Peds Final Review - Respiratory Flashcards
Need to know your normal for age respiratory rates and heart rates!
NCLEX HINT: Respiratory disorders are the primary reason most children and their families seek medical care. Therefore, these disorders are frequently tested on the NCLEX.
Knowing the normal parameters of respiratory rates and the key signs of respiratory distress in children is essential.
Neonatal Normal Vital Signs
Temp: 36.3oC – 37oC (97.3o – 98.6oF) axillary
Heart rate: 120 – 160
Resp rate: 30 – 60
Normal Infant Vital Signs
Temp: 36.5oC – 37.5oC (97.6o – 99.8oF) axillary
Heart Rate: 110 – 160
Respiratory Rate: 30 – 60
Normal Vital Signs for Toddlers
Heart Rate: 90 – 140
Respiratory Rate: 24 – 40
Systolic BP: 80 – 112
Diastolic BP: 50 – 80
Normal Vital Signs for Toddlers
Heart Rate: 90 – 140
Respiratory Rate: 24 – 40
Systolic BP: 80 – 112
Diastolic BP: 50 – 80
Normal Vital Signs for Preschoolers
Heart Rate: 80 – 110
Respiratory Rate: 22 – 34
Systolic BP: 82 – 110
Diastolic BP: 50 – 78
Normal Vital Signs for Preschoolers
Heart Rate: 80 – 110
Respiratory Rate: 22 – 34
Systolic BP: 82 – 110
Diastolic BP: 50 – 78
Normal Vital Signs for School Aged Children
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Normal Vital Signs for School Aged Children
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Respiratory distress:
Cardinal signs of respiratory distress:
Restlessness
Increased respiratory rate – Tachypnea
Increased pulse rate – Tachycardia
Diaphoresis
Other signs of respiratory distress
Flaring nostrils Retractions Grunting Adventitious breath sounds Use of accessory muscles, head bobbing Confusion, anxiety, irritability Wheezing
Signs of Impending Respiratory Failure
Depressed or slow respirations
(decreased inspiratory breath sounds)
Dyspnea Bradycardia Somnolence Stupor/coma Cyanosis Oxygen desat
Asthma:
Inflammatory reactive airway disease that is commonly chronic
Edematous airways
Airways congested with mucus
Smooth muscles of bronchi and bronchioles constrict
Air trapping occurs in the alveoli
Asthma Nursing Assessment:
History of asthma in the family
History of allergies
Home environment containing pets or other allergens
Tight cough (nonproductive cough)
Breath sounds: coarse expiratory wheezing, rales, crackles
Chest diameter enlarges (late sign and symptom)
Increased number of school days missed during past 6 months
Signs of respiratory distress
Asthma Nursing Diagnosis:
Impaired gas exchange
Ineffective breathing pattern
Asthma Nursing Interventions:
Monitor for increasing respiratory distress
Administer rapid-acting bronchodilators and steroids for acute attacks
Maintain hydration
Monitor blood gas values for signs of respiratory acidosis
Administer oxygen or nebulizer therapy as prescribed
Monitor pulse oximetry as prescribed (usually > 95%)
Administer cromolyn sodium prophylactically to prevent inflammatory response
Teach home care program
Refer child and family for emotional and psychological counseling
Asthma Home Care Program:
Identify precipitating factors
Reducing allergens in the home
Use metered-dose inhaler
Monitor peak expiratory flow rate at home
Do breathing exercises
Monitor drug actions, dosages, and side effects
Manage acute episode and when to seek emergency care
Respiratory Distress Syndrome:
Surfactant administration to preterm infants at delivery to prevent RDS
Cystic Fibrosis:
Autosomal-recessive disease that causes dysfunction of the exocrine glands
Multiple problems:
- Lung insufficiency
- Pancreatic insufficiency
- Increased loss of sodium and chloride in sweat
Cystic Fibrosis Nursing Assessment:
Usually found in a white infant or child
Meconium ileus at birth
Recurrent respiratory infection
Pulmonary congestion
Steatorrhea (excessive fat, greasy stools)
Foul-smelling bulky stools
Delayed growth and poor weight gain
Skin that tastes salty when kissed
Later: cyanosis, nail-bed clubbing, congestive heart failure
Cystic Fibrosis Nursing Assessment:
Usually found in a white infant or child
Meconium ileus at birth
Recurrent respiratory infection
Pulmonary congestion
Steatorrhea (excessive fat, greasy stools)
Foul-smelling bulky stools
Delayed growth and poor weight gain
Skin that tastes salty when kissed
Later: cyanosis, nail-bed clubbing, congestive heart failure
Cystic Fibrosis Nursing Diagnosis:
Ineffective airway clearance
Imbalanced nutrition: less than body requirements
Cystic Fibrosis Nursing Interventions:
Monitor respiratory status
Assess for signs of respiratory infection
Administer IV antibiotics as prescribed and manage vascular access
Physical activity and exercise loosen secretions and promote lung expansion
Administer fat-soluble vitamins (A,D,E,K) in water soluble form
Administer oxygen and nebulizer treatments (Pulmozyme) as prescribed
Evaluate effectiveness of respiratory treatments
Administer pancreatic enzymes with food. In infants with applesauce, rice, or cereal
Provide age appropriate activities
Refer family for genetic counseling
Cystic Fibrosis Nursing Interventions:
Teach family percussion and postural-drainage techniques
Chest percussion and postural drainage must be performed 3 – 4 times a day.
