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Pediatrics > Respiratory Alterations > Flashcards

Respiratory Alterations Flashcards

1
Q

Stridor

A

high-pitched inspiratory, expiratory, one or the other or both

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2
Q

Assessment Focus: Position of Comfort

A
  • is the child comfortable lying down? -
  • does the child prefer to sit up or be in tripod position (sitting forward with arms on knees for support and extending the chin forward)
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3
Q

Assessment Focus: Vital Signs

A
  • assess the rate, depth, and ease of respirations.
  • assess the pulse for rate and strength
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4
Q

Assessment Focus: Lung auscultation

A
  • are breath sounds bilateral, diminished, or absent?
  • are adventitious sound (wheezes, crackles, or rhonchi) present?
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5
Q

Assessment Focus: Respiratory effort (WOB)

A
  • is stridor (audible crowlike inspiratory and expiratory breath sounds) present? Is there grunting (a sound produced by the rapid breath release at the end of expiration after the newborn has used the vocal cords to hold the expiratory breath to prevent alveolar collapse)? dd
  • is breathing labored or taking extra effort?
  • are retractions present or are accessory muscles used to breathe?
  • is nasal flaring present?
  • is tachypnea (abnormally rapid respiratory rate) present?
  • can the child say a full sentence, or is breath needed every few words? Is the cry strong or weak?
  • Do the chest and abdomen rise simultaneously with inspiration, or is paradoxical breathing present in which the chest and abdomen do not rise simultaneously?
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6
Q

Assessment Focus: Colour

A
  • what is the color of the mucous membranes, skin, and nail beds? Pink, pale, cyanotic, or mottled (patches or pink, pale, and cyanotic skin)?
  • does crying improve or worsen the colour?
  • Mottled: is peripheral or central?
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7
Q

Assessment Focus: Cough

A
  • Is the cough dry (nonproductive), wet (productive, mucousy), brassy (noisy, musical), or croupy (barking, seal-like)?
  • Is the coughing effort forceful or weak?
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8
Q

Assessment Focus: Behaviour change

A

Is irritability, restlessness, or change in level of responsiveness present?

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9
Q

Assessment Focus: Family history

A

is there a family history of asthma or cystic fibrosis

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10
Q

Oxygen Saturation

A

measuring the oxygen that is flowing in your blood. infared is detecting hemoglobin that is flowing through the capillaries. Percentage of oxygen saturating hemoglobin.

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11
Q

Oxygen-Hemoglobin Dissociation Curve

A

Want to prevent and treat things that cause O2 levels in our blood to drop. as O2 drops, our PaO2 is dropping even more. High pH, alkalosis, hypothermia puts on a dangerous continuum. triggers clotting disorder that can lead to death. Prevent shift to the left.

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12
Q

Shift to the left

A

Hemoglobin has higher affinity for oxygen and is not releasing it to the tissues.
Patient condition is worsening.

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13
Q

Upper Respiratory Tract Infections (3)

A

Acute Streptococcal Pharyngitis
Tonsillitis
Croup Syndromes (3)

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14
Q

Upper Airway Obstruction (3)

A

Croup (nebulized epinephrine, corticosteroids)
Anaphylaxis (IM epinephrine, albuterol, antihistamines, corticosteroids)
Aspiration Foreign Body (allow position of comfort. specialty consultation)
- more commonly the right mainstem bronchus because it is bigger and more vertical

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15
Q

Lower Airway Obstruction (2)

A

Bronchiolitis (nasal suctioning, bronchodilator)
Asthma (albuterol + ipratropium, corticosteroids, SQ epinephrine, mag sulf)

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16
Q

Lung Tissue (Parenchymal) Disease (2)

A

Pneumonia/Pneumonitis (infectious, chemical, aspiration - albuterol, antibiotics)
Pulmonary Edema (cardiogenic or noncardiogenic - consider noninvasive ventilatory support, consider diuretic)

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17
Q

Disordered Control of Breathing (specific management for selected conditions)

A

increased ICP (avoid hypoxemia, avoid hypercarbia, avoid hyperthermia)
Poisoning/Overdose (antidote, contact poison control)
Neuromuscular Disease (consider noninvasive or invasive ventilatory support)

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18
Q

Acute Streptococcal Pharyngitis

A

“strep throat” - group A B-hemolytic streptococcus
At risk for acute rheumatic fever and acute glomerulonephritis. can cause more serious symptoms 18 days later like scarlet fever and permanent kidney damage
Abrupt onset: symptoms last 3-5 days.
Spread by direct contact or large droplets

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19
Q

Symptoms of Acute Streptococcal pharyngitis

A

Tonsils & pharynx inflamed and covered in exudate (50-80% of cases)
sore throat, redness, exudate, high fever

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20
Q

Medications and Nursing Care for Acute Streptococcal Pharyngitis

A

penicillin (10 days): noninfectious to others after 24 hours of appropriate antibiotics. Anti-inflammatory like ibuprofen
Nursing Care: cold or warm compresses, warm saline gargles, soft diet. Child can return to school after 24 hrs of antibiotics, wash or discard toothbrushes because it can spread.

