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Module 5 (Pediatrics) > Respiratory Dysfunction > Flashcards

Respiratory Dysfunction Flashcards

1
Q

What is the most critical and immediate physiologic change required of newborns?

A

onset of breathing

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2
Q

Chemical factors that stimulate breathing is

A

low O2
high CO2
low pH

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3
Q

Chemical and thermal factors in the blood initiate impulses exciting the

A

respiratory center in the medulla

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4
Q

Thermal stimulus for the onset of breathing in newborns is

A

sudden chilling of the infant (leaving the warm environment of the mother’s womb)

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5
Q

What are acceptable methods of tactile stimulation for stimulating breathing?

A

tapping or flicking the soles of the feet
gently rubbing the newborn’s back, trunk, or extremities

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6
Q

Should the nurse slap the newborn’s butt or back to stimulate breathing?

A

no, harmful technique and should not be used

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7
Q

What does prolonged tactile stimulation consist of?

A

2+ taps or flicks

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8
Q

Why should you not be able to use prolonged tactile stimulation on a newborn?

A

waste precious time in the event of respiratory difficulty
+ Become hypoxemic in the birth process

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9
Q

The initial entry of air into the lungs is opposed by

A

surface tension of the fluid-filled inside the lungs and alveoli

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10
Q

What happens to the remaining lung fluid instead of being pushed out during birth?

A

absorbed by the capillaries and lymphatic vessels

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11
Q

S/S of Respiratory Distress Syndrome

A

Tachypnea (80-120) initially (could be respiratory failure and shock due to prematurity)
Dyspnea
Retractions (intercostal and substernal)
Fine inspiratory crackles
Audible expiratory grunt
Flaring nares
Cyanosis or pallor

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12
Q

Respiratory Distress Syndrome of nonrespiratory origin is caused by

A

sepsis
cardiac defects
exposure to cold (Pneumonia - bacterial or viral)
airway obstruction (atresia)
intraventricular hemorrhage
hypoglycemia
metabolic acidosis
acute blood loss
drugs (rare in drug-exposed infants)

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13
Q

Respiratory Distress Syndrome carries the highest risk what type of complications

A

respiratory and neuro complications
- preterm infants

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14
Q

Patho of RDS

A

preterm infants born with premature lungs
- more cartilage in the chest wall (collapses inward to stiff tissues)
- Underdeveloped and under-inflatable alveoli
Blood flow is limited due to collapse and shunted from the lungs to ductus arteriosus and foramen ovale
Lack of surfactant and unable to adjust to lack of blood flow and inability to take in O2 and close the cardiac shunts

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15
Q

Surfactant

A

surface-active phospholipid secreted by alveolar epithelium
- reduces the surface tension of fluids that line the alveoli and respiratory passage
- uniform expansion and maintenance of lung expansion at low interalveolar pressure

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16
Q

Low surfactant production causes

A

unequal inflation of alveoli on inspiration and the collapse of alveoli on expiration
- Alveoli collapse
- not able to inflate lungs
- need to exert more effort to reexpand

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17
Q

This inability to maintain lung expansion produces

A

atelectasis

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18
Q

How does the O2 concentration normally increase after birth?

A

ductus arteriosus constricts and the pulmonary vessels dilate to decrease PVR

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19
Q

Atelectasis and the absence of alveolar stability relations to blood flow to the lungs

A

PVR increases with resistance to blood flow
increase of hypoperfusion to lung tissue
Increase of PVR = fetal shunts stay open = prevents blood flow oxygenation of the lungs

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20
Q

Inadequate pulmonary perfusion and ventilation produce

A

hypoxemia (pulmonary arterioles constriction)
hypercapnia

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21
Q

RDS is the deficiency of

A

surfactant

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22
Q

Dx of RDS

A

Chest Xray studies

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23
Q

Managing of RDS

A

immediate supplemental O2 and ventilation
IVF
TPN
Prevent hypotension
thermal environment

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24
Q

What type of feedings are contraindicated for an RSD pt?

A

nipple feedings
increases RR, aspirations

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25
Q

When do you suction the patient after administering surfactant?

A

an hour to allow maximum effects

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26
Q

Surfactant therapy is used in

A

RSD, meconium aspiration, pneumonia, sepsis, constant pulmon. HTN
- prophylactic or later after birth

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27
Q

Nursing management of surfactant administration

A
  • monitor blood gas
  • monitor Pulse Ox
  • assess tolerance
  • adjustment of vent and prevent overinflation
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28
Q

Treatment of RSD

A

exogenous surfactant to preterm (porcine, bovine)

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29
Q

Complications of surfactant administration through Endotracheal tube

A

pulmonary hemorrhage
mucous plug

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30
Q

Studies have shown the benefits of administering surfactant early (prophylactic) in infants at risk for developing RDS, then

A

extubating and place on CPAP
- decrease need for mech vent

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31
Q

O2 for newborns need to be

A

humidified and warmed up

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32
Q

Meconium Aspiration Syndrome
Therapeutic Management

A

Suction hypopharynx after delivery
- close monitoring of low APGAR
- resuscitation after suction
Monitor for respiratory distress with supplemental O2
Exogenous surfactant

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33
Q

Prevention of RDS

A

prevent preterm delivery esp elective early and C section
amniocentesis = assess fetal lung maturity
maternal steroid injection and surfactant after birth

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34
Q

Prognosis of RSD

A

SELF-LIMITING
improved by 72 hours
onset of diuresis shows improvement
decrease the need for vent support

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35
Q

Nursing Care Management of RDS

A

observe and assess the infant’s response to therapy
- O2 should improve
- hourly rounding
suctioning PRN (auscultation of the chest, low O2, excess moisture, irritability)

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36
Q

Best positioning for an infant’s open airway

A

side of the head supported by a folded blanket to keep the neck slightly extended

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37
Q

ETtube suctioning should only be used for no more than

A

10-15 seconds to maintain negative passage

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38
Q

When administering O2, what needs to be performed daily?

