Respiratory Flashcards
1
Q
What are the four main components that make up the upper respiratory tract?
A
- oronasopharynx
- pharynx
- larynx
- trachea
2
Q
What are the three main components of the lower respiratory tract?
A
- bronchi
- bronchioles
- alveoli
3
Q
what is a main protectant against an infection for infants younger than three months?
A
maternal antibodies (breastfeeding)
4
Q
at what age does the infection rate increase in infants?
A
three to six months
5
Q
what age group is at the highest rate of contracting viral infections?
A
toddlers in preschool ages
6
Q
there is an increase in mycoplasma pneumonia in beta strep infections for what age group?
A
children older than five years
7
Q
true or false: there is a decreased level of immunity with age.
A
false; immunity is increased as children age
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
9
Q
What is the respiratory rate for an infant that would concern the nurse?
A
greater than 60
10
Q
what is the respiratory rate for a toddler that would concern the nurse?
A
greater than 40
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)
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)
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
14
Q
What are the four early/Cardinal signs of respiratory distress?
A
- tachypnea
- restlessness
- tachycardia
- diaphoresis
15
Q
what are some other signs of respiratory distress (besides tachypnea, restlessness, tachycardia, diaphoresis)?
A
- grunting, flaring, retracting
- confusion, anxiety, irritability
- wheezing
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)
17
Q
What are the top 4 predictors of respiratory failure?
A
- level of consciousness
- inability to speak
- absent breath sounds
- central cyanosis
18
Q
what happens to serum potassium levels during acidosis?
A
K+ increases
19
Q
what happens to serum potassium levels during alkalosis?
A
K+ decreases
20
Q
What is the flow rate of a simple face mask?
A
at least 5 to 10L/min
21
Q
what is the flow rate of a low flow nasal cannula for infants?
A
0.1 to 2L/min
22
Q
what is the flow rate of a low flow nasal cannula for children?
A
0.5 to 4L/min
23
Q
what is the flow rate of a low flow nasal cannula for adolescents?
A
1 to 6L/min
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
25
A heat moisture exchanger is used to filter an create moisture and is attached to traches that do not have a _____ ______.
trach collar
26
What should the nurse have at the bedside of a patient who has a trach?
- 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)
27
What does the Passy-Muir Valve enable a patient who has a trach to do?
speak (this is a key part of development)
28
What is a lung sound that occur during inspiration?
inspiratory stridor =upper airway obstruction (croup)
29
what is a lung sound that occur during expiration?
wheezing =lower airway obstruction (asthma, bronchiolitis)
30
what are some causes (3) of upper airway obstruction?
- foreign body aspiration
- swelling of tissues (croup, tonsillitis, epiglottitis)
- congenital narrowing of upper airway
31
what are the clinical signs of upper airway obstruction?
- tachypnea
- increase inspiratory effort
- hoarse voice or cry , seal-like cough
- stridor
- sore throat
32
during what time of year does croup usually occur?
late autumn/early winter
33
what are the four types of croup?
- acute spasmodic croup
- laryngotracheitis/ laryngotracheobronchitis
- epiglottitis
- bacterial tracheitis
34
what age group is typically affected by croup?
six months to three years
35
what are some assessment findings of croup?
- barking cough
- hoarseness
- inspiratory stridor
- respiratory distress
36
What is the most common type of the croup syndromes?
laryngotracheobronchitis/ laryngotracheitis (LTB)
37
laryngotracheobronchitis/
| laryngotracheitis (LTB) generally affects what age group?
children <3 years of age
38
What are the organisms responsible for laryngotracheobronchitis/ laryngotracheitis (LTB)?
- viral
| - RSV, parainfluenza virus, Mycoplasma pneumoniae, influenza A & B
39
Is the onset of laryngotracheobronchitis/ laryngotracheitis (LTB) acute or chronic and when does it typically begin?
- acute onset
- usually at night
- sound worse than they look
40
What are some clinical manifestations of laryngotracheobronchitis/ laryngotracheitis (LTB)?
- could have a fever (gradual)
| - inspiratory stridor and maybe some rhinitis
41
What is the treatment option for mild case of laryngotracheobronchitis/ laryngotracheitis (LTB) and where is it given?
- outpatient supportive care
| - encourage fluids
42
What is the treatment option for moderate case of laryngotracheobronchitis/ laryngotracheitis (LTB) and where is it given?
- hospitalization for respiratory support
- IV fluids
- monitor pulse ox
- administer O2
43
What medications are commonly administered for laryngotracheobronchitis/ laryngotracheitis (LTB)?
- 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
True or false: cough medicine and decongestant medicine are contraindicated for laryngotracheobronchitis/ laryngotracheitis (LTB).
true
45
true or false: warm humidification, warm rags, and warm shower should be used for laryngotracheobronchitis/ laryngotracheitis (LTB) relief.
false; cool mist or humidification therapy should be used
46
Epiglottitis has an acute onset of what two symptoms?
fever and sore throat
47
what age group is commonly affected by epiglottitis?
two to five years old
48
what are some common clinical manifestations of epiglottitis?
- Drooling
- dysphonia (difficulty speaking)
- dysphasia (difficulty swallowing)
- tripod positioning
- retractions
- flaring
- inspiratory stridor
- mild hypoxia
- not hoarse
- no cough
49
True or false: epiglottitis is a life-threatening medical emergency.
true
50
what is the test done to diagnose epiglottitis and what does the imaging look like?
