Quiz Unit J Respiratory Dysfunction Flashcards
What do you assess for before drawing an ABG?
Respiratory rate, ease, depth, skin color, pain, and do an Allen test prior to drawing
When do babies stop being total nose breathers?
After the first month
Why are kids under the age of 8 more prone to aspiration?
Epiglottis is long and floppy, more susceptible to swelling. Trachea is shorter and narrower, and about the size of their pinkie finger (4mm in infants)
At what age are the lungs fully developed?
12
Kids are abdominal breathers until the age of _____.
6
What are the different croup syndromes?
Infections that affect the epiglottis and larynx, and bronchi
Most viral URI’s are caused by the _____virus.
RSV (Respiratory Syncytial Virus)
What are viral infections so common and severe in kids 6 month to 3 years old?
The bronchial and Eustachian tubes are short
When does RSV season occur?
Winter and spring
What are some common s/s of a URI?
Fever, anorexia, vomiting, diarrhea, abdominal pain, cough, sore throat, nasal discharge/blockage, respiratory sounds
At what point is a temperature addressed in children?
At 102 degrees
How are URI’s managed?
Ease respiratory effort, hydration/nutrition, rest/comfort, prevent spread, COMFORT measures only (most of the time)
Which symptom needs to be checked further?
Sore throat, may be strep, needs antibiotics
What is done for pharyngitis?
Usually nothing, unless strep. Soft or cool liquid diet (eases swelling and inflammation)
Who is a flu shot not recommended for?
Asthmatics
Who shouldn’t get the nasal mist?
Children under 2
Why don’t children get aspirin?
Reye’s syndrome
When can the flu virus be spread?
24 hrs before symptoms appear and 24 hrs after symptoms disappear
How is the flu spread?
By droplet and contact
What are the s/s of the flu?
Photophobia, exhaustion, red face, dry hacking cough, aches/pains
What is done for the flu?
Hydration, hydration, hydration
What is done for repeated occurrences of otitis media?
Tubes in the ears
What is usually done pharmacologically for otitis media?
Usually nothing
How can we prevent otitis media?
Reduce tobacco smoke exposure, no pacifier, no bottle propping
When is otitis common?
Before age 7 and in the winter months
If an antibiotic is needed for otitis media, what is given?
Amoxicillin, 80-90 mg/kg/day, divided into 2 doses, for 5-7 days
Describe the average case of mono?
Dx witha spot test (Epstein Barr virus), 30-50 days incubation, usually self-limiting
What s/s of epiglottitis is easiest to recognize?
Barking cough (also respiratory stridor)
What are some s/s of acute epiglottitis?
Tripod position, drooling, restlessness, sore throat, retractions, spontaneous coughing
What is the most important fact to know about acute epiglottitis?
Must be addressed by an MD experienced in this, nothing in the throat for any reason by staff. It is an emergent situation!
What is the treatment for acute epiglottitis?
IV antibiotics, steroids, HIB vaccine prevents
What do we do for acute epiglottitis?
Comfort, support family, NOTHING in the throat, DON’T even look at the throat, stay with the patient at all times
Who gets acute epiglottitis?
Usually kids under 7 yrs of age
Who gets LTB?
Age 3 months to 3 years
What is a complication of acute LTB?
Respiratory acidosis/failure, death
Who gets acute laryngitis?
Older children and teens and is more prevalent in males
When are kids with LTB treated in the hospital?
When stridor, retractions, or difficulty breathing is present, others treated at home
What does acute spasmodic laryngitis become if it is severe?
LTB
What is done for bacterial traceitis?
Humidified O2 (due to secretions), antipyretics, antibiotics, may need intubation
What are the s/s of acute bacterial tracheitis?
Stridor, barking cough, thick secretions, but no drooling
What is considered the “reactive” portion of the airway?
Bronchi and bronchioles (lower portion)
What is RAD and what are it’s manifestations?
Reversible, self-limiting, inflammation, mucous, edema, and bronchospasm of the airways that generally responds to supportive care. (ie, croup, asthma, and bronchiolitis)
What is the most common cause of hospitalization in kids under 1 yr of age?
