RESPIRATORY Flashcards
what medication is given for acute tonsillitis?
Penicillin/amoxicillin
what medicine is given for chronic tonsillitis? (hx of bad smelling material)
Clindamycin
what would you see with increased work of breathing?
retractions
if a chest is larger on the L side, it can be a sign of what with the heart/lungs
enlarged heart
collapsed R lung
what position are childrens lung sound best heard?
child sitting down
begin at apices then go side to side
what would a tachy HR be?
80-120
dominate way infants/newborns breath
thru nose
what is a primary intervention for stridor? & why?
humidified air to lubricate airway
s/sx of respiratory distress?
Grunting
Nasal flaring
Retractions
Cyanosis
Tachypnea
what is the first sign of hypoxia?
altered LOC
what sound/symptoms would indicate impending respiratory failure?
grunting
trt for impending respiratory failure?
PEEP
Positive pressure to keep lungs open
what does HR do in progression of respiratory distress?
tachy –> brady
tx of resp distress?
Chest percussion to loosen secretions
Stimulate (activity/crying) to mobilize secretions
Older child sit up & cough
on resp assessment, what would be a normal finding about inhale/exhale?
inspiratory phase slightly longer/= to expiratory phase
what resp phase is prolonged with asthma?
expiratory
which resp phase is prolonged with an upper air way obstruction? & ex’s of UAO
inspiratory
Croup/foreign body
Croup cough sounds like?
Hoarse, “barking” / “brassy” cough
s/sx of Croup?
Barking cough
Inspiratory stridor
Drooling
most severe variation of croup?
epiglottitis
Home treatment for Croup?
Cool mist
Fluids
Hospital care for croup?
Neb w/ epinephrine/steroid inhale
IV fluids if no PO fluids
how does a child progress with acute epiglottitis?
Goes to bed asymptomatic then wakes with sore throat & 103-105 fever
what position will a child likely assume with epiglot?
tripod (airway obstruct = immediate attention)
how does epiglot sound on inspiration?
Frog like croaking sound
Treatment for Epiglott?
Abx (amox)
IV fluids (NPO)
O2
Cool mist
what do you never do in treating epiglot? & why?
examine the throat/put anything in throat
increased risk of laryngospasm
acute epiglot is often caused by what virus
HiB (haem influ B)
what is laryngotracheobronchitis (LTB)?
viral
inflammation of mucosa of larynx & trachea = narrow passageway
DOESNT involve epiflot
what does laryngotracheobronchitis (LTB) cough sound like?
seal like/ crowing
s/sx of laryngotracheobronchitis
purulent sputum (?)
inspiratory stridor
suprasternal retractions
low grade fever
laryngotracheobronchitis is often developed after what infection?
upper respiratory infection
what is most common cause of bronchiolitis?
RSV (droplet + standard precautions)
initial s/sx of bronchiolitis?
lots of thick secretions
rhinorrhea
wheezing
intermittent fever
severe s/sx of bronchiolitis
tachypnea (>70)
decreased breath sounds
apneic episodes
tx of bronchiolitis
oxygen/humidified
Suctioning (30/40 degree angle)
ribavirin
in asthma w/ severe distress what may be heard?
Inspiratory wheeze
what part of the airway is obstructed in asthma
lower airway (air trapped)
bronchial hyperresponsive
s/sx of recurrent asthma episodes?
wheezing
chest tightness
non productive “hacking” cough
diaphoresis
what is an early s/sx of an asthma attack?
Decreased pCO2
complication of asthma?
hypoxemia r/t collapsed alveoli
what is normal PEFR for asthma action plan?
80-100
edu about asthma action plan?
Record PEFR 2x/day
estab personal best PEFR during 2-3 wk period when asthma is stable = baseline
monitor peak flow, if low = assess
medical emergency complication of asthma?
status asthmaticus
treat with epi 0.01 subQ
primary intervention for asthma?
Neb albuterol
(B2 agonist - bronchodilator)
2ndary med intervention for asthma?
Methylprednisolone (Solu-medrol) IV
(cortico - bronchodilator)
what position is best for child to be placed in with asthma?
high fowlers
heliox does what in/for asthma?
loosen secretions
edu about inhalers?
oral care to prevent thrush
how to do peak flow meter?
Tight seal around mouth, standing straight
then
Take 1 deep breath & blow as hard/fast as possible
edu about PFM (peak flow meter)?
Must repeat steps 3x
good TOD is 7-9am & 6-8pm
what is cystic fibrosis?
exocrine gland dysfunction, causes thick sticky mucus
mechanical obstruction
what organs are affected by CF?