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21
Q

Tonsillitis

A

Tonsils = masses of lymphoid tissue in pharyngeal cavity that filter and protect the resp tract from pathogenic organisms
Difficulty swallowing & Breathing
If adenoids enlarged: mouth breathing; mouth odour, impaired taste & smell; muffled & nasal voice; persistent cough; otitis media or hearing difficulties
May require surgery
- “kissing” tonsils could prevent food, fluid or air from entering.
Adenoids: behind the nasal passage, behind the pharynx. Hear a lot of snoring. mouth breathing during the day because they cant get air in through nose. muffled voice
- generally children have larger tonsils because they are more susceptible to RTI

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22
Q

Tonsillectomy post-op Nursing Care Management

A
  • not younger than 3-5 years because of risk of bleeding
  • if they are not sleeping, waking up at nigt, low O2 in the brain
  • 3 infections in a year
  • Position to facilitate drainage (HOB elevated)
  • careful suctioning prn (do not want to suck out clots or cause trauma)
  • Discourage coughing, clearing throats, blowing nose
  • ice colar
  • Regular analgesia for 24-48 hours (NOT CODEINE OR ASPIRIN)
  • NPO until alert, able to swallow & no signs of hemorrhage (popsicles, cool water, ice, soft foods; no straws
  • observe for hemorrhage (direct observation, tachycardia, pallor, frequent clearing of throat or swallowing, vomiting or secretions with bright red blood)
23
Q

Nursing Care Management of Tonsillitis: supportive care - no surgery

A
  • soft to liquid diet
  • cool-mist vaporizer
  • warm saltwater gargles
  • throat lozenges
  • analgesic-antipyretic drugs
24
Q

Tonsillectomy Primary post-op bleed

A

right after surgery, while still in hospital

25
Q

Tonsillectomy Secondary post-op Bleed

A

5-6 days later. eschar bleeding, sloughing off. tried to eat something hard and it opened up the area that was just operated on. day 5 is. the big red flag

26
Q

Otitis Media

A

Age 2: position of eustachian tube is at less of an angle (more horizontal) in the young child, resulting in decreased drainage.
- end of eustachian tube in nasal pharynx opens during sucking
- nearby swollen adenoids preventing drainage
- itching, pulling on the ears
- bottle feeding lying down is bad

27
Q

Reactive Airway Disorders (2)

A

Croup Syndromes - upper airway
- laryngotracheobronchitis
- epiglottitis
- bacterial tracheitis
Asthma - lower airway

28
Q

Croup Syndromes (HIVS)

A

upper airway illnesses that result from swelling of epiglottis & larynx; usually extends to trachea & bronchi
Viral or bacterial (viral is more common)
General term applied to a group of symptoms characterized by:
- hoarseness
- seal-like “barking” or “brassy” cough
- inspiratory stridor
- varying degrees of respiratory distress

29
Q

Mild Croup

A

occasional barking cough, no stridor at rest, no retractions

30
Q

Moderate Croup

A

Frequent barking cough, audible stridor at rest, no/mild agitation or distress, no cyanosis

31
Q

Severe Croup

A

Frequent barking cough, prominent inspiratory stridor, tachypnea, marked retractions, agitation &/or distress, no cyanosis, may be lethargic

32
Q

Impending Respiratory Failure

A

Barking cough & stridor at rest less prominent, retractions may be less apparent, lethargy or decreased LOC, cyanosis. Beware of the quiet child

33
Q

Acute Larygotracheobronchitis (LTB): Organisms

A

Viral - parainfluenza type 1,2,3, or 4; RSV, influenza A or B; adenovirus
Bacterial - mycoplasma pneumoniae ddd

34
Q

Acute LTB: clinical manifestations

A

URI for several days; progresses to cough & hoarseness; low-grade fever; tachypnea, inspiratory stridor; barking cough, hoarseness
Children < 5 years
Boys > girls

35
Q

Acute LTB Treatment

A
  • humification, cool mist
  • medications (epinephrine, corticosteroids (dexamethasone - liquid orally, once every 24 hours to reduce the swelling in the upper airway)
  • encourage fluids; comfort measures
  • supplemental O2 oximetry
  • rest, parental reassurance
    Airway obstruction possible - beware of the “quiet” child
36
Q

Acute Spasmotic Laryngitis

A

Spasmodic croup, “midnight” croup
Paroxysmal attacks of laryngeal obstruction that occur chiefly at night
Signs of inflammation are absent or mild
Often a history of previous attacks lasting 2-5 days followed by uneventful recovery
Children: 1-3 years
Usually managed at home with cool mist

37
Q

Acute Epiglottitis (Supraglottitis)

A

Potentially life-threatening - requires immediate attention
2-5 years of age
Sudden onset of illness with high fever (> 39)
Worst type of croup.
Bacterial - usually haemophilus influenza or group A streptococcus

38
Q

Classic Signs of Acute Epiglottitis: 4 D’s

A

Dysphonia
Dysphagia
Drooling
Distressed respiratory effort (tripod position)

39
Q

Treatment and Nursing Care of Epiglottitis

A

Lateral neck x-ray
Do not inspect mouth & throat unless prepared to intubate
Treatment: intubation, antibiotics, O2, antipyretics for fever & sore throat
Nursing Care: quiet environment; try to minimize crying! fluids, emotional support, droplet isolation for 24 after initiation of effective antibiotic therapy
Prophylactic antibiotic treatment of household contacts may be necessary

40
Q

Bacterial Tracheitis

A

Serious cause of airway obstruction with features of LTB and epiglottitis
Staphylococcus aureus (most frequent)
Typically 5-7 years
Croupy cough & stridor; high fever (>39) or several days; thick, purulent secretions
Child prefers lying flat to sitting up
Usually requires ventilatory support

41
Q

Lower Respiratory Tract Infections (3)

A

Bronchitis
Bronchiolitis (RSV)
Asthma

42
Q

Bronchitis

A

Inflammation of large airways (trachea & bronchi)
Frequently associated with URI
Usually viral
Dry, hacking, non-productive cough; worse at night; becomes productive in 2-3 days
Mild, self-limiting disease; symptomatic treatment

43
Q

Bronchiolitis (Respiratory Syncytial Virus)

A

Lower respiratory tract - inflammation & obstruction of bronchioles
Most severe in infants < 6 months
Initially ill with URI (nasal stuffiness and cough); progresses to deeper & more frequent cough; more stressful, laboured breathing
Fever < 39
Rapid RR, shallow, nasal flaring, retractions
Appear sick, less playful, not eating
Infant may spit up with thick, clear mucous (vomiting and difficulty breathing)
RSV is associated with developing asthma later in life

44
Q

Epidemiology of RSV

A

Initial infection most commonly occurs in 1st year of life (peak incidence between 2-6 months)
By age 2, most children have been infected at least once
Reinfection may occur in 3/4 of affected children in 2nd year of life
Males > females
Begins fall, peaks in winter, decreases during spring
incubation is 2 days

45
Q

Transmission of RSV

A

Direct contact with respiratory secretions (<1 metre); hand to eye, nose, or other mucous membrane
Can survive several hours on countertops, gloves, paper towels, cloth & remains infectious when transferred from hands to objects
Can survive 30 minutes on skin
Incubation 2-8 days; viral shedding can last several weeks

46
Q

Etiology & Pathophysiology of RSV

A

RSV is most common cause of bronchiolitis
Virus invades mucosal cells lining bronchioles; infected cell membranes fuse to form giant cel with multiple nuclei -> creates “syncytia” at cellular level; invaded cells die when virus bursts from inside cell to invade adjacent cells
Cell debris clogs & obstructs bronchioles & irritates airway; airway lining swells & produces excessive mucous; results in partial airway obstruction & bronchospasms - air can move in but not out - wheezes & crackles, air trapping
Risk for respiratory failure - beware “quiet” breath sounds

47
Q

RSV

A

G protein -> mediates attachment of virus to the host cells -> mediates cell penetration by the virus with F protein. F protein also promotes cell to cell spread of the virus through syncytial formation

48
Q

Highest Risk Groups for RSV

A

Premature birth (absence of maternal antibodies, smaller airways)
Bronchopulmonary Dysplasia (BPD) (bronchial hyper-responsiveness, reduced lung capacity)
Cardiac Disease (pulmonary vascular hyper-responsiveness, increased pulmonary blood flow)
Neuromuscular Disease (decreased respiratory muscle strength & endurance)
Immune Deficiency (decreased host defences, impaired capacity to eliminate virus)

49
Q

Diagnosis of RSV

A

Chest X-ray - not recommended unless severity suggests alternative disorder
- may be difficult to distinguish between RSV & asthma
Nasopharyngeal Wash or Nasopharyngeal Swab
- RSV antigen detection + other viral infections

50
Q

Guidelines for Admission RSV

A

Signs of severe respiratory distress
- indrawing, grunting, RR > 60/min
Supplemental O2 to keep sats > 90%
Dehydration or history of poor fluid intake
Cyanosis or history of apnea
Infant at high risk for severe disease
- infants born prematurely, <3 months old, hemodynamically significant cardiopulmonary disease, immunodeficiency
Family unable to cope

51
Q

Management of RSV

A

Oxygen
Hydration - IV or PO
Evidence is equivocal: epinephrine nebulization, nasal suctioning, combined epinephrine & dexamethasone
NOT recommended: ventolin, corticosteroids, antibiotics, antivirals, 3% hypertonic saline nebulization, chest physiotherapy, cool mist therapies or aerosol therapy with saline aerosol
OTHER: isolation (droplet & contact), cardiorespiratory monitor & pulse oximeter, intubation & ventilation

52
Q

Palivizumab - Synagis

A

Prophylactic treatment for high-risk infants
Pali = palliative
Vi = virus
Zu = humanization
Mab = monoclonal antibody
helpful for high-risk groups. an antiviral. given right before peak flu season (nov -mar)
IM injection given monthly during RSV season

53
Q

Criteria for discharge RSV

A

Tachypnea & WOB improved
maintain O2 sats > 90% without supplemental O2 OR stable for home oxygen therapy
Adequate oral feeding
Education provided and appropriate follow-up arranged

Pediatrics (25 decks)

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