Respiratory Flashcards

Question

BRUE

Answer 1

Refers to idiopathic or pathologic apnea occuring in infants >37 week gestation Involves significant intervention such as CPR

Answer 2

Apnea Change in color Change in muscle tone Choking, gagging or coughing

Answer 3

May include apnea, but can occur without apnea | Short periods of apnea <15 seconds can be normal at any age

Answer 4

May different tests, by exclusion: labs, upper GI, Ph probe, EEG, CT, EKG,CXR, skeletal muscle survey, PCG (pneumocardiogram to monitor respirations, HR, nasal airflow, O2), Polysomnography (sleep study, records brain waves)

Answer 5

If underlying problem is found: treat it | No cause: sent home for monitoring

Answer 6

Close and continuous monitoring Provide gentle tactile stimulation Educate and support the family

Answer 7

Teach home care: apnea monitoring, med admin, monitoring for A/E, CPR class for family members

Answer 8

The sudden death of an infant which remains unexplained after all known and possible causes have been carefully ruled out through autopsy, death scene investigation, and review of the medical history. Time of death occurs during sleep.

Answer 9

unknown Problems with the baby's ability to wake up (sleep arousal) Inability for the baby's body to detect a build-up of carbon dioxide in the blood

Answer 10

2-4 months of life

Answer 11

Takes 2250 lives each year, making it the leading cause of death from ages 1 month to 1 year. Increased incidence in winter. Increased occurrence in lower socio-economical class.

Answer 12

Reinforce with the parents that evidence based research has shown and proven that infants that are placed on their belly to sleep are at greater risk for SIDS. Prone sleeping may cause oropharyngeal obstruction or affect the thermal balance or the arousal state. Also rebreathing of CO2 while in the prone position may be a possible cause for SIDS Sleeping on soft mattresses or bedding may not be able to move their heads from side to side, and this increases their risk for suffocation and lethal rebreathing. Even lying baby on their side isn’t appropriate anymore.

Answer 13

``` Preterm infants Multiple births- where mother has been pregnant several times Low birth weight Low ABGAR scores Recent viral illness Hx of ALTE or AOP Siblings of SIDS victims Males African Americans, Native Americans, Hispanics all have a greater risk for SIDS ```

Answer 14

``` are placed in supine position to sleep sleep in their own crib sleep on firm mattresses are breast fed are put to sleep with pacifier • are immunized ```

Answer 15

A (alone), B (back), C (crib), S (smoking) Healthy infants on back to sleep No soft bedding, baby crib bumpers, blankets, quilts or pillows anywhere in your baby’s sleep area. Use a firm sleep surface, such as a mattress in a safety-approved crib, covered by a fitted sheet. No stuffed animals or towels while sleeping. Keep soft objects, toys, and loose beefing out of baby’s sleep area. Infant to sleep in same room as caregiver. No co-sleeping though. Baby should NOT sleep in an adult bed, on a couch, or on a chair alone, with you, or with anyone else. Infant should sleep in own bed/crib Do not let baby get too hot; dress infant in light clothing. Make sure nothing covers the baby’s head. Dress baby in sleep clothing, such as a one-piece sleeper, and don’t use a blanket. Change the position of the baby’s head to prevent flattening of the baby’s skull (called positional plagiocephaly) Offer pacifier during naps and at bedtime, the research has shown that it decreases the risk for SIDS Encourage breastfeeding for as long as possible Schedule and go to all WCC Have child immunized Don’t smoke or let anyone smoke around your baby.

Answer 16

Generally no attempt at resuscitation due to signs of prolonged death: rigor mortis, corneal clouding Once EMS arrives, they notify coroner of time of death. Arrival at the ER Questioned by MD and police officers- must perform an autopsy Returning home without the child Provide compassionate care- grieving lasts a year Support Parents- make sure they get involved in a support group

Answer 17

“common cold”, and like most viruses it usually lasts 7-10 days

Answer 18

``` Rhinovirus RSV Adenovirus Influenzavirus Parainfluenzavirus ```

Answer 19

``` Fever Irritability Restlessness Sneezing Post nasal drip Cough Diarrhea Runny or dry nose- make sure to keep their nose clean and dry. Decreased appetite ```

