Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics Test II > Respiratory > Flashcards

Respiratory Flashcards

1
Q

age related differences in A&P

A
  • chest wall and respiratory muscles:
    • ribs and sternum are toopliable to use intercostal muscles
    • diaphragmatic breathers until 7 yo
    • AP diameter inc
  • airways:
    • infants airways are 1/4 the size of adults, so any inflammation of airway will cause problems
  • alveoli/parenchyma:
    • neonates have 20 mil alveoli which inc to 300 mil by 8 yo
  • WOB: paradoxical chest movements
  • inc O2 consumption b/c of inc metabolic rate, inc HR, inc RR
    • infants need 6-8 mL/kg/min vs adults 3-4 mL/kg/min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

if you have varying children with respiratory issues, which one do you see first?

A
  • the youngest–b/c they will deteriorate the fastest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

clinical manifestations of respiratory alterations

A
  • changes in LOC: restlessness
  • alteration in perfusion: dec O2 sats, cyanosis/pallor (color changes)
  • cough: if present, worried about chlamydial pneumonia
  • dyspnea
  • tachypnea
  • tachycardia
  • grunting (late sign of compensation)
  • retractions
  • stridor/wheezing
  • nasal flaring
  • intercostal bulging (air trapping)
  • chest pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

stridor vs. wheezing

A
  • stridor: upper airway affected
    • see w/ croup
    • high pitched, noisy respiration
    • indicates narrowing of upper airway
    • can be inspiratory or expiratory
  • wheezing: bronchioles affected (lower airway)
    • continuous musical sound originating from vibrations in lower airways (bronchioles)
    • typically heard on expiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

respiratory distress

A
  • early recognition very important
  • distress is marked by inadequate elimination of CO2 or decrease in O2
  • resp assessment:
    • LOC
    • RR
    • WOB: can be inc by inflammation or excessive mucus
    • color of skin/mucous membranes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

grunting

A
  • late sign of sompensation
  • body’s attempt to create positive end expiratory pressure (PEEP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

retractions

A
  • sinking in of soft tissues–indicates use of accessory muscles in an attempt to improve respirations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

respiratory assessment in a healthy infant

A
  • response to environment: looking around, pink
  • color of skin, mucous membranes
  • accessory muscle use should be absent or minimal
  • work of breathing
  • normal breath sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

indications of mild respiratory distress

A
  • retractions–sub or intercostal
  • color changes: pink–>pale–>slight circumoral cyanosis
  • nasal flaring
  • response to envinronment: may not be as alert
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

indications of moderate to severe respiratory distress

A
  • LOC and response to environment: listless, lethargic
  • retractions
  • color changes: circumoral–>dusky–>cyanotic
  • breath sounds: inc wheezing/stridor
  • changes in O2 sats: decreased
  • head bobbing
    • indicates an exhausted infant
    • sign of dyspnea
    • use of scalene and SCM muscles–head bobs with each inspiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

nasal cannula

A
  • 2 short plastic nasal prongs: delivers 25-45% at 1-6 L/min
    • usually don’t go above 5 on kids
  • always humidify O2
  • if in distress, always start as high as you can w/ that apparatus then titrate down
    • make sure HR decreases as you add O2
  • O2 delivery: 4% O2/L
    • 0 L=21% RA
    • 1 L=25%
    • 2 L=29%
    • 3 L=33%
    • 4 L=37%
    • 5 L=41%
    • 6 L=45%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

oxygen mask

A
  • poorly tolerated by infants/toddlers
  • delivers 35-60% oxygen at 6-10 L/min
    • RA entrained during inspiration
    • reduced oxygen concentration if:
      • high spontaneous inspiratory flow
      • mask is loose
      • oxygen flow into mask is low
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

oxygen face tent/shield

A
  • high flow soft plastic “bucket” over nose and mouth
  • better tolerated than face mask
  • delivers only 40% O2 at 10-15 L/min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PaO2 (mmHg) vs. SaO2 (%)