RSV
What does bronchiolitis lead to?
Epithelial cells are shed into the bronchioles, causing obstruction/over inflation on exhalation (emphysema). This leads to hyperinflation and patchy atelectasis
What can RSV lead to?
Asthma
What is done for bronchiolitis/RSV? When is it most common?
Rivoviren, Numex, humidified O2, isolation, fluids, no chest therapy or ATB. Winter/spring
Where does interstitial pneumonia occur?
Alveoli
What is pneumonitis?
Infection of the lung wall
How are kids with pneumonia treated?
Postural drainage, antipyretics, fluids, cool mist humidifier. General support
What can provide immunity to pertussis?
A single episode, but booster now recommeded btwn 10 and 19 years old, if not given at 10-18, can be given up to age 64
What is the 2nd leading cause of death from infectious disease in the US?
TB
What is done if person is non-compliant with TB therapy?
DOT therapy (someone watches them take the meds to ensure compliance)
What causes resistant strains of TB?
Not completing TB therapy
How is TB treated?
Rifampin, INH, and PZA
What is done for resistant TB?
Streptomycin IM
What are some nursing precautions for TB?
Airborne precautions, negative pressure room, respirator for patient contact
How long does it take a child to die from aspiration?
4 minutes
What foods should be avoided when considering aspiration in kids?
Grapes, small candy, carrots, BB’s, marbles, apple slices, beads/buttons/batteries, coins, hot dogs, PB, grapes, biscuits
When are back blows/chest thrusts used for aspiration?
Back blows for >1 year, chest thrusts for <1 year
When do you check for gag reflex?
Before and after a procedure
How can you prevent aspiration?
Don’t feed laying down, frequent burping, no powders
What is ARDS?
Increased permeability of the alveolar and capillary membranes causes edema
When does ARDS require an ICU stay?
Sepsis, cancer, marrow transplant
What nursing measures are needed if a child is in ICU due to ARDS?
Monitor closely, examine skin q2hrs, cardiac output, fluid/electrolyte balance, strict I&O (urometer), ABG’s, pulse ox, monitor nutrition (probably enteral/parenteral), ROM/exercise
What 3 injuries occur from smoke inhalation?
Heat damages the upper airway, chimical damage occurs deep in the tract, and systemic damage occurs from CO
How fast does CO bind to hemoglobin?
230 times faster than O2
What are the 3 stages of smoke inhalation and when do they occur?
Pulmonary insufficiency occurs within 12 hrs, pulmonary edema occurs in 6-72 hours, and bronchial pneumonia occurs after 72 hours
What CAN’T you use on kids suffering from smoke inhalation?
Pulse ox
What are some effects of passive cigarette smoke?
Increased respiratory problems/asthma, otitis media, LBW/preterm/stillborn, SIDS, lung disease as adults, and a decrease in fetal growth
What is asthma?
It is a reversible, reactive airway disease
What are the most common s/s of asthma in children?
Cough/night time, wheeze, SOB
What does it mean if a child is having daily asthma symptoms?
It is not well controlled
What 3 things occur during an asthma flareup?
Bronchospasm/constriction, inflammation, mucous production
What are some asthma triggers?
Lung/sinus/respiratory/ear infection, tobacco/wood smoke, strong odors, allergens, emotions, GERD, cold air, hard exercise
What is the key to treating asthma?
Know the triggers for each individual child
What are some warning signs of asthma?
Early: cough/worse at night, expiratory wheezing, listless, itchy eyes/throat/nose, grumpy, decreased appetite, drop in peak flow. Late signs: head bobbing, vomiting, anxiety, rescue med doesn’t help, drop in peak flow below 50% of peak
What does it mean if your child has blue lips or blue nails?
Call 911
Is bronchial constriction normal?
Yes, it is a normal reaction to foreign invasion. Asthma is an abnormally severe reaction
What is “Step 1” asthma and what is the treatment?
Step system used in kids 5 and older. Step 1 = mild intermittent asthma; defined as s/s occurring 2 days per wk (only 1 per day), and 2 nights per nomth. It is treated with rescue meds only
What is “Step 2” asthma and what is the treatment?
