg & sneezing
-eye & ear infection
-intermittent fever

52
Q

progressive bronchiolitis symptoms

A

-increased coughing & wheezing
-tachypnea and retractions
-fever
-feeding problems
-increased secretions

53
Q

severe bronchiolitis symptoms

A

-increased tachypnea
-apneic spells
-reduced breath sounds
-listlessness
-poor air control
-cyanosis

54
Q

therapeutic mgt / nursing considerations for RVS

A

-maintain airway
-symptomatic treatment (suction, oxygen, pain meds)
-med (for severe cases): ribavirin, bronchodilators (albuterol), ~cort steroids
-contact isolation & hand wahsing
-hydration

55
Q

who can you not give ribavirin to

A

pregnant women

56
Q

what should we do before a respiratory baby eats

A

suction on the exam do not over think, suction first -> could keep baby off of O2

57
Q

RVS immunization

A

only for high risk infants (<29wk), very expensive

58
Q

pneumonias

A

inflammation of the alveoli, can be viral or bacterial

59
Q

pneumonias clinical manifestations

A

-fever
-chest pain child might say abdomen pain
-dullness to percussion
-non pro cough
-rhonchi or fine rales, decreased breath sounds
-res distress

60
Q

complications of bacterial pneumonia

A

-empyema
-pyopneumothorax
-tension pneumothorax
-pleural effusion

61
Q

therapeutic mgt & nursing care for pneumonia

A

-humidified oxygen
-antibiotics & may dilators
-possible chest tube for purulent drainage
-CPT
-rest & hydration
-elevate HOB
-close observation

62
Q

pertussis

A

Tdap vaccine so dont see very much
-cough so much that they cannot catch breath
-infants <6mo might need to be vented
-decreased intake, maintain hydration
-humidified oxygen
-treatment: erythromycin

63
Q

TB

A

-rare but presents exactly like adults (lung infection) & is treated like adults
-only do skin TBs if not high risk or traveling from different country
if you have had TB, you will always test positive so chest xray

64
Q

TB nursing care

A

-rarely need hospitalization
-adherence to medication
-isolation: can attend school once on therapy & S/s reduced
-adequate nutrition is as necessary as adherence to meds

65
Q

apparent life threatening event (ALTE)

A

when an infant will just stop breathing or turn blue
-come to ER and they recover on own, usualyl w/o CPR
-hook up to monitor and observe + try to figure out cause

66
Q

therapeutic mgt of ALTE

A

-lots of tests and monitoring
-assessments
-explore possible underlying conditions
-give methylxanthine (caffeine)

67
Q

discharge education for ALTE

A

-CPR
-monitor if they go home with it -> interference w/ TV, radio, phones, police scanners
-no extension cords
-emergency # on phones

68
Q

sudden infant death syndrome (SIDS)

A

the sudden death of an infant under 1 yr old that occurs during sleep & remains unexplained after a complete postmortem examination, including investigation of the death scene and a review of the case hx
leading cause of death in infants 1-12mo

69
Q

risk factors for SIDS

A

-overheating
-unsafe sleeping arrangements
-maternal age
-prenatal or postnatal smoking parents
-substance abuse parent
-poor prenatal care
-premature
-multiple births (youngest)
-low apgar score
-bottle feed (breast milk is protective)

70
Q

nursing considerations for SIDS

A

-safe sleep / back to sleep
-compassionate approach
-ask only factual questions
-allow family time to say goodbye
-provide a keep sake
-arrange home visit

71
Q

do premature babies have ALTEs

A

if an event occurs in a premature infant we do not consider it an ALTE bc so common

ABSN (145 decks)

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