Peds Exam 2 - Acute Res. Flashcards
respiratory assessment
-LOC
-RR
-respiratory effort
-skin & mucous membrane & cap refill
-breath sounds
RR: infants
30-40
RR: child
20-24
RR: adolescent
16-18
cardinal signs of respiratory distress
-tachypnea & cardia
-diaphoresis
-change in LOC restless, anxious, irritable
-possible cyanosis
-increased WOB
breathing levels in early respiratory distress vs later
breathing is fast but as they ware out then it will slow
depth & location associated with mild distress
isolated intercostal
depth & location associated with moderate distress
subcostal, suprasternal & supraclavicular
depth & location associated with severe distress
subcostal, suprasternal & supraclavicular + use of accessory muscles in the neck
general nursing interventions for res distress
-ease respiratory efforts
-promote comfort & proper position
-prevent spread of infection
-promote hydration & nutrition
need to know
how to ease respiratory efforts / promote rest & comfort
-positioning
-warm or cool mist no steam vaporizer
-mist tents
-saline nose drops w/ bulb suctioning
-bedrest or quiet activities
need to know
how to prevent spread of infection
-handwashing
-teaching
-judicious pt room assignments
-immunization
-antibiotics
need to know
how to promote hydration & nutrition
-high kcal foods
-avoid caffeine
-allow children to self regulate the diet
2nd line nursing interventions for res distress
-fever mgt
-family support & teaching
-provide support and plan for home care
specific therapies to improve oxygenation
-coughing & deep breathing
-suctioning
-aerosolized nebulizer meds
-percussion & portural draining
-chest physiotherapy
-supplemental oxygen
what makes a CPAP/NHF/Bubble different from the normal oxygen delivery decides
it has a seal so the alveoli stay open better and it keeps the kiddos off the vent
clinical manifestations of respiratory infections in infants & children
fever, meningismus, anorexia, V/D, abdominal pain, nasal blockage or drainage, respiratory sounds & sore throat
clinical manifestations of nasopharyngitis: younger child
-fever
-irritability
-restlessness
-sneezing
-vomiting and/or diarrhea
clinical manifestations of nasopharyngitis: older child
-dryness & irritation of nose & throat
-sneezing
-chilling (fever)
-muscular aches
-cough
-edema & vasodilatation of mucosa
how do you treat nasopharyngitis in a child <3 y/o
Tylenol & nasal suction & keep them hydrated
no over the counter cough&cold meds
how do you treat nasopharyngitis in a child >3 y/o
over the counter cold products (decongestants) cough suppressant, antihistamine & antibiotics should be avoided
tonsillitis
a sore throat that is not caused by strep (need to do strep test) viral so no antibiotics
what can untreated strep lead to
problems in the heart and kidneys
acute rheumatic fever or acute glomerulonephritis
pharyngitis “strep” (GABHS)
a sore throat that is caused by the bacteria group A beta-hemolytic streptococci
strep clinical manifestations
sudden onset, sore throat, headache, fever, vomiting, lymphadenopathy, abdominal pain, bad breath & a beefy red tongue
strep treatment
antibiotics for 10 days
strep therapeutic mgt & nursing care
-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)
tonsillectomy
wait until older & be cautious, can lead to death
indicated only if documented recurrent, frequent “strep”, perotonsillar abscess, or sleep apnea
contraindications of a tonsillectomy
-cleft palate
-acute infections
-uncontrolled systemic disease or blood dyscrasias
-age <4 y/o
nursing considerations post tonsillectomy
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
discharge teaching for a tonsillectomy
-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
External Otitis “swimmers ear”
inflammation/infection of outer ear (auricle or canal) -> water gets trapped by ear wax which mediates growth
external otitis clinical manifestations
-very painful (increases w/ movement)
-drainage (serosangeuineous or purulent)
treatment of external otitis
antibiotic drops or steroid drop + Tylenol
no oral antibiotics
otitis media
infection of middle ear (behind the tympanic membrane) associated w/ collection of fluid or pus
true ear infection
risk factors for otitis medias
-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
clinical manifestation of otitis media
-irritable (infants)
-holds or pulls at ear
-may roll head from side to side
-ruptured tympanic membrane
hearing loss if chronic
therapeutic mgt of an ear infection
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
chronic otitis media treatment
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
croup syndromes
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)
acute laryngotracheobronchitis (LTB)
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**
LTB clinical mgt
-usually can be managed at home as long as they are not hypoxic or in distress
-harsh, metallic “barky” cough, stridor, hoarseness
LTB therapeutic mgt
-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
LTB nursing considerations
-continuous, vigilant observation & accurate assessment of respiratory status
-bed rest to conserve energy
-decrease anxiety
-assess and prevent dehydration
-support the family
signs of increasing severity of croup
-increase RR, infants >60, keep child NPO
-increased agitation, restlessness, anxiety, decreased LOC
-cyanosis
epiglottitis
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
epiglottis clinical presentation
-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
epiglottitis interventions
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
bronchiolitis “RSV”
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
do we test for RSV
no -> go based on symptoms, all treatment is the same
initial bronchiolitis symptoms
-rhinorrhea
-pharyngitis
-couhg & sneezing
-eye & ear infection
-intermittent fever
progressive bronchiolitis symptoms
-increased coughing & wheezing
-tachypnea and retractions
-fever
-feeding problems
-increased secretions
severe bronchiolitis symptoms
-increased tachypnea
-apneic spells
-reduced breath sounds
-listlessness
-poor air control
-cyanosis
therapeutic mgt / nursing considerations for RVS
-maintain airway
-symptomatic treatment (suction, oxygen, pain meds)
-med (for severe cases): ribavirin, bronchodilators (albuterol), ~cort steroids
-contact isolation & hand wahsing
-hydration
who can you not give ribavirin to
pregnant women
what should we do before a respiratory baby eats
suction on the exam do not over think, suction first -> could keep baby off of O2
RVS immunization
only for high risk infants (<29wk), very expensive
pneumonias
inflammation of the alveoli, can be viral or bacterial
pneumonias clinical manifestations
-fever
-chest pain child might say abdomen pain
-dullness to percussion
-non pro cough
-rhonchi or fine rales, decreased breath sounds
-res distress
complications of bacterial pneumonia
-empyema
-pyopneumothorax
-tension pneumothorax
-pleural effusion
therapeutic mgt & nursing care for pneumonia
-humidified oxygen
-antibiotics & may dilators
-possible chest tube for purulent drainage
-CPT
-rest & hydration
-elevate HOB
-close observation
pertussis
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
TB
-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
TB nursing care
-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
apparent life threatening event (ALTE)
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
therapeutic mgt of ALTE
-lots of tests and monitoring
-assessments
-explore possible underlying conditions
-give methylxanthine (caffeine)
discharge education for ALTE
-CPR
-monitor if they go home with it -> interference w/ TV, radio, phones, police scanners
-no extension cords
-emergency # on phones
sudden infant death syndrome (SIDS)
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
risk factors for SIDS
-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)
nursing considerations for SIDS
-safe sleep / back to sleep
-compassionate approach
-ask only factual questions
-allow family time to say goodbye
-provide a keep sake
-arrange home visit
do premature babies have ALTEs
if an event occurs in a premature infant we do not consider it an ALTE bc so common
