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Critical Care > Peds Respiratory > Flashcards

Peds Respiratory Flashcards

1
Q

Upper vs. Lower Disorders

A

Upper (neck and above) - croup, epiglottitis
- Nasal cavity
- Pharynx
- Larynx
Lower (the majority of disorders)
- Trachea
- Primary bronchi
- Lungs

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2
Q

Lung Resistance vs. Lung Compliance

A

Lung Resistance = determined by airway size
- If small airway = more resistance; if bigger airway = less resistance
Lung Compliance = ease to breathe; measurement of the ease of chest expression

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3
Q

Describe what respiratory distress looks like in the peds population

A
  • As a child’s body starts working harder to breathe, the body will automatically start breathing faster.
  • Under 2 months > 60 breaths/min
  • 2 months - 12 months > 50 breaths/min
  • 1-5 years > 40 breaths/min
  • 6-12 years > 30 breaths/min
  • 12 years > 20 breaths/min
  • Abnormal breathing patterns
  • Abnormal sounds: grunting (signs of distress in babies)
  • Abnormal blood values to include ABG
  • Tachycardia, tachypnea, nasal flaring, retractions, head bobbing
  • Once distress has started if we can’t correct it in a timely manner, signs of failure begin.
  • Distress -> Failure -> Arrest
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4
Q

Early Signs of Respiratory Failure
Interventions

A

Pallor, anxious behavior, restlessness
Treatment – Raise HOB, give O2 (nasal cannula - babies are obligatory nose breathers), neck roll underneath them, suction if there is a mucus issue

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5
Q

Late Signs of Respiratory Failure
Interventions

A

Hypotension, cyanosis, apnea
Call Dr. - time to intubate

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6
Q

Managing Respiratory Failure

A
  • Recognition of prolonged periods of apnea
  • Maximize ventilation and oxygen delivery
  • Correct hypoxia and hypercapnia
  • Treat Underlying cause
  • Restrictive: Pneumothorax, Scoliosis (not a lot in pediatrics) - they can’t inhale well
  • Obstructive: Laryngospasm, Asthma, COPD - they can’t exhale well
  • Apply therapy to control oxygen demands
  • Anticipate complications
  • Identification of Compensatory Mechanisms
  • Decrease in retractions, RR, cough, etc
    Failure = decline in adequate oxygenation.
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7
Q

Pediatric Assessment Triangle

A

*Appearance
- Tone
- Interactiveness
- Consolability
- Look/Gaze
- Speech/cry
*Work of Breathing
- Abnormal breath sounds
- Abnormal position
- Head bobbing
- Retractions
- Gasping
- Nasal flaring
*Circulation to Skin
- Pallor
- Mottling
- Cyanosis
- Absent or Weak Pulses
- Abnormal BP
- Obvious signs of bleeding

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8
Q

Developmental and Biological Variances in Pediatric Population - Blood volume and shock

A
  • Total blood volume is smaller = small blood loss may lead to hypovolemia and impaired perfusion
  • Compensation: healthy children in shock can maintain their BP up until they lose 25% of their blood volume
  • Tachycardia and Delayed Capillary Refill = Early signs of shock
  • Cap refill looked at a lot in peds - it’s not affected by children being afraid
  • Decreased Blood Pressure = Late sign
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9
Q

Pediatric Cardiac Arrest Algorithm

A

Doses of Epi - 0.01 mg per kg repeat every 3-5 min
One person: 30 to 2. Two people: 15 to 2

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10
Q

Describe Cystic Fibrosis and effects of the disease

A
  • Genetic disorder regarding the production of mucus throughout the body.
  • Increase in mucus production often leads to secondary bacterial infections. = chronic damage overtime leading to respiratory failure
  • Can cause sterility due to mucus blocking the vans deferens and ovarian ducts
  • “Salty” skin reported by caregivers due to
    Metabolic system producing excess sodium chloride
  • Delayed growth/poor weight gain
  • Meconium ileus at birth is common to see
  • Lung transplant
  • Affects the lungs primarily as well as the pancreas
  • Digestive Impact
  • Thick mucus in pancreatic ducts = decrease in absorption of digestive enzymes = failure to absorb fat, proteins, and carbs.
  • Secondary DM1 “CF related Diabetes” – 20% adolescents
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11
Q

Cystic Fibrosis Management
Pulmonary Toileting

A

Chest physiotherapy
- Postural drainage: sitting upright, HOB up; gravity moves secretions from periphery to bronchi to be coughed out
- Controlled cough: get secretions out, sputum culture is usually obtained
- Percussion: cupped hands clap the chest
- Vibration: with hands or vest
- Vest: vibrates and percusses
- Usually done before bedtime, 1-2 hours AFTER meals
Expectorants: Guaifenesin (Mucinex)

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12
Q

Cystic Fibrosis Management
Nutrition

A
  • Need 1.5-2x the caloric intake recommended for an individual their age
  • 40% of meals should be from fat
  • Every meal/snack: take digestive enzymes within 30 minutes of eating
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13
Q

Cystic Fibrosis Management
Psychosocial considerations

A

Self Image
- Adolescent age group
- “Relentless cough”
- Medical devices
- Nutritional limitations
- Medication management
Independence
- Vulnerability
- Life-shortening disease
- Interaction with peers
- “Loss of power”
- “No cure”
Metabolic
- Delayed puberty
- Delayed menarche
- Infertility
- Delayed weight gain
- Height

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14
Q

Common CF Medications
Bronchodilators

A

albuterol (Ventolin, ProAir, Proventil), levalbuterol hydrochloride (Xopenex)
- Open airways and relaxes muscles
- Inhaled MDI with Spacer

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15
Q

Common CF Medications
Mucolytic

A

Dornase alfa (Pulmozyme), hypertonic saline
- Thins/breaks-up mucus, allowing patients to cough it out!
- Inhaled

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16
Q

Common CF Medications
Antibiotics

A

Varies, likely an oral penicillin
- Prophylaxis; oral
- Also used in treating breakthrough infections (can be IV, Oral, or inhaled)

17
Q

Common CF Medications
NSAIDs

A

Ibuprofen, Piroxicam
Recent evidence shows NSAID use in children may decreased pulmonary deterioration, improve FEV1, and decrease lung infection recurrence

18
Q

Common CF Medications
Contraceptives

A

Oral, IUD, IM, ring, etc.
- Pregnancy can reduce lung function, decrease quality/quantity of life without proper planning.
- All women with CF of childbearing age should use contraceptives (and many consider sterilization).

