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respiratory disorders Flashcards

1
Q

tonsils

A
  • Masses of lymph-type tissue.
  • Filter pathogenic organisms (viral and bacterial)
  • Contribute to antibody formation.
  • Tonsils are highly vascular.
  • Palatine and Pharyngeal
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2
Q

enlarged tonsils interferes with

A
  • Enlarged tonsils can block the nose and throat.

- Interferes with breathing, nasal and sinus drainage, sleeping, swallowing, and speaking.

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3
Q

acute tonsillitis

A

occurs when the tonsils become inflamed and reddened.

Can become chronic.

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4
Q

tonsillitis risk factors

A
  • Exposure to a viral or bacterial agent

- Immature immune systems (younger children)

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5
Q

tonsillitis expected findings

how to test for it

A
  • Sore throat with difficulty swallowing
  • History of otitis media and hearing difficulties
  • Mouth odor
  • Mouth breathing
  • Snoring
  • Nasal qualities in the voice
  • Fever
  • Tonsil inflammation with redness and edema
  • Throat culture for group A beta-hemolytic streptococci (GABHS)
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6
Q

tonsillits nursing care

A
  • Provide symptomatic treatment for viral tonsillitis (rest, warm fluids, warm salt-water gargles).
  • Administer antibiotic therapy as prescribed for bacterial tonsillitis.
  • Antipyretics/analgesics: acetaminophen
  • Hydrocodone is indicated for the child having difficulty drinking fluids.
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7
Q

tonsillectomy post op care

A
  • Place in position to facilitate drainage.
  • Elevate head of bed when child is fully awake.

Assess for evidence of bleeding:

  • frequent swallowing
  • clearing the throat
  • Restlessness
  • Bright red emesis, tachycardia, and/or pallor
  • Assess the airway and vital signs
  • Monitor for difficulty breathing related to oral secretions, edema, and/or bleeding
  • Administer liquid analgesics or tetracaine lollipops as prescribed
    Provide an ice collar
  • Offer ice chips or sips of water to keep throat moist
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8
Q

tonsillectomy after care

A
  • Encourage clear liquids and fluids after a return of the gag reflex, avoiding red‑colored liquids, citrus juice, and milk‑based foods initially.
  • Advance the diet with soft, bland foods.
  • Discourage coughing, throat clearing, and nose blowing in order to protect the surgical site.
  • Avoid straws
  • Alert parents that there can be clots or blood‑tinged mucus in vomitus.
    • Instruct the family to notify the provider if bright red bleeding occurs.
      Encourage the child to rest.
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9
Q

how many days can you bleed for after tonsillectomy

A

14

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10
Q

Tonsillectomy: Parent Education

A
  • Instruct the parents to contact the provider if the child experiences difficulty breathing, lack of oral intake, increase in pain, and/or indications of infection.
  • Ensure that the child does not put objects in the mouth.
  • Administer pain medications for discomfort.
  • Encourage fluid intake and diet advancement Instruct the child and family to limit activity to decrease the potential for bleeding.
  • Full recovery usually occurs in approximately 14 days.
  • Teach manifestations of hemorrhage: Dehydration
    Infection
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11
Q

manifestations of hemorrhage

A

dehydration

infection

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12
Q

tonsillectomy complications

A

hemmorrhage
dehydration
chronic infection

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13
Q

tonsillectomy hemorrhage

A
  • Use a good light source and possibly a tongue depressor to directly observe the throat.
  • Assess for bleeding (tachycardia, repeated swallowing and clearing of throat, hemoptysis).
  • Hypotension is a late sign of shock.
  • Contact the provider immediately if there is any indication of bleeding.
  • Instruct family to report indications of bleeding
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14
Q

bleeding s/s tonsillectomy

A

tachycardia, repeated swallowing and clearing of throat, hemoptysis

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15
Q

dehydration tonsillectomy nursing care

A
  • Encourage oral fluids.
  • Monitor I&O.
  • Instruct the family to encourage oral fluids.
  • Teach the family about manifestations of dehydration.
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16
Q

chronic infection tonsillectomy

A
  • GABHS can pose a potential threat to other parts of the body.
  • Some children who frequently have tonsillitis can develop other diseases, such as rheumatic fever and kidney infection.
  • Instruct the family to seek medical attention when the child presents with manifestations of tonsillitis.
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17
Q

risk factors for common respiraotry illnesses

A

Disorders can affect both the upper and lower respiratory tracts.

