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PEDs Exam 2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the four main components that make up the upper respiratory tract?

A
  • oronasopharynx
  • pharynx
  • larynx
  • trachea
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2
Q

What are the three main components of the lower respiratory tract?

A
  • bronchi
  • bronchioles
  • alveoli
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3
Q

what is a main protectant against an infection for infants younger than three months?

A

maternal antibodies (breastfeeding)

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4
Q

at what age does the infection rate increase in infants?

A

three to six months

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5
Q

what age group is at the highest rate of contracting viral infections?

A

toddlers in preschool ages

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6
Q

there is an increase in mycoplasma pneumonia in beta strep infections for what age group?

A

children older than five years

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7
Q

true or false: there is a decreased level of immunity with age.

A

false; immunity is increased as children age

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8
Q

true or false: the first thing a nurse should do to assess a child’s respiratory system is auscultation.

A

false; look and listen without a stethoscope first

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9
Q

What is the respiratory rate for an infant that would concern the nurse?

A

greater than 60

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10
Q

what is the respiratory rate for a toddler that would concern the nurse?

A

greater than 40

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11
Q

what are some normal periods of apnea that can occur in an infant or child?

A
  • during feedings
  • during sleep
  • crying
  • holding their breath (if greater than 20 seconds we need to intervene)
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12
Q

what are some visual assessments that can be done to determine respiratory status?

A

-work of breathing (grunting, flaring, retracting)
-infant: irregular breathing pattern, nose breathers
-rate of breathing
-chest movement
+abdominal distention can cause irregular chest movement
+cardiac problems can cause chest movements
-Posture an activity level (tripod position, lethargy)
-sensorium
-level of comfort
-color (mucous membranes)

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13
Q

what are some things you can hear during an assessment that can be done without a stethoscope?

A
  • grunting
  • stridor (barky cough, seal like cough=croup)
  • wheezing
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14
Q

What are the four early/Cardinal signs of respiratory distress?

A
  • tachypnea
  • restlessness
  • tachycardia
  • diaphoresis
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15
Q

what are some other signs of respiratory distress (besides tachypnea, restlessness, tachycardia, diaphoresis)?

A
  • grunting, flaring, retracting
  • confusion, anxiety, irritability
  • wheezing
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16
Q

what are the signs of impeding respiratory failure?

A 
1st Somnolence (excess sleepiness)
2nd Cyanosis
-dyspnea
-bradycardia
-stupor/coma
-oxygen desaturation
-depressed/slow respirations (decreased inspiratory breath sounds)
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17
Q

What are the top 4 predictors of respiratory failure?

A
  • level of consciousness
  • inability to speak
  • absent breath sounds
  • central cyanosis
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18
Q

what happens to serum potassium levels during acidosis?

A

K+ increases

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19
Q

what happens to serum potassium levels during alkalosis?

A

K+ decreases

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20
Q

What is the flow rate of a simple face mask?

A

at least 5 to 10L/min

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21
Q

what is the flow rate of a low flow nasal cannula for infants?

A

0.1 to 2L/min

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22
Q

what is the flow rate of a low flow nasal cannula for children?

A

0.5 to 4L/min

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23
Q

what is the flow rate of a low flow nasal cannula for adolescents?

A

1 to 6L/min

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24
Q

If using a nonrebreather oxygen flow rate must be sufficient enough to inflate reservoir bag __/__ to __/__ full during inspiration.

A

1/3 to 1/2

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25
Q

A heat moisture exchanger is used to filter an create moisture and is attached to traches that do not have a _____ ______.

A

trach collar

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26
Q

What should the nurse have at the bedside of a patient who has a trach?

A
  • trach of same size and one smaller
  • suctioning and make sure it works
  • trach to go bag (know size of Cath and how far it goes down)
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27
Q

What does the Passy-Muir Valve enable a patient who has a trach to do?

A

speak (this is a key part of development)

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28
Q

What is a lung sound that occur during inspiration?

A

inspiratory stridor =upper airway obstruction (croup)

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29
Q

what is a lung sound that occur during expiration?