19
Q

Common CF Medications
Pancreatic Enzyme Replacement Therapy

A

Oral capsule
- To replace the pancreatic enzymes that are blocked from the pancreas to digestion due to mucus blockages
- Take with each meal and snack (within 30 minutes)

20
Q

Common CF Medications
Vitamins

A

Multivitamins (in particular: vitamins A, D, E, K)
- Difficult to absorb fats

21
Q

Common CF Medications
Proton-pump inhibitors/ H2 blockers

A

Used to treat GER(D); those with CF are more likely to have GER(D) secondary to excessive coughing

22
Q

Common CF Medications
Stool softeners

A

Often used to help regulate BM.
Thick mucus and not adequate fluids in the bowel can lead to constipation = encourage fluid intake!

23
Q

Common CF Medications
Corticosteroids

A

Corticosteroids are used to help decrease inflammation, typically during infection.

24
Q

Bronchopulmonary Dysplasia

A

Chronic respiratory disorder in premature infants “CLD”
Characterized by stiff lung tissue = difficult delivery of oxygen
NICU admission, born prematurely = can’t fully oxygenate the lungs
Immature lungs have fewer alveoli
Hyperinflation of immature lungs produces inflammation and scarring in lungs
As they grow older - “Chronic Lung Disease”, always get respiratory illness, “junky”

25
Q

Bronchopulmonary Dysplasia (BPD) Risk Factors

A
  • Maternal: placental insufficiency, lack of antenatal steroids, infection, smoking
  • Infant: genetic, male, race, altered microbiome, sepsis
  • O2 Injury: DNA damage, lipid preoxidation, protein oxidation
  • Mechanical ventilation: volutruama, barotrauma, atelectotrauma
26
Q

Bronchopulmonary Dysplasia (BPD) Treatment, Nursing Interventions

A

Treatment
- High concentration O2 for weeks-years (low pressure setting)
- “Insure” Intubate, synthetic surfactant, extubate
Nursing Interventions
- Alleviate effort
- Mechanical ventilation
- Nutrition
- Medication
- Intake/Output
Home Teaching: O2

27
Q

Prevention & Management of Children with Respiratory Disease

A

Acute Illness (Ex: Croup)
- Caregiver education: transmission, safe practices; wash hands, don’t take child to school
- Medication management
- Triggers
- Specialist referral
Chronic Illness (Ex: BPD)
- Education: disease process, resources in the community
- Utilize resources: social work, case management
Genetic Disease (Ex: Cystic Fibrosis)
- Education
- Follow up with genetic counseling, nutrition
- Utilize resources

28
Q

Croup: what is it?
Treatment

A

Viral infection
Stridor, seal-like cough, usually at night
Treatment:
- Ineffective Breathing: Racemic Epinephrine
- Treat fever
- Dehydration: fluids, IV
- Can also have cough, runny nose

29
Q

Risk factors of Respiratory Illnesses
Triggers

A

Air Pollution/Quality
- Asthma
- CF
- BPD
Malnutrition
- CF: Pancreatic insufficiency
Genetic Predisposition
- CF
- BPD
Triggers
- Temperature change, stress, exercise, strong odors
- Respiratory infection, work, allergens
- Smoking, medications, pollutions, gastric reflux

30
Q

Common diagnoses for tracheostomy in Peds

A

Anoxic brain injury
Cerebral Palsy
Trauma

31
Q

Uncuffed vs. Trach tubes in Peds Population

A

Uncuffed tubes recommended for children under 8 yo
- Inflated cuffs can damage the child’s airway
- Cricoid is the narrowest area of their airway leading to more use of uncuffed airway devices in children
Cuffed tubes recommended for children over 8 yo
- Purpose = ensure airflow enters the lungs
- Mechanical vent considerations
- Post extubation complications: risk of laryngospasm when extubating

32
Q

Temporary vs. Long Term Peds Tracheostomy
Home Care

A

For peds, the use of trachs are not something you do after being on a vent for 7 days, as it is with adults.
Trachs are usually something that they go home on.
Home care: Need an HME cap - humidified air, so that secretions are not building up
Vocalization - Passy-Muir valves, make sure they have an fennestrated tube
Socialization - prepare child to go back out into the community with trach
Home = clean, Hospital = sterile

33
Q

Routine vs. Emergent Care for Peds Tracheostomy

A

Routine
- Suction less than FIVE sec, suction OUT
- Sterile
Emergency
- Always have intubation tray, tube same size and smaller size, and Ambu bag with patient in case of accidental extubation
- If there is no backup, airway trumps infection; this is when it can be “clean” instead of “sterile” in the hospital -> put dirty trach in

34
Q

Parts of Tracheostomy and purpose for peds
Inner/outer cannula
Obturator

A

Inner cannula fits inside outer cannula and is changed frequently
Inner cannula locks into place to ensure cough will not expel trach from airway
Obturator is used for placement and replacement of tube, firms up the tube for reinsertion

Critical Care (12 decks)

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