Answer 20

``` Sneezing Chills Muscular aches Post nasal drip Cough Dry throat Runny or dry nose Decreased appetite ```

Answer 21

Eyes- red, puffy Nose- red, swollen, make sure their not flaring Mouth- cough Throat- red, sore Respiratory effort- make sure breathing effectively, rising and falling appropriately, and not retracting Lung sounds- check for adventitious sounds V/S- especially her RR SPO2: make sure its at least 92% on room air, if not give supplemental O2

Answer 22

Impaired breathing pattern related to presence of semi- thick nasal discharge Acute pain related to inflammation of the throat Ineffective airway clearance related to thick secretions characterized by difficulty in breathing Imbalance nutrition less than body requirements related to respiratory distress AEB..... Knowledge deficit related to not familiar with the sources of information

Answer 23

Elevate HOB at least 30 degrees Maintain adequate fluids- because they’re at risk for dehydration Suction nares PRN, especially before she goes to bed and before she eats Saline nose drops before feeding and sleep, and before suctioning Humidification- will help thin secretions Tylenol/Ibuprofen- if still running a fever Promote rest- something is very wrong if a child doesn't want to play

Answer 24

``` Decrease work of breathing Increase Spo2 Less or no pain Decrease temperature Maintain fluid balance Increase PO intake Sleep through the night ```

Answer 25

``` Effectiveness? Did suctioning help? Nose clear? Breathing easier? Flaring or retracting? SPO2? HOB elevated? Were goals achieved? ```

Answer 26

Treating symptoms at home (how to use medications) Importance of hand washing When to go to the ER Warm against OTC cough medications for less than 6yr/o (proven to be ineffective and can be harmful; causing heart palpitations, hyperactivity, and even death, and worsen asthma)

Answer 27

Inflammation of the throat with exudate that can cause pain when swallowing Can occur at any age. Average age of occurrence 5-10 years Viral or bacterial (Group AB Hemolytic Streptococcus/GABHS)

Answer 28

``` Inflamed throat Strawberry tongue Exudate Pain when swallowing Headache Fever Abdominal pain Cervical lymphadenopathy Sandpaper rash: face,trunk, axillary perineal/ Scarlet fever ```

Answer 29

``` Throat Respiratory effort Lung sounds V/S: Temp., HR, RR, B/P SpO2 Skin Pain ```

Answer 30

Must do throat swab!! Quick Strep/Rapid Antigen Test Throat Culture

Answer 31

Must be treated with ABX: Penicillin or Amoxicillin Allergic to penicillin may use a cephalosporin such as cephalexin (Keflex), Clarithromycin (Biaxin), Azithromycin (Zithromax, Zmax), or Clindamycin

Answer 32

``` Monitor V/S Monitor I & O’s Monitor Pain Administer IV ABX as ordered Cold/warm compress to neck Warm saline gargles Encourage fluids Recommend soothing /soft foods Humidification Encourage low level activities ```

Answer 33

Disease transmission and prevention High contagiousness of this condition Importance of hand washing Make sure the child does not return to school until they have been on ABX for a full 24 hours Importance of giving the child ABX until finished No sharing utensils No eating or drinking after others Change out toothbrush after 24 hours of being on ABX

Answer 34

Usually occurs 2-6 weeks after pt. infected with GABHS ASO titers done Treated with PCN Prophylactic treatment required and depends on age of child and severity of condition

Answer 35

Most common post-infectious renal diseases in childhood ASO titers done Symptomatic treatment

Answer 36

Inflammation/infection of the tonsils Occurs most often with pharyngitis May be viral or bacterial

Answer 37

Early rapid strep test/throat culture to determine causative agent

Answer 38

Red, inflamed, enlarged, touching tonsils aka “kissing tonsils”, difficulty swallowing and breathing. Breathe through mouth because the adenoids enlarge and block the space between the posterior nares making it difficult or impossible for air to pass from the nose to the throat

Answer 39

Depends on causative agent | warm, salt water gargles, throat lozenges, Tylenol if patient in pain

Answer 40

Severe Remove the palatine tonsils and it will be nurse’s job to prepare them for surgery and monitor child post-op Prepare children Child comes back to surgery: placed on their side or in a prone position with their head to the side to facilitate the drainage of the secretions Careful suctioning as needed Avoid coughing and blowing nose Reddish brown secretions are normal Bright red blood is not normal and surgeon needs to be be notified immediately Watch for bleeding for up to 10 days post-operatively each the family and the patient to avoid red colored liquids and milk based foods (because they increase the production of mucous) initially Advance from a clear, soft diet to a regular diet. D/C instructions include teaching pt to avoid irritating and spicy foods, avoid gargles and vigorous tooth brushing, avoid coughing or clearing throat, avoid using straws and chewing gum, how to take medication appropriately to control pain/discomfort.

