Peds Respiratory Flashcards
1
Q
What infections are upper respiratory?
A
Croup syndromes
Acute epiglottis
LTB
2
Q
What infections are lower respiratory?
A
Bronchitis
Bronchiolitis - RSV
Pneumonia
3
Q
Why do infection rates increase for 3-6 month old children?
A
They lose their mother’s antibodies
4
Q
Why do we see a high rate of viral infections for toddlers/preschoolers?
A
Exposure to other children in various settings
5
Q
The eustachian tube in an infant is ___, ___ and ___ than in older children and adults.
A
shorter
wider
more horizontal
6
Q
Why is the tympanic membrane easily injured in an infant?
A
The internal and middle ear is relatively large at birth.
7
Q
What seasons do infections occur more frequently?
A
fall, winter, and spring
8
Q
What is considered RSV season?
A
winter and spring
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
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
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
12
Q
What s/sx are seen in otitis media (acute)?
A
Pulling at ear
irritiability/crying
waking at night
diarrhea/vomiting
fever
13
Q
How is acute otitis media diagnosed?
A
purulent effusion and bulging beefy red or yellow/green tympanic membrane
14
Q
Why do we see more ear infections in children?
A
Eustachian tube is shorter and not angled enough to facilitate drainage.
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
16
Q
Who is more likely to get ear infections?
A
boys
17
Q
What is pharyngitis?
A
Strep (group A strep)
18
Q
What is scarlet fever?
A
Rash that accompanies strep
19
Q
If strep not treated, what diseases can occur?
A
Rheumatic fever (heart valve damage)
Acute glomerulonephritis (kidney damage)
20
Q
What are clinical manifestations of pharyngitis (strep throat)?
A
Headache
Fever
Abdominal pain
Tonsils/throat red/inflamed
21
Q
If strep not treated, may progress to ___
A
tonsilitis.
22
Q
Strep accounts for ___% of sore throat
A
10-20
23
Q
Viral infections account for ___ % of sore throat
A
80-90%
24
Q
What is the test to diagnose strep throat?
A
culture (rapid strep)
25
What is the first line of drug therapy for strep throat?
PCN
Amoxicillin
Augmentin
26
What is the second line of drug therapy for strep throat and why?
Cephalosporins
| Azithromycin (if allergy to PCN or other abx have not worked in the past)
27
What is nursing care management for strep throat?
Warm compress to neck
Warm saline gargle
Cool liquid
Ice chips
28
What are tonsils?
Lymphoid tissues that filter and protect from respiratory/GI infections and help with formation of antibodies
29
What are clinical manifestations of tonsillitis?
```
Inflammation
Frequent infections
difficulty swallowing
obstructed airway
mouth breathing
snoring
Kissing tonsils (tonsils so swollen, they're touching each other)
```
30
What is therapeutic management for tonsilitis?
tonsillectomy if:
~peritonsillar abscess
~airway obstruction
~3 or more tonsil infections or adenoids in 1 year
31
Nursing care management for tonsillectomy
liquid-to-soft diet
cool-mist vaporizer
warm salt water gargles
throat lozenge
32
What medications for tonsillectomy?
Analgesics:
Tylenol with codeine
Lortab (hydrocodone/acetaminophen) elixir
Antipyretics (NO NSAIDs d/t bleeding risk)
Antiemetic (Zofran)
33
How should a post-op tonsillectomy patient be positioned?
on side or abdomen until awake, then sit up
34
What is post-op teaching for tonsillectomy?
no coughing, blowing nose, straining, or straw use
35
Is dark brown drainage normal for tonsillectomy?
yes. it is old blood
36
What other symptoms will patient have with tonsillectomy?
sore throat, ear pain, and foul breath and low-grade fever are all normal post-op
37
What are we looking out for in post-op tonsillectomy patient?
Bleeding.
Watch for frequent swallowing, tachycardia, pallor
38
What equipment is important to have at bedside post-op tonsillectomy?
suction and oxygen
39
What temperature of foods/treatments are best for post-op tonsillectomy patient?
Cold.
| Ice collar, cool water, ice chips, popsicles, diluted fruit juice
40
What are symptoms of foreign body aspiration?
Decreased breath sounds
Stridor
Respiratory distress
41
What is treatment for foreign body aspiration?
back blows and chest or abdominal thrusts
bronchoscopy or fluoroscopy may also be used
42
What is the nursing management for foreign body aspiration?
