Peds Respiratory Flashcards

Question

S/S of epiglottitis

Answer 1

``` May be sitting in Tripod position May be holding mouth open, with tongue protruding Muffled or hoarse cry Inspiratory stridor Tachycardia, tachypnea Pale, mottled, cyanotic skin Anxious, focused on breathing, lethargic Very sore throat Nasal flaring Looks very sick and high fever ```

Answer 2

When did the child become ill? Was it sudden? Is it suddenly worse after a couple of days or hours? Sore throat? Can the child swallow liquids or saliva? Is drooling present? Is there a high fever? Is there difficulty breathing? ``` Abrupt onset, rapid progression Sore throat Appears anxious/agitated* Unable to swallow & drooling* Absence of spontaneous cough* High temperature 102-104°F ``` Tachypneic, nasal flaring, retractions, pallor STRIDOR present “Cherry Red” epiglottis

Answer 3

``` 4 Ds Drooling Dysphagia Dysphonia Distressed respirations ```

Answer 4

``` Assess for patent airway Assess for presence of inspiratory stridor Measure body temperature Assess RR, HR, color Note presence of drooling Assess pulse oximetry ```

Answer 5

Increased pulse and respiratory rate Substernal, suprasternal, intercostal retractions Flaring nares Increased restlessness

Answer 6

Ineffective Airway Clearance R/T edema and placement of artificial airway Impaired Gas Exchange R/T edema of the epiglottis

Answer 7

Assess & monitor ABC’s, oxygen saturation Have child sit up Maintain patent airway High flow humidified O2; “blow by” if child won’t tolerate mask Limit exam/handling to avoid agitation Be prepared for respiratory arrest, assist ventilations and perform CPR as needed Artificial airway may be necessary Administer antibiotics Epinephrine may be required Administer analgesia as ordered Keep a calm and quiet environment

Answer 8

``` Bronchitis Bronchiolitis Respiratory syncytial virus (RSV)* Pneumonia Pertussis Tuberculosis Foreign body aspiration Smoke inhalation Asthma* Cystic fibrosis* Sudden Infant Death Syndrome (SIDS)* ```

Answer 9

Problem Respiratory infection of the bronchioles Occurs in early childhood (younger than 1 year) Caused by viral infection Assessment/History Length of illness or fever? Recent history of child or family having URI? Taking any medications? How much fluid has the child been drinking? Edema in mucous membrane lining in walls of bronchioles plus inc mucus causing obstruction and inc airway resistance

Answer 10

Most common cause of bronchiolitis and pneumonia among infants and children under 1 year of age. Illness begins most frequently with fever, runny nose, cough, and sometimes wheezing Most children recover in 8 to 15 days. Inflammation of smaller bronchioles characterized by thick mucus During their first RSV infection, between 25% and 40% of infants and young children have signs or symptoms of bronchiolitis or pneumonia UP to 2% require hospitalization- usually under 6 months of age

Answer 11

``` Acute respiratory distress Tachypnea May have intercostal and suprasternal retractions Nasal flaring, circumoral cyanosis Fever & dry cough think thick mucus May have wheezes - inspiratory & expiratory Confused & anxious mental status Possible anorexia, dehydration Nasal discharge ``` Most clinical laboratories use antigen detection assays to diagnose infection Elisa test: nasopharyngeal washing Chest xray H & H

Answer 12

Impaired gas exchange r/t edema and increased secretions Ineffective airway clearance r/t increased secretions Fluid volume deficit r/t decreased food and fluids

Answer 13

``` Management Assess & maintain airway Clear nasal passages if necessary IV LR or NS @KVO rate Contact precautions High risk infants may also receive RSV Immunoglobulin (Respigam) or Monoclonal Antibodies (Palivizumab) prophylactic vaccination ``` Intubate if airway management becomes difficult or fails Palivizumab = Synagis prophylactic vaccination Given as an IM injection before the start of the RSV season usually October to May and then every month during RSV season for a total of 5 injections at the cost of about 1000 dollars for the smallest single dose Treatment is recommended for high risk groups: Infants born at 29 weeks to 35 weeks gestation who are 3 months or younger at the start of the RSV season Infants and children under the age of 2 with congenital heart defects Infants born at 35 weeks gestation with chronic lung disease or neuromuscular disorders Symptom RX only (e.g., acetaminophen to reduce fever). Children with severe disease may require oxygen therapy and sometimes mechanical ventilation Ribavirin aerosol may be used in the treatment of some patients with severe disease but not routine due to concerns re side effects. Easily spread from hand to eye, nose or other mucous membrane Separate room or with other RSV patients HANDWASHING Contact precautions: gloves, gowns, mask, goggles; careful nurse assignments