- lateral neck X-ray
| - thumb print
51
what are some nursing considerations to follow when caring for a patient who has epiglottitis?
- maintain calm composure
- maintain calm environment
- maintain child in position of comfort
- keep Guardian close
- have emergency intubation equipment at hand
52
which vaccine is given as a preventative measure for epiglottitis?
hib vaccine
53
what is the treatment for epiglottitis?
- intubation
- obtain cultures post intubation
- IV antibiotics for two to three days then PO antibiotics for total of 10 days
54
What are some common causes of lower airway obstruction?
- asthma
| - bronchiolitis
55
what are some clinical signs of lower airway obstruction?
- typically heard an expiration
- wheezing
- tachypnea
- retractions
- nasal flaring
- prolonged expiration phase combined with expiratory effort
- cough
56
Respiratory syncytial virus is the most common cause of what lower airway obstruction?
bronchiolitis
57
what is the diagnostic test to detect bronchiolitis?
culture secretions
58
what are some therapeutic management used for bronchiolitis?
- hydration
- increase fluid intake
- rest
- humidification
59
What vaccine is used to prevent RSV (respiratory syncytial virus) bronchiolitis?
palivizumba; however, it is very expensive, and requires patient to meet certain parameters before administration
60
what is a chronic inflammatory disorder of the airways that limits airflow or obstruction that reverses spontaneously or with treatment?
asthma
61
what are some types of asthma triggers?
- allergens: dust, animal dander, smoke
- cold air
- weather changes
- infection
- exercise
- emotional distress
- fatigue
- environmental changes like starting a new school
62
what are the three categories of asthma severity?
mild, moderate, severe
63
what are some anti-inflammatory drugs that are used for asthma?
- inhaled corticosteroids (fluticasone propionate and budesonide)
- oral or corticosteroids
- Leukotriene receptor antagonist (montelukast)
64
What are some concerns that a nurse should have when administering corticosteroids?
-growth alterations
-immunocompromised=
infection
65
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?
atopy
66
What are some long-term meds that we use as preventative drug therapy for asthma?
- corticosteroids
- cromolyn sodium
- albuterol
- salmeterol
- leukotriene modifiers (montelukast)
67
what are some quick relief or rescue meds that we use for asthma exacerbations?
- albuterol
- ipratropium
- IV magnesium sulfate (ICU)
68
What are some nursing management interventions for asthma?
- 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
what is some patient and family teaching for asthma?
- 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
What is respiratory distress that continues despite vigorous therapeutic measures and is a medical emergency?
status asthmaticus
71
what are some interventions that need to be done for status asthmaticus?
- humidified oxygen
- aerosolized short-acting beta 2-agonist
- IV access
72
what are some goals of asthma management?
- 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
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?
cystic fibrosis
74
What is the most reliable diagnostic procedure of cystic fibrosis?
sweat chloride test (pilocarpine iontophoresis)
75
__________ viscosity of mucus gland secretions with cystic fibrosis causes thick mucoprotein to accumulate, dilate, precipitate, and coagulate to form concretions in glands and ducts.
increased
76
What are some respiratory manifestations of cystic fibrosis?
- 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
What are some types of management for cystic fibrosis patients?
- 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
What are some treatment drugs used in very specific populations of CF patients?
- ivacaftor
| - lumacaftor/ivacaftor
79
what does the CF diet include?
- high protein
- high caloric
- unrestricted fat
80
What two things occur when a CF patient does not take pancreatic enzymes?
- azotorrhea (excessive discharge of nitrogenous substances in the feces or urine)
- steatorrhea (oily stool)
81
What is azotorrhea?
increased protein in stool=pale
82
What is steatorrhea?
increased fat in stool= greasy stool= floats
83
What are the three types of otitis media?
- acute otitis media
- otitis media with effusion
- chronic suppurative otitis media
84
What are some S&S of acute otitis media?
- pain
- infection
- fever
- holding or pulling at ear
- rolling head side to side
- enlarged post-auricular, cervical lymph glands
85
what are some S&S of otitis media with effusion?
fluid in middle ear without S&S
86
what are some S&S of chronic suppurative otitis media?
- drainage
| - perforated tympanic membrane
87
what is primarily a result of a dysfunctioning eustachian tube?
otitis media
88
what are some risk factors for developing acute otitis media (AOM) or otitis media with effusion (OME)?
- 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
What are some treatment options for acute otitis media (AOM)?
- 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
True or false: it's okay to give ibuprofen to infants who are less than six months old if they have acute otitis media.
false
91
management of otitis media with effusion (OME)?
- 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
What are some management interventions used for pharyngitis?
- gargle with warm Saline three times a day
- ice chips and popsicles
- acetaminophen/ ibuprofen every four to six hours
93
what are some interventions used for strep throat?
-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
How long before a child can return to school or daycare after he/she has been taking antibiotics for acute streptococcal pharyngitis?
a full 24 hours
95
Acute streptococcal pharyngitis increases the risk for serious sequelae (a condition which is the consequence of a previous disease or injury) which include?
- acute rheumatic fever
- acute glomerulonephritis
- scarlet fever
96
What are some nursing care that is provided if a patient has a tonsillectomy and/or adenoidectomy?
- observe for bleeding ( 7 to 10 days)
- strict I&O
- oral fluids for hydration
