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Peds Exam 2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is asthma?

A

Inflammation/Edema, spasms, and mucus

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2
Q

What are the triggers? 13 of them

A 
anger and stress
pet dander
pollen and molds
exercise
cold air
strong odors
pollution
smoke
dust
chemicals 
bugs in the home
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3
Q

What are the risk factors for asthma?

A

Host Factors–
Age– Heredity– Gender– Obesity– Ethnicity
Environmental Factors–
Allergens– Infection– Tobacco Smoke– Indoor/outdoor air pollution– Diet

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4
Q

What are the clinical manifestations of asthma?

A

Dyspnea, Cough
Expiratory wheezing, Prolonged expiratory phase

Diaphoresis
Anxious expression, restlessness
Setting position

Signs of respiratory distress; nasal flaring, cyanosis, intercostal retractions, coarse rhonchi

Paroxysmal, hacking, & nonproductive cough at onset; becomes rattling and productive of clear sputum

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5
Q

How do we prevent asthma attacks?

A

avoid triggers - environmental allergens

  • air conditioning
  • -humidify air 30-50%
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6
Q

What are maintenance drugs for asthma?

A

cortico steroids- QVAR, Pulmicort, flovent

Long acting beta adrenergic agonists - advair, serevent

Mast cell stabilizers - cromolyn

Leukotriene inhibitors - singulair

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7
Q

What are the rescue medications for asthma

A

short acting beta 2 adrenergic agonists/bronchodilators - proventil, xopenex, albuterol

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8
Q

What does stop light mean?

A

monitors FEV compared to personal best
Green light FEV is between 80 - 100%
Yellow light FEV between 79 - 50%
Red light 50 % or below

yellow means monitor more closely, be aware of s/s you may need more medication

Red means you need to use rescue medications and call the provider

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9
Q

What are Nursing Interventions For Asthma Exacerbations?

A

High Fowler’s Position
O2
Teach child to use diaphragm to pull in and expel air Control Panic
Administer Rescue Drugs

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10
Q

What do we teach parents and children about using an inhaler?

A 
Sit up tall
shake the medication
exhale completely
put mouth to device 
compress it and inhale deeply, hold for 10 sec.,repeat
rinse out your mouth
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11
Q

When should you use a spacer?

A

When patient lacks dexterity to compress the canister and breath deeply simultaneously, they do not need to hold for 10 second just take 10 good breaths through he spacer

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12
Q

When do you use a face mask?

A

When the child cannot form a good seal around the mouthpiece of the device

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13
Q

What test Dx CF?

A 
Pilocarpine electrophoresis
sweat chloride test
result greater than 60 is positive
can also test stool for fat
DNA of chorionic villi or amniotic fluid prenatally
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14
Q

What does CF do at the cellular level?

A

It disrupts the normal function of the exocrine glands related to NaCL and fluid balance.

CFTR cystic fibrosis transmembrane protein function is disrupted.

Results in impaired fluid secretion and abnormally thick secretions

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15
Q

Where are the effects to the body?

A

bronchi - PNE, obs. emphysema
sinuses - chronic infection
small intestines - obstruction in newborns
pancreatic ducts - malabsorption syndrome, DM
bile ducts - portal hypertension
clubbed fingers
Reproductive infertility

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16
Q

What are the recommendations related to the vest?

A

Wear it twice a day before meals or two hours after meal

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17
Q

What meds do they take?

A

Oxygen therapy cautiously r/t chronic CO2 retention
Aerosols, nebulizers, Bronchodilators, Mucolytics; Dornase Alfa (Pulmozyme)

Pancreatic enzymes by mouth
 Fat-soluble vitamins (A, D, E, K)
 Stool softeners PRN
NaCl tablets added to diet in hot weather
Oral iron supplements
 Monitor blood glucose

Chloride channel activators &
Sodium channel blockers
Gene therapy, activation of
mutant CFTR, Protein replacement therapy.

Antibiotic therapy; therapeutic & prophylactic

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18
Q

What is recommended for their diet?

A

high calorie, high protein and high fat
give pancreatic enzymes in applesauce
too little enzymes causes steatorrhea

19
Q

What do we need to know about chest physiotherapy?

A 
Aggressive airway clearance (BID) 
– Percussion
• Manual
• Positive expiratory pressure (PEP mask)
• High frequency chest percussion vest
• Airway oscillators like the Flutter device.
– Postural drainage
– Breathing exercises
– Physical exercise
20
Q

What precautions do you take with bronchiolitis?

A

Droplet

21
Q

What URI s/s do older kids get?

