Respiratory Flashcards
Why are respiratory issues in children concerning?
They don’t have as much respiratory reserve or musculature. They also have an immature immune system.
What is the child’s trachea like?
What does this mean?
Shorter and narrower than an adults.
It technically makes breathing even harder.
What about the bronchi?
Bronchi angle is more acute
What about their tongue?
Infant tongue is huge in relation to their mouth.
What about the size of the nares?
The nose nostrils are smaller and it makes it harder to breath - especially since they’re obligate nose breathers
What is the epiglottis like in infants and children?
Longer and floppier
What about soft tissue and alveoli development?
Children/infants have ore soft tissue but fewer alveoli.
What about the chest wall?
The chest does not have the development that ours does
as adults.
T/F
Adults are at bigger risk for obstruction of the airway than children
False.
Children are way more at risk for obstruction. And can be from literally anything
What should we look for first when assessing a child?
Their general appearance and behavior. Alert? Restless? Color? Skin perfusion? Positioning for comfort?
What if a patient has a weak cough?
Very concerning. Shows that their body can no longer compensate for the issue for the cough.
When listening to the chest, why is it important to differentiate between breath sound?
Different issues have different breath sounds
When the patient coughs, should we pay attention to the characteristics of their cough?
Yes. Different disease will present with different types of coughing.
Again, weak cough is not good. Means they can’t compensate.
When checking vital signs, what is the most important thing to look for?
Trends. If all of a sudden a trend changes and it cant be explain by pt condition, you have a problem.
When checking respiratorions what should you look for besides rate?
Need to check for whether their breathing is labored. Or if they need to use extra muscles above clavicle or outside the sternum
What does grunting indicate?
Body is trying to push open the alveoli
How might the body compensate for nose breathing?
Nare flaring
What if the patient has a mottled color?
What should you check?
This means the body is only perfusing the core and not the extremities to compensate
Check O2 and Co2
Late signs of respiratory distress
Poor air entry Apnea or gasping Deterioration or change in responsiveness Bradycardia Cyanosis
What type of illnesses are tonsillitis and pharyngitis?
Symptoms 3
Usually viral herpes unless it is strep
Sore throat
Fever
Swollen lymph nodes and edema (including adenoids)
What is a big issue with having tonsillitis?
Main form of care?
Why do we need to treat kids if they have strep?
Kids may not want to drink anything. Need to find ways to get kids to drink or get fluids
We want to control pain
Strep can cause kidney issues so need to give antibiotics.
Education when giving antibiotics for strep?
Wait full 24 hrs and finis off the meds
Why might someone get a tonsillectomy?
Will they remove adenoids?
Chronic strep
They assess adenoids if they need to.
Why would they do a tonsillectomy due to snoring?
Snoring is a sign of tonsil obstruction
How to care for someone with a tonsillectomy?
What if they frequently swallow?
Pain management with ice collar
Positioning - they can’t be on their back
Swallowing means bleeding which can lead to vomiting
Should you let a kid after tonsillectomy drink with a straw?
or blow nose?
No, these things add pressure inside the mouth.
NEED to educate on this.
What types of ear infections are there?
Otitis externa
Otitis media
Otitis Externa is?
What does it look like?
Inflammation of outer ear caused by exposure to other things
Such as bacteria in water
Can be red, swollen, with drainage and painful.
How can you treat otitis externa?
Keep clean and dry
Topical creams
What is otitis media?
Two types?
Inflammation of middle ear
acute otitis media
otitis media effusion
Acute otitis media
sudden issue probably from an infection of some sort. May see some bulging, cream like fluid
Otitis media w effusion
What does it feel like?
More chronic due to ongoing accumulation of fluid behind the tympanic membrane due to anatomy. Not an infection.
Can be painless but can interfere with hearing and possibly language development.
Most common organisms to cause acute otitis media
H. flu
Strep
RSV
Influenza
Is acute otitis media as common as it used to be?
No it is not. Populations have built up resistance to it, and bc of resistance we just try to be a little more strict when we give antibiotics.
Need to know if it is bacterial or viral
What if we watch & wait to see if something is viral or bacterial for acute otitis media?
Viral will get better usually but bacterial will need antibiotics
But we do want to make sure to know if it is acute or chronic
What do we want to see improvement in for acute otitis media in general?
Ability for tympanic membrane to move so they can hear again & develop language skills
(so if we do a watch & wait, and this ^ doesn’t happen, then it is bacterial and needs antibiotics)
How long do we give antibiotics to a child under 5
10 days - in order to make sure it is cleared
How do they manage pain for acute otitis media infections?
Pain meds like analgesics
Drops to numb the area
What if a child has multiple otitis media cases?
Hearing screen
Just evaluate language development
What does otitis media with effusion look like?