A
  • PaO2=SaO2 (%)
    • 100=98%
    • 90=97%
    • 80=95%
    • 70=93%
    • 60=90%
    • 50=84%
    • 40=75%
    • 30=60%
    • 20=35%
    • 10=14%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

chest physiotherapy

A
  • postural drainage: want to try to loosen up secretions so child can cough out or suction out secretions
  • percussion: cupping to loosen secretions
  • vibration
  • incentive spirometer
  • breathing exercises
  • suctioning
    • if child has a lot of secretions, need to pay attn to hydration status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Asthma

A
  • wheezing occurs due to constriction of the lower airways
    • higher incidence in African Americans and children who are overweight
  • have to educate client about having albuterol on them at all times
    • teach about maintenance vs. rescue drugs
  • need to teach the client about asthma triggers:
    • pollen, dust mites, mold, pet dander
  • teach about using peak flow meters
  • if on any corticosteroids as an anti-inflammatory: concerned about immunsuppression, may have salt cravings, and do not d/c the meds abruptly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

peak flow meters

A
  • measure peak expiratory flow rate (PEFR) which is the maximum flow of air that can be forcefully exhaled in 1 second
  • child’s personal best PEFR should be measured when asthma is stable
    • GREEN: 80-100% of child’s best–>no symptoms, continue maintenance tx
    • YELLOW: 50-79% of child’s best–>an acute exacerbation may be occurring–maintenance therapy may need to be inc
      • may need to call practitioner if stay in this range
    • RED: <50% of child’s best–>signals a medical alert b/c airway narrowing is occurring
      • short acting bronchodilator should be administered
      • notify HCP immediately if PEFR does not return to and stay in yellow/green
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

which asthma drugs should not be used as rescue drugs? why?

A
  • salmeterol and foradil
    • long acting beta 2 agonists
19
Q

Nasopharyngitis

A
  • concerned about alteration in respiratory distress, ineffective airway clearance, impaired oxygenation
  • S/S: fussy, peeing less, skin color, high RR, congestion and thick nasal drainage, high HR, may have some signs of dehydration
  • nursing interventions:
    • bulb suction
      • can use saline nose drops if needed after trying to suction
      • clean at least 1x/day
    • weigh infant: to look at hydration
    • cool mist vaporizer
    • educate parents about what to look for w/ resp distress
      • inc WOB, use of accessory Ms, dec activity, change in color
20
Q

pertussis

A
  • whopping cough
    • S/S: dry cough that progresses to high pitched/whooping sound while inhalaing during cough, runny nose, inc temperatures, periods of apnea, color change
  • would obtain cultures, ABGs
    • more concerning the lower the pH is–>resp acidosis
  • administer tylenol, abx, fluids
    • fluids b/c dehydration may occur otherwise
  • nursing interventions:
    • educate about being vaccinated
21
Q

bronchopulmonary dysplasia (BPD)

A
  • caused by damage to the tissues of the lungs r/t high pressure of ventilator
    • due to a child’s prematurity/resp distress, may need to be placed on a ventilator which will cause trauma to the lung tissue, causing interstitial edema, epithelial swelling, then thickening of the tissue, proliferation of alveolar walls
  • may need to receive inc calories and has to conserve calories while feeding, so may need G tube
    • may need inc cal/oz, b/c can’t take extra volume, but if you inc the caloric content, then you inc solute load–>have to monitor kidney function
22
Q

tonsillitis

A
  • can be tx w/ abx, but may need to do a tonsillectomy/adenoidectomy
  • often caused by strep
  • w/ a tonsillectomy, need to monitor for bleeding which will show up as bright red blood and excessive swallowing
    • dark blood–old blood that child swallowed in surgery, not concerned
    • concern for bleeding immediately post op, up to 10 days later
  • has to have fluids after surgery and need to monitor urinary output
    • often should avoid milk products b/c will make you cough which could cause bleeding
    • give clear fluids–don’t need to check gag reflex first, b/c will vomit
  • can give opioids for pain relief
    • have to be diligent about pain control, or she will not drink and will become dehydrated
23
Q