  • Age
    I- nfants between 3 and 6 months are at increased risk due to the decrease of maternal antibodies acquired at birth and the lack of antibody protection.
  • Viral infections are more common in toddlers and preschoolers.
  • Certain viral agents can cause serious illness during infancy, but only cause a mild illness in older children.
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18
Q

Nasopharyngitis (Common Cold)

A

Nasal inflammation, dryness and irritation of nasal passages and the pharynx
- Fever, decreased appetite, and restlessness

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19
Q

Nasopharyngitis (Common Cold) interventions

A
  • Instruct parents about home management.
  • Give antipyretic for fever.
  • Encourage rest.
  • Provide vaporized air (cool mist).
  • Give decongestants for children older than 6 years.
  • Give cough suppressants with caution
  • Antihistamines are not recommended.
  • Antibiotics are not indicated.
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20
Q

Acute Streptococcal Pharyngitis

A
  • Infection of the upper airway (strep throat)
  • Onset is abrupt and characterized by pharyngitis, headache, fever and abdominal pain.
  • can affect kidney and heart
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21
Q

Acute Streptococcal Pharyngitis interventions

diagnosed by

A

Throat culture or rapid antigen testing to determine GABHS infection

Administer IV antibiotics as prescribed.

Oral penicillin for at least 10 days.

Amoxicillin once a day for 10 days.

IM penicillin G benzathine is also appropriate.

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22
Q

bronchitis

A
  • Associated with an upper respiratory infection and inflammation of large airways
  • Requires symptomatic relief
  • Persistent dry, hacking cough as a result of inflammation
  • Resolves in 5 to 10 days
  • Test nasopharyngeal secretions
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23
Q

bronchitis interventions

A
  • Test nasopharyngeal secretions
  • Instruct parents about home management.
  • Give antipyretics for fever.
  • Give a cough suppressant.
  • Provide increased humidity (cool mist vaporizer).
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24
Q

bronchiolitis

A

Mostly caused by RSV

  • Occurs at the bronchiolar level, may be progressive
  • Rhinorrhea, intermittent fever, pharyngitis, coughing, sneezing, wheezing, possible ear or eye infection
  • Increased coughing and sneezing, fever, tachypnea and retractions, refusal to nurse or bottle feed, copious secretions
  • 1Tachypnea (greater than 70/min), listlessness, apneic spells, poor air exchange, poor breath sounds, cyanosis
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25
Q

bronchiolitis nursing care

A
  • Supplemental oxygen to maintain oxygen saturation equal to or greater than 90%.
  • Encourage fluid intake, otherwise IV fluids until acute phase has passed.
  • Maintain airway.
  • Medications as prescribed.
  • Antibiotics if a coexisting bacterial infection is present
  • Nasopharyngeal or nasal suctioning as needed.
  • Encourage breastfeeding
  • Ng tube for food
  • Corticosteroid use is controversial.
  • Bronchodilators are not recommended.
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26
Q

allergic rhinitis

A
  • Caused by seasonal reaction to allergens most often in the autumn or spring
  • Watery rhinorrhea; nasal obstruction; itchiness of the nose, eyes, pharynx and conjunctiva;
  • Snoring; fatigue, malaise, headache and poor performance in school.
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27
Q

allerguc rhinitis interventions

A
  • Instruct parents about home management.
  • Avoid allergens (epi for severe)
  • Give nasal corticosteroids (first-line medications used).
  • Give antihistamines, beta-adrenergic decongestants, and ipratropium.
28
Q

bacterial pneumomia s/s

A
  • High fever
  • Cough that can be unproductive or productive of white sputum
  • Tachypnea
  • Retractions and nasal flaring
  • Chest pain
  • Dullness with percussion
  • Adventitious breath sounds (rhonchi, fine crackles)
  • Pale color that progresses to cyanosis
  • Irritability, restless, lethargic
  • Abdominal pain, diarrhea, lack of appetite, and vomiting
29
Q

