Respiratory Flashcards
1
Q
How long are newborns obligatory nose breathers?
A
Until at least 4 weeks of age
- Newborns only breath through their mouth when they are crying
2
Q
Anatomical Differences of Respiratory Structures in Children
A
- Infants are nose breathers with very small nasal passages
- More space is taken up by the tongue
- Enlarged tonsils and adenoids
- Smaller airway
- Narrow larynx (and higher location)
- Airway has less functional supporting muscles
- Smaller number of alveoli
3
Q
For a focused respiratory assessment, what should be included in the health history?
A
- Recurrent respiratory issues
- Chronic respiratory disorders
- Fever
- Cough
- Sore throat
- Congestion
- Second hand smoke
- Prematurity
- Daycare/school
4
Q
Respiratory Focused Assessment (Physical Exam)
A
- Color
- Nose and oral cavity
- Cough and airway noise
- Respiratory effort
- Retractions
- Anxiety and restlessness
- Clubbing
- Hydration status
- Breath sounds
5
Q
Wheezing Lung Sounds
A
High pitched sound (expiration)
6
Q
What causes wheezing?
A
Secretions which can be coughed up or cleared, or obstruction of the bronchioles (bronchiolitis, asthma, chronic lung disease, cystic fibrosis) that does not clear with coughing
7
Q
Rales
A
AKA crackles
8
Q
What causes rales?
A
Caused by the alveoli becoming fluid filled (pneumonia)
9
Q
Stridor
A
Heard on inspiration
10
Q
What causes stridor?
A
Caused by upper airway obstruction
11
Q
What is Croup?
A
A viral infection that causes inflammation, edema, and mucus to obstruct the airway. Narrowing of the trachea occurs.
12
Q
S/Sx of Croup
A
- Inspiratory stridor
- “barking” cough
- Symptoms are more severe at night
13
Q
How long does croup usually last?
A
3-5 days
14
Q
Croup Treatment
A
- Rest
- Corticosteroids
- Racemic epinephrine treatment
- Humidified air
- Increased fluids
15
Q
What should we teach the parent about croup?
A
- Its viral so antibiotics are ineffective
- The importance of hygiene
- The s/sx of croup getting worse
16
Q
What are the s/sx that croup is getting worse?
A
- Tachypnea
- Lethargy
- Paleness, cyanosis
- Retractions
- Nasal flaring
- Irritability
17
Q
Home Care of Croup
A
- Keep the child quiet and discourage crying
- Allow the child to sit up (in your arms)
- Encourage rest and fluid intake
- If stridor occurs, take the child into a steamy bathroom for 10 minutes
- Administer medication (corticosteroid) as directed
18
Q
What is Bronchiolitis (RSV)?
A
Highly contagious, acute inflammatory process of the bronchioles and small bronchi. Invades the nasopharynx, replicates, and spreads to the lower airway causing small airway obstruction and necrosis(from mucus and exudate). Almost always caused by the RSV virus.
19
Q
How do you diagnose RSV?
A
Mucus swab
20
Q
S/Sx of RSV
A
- Fever
- Wheezing
- Cough
- Mucus congestion
- Frequency and severity of the viral infection decreases with age
21
Q
Nursing Management of RSV
A
- Management is largely supportive
- Contact and droplet isolation
- Supplemental oxygen
- Suctioning
- Hydration
- Antipyretics
- Bronchodilators
- Sleep with HOB elevated
22
Q
What should we teach the parents about RSV?
A
- Very dangerous for infants
- No sick people around infants
- Hand hygiene
- It’s viral, so antibiotics are ineffective
23
Q
What is pneumonia?
A
Inflammation of the lung parenchyma. Can be viral, bacterial, or fungal.
24
Q
What is aspiration pneumonia?
A
Aspiration of a foreign body
25
S/Sx of pneumonia
1. Fever
2. Wheezing
3. Rales
4. Cough
5. Chest pain
6. Retractions
26
Nursing Management of Pneumonia
1. Rest
2. Analgesics
3. Antipyretics
4. Adequate hydration
5. Supplemental oxygen
6. Antibiotic (for bacterial pneumonia)
7. Close observation
27
Pneumonia Recovery
For 1-2 weeks the child might continue to tire easily and the infant might continue to need small, frequent feedings. Cough may also persist after the acute recovery period but should lessen over time.
28
What is foreign body aspiration?
When any solid or liquid substance is inhaled into the respiratory tract. Can become lodged in the upper or lower airway, causing varying degree of respiratory difficulty.
29
Treatment of foreign body aspiration
Removed via bronchoscopy and treated with antibiotics if infection is present
30
Complications of foreign body aspiration
1. Pneumonia
2. Abscess formation
3. Hypoxia
4. Respiratory failure
5. Death
31
What is the most important intervention for foreign body aspiration?
