Respiratory

Question 1

Differentiate between early and late/severe, signs of respiratory distress/respiratory failure.

Early signs
7

Answer 1

-tachypnea
-tachycardia
-irritability, restlessness
-nasal flaring
-retractions
-Expiratory grunting
-hypertension

Question 2

Late/severe signs of respiratory distress

Answer 2

-depressed respirations (retain CO2)
-bradycardia
Somnolence (lethargic, drowsy)
-cyanosis
-hypotension

Question 3

Review Croup (acute laryngotracheobronchitis)

Answer 3

Viral

6 months-6 years of age

Fever,
Pharyngitis,
Coryza prior to onset of croup

Abrupt onset, most commonly at night

Characterized by hoarseness, “barking” cough, inspiratory stridor, fever, and respiratory distress.

Can be life threatening and progress quickly

Question 4

treatment of croup

Answer 4

Racemic epinephrine nebulizer
oral steroids (reduces laryngeal mucosal edema)
cool mist vaporizer
IV fluids if unable to take fluids due to tachypnea, oxygen if needed.

Oxygen if O2 sat < 92% : Blow-by oxygen most effective.

Question 5

Review care of the child with a tracheostomy including decannulation and checking/changing of trachea ties.

Answer 5

May be temporary or long term

Emergency care—accidental decannulation

Always have two extra tracheostomy tubes at the bedside: one same size and one smaller

Tracheostomy Ties Snug but Allow Finger to Be Inserted

Change trachea ties with 2 people

Question 6

Epiglottitis
Occurs in what age?
Bacteria?
What vaccine to prevent?

Answer 6

Inflammation of the epiglottitis

-Occurs predominantly in ages 2-5, but can occur from infancy to adulthood

-Most common cause is the bacteria Haemophilus influenzae type B

-Prevention: Haemophilus influenzae type B vaccine

Question 7

symptoms of epiglottitis five

Answer 7

-Drooling
-Sore throat
-Stridor
-Tripod position
-Fever

Question 8

Treatment of epiglottitis

Answer 8

Primary (A-B-C)
-Airway management (intubation) - if possible in the operating room

Secondary
-IV antibiotics
-IV corticosteroids

Question 9

RSV

Answer 9

Viral

Children at risk for severe illness:

-Premature infants

-Children younger than 2 years old with chronic lung disease or congenital heart disease

-Palivizumab (Synagis) prophylaxis -monthly IM injections during RSV season (Fall-Spring).

-Synagis is not a vaccine

Question 10

RSV vaccine

What vaccine for pregnant women?
When should they be immunized?

Answer 10

RSV vaccine (Abrysvo) for pregnant women.

Immunization 32-36 weeks gestation.

Antibodies developed against RSV will be passed to the fetus to protect infant for the first 6 months of life.

Question 11

Diagnostics of RSV

Answer 11

Nasopharyngeal washes or Nasal viral swab

Question 12

management of RSV

Answer 12

Symptomatic care

Respiratory
monitoring (e.g., O2 sats)

Nasopharnyx suction

Nutrition, hydration

Question 13

Group A beta hemolytic Streptococci Pharyngitis diagnosis

Answer 13

Group A β-hemolytic streptococci (GABHS)

Diagnostic evaluation-throat culture

Question 14

Risk for serious consequence if strep A is untreated?

Answer 14

Acute rheumatic fever

Acute glomerulonephritis

Scarlet fever

Question 15

Treatment of group A strep

Answer 15

antibiotics-take complete course of treatment

Question 16

Nursing—Post-Op Tonsillectomy

What indicates bleeding?

