Respiratory/ENT Conditions Flashcards
1. Describe assessments for respiratory distress in children. 2. Describe the conditions or complications related to immature lung development in children. 3. Explain the treatments most commonly implemented for respiratory/ENT conditions in children. 4. Differentiate among various childhood respiratory/ENT conditions, and plan appropriate nursing interventions.
The parents of a 2-year-old child with chronic otitis media are concerned that the disorder has affected the child’s hearing. Which behavior suggests that the child has developed a hearing impairment related to the chronic otitis media?
a. Stuttering
b. Using gestures to express desires
c. Babbling continuously
d. Playing alongside rather than interacting with peers
c
Babbling continuously is indicative of marked speech delay in a two-year-old and warrants evaluation of hearing. Developmentally, a two-year-old should be speaking in two to three-word sentences and may have speech that is unclear to strangers, but generally understood by caregivers. Two-year-olds typically play alongside peers in a type of play that is called parallel play. Using gestures and stuttering at this age are not necessarily indicative of hearing loss.
A 10-month-old child with recurrent otitis media is brought to the clinic for evaluation. To help determine the cause of the child’s condition, the nurse should ask the parents:
a. “Does water ever get into the baby’s ears during shampooing?”
b. “Do you give the baby a bottle to take to bed?”
c. “Do you see a lot of wax in the baby’s ears?”
d. “Can the baby combine two words when speaking?”
b
A primary cause of otitis media is bottle propping and drinking from a bottle in a recumbent position. Ear wax is not associated with otitis media. Developmentally, children at 10 months do not yet combine two words when speaking.
Which of the following would be the most concerning finding for the child who has just had a tonsillectomy?
a. Fever of 101°F
b. Increased swallowing
c. Pain score of 4/10 on the numeric scale
d. Pain score of 7/10 on the numeric scale
b
Following a tonsillectomy, a priority nursing intervention is assessment for post-surgical complications such as bleeding. Increased swallowing is a sign of bleeding at the surgical site. Low-grade fever and pain are expected and should be managed.
When planning care for a child with epiglottitis, the nurse should assign the highest priority to which of the following interventions?
a. Providing psychological support.
b. Ensuring respiratory patency.
c. Instituting infection control practices.
d. Administering prescribed drug therapy.
b
Epiglottitis is a medical emergency in which the airway closes due to a progressive inflammation caused by infection of the epiglottis. The airway is hyperesponsive and should not be examined unless healthcare providers are prepared to rapidly intubate the child or place a tracheostomy.
When is the best time to administer pancreatic enzymes for a child with cystic fibrosis?
a. 30 minutes before meals
b. immediately before meals
c. in the middle of the meal
d. 30 minutes after the meal
b
Pancreatic enzymes for children with cystic fibrosis should be given immediately before a meal. Pancreatic enzymes are given to improve absorption, particularly of fats.
Five-year-old Alexandra is a patient you are caring for on the inpatient pediatric unit status post-tonsillectomy. Which of the following symptoms would indicate immediate post-operative complications?
a. Spitting out brown, coffee-ground-colored secretions
b. complaining of a sore throat and refusing liquids
c. vomiting bright red blood
d. crying
c
One of the greatest risks post-operatively for the child undergoing a tonsillectomy is the risk of bleeding. Vomiting bright red blood, tachycardia, and increased swallowing are signs of potential bleeding at the operative site. Spitting out blood-tinged mucous, crying, complaints of sore throat, and refusal to drink fluids are all common findings and in the post-operative care of the child with a tonsillectomy.
You are teaching teenagers and their parents about early signs of carbon monoxide poisoning. You know that a parent needs further education when she lists which of the following as a sign:
a. light-headedness
b. nausea
c. headache
d. shortness of breath
d
Early signs of carbon monoxide poisoning include light-headedness, nausea, and headache.
The nurse is reviewing the following results of a blood gas: pH 7.32, PaO₂ 88, PCO₂ 48. Which of the following best describes these results?
a. respiratory acidosis
b. respiratory alkalosis
c. metabolic acidosis
d. metabolic alkalosis
a
A normal pediatric pH = 7.35 - 7.45. A normal pediatric CO₂ = 35-45. A pH that is less than 7.35 is acidosis. An elevated CO₂ indicates that the disturbance is respiratory in nature.
