Respiratory

Question 1

Purpose of the Respiratory System

Answer 1

Provides O2 to the cells
Ventilation
Removal of O2

Question 2

Respiratory Dysfunction Causes

Answer 2

Infection
Trauma- pneumothorax
Oncology- tumor

Question 3

Upper Airway Anatomy

Answer 3

Tongue is a lot larger- sleep apnea- obstruction
Throat is smaller
Pharynx- a lot narrower

Question 4

Cartilage in Upper Airway

Answer 4

Funnel shaped airway- 12 yrs old straightens out

Relevant for nurses who preform intubation

Question 5

Development of Lower Airway

Answer 5

Increases A LOT up into adolescence
With a vent- weight is based on norms when thinking of volume
Bagging- small children = small bag, risk of pneumothorax if too much air!
Increase in diameter of lower airway
Increase in alevoli in 8-10 year olds

Question 6

Musculoskeletal Development

Answer 6

Increase rigidity in the rib cage- uses energy to open the muscles
Babies are belly breathers!

Question 7

Respiratory Assessment

Answer 7

Rate, Rhythm, Depth, Quality

Can assess most visually

Question 8

Tachypnea

Answer 8

Increased rate

Question 9

Bradypnea

Answer 9

Decreased rate

Question 10

Dyspnea

Answer 10

Distress during breathing

Question 11

Apnea

Answer 11

Cessation of breathing

Question 12

Hypoventilation

Answer 12

Decreased depth (shallow) and irregular rate

Question 13

Hyperventilation

Answer 13

Increased rate and depth

Question 14

Kussmal Respiration

Answer 14

Hyperventilation, gasping and labored respiration
Diabetic coma
Respiratory Acidosis

Question 15

Cheyne- Stokes Respiration

Answer 15

Gradually increasing rate and depth with periods of apnea

Question 16

Seesaw Respiration

Answer 16

Chest falls on inspirations and rises on experiation
Upper airway occlusion
Croup, foreign body

Question 17

Initial Signs of Respiratory Distress

Answer 17

Restlessness
Tachypnea
Nasal flaring
Retractions
Color Changes
Head bobbing
Grunting, striddor, wheezing

Question 18

Decompensataion Signs

Answer 18

Anxiety Irritability
Decreased level of consciousness
Confusion
Hyper/hypotensioin
Suddenly decompensates because the child can compensate for a long time!

Question 19

Imminent Respiratory Arrest

Answer 19

Bradypnea
Bradycardia
Cyanosis
Stupor
Coma
Then quickly into cardiac arrest

Question 20

Respiratory Failure

Answer 20

A laboratory diagnosis
PO2 < 60  (normal 80-100)
PCO2 > 50 (normal 35-45)
NEED ABGs to say failure
Interventions: supplemental O2, determine increasing level of O2 by checking pulse ox, positioning, suctioning, cough and deep breathing, percussion and vibration

Question 21

Respiratory Distress Management

Answer 21

EARLY RECOGNITION IS KEY
Watch for increase in heart rate and RR
NO change in BP
NPO- risk of aspiration
Position, O2, clear secretions, equipment at bedside, Rapid response team, PICU transfer

Question 22

Respiratory Acidosis

Answer 22

Increase CO2
Hypo-ventilation- airway obstruction, neuro-trauma
<7.35 pH
Confusion, lethargy, headache, increase ICP, Coma

Question 23

Respiratory Alkalosis

Answer 23

Decrease CO2
Hyperventilation- hypoxia, anxiety, fever
>7.45 pH
Confusion, dizziness, neuromuscular irritability, muscle cramping and spasms

Question 24

Acute Life Threatening Event

Answer 24

ALTE
Under 2 months
During feeding, sleep, wide awake
Emergency resuscitation
Does not mean it will turn into SUIDS
Several times a month will see the symptoms
Causation: significant reflex, seizure, infection, acute sepsis

Question 25

Sudden Unexpected Infant Death Syndrome

Answer 25

SUIDS | Leading cause of death , No co-sleeping, no extra blankets, no bumpers in bed

Question 26

Risk Factors for SUIDS

Answer 26

``` Low Apgar scores Viral Infections Siblings with SUIDS Male Native or African American ```

Question 27

Foreign Body Aspiration

Answer 27

Assess patency and ventilation Positioning is important, CR and pulse ox monitor, supplemental O2 Coins, legos, hot wheel cars, grapes, popcorn Not always hypoxia

Question 28

Nasopharyngitis/ Pharyngitis

Answer 28

Inflammation of the nose and throat Multiple viral (supportive care) and bacterial (treat with antibiotics) Lots of strep test, not always necessary to treat Think about dehydration and pain control

Question 29

Nasopharyngitis/ Pharyngitis Manifestations

Answer 29

Feeding poorly/ poor appetite Lethargy, irritability, restlessness, fever, vomiting, diarrhea, upper airway congestion THROAT PAIN

Question 30

Tonsillitis and Adenoiditis

Answer 30

Common condition in kids Smaller airway- swelling = pain and upper airway exchange issues Primary complication- hemorrhage

Question 31

Tonsillitis and Adenoiditis Management

Answer 31

Medical- with antibiotics | Surgical- removal of the tonsils and adenoids usually not until after age 3

Question 32

Tonsillitis and Adenoiditis Care

Answer 32

``` Assessment of vitals Pain management HEMORRHAGE NO aspirin or Motrin for pain or fever Assess swallowing ```

Question 33

Epiglottitis

Answer 33

EMERGENCY!!! 2-8 years, onset within hours, high fever, intense sore throat, difficulty swallowing, drooling, tripod position for breathing, IS, severe respiratory distress NPO- could do into a spasm and block airway Extreme lethargic/ irritable Treat with antibiotics- IV only

Question 34

Bronchiolitis

Answer 34

Viral infection of the lower respiratory tract Common cold in adults, more severe in children Most common RSV Discharge: provide supportive care, nutrition and fluids, supplemental O2, NG tubes due to respiratory stress

Question 35

Pertussis

Answer 35

HIGHLY CONTAGIOUS Bacterial infection of the upper and lower tracts Most severe in infants and young children IMMUNIZATION IS KEY! Treat with antibiotics

Question 36

Asthma

Answer 36

``` Decreases the airways, chronic disorder Swelling Constriction Mucus Production 50% reduction in a very small airway (like a child) Do not diagnosis until a few episodes ```

Question 37

Asthma Management

Answer 37

Rescue broncho dilators (beta- agonist) Systemic and inhaled corticosteroids Asthma action plan for home management All three means quality care!

Question 38

Cystic Fibrosis

Answer 38

Inherited autosomal recessive disorder of the exocrine glands affecting the respiratory, GI, integumentary, musculoskeletal and reproductive system Both mom and dad have to be carriers- 25% child will have it ANY gland that produces mucus can become involved

Question 39

Cystic Fibrosis Technical

Answer 39

Mutation of CFTR gene Chronic accumulation of thick, dry mucus Primary digestive problems- fats digestion is impaired Respiratory- lots of congestion, clear out the mucus Bronchodilators are 1st - then percussion

Question 40

Clubbing

Answer 40

Chronic De-oxygenated blood

Question 41

Cystic Fibrosis Care

Answer 41

Monitor respiratory rate and depth, VS, LOC and O2 stats Position of comfort- Elevate HOB Percussion and postural drainage Suction nares Maintain hydration and nutrition Meds- antibiotics, pancreatic enzymes, bronchodilator Assess and address anxiety