resp part 2 Flashcards
what is BRUE
- brief resolved unexplained event
- previously known as a “life threatening event”
- typically lasts less than 1 min and resolves on its own
what are some symptoms of BRUE
- pale or cyanotic
- irregular, decreased, or absence of breathing
- changes in muscle tone (hypotonic or hypertonic)
- altered responsiveness
with BRUE, when would extensive testing be recommended
- high risk infants
- infants suspected of child abuse/maltreatment
- infection
- recurrent episodes
- fam history of genetic or metabolic conditions
someone brings a dead infant into the ED, whats your first priority
- family support
answer their questions, allow time with their baby to grieve, and offer resources
what is SIDS
- sudden death of an infant <1yr of age
- leading cause of infant mortality
- peak incidence in 2-4mo of age
what are some clinical manifestations of SIDS
- evidence of a struggle or change in position
- presence of frothy blood tinged secretions from the mouth and nares
- parents find the infant dead in the crib in the morning of after a nap
- no cry or disturbance while infant is sleeping
theres no definitive cause of SIDS, what are some risk factors?
- abnormality in medulla oblongata with neurotransmitter serotonin
- may interfere with brain stem mediated protective responses during sleep (arousal)
- uderlying vulnerability of infant (cardiac or neuro)
- cerebral oxygenation depressed in healthy infants with prone sleeping
- maternal smoking, alcohol intake, or substance abuse
- preterm or low birth weight
- native americans and black infants are at higher risk
what are some environmental risk factors for SIDS
- sleeping prone or side lying
- use of soft bedding
- overheating
- bed sharing
- second hand smoke
whats the #1 way to decrease incidence of SIDS
safe sleep practices
what are the 2015 AAP recommendations
- infants should sleep in the same room but not in the same bed, ideally for one year, at least for 6 months
- parent should spend time in skin-skin contact with newborns
additional:
- breastfeeding
- use of pacifier at naps/bedtime
- complete immunizations
- tummy time
- swaddling: up to 2mo, after sleep in sleep sack
what is plagiocephaly
molding of the head by continued pressure against a surface
how can plagiocephaly be resolved
rotating the side of the head the infant sleeps and by placing the infant prone while awake and being observed
describe SUIDS and how to prevent it
- sudden unexpected infant death
- not due to SIDS
- due to suffocation in pillow, bumpers, blankets
- no pillows, bumpers, or blankets in crib
- no stuffed animals in crib
- high incidence with co sleeping
- swaddling after 2 months, increases risk
whats the other name for croup
acute laryngotracheobronchitis
what is croup or LBT
- a viral invasion of upper airway extends through larynx, trachea, and bronchi
- inflammation of the mucosal lining of the larynx/trachea: narrowing of the airway
- most common under 6; peak between 7-36mo
what clinical manifestations would you expect to see with croup or LBT
- fever
- tachycardia
- barking seal like cough
- hoarseness
- dyspnea
- inspiratory stridor
- possible retractions
if a kid is in mild resp distress how are you gonna hydrate
oral fluids
if a kid is in moderate to severe resp distress how are you gonna hydrate
IV fluids
what are some nursing interventions for croup or LBT
- assessments and vital signs
- hydrations and I+O
- pulse ox and oxygen as ordered
- meds
- parents need to keep the kid calm
- education and discharge planning
priority intervention: do as little as possible
only hands on when necessary
describe giving nebulized epi (racemic epi) for croup or LBT
- alpha adrenergic effects causes vasoconstriction and decreases edema of cells
- beta adrenergic acts as bronchodilator
monitor afterwards for rebound symptoms
describe giving dexamathasone for croup or LBT
- anti inflammatory corticosteroid
- decreases airway edema
when do most kids go home with croup or LBT
- 24-72 hours
- viral illness lasts several days to several weeks
describe managing mild croup at home
- take outside and breathe in cold air/freezer; cold temps decrease edema in airway
- hydration and I+O
- calm parents = calm kid
- teach parent signs and symptoms of resp distress and who to call and where to go
what is epiglottitis
- inflammation of the epiglottis; upper airway