A

Mouth care

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39
Q

Meconium Aspiration Syndrome is

A

Aspiration of amniotic fluid containing meconium into fetal or newborn trachea in utero or at first breath

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40
Q

Prematurity Apnea

A

lapse of spontaneous breathing for greater than 20 seconds, may be followed by bradycardia, O2 low, and color chnage

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41
Q

Prematurity Apnea
Therapeutic Management

A

Thermal stability and Blood sugar for hypoglycemia
Admin caffeine and CPAP
tactile stimuli and check for breakdown

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42
Q

Signs of caffeine toxicity

A

Tachycardia (>180)
vomit, restless, irritable

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43
Q

Pneumothorax

A

presence of extraneous air in pleural space as a result of alveolar rupture

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44
Q

Pneumothorax
Therapeutic Management

A

evacuate trapped air in pleural space through needle aspiration or chest tube
care of drainage
emergency needle aspiration setup

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45
Q

S/S of pneumothorax

A

tachypnea or apnea
hypotension
nasal flaring
retractions
bradycardia, cyanosis
low to no breath sounds

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46
Q

Bronchopulmonary Dysplasia

A

alveolar damage from lung disease, prolonged exposure to mechanical ventilation, high peak inspiratory pressures and oxygen, and immature
alveoli and respiratory tract

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47
Q

Bronchopulmonary Dysplasia
Prevention

A

steroids and surfactant to avoid intubation
PFT
no air leaks or infections
minimize high O2 concentration and implement resus. if low o2

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48
Q

Bronchopulmonary Dysplasia
Nursing Care Mgmt

A

Monitor O2 sat
additional rest during feedings
signs of overload
Increased calorie feedings

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49
Q

Persistent Pulmonary HTN of the Newborn

A

severe pulmonary HTN and large right to left shunt through foramen ovale and ductus arteriosus

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50
Q

Persistent Pulmonary HTN of the Newborn
s/s

A

hypoxia
cyanosis
tachypnea with grunting and retractions
decreased pulses and poor perfusion
Shock

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51
Q

Persistent Pulmonary HTN of the Newborn
Therapeutic Mgmt

A

supplemental O2 and vent
vasodilators
prevent Hypoxemia

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52
Q

Persistent Pulmonary HTN of the Newborn
Nursing Actions

A

reduce stress
do not move or disturb

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53
Q

S/S with Respiratory Infections in infants

A

Fever (103-105) 1st sign
- listless/irritable
- precipitate febrile seizures
Poor feeding/anorexia
V/D
- dehydration
Abd Pain
Nasal Block/Discharge (Otitis Media)
Cough (persist)
Sore throat (older children)
- refuse oral meds
Meningismus
- HA, pain and stiff neck
- Kernig and Brudzinski signs +

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54
Q

Respiratory Sounds of Respir. Illness

A

Hoarse
grunt
stridor
wheeze
crackles
no sounds

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55
Q

Croup is characterized by

A

hoarseness, a resonant cough like “Barking or brassy”, inspiratory stridor
swelling or obstruction

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56
Q

Why is respiratory swelling worse for infants?

A

the airway is already narrow the inflammation makes it tiny
- prevents feedings and aspirations

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57
Q

Croup syndromes affect what anatomical structures

A

larynx - voice and breathing harshness
trachea
bronchi

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58
Q

Acute Epiglottitis
-age
-cause
-onset
-s/s
- tx

A
  • 2-5 y/o
  • bacteria
  • rapid progressive
  • dysphagia, stridor, drool, high fever, toxic appearance, rapid pulse and respirations
  • airway, corticosteroids, fluids, antibiotics, reassurance
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59
Q

Acute Larygotracheobrochitis
-age
-cause
-onset
-s/s
- tx

A
  • < 5/o
  • viral
  • slow progressive
  • stridor, brassy, hoarse, low fever, nontoxic
  • humidify O2, corticosteroids, fluids, reassurance
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60
Q

Acute Spasmodic Laryngitis
-age
-cause
-onset
-s/s
- tx

A
  • 1-3 y/o
  • viral with an allergic component
  • sudden; night
  • croupy, stridor, symptoms awakening the child but disappearing during the day
  • cool mist, reassure
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61
Q

Acute Tracheitis
-age
-cause
-onset
-s/s
- tx

A
  • 1mn to 6 y/o
  • viral/bacterial with allergic component
  • moderate progressive
  • purulent secretions, high fever, no response to LTB therapy
  • antibiotics, fluids
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62
Q

S/S of Respiratory Failure
Cardinal

A

restless
tachypnea
tachycardia
Sweating

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63
Q

S/S of Respiratory Failure
Early but subtle

A

mood swings (euphoria or depression)
HA
Altered depth and respir. pattern
HTN
exertional dyspnea
anorexia
increased output
CNS with impaired LOC
FLARES NOSTRILS
retractions
grunt expiratory
wheezing or prolonged expiration

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64
Q

S/S of Respiratory Failure
Severe Hypoxia

A

Hypo/Hypertension
altered vision
somnolence
stupor to coma
dyspnea
depressed respirations
low HR
cyanosis

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65
Q

Asthma Severity in Children

A

Severe = night (1+ (birth to 4 y/o) and 7+ (>5 y/o) per week) and day, extremely limited in activity, use short-acting Beta agonist several times
Moderate = daily, 3-4x nighttime s/s, some limitation, daily use of beta shot-acting
Mild = 2+ times a week, nighttime s/s once a month, minor limitations, twice a week of inhaler
INT = less than 2 days a week, no nighttime awakening, no limitation, use inhaler less than twice a week

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66
Q

Triggers of Asthma Exacerbations

A

allergens
- trees, shrubs, weeds, grass, pollution
- dust, mold, cockroach antigen
smoke, spray, odors
exercise
cold air
new environment
animals
strong emotions

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67
Q

Asthma components

A

Inflammation
Bronchospasm
Airflow obstruction

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68
Q

Spirometry can be performed on children as young as

A

5-6 y/o and assessed yearly

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69
Q

Because inflammation is considered an early and persistent feature of asthma, HCP use what drug

A

long term corticosteroids (Beta agonists)
- control
short term (rescue)

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70
Q

Corticosteroids in Asthma drug therapy

A

tx reversible airway obstruction. control s/s, reduce hypersensitivity of the bronchi
1st line in children over 5

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71
Q

Beta-Aderergic Agonists in Asthma therapy

A

prevent exercise-induced exacerbation

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72
Q

Anticholinergics in asthma therapy

A

relieve acute bronchospasms
- dries out everything (eyes, throat)
no CNS effect

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73
Q

Should an asthma child stop exercising due to provoking an exacerbation?