Which of the following would be the priority treatment for a child diagnosed with respiratory acidosis?
a. Have the child slowly breathe in a paper bag.
b. Administer oxygen and monitor the child’s work of breathing, preparing for intubation, as necessary.
c. Administer bicarb via IV infusion.
d. Have the child’s mother attempt to help calm the child and slow his breathing.
b
The administration of oxygen and preparation for intubation is the treatment for respiratory acidosis, which indicates that the child is in respiratory failure. Although it is important to encourage the mother to remain with the child, encouraging the child to slow his breathing is the treatment for respiratory alkalosis.
The nurse is caring for a 12-year-old with cystic fibrosis who has had problems with chronic hypoxemia most of his life. Which of the following would indicate that the child is having acute respiratory distress?
a. barrel-shaped chest
b. clubbing of the toes
c. intercostal retractions
d. having to take a breath after each sentence
c
Intercostal retractions indicate that the child is having to work harder to maintain respirations and indicate acute respiratory distress. A barrel-shaped chest is a sign of chronic respiratory distress that results from air trapping. Clubbing of the toes is a sign of chronic respiratory distress that results from chronic hypoxia. Having to take a breath after each sentence is an expected finding and does not imply a situation of acute respiratory distress.
The child in respiratory distress should not be given _______.
Anything to drink or eat as it requires too much effort to coordinate sucking, swallowing, and breathing. The risk for aspiration is increased.
The parents of a 3-year-old are concerned that she may have allergies. They ask the nurse how they can differentiate between allergies and a cold. Which of the following is the nurse’s best response?
a. “Children with allergies always come from a family with a strong history of allergies.”
b. “Children with colds tend to sneeze more than children with allergies.”
c. “Children with colds always have yellow discharge.”
d. “Children with allergies tend to complain of itchiness in their throats instead of pain.”
d
Allergies tend to cause pruritus of the throat instead of pain. Although there tends to be family history of allergies, they can occur without a history. Upper respiratory infections tend to have nasal discharge that is yellow, green, or purulent. Allergies tend to cause more sneezing than upper respiratory infections.
The nurse is caring for a 3-month-old in the pediatric clinic who has an upper respiratory infection and is congested with very thick secretions. They parents are very anxious as this is the first time the child has been ill. Which of the following statements would be the most helpful for the nurse to say?
a. “Before each feeding, place a few drops of saline in his nose and use the bulb syringe to suction the secretions.”
b. “Since he is so congested, he needs more fluids, replace one or two feedings a day with sterile water.”
c. “There really is no need to worry, all babies get colds and recover just fine.”
d. “After each feeding, place a few drops of saline in his nose and use the bulb syringe to suction the secretions.”
a
In order to help the infant with an upper respiratory infection tolerate feeding, it is essential to help clear his nose so that he can breathe while he feeds. The infant should be suctioned prior to feeding. Suctioning after a feeding may cause the infant to vomit. Feedings should not be replaced with water as there are not enough electrolytes in water. Although it is important to reassure the parents, the potential to develop respiratory distress exists and parents should be taught what to look for.
The nurse calls Mr. Webb to see how his 8-year-old son, Curtis is recovering from a tonsillectomy performed one day ago. Which of the following statements would indicate that Curtis needs to be seen emergently?
a. “He is sleeping but appears to be swallowing a lot.”
b. “He just had coffee-colored emesis.”
c. “He is complaining that his throat hurts more now than it did earlier today.”
d. “He is still not back to himself; he just wants to sleep and be left alone.
a
Frequently swallowing can indicate hemorrhage and needs immediate attention. While vomiting bright red blood is concerning, old blood is expected. Discomfort and fatigue is not unusual.
Children are more likely to get ear infections because ________.
The eustachian tubes are shorter more horizontally positioned.
Which of the following is the correct way to administer antibiotic ear drops to a 6-month-old?
a. Pull the ear down and back to open the canal.
b. Pull the ear up and back to open the canal.
c. Pull the ear down and forward to open the canal.
d. Pull the ear up and forward to open the canal.
a
In order to open the ear canal of a child less than 3 years of age, the ear needs to be pulled down and back.