viral pneumonia interventions

A
  • Administer oxygen with cool mist.
  • Monitor continuous oximetry.
  • Administer antipyretics for fever.
  • Monitor I&O.
  • CPT and postural drainage
30
Q

s/s of hypoxic

A

irritabile

restless

31
Q

bacterial pneumonia interventions

A
  • Encourage rest.
  • Administer IV antibiotics.
  • Promote increased oral intake.
  • Monitor I&O.
  • Administer antipyretics for fever.
  • CPT and postural drainage can be helpful.
  • Administer IV fluids.
  • Administer oxygen.
  • Monitor continuous oximetry
32
Q

pneuomonia complications

A

pneumothorax

pleural effusion

33
Q

pneumonia complication: pneumothorax

A
  • Accumulation of air in the pleural space

- Dyspnea, chest pain, back pain, labored respirations, decreased oxygen saturations, and tachycardia

34
Q

pneumonia complication: pneumothorax interventions

A
  • Prepare the client for an emergent needle aspiration with insertion of chest tube to closed drainage.
  • Provide for chest tube management.
  • Assess respiratory status.
  • Administer oxygen.
35
Q

pneumonia complication: pleural effusion s/s

A

Dyspnea, chest pain, back pain,

labored respirations, decreased oxygen saturations, and tachycardia

36
Q

pneumonia complication: pleural effusion interventions

A
  • Prepare the client for an emergent needle aspiration to remove fluid in the pleural space, with insertion of chest tube to closed drainage.
  • Provide for chest tube management.
  • Assess respiratory status.
  • Administer oxygen as prescribed.
37
Q

croup syndrome

A

bacterial apiglottitis

  • swelling of airway
  • HIB vaccine
  • Medical emergency
  • Usually caused by Haemophilus influenza
  • Absence of cough, drooling, and agitation
  • Sitting upright (tripod position)
  • Dysphonia/Dysphagia
  • Inspiratory stridor (noisy inspirations)
  • Suprasternal and substernal retractions
  • Sore throat, high fever, and restlessness
  • With chin pointing out, mouth opened, and tongue protruding
    (thick, muffled voice and froglike croaking sound)
38
Q

croup sundrome interventions

diagnosed by

A
  • Diagnosed by lateral neck X-Ray
  • Protect airway.
  • Avoid throat culture or using a tongue blade.
  • Prepare for intubation (last resort).
  • Provide humidified oxygen (cold).
  • Monitor continuous oximetry.
  • Administer corticosteroids, and IV fluids as prescribed.
  • Administer antibiotics.
  • Droplet isolation precautions for first 24 hr after IV antibiotics initiated
39
Q

croup syndrome:Acute laryngotracheobronchitis

A

Causative agents include RSV, influenza A and B, and Mycoplasma pneumonia, parainfluenza types 1, 2, and 3.

40
Q

croup: Acute spasmodic laryngitis:

A
  • Self-limiting illness that can result from allergens.

- Characterized by paroxysmal attacks of laryngeal obstruction that occur mainly at night.

41
Q

croup: Acute laryngotracheobronchitis s/s

A

Low-grade fever, restlessness, hoarseness, barky cough, dyspnea, inspiratory stridor, and retractions.
Nasal flaring, intercostal retractions, tachypnea, and continuous stridor.

42
Q

croup: Acute spasmodic laryngitis: s/s

A

Croupy barky cough, restlessness, difficulty breathing, hoarseness, and nighttime episodes of laryngeal obstruction

