Respiratory part 2 Flashcards
Inflammation of the lung parenchyma is called what
Pneumonia
Viruses that are known to cause pneumonia?
How will we do treatment for viral?
adenoviruses, influenza, RSV
Symptom support
Bacteria that are known to cause pneumonia?
strep, staph, enteric bacilli
What is the good thing about bacteria having specific ages whey they occur?
You can figure out the cause due to child’s age & get started on the antibiotics
what age has pneumococcal or hib
3 months - 5 yrs
what age has mycoplasma pneumonia
5 - 12 years
Set of pneumonia symptoms
Child will probably have a fever and have a cough.
They will also tachypnea (rapid breathing) & you may see that their skin shows cyanosis.
To compensate they may do nasal flaring or retractions.
How is pneumonia diagnosed?
Chest Xray & sputum culture
Why is it important to make sure pneumonia patients are hydrated?
There will be consolidation and increased mucus therefore we need hydration to try to clear those & all to help the body since it is in a feverish state.
How often should we assess respiratory status and oxygenetion?
Frequently! Very important in children bc they can go into resp distress much faster than adults. We need to make sure gas exchange is able to happen.
Ways to assess their hydration?
Check cap refill
Check their input & output
Whose job is it to try and watch for the bacterial cultures from lab for a pneumonia patient?
The nurse is one person who should be watching for them just because it can speed things along & pt can have the focused antibiotics sooner.
Rationale for why we lift HOB for pneumonia /respiratory patients? Why
Takes pressure off lungs & opens the airways - and thus helps gas exchange
What is splinting again? Which age group can be taught this?
Splinting is when you hold a pillow to your chest when coughing.
Older children can probably do this.
What type of environment should a pneumonia patient be in? And why?
A quiet environment. A feverish respiratory patient has to use a lot of energy - and so the quietness can help them reserve. it.
What should we educate families on with penumonia?
Tell them everything you can really. Helps with compliance.
Sti infection that can cause Pneumonia? How?
Chlamyida can be passed to the infant through vaginal canal during birth.
Symptom of chlamydia pneumonia in infants?
And for how long?
Persistent cough causing an altered respiratory status like tachypnea.
No fever
With chlamydia, the infection can remain delayed & can show up 4-5 months later.
Chlamyida Pneumonia treatment for infants?
Erythromycin
Will an infant have to be hospitalized for chlaymdia pneumonia?
No they can just treat with erythromycin at home but if they really can’t breath then yes.
Pertussis is also known as
whooping cough due to nature of cough
What bacteria causes pertussis?
Bordatella pertusis
How is pertussis spread?
Direct contact or droplet
Can even stay on contaminated objects
Highly contagious!!! We want to minimize spread.
Seasons of pertussis?
How long does pertussis persist?
spring & summer
4-6 weeks
How is pertussis treated?
With antibiotics - even for those who’ve only been in contact with someone.
Supportive tx as well.
T/F
Infants can be given the pertussis T-dap vaccine to prevent disease state
False.
Infants are too young & their immune system is too immature BUT a pregnant mom can get this.
Describe the catarrhal stage of pertussis
First stage that has a mild cough & low grade fever (but this is still not a good thing in infants).
Paroxysmal stage of pertusis.
Second stage with increased cough that sounds like a whooping noise. Scary because the cough is unstoppable & they may not be able to breath.
At this point it’s been 2-3 weeks.
Convalescent stage of pertusis
Third stage of pertussis where symptoms begin to diminish
What are pertussis symptoms like in an infant that is greater than 6 months?
Apnea is more common in older infants instead of a cough
Which strains of the flu are more common
Flu A & B
When are flu viruses more common
Winter seasons
Oct - March usually
How do they predict the type of flu vaccine to produce for the season?
What is the percentage rate of immunity like for the flu?
Uses an estimation of prominent strains for that upcoming season
The percentage rate is not 100% (all you need to know).
Influenza symptoms
Infant will have a fever, chills, and body aches.