Prevention
- Avoid toys with small parts, balloons, coins, peanuts
- Cut grapes, hot dogs, and carrots into small pieces
32
Lungs sounds that point to foreign body aspiration
The infant or young child might present with a history of sudden onset of cough, wheeze, or stridor. Stridor suggests that the foreign body is lodged in the upper airway. When the item has traveled down one of the bronchi, then wheezing, rhonchi, and decreased aeration can be heard on the affected side
33
What is asthma?
Chronic inflammatory disorder characterized by airway hyperresponsiveness, airway edema, mucus production, and constriction of the airway. Occurrence ranges from long periods of control or have symptoms daily.
34
S/Sx of asthma
1. Persistent cough (particularly at night)
2. Difficulty breathing
3. Chest tightness
4. Wheezing
5. Restlessness
6. Barrel chest in severe cases
7. Mild retractions can be present
35
Management of asthma goal
Avoid asthma triggers (allergy testing) and reduce and control inflammatory episodes
36
What is the stepwise approach?
Used for prescribing medication to asthma patients
Increasing medications as the child's condition worsens, then backing off as the condition improves. Asthma requires periodic assessment of control and periodic education.
37
Laboratory Tests for Asthma
1. Allergy test
2. Pulmonary function tests (PFTs)
3. Peak expiratory flow rate (PEFR)
38
Pulmonary Function Tests for Asthma
Can be very useful in determining the degree of disease but are not useful during an acute attack.
39
Peak Expiratory Flow Rate during an asthma attack
Is decreased during an exacerbation (asthma attack)
40
What is cystic fibrosis?
Autosomal recessive disorder
Dysfunction of the exocrine glands resulting in thickened, tenacious secretions (sweat glands, GI tract, pancreas, respiratory tract)
41
S/Sx of cystic fibrosis
1. Salty skin
2. Cough
3. Barrel chest
4. Clubbing of nail beds
5. Small appearance for age
6. Fine or coarse crackles
7. Wheezing
8. Diminished breath sounds
42
Sweat Chloride Test (cystic fibrosis)
Considered suspicious if the level of chloride in collected sweat is above 50 mEq/L and diagnostic if the level is above 60 mEq/L
43
Pulmonary Function Tests (cystic fibrosis)
Might reveal a decrease in forced vital capacity and forced expiratory volume, with increases in residual volume.
44
Cystic Fibrosis Interventions
1. When in hospital, droplet and contact precautions
2. Daily chest physiotherapy
3. Vest airway clearance
4. Physical exercise (when not in acute exacerbation)
5. Flutter valve
6. Nebulizer treatments
7. Bronchodilators
8. Anti-inflammatory agents
9. Aerosolized antibiotics
10. Pancreatic enzymes
11. Supplemental fat-soluble vitamins
12. High calorie, high protein diets
13. Lung transplant
45
What is a vest airway clearance system?
Provides high-frequency chest wall oscillation to increase airflow velocity to create repetitive cough-like shear forces and to decrease the viscosity of secretions.
46
Gastrointestinal Manifestations of Cystic Fibrosis
1. Meconium ileus
2. Retention of fecal matter in distal intestine
3. Sludging of intestinal contents
4. Obstructive cirrhosis with esophageal varices, and splenomegaly
5. Gallstones
6. GERD
7. Inadequate protein absorption
8. Altered absorption of iron and vitamins A, D, E, and K
9. Failure to thrive
10. Hyperglycemia and development of diabetes later in life
47
How does retention of fecal matter manifest itself in a patient with cystic fibrosis?
1. Vomiting
2. Abdominal distention
3. Cramping
4. Anorexia
5. Right lower quadrant pain
48
How does sludging of intestinal contents manifest itself in a patient with cystic fibrosis?
1. Fecal impaction
2. Rectal prolapse
3. Bowel obstruction
4. Intussusception
49
Indication for tracheostomy
Patients who require chronic mechanical ventilation or those who need mechanical ventilation weaning.
50
Post-Op Complications of Tracheostomy
1. Hemorrhage
2. Decreased air entry
3. Pulmonary edema
4. Anatomic damage
5. Respiratory arrest
51
Chronic Complications of Tracheostomies
1. Infection
2. Cellulitis
3. Formulation of granulation tissue around the insertion site
52
Tracheostomy Assessment
1. Note the size and type
2. Stoma should appear pink, without bleeding or drainage
3. Tube should be clean, patent, and well secured
4. Surrounding skin should be free form redness and rash
5. Secretions - color, thickness, amount
6. Breath sounds should be clear and equal
7. Frequent or continuous pulse oximetry
53
Nursing Management of Tracheostomies
1. Restraints may be needed to avoid accidental dislodgement
2. Humidified oxygen or air
3. Suctioning (know appropriate catheter length)
4. Trach care (2 nurses with pediatrics)
5. Emergency equipment kept at the bedside
54
What kind of emergency equipment is kept at the bedside for tracheostomy patients?