A

wheezing =lower airway obstruction (asthma, bronchiolitis)

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30
Q

what are some causes (3) of upper airway obstruction?

A
  • foreign body aspiration
  • swelling of tissues (croup, tonsillitis, epiglottitis)
  • congenital narrowing of upper airway
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31
Q

what are the clinical signs of upper airway obstruction?

A
  • tachypnea
  • increase inspiratory effort
  • hoarse voice or cry , seal-like cough
  • stridor
  • sore throat
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32
Q

during what time of year does croup usually occur?

A

late autumn/early winter

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33
Q

what are the four types of croup?

A
  • acute spasmodic croup
  • laryngotracheitis/ laryngotracheobronchitis
  • epiglottitis
  • bacterial tracheitis
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34
Q

what age group is typically affected by croup?

A

six months to three years

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35
Q

what are some assessment findings of croup?

A
  • barking cough
  • hoarseness
  • inspiratory stridor
  • respiratory distress
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36
Q

What is the most common type of the croup syndromes?

A

laryngotracheobronchitis/ laryngotracheitis (LTB)

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37
Q

laryngotracheobronchitis/

laryngotracheitis (LTB) generally affects what age group?

A

children <3 years of age

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38
Q

What are the organisms responsible for laryngotracheobronchitis/ laryngotracheitis (LTB)?

A
  • viral

- RSV, parainfluenza virus, Mycoplasma pneumoniae, influenza A & B

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39
Q

Is the onset of laryngotracheobronchitis/ laryngotracheitis (LTB) acute or chronic and when does it typically begin?

A
  • acute onset
  • usually at night
  • sound worse than they look
40
Q

What are some clinical manifestations of laryngotracheobronchitis/ laryngotracheitis (LTB)?

A
  • could have a fever (gradual)

- inspiratory stridor and maybe some rhinitis

41
Q

What is the treatment option for mild case of laryngotracheobronchitis/ laryngotracheitis (LTB) and where is it given?

A
  • outpatient supportive care

- encourage fluids

42
Q

What is the treatment option for moderate case of laryngotracheobronchitis/ laryngotracheitis (LTB) and where is it given?

A
  • hospitalization for respiratory support
  • IV fluids
  • monitor pulse ox
  • administer O2
43
Q

What medications are commonly administered for laryngotracheobronchitis/ laryngotracheitis (LTB)?

A
  • nebulized racemic epinephrine (bronchodilation, improvement within 30 minutes, but only lasts a couple hours, so the patient will be monitored for 3 hours before discharged)
  • short course of corticosteroids (dexamethasone)
44
Q

True or false: cough medicine and decongestant medicine are contraindicated for laryngotracheobronchitis/ laryngotracheitis (LTB).

A

true

45
Q

true or false: warm humidification, warm rags, and warm shower should be used for laryngotracheobronchitis/ laryngotracheitis (LTB) relief.

A

false; cool mist or humidification therapy should be used

46
Q

Epiglottitis has an acute onset of what two symptoms?

A

fever and sore throat

47
Q

what age group is commonly affected by epiglottitis?

A

two to five years old

48
Q

what are some common clinical manifestations of epiglottitis?

A
  • Drooling
  • dysphonia (difficulty speaking)
  • dysphasia (difficulty swallowing)
  • tripod positioning
  • retractions
  • flaring
  • inspiratory stridor
  • mild hypoxia
  • not hoarse
  • no cough
49
Q

True or false: epiglottitis is a life-threatening medical emergency.

A

true

50
Q

what is the test done to diagnose epiglottitis and what does the imaging look like?

A
  • lateral neck X-ray

- thumb print

51
Q

what are some nursing considerations to follow when caring for a patient who has epiglottitis?

A
  • maintain calm composure
  • maintain calm environment
  • maintain child in position of comfort
  • keep Guardian close
  • have emergency intubation equipment at hand
52
Q

which vaccine is given as a preventative measure for epiglottitis?

A

hib vaccine

53
Q

what is the treatment for epiglottitis?