They may also have a cough.
Why is hydration so important when taking care of sick children & even specifically flu patients?
Tip to get fluids into the child?
Hydration is important because they are having to use up energy due to being feverish, coughing, and chills.
May need to educate parents on popsicles or other tricks.
Influenza medication that we can give
Tylenol or Advil to help the fever
Antipyretic as well.
How soon do you need to begin antiviral influenza drugs?
Must be started 24-48 hrs before symptoms for them to reduce the symptoms & length of illness (by 24-36 hrs).
But it won’t make it just go away.
Ex: tamiflu (tastes horrible tho)
How is it that influenza is a problem with pneumonia?
Why must we keep them hydrated?
Influenza can most definitely develop into secondary pneumonia. And from there, bacteria can set up and dwell to make things much worse.
Keep them hydrated so secretions don’t have the chance to breed more bacteria
Antiviral that is ok for 2 weeks & older patients
Which strains does this one treat?
And is taken 2x a day for how many days?
Tamiflu
A&B
5 days total
Antiviral for flu for kids older than 12?
Take 1 tablet which route?
Xofluza
PO
Antiviral for flu for kids older than 7?
Which strains is it?
How is it given?
Relenza
A&B
Inhaled twice a day for 5 days
Antiviral that is for a child over 2 years?
Which strains does it treat?
And what is the route?
Rapivab
Strains A&B
Injectable route for a single dose
How old can a flu vaccine be given to an infant?
How many doses?
6 months & will be repeated every year
anyone under age of 9 needs 2 doses given a month apart the FIRST TIME they ever receive the vaccine. After that, once a year.
Are there any medical reasons to not give vaccine?
What about Guillian-Barre?
Not really. They have egg free vaccines now for those who were concerned about the egg component.
Some may not do it for Guillan-Barree BUT most doctors understand risk vs reward and do it anyways.
What is asthma considered?
How is it more of a concern in children as opposed to adults?
A chronic inflammatory disease also known as reactive airway disease
Dangerous in children bc their narrow airway & immature anatomy puts them more at risk.
7 million kids are affected by it
Are there certain things that trigger an asthma or reactive airway attack?
Lots of things.
Pollen, smoke, temp change, anxiety, drugs, dander, dust
What exactly happens to the airway in asthma?
Their airway muscles will tighten & narrow. Then tissue swells and secretions increase occluding the airway which can traps air to where they can’t exhale correctly and therefore wheeze.
What tools can asthma be diagnosed with & managed?
Standardized Questions - helps identify they have asthma or maybe trigger
Spirometry - measures breathing to see if it is normal
Peak expiratory flow measurement - a daily breathing measurement to see how much they can move today (like we do vitals) & adjust days treatment based off that
Peak expiratory flow management colors:
green, yellow, red meaning?
Green - do the normal routine
yellow - caution should be used
red - acute exacerbation may be approaching - need short acting bronchodilator. Notify PCP if no improvement
What is a main goal when treating asthma?
Care for chronic symptoms with long term meds as much as possible to help them maintain their functioning & activity
Why should an asthma pt have a good relationship with provider?
So the provider knows their routine to give instruction.
BUT a written plan should always be provided. Don’t want to rely on verbal instruction or emergency call to PCP
Can triggers for asthma be avoided?
Yes asthma environment can somewhat be manipulated to limit exacerbations.
How are meds chosen for asthma patient?
Based off patient needs really but we want as few as possible while still helping
Types of asthma med treatments
Long term control or prevention
Short acting or rescue
anticholinrgics
corticosteroids
Can be used in combo with one another
Short acting Bronchodilators that are rescue meds?
Albuterol & Levalbuterol
They relax muscles to open only.
Inhaled corticosteroids used for inflammation treatment?
When using these what do we need to educate patients about?
Beclomethosone, budesonide, fluticasone, & mometasone
Educate patients that they need to rinse their mouths out after using due to oral thrush risk.
