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Respiratory Disorders Flashcards

1
Q

Explain why anatomic size is a significant variable in respiratory tract infection in a child.

A
  1. Chest relatively round at birth
  2. Thyroid, cricoid, tracheal cartilages immature
  3. Nasopharynx & nares smaller
  4. Ribs, diaphragm are more horizontal;
  5. abdominal breathing
  6. Fewer muscles functional in airway
  7. Small oral cavity; large tongue
  8. Long, floppy epiglottis
  9. Larynx & glottis higher in airway
  10. Large amounts of soft tissue along airway
  11. Chest wall is more pliable
  12. Lymph tissue grows rapidly in childhood
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2
Q

Describe the three types of respiratory insufficiency. (respiratory emergencies)

A
  1. Respiratory distress
    1. Increased work of breathing WITH adequate gas exchange
  2. Respiratory failure
    1. Inability to maintain adequate oxygenation
  3. Respiratory arrest
    • Cessation of respiration
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3
Q
  1. What are the two lifesaving procedures a nurse should be able to implement to treat aspiration of a foreign body?
A
  1. Backslaps
  2. abdominal thrusts (heimlech)

(Suction, Expert consultation (Radiology studies; endoscopy)
Tracheostomy as needed)

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4
Q

Describe respiratory distress.

A
  • Airway is open
  • Tachypnea
  • Increased respiratory effort
  • Normal respiratory sounds possible
  • Tachycardia
  • Agitation
  • Pale
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5
Q

What are the symptoms of a child in early respiratory distress and severe respiratory distress?

A
  • Early
    • Restless/Irritable
    • Tachypnea/Tachycardia
      • Infant/Child with RR >60 at risk for apnea secondary to ↑ CO2 & ↑ WOB
    • Increased effort – retractions, nasal flaring, head bobbing, grunting
  • Late
    • Decrease in respiratory rate or irregular pattern
    • Diminished breath sounds
    • ↓ LOC (drowsiness)
    • Skin color (cyanosis)
    • Apnea/Bradycardia
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6
Q

What are early signs of respiratory distress?

A
  • Restless/Irritable
  • Tachypnea/Tachycardia
    • Infant/Child with RR >60 at risk for apnea secondary to  CO2 &  WOB
  • Increased effort – retractions, nasal flaring, head bobbing, grunting

So, we want to intervene before pt gets to resp failure.

If pt displaying these signs of distress, be aware. Pt may rapidly progress to resp failure

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7
Q

What are the cardinal signs of respiratory failure?

A
  • Airway obstruction possible
  • Slow respiratory rate
  • Decreased respiratory effort
    • Progresses to no respiratory effort
  • Abnormal respiratory sounds
  • Bradycardia
  • Decreased LOC
  • Cyanosis
  • Can occur without distress*
    • Cause = respiratory depression
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8
Q

What are late signs of respiratory distress/resp failure?

A
  • Decrease in respiratory rate or irregular pattern
  • Diminished breath sounds
  • decr LOC (drowsiness)
  • Skin color (cyanosis)
  • Apnea/Bradycardia
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9
Q

List strategies that may be used to manage acute respiratory distress and failure in children.

A
  • Support compensatory efforts of child
    • Elevate HOB
    • Allow patient to assume “position of comfort”
    • Minimize sources of stress – cluster care
    • Suction as needed (Yankauer/Neosucker)
    • Humidified O2
    • Do not give oral feeds/fluids if RR > 60
      • NGT for abdominal distention
  • Respiratory distress → Respiratory failure
    • Intubate/Ventilate
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10
Q

The quieter the child, ________________________

A

the greater the cause for concern!!
If any of these signs occur, get medical help immediately!
Inability to swallow
Absence of voice sounds
Increasing respiratory distress
Acute onset of drooling (sign of supraglottic obstruction)

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11
Q

Describe the different oxygen delivery methods and what percent oxygen is delivered by each.

A
  • “Blow-by” – unreliable
  • Nasal Cannula – ¼-4 L
    • (5-8L heated/humidified – Optiflow/Vapotherm)e
  • Venturi Face Mask – 24%-48% variable
  • Simple Face Mask – 6-10 L (40-60%)
  • Non-rebreather Mask – 100%
  • Bag-valve Mask (BVM)
  • Bi-pap/CPAP
  • Intubation/Mechanical Ventilation
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12
Q

What are the abnormal breath sounds?