A

no, exercise is beneficial for physical health

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74
Q

The Child with Asthma Case Study
Jeremy is a 17-year-old male with a history of asthma. His asthma symptoms have been controlled
with use of a long-acting inhaler twice daily but an increase in seasonal allergies and a recent
upper respiratory infection (URI) has caused an exacerbation of his symptoms. Jeremy rarely uses
his peak expiratory flow meter (PEFM), instead he waits until his symptoms become severe before
starting to use his rescue medications. He now presents to his primary care provider with his
mother to seek further treatment as his symptoms are not resolving with his current treatment.
Assessment
Based on these events, what are the most important subjective and objective data that should be
assessed?

A

Dyspnea
Shortness of breath
Diminished breath sounds and/or adventitious breath sounds (wheezing)
Increased respiratory rate
Use of accessory muscles (retractions)
Dry cough
Chest tightness or chest pain

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75
Q

What are the most appropriate nursing interventions for a child with acute respiratory tract
infection?

A

monitor ABCs
assume the position of comfort
humidified O2 > 90
rescue inhalers
assist in triggers monitors

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76
Q

Blow-By O2

A

occasional in newborns
- no control of O2 amount (30%)
- issues with eyes drying out

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77
Q

Nasal Cannula

A

24-44% on 1-6L
- drys out nose and skin breakdown (esp. with babies

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78
Q

If the nasal cannula is giving 4L+, then what is also provided?

A

humidity

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79
Q

What is the % of O2 in RA?

A

21%

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80
Q

Simple Mask

A

5-8L 40-60% O2
- No holes in the mask
- develop CO2 in the mask when LESS than 5L
NEED TO ENSURE 5L FLOW

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81
Q

Venturi Mask

A

4-12L 24-60%
Large holes to prevent CO2 build-up

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82
Q

Non-rebreather Mask

A

10-15L 100%

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83
Q

The reservoir bag needs to be what before use?

A

filled with pure O2

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84
Q

Respiratory Risk Factors in Infants and Children

A

Age
Airway diameter small
shorter trachea

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85
Q

Infant (0-3mn) infection rates are _______ due to

A

lower rate of infection from maternal antibodies
with breastfeeding

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86
Q

What is a common illness for healthy full-term infants (0-3 months)?

A

Pertussis
- vaccination

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87
Q

3-6 month old infants infection rate is

A

increased rate of infection due to maternal antibodies going toward the mother
- Baby starts to make her own antibodies

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88
Q

Toddlers and Preschoolers common illness

A

viral infections from daycare

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89
Q

5+ y/o common illnesses

A

Kindergarten
- viral decreases
- STREP increases

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90
Q

Infants airway diameter compared to adolescents

A

smaller

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91
Q

The trachea structure is how long in infants

A

short distance
- organisms rapidly down the tract

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92
Q

The Eustachian tube in small children is

A

short, open, and flat

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93
Q

Upper Airway

A

oral nasopharynx
Pharynx
Larynx
Upper part of the trachea

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94
Q

Lower airway

A

Lower trachea
Bronchi
Bronchioles
Alveoli

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95
Q

Inadequate ______ can lead to immune deficiencies.

A

diet/nutrients; no supplements
- heart and asthma conditions to consider

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96
Q

What viral infection is the biggest in Pediatric populations?

A

RSV lasting longer and more severe
- COVID extended because isolation caused the immune system to pause in children

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97
Q

Seasonal variations of viruses occur around

A

winter and spring

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98
Q

Preterm newborns have an increased danger of

A

respiratory obstructions
- small

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99
Q

In the NICU, can you place a baby prone if they are having respiratory issues?

A

Yes, PUT THEM PRONE AND LEAVE THEM ALONE
- opens up the airway and improves drainage out of the lungs
- SIDS is not a worry due to ABC and continuous monitoring

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100
Q

The bronchi and trachea are so narrow that

A

mucous can obstruct the airway

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101
Q

What position is okay to have the preterm infant in when allowing for normal respiratory functions regardless of SIDS?

A

Prone - chest expansion
because of continuous monitoring in the NICU, we are not worried much about SIDS

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102
Q

When does the infant get their gag reflex at?

A

6 months old

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103
Q

A weak or absent gag reflex increases the chance of

A

aspiration in the premature

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104
Q

S/S of Respiratory Distress in NEWBORN

A

subcostal retraction with tachypnea
expiratory grunting
nasal flaring
cyanosis (lips and spread)
- serious when generalized
apneic episodes
diminished air entry
presence of crackles or rhonchi (after 4-6 hour of birth normally bad)

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105
Q

Tachypnea is

A

sustained rate >60 after 4-6 hours of life

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106
Q

Why does a baby grunt with expirations (not normal)?

A

trying to create their own positive pressure
push open their alveoli

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107
Q

Cyanosis starts where?

A

lips and spreads (mucous membranes)
- serious when generalized

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108
Q

Apneic episodes are characterized as

A

over 15 seconds of not breathing with color changes

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109
Q

What respiratory sounds with RDS do you hear when you auscultate the lungs?

A

Crackles or rhonchi
- Okay at birth not after 4-6 hours

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110
Q

Apnea of Prematurity refers to

A

cessation of breathing for 20 + seconds with signs of cyanosis, pallor, and low HR
- day 2 shows extent and problems

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111
Q

What is the 1st sign of a breathing or apneic issue?

A

cyanotic on the mouth and spreads

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112
Q

Apnea is the most common problem in the preterm infant < ____ weeks starting within day ___-___ days of life

A

36 weeks
2-7 days of life

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113
Q

Central apnea occurs in

A

preterm infant’s irregular breathing Patterns
- neuronal immaturity

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114
Q

Apnea is primarily thought to be the result of

A

neuronal immaturity
- not good at multitasking
- forget to start breathing again

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115
Q

Obstructive apnea occurs in

A

a preterm infant when there is a cessation of airflow associated with blockage of the upper airway (small airway diameter, increased pharyngeal secretions, improper body alignment, and positioning)
- positioning issue in opening the airway
- reflux after eating
- no suction

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116
Q

Apnea onset is usually

A

quick and insidious

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117
Q

Apnea occurs during what type of activity

A

feeding
suctioning
stooling
- no observation activity related

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118
Q

Does all apnea spells have observable activity r/t apnea?

A

No

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119
Q

How do you document apnea and what should be documented with it?