The emergency room nurse is caring for Ella, a 3-year-old who is suspected of having epiglottitis. Ella, who is very irritable and anxious, is seated in her mother’s lap, leaning forward. She is drooling and points to her throat when the nurse asks what hurts. Which of the following should be included in Ella’s care?
a. Allow Ella to play with the flashlight and tongue blade prior to examining her throat.
b. Allow Ella’s mom to accompany her to radiology.
c. Quickly perform an assessment while Ella’s mom is out of the room registering.
d. Obtain Ella’s vital signs prior to performing a complete assessment.
b
Epiglottitis is a potentially life-threatening emergency. Inflammation and subsequent obstruction can occur. The throat should never be examined unless there is a team ready to perform an emergency tracheostomy in the event of complete closure. Every attempt at keeping the child calm is made. The parent should be encouraged to stay with the child at all times. Only the necessary parts of an assessment are initially done to keep the child from becoming more anxious and possibly leading to more inflammation.
A nurse is caring for a 3-year-old diagnosed with croup. The nurse knows that the organism that most likely led to croup in this child is:
a. Streptococcus pneumonia
b. Influenza A & B
c. Staphylococcus aureus
d. H. Influenzae
b
Most cases of croup are caused by influenza A and B.
The nurse is caring for a 4-year-old with laryngotracheobronchitis (LTB). When assessing the child and reviewing the history, the nurse would expect to find:
a. The child began having a ‘seal’ like cough immediately after dinner.
b. The child’s symptoms occurred on a winter evening.
c. The child was noted to have inspiratory and expiratory wheezing to the lower lobes bilaterally.
d. The child’s condition worsened when she went outside.
b
Symptoms of laryngotracheobronchitis (also called croup) typically occur during cold weather. Inspiratory stridor accompanies a seal-like cough that usually begins during the night. There is no evidence that cool mist has any effect on croup symptoms.
Lexy is a 3-year-old who is being admitted to the pediatric unit with a diagnosis of croup and moderate respiratory distress. Which of the following should be included in Lexy’s plan of care?
a. encourage bed rest.
b. limit fluids in order to decrease the risk of pulmonary edema.
c. administer oral steroid therapy.
d. if oral antibiotics are not well tolerated, administer IV antibiotics.
c
Oral steroid therapy serves to decrease the inflammation of the upper airway in croup. Oral fluids are encouraged to keep the child well-hydrated. Although rest is necessary, developmentally appropriate play is encouraged. Since croup is caused by a virus, antibiotics are unnecessary.
A nursing student asks how RSV is spread. The nurse bases her response on which of the following?
a. RSV is spread by direct contact with secretions and inhalation of droplets.
b. RSV is spread only by direct contact with secretions.
c. RSV is spread through direct contact with all body fluids.
d. RSV has been found in all body fluids including stool.
a
RSV is not spread through contact with all body fluids, but rather by contact with and inhalation of respiratory secretions. Development of asthma is associated with infant RSV infection.
A nurse is caring for 6-month-old Lauren who is admitted with RSV. Lauren was born 8 weeks prematurely and lives with parents who both smoke. Lauren is very congested and is not interested in playing. Which of the following would the nurse expect to see included in Lauren’s plan of care?
a. Place Lauren on pulse oximetry and administer oxygen, as necessary.
b. Administer IV fluids at 1/2 maintenance rate.
c. Administer a broad-spectrum IV antibiotic.
d. Administer albuterol every 4 hours as needed.
a
The hospitalized child with RSV should have their oxygen saturation monitored and be given supplemental oxygen as required. The infant with RSV is likely to be dehydrated and not interested in feeding therefore requiring IV fluid at more than 1/2 maintenance. Since RSV is caused by a virus, antibiotic therapy is not indicated as part of the treatment plan. The use of nebulized albuterol is not part of the standard treatment.