Answer 14

Watch high risk premature infants and children for tachycardia, HTN, vomiting, diarrhea, wheezing, tachypnea, rales

Answer 15

Sudden and unexplained death of a seemingly healthy baby. Most SIDS deaths usually occur in children who are between 2 months and 4 months Typically, a peacefully sleeping baby simply never wakes up. In most cases, no cause is ever found. multiple factors cause SIDS infant must have some sort of biological vulnerability, such as a heart or brain defect, combined with an environmental stressor, such as stomach sleeping, before SIDS can occur must also occur during a critical developmental period in the baby's life, typically during the first six months. These three factors — vulnerability, critical developmental period and outside stressor — combine to form what's known as the triple-risk model.

Answer 16

In 2006, researchers discovered that abnormalities in a part of the brain that helps control breathing and arousal likely play a role in SIDS. Other research has focused on the way babies breathe while they're asleep — especially their response to low blood oxygen levels (hypoxia) — and on heart function Investigations link SIDS and long QT syndrome, an electrical disturbance in the heart that causes sudden, extremely rapid heart rates

Answer 17

``` Avoid smoking Encourage supine sleeping position (back to sleep) Avoid soft mattress, blankets, pillows Discourage bed sharing Encourage breast feeding, pacifiers Avoid overheating during sleep Vary infant’s head position ``` Since 1992 death rate decreased by 40% Babies found huddled in corner with blankets over head; frothy blood tinged oral/nose; full diaper

Answer 18

Asthma * Bronchopulmonary dysplasia (BPD) Cystic Fibrosis * Tuberculosis

Answer 19

Pathophysiology Chronic recurrent lower airway disease with episodic attacks of bronchial constriction Multiple precipitating factors Age of diagnosis The decreased size of child’s airway due to edema & mucus leads to further compromise ``` MOST COMMON CHRONIC DISEASE OF CHILDHOOD: 5 million children suffer/yr; 80% dx before age 5 Precipitating factors: Exercise psychological stress respiratory infections changes in weather & temperature genetics ``` Occurs commonly during preschool years, but also presents as young as 1 year of age Labeled as RAD (Reactive Airway Disease)

Answer 20

``` Dietary habits Time indoors Energy efficient homes Decrease in breastfeeding Survival of low birth weight babies ``` Western dietary habits (which commonly include more fast foods and less fruits, vegetables, fiber, minerals, and other nutrients) Children are spending more time indoors watching television, playing video games, or using the computer and are, therefore, overexposed to indoor allergens making homes more energy-efficient may result in dust mites being trapped inside them Survival rates are now higher in low-birth-weight babies, who may be more susceptible to asthma Declining rates in nursing may be a contributor. Breast milk contains important anti-inflammatory substances, such as omega-3 fatty acids, which might protect against asthma

Answer 21

History Physical Exam assessments SOB, shallow, irregular respirations, increased or decreased respiratory rate Pale, mottled, cyanotic, cherry red lips Restless & scared Cough Inspiratory & expiratory wheezing, rhonchi* Tripod position History Time of last attack & severity Presence of fever Medications, treatments administered * Diminished breath sounds could indicate decrease in air passage Higher incidence in September Back to school exposure to cold virus with lots of kids and inside Exercise increase with sports High ragweed allergens

Answer 22

``` Administer bronchodilators (know SE’s) Administer corticosteroids, inhaled and oral/IV as ordered Assess & monitor ABC’s Apply oxygen (Humidified if possible) Provide IV of LR or NS at a KVO rate Prepare for possible vomiting Assess pulse oximetry Intubate if airway management becomes difficult or fails ``` Beta-adrenergic drugs Rinse mouth after inhalers. Bronchodilators 1st, then corticosteroids.

Answer 23

``` Sweat profusely Insists on sitting upright Severe respiratory distress Bronchospasm Either suddenly agitated or suddenly quiet Hypoxic ``` Medical emergency that may result in death Symptoms are refractory to initial bronchodilator therapy in the emergency department. Patients report chest tightness, rapidly progressive shortness of breath, dry cough, and wheezing. Therapy directed at improving ventilation Correct dehydration and acidosis with IV fluids; NPO Meds inhaled albuterol Cortisone Subq epinephrine or terbutaline

Answer 24

Teach regarding correct use of peak flow meters, inhalers and nebulizers ``` Allergen control -Drug therapy-Sometimes hyposensitization No smoking near children Allergen control Avoid temperature extremes Meal planning Good hygiene Activity tolerance Moist air Correct use of peak flow meters, inhalers and nebulizers ```