A
  • stridor
  • wheezing
  • crackles
  • ronchi
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13
Q

When would you hear stridor?

A
  • Foreign body
  • Croup
  • Swelling in the throat, abscess or tumor
  • laryngospasm
  • epiglottitis
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14
Q

When would you hear wheezing?

A
  • asthma
  • bronchitis
  • pneumonia
  • allergic reaction
  • foreign body inhaled into lung
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15
Q

When would you hear crackles?

A
  • pneumonia
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16
Q

When would you hear ronchi?

A
  • pneumonia
  • cystic fibrosis
  • chronic bronchitis
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17
Q

What is the defn of respiratory failure?

A

Inability to maintain adequate oxygenation

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18
Q

What is happening with an airway obstruction?

A

Not enough oxygen is getting in/out.

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19
Q

What is respiratory distress/failure caused by inadequate effort?

A

can be resp depression from meds, or getting too tired, paralysis due to Cspine injury

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20
Q

What kind of pulmonary abnormalities can causes respiratory distress/failure?

A

BPD, asthma, pleural effusion, pneumonia

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21
Q

What can cause respiratory distress/failure of the upper airway?

A
  • anaphylaxis
  • epiglottitis
  • croup
  • foreign body
  • abscess or tumor
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22
Q

What can cause respiratory distress/failure of the lower airway?

A
  • bronchiolitis
  • cystic fibrosis
  • asthma
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23
Q

What types of lung tissue disease can cause respiratory distress/failure?

A
  • pneumonia
  • pulmonary edema
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24
Q

What types of CNS issues can cause respiratory depression/failure?

A
  • pharmacological/chemical (overdose)
  • neurological (head trauma)
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25
Q

What are 4 causes of respiratory distress/failure?

A
  1. upper airway issues
  2. lower airway issues
  3. lung tissue disease
  4. CNS causes
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26
Q

How can you help manage respiratory distress?

A

try to calm pt to (1) decrease oxygen demand & (2) reduce fatigue (child working harder – gets tired, stops breathing (3) increase oxygen delivery – more effective breaths

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27
Q

How can you support the compensatory efforts of the child?

A
  • Elevate HOB
  • Allow patient to assume “position of comfort”
  • Minimize sources of stress – cluster care
  • Suction as needed (Yankauer/Neosucker)
  • Humidified O2
  • Do not give oral feeds/fluids if RR > 60
    • NGT for abdominal distention
28
Q

How do you support worsening respiratory distress leading to respiratory failure?

A

intubate/ventilate

29
Q

Describe different types of oxygen delivery methods.

A
  • “Blow-by” – unreliable
  • Nasal Cannula – ¼-4 L
  • (5-8L heated/humidified – Optiflow/Vapotherm)e
  • Venturi Face Mask – 24%-48% variable
  • Simple Face Mask – 6-10 L (40-60%)
  • Non-rebreather Mask – 100%
  • Bag-valve Mask (BVM)
  • Bi-pap/CPAP
  • Intubation/Mechanical Ventilation
30
Q

What are some causes of metabolic acidosis?

A
  • Diabetes
  • Kidney Failure
  • Shock
31
Q

What are some causes of respiratory acidosis?

A
  • pneumonia
  • drug overdose
32
Q

What are some causes of metabolic alkalosis?

A
  • Vomiting
  • Diuretics
33
Q

What are some causes of respiratory alkalosis?

A
  • Anxiety
  • Pain
  • Fever
34
Q

What are disorders of the upper airway?

A
  • Anaphylaxis
  • Croup (laringotracheobronchitis - LTB)
  • Epiglottitis (med emergency)
35
Q

What are disorders of the lower airway?

A
  • bronchiolitis
  • asthma
  • cystic fibrosis
36
Q

What is an example of lung tissue disease?

A

Pneumonia

37
Q

What is the patho & s/s of anaphylaxis?

A
  • exaggerated hypersensitive allergic reaction to a trigger
  • s/s
    • itching, hives, cough, dyspnea, pallor, wheezing, stridor, sweating, tachycardia, respir distress that could lead to failur
38
Q

What is the patho & s/s of Croup (Laryngotracheobronchitis - LTB)?

A

develops dt inflammation of larynx, trachea and bronchi, caused by viral resp infection.