equipment needed when caring for a child with a trach

A
  • extra trach–same size and size smaller
  • resuscitation bag and oxygen
  • suction set up and at least 6 catheters
  • scissors
  • goggles
  • sterile water/saline–only good for at least 24 hours
  • Q tips
  • 4x4 gauze
24
Q

suctioning a child w/ a trach

A
  • don’t go down until cough b/c hitting the bifurcation of the airway and causing inflammation and scar tissue
    • should measure length of trach and go just beyond the end of it (~0.5 cm)
  • don’t put saline down the trach
  • as suction, don’t apply pressure when you go down
    • apply no more than 80-100 mmHg of pressure
    • suction continuously as you come out
      • 5 sec at most for little ones
      • 10 sec at most for older kids
25
Q

list risk factors for RSV

A
  • prematurity
  • BPD
  • preexisting heart and respiratory conditions
  • neuromuscular impairment
  • immunodeficiency
  • Down’s syndrome
  • attendance at daycare centers
  • exposure to environmental pollutants (particular cigarette smoke)
  • having school aged siblings
  • living in crowded conditions
26
Q

respiratory assessment with RSV

A
  • fuzziness
  • dyspnea
  • wheezing
  • tachypnea (b/c of inc WOB)
  • nasal drainage
  • cough (b/c of nasal drainage)
  • retractions (w/ inc WOB)
  • grunting (r/t extreme resp distress due to body trying to create PEEP)
27
Q

what causes the airway obstruction in bronchiolitis?

A
  • edema
  • accumulation of mucus
  • dyspnea
28
Q

why should you administer O2 to RSV patients?

A
  • to maintain O2 over 93%
  • to dec WOB
29
Q

when do you withhold food from an infant?

A
  • if RR is over 60, b/c high risk of aspiration
30
Q

nursing interventions w/ RSV patients

A
  • saline nose drops w/ bulb suctioning–try suctioning first
  • raising HOB
  • humidified O2
  • fever control
  • adequate fluid intake
  • suctioning of upper airway
31
Q

abx and RSV

A
  • not effective b/c RSV is a virus
  • may be used for a child who develops a complication from RSV, like pneumonia
  • may be used prophylactically for children who require intubation and mechanical intubation for respiratory failure
32
Q

short acting beta agonists and RSV

A
  • not recommended for routine care of first time wheezing assoc with RSV
    • but we will use it if they have pre-existing condition
  • ie. albuterol
    • administered by respiratory therapist
33
Q

antivirals and RSV

A
  • Ribavirin: only specific tx of RSV approved by FDA
    • has been assoc with small inc in O2 sats
    • but has not consistently decreased the need for ventilation, dec LOS in ICU, or dec length of hospitalization
    • administered by aerosol–so possible ADRs for healthcare workers
      • does have teratogenic effects
34
Q

corticosteroids and RSV

A
  • has not demonstrated any effect on dz length or severity
  • not recommended for first time wheezing assoc with RSV
  • should not be given to infant w/ diagnosis of bronchiolitis
35
Q

prevention of RSV

A
  • Palivizumab/Synagis
    • IM injection only
    • reduces RSV hospitalization
    • prophylaxis for RSV, but can also be given to children who’ve already had RSV and want to try to dec S/S and help prevent again
    • get injections once a month *3 or *5, during RSV season Oct-March
    • eligible: premies if <30 weeks; other infants born b/w 32 weeks and 34 weeks 6 days and attend child care center/live w/ a sibling under 5 yo
36
Q