A
  • intubation
  • obtain cultures post intubation
  • IV antibiotics for two to three days then PO antibiotics for total of 10 days
54
Q

What are some common causes of lower airway obstruction?

A
  • asthma

- bronchiolitis

55
Q

what are some clinical signs of lower airway obstruction?

A
  • typically heard an expiration
  • wheezing
  • tachypnea
  • retractions
  • nasal flaring
  • prolonged expiration phase combined with expiratory effort
  • cough
56
Q

Respiratory syncytial virus is the most common cause of what lower airway obstruction?

A

bronchiolitis

57
Q

what is the diagnostic test to detect bronchiolitis?

A

culture secretions

58
Q

what are some therapeutic management used for bronchiolitis?

A
  • hydration
  • increase fluid intake
  • rest
  • humidification
59
Q

What vaccine is used to prevent RSV (respiratory syncytial virus) bronchiolitis?

A

palivizumba; however, it is very expensive, and requires patient to meet certain parameters before administration

60
Q

what is a chronic inflammatory disorder of the airways that limits airflow or obstruction that reverses spontaneously or with treatment?

A

asthma

61
Q

what are some types of asthma triggers?

A
  • allergens: dust, animal dander, smoke
  • cold air
  • weather changes
  • infection
  • exercise
  • emotional distress
  • fatigue
  • environmental changes like starting a new school
62
Q

what are the three categories of asthma severity?

A

mild, moderate, severe

63
Q

what are some anti-inflammatory drugs that are used for asthma?

A
  • inhaled corticosteroids (fluticasone propionate and budesonide)
  • oral or corticosteroids
  • Leukotriene receptor antagonist (montelukast)
64
Q

What are some concerns that a nurse should have when administering corticosteroids?

A

-growth alterations
-immunocompromised=
infection

65
Q

What is a genetic disposition for the development of an IgE-mediated response to common aeroallergens and is the strongest predisposing factor for developing asthma?

A

atopy

66
Q

What are some long-term meds that we use as preventative drug therapy for asthma?

A
  • corticosteroids
  • cromolyn sodium
  • albuterol
  • salmeterol
  • leukotriene modifiers (montelukast)
67
Q

what are some quick relief or rescue meds that we use for asthma exacerbations?

A
  • albuterol
  • ipratropium
  • IV magnesium sulfate (ICU)
68
Q

What are some nursing management interventions for asthma?

A
  • based on assessment of depth, rate, rhythm, and type of patient respirations
  • monitor the quality and rate of patients pulse
  • assess the patient’s lung sounds for crackles, ronca, and wheezing
  • observe fingernails and lips for signs of cyanosis
69
Q

what is some patient and family teaching for asthma?

A
  • increase fluid intake to decrease viscosity of lung secretions
  • never abruptly discontinue asthma meds
  • practice good, oral hygiene
  • house at 50-60% humidity
  • no carpet comma, but if there is carpet vacuum daily
70
Q

What is respiratory distress that continues despite vigorous therapeutic measures and is a medical emergency?

A

status asthmaticus

71
Q

what are some interventions that need to be done for status asthmaticus?

A
  • humidified oxygen
  • aerosolized short-acting beta 2-agonist
  • IV access
72
Q

what are some goals of asthma management?

A
  • avoid exacerbation
  • avoid allergens/triggers
  • relieve asthmatic episodes promptly
  • relieve bronchospasm
  • monitor function with peak flow meter
  • self management of inhalers, devices, an activity regulation
  • participate in sports/exercise when asthma is controlled
73
Q

what is the most common lethal genetic (autosomal recessive) illness among Caucasian children that is caused by endocrine gland dysfunction that produces multi system involvement?

A

cystic fibrosis

74
Q

What is the most reliable diagnostic procedure of cystic fibrosis?

A

sweat chloride test (pilocarpine iontophoresis)

75
Q

__________ viscosity of mucus gland secretions with cystic fibrosis causes thick mucoprotein to accumulate, dilate, precipitate, and coagulate to form concretions in glands and ducts.

A

increased

76
Q

What are some respiratory manifestations of cystic fibrosis?