Answer 41

Humidification Warm salt water gargles Throat lozenges

Answer 42

Tylenol | Antibiotics if bacterial

Answer 43

Recurrent infections/obstructive sleep apnea

Answer 44

Room set up

Answer 45

Positioning: abdomen/side lying Monitor for bleeding Minimize activities that precipitate bleeding Monitor I & O’s

Answer 46

Inflammation of the middle ear Most prevalent diseases of early childhood Increase incidence between 6 months and 2 years Breast feed have a lower incidence than those who bottle feed, related to positioning of the baby. If parents have a history of otitis media, their children will be at greater risk for it. Children who are around passive smoke, in a household with many members, attend day care, cleft lip/palate, have Down’s Syndrome, are at increased risk for it. Most common in winter months

Answer 47

Environmental | Life style factors

Answer 48

Bacterial/ viral infection Allergies Enlarged tonsils

Answer 49

blocked Eustachian tubes from edema

Answer 50

Bacterial infection that causes inflammation of the middle ear space with rapid onset. It is generally caused by Streptococcus Pneumonia, H.Influenza, and Marxella Cateralis. Usually follows an upper respiratory infection.

Answer 51

``` Painful ear Pulling or rubbing the ears Fever Fussiness or irritability Fluid leaking from the ear Changes in appetite or sleep Trouble hearing ```

Answer 52

Made by a visual inspection with otoscope of tympanic membrane to check for its mobility. Done by MD or Np

Answer 53

``` Tylenol/Ibuprofen Benzocaine Cold packs ABX- usually Amoxicillin Surgery ```

Answer 54

Relieving pain either with Tylenol or Tylenol with Codeine, ice pack, or Ibuprofen, or Benzocaine Facilitate drainage when possible, prevent complications of recurrence

Answer 55

How to hold the baby during feeding, making sure the child is sitting upright, discourage propping of bottle, encourage breastfeeding Maintain immunization Decrease exposure to smoke May need surgical intervention may also need a tympanostomy, tube placement, and also an adenoidectomy procedure to treat recurrent chronic otitis media. 3 bouts in 6 months, 6 and 12 months, or 6 by 6 years of age.

Answer 56

Generally caused by middle ear infections, may lead to “glue ear”, which is OME, where sticky fluids build up and affect the child’s hearing. May also lead to unclear speech and behavioral problems.

Answer 57

OME may have no symptoms at all Most frequent presentation is covert and overt hearing loss, which mostly fluctuates with season and may be affected in changing position Plugged ear or a stuffy or wooly feeling in the air Child is talking loudly or not responding to verbal commands Have their music/tv turned up really loud. No c/o pain. No fever. Speech delay. Sometimes it can be detected on routine audiometry.

Answer 58

Visualization of tympanic membrane and use of an otoscope to test for mobility of the tympanic membrane

Answer 59

Bilateral myringotomy/PE (pressure equalizing) tubes, surgical placement of tympanostomy tubes (takes only 15 minutes and usually the tubes come out on their own in 6-12 months)

Answer 60

General term applied to a symptom complex characterized by hoarseness, a resonant cough, described as “barking” or “brassy” (croupy), varying degrees of inspiratory stridor, and varying degrees of respiratory distress resulting from swelling or obstruction in the region of the larynx and trachea Affect the larynx, bronchi, and trachea. Croup syndromes are described according to the primary anatomical area affected

Answer 61

Serious obstructive inflammatory condition Predominately in children ages 2 years to 5 years old- but can occur from infancy through adulthood. H. Influenza B is the main culprit- bacteria Considered a medical emergency due to fast onset Epiglottitis looks worse than they sound, there’s a high degree of toxicity, no cough, and dysphagia

Answer 62

Sudden abrupt onset of: heigh fever >39 C, Sore, red, swollen throat, Absence of cough The 4 D’s ▪ Dysphonia- a muffled, hoarse, or absent voice. ▪ Dysphagia- difficulty swallowing due to the pain ▪ Drooling- also due to the pain ▪ Distressed respiratory effort- inspiratory stridor as the larynx becomes obstructed Agitation/Irritablity Tripod position- the child may insist on sitting upright and leaning forward, with the chin thrusted out, mouth open, and the tongue protruding Expiratory Stridor

Answer 63

Clinical manifestations Radiography- a lateral neck x-ray, which will show a thumb sign from an enlarged epiglottis Blood cultures- to show what antibiotic to use