S/s

usually abrupt and worsens at night. barky, brassy cough, hx or URI, inspiratory stridor, resp distress, low grade fever, tracheal narrowing on x-ray (steeple sign)

39
Q

What is the patho & s/s of epiglottitis?

A
  • Patho
    • Acute, severe inflammation of the epiglottis.
    • Abrupt onset and rapid progression
    • Caused by bacterial respiratory infection
  • S/s
    • Sore throat and difficulty swallowing
    • drooling, “croaking” or stridor
    • restlessness, anxiety
    • hyperextension of neck,
    • characteristic “tripod” position
    • x-ray shows epiglottal enlargement (thumb sign)
40
Q

What is the cause, patho, s/s, of bronchiolitis?

A
  • patho
    • obstruction of the small airways
    • seasonal illness starting in Fall and ending in Spring
    • Spread by direct CONTACT with secretions
  • causes/triggers
    • most commonly causes by viral respiratory infection
      • respiratory syncytial virus (>80%)
  • s/s
    • cough, rhinorrhea, wheezing, retractions, crackles, dyspnea, tachypnea
41
Q

What is the cause, patho, s/s, of asthma?

A
  • patho
    • chronic inflammation of the airways with reversible episodes of obstruction, caused by an increased reaction of the airways to various stimuli
    • most common cause of missed school days
  • causes/triggers
    • pets, cockroaches, dust mites, pollens, molds, infections, exercise, weather change, cigarettes’ smoke, scented products, chemicals
  • s/s
    • cough, (especially at night, after physical activity, lasting >1 week), chest tightness, shortness of breath, wheezing, respiratory distress
42
Q

What is the cause, patho, s/s, of cystic fibrosis?

A
  • patho
    • most common genetic disease in the US that affects the respiratory, GI, endocrine, reproductive and integumentary systems
  • causes/triggers
    • inherited autosomal recessive disorder of the exocrine glands. Causes incr viscosity of bronchial mucus
  • s/s
    • respiratory: wet, chronic cough, wheezing, dyspnea, clubbing, hypoxia, hypercapnia, acidosis, barrel chest, sinusitus, nasal polyps, repeated bacterial infections
    • GI: meconium ileus at birth (<10% of newborns with CF), bulky foul smelling stools, delayed G&D
    • Endocrine: mucus blocks the pancreatic ducts so unable to digest fats, may develop diabetes d/t pancreatic scarring
    • Liver: increased LFTs and gallstones
    • Reproductive sys: females - delayed puberty, difficulty with conception. males -sterile
    • integumentary: excessive sodium loss from sweat glands
43
Q

What is the cause, s/s, of pneumonia?

A
  • causes/triggers
    • primary infection or aspiration (chemical or vomitous)
  • s/s
    • increased WOB
    • Decr sats despite incr in oxygen delivery and/or mode of ventilation
    • possible fever (febrile or hypothermic)
    • coarse or crackles (junky)
    • chest pain
    • tachypnea
44
Q

What are neurological causes, s/s of respiratory distress?

A
  • causes
    • trauma (closed head injury), neuromuscular disease (muscular dystrophy, SMA), central hypoventilation syndrome, seizures, hydrocephalus
  • s/s
    • variable respiratory rate
    • variable respiratory effort
    • respirations become ineffective causing an inability to oxygenate and/or ventilate
45
Q

What are pharmacological/chemical causes, s/s of respiratory distress?

A
  • causes
    • any med either given or potentially taken
  • s/s
    • variable respiratory rate
    • variable respiratory effort
    • respirations become ineffective causing an inability to oxygenate and/or ventilate
46
Q

What is the intervention/management of anaphylaxis?

A
  • Allow position of comfort
  • epinephrine IM, SQ, ET
  • Oxygen
  • Antihistamines
  • Steroids
  • Fluids
47
Q

What is the intervention/management of croup (largyngotraceobronchitis LTB)?

A
  • Allow parent to STAY w/child
  • do not upset the child
  • allow position of comfort
  • cool mist oxygen therapy
  • nebulized epinephrine (racemic epi) - for stridor
  • corticosteroids (IM, IV, PO) - dexamethasone
  • fluids
48
Q

What is the intervention/management of epiglottitis? med emergency

A
  • Allow parent to STAY w/child
  • do not upset the child
  • allow position of comfort
  • have tracheostomy and intubation equipment readily available
  • IV antibiotic therapy
  • IV corticosteroids
  • 7-10 days oral antibiotics after IV therapy
49
Q

What is the appropriate education for epiglottitis? med emergency

A
  • encourage family to participate in care
  • keep pt calm and decrease stimuli as much as possible
  • importance of Hib Vaccine
  • prevention = immunizations
50
Q

What is the appropriate education for croup (LTB)?