Answer 16

Airway
-Positioning

Bleeding
-Observation—frequent swallowing may indicate bleeding
-Maintain quiet environment
-Minimize agitation/crying
-NO suctioning

Comfort

Question 17

asthma patho

Answer 17

1. Constriction of smooth muscle around Bronchi
2. Inflammation-response by eosinophils, Mast, neutrophils
3. Secretions-mucous plugging

Question 18

Risk factors for asthma

Answer 18

Family History-genetic susceptibility

Allergies (environmental, food)

Exposure to smoke

Frequent respiratory infections (RSV, influenza)

Obesity

Question 19

clinical manifestations of asthma

4 symptoms

Answer 19

Shortness of breath (dyspnea)

Cough (often worse at night)

Chest tightness

Wheezing

Question 20

Diagnostic Evaluation of asthma

Answer 20

FEV1 : Forced Expiratory Volume in 1 second

-Decreased value indicates airway obstruction

Peak Expiratory Flow
-Measures how fast air is expelled from the lungs during forceful expiration.

Question 21

Rescue Drug Therapy for asthma

What quick relief drug is used?

Answer 21

Rescue (Quick Relief) medications

-Short-acting b2-agonists bronchodialators Bronchial constriction

–Albuterol 2.5mg per nebulizer treatment

-Corticosteroids-Inflammation
-Prednisolone (oral)
-Methylprednisolone (Solumedrol) IV

Question 22

Maintenance Drug Therapy for Asthma

Long-term control meds (Maintenance)

Answer 22

-Inhaled corticosteroids (e.g., Pulmicort),

-long-acting b2-agonists and Inhaled Corticosteroids(e.g., Advair)

-Leukotriene modifiers (e.g., Singulair).
–[Leukotriene modifiers block the action of leukotrienes which cause inflammation associated with allergies].

Question 23

Discuss the management of Status Asthmaticus.

What Is status asthmaticus?
what are the first lines of treatment?

Answer 23

Asthma unresponsive to repeated courses of beta-agonist therapy. (no air movement.. NOT GOOD)

IV Epinephrine and Corticosteroid (Solu Medrol) first line of treatment.

Question 24

Cystic firbrosis

What kind of disorder is it?

Answer 24

Cystic fibrosis is an autosomal recessive disease due to mutations in cystic fibrosis transmembrane regulator (CFTR) gene.

If both parents are carriers there is a 1 in 4 (25%) chance of each child having CF.

2000 mutations in CFTR gene

CF occurs across the world and in people of all races and ethnicities. 95% known cases occur in White people. (African American, Hispanic, and others may be affected).

Chronic

Progressive

Question 25

PATHO of cystic fibrosis

What gene?
Impaired secretion of what?
Abnormal what?
will have what?

Answer 25

CFTR gene

impaired secretion of chloride

abnormal thick mucous (will have clubbing of nails)

Question 26

symptoms of respiratory system for cystic fibrosis what is heard upon auscultation?

Answer 26

Fever, increased coughing and shortness of breath, increased mucus production, and loss of appetite. Crackles at bases on auscultation.

Question 27

treatment for cystic fibrosis
(respiratory)

Answer 27

Antibiotics (Tobramycin) aerosolized is the main treatment for Pseudomonas aeruginosa

Question 28

Gastrointestinal system

cystic fibrosis

pancreas?
what does stool look like?
what is cf diabetes?

Answer 28

Pancreas- obstruction of pancreatic ducts -pancreatic enzymes blocked- malabsorption of proteins and fats.

Failure to Thrive- poor weight gain, poor growth

Large, loose, greasy, foul-smelling stools-(malabsorption of fat)

Cystic Fibrosis Diabetes - inflammation and scarring of pancreas - insulin

Question 29

CF Presentation

earliest sign?

children taste what?

Answer 29

One of the earliest signs of CF is the
development of a Meconium ileus in a newborn (Meconium is the first stool passed by a newborn and should occur in the first 24 hours of birth) bowel obstruction due to thick meconium stool).

Parents report children taste “salty”

Question 30

Diagnostic Evaluation cystic firbrosis
what kind of test?
result?
gentetic dna test?

Answer 30

Sweat chloride test-Gold Standard

-Chloride greater than 60 mmol/L is diagnostic for CF.

Genetic (DNA) testing: Positive for CFTR gene mutation.