respiratory function pt. 2 (1) Flashcards
what is the old term for brief resolved unexplained event (BRUE)
aparent life-threatening event
at what ages do BRUEs occur?
infant-1 yr
symptoms of BRUE
- pale or cyanotic
- irregular, dec, absent breathing
- changes in tone
- altered responses
how long does a BRUE last
less than a minute, self resolving
when is extensive testing reccomended for BRUE?
only for…
* high risk infants
* suspected abuse
* suspected infection
* recurrent episodes of fam hisotry of genetic or metabolic cionditions
what would the priority be with the family if an ambulance brought in a 3 m.o. who died in the crib?
- family support
- answer questions
- allow fam time with the baby
what is sudden death, during sleep, of an infant less than a year old
SIDS
how is SIDS explained after autopsy/death scene investigation?
unexplained
what ages is SIDS most common
2-4 months
leading cause of infant mortality
SIDS
clinical manifestations of SIDS
- evidence of a struggle or change in position (prone)
- presence of frothy blood tinged secretions from the mouth and nares
do parents notice disturbance or cry when a baby dies of SIDS
no
what is possible etiology and pathophysiology of SIDS
- abnormality of medulla oblongata with serotonin
- may interfere with brainstem mediated protective responses during sleep
why can prone sleeping cause SIDS
cerebral oxygenation depressed
which of the following are infant risk factors for SIDS?
a) meternal smoking, alcohol or substane use
b) preterm or low birth weight
c) native maerican of black infants at higher risk
d) females at higher risk
a,b,c (males more at risk)
which of the following are environmental factors of SIDS
a) sleeping prone or side-lying
b) soft bedding
c) sleeping supine
d) overheating
e) bed sharing
f) second hand smoke
all except sleeping supine!
who/when was the back to sleep reccomendation initiated?
american acedemy of pediatrics in 1992
when was back to sleep recommendation revised and what did it say
only sleep on back!
what did the back to sleep recommendation initially say?
sleep on back or side
which campaign involved prevention of all sleep related causes of death?
safe to sleep campaign (2012)
what were the 2 main AAP recommendations for safe sleep
- should sleep in same room, not bed as mom ideally for a year, at least 6 m.o.
- mothers and fathers should do skin/skin with newborns
what is molding of the head by continued pressure against a surface
plagiocephaly
how is plagiocephaly resolved?
rotating side of head that infant sleeps on, place the infant prone while awake and supervised (tummy time)
what is due to suffocation in pillow, bumpers, or blankets
suddent unexpected infant death (NOT SIDS)
how to prevent sudden unexoected infant death?
no pillows, bumpers, blankets, animals
sleep alone
no swaddle after 2 mo
a 6 mo old was admitted with dyspnea, hoarse barky cough, and insp. stridor.
what is diagnosis?
acute laryngotracheobronchitis (croup)
what is a viral invasion of upper airway and extneds through larynx, trachea, and bronchi. includes inflammation of mucosal lining of larynx/trachea: narrowing of airway
acute laryngotracheobronchitis (croup)
what is the most common age group and oeak age group for laryngotracheobrinchitis (croup)
- most common under 6 y.o.
- peaks between 7-36 months
manifestations of laryngotracheobronchitis (croup)
fever, tachypnea, tachycardia, barky cough!, hoarse voice, dyspnea, insp. stridor, possible retractions
what is the priority intervention with laryngotracheobronchitis?
do as little as possible! (touch agitates child, stridor and irritation worsens)
assessment includes RR 76, HR 180, pale pink color, severe insp stridor, frequent harsh barky cough, moderate intercostal retractions, POX 93
what is the plan of care?
what is priority?
call HCP for nebulized epinephrine (laryngotracheobronchitis)
what are alpha adrenergic effects?
vasoconstriction and decrease edema
what are beta adrenergic effects
bronchodialtor
when and why is dexamethasone given?
laryngotracheobronchitis (croup)
given in ED, anti-inflamamtory corticosteroid, decreases edema
what is the duration adn peak of dexamethasone
duration= 72 hours
peak= 1-2 hours
when do most children go home from the hospital after laryngitracheobroncitis (croup)?