Long acting beta agonists that are used instead of short acting to improve lung functioning?
Salmeterol, formoterol, terbutaline
But also in combo: Advair and Symbicort
Short & Long acting beta agonist side effects
Decreased diastolic blood pressure & arterial pressure
Tachycardia
Jitters
Myocardial ischemia if dose is too high
Terbutaline but be aware of hypokalemia risk
Type of drug class that is Iprapropium Bromide?
Side effects?
An anticholinergic
DRY drug but it blocks cholinergic spasms.
Can increase CNS tho bc it is a stimulant
What is an asthma inhaler spacer?
Helps everyone get a full dose of medication. Adults & kids can both need this.
What is Nebulizer treatment?
Put liquid med into gas form to be inhaled
What is Heliox?
Combo of helium and oxygen to help o2 move easier
What if allergies are the asthma trigger?
Control allergen
Can do allergy shots
Can do sublingual immunotherapy or under tongue
Status Asthmaticus
How to treat it?
Emergency situation where the medication does not help the narrowing airway
Need to act fast and get them an established airway and oxygen. Maintenance fluids will be needed. Meds like epinephrine
Cystic Fibrosis affects who?
Disease of children rt short lifespan of late 30’s that recessive
What causes increased mucus in cystic fibrosis
Increase mucus rt exocrine gland dysfunction that blocks airways & stop food from being absorbed.
Sign infant may have cystic fibrosis
meconium illeus but symptoms dont always show.
Could be resp issues more
Will cystic fibrosis patient be overweight or underweight?
probably underweight - may even be considered a failure to thrive
Will pulmonary infections be common in cystic fibrosis kids? why?
Infections will be frequent due to plugging from mucus
What will cystic fibrosis stool look like
Bulky & loose due to no pancreatic enzymes
What vitamins can you not absorb w cyctic fibrosis?
A, D, E, K
Will puberty have normal onset in female cystic fibrosis patients
No it will be delayed. Affects conception due to cervical mucus
What will fetility be like for men cyctic fibrosis patients?
Will often be sterile by the time they’re adults due to their vas deferens becoming blocked
What things can help clear lungs in cystic fibrosis?
Chest physiotherapy
Postural drainage
percussion vests
fluids to thin secretions
aerosolized bronchodilators
ibuprofen
What are cystic fibrosis patients prone to having infection wise?
Psuedonomas & Fungal infections
What can cystic fibrosis patients develop over time?
COPD
How to cystic fibrosis patients eat?
what should their diet be like?
They take pancreatic enzymes before eating so that they can digest and absorb nutrients. Including water miscible forms of adek.
Will need to eat high protein & high calorie diet. Even extra sodium
What should we never forget about cystic fibrosis care in kids?
Psychological aspects of knowing the lifespan is shorter
How is it diabetes and cystic fibrosis can be related?
What about osteoporosis?
The pancreatic dysfunction of cystic fibrosis can cause diabetes. Very common.
Steroid use can hurt bone health and lead to osteoporosis.
Can IV care be taken home with cystic fibrosis
yes
One of the most important things a family will need when caring for a child with cystic fibrosis?
support bc they have to live with anticipating grief
Why might genetic counseling be recommended to even siblings?
They carry the odds too most likely as carriers
What is sudden infant death?
SIDS which is the 3rd leading cause of infant death
Sort of unexplainable apart from the risk factors. They say it has more to do with preexisting conditions tho. Could be neuro
What age does sudden infant death happen to
2-3 months but most cases occur before 6 months old
what season does SID occur
winter or cold months
Population where SID occurs
african american, native american, alaskan native
SID: how should you lay the baby down to sleep
Put the baby on their back - NOT on their side
SID: what type of mattress do you need?
a firm one. not soft
SID: is smoking around a baby acceptable
NOOO never actually
SID: is it ok to sleep with the baby in your bed
NOO
SID: how can a pacifier help
helps build muscles
SID: when its cold , should you turn the heater all the way up
noooo