A

ALWAYS document as a drop
- time
- length of episode
- treatment required

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120
Q

Interventions of apnea depend on the

A

severity

121
Q

Mild and acute apnea interventions by the nurse

A

Stimulate or rub their chest to create positive pressure
Air then Supplemental O2

122
Q

Severe apnea interventions

A

Supplemental O2
Caffeine Citrate (shot of espresso)

123
Q

What is the medication tx for apnea prematurity?

A

Caffeine Citrate (methylxanthine)

124
Q

Caffeine Citrate
Monitor for

A

HR raising and bounding
- higher range of normal
Continous monitoring with med
IV/PO

125
Q

Caffeine Citrate
Toxicity

A

low and safer

126
Q

Caffeine Citrate is withheld if

A

HR 170+

127
Q

Caffeine Citrate given ONLY

A

in hospital and need to wean baby off
DO NOT SEND BABY HOME WITH IT!!

128
Q

If order to D/C the baby from the hospital that has caffeine Citrate, what criteria do they need to meet?

A

NO apneic episodes within 7 days
- clock resets for another 7 days when apneic episode starts again

129
Q

Respiratory Distress Syndrome is due to

A

surfactant deficiency
- underdeveloped alveoli

130
Q

Surfactant

A

Liquid around the lungs allows the lungs to open

131
Q

Are premature babies the only ones affected by RDS?

A

no, near-term babies too.

132
Q

RDS peak severity with no complications is

A

1-3 days

133
Q

Onset of recovery of RDS

A

around 3 days
- with diuresis

134
Q

RDS patients need to be on what type of I&Os

A

strict (and with O2)
- notice when recovery occurs with diuresis

135
Q

RDS Risk factors

A

Low Gestational age (PRETERM < 37 weeks)
Male predominance (NOT FIGHTERS like AA women)
Maternal diabetes
Perinatal depression (mom drugs)

136
Q

Maternal diabetes causes what in the infant related to RDS

A

An increase in sugar and insulin causes a decrease of surfactant

137
Q

S/S of RDS** similar to all

A

Tachypnea initially
Dyspnea
Intercostal or subcostal retractions
Inspiratory crackles
Audible expiratory grunt
Flaring of the nares
Cyanosis
Pallor

138
Q

RDS Mgmt

A

Artificial surfactant replacement
Respiratory support and monitoring
Oxygen supplementation
IVF, TPN, Gavage feedings (Tropic feeds start)

139
Q

Artificial Surfactant Replacement
is made of what

A
  • ground up pig/cow lungs ($$$$)
140
Q

What is monitored with an Artificial Surfactant Replacement, and what interventions must be implemented?

A

Intubate and surfactant placed directly and slowly
- Frequent turning to coat the lungs
- SAT 100% and wean off O2
- Respiratory Therapist

141
Q

RDS support for respirations

A

surf and turf = intubate and pull the tube with CPAP
- keep the tube in if O2 sat does not improve with replacement

142
Q

Why do you not want an infant to Ox Sat at 100% if on supplemental O2?

A

cause blindness (o2 Toxicity in preemies)
- air and O2 mix
- INT mixed flow

143
Q

Bronchopulmonary Dysplasia aka

A

Chronic lung disease

144
Q

Bronchopulmonary Dysplasia occurs in primarily?
and secondary?

A

1st: low birth weight preterm infants
2nd: O2 and mech vent tx of RDS

145
Q

What is the complication of RDS of using O2 and mechanical ventilation?

A

Bronchopulmonary Dysplasia
- asthma later
- severe RDS with small airway from early on in life

146
Q

Bronchopulmonary Dysplasia is defined as

A

dependence on O2 >28 days + of age
- more support early on leads to more o2 for longer periods
- increase risk of reactive airway/respiratory disease

147
Q

Early signs of respiratory complications in children

A

Refuse fluids with low urine
- too many dry diapers
earache (respir. infection)
RR>50-60
Fever >101
listless (confused with no energy)
increased irritation
persistent cough
wheeze
restless

148
Q

If they have early signs of respiratory s/s, then what does the parent need to do?
If blue?

A

Call HCP
- If blue then ER

149
Q

Upper Respiratory Disorders

A

Acute Streptococcal Pharyngitis
Tonsilitis
Otitis Media
Croup (Acute Epiglottitis, Acute Laryngotracheobronchitis)

150
Q

Lower Respiratory Disorders

A

RSV
Bronchiolitis
Asthma

151
Q

Acute Streptococcal Pharyngitis aka

A

Strep throat

152
Q

Strep is what type of infection

A

Bacterial infection of the throat and tonsils

153
Q

What is the most common types to have Strep?

A

5-15 y/o

154
Q

What causative agent/bacteria causes Strep throat?

A

Group A Beta-Hemolytic Streptococcus (GABHS)

155
Q

Strep Throat S/S

A

FINE SANDPAPER RASH
Sore throat
- uvula edematous and red
- inflamed tonsils and lymph nodes
- exudate
HA
Fever
Abd pain (Stomach bug with N/V)

156
Q

Strep Throat Dx

A

Rapid Streptococcal Antigen Test/ Throat Culture
- gag reflex
- back of the throat
- results within 15 mins
pos. : antibiotics
neg. with s/s: send in throat culture with antibiotics

157
Q

If the strep test is negative but they still have s/s, then

A

send in throat culture
send home on antibiotics

158
Q

If the strep test is positive, then what interventions should be implemented and teachings involved?

A

Amoxicillin or Erythromycin
Take fluids
24 hours return after all antibiotics
Discard the toothbrush and replace it after antibiotics
TAKE antibiotics all Rx
- Rheumatic fever or Acute Glomerulonephritis can affect the heart and kidneys

159
Q

Why should the patient take all their antibiotics for Strep?

A

Rheumatic fever or Acute Glomerulonephritis will develop and can affect the heart and kidneys

160
Q

Tonsillitis is the

A

inflammation of the tonsils

161
Q

What is the causative agent for Tonsillitis?

A

viral or bacterial
- frequency of respiratory infections

162
Q

What is the major difference between strep and tonsillitis?

A

Tonsillitis is a bacterial and/or viral
Strep is only bacterial

163
Q

What are your different tonsils from top to bottom?