43
Q

croup o2 and meds

A
  • Provide humidity with cool mist.
  • Administer oxygen if needed.
  • Monitor continuous oximetry.
  • Administer nebulized racemic epinephrine as prescribed.
  • Administer corticosteroids: oral or IM (dexamethasone), or nebulized (budesonide).
  • Encourage oral intake if tolerated.
  • Administer IV fluids as prescribed.
44
Q

flu a & b s/s

A
  • Sudden onset of fever and chills
  • Dry throat and nasal mucosa
  • Dry cough
  • Flushed face
  • Photophobia
  • Myalgia
  • Fatigue
45
Q

flu a & b interventions

A
  • Instruct parents about home management.
  • Promote increased fluid intake.
    Rest.
  • Acetaminophen or ibuprofen for fever
  • Give medications, as prescribed.
  • Amantadine (type A)
  • Rimantadine (type A)
  • Zanamivir (type A and B)
  • Oseltamivir (type A and B)
46
Q

a &B vaccine

A
  • Inactivated influenza vaccine recommended for children 6 months and older.
  • Live vaccination should not be used in children who have heart or lung disease, diabetes or kidney failure, are immunocompromised, have respiratory conditions, are pregnant, have a severe allergy to chicken eggs, or have a history of Guillain-Barré syndrome
47
Q

asthma

A
  • A chronic inflammatory disorder of the airways
  • most common s/s: wheezing
  • Results in intermittent and reversible airflow obstruction of the bronchioles.
  • Obstruction occurs either by inflammation or airway hyper-responsiveness.
48
Q

asthma diagnoses categories

A

Diagnoses are classified into one of four categories based on effects on the child:

  • Intermittent
  • Mild and moderate persistent
  • Severe persistent
49
Q

asthma risk factors

A
  • Family history of asthma and allergies
  • Gender
  • Exposure to smoke
  • Low birth weight
  • Being overweight
    (boys affected more than girls until adolescence, then the incidence is greater among girls)
50
Q

asthma triggers

A
  • Allergens
  • Indoor: mold, cockroach antigen, dust, dust mites
  • Outdoor: grasses, pollen, trees, shrubs, molds, spores, air pollution, weeds
  • Irritants: Tobacco smoke, wood smoke, odors, sprays
  • Exercise
  • Cold air
  • Environmental change (new home or school)
  • Infections/colds
  • Animal hair or dander
  • Medications: Aspirin, nonsteroidal anti-inflammatory drugs, antibiotics, beta blockers
  • Strong emotions: Fear, anger, laughing, crying
  • Conditions: Gastroesophageal reflux, tracheoesophageal fistula ­
  • Food allergies or additives (sulfites)
  • Endocrine factors: Menses, pregnancy, thyroid disease
51
Q

asthma symptoms

A
  • Chest tightness
  • History regarding current and previous asthma exacerbations
  • Dyspnea
  • Cough
  • Audible wheezing
  • Coarse lung sounds, wheezing throughout possible crackles
  • Mucus production
  • Restlessness, irritability, anxiety
  • Sweating
  • Use of accessory muscles
  • Decreased oxygen saturation (low SaO2)
52
Q

asthma diagnostic

A

pulmonary function test
peak expiraotry flow rate
bronchoprovocation testing

53
Q

asthma: pulmonary function tests

A
  • The most accurate tests for diagnosing asthma and its severity
  • Baseline test at time of diagnosis
  • Repeat testing after treatment is initiated and child is stabilized
    T- est every 1 to 2 years
54
Q

asthma: peak expiratory flow rates

A
  • Measures the amount of air that can be forcefully exhaled in 1 second
  • Each child needs to establish personal best
55
Q

asthma: bronchprovoation testing

A
  • Exposure to methacholine, cold air, histamine, exercise
  • Skin prick testing: Identify allergens
  • Chest x-ray: Showing hyperexpansion and infiltrates
56
Q

asthma nursing care for s/s

A
  • Assess airway patency, respiratory rate, symmetry, effort, and use of accessory muscles.
  • Assess breath sounds in all lung fields.
  • Monitor for shortness of breath, dyspnea, and audible wheezing.
  • An absence of wheezing can indicate severe constriction of the alveoli.
  • Monitor vital signs and oxygen saturation.
  • Check CBC and chest x-ray results, possible ABGs.
57
Q

asthma nursing care

A
  • Position the child to maximize ventilation.
  • Administer oxygen as prescribed.
  • Keep intubation equipment nearby.
  • Initiate and maintain IV access as prescribed.
  • Maintain a calm and reassuring demeanor.
  • Encourage appropriate vaccinations and prompt medical attention for infections.
  • Administer medications.
  • The provider can prescribe antibiotics if a bacterial infection is confirmed.
58
Q

asthma medications: bronchodilators

short acting
long acting

A 
Short-acting beta2 agonists (SABA) 
- albuterol, levalbuterol, terbutaline
- Used for acute exacerbations
- Prevention of exercised-induced 
asthma