Answer 64

``` Avoid looking in mouth without emergency equipment readily available Calm environment Encourage position of comfort Let caregiver stay with child Emergency intubation/tracheostomy if child is in severe respiratory distress Humidified oxygen Antibiotic therapy Corticosteroids ```

Answer 65

``` Frequent assessments Continuous cardiopulmonary monitoring Maintain airway patency NPO IV fluid administration as prescribed ABX Provide emotional support Discharge planning- home teaching includes completing a 7-10 day course of antibiotics. For children under the age of 4 years, Rifampin is used for treatment for 4 days. ```

Answer 66

Most common of croup syndromes affecting children < 5 years of age Mostly caused by para-influenza virus types 1 & 2, RSV, influenza A & B*** Usually starts as an upper respiratory tract infection that descends to adjacent structures Inflammation and swelling of the mucosa lining, the larynx, and trachea causes a narrowing of the airway that result in the onset of the classic symptoms like the croupy, barking cough They sound worse than they look, have a seal-like cough***

Answer 67

Gradual onset of low grade-fever- *** Ill with URI for several days- see a runny nose or cough that’s escalated into a severe cough with hoarseness (because the inflammation of the trachea and larynx is causing severe swelling) Inspiratory stridor Seal like barking cough and hoarseness Tachypnea

Answer 68

Clinical signs and history Cardiopulmonary monitoring and SPO2 for hypoxemia Chest x-ray

Answer 69

Humidification, Medications- (IV therapy for hydration and steroids for inflammation), O2 therapy Observation in ER, sent home if showing good response to treatment. Encourage fluids if mild symptoms to prevent dehydration Uncommonly – children will need intubation and be sent to ICU. Admitted if moderate to severe symptoms. If LTB is severe, nebulized Epi is often used in children with severe disease, stridor at rest, retractions, or difficulty breathing, administration of Heliox is used to decrease the work of breathing and relieve airway obstruction.

Answer 70

Oxygen therapy & Closely monitor pulse oximetry- to monitor O2 status Nebulized epinephrine- to help with stridor Corticosteroids IV therapy Placing patient on NPO status for RR > 60/ minute, because this puts them at risk for aspiration ABG/VBG monitoring for acidosis Accurate & frequent assessments- continuous vigilant observation & accurate assess of respiratory status because changes in therapy are performed based on your observation as a nurse, child’s response to the therapy, and tolerance of the procedure. Early signs of airway obstruction include increased pulse, RR, sub-sternal, supra-sternal, and intercostal retractions, nasal flaring, and increased restlessness Intubation equipment readily available & patient’s code drugs listed on a sheet and readily available

Answer 71

Maintain airway patency, meet fluid & nutritional needs, discharge planning, home care teaching Home care includes monitoring for worsening of symptoms, continued humidity, adequate nutrition/nourishment

Answer 72

Ineffective breathing pattern related to tracheobronchial obstruction, decreased energy and fatigue Impaired gas exchange related to altered O2 supply Altered nutrition: less than body requirements related to expenditure of glycogen stores and inadequate food and fluid intake prior to admission Fear/anxiety in parents or child related to acute illness, uncertainty of prognosis, unfamiliar surrounds and procedures Knowledge deficits in parent- related to diagnosis, prognosis, treatment, and home care needs

Answer 73

Inflammation of the large airways Usually follows an URI in children < 4 years of age Usually caused from virus Self-liming, child recovers with symptomatic treatment within 5-10 days

Answer 74

Course, hacking, dry/non-productive cough with increased severity at night, may turn productive in 2-3 days Audible wheezing

Answer 75

Antipyretics- if they do run a fever Analgesics- such as Tylenol and Ibuprofen Humidity- help with inflammation Hydration Cough suppressants (caution: can interfere with clearing secretions, don't used under 6yr)

Answer 76

An acute viral infection, mostly caused by Respiratory Syncytial Virus (RSV) Primarily affects the bronchi and bronchioles Rare in children > 2 years of age Occurs most often in winter and early spring Affects boys more than girls

Answer 77

URI (upper respiratory symptoms such as rhinorrhea, pharyngitis, cough, and fever) Progress to lower tract, more cough, labored breathing, shallow respiration, nasal flaring, retractions, cyanosis Child acting more ill, may refuse to eat, spits up more May also have emphysema, increased nasal mucous, wheezing, fever Apnea may be the first recognized indicator of RSV infection in infants < 1 month of age

Answer 78

Most frequent cause of hospitalization in children less than 1 year old Peak infection season is November – April Transmitted through direct person-person contact & by droplet inhalation