A

Pharyngeal (adenoids)
Tubal
Palatine (faucial) (see them)
Linguinal

164
Q

Tonsils are larger in

A

children than adolescents
- protective

165
Q

S/S of Tonsillitis

A

Sore Throat
Difficulty Swallowing
Fever
Enlarged Tonsils
- “Kissing Tonsils” = touching together
Obstructed Breathing
Exudate, Maybe
snoring at night
talk with a frog croak

166
Q

Interventions of Tonsillitis

A

Rapid “Strep” Test And/Or Throat Culture
- If Positive, Antibiotics
Antipyretics - Acetaminophen/Ibuprofen
Ice Chips, Soft Or Liquid Diet
Warm Saline Gargles help irritation
For Frequent Episodes, Consider Surgical Options

167
Q

If you have frequent episodes of tonsillitis, what interventions should be considered?

A

Elective Surgical
- Tonsillectomy
- Adenoidectomy

168
Q

Tonsillectomy

A

removal of palatine tonsils

169
Q

Adenoidectomy

A

removal of pharyngeal tonsils
- back of the throat

170
Q

Contraindications of Tonsillitis Surgery options

A
  • NO cleft palate = tonsils help speak
  • NO fever within 24 hrs (inflamed lymph nodes cause more bleeding risk)
  • Blood disease or clotting issue
  • Anesthesia risk (not wanting to wake up)
171
Q

What anestesia is used in tonsillectomy?

A

general (outpt)

172
Q

Pre-Op for tonsillectomy/adenoidectomy

A

Assess possible infections, lab values
Check for loose teeth that could dislodge and aspirate
- warn anesthesia won’t be themselves after (confused)
Happy Juice = Versed

173
Q

Post-Op for tonsillectomy/adenoidectomy

A

Comfort
- prone or side-lying
- HOB up after alert
- analgesic, ice collar
encourage rest
NO coughing, throat clearing, nose blowing

174
Q

Post-Op Tonsillectomy and Adenoidectomy
Diet

A

Ice Chips, Sips Of Water, And Clear Liquids
No Red-Colored Liquids, Citrus, or Milk-Based Foods Initially

175
Q

What is the biggest post-op problem of tonsillectomy and adenoidectomy?

A

bleeding

176
Q

D/C Education of Tonsillectomy/Adenoidectomy

A

cont. soft, bland food (jello, smoothie with spoon)
- no sharp objects in the mouth (NO straws or forks)
Scheduled Analgesic for 1st 48 hours
- esp. at night for breakthrough pain
Limit activity 2 weeks along with no swimming
Immediate HCP for signs of hemorrhage
- mostly in 1st 24 hours

177
Q

S/S of Hemorrhage Post-Op Tonsillectomy

A

Heart is beating fast (tachycardia)
Pallor
Frequent clearing and swallowing (blood builds)
Vomit of bright red blood
Restless
Hypertensive or shocky (not usually noticed)

178
Q

Post-Tonsillectomy Appearance tell the parents

A

White scab is normal when healing
7-10 starts to come off – higher pain and sensitivity

179
Q

Otitis Media

A

inflammation of the middle ear

180
Q

Otitis Media is precipitated by

A

pharyngeal infection and RSD

181
Q

Why is OM more common in children?

A

Eustachian tube is smaller and flatter allowing the bacteria to travel easier

182
Q

Acute Otitis Media (AOM):

A

An inflammation of the middle ear space with a rapid onset of the signs and symptoms of acute infection (Fever And Ear Pain)

183
Q

Otitis Media With Effusion (OME):

A

Fluid in the middle ear space without symptoms of acute infection
Hole all the time annoyed

184
Q

OM Risk Factors

A

Age < 2 Years Old - anatomy structure
Recent URI
Family Hx
Socioeconomic Status (exposure to related factors)
- Day Care/Exposure To Other Children
- Allergies
- Crowded Households
- Secondhand Smoke Exposure
Bottle-feeding (no maternal antibodies)
Bottle Propping (milk down eustachian tube)
Winter month
Enlarged Tonsils/Adenoids
Cleft Lip/Cleft Palate
Down Syndrome
Males
Pacifier Use (constant sucking)

185
Q

Infant S/S of Acute OM

A

Crying
Fussiness (↑ When Lying Down)
Tendency To Rub, Hold, Or Pull Affected Ear
Rolls Head From Side To Side
Difficult To Comfort
Refuses To Feed
Vomiting, Diarrhea
- Lack of swallowing

186
Q

Older Children S/S of Acute OM

A

Crying Or Verbalizes Feelings Of Discomfort
Irritability
Lethargy
Loss Of Appetite

187
Q

Purulent Drainage S/S of OM is a sign of

A

tympanic membrane rupturing
- a sense of relief no pain
BAD THING

188
Q

AOM Dx

A

Otoscopic Examination Of Tympanic Membrane
Presence Of Purulent Discolored Effusion
Bulging Or Full
Immobile
Red
Opaque
- gray = normal

189
Q

AOM interventions

A

Administer Antibiotics – PO and/or ear drops
Administer Analgesic-Antipyretic (acetaminophen, 6 months + = ibuprofen)
Facilitate Drainage If Possible
Position Child On Affected Ear** - towel
Warm Compress Relief on Affected Ear

190
Q

Otitis media with effusion if drainage longer than

A

3 months

191
Q

Otitis media with effusion s/s

A

May Have Rhinitis, Cough, Diarrhea
Feeling Of Fullness And/Or Motion In-Ear
Popping Sensation When Swallowing

192
Q

Otitis media recurrent or with effusion Dx through

A

Otoscopic Examination Of Tympanic Membrane
Orange, Discolored
Immobile

193
Q

OME usually resolves

A

on its own
- antibiotics if longer then to Myringotomy

194
Q

OME precipitated by

A

upper respiratory infection
OM

195
Q

Myringotomy

A

Tympanostomy Tubes
Alleviates Pain
Facilitates Drainage
Allows For Ventilation
- quick 20-45 minutes

196
Q

Myringotomy Post-Op

A

Position To Facilitate Drainage with the affected ear down
Keep Ears Dry
Antibiotics – PO and ear drops (drainage thinner)
Analgesics – Tylenol and ibuprofen
Discourage Nose Blowing For 7-10 Days can dislodge
Notify Provider If Tubes Fall Out
Keep Immunizations Up-To-Date**
Decrease OM/AOM Risk Factors
When you can

197
Q

What happens when the myringotomy tube falls out?