A
  • present in almost all CF patients but onset and extent are variable
  • stagnation of mucus and bacterial colonization result in destruction of lung tissue
  • tenacious secretions are difficult to expectorate, and can cause obstruction of bronchi and bronchioles
77
Q

What are some types of management for cystic fibrosis patients?

A
  • percussion and postural drainage
  • mucolytic agents- dornase alfa
  • antibiotics (vancomycin, tobramycin, cefepime, piperacillin/tazobactam extended infusion)
  • pancreatic enzymes
  • supplement fat soluble vitamins
  • keep hydrated
  • assess work of breathing
78
Q

What are some treatment drugs used in very specific populations of CF patients?

A
  • ivacaftor

- lumacaftor/ivacaftor

79
Q

what does the CF diet include?

A
  • high protein
  • high caloric
  • unrestricted fat
80
Q

What two things occur when a CF patient does not take pancreatic enzymes?

A
  • azotorrhea (excessive discharge of nitrogenous substances in the feces or urine)
  • steatorrhea (oily stool)
81
Q

What is azotorrhea?

A

increased protein in stool=pale

82
Q

What is steatorrhea?

A

increased fat in stool= greasy stool= floats

83
Q

What are the three types of otitis media?

A
  • acute otitis media
  • otitis media with effusion
  • chronic suppurative otitis media
84
Q

What are some S&S of acute otitis media?

A
  • pain
  • infection
  • fever
  • holding or pulling at ear
  • rolling head side to side
  • enlarged post-auricular, cervical lymph glands
85
Q

what are some S&S of otitis media with effusion?

A

fluid in middle ear without S&S

86
Q

what are some S&S of chronic suppurative otitis media?

A
  • drainage

- perforated tympanic membrane

87
Q

what is primarily a result of a dysfunctioning eustachian tube?

A

otitis media

88
Q

what are some risk factors for developing acute otitis media (AOM) or otitis media with effusion (OME)?

A
  • horizontal, short eustachian tube
  • immature immune system
  • less than two years of age-peak incidents between 6 and 18 months
  • atopy
  • bottle propping
  • chronic sinusitis
  • cleft palate
  • child care attendance
  • down syndrome
  • passive smoke
89
Q

What are some treatment options for acute otitis media (AOM)?

A
  • spontaneous resolution in 80% of children
  • wait up to 48 -72 hours for spontaneous resolution while providing pain control
  • amoxicillin 80 – 90mg/kg/day divided BID x 10 days
  • second-line antibiotics: amoxicillin + clavulanate
  • third-line: ceftriaxone
90
Q

True or false: it’s okay to give ibuprofen to infants who are less than six months old if they have acute otitis media.

A

false

91
Q

management of otitis media with effusion (OME)?

A
  • 75% of cases resolved within three months
  • temporary hearing deficit
  • persistent OME past three months with hearing or language delays may benefit from tympanostomy tubes
92
Q

What are some management interventions used for pharyngitis?

A
  • gargle with warm Saline three times a day
  • ice chips and popsicles
  • acetaminophen/ ibuprofen every four to six hours
93
Q

what are some interventions used for strep throat?

A

-penicillin VK/amoxicillin for 10 days
((Erythromycin/cephalexin for 10 days if patient has a penicillin allergy))

  • gargle with warm Saline three times a day
  • ice chips and popsicles
  • acetaminophen/ ibuprofen every four to six hours
94
Q

How long before a child can return to school or daycare after he/she has been taking antibiotics for acute streptococcal pharyngitis?

A

a full 24 hours

95
Q

Acute streptococcal pharyngitis increases the risk for serious sequelae (a condition which is the consequence of a previous disease or injury) which include?

A
  • acute rheumatic fever
  • acute glomerulonephritis
  • scarlet fever
96
Q

What are some nursing care that is provided if a patient has a tonsillectomy and/or adenoidectomy?

A
  • observe for bleeding ( 7 to 10 days)
  • strict I&O
  • oral fluids for hydration

PEDs Exam 2 (4 decks)

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