- edema is rapid… within minutes/hours
- potentially life threatening condition
- usual age range 3-7yrs
what are some symptoms of epiglottitis
- high fever
- high RR
- dysphagia
- dysphonia
- drooling
- dyspnea
- inspiratory stridor (late sign)
whats the clinical therapy for epiglottitis
immediate intubation and antibiotics
extubated in 1-2days and home for full course of antibiotics
what should you most definitely not do for someone with epiglottitis
do not obtain any cultures from throat if epiglottitis is suspect, any stimulation can trigger complete airway obstruction
also dont leave em unattended
what are some possible causes of epiglottitis
- H. influenzae, but may be staph or strep as well
- burning from hot liquids
- direct injury to throat
describe bronchiolitis
- RSV is the cause in majority of cases
- multiple other viruses may also cause
- annual epidemic from october to march
- particularly dangerous in infants and young children d/t small airway and other differences
describe the patho/phys of bronchiolitis
- RSV invades mucosal cells in bronchi and bronchioles
- invaded cells die when virus bursts from inside cell
- membranes of infected cells fuse with adjacent cells creating large masses
- cell debris obstructs bronchioles and irritates airway
- airway lining swells and produces excessive amounts of mucus
- airway obstruction results during expiration with bronchospasms
- air can come in but mucus and edema do not allow air out causing air trapping and hyperinflation of alveoli
- interferes with normal gas exchange = hypoxemia
what symptoms are associated with bronchiolitis
- wheezing
- moist cough
- nasal drainage
- retractions
- poor feeding
- dyspnea, tachypnea, tachycardia
will albuterol help with wheezing associated with bronchiolitis
nope
where are most children with bronchiolitis cared for
home
in what situations are children with bronchiolitis usually hospitalized
hx of congenital heart disease, lung disease, bronchopulmonary dysplasia, prematurity, congenital disorder, young age
whats used to diagnose bronchiolitis
- history and physical
- nasal swab is best practice
- CXR
will antibiotics help with bronchiolitis
nope
whats the plan of care with bronchiolitis
- assessments and vital signs
- cardiac/pulmonary monitor/pulse ox
- humidified oxygen
- nasal suctioning with nose drops
- elevate HOB
- hydration and I+O
- contact isolation for RSV, usually droplet til be know what it is
- acetaminophen/ibuprofen
- psychosocial care and education
whats the first intervention for kids with bronchiolitis
nasal suctioning with nose drops
what meds are used for bronchiolitis
nebulized hypertonic saline (3%)
Synagis (palivizumab)
antipyretics: acetaminophen/ibuprofen
corticosteroids, cough suppressants and antibiotics are not recomended for routine use
bronchodilators may be tried but there not support in literature
what does nebulized hypertonic saline (3%) do for bronchiolitis
- softens secretions, induces cough, reduces edema by absorbing water through mucosa, dislodges materials causing obstruction
- research demonstrated effectiveness and shorter hospitalization (AAP)
describe synagis (palivizumab)
- monoclonal antibody
- reduces RSV related hospitalizations
- IG1 antibody that neutralizes and inhibits RSV replication
- used for high risk infants
- IM (provide atraumatic care)
- first dose prior to start of RSV season and monthly IM until season finished (october through march)
whats the length of illness with bronchiolitis
- most symptoms abate within 24-72hrs
- resolution of all symptoms may take weeks
- some infants have repeated occurrences
- may increase risk for wheezing and the development of asthma
what are some symptoms of pneumonia
- high fever
- crackles in the affected lung
- dyspnea, tachycardia, tachypnea
- abdominal pain
- diarrhea
describe the difference between bacterial and viral pneumonia
bacterial
- get sick super quickly
- sudden high fever and rapid breathing
viral
- more gradual onset and less severe sx
what would be included in the plan of care for a child with pneumonia
- assessments and vital signs
- assist with lab studies/radiology
- oxygen therapy
- pulmonary care: cough and deep breathing (bubble bloing, pinwheels)
- antibiotics
- acetaminophen/ibuprofen for fever or discomfort
- hydration and I+O
- discharge planning: education regarding meds, signs and symptoms of resp distress