CF

A
  • autosomal recessive (so both parents have to be carriers)
  • can do a transplant to tx bt doesn’t cure
  • problem is w/ inc viscosity of secretions
    • bronchial obstruction
    • pancreatic duct obstruction–>malabsorption syndrome
    • biliary cirrhosis and portal HTN
    • steatorrhea
  • FTT, inc AP diameter, inc Hgb/HCT (b/c body not being oxygenated properly so inc RBC production (polycythemia)–>makes blood thicker), inc risk of infection
    • w/ polycythemia, inc risk of stroke b/c of thick blood so need to keep pt adequately hydrated
    • pt needs to be fully vaccinated
  • must have pancreatic enzyme replacement prior to meals/snacks
  • must have chest physiotherapy to get mucus out and prevent infection
37
Q

how to dx CF

A
  • buccal biopsy
  • sweat chloride test: make child sweat and then test how much NaCl in sweat and can indicate CF
  • child “tastes” salty
38
Q

diet of CF pts

A
  • need a high intake of fat–b/c have difficulty absorbing fat and have steatorrhea
  • pancreatic duct is often blocked, so need pancreatic enzyme replacement before meals and snacks
    • for babies, open capsule and sprinkle on bite of applesauce b/c crushing them changes composition!
39
Q

Croup Syndromes

A
  • to varying degrees it affects the larynx, trachea, and bronchi
  • usually described according to the primary anatomic site affected
  • all are under the umbrella of laryngotracheal bronchitis
40
Q

Croup

A
  • AKA acute laryngotracheobronchitis (LTB)
  • most common form of croup
  • usually viral
    • RSV, parainfluenza, influenza A/B
    • usually preceded by a URI
  • usually affects smaller/younger kids
  • s/s:
    • hoarseness
    • low grade feever
    • resonant cough (“brassy” or “barky”)
    • inspiratory stridor, mild wheezing
    • respiratory distress
      • suprasternal retractions
        • from inflammation or obstruction in region of larynx
  • tx:
    • maintain airway: cool mist, nebulized epinephrine, IV corticosteroids
41
Q

acute epiglottitis

A
  • AKA supraglottitis
  • usually bacterial
  • high fever common
  • usually affects slightly older kids
  • these kids are usually sicker than they are with croup
  • S/S
    • onset is abrupt–very sick, very fast
    • responsible organism is Haemophilus influenza–dec incidence since Hib vaccine
    • preceded by sore throat–pain on swallowing
      • dysphagia–drooling is common
    • toxic looking
    • tripod position
  • don’t really do anything with these kids, esp if it will upset them/make them cry b/c this leads to inc airway inflammation and may close the airway
    • do NOT do a throat inspection (only should be done by someone immediately prepared to intubate)
    • do NOT obtain throat culture
  • tx:
    • IV abx
    • corticosteroids
42
Q

pneumonia

A
  • inflammation of pulmonary parenchyma
    • common in childhood, more common in infants/early childhood
  • clinical manifestations:
    • depends on child’s age and the etiological agent, as well as degree of bronchial/bronchiolar obstruction
43
Q

viral pneumonia

A
  • occurs more frequently than bacterial pneumonia–usually assoc with URI
  • pathological changes include interstitial pneumonitis along with inflammation of the mucosa and the walls of the bronchi/bronchioles
  • organisms:
    • RSV in infants
    • parainfluenzae, influenzae, adenovirus in older children
  • clinical manifestations:
    • abrupt/insidious
    • mild to high fever
    • slight to severe cough
    • nonproductive cough to productive of small amounts of white mucus
    • tachypnea
    • diminished breath sounds over area of consolidation
    • grunting respirations b/c body trying to create PEEP
  • mgmt:
    • prognosis is good, does make child susceptible to bacterial infection
    • tx is symptomatic: promote oxygenation
44
Q

therapeutic mgmt of bacterial pneumonia

A
  • antimicrobial therapy
  • promote oxygenation
  • promote hydration
  • thoracentesis–pleural effusion

Pediatrics Test II (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions