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Peds Week 2 > Peds Respiratory > Flashcards

Peds Respiratory Flashcards

1
Q

What infections are upper respiratory?

A

Croup syndromes
Acute epiglottis
LTB

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2
Q

What infections are lower respiratory?

A

Bronchitis
Bronchiolitis - RSV
Pneumonia

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3
Q

Why do infection rates increase for 3-6 month old children?

A

They lose their mother’s antibodies

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4
Q

Why do we see a high rate of viral infections for toddlers/preschoolers?

A

Exposure to other children in various settings

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5
Q

The eustachian tube in an infant is ___, ___ and ___ than in older children and adults.

A

shorter
wider
more horizontal

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6
Q

Why is the tympanic membrane easily injured in an infant?

A

The internal and middle ear is relatively large at birth.

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7
Q

What seasons do infections occur more frequently?

A

fall, winter, and spring

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8
Q

What is considered RSV season?

A

winter and spring

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9
Q

What s/sx will you see in infants and children who are having respiratory issues?

A 
Generalized signs:
fever
anorexia
vomiting
diarrhea
cough
sore throat
nasal blockage/DC
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10
Q

What kinds of lung sounds will you hear in an infant with respiratory issues?

A 
cough
hoarseness
grunting
stridor
wheezing
crackles
absence of breath sounds
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11
Q

What are some general nursing care things to do for child having respiratory issues?

A

Ease respiratory effort with saline drops, nasal suction, moist air

Promote rest/comfort

O2 support

Prevent spread of infection

Antipyretics

Promote hydration/nutrition

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12
Q

What s/sx are seen in otitis media (acute)?

A

Pulling at ear

irritiability/crying

waking at night

diarrhea/vomiting

fever

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13
Q

How is acute otitis media diagnosed?

A

purulent effusion and bulging beefy red or yellow/green tympanic membrane

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14
Q

Why do we see more ear infections in children?

A

Eustachian tube is shorter and not angled enough to facilitate drainage.

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15
Q

What are some risk factors for acute otitis media?

A

Pacificer and bottle use leads to back flow of secretions

Daycare

Exposre to secondhand smoke

Allergies

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16
Q

Who is more likely to get ear infections?

A

boys

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17
Q

What is pharyngitis?

A

Strep (group A strep)

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18
Q

What is scarlet fever?

A

Rash that accompanies strep

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19
Q

If strep not treated, what diseases can occur?

A

Rheumatic fever (heart valve damage)

Acute glomerulonephritis (kidney damage)

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20
Q

What are clinical manifestations of pharyngitis (strep throat)?

A

Headache
Fever
Abdominal pain
Tonsils/throat red/inflamed

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21
Q

If strep not treated, may progress to ___

A

tonsilitis.

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22
Q

Strep accounts for ___% of sore throat

A

10-20

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23
Q

Viral infections account for ___ % of sore throat

A

80-90%

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24
Q

What is the test to diagnose strep throat?

A

culture (rapid strep)

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25
Q

What is the first line of drug therapy for strep throat?

A

PCN
Amoxicillin
Augmentin

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26
Q

What is the second line of drug therapy for strep throat and why?

A

Cephalosporins

Azithromycin (if allergy to PCN or other abx have not worked in the past)

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27
Q

What is nursing care management for strep throat?

A

Warm compress to neck
Warm saline gargle
Cool liquid
Ice chips

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28
Q

What are tonsils?

A

Lymphoid tissues that filter and protect from respiratory/GI infections and help with formation of antibodies

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29
Q

What are clinical manifestations of tonsillitis?

A 
Inflammation
Frequent infections
difficulty swallowing
obstructed airway
mouth breathing
snoring
Kissing tonsils (tonsils so swollen, they're touching each other)
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30
Q

What is therapeutic management for tonsilitis?

A

tonsillectomy if:
~peritonsillar abscess
~airway obstruction
~3 or more tonsil infections or adenoids in 1 year

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31
Q

Nursing care management for tonsillectomy

A

liquid-to-soft diet
cool-mist vaporizer
warm salt water gargles
throat lozenge

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32
Q

What medications for tonsillectomy?