This is mild persistent asthma, and is defined as s/s 2 days per wk (1 per day at most) and more than 2 times a month at night. It is treated with low dose inhaled steroids
What is “Step 3” asthma and what is the treatment?
This is moderate persistent asthma, and is defined as daily symptoms, with symptoms at night greater than 1 per week. It is treated with low to medium dose inhaled steroids and long acting Beta 2
What is “Step 4” asthma and what is the treatment?
This is severe persistent asthma and is defined as continual symptoms during the day and frequently at night. Treatment is high dose inhaled steroids and long acting Beta 2
What is done after a treatment involving steroids?
Brush teeth, rinse/spit, wash face if mask used
What are some risk factors for asthma?
More common in boys before puberty, girls after puberty. Exposure to chemicals, parent with asthma, silicon exposure, LBW, obesity, GERD
What is usually used for long term asthma control?
Prednisone, methylprednisone
What meds is normally used as a rescue med for asthma?
Short acting Beta 2 like Proventyl, Ventalyn, Maxiair
What are some examples of long acting Beta 2’s?
Formoterol and Budesonide = Symbicort, Salmeteraol and Fluticasone = Advair Formoterol and mometason = Dulera
What is done for exercise induced asthma?
Use a rescue inhaler before exercise
What does status asthmaticus require and what is it?
Ventilation. It is an asthma attack that does not subside with treatment
What is done for status asthmaticus?
Epinephrine (Epi Pen) 0.01 mL/kg SubQ - Max dose is 0.03 mL/kg
Why use a spacer with inhaled steroids?
With a spacer, only 22% of the med reaches the lungs. Without it, only 9%
How long do you wait between puffs on an inhaler?
1 minute
What is CF?
Cystic fibrosis is an exocrine gland dysfunction that produces multisystem involvement. It is the most common genetic illness in children
How does CF affect the sexes differently?
Delayed puberty in females and sterility in males
CF is an _____ _____ trait that affects 1 in 4 of the offspring if both parent have the defect.
Autosomal recessive
What does CF cause (respiratory), and what is the treatment for it?
CF causes mechanical obstruction of the airways and is treated with giving the child a thumping
What else does CF affect besides the respiratory tract?
Pancreatic, reproductive, and digestive tracts
Why do CF patients develop anemia?
Lack of vitamins A, D, E, K (fat soluble)
What does inspissated mean?
To thicken or congeal (mucous).
What are some respiratory manifestations of CF?
Infection, difficulty expectorating secretions, decreased O2 exchange, hypoxia, pulmonary hypertension, cor pulmonale, failure and death
What is cor pulmonale?
Hypertrophy or dilation of the right ventricle
What pathogen can’t alveolar microphages destroy in CF patients?
Pseudomonas
How does CF affect the GI tract?
It impairs the absorption of proteins and fats, causing steatorrhea and azotorrhea
What test is used to determine if a child has CF?
Sweat test
What drug is used to stimulate sweating for the sweat test?
Pilocarpine
What are some manifestations of CF?
COPD, sweat gland dysfunction, FTT, weight loss, wheezing, dry cough, patchy atelectasis, clubbing repeated bronchitis/pneumonia, bulky/frothy/foul smelling stools, rectal prolapse, dehydration, alkalosis, hypoalbuminemia
How is CF managed?
CPT, bronchodilator, home IV antibiotics therapy, transplantation, steroids, replace pancreatic enzymes, high protein diet, salt
What is the prognosis for kids with CF?
Life expectancy of 36.5 years. Lung transplant = 75% at 1 year and 55% at 3 years
What is sleep apnea and what are the treatments for it?
Cessation of breathing for more than 20 seconds due to mechanical obstruction of the airway while sleeping. It is treated with CPAP/BIPAP or surgery
What are the classic s/s of respiratory failure?
Restlessness, tachypnea, tachycardia, diaphoresis
What happens if tachycardia turns into bradycardia?
Bradycardia is s/s of severe hypoxia, so you better act fast
What is a major cause of cardiac arrest in children?
Drowning