```
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
43
What is important to teach to parents to prevent FBA?
prevention and safety
44
What is normal breath rate for infants?
regular-irregular
Can have pauses of up to 20 seconds between breaths
45
What is considered apnea?
Cessation of respiration >20 seconds
OR
Any pause with cyanosis, pallor, hypotonia, bradycardia
46
Sometimes, apnea may be the _____ of respiratory dysfunction
only sign
47
What does ALTE mean?
Apparently Life Threatening Event
48
What are signs of ALTE?
color change
limp muscle tone
choking
gagging
49
When is ALTE seen?
not seen after 12 months of age
50
What are the causes of ALTE?
GERD (most common)
seizures
lower respiratory infection
51
What do we assess for ALTE?
Detailed history
responsiveness/behavior (LOC)
VS
Growth history (are they hitting their milestones)
Physical exam for injury, infection, symptoms for metabolic syndrome
52
What is nursing management for ALTE?
```
CR monitor
Pulse ox
Resuscitation equipment at bedside
Provide emotional support to parents
Encourage parent involvement/bonding
```
53
What teaching do we provide to ALTE parent?
Safe sleep position
Home apnea monitor
Teach CPR/choking intervention
54
What is the cause for SIDS?
unknown
POSSIBLY
Maternal smoking
type of bed
co-sleeping
55
What is the nursing care management for SIDS?
```
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
When does respiratory failure occur?
Body can no longer maintain effective gas exchange
Muscles of breathing are fatigued
OR
Impaired ventilation/blood flow to alveoli
57
What is the most common cause of cardiopulmonary arrest in children?
Respiratory failure
58
There is a better survival rate for respiratory failure than there is for ____
cardiac arrest
59
What are initial signs of respiratory failure progression?
restlessness
tachypnea
tachyardia
diaphoresis
60
What are early decompensation signs of respiratory failure?
```
Nasal flaring
Retractions
Grunting
Wheezing
Anxiety
Irritatabilty
ALOC
```
61
What are signs of severe hypoxia and imminent respiratory failure?
```
Dyspnea
Bradycardia
Cyanosis
Stupor
Coma
```
62
What is the key thing to do with respiratory patients?
Assess every 2 hours to look for subtle/gradual changes
63
What signs will tell you the most about respiratory patients?
HEART AND RESPIRATORY RATES
these will give you the best indicators if patient starting to progress into failure.
64
What are goals in treatment of respiratory failure?
Maintain ventilation
correct hypoxemia
treat underlying cause (flu, etc...)
65
What are croup syndromes?
Affects larynx, trachea, and bronchi
Viral: LTB ("croup")
Bacterial: epiglottitis
66
What is the most common of croup syndromes?
LTB
67
What seasons do we generally see LTB/croup?
fall and winter
68
What age group is most affected by croup?
6 months to 3 years of age
69
What organisms are responsible for LTB/croup?
RSV
Parainfluenza virus
Influenza A and B
mycoplasma pneumoniae
70
What is normally seen prior to a croup infection?
URI
71
What are manifestations of croup?
```
Stridor
suprasternal retractions
barking/seal-like cough
tachypnea
low SpO2
increasing respiratory distress and hypoxia
```
72
What can croup progress to?
Respiratory acidosis
respiratory failure
death
73
What is management for croup?
Airway management
Maintain hydration
High humidity with cool mist
74
What medication is used for croup?
Nebulizer treatments with racemic epinephrine (this works on upper airway)
IV/IM dexamethasone (Decadron)
Oral - prednisolone
75
What is important to have near bedside for croup patient?
intubation equipment
76
What is acute epiglottitis?
serious obstructive inflammatory process requiring IMMEDIATE MEDICAL ATTENTION
77
What are the causes of acute epiglotitis?
Influenza B
Strep
Staph
78
What are clinical manifestations of acute epiglottitis?
```
Fever
Sore throat
**Dysphagia
**Drooling
**Tripod position
**Inspratory stridor (frog-like sound on inspiration)
Mild hypoxia
Irritable
Restless
Anxious
Frightened
```
79
What is the biggest worry for acute epiglottitis?
potential for respiratory obstruction
80
What medications do we see for acute epiglottitis?
helix
Rifampin (abx)
Anitypyretics
81
What is nursing care management for acute epiglottitis?