Pancreas & respiratory tract
edu about pancreas in CF?
will have to consume pancreatic enzymes before every meal (even a snack)
diagnosis of CF? & + result?
Swear chloride test
+: =/> 75 mmol/L
what type of questions should you ask regarding future with CF
are they planning on having kids - genetic counseling
what electrolytes will be low in CF labs? & edu about them
sodium & chloride
unrestricted salt intake
what should the nurse do before physiotherapy for a CF patient? & why?
admin bronchodilator via neb
cant cough up secretions - too thick/too weak
edu about diet & CF?
Increased calories & protein (150%)
which vitamins are recommended for CF?
water soluble
(ADE&K)
how do children with CF physically appear?
short w/ thin skin
(short from lack of O2)
GI issue/presentation with CF?
Steatorrhea (fatty/smelly stool) from undigested fat - lack enzyme
what disease process can result from blocked pancreatic ducts?
T1 diabetes
best tx for a patient using accessory muscles with an RR of 40 & O2 of 88?
Oxygen with non rebreather
a pt presents with drooling, leaning forward and a high pitched crowing sound. what do they have & what is tx?
Stridor from croup
&
admin humid O2
with a foreign body obstruction, wheezing & diminished breath sounds, what is the priority intervention?
high flow O2
what is esophageal atresia?
esophagus ends in blind pouch
what normal function is complicated by esophageal atresia?
Swallowing normally
s/sx of esophageal atresia
excessive drooling
resp distress/coughing
choking w/ attempted feedings
inability to pass NG/OG tube
management of esophageal atresia?
Suction
Monitor for patency (don’t irrigate)
NPO (high aspiration risk)
Positioning
what is proper positioning for esophageal atresia?
30-45 degree HOB elevation
Head turned side to prevent aspiration
or lat side lying
how to administer ear medication?
Place dropper above ear canal
Gently pull outer flap down & back to straighten ear canal
what type of babys are at lower risk of otitis media?
breast fed babies
s/sx of otitis media?
Very irritable
pulling on ear
purulent effusion/bulging red membrane
doesnt want to eat (swallow hurts)
fever
management for otitis media?
Abx
hold upright when feeding
Tympanostomy
edu about tympanostomy
may have temp hearing loss
keep water out of ear/no swimming 2 weeks
(use earplugs or cotton ball)
No blowing nose for 7-10 days
what is criteria for tonsillectomy?
3+ treated infections a year
done 6wk after acute infection is resolved
what liquids shouldnt be consumed after tonsillectomy?
no mouthwash/citrus juice
red/brown colored
dairy
what would be indicative of post op bleeding of a tonsillectomy?
frequent swallowing
restlessness
Rapid HR
bright red blood in vomit (emergency!)
how should a pt sleep after a tonsilectomy?
lateral/side
facilitate drainage
chronic pharyngitis can lead to what?
rheumatic fever/scarlet fever
management of pharyngitis?
Penicillin (2xday/10day)
no 2nd hand smoke
s/sx of pharyng?
halitosis (bad breath)
enlarged tonsils
petechiae on palate
fine red sandpaper rash on trunk
staple s/sx of Bronchilotis/RSV?
Intercostal retractions
other s/sx of bronchiloitis/RSV?
apnea
non productive cough
fever up to 102
rhinorrhea for 3-7days
management for BRONCHILOITIS & RSV?
bulb syringe & saline drop to nares
(prior to all feeds)
suction first!!!
contact precautions
what causes bronchopulmonary dysplasia?
Long term O2 = dependence
how to prevent bronchopulmonary dysplasia?
Keep o2 low as possible in newborn
wean off asap
meds for BPD (bronchpulm dys)
bronchodilators (albuterol)
anticholingergic (ipratropium)
lower resp infections affect what structures?
alveoli
bronchi
lungs
how does air move thru resp system?
Pharynx –> Larynx
Larynx –> trachea
trachea –> bronchi (L/R)
passes thru the trachea into bronchus
how long are infants obligate nose breathers?
4wk
which anatomical diff in younger children puts them at higher risk for aspiration?
Larynx & glottis are higher in neck
giving corticosteroids for pertussis can mask what?
s/sx of infection
if a child with pertussis is given prednisone & is sleeping more than usual/not eating well, what should be recommended?
go to ED for infection workup
what lung sounds would be heard in foreign body aspiration?
Unilateral wheezing
what lung sounds does asthma present with?
BIlateral wheezing
