PEDS resp exam 1 Flashcards

Question

s/s for LTB?

Answer 1

Inflammation and narrowing of airways cause inspiratory stridor and suprasternal retractions Increased production of thick secretions and edema Hypoxia and carbon dioxide accumulation Respiratory acidosis

Answer 2

Onset is gradual after upper respiratory infection Child awakens at night with low-grade fever, barking seal-like cough, and stridor Noisy breathing and use of accessory muscles Agitation, restlessness, sore throat, rhinorrhea

Answer 3

Chest x-ray Pulse oximetry

Answer 4

Monitor respirations Observe for diminished breath sounds Circumoral cyanosis Cessation of noisy breathing (airways are getting tighter not better) Drooling (not swallowing) Quiet respiratory effort is a sign of physical exhaustion and impending respiratory failure

Answer 5

IV fluids Humidified oxygen Corticosteroids

Answer 6

Assess parental anxiety and ability to adhere to medical recommendations. Instruct to seek medical care if breathing becomes labored, child seems exhausted or very agitated or if symptoms do not improve with cool air humidity treatment

Answer 7

Inflammation and swelling of epiglottis, primarily affecting children between ages 2 and 8. The site of obstruction is supraglottic and is life-threatening because edema in this area can obstruct airway and occlude the trachea within minutes.

Answer 8

Bacteria, usually Haemophilus influenzae, cause epiglottis to become cherry red, swollen, and so edematous that it obstructs airway Secretions pool in pharynx and larynx Child has a sore throat and is unable to swallow Complete airway obstruction can occur within 2 – 6 hours

Answer 9

Onset is sudden in a previously healthy child Child awakens with sudden onset of high fever, sore throat, pain with swallowing Anxious, restless, looks ill, insists on sitting upright leaning on arms with chin thrust out and mouth open (tripod position) Dysphonia (muffled voice). Dysphagia, drooling of saliva, are classic signs Edematous, cherry red epiglottis is most reliable diagnostic sign Examination of the throat is contraindicated Physical manipulation of hypersensitive and irritated airway muscles may result in spasm and complete obstruction Lateral neck x-ray confirms an enlarged epiglottis X-rays should be portable CBC, blood cultures

Answer 10

NPO, IV fluids for hydration Assess for resp distress continuously Never leave child unattended Keep intubation equipment available

Answer 11

Antibiotics (H. Flu) Antipyretics (fever) Corticosteroids (swelling) IV fluids

Answer 12

Discuss importance of Hib vaccine and reassure parents that recurrence of epiglottitis is uncommon Provide emotional support and explain all procedures Teach parents importance of completing antibiotic regimen after discharge

Answer 13

Inflammation of lungs that occurs most often in infants and young children Bronchioles and alveolar spaces are affected

Answer 14

Viral – virus invades alveoli and bronchial mucosa, causing sloughing and debris Respiratory syncytial virus is most common organism and causes severe illness in immunocompromised infant Bacterial pneumonia – occurs when organisms circulating in bloodstream travel to lungs, increase in number, and damage pulmonary cells Alveoli are filled with fluid and exudate and may involve one segment or entire lung History of a viral infection usually precedes bacterial pneumonia Mycoplasma pneumoniae infection is most common in older children (over 5 yrs.) in fall and winter Occurs in crowded living conditions Pneumococcal vaccine  herd immunity

Answer 15

Viral pneumonia – mild fever, nonproductive cough, rhinitis, self-limiting and lasts 5-7 days High risk infants with RSV may have wheezing, tachypnea, and increased resp. distress Bacterial pneumonia – high fever, productive cough, ill appearance Retractions, grunting respirations, chills, chest pain, restlessness, anxiety Respiratory distress is significant

Answer 16

Chest x-ray – increased density of lung tissue, patchy infiltrates, increased fluid Pulse oximetry Arterial Blood Gas CBC Blood cultures – determine if viral or bacterial

Answer 17

Monitor breath sounds, resp rate, use of accessory muscles, color, o2 saturation, level of activity, restlessness Assist child to chough, deep breathe, and change positions often Teach splinting with coughing Lying on affected side may also splint chest and decrease discomfort Incentive spirometer

Answer 18

Antipyretics, analgesics IV or oral fluids Antibiotics for bacterial infections Cool, humidified oxygen

Answer 19

Encourage parents to assist in care of patient Assess parents’ ability to care for child at home Provide emotional support Discuss importance of oral fluids Explain importance of adhering to immunization schedule Follow-up chest x-ray may be indicated

Answer 20

Inflammation of bronchioles with edema and excess accumulation of mucus Air trapping and atelectasis result from increased airway resistance because of small obstructed bronchioles Major cause of hospitalization in infants

Answer 21

Respiratory syncytial virus (RSV) is primary causative organism Spread by contact with contaminated objects Not airborne but can live for several hours on nonporous surfaces Most prevalent during first 2 years of life

Answer 22

Nasopharyngeal swab (culture) is obtained to identifies causative virus Chest x-ray may be normal or indicate hyperinflation or nonspecific inflammation

Answer 23

Worsening of an upper respiratory tract infection with tachypnea, retractions, low-grade fever, anorexia, thick nasal secretions, and increasingly labored breathing Older infants may have a frequent, dry cough Lungs reveal wheezing or crackles

Answer 24

Bronchodilators (may not help) Steroids IV fluids (hydration)

Answer 25

Complete respiratory assessment Provide humidified oxygen Pulse oximetry Clear nasal passages with bulb syringe or deep nasal suctioning Cluster nursing care IV fluid, I & O, Weigh daily Contact precautions

Answer 26

Encourage parents to assist in infant care Teach parents to use bulb syringe Teach parents about frequent oral fluids Instruct parents to notify physician if child refuses to eat or breathing becomes worse Avoid smoking, strict handwashing

Answer 27

Foreign Body Aspiration - Inhalation of an object into respiratory tract, intentional or otherwise - Peak age is less than 3 years - Leading cause of death in children <1

Answer 28

Foreign bodies usually lodge in right main bronchus because it is shorter and wider than the left Obstruction may be partial or complete Causes atelectasis, air trapping, and hyperinflation distal to the site of obstruction Type and shape of object, as well as small diameter of an infant’s airway, determines severity of problem Round objects, such as hot dogs, round candy, nuts, popcorn kernels,& grapes do not break apart and are more likely to occlude the airway Latex balloons are particularly hazardous Objects with irregular may irritate airway and partially obstruct airflow

Answer 29

Fluoroscopy and chest x-ray reveal foreign body in respiratory tract

Answer 30

Sudden coughing and gagging Symptoms of respiratory infection, hoarseness, croupy cough, wheezing, and dyspnea Worsening – stridor, cyanosis, difficulty swallowing and speaking A child who cannot speak, is cyanotic, and collapses requires immediate attention for complete airway obstruction Failure to remove a foreign object is usually fatal A delay in removal may cause aspiration pneumonia

Answer 31

Respiratory assessment with continuous monitoring NPO Prepare for surgery Position child for comfort Post-op assess for additional obstruction that may be caused by laryngeal edema and tissue swelling

Answer 32

Antibiotics if secondary infection Or if purulent secretions are present in airway, with or without signs of pneumonia

Answer 33

Review age-appropriate foods and discuss frequently aspirated objects: coins, hot dogs, balloons, nuts, popcorn, grapes, round candy, peanut butter Discuss toy safety and avoidance of toys with small, removable parts Caution against allowing child to run and play with objects in mouth