Answer 79

Primarily supportive, unless high risk give Synagis prophylactically

Answer 80

Infants born before 35 weeks of gestation, infants with chronic lung disease, and infants born with hemodynamically significant congenital heart disease

Answer 81

Only product available in the US used for the prevention of RSV infection It’s a monoclonal antibody and is given monthly in an IM injection to prevent hospitalization of patients who are at high risk for developing RSV It can be given in 3 or 5 doses depending on patient and severity

Answer 82

Edema of bronchioles and thick secretions Obstruction and hyperinflation Increased respiratory effort=respiratory distress Respiratory Failure

Answer 83

``` Fever Cough Tachycardia Cyanosis Tachypnea Retractions Wheezing Sepsis like appearance Apneic episodes (in the very young) Dehydration ```

Answer 84

Rapid RSV antigen testing done via nasal aspirate or nasal wash or nasopharyngeal swab Chest X-Ray

Answer 85

Ineffective airway clearance related to increased airway secretions, fatigue from coughing, dyspnea, air trapping Ineffective breathing patterns related to inflamed tracheobronchial tree and progression of bronchiolitis, increased work of breathing and decreased energy Fluid volume deficit r/t inability to meet fluid needs and increased metabolic demands Altered tissue perfusion r/t partially obstructed airways

Answer 86

Separate rooms or grouped with other RSV infected children Contact and standard precautions Maintaining respiratory function Supporting overall physiologic function Hydration Reducing child’s and family’s anxiety Preparing child and family for home- teaching them about med administration, symptoms of RSV, and when to call doctor

Answer 87

Inflammation of the pulmonary parenchyma or infection in one or both lungs is common in childhood but occurs more frequently in early childhood May occur as a primary disease or as a complication of another illness Caused from virus, bacteria, fungus or aspiration

Answer 88

``` Fever-Usually high > 39.5 C (103 F) Respiratory: • Cough • Tachypnea • Rhonchi • Crackles • Chest/abdominal pain • Retractions • Flaring • Pallor Behavior: • Irritable • Restless • Lethargic Gastrointestinal: • Anorexia- doesn’t want to eat • Vomiting • Diarrhea ```

Answer 89

Respiratory assessment, and a continuous assessment Monitoring: VS and pulse oximetry Administration of supplemental oxygen as ordered IV fluids- to prevent dehydration Antibiotics- depending Pharmacological/non-pharmacological pain relieve measures Elevate HOB to get good chest expansion Possible Chest tube placement- to remove fluid or air that’s accumulated in the lung Daily chest x-rays Provide calm environment- allow for presence of caregivers as they provide a source of comfort for patient Teach and support patient/family, prepare for d/c- teach regarding O2 needs, medication needs, positioning

Answer 90

Chronic inflammatory disorder of the airways characterized by: Recurring symptoms Airway obstruction Bronchial hyper-responsiveness

Answer 91

Exact cause is unknown Allergies Frequent viral respiratory infections

Answer 92

Eczema starting in the early months Frequent lower respiratory symptoms Respiratory problems appearing before the first birthday Having a family history of asthma

Answer 93

Classic manifestations: Dyspnea, Wheezing, Coughing History/Physical Exam: ➢History of chronic cough with absence of infection ➢Diffuse expiratory wheezing PFT Incentive spirometry PEFR Bronchoprovocation testing Skin prick testing and immunological testing Laboratory tests Frontal and lateral view chest X-ray

Answer 94

Provide an adjective measure of evaluating the presence and degree of lung disease as well as the response to therapy