Long-acting beta2 agonists (LABA)

  • formoterol, salmeterol
  • Used to prevent exacerbations, especially at night, and reduce use of SABA.
  • Must be used along with anti-inflammatory therapy.
  • Cannot be used to treat acute exacerbations.
59
Q

asthma meds: cholinergic antagonists

A
  • atropine, ipratropium
  • Instruct the child and family in the proper use of metered-dose inhaler or nebulizer.
  • Watch the child for tremors and tachycardia when taking albuterol.
  • Observe the child for dry mouth when taking ipratropium.
  • Encourage older children who are taking ipratropium to suck on hard candies to help with dry mouth.
  • Teach children to administer prior to exercise or activity.
60
Q

asthma medications: corticosteroids

A
  • Can be given parenterally (methylprednisolone), orally (prednisone), or by inhalation (fluticasone).
  • Oral systemic steroids can be given for short periods (3 or 10 days).
  • Inhaled corticosteroids are administered daily as a preventive measure.
  • Leukotriene modifiers (zafirlukast, montelukast).
  • Mast cell stabilizers (cromolyn)
  • Monoclonal antibodies (omalizumab)
61
Q

asthma corticosterioids interventions

A
  • Combination medications contain an inhaled corticosteroid and a LABA (fluticasone/salmeterol)
  • Observe the oral mucosa for infection secondary to use of inhaled medication.
  • Encourage fluids to promote hydration.
  • Encourage taking with food.
  • Instruct to rinse mouth
  • Instruct to watch for redness, sores, or white patches in the mouth.
  • Teach dosage, tapering off medication, length of time to take.
  • Assess weight, blood pressure, electrolytes, glucose, and growth with oral corticosteroid use.
62
Q

asthma pt. teaching

A
  • Instruct the family and child to identify personal triggering agents.
  • Provide the family and child with an asthma action plan.
  • Instruct the child how to properly self-administer medications (nebulizers, inhalers, and spacer).
  • Teach the child how to use a peak flow meter. (Use at the same time each day.)
  • Teach the family to keep a record of PEFR results. Readings over time show the child’s “best” efforts, and to provide a warning of increased airway impairment.
  • Teach the family and child how to recognize an asthma exacerbation
  • Teach the family and the child about when to use medications
  • Educate the child and family regarding infection prevention techniques.
  • Promote good nutrition.
  • Encourage prompt medical attention for infections.
  • Stress the importance of keeping immunizations, including seasonal influenza and pneumonia vaccines, up to date.
  • Encourage regular exercise as part of asthma therapy.
63
Q

asthma promote ventilation and perfusion

A

◯ Maintains cardiac health
◯ Enhances skeletal muscle strength
● Children can require medication before exercise.

64
Q

asthma complications

A

status asthmaticus

respiratory failure

65
Q

status asthmaticus interventions

A
  • Monitor oxygen saturations and continuous cardiorespiratory monitoring.
  • Position the child sitting upright, standing, or leaning slightly forward.
  • Administer humidified oxygen.
  • Administer three nebulizer treatments of a beta2-agonist, 20 to 30 min apart or continuously. Ipratropium bromide can be added to the nebulizer to increase bronchodilation.
  • Obtain IV access.
  • Monitor ABGs and serum electrolytes.
  • Administer corticosteroid.
  • Prepare for emergency intubation.
  • Magnesium sulfate : moderate to severe asthma when treated in the emergency department or pediatric ICU.
  • Heliox (a mixture of helium and oxygen
66
Q

asthma: respiratory failure

A
  • Persistent hypoxemia related to asthma can lead to respiratory failure.
  • Monitor oxygenation levels and acid-base balance.
  • Prepare for intubation and mechanical ventilation as indicated.

pediatrics (19 decks)

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