Cystic Fibrosis Nursing Interventions:
Teach dietary recommendations:
high in calories, high in protein, moderate to high in fat, and moderate to low in carbohydrates (to avoid an increase in the CO2 drive)
A child with cystic fibrosis needs 150% of the usual calorie intake for normal growth and development.
Male cystic fibrosis patients need to be informed at some point that they will probably not be able to produce offspring.
Be sure to emphasize this does not mean they will be impotent.
Normal sexual relationships can be expected.
Female cystic fibrosis patients may be able to bear children but should be informed of the possible harmful effects on the respiratory system created by the burden of pregnancy.
Cystic Fibrosis Nursing Evaluation of family teaching:
Family demonstrates and verbalizes intent to adhere to home care regimen of pulmonary treatments, medications, diet, and exercise;
child gains weight consistently;
participates in self-care and age-appropriate activities,
child demonstrates ability to clear secretions from airway by productive cough;
O2 sat greater than 94%, and decreased respiratory distress.
Cystic Fibrosis Nursing Evaluation of family teaching:
Family demonstrates and verbalizes intent to adhere to home care regimen of pulmonary treatments, medications, diet, and exercise;
child gains weight consistently;
participates in self-care and age-appropriate activities,
child demonstrates ability to clear secretions from airway by productive cough;
O2 sat greater than 94%, and decreased respiratory distress.
Procedure for Chest Physiotherapy (CPT)
Child is dressed in a lightweight shirt
Percussion is performed with a cupped hand striking the chest over a portion of the lung; if done properly , a popping sound will be heard
Some children, esp. older children and adolescents, use an oscillating vest to mobilize secretions instead of chest physiotherapy
Postural drainage facilitates removal of secretions that are loosened during percussion; for drainage, various head-down positions drain all lung segments
Positioning for bronchial drainage can be achieved by child standing on his head, hanging upside down on monkey bars and other playground activities that are fun for the child.
Avoid performing CPT immediately after eating.
laryngotracheobronchitis
Most common of the croup syndromes
- Sound worse than they look
- Abrupt onset, usually at night
Generally affects children
laryngotracheobronchitis Treatment
Dexamethasone – oral or IM
Duration of action is 48 – 96 hours
Nebulized epinephrine – racemic epinephrine
-Duration 1 – 2 hours
-Observe patient for 2 – 4
hours
EPIGLOTTITIS
Severe life-threatening infection of the epiglottis
Epiglottitis progresses rapidly, causing acute airway obstruction
The organism usually responsible for epiglottitis is Haemophilus influenza
EPIGLOTTITIS Nursing Assessment:
Sudden onset Restlessness High fever Sore throat, dysphagia Drooling Muffled voice
Child assuming upright position with chin out and tongue protruding (tripod position)
EPIGLOTTITIS Nursing Diagnosis
Ineffective breathing pattern related to
Anxiety related to
EPIGLOTTITIS Nursing Interventions:
Employ measures to decrease agitation and crying
Maintain child in upright sitting position
Prepare for intubation or tracheostomy
Administer IV antibiotics as prescribed
Prepare for hospitalization in ICU
Restrain as needed to prevent extubation
Encourage prevention with Hib vaccine
DO NOT EXAMINE THE THROAT OF A CHILD WITH EPIGLOTTITIS.