Answer 25

A multisystem disorder affecting exocrine glands. Transmitted by an autosomal recessive gene that both parents must carry for child to be affected Deletion of chromosome 7 Absence of gene decreases chloride-ion and water transport at cellular level 25% chance that each child will have the disease, 50% chance that each child will be a carrier. A chronic, sometimes fatal disease. Most common inherited disease of children One of the most common causes of childhood death Affects multiple organs so have MSOF NOT the most common chronic resp illness of children – asthma is. 70% of population is diagnosed by age 2 and 55% under age of 18 The mean survival age is mid 30’s CFF 2011 As they age: Infertile Hyponatremic Build up of amylase lipase trypsin Inability to absorb fat protein carbohydrates Chronic lung infections leading to vent dependence

Answer 26

Exocrine glands produce tenacious mucous leading to Obstruction of the small passageways of the bronchioles small intestine pancreatic and bile ducts. ``` Complications Malabsorption Syndrome Congestive heart Failure Diabetes Mellitus (IDDM)‏ Pneumonia ```

Answer 27

``` Recurrent respiratory infections Use of accessory muscles, nasal flaring Productive cough Barrel chest CHF Meconium ileus Steatorrhea FTT (failure to thrive) Deficiencies in the fat soluble vitamins (ADEK)‏ IDDM in older children Salty taste of skin due to high concentrations of sodium and chloride in sweat ```

Answer 28

``` Sweat test-still best way to diagnose CF* Family hx of CF or positive newborn blood screening 72- hour fecal fat Fasting blood sugar Sputum culture and sensitivity PFT’s Prenatal chorionic villi sampling Liver enzymes ``` ``` The sweat test does not hurt and you can stay with your baby throughout the procedure. A special gel is put on your baby’s skin on an arm or leg and small patches with wires cover the gel for about 5 minutes. This causes your baby to sweat. The skin may feel warm and tingly while the patches are in place, but it is not painful. The sweat is then collected on a gauze pad or disk. After about 30 minutes, the gauze or disk is removed and taken to a laboratory to measure the salt. The sweat test takes about one hour from start to finish.Diagnosis: amount of chloride in sweat. It’s positive if greater than 60 meq/liter Family history Altered sweat electrolyte content Absent pancreatic enzymes Chronic pulmonary involvement ```

Answer 29

``` Stool specimen for absence of trypsin and fecal fat content Assess respiratory status Measure height and weight Assess for signs of malabsorption Assess for growth and development Serum albumin to assess nutritional status Metabolic panel for hydration status Liver enzymes to assess liver function ``` ``` Stool specimen for absence of trypsin and fecal fat content Assess respiratory status Measure height and weight Assess for signs of malabsorption Assess for growth and development Serum albumin to assess nutritional status Metabolic panel for hydration status Liver enzymes to assess liver function ```

Answer 30

Ineffective Airway Clearance R/T tenacious and increased pulmonary secretions Impaired Gas Exchange R/T air trapping in alveoli secondary to airways obstructed by thick mucus Altered Nutrition: less than Body Requirements R/T poor nutrient absorption in the intestine

Answer 31

Promote airway clearance and gas exchange Assess respiratory status Assess pulse oximetry Administer bronchodilators, antibiotics (inhaled and systemic) Perform chest PT, postural drainage & teach this Promote cough Position for comfort Administer IV and po fluids as ordered Assess vital signs especially temperature Monitor WBC count Assess color, odor and amount of sputum

Answer 32

Practice good handwashing/isolation from those with resistant bacteria, (Pseudomonas aeruginosa, Burkholderia cepacia ) Keep immunizations up to date Take antibiotics and do pulmonary hygiene as ordered No anti-tussives; cough is critical Promote optimum nutrition; teach re diet and to administer pancreatic enzymes with meals Promote effective individual/family coping

Answer 33

Promote optimum nutrition Hi calorie, Hi protein with supplemental snacks Administer pancreatic enzymes with meals and snacks Administer vitamin supplements Monitor weight Monitor I & O Note, color, frequency and consistency of stools

Answer 34

Lung Transplant Hypertonic Saline New inhaled antibiotics to target resistant bacteria VX-770, faulty gene targeted therapy in Phase 3 Clinical Trials .Compacted DNA, In Phase 1 Clinical Trials

Answer 35

Penicillins- commonly used for ear infections Macrolides- used often in PCN allergy and with lower respiratory infections Erythromycin Cephalosporins-also used in ear infections, often 2nd line (10% cross reactivity/allergic reaction in pts with pcn allergy)