Peds Final Review - Respiratory

Question 1

Need to know your normal for age respiratory rates and heart rates!

Answer 1

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.

Question 2

Neonatal Normal Vital Signs

Answer 2

Temp: 36.3oC – 37oC (97.3o – 98.6oF) axillary

Heart rate: 120 – 160

Resp rate: 30 – 60

Question 3

Normal Infant Vital Signs

Answer 3

Temp: 36.5oC – 37.5oC (97.6o – 99.8oF) axillary

Heart Rate: 110 – 160

Respiratory Rate: 30 – 60

Question 4

Normal Vital Signs for Toddlers

Answer 4

Heart Rate: 90 – 140

Respiratory Rate: 24 – 40

Systolic BP: 80 – 112

Diastolic BP: 50 – 80

Question 5

Normal Vital Signs for Toddlers

Answer 5

Heart Rate: 90 – 140

Respiratory Rate: 24 – 40

Systolic BP: 80 – 112

Diastolic BP: 50 – 80

Question 6

Normal Vital Signs for Preschoolers

Answer 6

Heart Rate: 80 – 110

Respiratory Rate: 22 – 34

Systolic BP: 82 – 110
Diastolic BP: 50 – 78

Question 7

Normal Vital Signs for Preschoolers

Answer 7

Heart Rate: 80 – 110

Respiratory Rate: 22 – 34

Systolic BP: 82 – 110
Diastolic BP: 50 – 78

Question 8

Normal Vital Signs for School Aged Children

Answer 8

….

Question 9

Normal Vital Signs for School Aged Children

Answer 9

….

Question 10

Respiratory distress:

Cardinal signs of respiratory distress:

Answer 10

Restlessness

Increased respiratory rate – Tachypnea

Increased pulse rate – Tachycardia

Diaphoresis

Question 11

Other signs of respiratory distress

Answer 11

Flaring nostrils
Retractions
Grunting
Adventitious breath sounds
Use of accessory muscles, head bobbing
Confusion, anxiety, irritability
Wheezing

Question 12

Signs of Impending Respiratory Failure

Answer 12

Depressed or slow respirations

(decreased inspiratory breath sounds)

Dyspnea
Bradycardia
Somnolence
Stupor/coma
Cyanosis
Oxygen desat

Question 13

Asthma:

Inflammatory reactive airway disease that is commonly chronic

Answer 13

Edematous airways

Airways congested with mucus

Smooth muscles of bronchi and bronchioles constrict

Air trapping occurs in the alveoli

Question 14

Asthma Nursing Assessment:

Answer 14

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

Question 15

Asthma Nursing Diagnosis:

Answer 15

Impaired gas exchange

Ineffective breathing pattern

Question 16

Asthma Nursing Interventions:

Answer 16

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

Question 17

Asthma Home Care Program:

Answer 17

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

Question 18

Respiratory Distress Syndrome:

Answer 18

Surfactant administration to preterm infants at delivery to prevent RDS

Question 19

Cystic Fibrosis:

Autosomal-recessive disease that causes dysfunction of the exocrine glands

Answer 19

Multiple problems:

1. Lung insufficiency
2. Pancreatic insufficiency
3. Increased loss of sodium and chloride in sweat

Question 20

Cystic Fibrosis Nursing Assessment:

Answer 20

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

Question 21

Cystic Fibrosis Nursing Assessment:

Answer 21

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

Question 22

Cystic Fibrosis Nursing Diagnosis:

Answer 22

Ineffective airway clearance

Imbalanced nutrition: less than body requirements

Question 23

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

Answer 23

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

Question 24

Cystic Fibrosis Nursing Interventions:

Teach family percussion and postural-drainage techniques

Answer 24

Chest percussion and postural drainage must be performed 3 – 4 times a day.

Question 25

Cystic Fibrosis Nursing Interventions: Teach dietary recommendations:

Answer 25

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.

Question 26

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.

Answer 26

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.

Question 27

Cystic Fibrosis Nursing Evaluation of family teaching:

Answer 27

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.

Question 28

Cystic Fibrosis Nursing Evaluation of family teaching:

Answer 28

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.

Question 29

Procedure for Chest Physiotherapy (CPT)

Answer 29

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.

Question 30

laryngotracheobronchitis

Answer 30

Most common of the croup syndromes - Sound worse than they look - Abrupt onset, usually at night Generally affects children

Question 31

laryngotracheobronchitis Treatment

Answer 31

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

Question 32

EPIGLOTTITIS Severe life-threatening infection of the epiglottis

Answer 32

Epiglottitis progresses rapidly, causing acute airway obstruction The organism usually responsible for epiglottitis is Haemophilus influenza

Question 33

EPIGLOTTITIS Nursing Assessment:

Answer 33

``` Sudden onset Restlessness High fever Sore throat, dysphagia Drooling Muffled voice ``` Child assuming upright position with chin out and tongue protruding (tripod position)

Question 34

EPIGLOTTITIS Nursing Diagnosis

Answer 34

Ineffective breathing pattern related to Anxiety related to

Question 35

EPIGLOTTITIS Nursing Interventions:

Answer 35

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

Question 36

DO NOT EXAMINE THE THROAT OF A CHILD WITH EPIGLOTTITIS.

Answer 36

Do not put a tongue blade or any object into the throat because of the risk of obstructing the airway completely.

Question 37

BRONCHIOLITIS Viral infection of the bronchioles that is characterized by thick secretions

Answer 37

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

Question 38

BRONCHIOLITIS Nursing Assessment:

Answer 38

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

Question 39

BRONCHIOLITIS Nursing Diagnosis:

Answer 39

Impaired gas exchange related to …….. Ineffective airway clearance related to ………

Question 40

BRONCHIOLITIS Nursing interventions:

Answer 40

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).

Question 41

BRONCHIOLITIS

Answer 41

NCLEX HINT: In planning and providing nursing care, a patent airway is always the priority of care, regardless of age!

Question 42

OTITIS MEDIA Inflammatory disorder of the middle ear

Answer 42

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

Question 43

OTITIS MEDIA Nursing Assessment

Answer 43

Fever, pain; infant may pull at ear Enlarged lymph nodes Discharge from ear (if drum is ruptured) Upper respiratory symptoms Vomiting, diarrhea

Question 44

OTITIS MEDIA Nursing Diagnosis

Answer 44

Risk for infection related to Acute pain related to

Question 45

OTITIS MEDIA Nursing Interventions:

Answer 45

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) ```

Question 46

TONSILLITIS Inflammation of the tonsils

Answer 46

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.

Question 47

TONSILLITIS Nursing Assessment:

Answer 47

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

Question 48

TONSILLITIS

Answer 48

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.

Question 49

TONSILLITIS Nursing Diagnosis:

Answer 49

Impaired swallowing related to….. Risk for injury related to …….

Question 50

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

Answer 50

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