A

Notify provider
- if falls out within 7-10 days
After not a big deal

198
Q

Croup Syndromes includes

A

Acute Epiglottitis
Acute Laryngotracheobronchitis (Croup)
Acute Spasmodic Laryngitis (Spasmodic Croup)
Bacterial Tracheitis

199
Q

Croup Characteristics

A

Hoarseness
“Barking” Or “Brassy” Cough- seals
Varying Degrees Of Inspiratory Stridor
Varying Degrees Of Respiratory Distress

200
Q

Acute Epiglottitis

A

serious obstructive inflammatory process
- severe and life-threatening infection

201
Q

The most common causative organism of Acute Epiglottitis

A

Haemophilus Influenza

202
Q

Acute Epiglottitis is a medical

A

EMERGENCY

203
Q

What age of children is more likely to have acute epiglottitis?

A

2-5 y/o

204
Q

Acute Epiglottitis PREDICTIVE S/S

A

Absence Of Spontaneous Cough
Presence Of Drooling
Agitation

205
Q

Acute Epiglottitis S/S

A

Abrupt Onset
**Predictive Signs (Absence Of Spontaneous Cough, Presence Of Drooling, Agitation)
Fever And Appears Very Sick (“Toxic”)
Tripod Positioning
Irritability and Restlessness
Thick, Muffled, Froglike Croaking Voice
Retractions
Red And Inflamed Throat
Large, Cherry Red, Edematous Epiglottis Visible Upon CAREFUL Throat Inspection

206
Q

Acute Epiglottitis: the throat looks like on careful inspection

A

Large, Cherry Red, Edematous Epiglottis Visible Upon CAREFUL Throat Inspection

207
Q

Acute Epiglottitis positioning is known as

A

Tripod

208
Q

Acute Epiglottitis Dx

A

Throat Inspection
Laryngoscopy-With Airway Protected
Lateral Neck X-Ray
“Thumb Sign”
Throat and Blood Cultures

209
Q

What needs to be avoided when doing a throat inspection for acute epiglottitis?

A

Oral Temperature
Tongue Depressors

210
Q

Acute Epiglottitis patho

A

Epiglottis swells up and closes the airway and won’t pop open
Airway opens then cultures
Intubate if unable then trach

211
Q

Acute Epiglottitis Mgmt

A

Protect Airway – Keep Child NPO
NOTHING BY MOUTH OR OBJECTS
Position Of Comfort
– HOB ELEVATED
- Avoid Supine Position
Pulse Oximetry (everything)
Antibiotics - IV
Corticosteroids
Droplet Isolation for at least 24 hours after antibiotics

212
Q

For acute epiglottitis, what isolation needs to be taken, and for how long?

A

Droplet for at least 24 hours after antibiotics

213
Q

Acute Laryngotracheobronchitis is the main version of

A

Croup

214
Q

Acute Laryngotracheobronchitis is the

A

inflammtion of laynx, trachea, and bronchi

215
Q

Acute Laryngotracheobronchitis is preceded by

A

URI
causative agent: VIRAL

216
Q

Acute Laryngotracheobronchitis is seen in what age groups

A

less than 5 y/o
- head cold then down

217
Q

Croup S/S

A

Usually Preceded By Upper Respiratory Infection (URI)
Low-Grade Fever 101 usually
Barky, Brassy (“Seal-Like”) Cough
Hoarseness

218
Q

Croup S/S AS THE AIRWAY NARROWS

A

Inspiratory Stridor (HIGH PITCH)
Retractions
Increasing Respiratory Distress And Hypoxia
Can Lead To Respiratory Acidosis And Respiratory Failure if untreated

219
Q

Upper respiratory infections have what sound

A

stridor

220
Q

Lower respiratory infections have what sound

A

wheezing

221
Q

Mild Croup Home Care Education

A

Observe Respiratory Status
- Monitoring For Worsening Symptoms and call

Cool-Air Vaporizer
Or Cool-Air Environment

Oral Hydration And Nourishment

Comfort Measures
- riding in the cold will help airway open

222
Q

Hospitalized Care of Croup

A

Cool Mist Humidity And O2 As Needed
Pulse Oximetry
IV Fluids As Needed
Nebulized Epinephrine
Corticosteroids

223
Q

Do you use antibiotics or antivirals on croup?

A

no
- oral/IV fluids

224
Q

Nebulized Epinephrine

A

hand-held breathing treatment help with edema in the throat
1 =
2 = ED and monitor
3 = pediatric ED and stay over night

225
Q

RSV and Bronchiolitis are ________ communicable

A

highly

226
Q

RSV and Bronchiolitis are what type of infection

A

acute viral with max effect at the bronchiolar level

227
Q

What kids can get RSV?

A

UNDER 2 Y/O (common in Premies)
- Recurrent over the years
- same with RSV
- vaccine coming out

228
Q

RSV can live on objects for

A

7 hours 30 mins on hands (hand hygiene)

229
Q

What is the incubation period of RSV?

A

2-8 days
- begins replication in the nasal
- epithelial lining to tissue

230
Q

What months is RSV more prevalent?

A

November to April

231
Q

Initial S/S of RSV

A

History Of URI - RSV
Rhinorrhea – runny nose (constant)
suctioning
Pharyngitis
Coughing, Sneezing
Wheezing
Possible Ear Or Eye Drainage
Intermittent Fever
RefusalFeed
Copious Nasal Secretions

232
Q

At what point during RSV s/s do you take them to the hospital?

A

stop eating

233
Q

In RSV, the younger the infant the greater the

A

severity
- size of the airway and lungs

234
Q

W/ Progression S/S of RSV

A

Increased Coughing And Wheezing
Retractions
Crackles
Dyspnea
Tachypnea
Cyanosis
Diminished breath sounds
- Intubation in PICU

235
Q

Severe S/S of RSV

A

Tachypnea > 70 breaths/min.
Listlessness
Apneic Spells
Poor Air Exchange
Poor Breath Sounds

236
Q

Dx RSV

A

Nasopharyngeal Secretions ~ RSV Antigen Detection
- Swab nose and mouth with rapid test

237
Q

Supportive RSV pt care

A

Contact Isolation
Monitor Airway
Humidified O2 With Pulse Ox
Hydration – IV, If Oral Not Tolerated
Nasal Suctioning esp. with feeding times
Antibiotics, Possibly (coexisting bacterial infections)
Bronchodilators, Possibly with mechanical ventilation
Racemic Epinephrine (antiviral – last effort), Possibly
Ribavirin, Possibly
RT sets up medication, watch them

238
Q

What is chest percussion used for in RSV pts?

A

RT with cupping to prevent progress to pneumonia

239
Q

Would you use antibiotics?