24-72 hr
how long does laryngotracheobronchitis last?
several days to weeks
how can mild croup be managed at home?
- take child outside to breathe in cold air (wear jacket) (decreases edema)
- maintain hydration and I&O
- calm the parents by educating
- teach s/sx of resp distress
can epiglottitis be life threatening?
true
how can epiglottitis be life threatening?
inflammation of upper airway, edema is rapid (mins/hrs) can obstruct
non resp symptoms of epiglottitis
muffled voice, dysphagia, drooling
resp symptoms of epiglottitis
dyspnea, insp stridor, high fever, high RR
clinical therapy of epiglottitis
immediate intubation and antibiotics
when is a child with epiglottitis extubated
1-2 days
what is a child sent home with after being extubated for epiglottitis
full course of antibiotics
if youre working in february, a large percent of infants have the same resp diagnosis, what is it? does it occur every year?
bronchiolitis, annual outbreak
when does bronchiolitis anually outbreak?
octiber-march
what is the main cause of bronchiolitis?
RSV, other viruses too
how does bronchiolitis airway obstruction occur
virus invades bronchi and bronchioles, cells die inside, fuse and collect cells, obstructing bronchioles, airway swells
describe ibstruction in bronchiolitis
air allowed in but mucus and edema does not allow air out, air trapping and hyperinflation of alveoli
which symptoms are in bronchiolitis?
1. wheezing
2. stridor
3. dry cough
4. nasal drainage
5. retractions
6. poor feeding
7. dyspnea, tachypnea, tachycardia
1, 4,5,6,7
what is always a characteristic of brinchiolitis?
moist cough
describe when a child is hospitalized for bronchiolitis?
- most not hospitalized
- if they have a history of congenital heart disease, lung disease, BPD, prematurity, congenital disorder, young age
how is bronchiolitis diagnosed?
history and physical, nasal swab for isolation
what is not recommended to diagnose bronchiolitis and why?
CXR, nonspecific lung inflammation
acetaminophen vs. ibuprofen use
acetaminophen at any age, ibuprofen only if older than 6 mo old
what meds are used for brinchiolitis?
nebulized hypertonic saline!!!
antipyretics
corticosteroids
bronchodilators (not as much)
why is nebulized hypertonic saline used?
- softens secretions, induce cough, reduces edema, dislodges material
- can lead to shorter hospitalization
what is an IG1 antibody that neutralizes and inhibits RSV replication and reduces hospitalization
synagis (palivizumab)
how is synagis given?
IM, use emla cream to numb
when is the first synagis dose given and how is it given after that
first dose prior to start of RSV season and then monthly IM until season finishes (october through march)
how is bronchiolitis transmitted?
direct contact with secretions
how long does brinchilitis last on surfaces and on stethoscopes?
12h surfaces, 6h steth
what is the main major source of transmission for bronchiolitis, and how long does it live on that surface
hands, 30 min
what is the incubation period for bronchiolitis and how long does it take to shed it
incubation 2-8 days, shed in 3-8 days
how long does it take for bronchiolitis symptoms to abate?
24-72 hours, full resolution may take weeks
which of the following are symptoms of pneumonia?
a) high fever
b) crackles in effected lung
c) dyspnea and tachycardia
d) abdominal pain
e) diarrhea
all
what is a rating scale based on behavior, cardiovascular status, and resp status. the score determines intervention
pediatric early warning scale
which of the following are risk factors for SIDS
1. prone sleeping
2. maternal smoking
3. breast feeding
4. bed sharing
5. use of pacifier
6. premature infant
1,2,4,6
what is the cause of SIDS?
suffocation
laryngotracheobronchitis (croup) has which of the following symptoms?
a) bilateral inspiratory and expiratory wheezing
b) insp stridor and hoarse barky cough
c) crackles in effected lung
d) copious nasal secretions
b
what is the benefit of taking a child outside to breathe in cold air when they have croup?
decrease edema in the airway
what isolation is used for bronchiolitis?
contact isolation