The school nurse is teaching a class about asthma to a group of teachers. Which of the following should be included in the education?
a. Asthma is the leading cause of acute illness in children.
b. Most children with asthma have a cough that disappears at night.
c. Asthma is the number one cause of hospitalization among children.
d. Asthma has the potential to be fatal.
d
Asthma, which has the potential to be fatal, is the third leading cause of hospitalization among children less than 15 years old. Injuries continue to account for more hospitalizations. Asthma is the leading cause of chronic, not acute illness in children. Children with asthma experience nighttime coughing.
The nursing student is preparing a poster project on pediatric asthma. When reviewing her poster, the nursing instructor questions which of the following statements?
a. Inflammation only occurs when a child with chronic asthma is exposed to triggers.
b. Swelling of the airway and mucus production occurs during the acute phase of asthma.
c. The narrowing of the airway occurs due to bronchospasm.
d. Most children with chronic asthma have allergies.
a
Inflammation is thought to always be present in children with chronic asthma. Swelling of the airway and mucus production occurs during the acute phase of asthma. The narrowing of the airway occurs due to bronchospasm. Most children with asthma have allergies.
Shelby is an 11-year-old who has just been diagnosed with asthma. When reviewing Shelby’s history, the nurse would expect to hear which of the following?
a. Shelby has been complaining that she just can’t get a ‘deep enough breath.’
b. Shelby has been having trouble concentrating at school as she seems to cough a lot during the early afternoon.
c. Shelby looks exhausted as she is not sleeping well at night.
d. Shelby has noticed that breathing is difficult at times, and she hears a whistling noise when she breathes in.
c
Children newly diagnosed with asthma often experience difficulty sleeping as they may have coughing spells during the night. Children typically complain that they have chest tightness and difficulty with expiration, not inspiration. Wheezing is also usually noted on expiration, not inspiration.
Cyndi, an 8-year-old newly diagnosed with asthma, is being discharged with several medications. When discussing potential side effects of her asthma medications, the nurse knows that Cyndi’s mom needs more education when she makes which of the following statements?
a. “Cyndi may appear nervous and jittery after taking her quick relief medication.”
b. “Cyndi may complain of a headache after taking her quick relief medication.”
c. “Cyndi may vomit after taking her quick relief medication.”
d. “Cyndi may be irritable and sleep more while she gets used to get quick relief medication.”
d
Children usually complain of sleeplessness.
Caleb is being evaluated in the pulmonary clinic for asthma. After taking his controller medication, the nurse instructs Caleb to do which of the following?
a. Breathe in and out several times and cough vigorously.
b. Meticulously wash his hands.
c. Rinse his mouth.
d. Lie down and rest.
c
Controller medications can lead to thrush, so oral care is essential.
Courtney is a 6-month-old with cystic fibrosis. Her mother demonstrates understanding of how to give her enzymes by stating which of the following is the administration technique?
a. Give applesauce before meals.
b. Give applesauce after meals.
c. Give an ounce of water before meals.
d. Give an ounce of water after meals.
a
Enzymes for children with cystic fibrosis should be suspended in applesauce and given immediately before meals.
The alveoli
Continue to develop an increase in size through puberty.
Eustachian Tubes
Infants and young children have shorter, broader, and more horizontally positioned tubes.
Ventilation
is the movement of gases from the atmosphere into (inspiration) and out of (expiration) the lungs.
Diffusion
is the movement of inhaled gases in the alveoli and across the alveolar capillary membrane.
Perfusion
is movement of oxygenated blood from the lungs to the tissues.
Respiratory Distress
Hyperpnea
Assessment
Deep respirations
Respiratory Distress
Apnea
Assessment
unintentional cessation in spontaneous breathing for greater than 20 seconds with or without bradycardia and color change.
Respiratory Distress
Monitor blood gas measurements
Assessment
a. Assess for hypercapnia (excessive Co2 in the blood because of inability to blow off CO2).
b. Assess for hypoxia (decreased tissue oxygenation).
1. Increase in partial pressure of arterial CO2 stimulates ventilation.
2. Decrease in arterial CO2 inhibits ventilation.
Inspiratory stridor
Lung Sounds
a harsh sound from laryngeal or tracheal edema while trying to inhale.
Productive cough
Lung Sounds
coughing up mucus and swallowing it; need not be expectorated for a cough to be considered productive.