A
  • Teach caregiver signs of respiratory distress
  • cool or moist air humidifier/vaporizer
  • Feverl 100-101 is common
  • stay w/child and keep calm
  • infection prevention = hand washing
51
Q

What is the appropriate education for anaphylaxis?

A
  • know and avoid triggers
  • always carry epi pen
52
Q

What is the intervention/management of bronchiolitis?

A
  • allow position of comfort
  • oxygen
  • suction secretions
  • especially before feedings
  • small frequent, feedings and oral fluids
  • IV fluids if unable to take adquate PO
  • may trial bronchodilators
53
Q

What is the intervention/management of asthma?

A
  • allow position of comfrot
  • oxygen
  • bronchodilators
  • corticosteroids
  • anticholinergics
  • support breathing
  • fluids
54
Q

What is the appropriate education for bronchiolitis?

A
  • prevention with GOOD handwashing
  • Bulb suction technique
  • suction prior to each feed
  • small, frequent feedings
55
Q

What is the appropriate education for asthma?

A
  • compliance w/treatment plan
  • trigger management
  • medication use & delivery (controller vs. rescue meds, rinse mouth after inhaler, give bronchodilators first prior to steroid inhalers)
  • asthma action plan (when to take meds & call/see PCP)
  • Peak flow meter use & monitor PF daily
56
Q

What is the intervention/management of CF?

A
  • Respiratory: Chest Physiotherapy, Bronchodilators (albuterol, ipratropium), aerolized pulmozyme - decrease viscosity of mucous, antibiotlics (PO,IV,INH), oxygen
  • Gastrointestinal: pacreatic enzymes w/meals and snacks, extra enzymes for high fat foods. Vitamins A, D, E, & K, Diet: high calorie, high fat, high SALT (b/c CF is salt wasting) may need suppl fats
  • may not get enough fat PO
  • Endocrine: diabetes mgmt as applicable
  • Integumentary: replace lost electrolytes as applicable (risk heat exhaustion)
57
Q

Classic signs of epiglottitis?

A

Drooling - may need to intubate

don’t stick anything in their mouth until then

58
Q

What is the appropriate education for CF?

A
  • compliance w/tx plan (rep meds, GI enzymes, diet, resp therapy)
  • encourage physical exercise program
  • follow-up w/specialist care team (pulm, endo, resp therapist, care coord, genetic counseling)
  • resources & support services
59
Q

What is the intervention/management of pneumonia?

A
  • oxygen
  • abx after sputum culture sent
  • treat fever
  • pulomonary toileting (CPT, breathing tx, suction etc)
  • if wheezing, consider bronchodilator
60
Q

What is the appropriate education for pneumonia?

A
  • signs and symptoms to watch for and when to return to PCP or ED
  • med admin instructions
  • encourage hydration and rest
61
Q

What is the intervention/management of neurological causes of respiratory distress?

A
  • support breathing
  • treat the cause (neurosurgery to decr intracranial pressure, etc)
62
Q

What is the intervention/management of pharmacological/chemical causes of respiratory distress?

A
  • support breathing
  • reversal agents/antidotes
    • narcan/naloxone - opioids
    • romazicon/fslumazenil - benzodiazepine
  • Do not reverse anti-seizure meds
63
Q

What is BPD?

A

Breathing disorder primarily found in premature infants - abn development of lung tissue,

s/s resp. distress, grunting, nasal flaring, tachypnea, retractions

CPAP and oxygen - tx

meds: diuretics excess fluid - pulmonary edema can be issue, bronchodilators and steroids

small, short feeds, incr calorie and protein

risk: low birth rate, prematurity, mechanical ventilation & high levels of oxygenation

64
Q

What is tonsillitis?

A
65
Q

What is otitis media?

A
66
Q

Types of retractions

A

subcostal retractions

intercostal retractions

supraclavicular retractions

suprasternal retractions

substernal retractions

belly breathing (not retractions)/mild subcostal

67
Q

asthma

A

inspiratory wheezing

expiratory wheezing

= both is worse

louder wheezing (incr sounds) can actually be good

Peds (13 decks)

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