A 
Fever
 Irritability
 Restlessness
 Sneezing
 Vomiting &/or diarrhea
22
Q

What URI s/s do younger kids get?

A 
Dryness & irritation of nose & throat
– Edema & vasodilatation of mucosa
– Sneezing
– Chilling
– Muscular aches
– Cough
23
Q

What can we do for infants under 6 months when they get a cold?

A 
comfort measures and rest
watch for respiratory distress
watch for dehydration
tylenol as needed
prevent the spread to others
nasal suctioning
24
Q

What medications can we give older kids?

A

tylenol or IBU if over age 6 months old
decongestants
cough suppressants with caution

25
Q

Do we give cough and cold preparations to kids under 3 years old?

A

No

26
Q

Should we give antihistamines or expectorants for URI?

A

No

27
Q

What are basic nursing interventions for URI?

A

C-Comfort symptoms
O-Offer fluids
L- Look for complications
D-Decrease disease spread

28
Q

Is blood tinged sputum after a tonsillectomy ok?

A

yes

29
Q

What does excessive swallowing indicate after a tonsillectomy?

A

bleeding

30
Q

Other than bleeding, what are we assessing for after a tonsillectomy?

A

swelling and airway compromise, aka stridor

31
Q

How long after tonsillectomy does the scab come off?

A

10 days, monitor for s/s of bleeding then as well, teach parents to watch for it

32
Q

Nursing considerations after tonsillectomy

A

Observe for signs and symptoms of excessive bleeding
• Positioning?
• Avoid suctioning if possible-drooling is ok.
• Discourage straws, coughing, laughing, or crying.
• Diet - avoid milk and red dyes
• Swelling and airway compromise
– Watch for stridor
• Comfort Ice Collar
• Cool mist vaporizer

33
Q

What are the s/s of otitis media?

A 
Ear pain (otalgia)
• Infants get irritable
• Child holds or pulls at ear
• May roll head from side to side
• May have fever up to 104
• Ruptured tympanic membrane
• If Chronic may lead to hearing loss!
34
Q

How can OM be prevented?

A

-breast feed
-sit upright to feed
-no smoking
no bottle in bed
-immunize
-lose the paci
-treat allergies-zyrtec

35
Q

What is the teaching for myringotomy with pressure equalization (PE) tympanostomy tubes?

A

No diving, jumping, or prolonged submersion.
– No swimming in lakes, rivers
– Avoid pressure postoperatively

36
Q

What can you do at home for croup?

AKA viral croup

A

cool mist, stand in front of freezer
hot shower, damp basement
go outside if it is humid or cool
encourage hydration

tylenol

37
Q

When do you go to the ER with croup?

A 
when you see s/s of stage 2 
Stage II
– Continuous stridor 
– Lower lip retraction
– Retraction of soft 
tissue of the neck
– Use of accessory 
muscle of respiration
– Labored breathing
38
Q

How do you recognize epiglottitis?

A

Sitting forward and drooling

Abrupt onset, starts with sore throat
– High fever, mouth open, tongue protruding,agitation.
– Looks very sick,
– Sore red inflamed throat, difficulty swallowing
– Muffled voice, inspiratory stridor, No spontaneous cough

39
Q

What do you do if you suspect epiglottitis?

A

Keep calm, get the crash cart, and call the provider!

Maintain the airway– 
NO tongue blades! Don’t look in the throat
– Avoid x-ray and transport
– Let parents be with child
– Prepare for sedation & intubation
40
Q

What does RSV look like?

A

Its all about getting the mucus out

Apnea may be first sign in infancy
• Rhinorrhea
• Pharyngitis
• Coughing/sneezing
• Wheezing, crackles, decreased breath sounds
• Possible eye and ear infection
• Intermittent low-grade fever
• Difficulty feeding
• Irritability
41
Q

What are the nursing interventions for RSV?

A

Good I & o’s and airway maintenance

Consistent hand-washing
• Encourage parental participation
• Supportive care
–*** Measures to keep airways open
– Saline drops & bulb suction
– Increased humidity (mist tent or vaporizer)
– Adequate fluid intake (NPO if RR > 60)
– Rest
– Humidified Oxygen
– Antipyretics
– Monitor pulse Ox
– Monitor hydration & Encourage PO intake of clear fluids
42
Q

What is pertussis?

A

whooping cough

43
Q

How do we treat pertussis?

A 
Treatment; Erythromycin****
•  Infants < 6-mos may need ventilator support.
• Humidified oxygen
• Maintain Hydration
• Watch for and prevent pneumonia

Peds Exam 2 (3 decks)

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