A

possibly to help the coexisting illness

240
Q

Racemic Epinephrine

A

high cost, toxic to healthcare providers
- opens airway
administering it aerosol, efficacy questioned, need N95 to protect yourself

241
Q

If the nurse has an RSV pt then the charge nurse will not assign them

A

immunodeficient

242
Q

RSV Prevention

A

Encourage Breastfeeding (IgA)
Avoid Tobacco Smoke Exposure
Good Handwashing
Palivizumab (Synagis)
- Monthly IM Injections for High-Risk Infants
–November – March/April
–Preemies
–Decrease severity and fewer hospitalizations

243
Q

Asthma

A

Chronic Inflammatory Reactive Airway Disease
- 3rd leading cause of hospitalizations
80-90% 1st s/s <4-5 y/o

244
Q

INT Ashtma

A

– symptoms less than twice a week
not pharmo

245
Q

Mild ashtma

A

s/s more than 2 a week but not daily

246
Q

Moderate asthma

A

daily s/s occur with exacerbations 2x a week

247
Q

Severe asthma

A

affects the quality of life
s/s persistent along with frequent exacerbations

248
Q

Airway Obstruction caused by asthma

A

Thick mucus, mucosal edema, and smooth muscle spasms obstruct small airways; breathing becomes labored, and expiration is difficult
- triggers inflammation and edema
- mucous builds
- narrow airway and wheezing
expiratory traps CO2 in alveoli

249
Q

Asthma Risk Factors

A

Family Hx
Hx Allergies (inflammation and mucous buildup)
Gender (males younger than girls in older)
Smoking Or Exposure To Secondhand Smoke
Maternal Smoking During Pregnancy
Ethnicity – AA at greatest risk
Low Birth Weight – underdeveloped lungs and BPD)
Being Overweight

250
Q

Which ethnicity has the greatest risk of asthma?

A

AA

251
Q

Triggers of ASTHMA

A

Allergens (Outdoor/Indoor/Irritants) - smoking
Exercise (mouth breathing and temperature outside)
Cold Air Or Changes In Weather Or Temperature
Environmental Change
Colds And Infections
Animals
Medications – aspirin, NSAIDs, beta blockers
Strong Emotions (scared, anger, crying)
Foods And Food Additives
And So On…

252
Q

“CLASSIC” S/S of asthma

A

Shortness Of Breath
Wheezing
Non-Productive Coughing
(Worsens During Nighttime)
Chest Tightness/Pain
- Rash red on the chest
Increased Restlessness/Anxiousness

253
Q

DX of Ashtma

A

Clinical Manifestations
H&P (rash, ears and nails blue, sweat, tripod, short phrasesVS, wheezing/crackles, and accessory muscle use)
-CBC with differential; (WBC elevated)
-CXR (infiltrates and hyper expansion of the airway
-Pulmonary Function Tests (PFTs)
-Peak Expiratory Flow Rate (PEFR)
(How much air they can push out)
Skin Prick Testing (SPT) – allergy
- Get itchy but don’t itch
- Gel afterward

254
Q

Long-Term Control (Preventive) Medications

A

To Achieve And Maintain Control of Inflammation
Every day

255
Q

Quick-Relief (Rescue) Medications

A

To Treat Symptoms And Exacerbations
When in an attack for relief

256
Q

What meds are used for Asthma pts every day?

A

Long-Term Control (Preventive) Medications
Quick-Relief (Rescue) Medications

257
Q

Long Term Control of Asthma

A

Corticosteroids (Anti-Inflammatory)
Fluticasone (Flovent) – INH
Budesonide (Pulmicort) – INH

Mast Cell Stabilizers (Anti-Histamine)
Cromolyn Sodium (Intal) – INH
Nedocromil (Tilade) – INH (Not Used In Children < 5 Yrs)

Long-Acting β2 Agonists “LABA” (Bronchodilator)
Salmeterol (Serevent) – INH
Formoterol (Foradil) – INH

Leukotriene Modifiers (Blocks Inflammatory And Bronchospasm)
Montelukast (Singulair) – PO (Not Used in Children < 12 Mo.)
Zafirlukast (Accolate) – PO (Not Used in Children < 7 Yrs.)

Monoclonal Antibodies (Blocks Binding Of Immunoglobulin E To Mast Cells To Inhibit Inflammation)
Omalizumab (Xolair) – SQ (Not Used in Children < 12Yrs.)

Methylxanthine (Bronchodilator)
Theophylline – PO
Aminophylline – IV
- Used Primarily In The ED When The Child Is Not Responding To Maximal Therapy

258
Q

Quick Relief Medications for Asthma

A

Short-Acting β2-Agonists “SABA” (Bronchodilator)
Albuterol (Ventolin) – PO, INH
Levalbuterol (Xopenex) – INH
Terbutaline – PO, INH, SQ, IV

Anticholinergics (Bronchodilator)
Ipratropium Bromide (Atrovent) – INH

Corticosteroids (Anti-Inflammatory)
Methylprednisolone (Solu-Medrol, Prednisone) – IV, PO

259
Q

Rescue relief is used for

A

exacerbation in with the long term preventative
- inhaler or nebulizar with face mask

260
Q

Exercise-Induced Bronchospasm

A

Acute, Reversible Airway Obstruction

During Or After Vigorous Exercise
Rare In Activities That Require Short Bursts Of Energy - basketball, soccer

Cough, SOB, Chest Pain Or Tightness, Wheezing, Endurance Problems

261
Q

Endurace-based Bronchospams can taken what before PE or athletics to help prevent EIB?

A

Prophylactic Quick-Relief (Rescue) Medication Before Exercise – albuterol or SABA
Before PE or athletics

262
Q

What exercises are considered vigorous for asthma pts

A

Sprint, skiing, gymnastics, baseball

263
Q

What exercises should asthma pts do?