1. Two spare tubes (same size, the other a size smaller)
2. Suction equipment
3. Stitch cutter (new trachs)
4. Spare ties
5. Lubricating jelly
6. Ambu bag
7. Call light within reach of patient/parent
55
What is the common cold?
An upper respiratory infection
- Viral
- Can be caused by RSV
56
How long does the common cold typically last?
7-10 days
57
S/Sx of the common cold
1. Stuffy or runny nose
2. Sore throat
3. Cough
4. Watery eyes
5. Fever
58
What kind of secondary infections can occur with the common cold?
Bacterial infections to the ears, throat, sinuses, or lungs
59
Nursing Management of the common cold
1. Humidified air
2. Nasal wash
3. Suctioning
60
What is sinusitis?
A bacterial infection of the sinuses.
| - Can be acute or chronic
61
How long does sinusitis typically last?
Last 7 days to 4-6 weeks (chronic)
62
S/Sx of sinusitis
1. Cough
2. Fever
3. Bad breath
4. Facial pain
5. Eyelid edema
6. Poor appetite
63
Treatment for chronic sinusitis
Surgery
64
Nursing Management of sinusitis
1. Saline drops
2. Humidified air
3. Fluids
4. Nasal wash
5. Antibiotics
65
What is influenza?
A virus that is spread through inhalation of droplets or contact with particles
66
How is influenza diagnosed?
Nasal swab
67
S/Sx of influenza
1. Fever
2. Facial flushing
3. Chills
4. Headache
5. Fatigue
6. Cough
7. Nasal discharge
8. Rash
9. Diarrhea
10. Secondary bacterial infections may occur
68
Nursing Management of influenza
1. Treat symptoms
2. Staying hydrated
3. Antiviral drug only if first 24-48 hours
69
What is pharyngitis?
Inflammation of the throat mucosa. Often viral but can be bacterial.
70
How is pharyngitis diagnosed?
Throat culture
71
S/Sx of pharyngitis
1. Fever
2. Sore throat
3. Nasal congestion
4. Difficulty swallowing
5. Headache
6. Abdominal pain
72
Management of pharyngitis
1. Saline gargles
2. Analgesics
3. Throat lozenges
4. Hydration
5. Antibiotics if bacterial
6. Humidified air
7. Monitor for airway obstruction in severe cases
73
What is tonsillitis?
Inflammation of the tonsils. Can be viral or bacterial.
74
How is tonsillitis diagnosed?
Throat culture
75
S/Sx of tonsillitis
```
1. Hoarseness
Same as Pharyngitis
1. Fever
2. Sore throat
3. Nasal congestion
4. Difficulty swallowing
5. Headache
6. Abdominal pain
```
76
Nursing Management of Tonsillitis
```
1. For chronic, tonsillectomy may be required
Same as Pharyngitis
1. Saline gargles
2. Analgesics
3. Throat lozenges
4. Hydration
5. Antibiotics if bacterial
6. Humidified air
7. Monitor for airway obstruction in severe cases
```
77
What is Mono?
Viral "kissing disease"
78
S/Sx of mono
1. Fever
2. Malaise
3. Sore throat
4. Lymphadenopathy
79
Nursing Management of Mono
1. Bedrest while febrile
2. Analgesics
3. Saline gargles
4. Frequent rest periods after fever subsides (may fatigue easily for up to 6 weeks)
5. Corticosteroids
80
What is laryngitis?
Inflammation of the larynx
81
S/Sx of laryngitis
Hoarseness
82
Nursing Management of Laryngitis
1. Fluids
2. Resting voice
3. Time
83
What is epiglottitis?
Inflammation of the epiglottis.
| - Rare due to the Hib vaccine, but can be life threatening
84
S/Sx of epiglottitis
1. Fever
2. Drooling
3. May refuse to speak
4. Anxious
5. Difficulty breathing
6. Toxic appearance
85
Nursing Management of epiglottitis
1. ICU
2. Airway maintenance
3. IV antibiotics
4. HOB remains elevated
5. Emergency trach kit at bedside
86
What is epistaxis?
Nosebleed.
87
Causes of epistaxis
May not have a cause. Could be caused by trauma (even nose picking), inflammation, mucosal drying
88
Nursing Management of Epistaxis
1. Stay calm, blood frightens children
2. Have child sit up and lean forward
3. Apply pressure by pinching the nose
4. Ice may help
5. Usually subsides in 10-15 minutes
6. Apply vaseline to moisten mucosa and prevent recurrence.
89
What is allergic rhinitis?
Intermittent or persistent inflammatory state in response to airborne allergens.
90
S/Sx of allergic rhinitis
1. Runny nose
2. Watery eyes
3. Nasal congestion
4. Itching
5. Sneezing
91
Nursing Management of allergic rhinitis
1. Avoid allergens!
2. Saline nasal wash
3. Steroid nasal spray
4. Oral antihistamines
5. Decongestants
6. Mast cell stabilizing nasal spray
7. Leukotriene modifiers