A

Analgesics:
Tylenol with codeine
Lortab (hydrocodone/acetaminophen) elixir
Antipyretics (NO NSAIDs d/t bleeding risk)
Antiemetic (Zofran)

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33
Q

How should a post-op tonsillectomy patient be positioned?

A

on side or abdomen until awake, then sit up

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34
Q

What is post-op teaching for tonsillectomy?

A

no coughing, blowing nose, straining, or straw use

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35
Q

Is dark brown drainage normal for tonsillectomy?

A

yes. it is old blood

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36
Q

What other symptoms will patient have with tonsillectomy?

A

sore throat, ear pain, and foul breath and low-grade fever are all normal post-op

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37
Q

What are we looking out for in post-op tonsillectomy patient?

A

Bleeding.

Watch for frequent swallowing, tachycardia, pallor

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38
Q

What equipment is important to have at bedside post-op tonsillectomy?

A

suction and oxygen

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39
Q

What temperature of foods/treatments are best for post-op tonsillectomy patient?

A

Cold.

Ice collar, cool water, ice chips, popsicles, diluted fruit juice

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40
Q

What are symptoms of foreign body aspiration?

A

Decreased breath sounds
Stridor
Respiratory distress

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41
Q

What is treatment for foreign body aspiration?

A

back blows and chest or abdominal thrusts

bronchoscopy or fluoroscopy may also be used

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42
Q

What is the nursing management for foreign body aspiration?

A 
Watch vitals
ALOC
Audible wheezing
Breath sounds!!!!!
Cardiorespiratory monitor (heart and RR monitor)
Pulse ox (keep >95%)

KEEP CHILD CALM

have code cart near in case of complete obstruction

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43
Q

What is important to teach to parents to prevent FBA?

A

prevention and safety

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44
Q

What is normal breath rate for infants?

A

regular-irregular

Can have pauses of up to 20 seconds between breaths

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45
Q

What is considered apnea?

A

Cessation of respiration >20 seconds
OR
Any pause with cyanosis, pallor, hypotonia, bradycardia

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46
Q

Sometimes, apnea may be the _____ of respiratory dysfunction

A

only sign

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47
Q

What does ALTE mean?

A

Apparently Life Threatening Event

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48
Q

What are signs of ALTE?

A

color change
limp muscle tone
choking
gagging

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49
Q

When is ALTE seen?

A

not seen after 12 months of age

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50
Q

What are the causes of ALTE?

A

GERD (most common)
seizures
lower respiratory infection

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51
Q

What do we assess for ALTE?

A

Detailed history
responsiveness/behavior (LOC)
VS
Growth history (are they hitting their milestones)
Physical exam for injury, infection, symptoms for metabolic syndrome

52
Q

What is nursing management for ALTE?

A 
CR monitor
Pulse ox
Resuscitation equipment at bedside
Provide emotional support to parents
Encourage parent involvement/bonding
53
Q

What teaching do we provide to ALTE parent?

A

Safe sleep position
Home apnea monitor
Teach CPR/choking intervention

54
Q

What is the cause for SIDS?

A

unknown

POSSIBLY
Maternal smoking
type of bed
co-sleeping

55
Q

What is the nursing care management for SIDS?

A 
Infant should sleep on back
Avoid excess blankets/bedding
No tight swaddling
OK to use pacifier
Parent will model behaviors they see in nurses
56
Q

When does respiratory failure occur?

A

Body can no longer maintain effective gas exchange

Muscles of breathing are fatigued
OR
Impaired ventilation/blood flow to alveoli

57
Q

What is the most common cause of cardiopulmonary arrest in children?

A

Respiratory failure

58
Q

There is a better survival rate for respiratory failure than there is for ____

A

cardiac arrest

59
Q

What are initial signs of respiratory failure progression?

A

restlessness
tachypnea
tachyardia
diaphoresis

60
Q

What are early decompensation signs of respiratory failure?

A 
Nasal flaring
Retractions
Grunting
Wheezing
Anxiety
Irritatabilty
ALOC
61
Q

What are signs of severe hypoxia and imminent respiratory failure?

A 
Dyspnea
Bradycardia
Cyanosis
Stupor
Coma
62
Q

What is the key thing to do with respiratory patients?

A

Assess every 2 hours to look for subtle/gradual changes

63
Q

What signs will tell you the most about respiratory patients?