A

swimming
endurance
soccer
basketball’football
work out with SABA

264
Q

Ashtma for inpts

A

Position Of Comfort
**Supplemental O2 – Keep O2 Sats > 90%
Short-Acting β2-Agonists (Quick-Relief Medications) – metered or nebulizer
Anticholinergic, May Be Added
Corticosteroids – inflammation in the airway
Hydration – IV if not PO
Reassurance, Support, Education
Calm environment with no anxiety, sounds or songs, or video to relax
Let them find their comfort position - Tripod

265
Q

Status Asthmaticus

A

Respiratory Distress Despite Vigorous Therapeutic Measures

Inhaled Nebulized Short Acting β2-Agonists
- 3 Treatments: 20-30 Minutes Apart

266
Q

Status Asthmaticus tx

A

O2 Above 90%
Mag sulfate – muscle relaxant, IV
Heliox – helium and O2, inhalation, keep decrease airway to help with breathing
Anticholinergics
Corticosteroids
Keta –
= ready CODE in case

Sit upright and sweating
Hypoxic and intubate if no talking and quiet

267
Q

Medication Delivery Devices for Ashtma medication

A

Metered Dose Inhaler (MDI)
with Spacer (more time and breath slowly for 10-15 seconds)

Nebulizer (customized)
Time to complete with show or game

268
Q

Peak Expiratory Flow Meter (PEFM) is used in children

A

greater or 5 y/o

269
Q

Peak Expiratory Flow Meter (PEFM)

A

Child’s Personal Best
“Zones” For Asthma Management
Green Zone (Mild) - 80-100%
Yellow Zone (Moderate) 50-80%
Red Zone (Severe) <50%

270
Q

Steps of Peak Expiratory Flow Meter

A

Stand or sit straight with chin lifted
Breath out completely
Set to 0
Breath in
Lips around
Blow out hard and fast
Look at meter and mark
Repeat and measure 3 times
Highest number is PEAK
Repeat
Document for 2 weeks

271
Q

Prevention of Asthma

A

Recognition And Avoidance Of Triggers
Recognize Signs And Symptoms Of Exacerbation
Compliance With Asthma Action Plan
Medications And Use Of Delivery Devices
Good Handwashing
Up-To-Date Immunizations
Exercise
- teach deep breathing and relaxation techniques

272
Q

Cystitic Fibrosis

A

Autosomal Recessive Disease That Causes Exocrine Gland (Mucus Producing Glands) Dysfunction
- thick and sticky

273
Q

Cystitic Fibrosis is caused by

A

Mutation In The Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Gene
Results In Exocrine Gland Secreting Mucus That Is Thick And Sticky

274
Q

Cystic Fibrosis results in

A

Exocrine Gland Secreting Mucus That Is Thick And Sticky

275
Q

Is CF curable?

A

no
- more common in causacians

276
Q

CF is screened on the

A

newborn

277
Q

What trait causes CF

A

RECESSIVE
- both parents need the gene

278
Q

CF Patho

A
  • Exocrine Glands Produce Thick And Sticky Mucus
  • mechanical Obstruction Of The Affected Organs - Altering Their Function
    Primarily Affects Skin, Respiratory, Gastrointestinal, And Reproductive Systems
279
Q

What body systems are normally affected by CF

A

SKIN
respiratory
GI
reproductive

280
Q

CF skin s/s

A

elevated of sweat electrolytes (Na AND Cl)
Salty skin

281
Q

CF respiratory s/s

A

progressive lung failure result from infection

282
Q

CF GI s/s

A

pancreatic enzyme deficit and pancreatic kyphosis

283
Q

CF reproductive s/s

A

= delay puberty and infertility (men sterile)

284
Q

What body system is not affected by CF?

A

brain and nervous system
- learning is not affected

285
Q

CF Dx

A

Family History
Genetic Testing
Newborn Screening
Sweat Chloride Test
Chest X-Ray
Pulmonary Function Tests
Stool Analysis = fat in stool - no pancreatic enzymes

286
Q

Sweat Chloride Test results

A

< 40 normal
> 60 CF
usually takes an hour, noninvasive

287
Q

CF Respiratory Assessment

A

Symptoms Produced By Stagnation Of Mucus Infection
Airway
Persistent Coughing
May Be Productive
Recurrent Respiratory Tract Infections
Pneumonia And Bronchitis
Wheezing
Shortness Of Breath

288
Q

In CF pts, the mucous sits in the lungs causing

A

Infections:
Bacteria attracted to the mucous
Greater damage to airway
Lungs become destroyed and death

289
Q

Respiratory Interventions for CF

A

Prevent Or Minimize Pulmonary Complications
Airway Clearance Therapies
- Inhaled Medications
- Bronchodilators
- dornase alfa (Pulmozyme)
- Nebulization with percussion
Exercise –stimulate clearing out
Antibiotics As Needed
-Vest for vibrations to clear mucous out**

290
Q

What medication for CF pts is used daily with percussion vest in the nebulizer?

A

dormase alfa (Pulmozyme)
- decreases viscosity of the mucous

291
Q

GI Assessment for CF

A

1ST = Meconium Ileus At Birth - blocked by thick poop (20-30%)
Pancreatic Fibrosis:
Impaired Digestion And Absorption Of Nutrients
Fat-soluble vitamins (A, D, E, K)
Steatorrhea (Excessive Fat, Greasy Stools)
Foul-Smelling Bulky Stools
Failure To Gain Weight And Delayed Growth Patterns
Look like FTT pt
Diabetes Mellitus - need insulin
Rectal Prolapse

292
Q

Panceratic Fibrosis

A

Impaired Digestion And Absorption Of Nutrients
Fat-soluble vitamins (A, D, E, K)

293
Q

In CF, what vitamins are not absorbed in the body?

A

fat-soluble (A,D,E,K)

294
Q

GI Interventions for CF pts

A

Replace Pancreatic Enzymes

High-Calorie, High-Protein, High-Fat Diet
- malnutrition from partial absorption
Vitamins A,D, E, K And Multivitamins (water soluble)
150% MORE DAILY ALLOWANCE

Laxatives Or Stool Softeners

295
Q

What type of diet does a CF patient eat?

A

HIGH calorie, protein , and fat diet
with water soluble vitamins

296
Q

Pancreatic Enzymes should be taken with

A

fatty foods to absorb

297
Q

Education of CF

A

Multidisciplinary Approach
MD, Nurse, Respiratory Therapist, Nutritionist, Social Services
Infection Prevention
- Discouraging Close Contact With Other CF Children
- Up-To-Date Immunizations
- Notify Provider For Signs And Symptoms Of Infection
Encourage Compliance With Care Plan
Encourage Physical Activity
VEST, NEB, MEAL PLAN
- support due to separation

298
Q

CF pts each have a unique bacteria colonized so CF patients need to

A

stay away from one another

299
Q

Should you recommend an adolescents CF pt. to go to a camp for CF pts?

A

No

Module 5 (Pediatrics) (27 decks)

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