respiratory disorders Flashcards
tonsils
- Masses of lymph-type tissue.
- Filter pathogenic organisms (viral and bacterial)
- Contribute to antibody formation.
- Tonsils are highly vascular.
- Palatine and Pharyngeal
enlarged tonsils interferes with
- Enlarged tonsils can block the nose and throat.
- Interferes with breathing, nasal and sinus drainage, sleeping, swallowing, and speaking.
acute tonsillitis
occurs when the tonsils become inflamed and reddened.
Can become chronic.
tonsillitis risk factors
- Exposure to a viral or bacterial agent
- Immature immune systems (younger children)
tonsillitis expected findings
how to test for it
- 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)
tonsillits nursing care
- 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.
tonsillectomy post op care
- 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
tonsillectomy after care
- 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.
- Instruct the family to notify the provider if bright red bleeding occurs.
how many days can you bleed for after tonsillectomy
14
Tonsillectomy: Parent Education
- 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
manifestations of hemorrhage
dehydration
infection
tonsillectomy complications
hemmorrhage
dehydration
chronic infection
tonsillectomy hemorrhage
- 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
bleeding s/s tonsillectomy
tachycardia, repeated swallowing and clearing of throat, hemoptysis
dehydration tonsillectomy nursing care
- Encourage oral fluids.
- Monitor I&O.
- Instruct the family to encourage oral fluids.
- Teach the family about manifestations of dehydration.
chronic infection tonsillectomy
- 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.
risk factors for common respiraotry illnesses
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.
Nasopharyngitis (Common Cold)
Nasal inflammation, dryness and irritation of nasal passages and the pharynx
- Fever, decreased appetite, and restlessness
Nasopharyngitis (Common Cold) interventions
- 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.
Acute Streptococcal Pharyngitis
- Infection of the upper airway (strep throat)
- Onset is abrupt and characterized by pharyngitis, headache, fever and abdominal pain.
- can affect kidney and heart
Acute Streptococcal Pharyngitis interventions
diagnosed by
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.
bronchitis
- 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
bronchitis interventions
- Test nasopharyngeal secretions
- Instruct parents about home management.
- Give antipyretics for fever.
- Give a cough suppressant.
- Provide increased humidity (cool mist vaporizer).
bronchiolitis
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
bronchiolitis nursing care
- 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.
allergic rhinitis
- 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.
allerguc rhinitis interventions
- Instruct parents about home management.
- Avoid allergens (epi for severe)
- Give nasal corticosteroids (first-line medications used).
- Give antihistamines, beta-adrenergic decongestants, and ipratropium.
bacterial pneumomia s/s
- 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
viral pneumonia interventions
- Administer oxygen with cool mist.
- Monitor continuous oximetry.
- Administer antipyretics for fever.
- Monitor I&O.
- CPT and postural drainage
s/s of hypoxic
irritabile
restless
bacterial pneumonia interventions
- 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
pneuomonia complications
pneumothorax
pleural effusion
pneumonia complication: pneumothorax
- Accumulation of air in the pleural space
- Dyspnea, chest pain, back pain, labored respirations, decreased oxygen saturations, and tachycardia
pneumonia complication: pneumothorax interventions
- 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.
pneumonia complication: pleural effusion s/s
Dyspnea, chest pain, back pain,
labored respirations, decreased oxygen saturations, and tachycardia
pneumonia complication: pleural effusion interventions
- 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.
croup syndrome
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)
croup sundrome interventions
diagnosed by
- 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
croup syndrome:Acute laryngotracheobronchitis
Causative agents include RSV, influenza A and B, and Mycoplasma pneumonia, parainfluenza types 1, 2, and 3.
croup: Acute spasmodic laryngitis:
- Self-limiting illness that can result from allergens.
- Characterized by paroxysmal attacks of laryngeal obstruction that occur mainly at night.
croup: Acute laryngotracheobronchitis s/s
Low-grade fever, restlessness, hoarseness, barky cough, dyspnea, inspiratory stridor, and retractions.
Nasal flaring, intercostal retractions, tachypnea, and continuous stridor.
croup: Acute spasmodic laryngitis: s/s
Croupy barky cough, restlessness, difficulty breathing, hoarseness, and nighttime episodes of laryngeal obstruction
croup o2 and meds
- 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.
flu a & b s/s
- Sudden onset of fever and chills
- Dry throat and nasal mucosa
- Dry cough
- Flushed face
- Photophobia
- Myalgia
- Fatigue
flu a & b interventions
- 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)
a &B vaccine
- 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
asthma
- 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.
asthma diagnoses categories
Diagnoses are classified into one of four categories based on effects on the child:
- Intermittent
- Mild and moderate persistent
- Severe persistent
asthma risk factors
- 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)
asthma triggers
- 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
asthma symptoms
- 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)
asthma diagnostic
pulmonary function test
peak expiraotry flow rate
bronchoprovocation testing
asthma: pulmonary function tests
- 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
asthma: peak expiratory flow rates
- Measures the amount of air that can be forcefully exhaled in 1 second
- Each child needs to establish personal best
asthma: bronchprovoation testing
- Exposure to methacholine, cold air, histamine, exercise
- Skin prick testing: Identify allergens
- Chest x-ray: Showing hyperexpansion and infiltrates
asthma nursing care for s/s
- 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.
asthma nursing care
- 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.
asthma medications: bronchodilators
short acting
long acting
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.
asthma meds: cholinergic antagonists
- 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.
asthma medications: corticosteroids
- 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)
asthma corticosterioids interventions
- 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.
asthma pt. teaching
- 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.
asthma promote ventilation and perfusion
◯ Maintains cardiac health
◯ Enhances skeletal muscle strength
● Children can require medication before exercise.
asthma complications
status asthmaticus
respiratory failure
status asthmaticus interventions
- 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
asthma: respiratory failure
- 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.