A

HEART AND RESPIRATORY RATES

these will give you the best indicators if patient starting to progress into failure.

64
Q

What are goals in treatment of respiratory failure?

A

Maintain ventilation
correct hypoxemia
treat underlying cause (flu, etc…)

65
Q

What are croup syndromes?

A

Affects larynx, trachea, and bronchi

Viral: LTB (“croup”)
Bacterial: epiglottitis

66
Q

What is the most common of croup syndromes?

A

LTB

67
Q

What seasons do we generally see LTB/croup?

A

fall and winter

68
Q

What age group is most affected by croup?

A

6 months to 3 years of age

69
Q

What organisms are responsible for LTB/croup?

A

RSV
Parainfluenza virus
Influenza A and B
mycoplasma pneumoniae

70
Q

What is normally seen prior to a croup infection?

A

URI

71
Q

What are manifestations of croup?

A 
Stridor
suprasternal retractions
barking/seal-like cough
tachypnea
low SpO2
increasing respiratory distress and hypoxia
72
Q

What can croup progress to?

A

Respiratory acidosis
respiratory failure
death

73
Q

What is management for croup?

A

Airway management
Maintain hydration
High humidity with cool mist

74
Q

What medication is used for croup?

A

Nebulizer treatments with racemic epinephrine (this works on upper airway)

IV/IM dexamethasone (Decadron)
Oral - prednisolone

75
Q

What is important to have near bedside for croup patient?

A

intubation equipment

76
Q

What is acute epiglottitis?

A

serious obstructive inflammatory process requiring IMMEDIATE MEDICAL ATTENTION

77
Q

What are the causes of acute epiglotitis?

A

Influenza B
Strep
Staph

78
Q

What are clinical manifestations of acute epiglottitis?

A 
Fever
Sore throat
**Dysphagia
**Drooling
**Tripod position
**Inspratory stridor (frog-like sound on inspiration)
Mild hypoxia
Irritable
Restless
Anxious 
Frightened
79
Q

What is the biggest worry for acute epiglottitis?

A

potential for respiratory obstruction

80
Q

What medications do we see for acute epiglottitis?

A

helix
Rifampin (abx)
Anitypyretics

81
Q

What is nursing care management for acute epiglottitis?

A 
do NOT examine throat
Delay start of IV or procedure that will agitate child
Administer O2
Prepare for intubation
Reduce anxiety, minimize crying
82
Q

What is prime prevention of acute epiglottitis?

A

Hib vaccine (99% reduction of epiglottitis)

83
Q

What is mnemonic for acute epiglottitis?

A

Airway inflammation
Increased pulse
Restlessness

Retractions
Anxiety increased
Inspiratory stridor
Drooling

84
Q

What is bronchiolitis?

A

Acute viral infection that affects bronchioles

85
Q

What is the biggest cause of bronchiolitis?

A

RSV

86
Q

When does RSV occur?

A

Winter and spring

87
Q

What age group is RSV seen?

A

children under 3

88
Q

If a child has severe RSV infections in first year of life, what disease are they likely to develop in later years?

A

asthma

89
Q

When do symptoms of RSV peak?

A

5-7 days

90
Q

What are clinical manifestations of RSV?

A

After URI

May have no symptoms except slight lethargy, poor feeding, or irritability

91
Q

What symptoms do we see progress in RSV?

A 
severe runny or stuffy nose
wheezing
retractions
crackles
dyspnea
tachypnea
diminished breath sounds
92
Q

What do retractions look like on RSV child?

A

low (substernal or subcostal)

moves upward as severity increases (intercostal, then supraclavicular and suprasternal)

93
Q

What is a first symptom of RSV in young infants?

A

apnea

94
Q

How is RSV diagnosed?

A

CXR

NP swab

95
Q

Is RSV preventable?

A

Yes, but only for children who are preemies, have congenital heart problems, and other chronic illnesses.

they get an immunoglobulin (synagis - palivzumab) given every 30 days for 5 months at beginning of RSV season.

96
Q

What is nursing care for RSV?

A 
Private room OR room with other RSV patient
pulse ox
IV if needed for feeding difficulties 
humidified O2
Cluster care
antipyretics
bronchodilator therapy if responsive
97
Q

What precaution for RSV?

A

Droplet AND contact (mask, gloves, gowns)

lives up to 8 hours

98
Q

What is the predisposing factor for asthma?

A

Allergies

99
Q

What are unique asthma manifestations?

A

Frequent coughing (especially at night)

constant dry cough that doesn’t seem to go away

100
Q

What are signs of asthma exacerbation?

A

Respiratory distress despite vigorous therapy
~unable to speak more than 1-2 words without gasping
~diaphoretic
~cyanotsis

101
Q

What is therapeutic intervention for status asthmatics?

A

back-to-back SVN treatments

Mag Sulfate (to relax smooth muscle in lungs)

102
Q

What is emergency treatment for status asthmaticus?

A

Epinephrine

Heliox

103
Q

What meds used for asthma?

A

Rescue meds:
SVN, fast-acting inhalers (albuterol, terbutaline)

Anticholinergics:
Atrovent

Corticosteroids
IV - solumedrol (methylprednisolone)
Oral - prednisone or prednisolone

104
Q

What drug is a long-acting beta agonist?

A

salmeterol (Serevent)

105
Q

What drugs are inhaled corticosteroids?

A

fluticasone (Flovent, Flonase)

budesonide (Pulmicort)

106
Q

What drug is fluticasone/salmeterol?

A

Advair

107
Q

What drug is a leukotriene receptor antagonist?

A

montelukast (Singulair)

108
Q

What is cystic fibrosis?

A

Exocrine gland dysfunction that affects multiple body systems

109
Q

What is autosomal recessive trait?

A

Defective gene inherited from both parents

110
Q

What are the clinical manifestations for cystic fibrosis?

A

Increased thickness of mucous gland secretions

Elevation of sweat electrolytes

Increased level of digestive enzymes in mouth

Abnormalities in autonomic nervous system

111
Q

What is the main problem in CF?

A

Thick, sticky mucous that clogs up glands and ducts.

112
Q

What two areas are most affected by CF?

A

respiratory tract and pancreas

113
Q

What is one of the first signs of CF?

A

Salty taste to skin

Delayed puberty

114
Q

Why salty taste to skin with CF?

A

Increased Na production, decreased Cl production

115
Q

Are respiratory symptoms present in all CF patients?

A

Almost all, yes!

Stagnation of mucus leads to bacteria that ends up destroying lung tissue

116
Q

What are respiratory manifestations in CF patients?

A

Hypoxia

CO2 retention

Acidosis

barrel-shaped chest

clubbing of fingers/toes

Can lead to pulmonary HTN, then cor pulmonale, respiratory failure, and death

Progressive COPD associated with infection

117
Q

What drug therapy used for CF?

A

Antibiotic therapy

118
Q

What kinds of issues occur in GI tract with CF?

A

Thick secretions block ducts.

Pancreatic enzymes cannot reach duodenum causing impaired digestion/absorption of fat and protein

Meconium ileus may be seen in newborns (this is why we wait for them to poop! Meconium ileus is when their poop gets too thick and becomes stuck)

119
Q

What are GI issues affiliated with CF?

A

Pancreas functions initially, then pancreatic fibrosis occurs.

May result in diabetes mellitus

Biliary obstruction can lead to biliary cirrhosis

Poor growth due to malabsorption (they can’t digest fat/protein, they can’t grow)

120
Q

What are the GI clinical manifestations of CF patients?

A

pancreatic enzyme deficiency

sweat gland dysfunction

failure to thrive

increased weight loss despite increased appetite

abdominal distention

deficiency of fat-soluble vitamins (ADEK)

anemia

bulky, loose, frothy, super stinky stools

121
Q

How are pancreatic enzymes given to CF patients?

A

As capsule or sprinkled on food.

Given at the beginning of meal or snack

122
Q

What diet are CF patients on?

A

High protein, high calories
(as much as 150% recommended dietary allowance)

Salt supplementation

Vitamins ADEK supplementation

123
Q

How is CF diagnosed?

A

sweat chloride test

Na and Cl will be 2-5 times greater than normal

Saliva is measured for enzymatic constituents

Newborn screen - DNA

Abnormalities of autonomic nervous system

124
Q

Is CF curable?

A

No

125
Q

What is the expected life expectancy for CF patients?

A

early 40’s

Peds Week 2 (2 decks)

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