Answer 95

Performed reliably on children 5-6 years of age

Answer 96

Measures maximum flow of air that can be forcefully exhaled/second

Answer 97

For allergen specific IgE, used to ID environmental triggers

Answer 98

``` Cough Shortness of breath Audible wheeze Malar flush, red ears Cyanosis of nail beds Circumoral cyanosis Dyspnea Nasal flaring Retractions Hyperresonance on chest percussion Coarse and/or crackles and wheezes throughout all the lung fields Sweating Posture/ tripod position Changes in speech Restlessness Anxiety Fatigue ```

Answer 99

Airway potency, RR, symmetry, effort, and use of accessory muscles, breath sounds in all lung fields

Answer 100

Child who sweats profusely, remains sitting upright, and refuses to lie down is in severe respiratory distress!!! Pay close attention to this child and have emergency equipment readily available A child who suddenly becomes agitated or an agitated child who suddenly becomes quiet may have serious hypoxia and require immediate intervention

Answer 101

Allergens: indoor (dust mites, mold, etc.) and outdoor (trees, pollen, pollution, etc.) Irritants (tobacco or wood burning smoke, odors, sprays) Exercise Sudden weather or temperature changes (extreme cold or hot) Seasonal allergens (grass, trees, weed pollen) Animal dander Strong emotions Food Medications

Answer 102

Step 1. Mild intermittent- Symptoms occur < twice a week Step 2. Mild persistent- Symptoms occur more than twice a week, but not daily Step 3 or 4: Moderate persistent- Daily symptoms occur in conjunction with exacerbations twice a week Step 5 or 6: Severe persistent- Symptoms occur continually, along with frequent exacerbations twice a week

Answer 103

Prevention and reduction of exposure to airborne allergens and irritants Nurses Role: Family and patient teaching on “Allergy proofing the home and community”

Answer 104

Preventing and controlling asthma symptoms Reducing the frequency and severity of the child’s asthma Reversing airflow obstruction Providing long term suppression of inflammation

Answer 105

``` Bronchodilators used to treat symptoms and exacerbations. Include SABA Prevent exercise induced asthma Only taken PRN Albuterol Xopenex Terbutaline Metaproterenol ```

Answer 106

Achieve and maintain control of inflammation Used daily to control and reduce the number of day or night symptoms Not used for relief Symptoms more than 2x/week or who wake > 2x/month should be on a controller medication. Inhaled corticosteroids: QVAR, Pulmicort, Flovent Long acting bronchodilators (LABA): Salmeterol Leukotriene Receptor Agonists Methylxanthines: Theophylline

Answer 107

Metered-dose inhalers, Dry powder inhalers, Liquids that can be used in nebulizers, Pills

Answer 108

Severity and frequency of symptoms Child’s age Child’s developmental level Child’s coordination- must be able to push down on inhaler and breathe in at same time

Answer 109

``` Corticosteroids Cromolyn sodium Nedocromil sodium Xopenex Albuterol Metaproterenol Terbutaline Salmeterol (Serevent) Methylxanthines (theophylline) ```

Answer 110

shakiness, tremors, tachycardia, hyperactivity

Answer 111

thrush, modest reduction in height

Answer 112

``` Observe for signs of trouble breathing Teach family on how to avoid allergens Take medications appropriately and caution with A/E and dangers of over use of SABA/LABA Monitor for medication toxicity while in hospital (shakiness, irritability, jitteriness, increased HR) Show how to use PEFM in child >5yr Provide supportive environment At home action plan Have Epipen for severe allergic reaction ```

Answer 113

Shortness of breath with air movement in the chest restricted to the point of absent breath sounds accompanied by a sudden rise in respiratory rate is an ominous sign indicating ventilatory failure and imminent respiratory arrest Not hearing any air movement Continue to display respiratory distress despite vigorous therapeutic treatment with bronchodilators such as Albuterol and Epinephrine are considered to be in Status Asthmaticus.

Answer 114

A life threatening episode of airway obstruction, unresponsive to common treatment Medical Emergency Can result in respiratory failure and death if untreated It may develop gradually or rapidly

Answer 115

``` Improving ventilation Decreasing airway resistance Relieving bronchospasms Correcting dehydration and acidosis Allaying child and parent fears/anxieties by providing a quiet, calm, family-centered environment ```

Answer 116

Maintain patent airway Administer humidified O2 Administer 3 neb tx of a beta2-agonist, 20-30 apart (usually Albuterol) Obtain IV access: hydration and to correct acidosis, IV Epi/Magnesium Sulfate Monitor ABGs and serum electrolytes Administer corticosteroids, either PO, IV, or IM to help with inflammation Prepare for emergency intubation if patient goes into respiratory distress Have crash cart, code sheet and code drugs readily available Establish calm environment, allowing parent presence at all times

Answer 117

Chronic autosomal recessive disorder of the exocrine glands. It is the most common inherited metabolic disorder Thick and copious mucous obstructs the small passageways of the affected organs

Answer 118

Inherited as an autosomal recessive trait Mutated gene for CF is located on the long arm of chromosome 7. It codes for a protein of 1480 AA called CF-Transmembrane Regulator

Answer 119

Bronchial – chronic bronchial pneumonia, emphysema Small intestine – meconium impaction, bowel obstruction Pancreatic duct – malabsorption syndrome Bile duct – biliary fibrosis, portal hypertension

Answer 120

Average age of dx is 14 months 2 Positive sweat chloride tests: a consistent finding of abnormally high NaCl concentrations in the sweat is a unique characteristic of CF: Normal < 40 Meq/L Positive > 60 Meq/L in children >40 Meq/L in infants Chest Radiography: patchy atelectasis, obstructive emphysema Positive family history 72 hour stool sample- steatorrhea (undigested fats), azotorrhea (foul-smelling stools) Enzyme Analysis- Absence of pancreatic enzymes

Answer 121