```
do NOT examine throat
Delay start of IV or procedure that will agitate child
Administer O2
Prepare for intubation
Reduce anxiety, minimize crying
```
82
What is prime prevention of acute epiglottitis?
Hib vaccine (99% reduction of epiglottitis)
83
What is mnemonic for acute epiglottitis?
Airway inflammation
Increased pulse
Restlessness
Retractions
Anxiety increased
Inspiratory stridor
Drooling
84
What is bronchiolitis?
Acute viral infection that affects bronchioles
85
What is the biggest cause of bronchiolitis?
RSV
86
When does RSV occur?
Winter and spring
87
What age group is RSV seen?
children under 3
88
If a child has severe RSV infections in first year of life, what disease are they likely to develop in later years?
asthma
89
When do symptoms of RSV peak?
5-7 days
90
What are clinical manifestations of RSV?
After URI
| May have no symptoms except slight lethargy, poor feeding, or irritability
91
What symptoms do we see progress in RSV?
```
severe runny or stuffy nose
wheezing
retractions
crackles
dyspnea
tachypnea
diminished breath sounds
```
92
What do retractions look like on RSV child?
low (substernal or subcostal)
moves upward as severity increases (intercostal, then supraclavicular and suprasternal)
93
What is a first symptom of RSV in young infants?
apnea
94
How is RSV diagnosed?
CXR
| NP swab
95
Is RSV preventable?
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
What is nursing care for RSV?
```
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
What precaution for RSV?
Droplet AND contact (mask, gloves, gowns)
| lives up to 8 hours
98
What is the predisposing factor for asthma?
Allergies
99
What are unique asthma manifestations?
Frequent coughing (especially at night)
constant dry cough that doesn't seem to go away
100
What are signs of asthma exacerbation?
Respiratory distress despite vigorous therapy
~unable to speak more than 1-2 words without gasping
~diaphoretic
~cyanotsis
101
What is therapeutic intervention for status asthmatics?
back-to-back SVN treatments
Mag Sulfate (to relax smooth muscle in lungs)
102
What is emergency treatment for status asthmaticus?
Epinephrine
| Heliox
103
What meds used for asthma?
Rescue meds:
SVN, fast-acting inhalers (albuterol, terbutaline)
Anticholinergics:
Atrovent
Corticosteroids
IV - solumedrol (methylprednisolone)
Oral - prednisone or prednisolone
104
What drug is a long-acting beta agonist?
salmeterol (Serevent)
105
What drugs are inhaled corticosteroids?
fluticasone (Flovent, Flonase)
| budesonide (Pulmicort)
106
What drug is fluticasone/salmeterol?
Advair
107
What drug is a leukotriene receptor antagonist?
montelukast (Singulair)
108
What is cystic fibrosis?
Exocrine gland dysfunction that affects multiple body systems
109
What is autosomal recessive trait?
Defective gene inherited from both parents
110
What are the clinical manifestations for cystic fibrosis?
Increased thickness of mucous gland secretions
Elevation of sweat electrolytes
Increased level of digestive enzymes in mouth
Abnormalities in autonomic nervous system
111
What is the main problem in CF?
Thick, sticky mucous that clogs up glands and ducts.
112
What two areas are most affected by CF?
respiratory tract and pancreas
113
What is one of the first signs of CF?
Salty taste to skin
| Delayed puberty
114
Why salty taste to skin with CF?
Increased Na production, decreased Cl production
115
Are respiratory symptoms present in all CF patients?
Almost all, yes!
Stagnation of mucus leads to bacteria that ends up destroying lung tissue
116
What are respiratory manifestations in CF patients?
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
What drug therapy used for CF?
Antibiotic therapy
118
What kinds of issues occur in GI tract with CF?
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
What are GI issues affiliated with CF?
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
What are the GI clinical manifestations of CF patients?
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
How are pancreatic enzymes given to CF patients?
As capsule or sprinkled on food.
Given at the beginning of meal or snack
122
What diet are CF patients on?
High protein, high calories
(as much as 150% recommended dietary allowance)
Salt supplementation
Vitamins ADEK supplementation
123
How is CF diagnosed?
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
Is CF curable?
No
125
What is the expected life expectancy for CF patients?
early 40's