Is this less or more likely to affect language?
More normal color - not red.
More likely due to it being a chronic problem.
Typanomstomy tubes
Tubes placed through tympanic membrane to remove fluid and reduce pressure that are mainly used in otitis media with effusion
Can the tympanic membrane still work with a typanomstomy tube?
Yes, it can still work & often works better.
Will they do a typanomstomy tube insertion or do antibiotics/meds first when dealing with otitis media with effusion?
They’ll do the antibiotics first and then do the surgical intervention
What is another cause of otitis media that is more seasonal?
How do they treat this?
Allergies
Take allergy meds
What does follow up care look like for anyone with typanomstomy tubes or even just ear infections in general?
Speech and language professional
Post op care of a Tympanostomy
Analgesics
Hygiene
Educate on antibiotics use
What if a Tympanostomy tube falls out of the ear? Is this normal? What time frame?
It is common. Some kids may be passed the issue & others may have to have a new one inserted.
6 mo to 1 yr
Strong recommendations to avoid otitis in general?
Breastfeed for at least 6 months
Avoiding daycare
Soft recommendations to avoid otitis
No bottle in bed
No pacificier after 6 months
Avoid second hand smoke
What is epiglottitis and supraglottitis?
Why is this dangerous?
Life threatening inflammation & swelling of the epiglottis and surrounding tissue
Can close the airway
Epiglottitis and Supraglottitis are caused by which bacteria?
Strep
Staph
H-flu
What does the clinical manifestation of Epiglottitis and Supraglottitis look like?
Four D's = Dysphonia (Can't talk) Distressed inspiratory (Can't breath) Dysphagia (Can't swallow) Drooling
Interventions for Epiglottitis and Supraglottitis?
Should you hesitate?
Supplementary oxygen
Tracheostomy to find a new airway if its too edematous (might have to do this first so they can survive)
Antibiotics
Steroids
Give a quiet environment
Need to act fast!!! And don’t spend time poking around or try to get a look. Just react bc waiting can make it worse
Laryngotracheobronchitis (LTB)
Main symptom?
Viral infection that typically happens to kids younger than 5 due to inflammation of larynx, mucosa, and narrowing of an airway
Croup cough or barking cough
When does croup get worse in Laryngotracheobronchitis?
Gets worse at night
How is it that Laryngotracheobronchitis in children can progress to respiratory failure?
Children don’t have strong accessory muscles or drive. The constant coughing can wear them out. Younger the child more likely this happens.
Croup management
Maintain airway! Monitor o2 levels & vitals.
Nebulizer or cool mist
Heliox - lighter than oxygen so easier to get into alveoli
What is Bronchiolitis characterized by?
Viral or bacterial? Result of?
Inflammation of bronchioles and is a primary illness in infants!
Viral infection resulting from RSV or Respiratory syncytial virus.
Is RSV dangerous to adults?
What can it cause in children?
Not really but it is very dangerous to children. We would just have cold symptoms.
The inflammation + secretions would cause a hard time breathing in children bc their airways are smaller and even leads to hypoxia.
When does RSV usually hit seasonal wise?
Begins in the fall, peaks in winter, declines in spring.
How can a cpap help with infants with RSV?
The cpap mask delivers a level of air pressure to lungs to keep alveoli open. If the alveoli remained collapsed, it would require way too much work from the child to keep them open. The cpap makes sure the child doesn’t have to work as hard to do gas exchange. Like a balloon.
Which condition is closely associated with RSV again?
Bronchiolitis
What are Bronchiolitis symptoms?
Diagnosis?
Dyspnea (labored breathing) Hypoxia since there's no perfusion Tachypnea with retractions (fast breathing) Tachycardia for compensation Wheezing & crackles Hypothermic in infants
To diagnose we might take a naso-pharyngeal swab from the aspirate sample and send to lab
Explain the rationale behind each intervention for Bronchiolitis
Assessment of respirations and O2
Humidified Oxygen or Humidifier
Heliox
Hydration status
Suctioning
Include parents in care
Bronchiolitis:
Assess respiratory and O2 to make sure there isn’t respiratory failure
Using a humidifier can help add moisture to the air and facilitate breathing
Heliox is lighter than normal oxygen & so it can pass through the edema & inflammation better to help with breathing and thus perfusion
Need to make sure pt is hydrated for body system functioning but also to clear secretions. IV fluid methods of hydration can be used.
But, they will need to be given an energy source such as dextrose IV.
Suctioning is used in order to make sure the infant can breath as much as possible through their nose.
Parents should be included in care since they know the child best & it helps ease their fears and anxiety
RSV prevention?
RSV can be prevented by vaccine during the season. It is extremely expensive though so more for high risk infants.
- chronic lung diseases
- heart disease
- neuro