Do not put a tongue blade or any object into the throat because of the risk of obstructing the airway completely.
BRONCHIOLITIS
Viral infection of the bronchioles that is characterized by thick secretions
Bronchiolitis is usually caused by respiratory syncytial virus (RSV) and is found to be readily transmitted by close contact with hospital personnel, families, and other children.
Bronchiolitis occurs primarily in young infants, and is more common in infant born preterm or infants with congenital heart disease.
Prevention of RSV – Synagis (palivizumab)—monthly IM injection during RSV season
BRONCHIOLITIS Nursing Assessment:
History of upper respiratory symptoms
Irritable, distressed infant
Paroxysmal coughing
Poor eating
Nasal congestion
Nasal flaring
Prolonged expiratory phase of respiration
Wheezing, rales can be auscultated
Deteriorating condition that is often indicated by shallow, rapid respirations
BRONCHIOLITIS Nursing Diagnosis:
Impaired gas exchange related to ……..
Ineffective airway clearance related to ………
BRONCHIOLITIS Nursing interventions:
Isolate child – Contact isolation for RSV
Assign nurses to clients with RSV who have no responsibility for any other children
Monitor respiratory status; observe for hypoxia
Clear airway of secretions using a bulb syringe for suctioning
Provide care in mist tent; administer oxygen as prescribed
Maintain hydration
Monitor antiviral agent, ribavirin aerosol, if prescribed
– Ribavirin is rarely used,
but if used can not have
pregnant care taker as it
is teratogenic.
Evaluate response to respiratory therapy treatments
Administer palivizumab (Synagis) to provide passive immunity against RSV in high-risk children (those less than 2 years of age with a history of prematurity, lung disease, or congenital heart disease).
BRONCHIOLITIS
NCLEX HINT: In planning and providing nursing care, a patent airway is always the priority of care, regardless of age!
OTITIS MEDIA
Inflammatory disorder of the middle ear
Otitis media may be suppurative or serous
Anatomic structure of the ear predisposes young child to ear infections – horizontal position
There is a risk for conductive hearing loss if untreated or incompletely treated
OTITIS MEDIA Nursing Assessment
Fever, pain; infant may pull at ear
Enlarged lymph nodes
Discharge from ear (if drum is ruptured)
Upper respiratory symptoms
Vomiting, diarrhea
OTITIS MEDIA Nursing Diagnosis
Risk for infection related to
Acute pain related to
OTITIS MEDIA Nursing Interventions:
Administer antibiotics if prescribed
Reduce body temperature
-Tepid baths
- Acetaminophen is
prescribed
Position child on affected side
Provide comfort measure: warm compress on affected ear
Teach home care:
-Teach to finish all prescribed
antibiotics
- Encourage follow-up visit - Monitor for hearing loss
- Teach preventive care
(smoking and bottle
feeding when child is in
supine position are
predisposing factors)
TONSILLITIS
Inflammation of the tonsils
Tonsillitis may be viral or bacterial
Tonsillitis may be related to infection by a Stretococcus species
If related to strep, treatment is very important because of the risk for developing acute
Glomerulonephritis or rheumatic heart disease.
TONSILLITIS Nursing Assessment:
Sore throat
Fever
Enlarged tonsils, with possible purulent discharge on tonsils
Breathing may be obstructed
Tonsils may be touching (called “kissing tonsils”)
Need throat culture to determine bacterial or viral cause
TONSILLITIS
The nurse should be sure that a PT and PTT have been determined prior to a tonsillectomy.
More important, the nurse should ask whether there has been a history of bleeding, prolonged or excessive, and whether there is a history of any bleeding disorders in the family.
TONSILLITIS Nursing Diagnosis:
Impaired swallowing related to…..
Risk for injury related to …….
TONSILLITIS Nursing Interventions:
Collect throat culture if prescribed
Instruct parents in home care
Encourage warm saline gargles
Provide ice chips
Administer antibiotics if prescribed
Manage fever with acetaminophen
Provide surgical care if indicated
Provide preoperative teaching and assessment
Monitor for signs of postoperative bleeding
- Frequent swallowing - Vomiting fresh blood - Clearing throat
Encourage soft foods and oral fluids. Avoid red fluids, which mimic signs of bleeding.
Do not use straws
Provide comfort measures: Ice collar helps with pain and with vasoconstriction
Teach that the highest risk for hemorrhage is during the first 24 hours and 5 – 10 days after surgery
