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PEDS > PEDS resp exam 1 > Flashcards

PEDS resp exam 1 Flashcards

1
Q

Multisystem disorder of exocrine glands

A

cystic fibrosis

Increased production of thick mucus in bronchioles, small intestines, and pancreatic and bile ducts

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2
Q

what is the etiology of cystic fibrosis?

A

Inherited autosomal recessive trait
Usually diagnosed in infancy and early childhood
Life expectancy increasing - >30 years now

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3
Q

what is the patho of cystic fibrosis?

A

Increased viscosity of secretions
Lungs – atelectasis
Clogged pancreatic ducts
Absence of pancreatic enzymes in small intestines – unable to absorb fats and protein

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4
Q

what is the diagnosis for cystic fibrosis?

A

Sweat test
72 hours fecal fat
Chest x-ray
Prenatal DNA of amniotic fluid

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5
Q

what is the nursing and s/s of cystic fibrosis?

A

History of frequent respiratory infections

S/SX: cough, sputum, dyspnea, decreased Sao2, crackles or wheezes in lungs, cyanosis, digital clubbing, bulky, frothy, foul-smelling stools (steatorrhea), meconium ileus

Assess: skin turgor, hydration status,

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6
Q

what is the nursing care for cystic fibrosis?

A

Provide high-calorie, high-protein foods
Administer pancreatic enzymes with all meals and snacks
Administer fat-soluble vitamins (A,E,D,K)
Avoid pulmonary treatments after meals to decrease the chance of vomiting

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7
Q

what are the meds for cystic fibrosis?

A

Antibiotics – treat pulmonary infection
Pancreatic enzymes – for fat absorption
Fat-soluble vitamins A,E,D,K
Mucolytics – to decrease viscosity of sputum
Bronchodilators – to improve lung function

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8
Q

what is the education for cystic fibrosis?

A

Avoid exposure to respiratory infections
Chest percussion and postural drainage
High-calorie and high protein diet
Activity and exercise will loosen secretions
Genetic counseling

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9
Q

what are your acquired resp probs?

A

Bronchopulmonary dysplasia (BPD)

Asthma

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10
Q

what is bronchopulmonary dysplasia (BPD)?

A

Chronic obstructive pulmonary disease occurring in infants after prolonged oxygen therapy and mechanical ventilation

Possible genetic predisposition

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11
Q

what is your patho for BPD?

A

High oxygen concentrations and mechanical ventilation damage bronchial epithelium and alveoli;

thickened alveolar walls, scarring, and fibrosis lead to atelectasis, poor airway clearance of mucus, and poor gas exchange;

chronic low oxygenation results in decreased lung compliance and altered function

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12
Q

What are the diagnosis and s/s of BPD?

A

Diagnosed by chest x-ray
ABGs reveal hypercapnia and respiratory acidosis

S/SX: tachypnea, tachycardia, increased work of breathing, retractions, wheezing, barrel chest, pallor, poor feeding, activity intolerance

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13
Q

what is the nursing care for BPD?

A

ICU
Intubation with mechanical ventilation
Suction, turn, and weigh carefully to ensure oxygen saturations are maintained
Monitor continuously; condition can deteriorate quickly
Monitor for fluid overload
Cluster nursing care

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14
Q

what are the meds for BPD?

A

Bronchodilators
Corticosteroids
Diuretics
Antibiotics

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15
Q

what is the fam education for BPD?

A

May be discharged with multiple needs
Teach parent CPR, use of home oxygen equipment, trach care, feeding
Review infection control practices
Referrals to community agencies

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16
Q

Chronic inflammatory disorder in which airways narrow and are hyperreactive to stimuli that do not affect nonasthmatic individuals.

A

asthma

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17
Q

what is the patho for asthma?

A

Exposure to irritants causes constriction of bronchial smooth muscle, edema, increased secretion of thick mucus, and airway narrowing;

Expirations through the narrowed lumen is impaired, resulting in air trapping and hyperinflation of the alveoli

Triggers

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18
Q

what is the diagnosis and s/s of asthma?

A

Chest x-ray and symptoms
Pulmonary Function Tests
Wheezing and dry cough, prolonged expiration, restlessness, fatigue, tachypnea, cyanosis, marked respiratory distress
Chronic use of accessory muscles for respiration leads to barrel chest

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19
Q

what is the nursing care for asthma?

A

Assess resp status, administer humidified oxygen prn, monitor pulse ox
Maintain IV access, avoid cold liquids to avoid bronchospasm
Position high-fowlers and cluster nursing care
Sudden cessation of wheezing and decreased breath sounds indicates worsening

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20
Q

what are the meds for asthma?

A

Bronchodilators
Anti-inflammatory agents (steroids)
IV fluids
Oxygen

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21
Q

what is the fam education for asthma?

A

Teach to identify and avoid potential triggers
Check peak flow daily
Keep rescue inhaler with patient at all times

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22
Q

what are infectious resp probs?

A

Acute laryngotracheobronchitis (LTB)
Epiglottitis
Pneumonia
Bronchiolitis

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23
Q

what is acute laryngotracheobronchitis? (LTB)

A

Viral infection that causes inflammation, edema, and narrowing of the larynx, trachea, and bronchi
Usually preceded by a recent upper respiratory infection.
Most common in infants and toddlers
Most common croup syndrome

24
Q

patho for LTB?

A

Usually caused by one of the following:
parainfluenza virus,
influenzae A and B,
respiratory syncytial virus (RSV),
and mycoplasma pneumoniae

25
Q

s/s for LTB?

A

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

26
Q

What is the progression of disease for LTB?

A

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

27
Q

diagnosis for LTB?

A

Chest x-ray
Pulse oximetry

28
Q

nursing care for LTB?

A

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

29
Q

meds for LTB?

A

IV fluids
Humidified oxygen
Corticosteroids

30
Q

fam education for LTB?

A

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

31
Q

what is epiglottis?

A

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.

32
Q

epiglottis patho?

A

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

33
Q

diagnosis and s/s of epiglottis?

A

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

34
Q

nursing care for epiglottis?

A

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

35
Q

meds for epiglottis?

A

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

36
Q

fam education for epiglottis?

A

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

37
Q

what is pneumonia?

A

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

38
Q

pneumonia patho?

A

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

39
Q

s/s of pneumonia?

A

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

40
Q

diagnosis of pneumonia?

A

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

41
Q

nursing care of pneumonia?

A

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

42
Q

pneumonia meds?

A

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

43
Q

fam education for pneumonia?

A

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

44
Q

what is bronchiolitis?

A

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

45
Q

bronchiolitis patho?

A

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

46
Q

bronchiolitis diagnosis?

A

Nasopharyngeal swab (culture) is obtained to identifies causative virus

Chest x-ray may be normal or indicate hyperinflation or nonspecific inflammation

47
Q

s/s of bronchiolitis?

A

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

48
Q

bronchiolitis meds?

A

Bronchodilators (may not help)

Steroids

IV fluids (hydration)

49
Q

bronchiolitis nursing care?

A

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

50
Q

bronchiolitis fam education?

A

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

51
Q

what are the accidents and injuries causing resp probs?

A

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
52
Q

patho of foreign body aspiration?

A

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

53
Q

foreign body aspiration diagnosis?

A

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

54
Q

foreign body aspiration s/s?

A

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

55
Q

foreign body aspiration nursing care?

A

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

56
Q

foreign body aspiration meds?

A

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

57
Q

foreign body aspiration fam education?

A

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

PEDS (31 decks)

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