``` Thick, sticky mucous Bowel obstruction (newborn) Intussusception (telescoping bowel) Impaction in infants and toddlers Chronic cough Difficulty in gaining weight FTT-failure to thrive Skin is salty ```

Answer 122

Steatorrhea (fatty), frothy, foul smelling, floats. This is because in the pancreas, the thick secretions block the ducts, which eventually causes pancreatic fibrosis. This blockage prevents essential pancreatic enzymes from reaching the duodenum, which causes marked impairment in the digestion and impairment of nutrients.

Answer 123

1. Prevent or minimize pulmonary complications 2. Ensure adequate nutrition for growth 3. Encourage appropriate physical activity 4. Promote a reasonable quality of life for the child and family, which will require a multi-disciplinary approach

Answer 124

to treat pulmonary infections

Answer 125

Very important and is a good adjust to daily ACT. Remember exercise stimulates mucous excretion and provides a sense of well-being and increased sense of self-esteem.

Answer 126

Improve ventilation. These may be given in an aerosolized form to open up the bronchi foreasier expectoration. These are administered before percussion and postural drainage, especially when patient is exhibiting signs of active airway disease or wheezing.

Answer 127

Remove mucopurulent secretions. Another aerosolized medication that’s popular is DNase or

Answer 128

New drug First drug for cystic fibrosis directed at treating the cause of the disease in people who have two copies of a specific mutation For 12yr/o + who have F508del mutation, which causes the production of an abnormal protein that disrupts thow water and chloride ar transported in the body

Answer 129

Improve ventilation and remove mucopurulent secretions Performed 2x a day: upon rising and in the evening, more frequently when they have an infection Perform at least 30 minutes after meal to prevent N/V ➢Chest Percussion Therapy ➢ Postural drainage- kids like wheel barrow pose, walk on their hands & you hold their feet, works great! ➢ Flutter mucous clearance device ➢ Positive expiratory pressure or PEP devices ➢ Active-cycle-of-breathing techniques ➢ High frequency chest compression

Answer 130

Pancreatic Enzymes- should be taken at the beginning of the meal and should be taken WITH IN 30 minutes of eating. These can be swallowed whole or sprinkled on food. Encourage well-balanced, high protein, high calorie diet due to their impaired intestinal absorption Fat soluble vitamins: A, D, E, K given in water soluble form for easy digestion Prevent/treat constipation- treat with laxatives or stool softener

Answer 131

Diabetes mellitus (DM) or Cystic fibrosis related diabetes (CFRD) is greater in children with CF than in general population. CFRD is the most common complication associated with CF. By age 30 years, approx. 50% of people with CF will develop diabetes Close monitoring of blood glucose levels is imperative

Answer 132

Main goal also is to prevent respiratory infection Continuous assessment of Respiratory, GI and Endocrine system Provide supplemental oxygen as needed Provide ACT therapy/ but not before meals or immediately after meals, to avoid inducing N/V Administer pancreatic enzymes with all meals and snacks Teaching regarding consuming a high calorie, high protein diet, medications, therapy Encourage compliance with therapeutic medication and diet regimen

Answer 133

Long disease process Persistent need for treatment Child and family activities are built around treatments- so always involve family around treatment plans Life long medications expensive Poor prognosis: increased survival rates due to lung, heart, pancreas, and liver transplantation, mean age of life: 38yr, progressive and incurable Encourage support groups Anticipatory grieving- it’s a long disease process and life-long medications become very expensive

Answer 134

BPD can be mild, moderate, or severe. Diagnosis depends on how much extra oxygen a baby needs at the time of his or her original due date. It also depends on how long the baby needs oxygen therapy.

Answer 135

Affects infants who are born early- usually more than 10 weeks before their due dates- and still need oxygen therapy by the time they reach their original due dates are diagnosed with broncho-pulmonary dysplasia (BPD).

Answer 136

Chest x ray- shows: alveolar damage, inflammation lungs, and scarring of lungs Blood work- to rule out infection Echocardiogram- to rule out pulmonary HTN

Answer 137

Pathologic process related to alveolar damage from lung disease, prolonged exposure to high peak inspiratory pressures, antimatter alveoli and respiratory tract.

Answer 138

Mortality is 10-25%

Answer 139

``` Dyspnea Barrel chest Inability to wean from ventilator following a course of respiratory distress syndrome Wheezing Cyanosis Irritability Nasal flaring Retractions ```

Answer 140

``` Administer maternal steroids Administer exogenous surfactant post-natal ● Use nasal CPAP Prevent air leaks Use high frequency ventilation Maintain adequate oxygenation Administer bronchodilators Administer diuretics Administer immunizations ```

Answer 141

Monitor oxygen saturations and VS closely Avoid hypo/hyperoxemia. So anticipate ABG or VBGs to be done routinely. Cluster care, provide infant additional time to rest Observe for signs of fluid overload or pulmonary edema Assist in preventing upper respiratory infections- includes judicious hand washing and PPE when indicated Provide increased calorie feedings with human milk fortifiers or protein supplements

Answer 142

Home ventilatory need Medications, and their AE Immunizations- go to all well child check ups Preventing respiratory infections and frequent hospitalizations

Answer 143

Almost exclusively in preterm infants. Most common lung problem in a premature baby. The name is applied to respiratory dysfunction in the neonate and is primarily a disease related to developmental delay in lung maturation. Deficiency in pulmonary surfactant in the infants immature lungs. Surfactant is a substance that keeps the tiny air sacs in the lungs open. Responsible for more infant deaths than any other disease. Carries the highest risk in terms of long term respiratory and neurologic complications.

Answer 144

``` Tachypnea (> 60 breaths/min) Dyspnea Nasal flaring Retractions Grunting Fine inspiratory crackles Cyanosis and/or pallor Chest X-ray which shows common characteristics (diffuse granular pattern over both lung fields, resembles ground glass and represents alveolar atelectasis, Dark streaks representing dilated air-filled bronchioles) ```

Answer 145

``` Use of warmer Close monitoring Pulse oximetry and blood gas monitoring O2 therapy with CPAP Surfactant Administration Minimize unnecessary physical stimulation Positioning to facilitate breathing Teach parents CPR and home monitoring ```

Answer 146

Maintain adequate ventilation and oxygenation Maintain acid-base balance Maintain a neutral thermal environment Maintain adequate tissue perfusion and oxygenation Prevent hypotension Maintain adequate hydration and electrolyte status

Answer 147

Assisting in the delivery of the product Collecting and monitoring of arterial blood gases Continuous monitoring of oxygenation with pulse oximetry Assessment and documentation of the infants tolerance of the procedure

Answer 148

May be administered at birth as a preventative or prophylactic treatment of RDS or later in the course of RDS as a rescue treatment. Studies have shown that early administration of surfactant decreased the overall incidence of BPD, need for mechanical ventilation, and fewer air leaks.

Answer 149

Assisting in the delivery: infant is temporarily intubated, surfactant is administered down the endo-tube, give supportive O2 Turn baby from one side to other for the medication to get farther down into the alveoli, then extubated, then on supplemental O2 Collect ABG, continuous monitoring of O2 Assessment and documentation of infants tolerance of the procedure

Answer 150

Swallowing of small items getting lodged in the bronchi

Answer 151

Sudden, violent coughing, gagging, wheezing, vomiting, brief episode of apnea, cyanosis Not talking Can die with in 4 minutes if nothing is done

Answer 152

Good history Physical Exam X-ray Endoscopy can be diagnostic and therapeutic if ever there was a doubt about foreign body obstruction. Foreign bodies are rarely coughed up and must be removed by endoscopy

Answer 153

Removal of object via back blows and chest thrusts in infants, abdominal thrusts in children, or endoscopy Keep environment and child quiet until object removed

Answer 154

Foods, secretions, or liquids enter the lung and cause inflammation and chemical pneumonitis. Difficulty swallowing, unable to swallow because of paralysis, weakness, or congenital anomalies, or an absent cough reflex, or in a child who is force fed especially if they’re crying or breathing rapidly, and tracheoesophageal fistula are at high risk for aspiration.

Answer 155

Increasing cough, fever, foul-smelling sputum, decrease in oxygenation, and evidence of chest infiltrates on a chest x-ray.

Answer 156

O2 administration as needed Elevate HOB at least 30-45. If they are at risk for vomiting or can’t protect their airway, then put them in side lying position Encourage slow, frequent feeding Positioning Antibiotics if infection present Safety teaching- teach parents how to prevent aspiration pneumonia

Answer 157

Direct exposure of mucous membranes to a suspected antigen at increasing concentrations. This helps identify allergens.