T2: Respiratory/Renal/GU/Abuse/Pain/Suicide Flashcards
When do infants begin to mouth breath more?
4-6 weeks
What are some physiological differences of the pediatric respiratory system?
- Ribs horizontal, uses diaphragm in increase lung capacity.
- Abdominal breathers (so they struggle if have abdominal distention.
- Airway more flexible and floppy, it’s easy to occlude with poor position (like kinking a straw).
- Shape/location of airway differs; more like a funnel and more anterior (funnel shape makes objects more lodged-harder to cough out).
- Bronchus more vertical = foreign body obstruction
- More barrel chested, tongue proportionally larger.
- Shorter distance for organisms to travel down.
- Their muscles are less functional and they are less capable of compensation for edema/trauma/spasm.
- They have few alveoli (they have 9x as many by 12)
- Compliance is high in infants, but less recoil
What is the respiratory rate for infants?
40-60/min
Resp rate for a 1 year old?
20-40/min
Resp rate for 2-4 year old?
20-30/min
Resp rate for 5-10 years:
20-25/min
Resp rate for 10-15 years:
17-22/min
Resp rate for 15+?
15-20/min
What is respiratory “compliance?”
The lung’s ability to stretch and expand/distend. The more compliance, the more like a rubber-band. Resistance depends on airway size and compliance; if either increase = increase work to breath.
What are the stages of pediatric sinus development?
Infancy = maxillary and ethmoid
3-5 years = sphenoid
6-10 years = frontal
First 5 years of immune development:
Infants less than 3 months have maternal antibodies.
3-6 months are between antibodies
Toddlers and preschoolers have lots of exposure.
Older than 5 years, infections decrease except for strep and mycoplasmas.
What is the most common cause of conjunctivitis?
Bacteria.
In infants: recurrent may be a sign of tear duct obstruction.
Wipe from inner to outer, warm moist compress to remove crusts, refrain from rubbing. WASH HANDS.
Common signs and symptoms to look for in assessment for respiratory disorder:
- Notice work of breathing
- Rate for one minute, symmetry, depth, effort, use of accessory muscles…
** Tachypnea is often the FIRST sign of a problem.
- Retractions: (1) Suprasternal “tug” (2) Intercostal (3) Substernal (4) Subcostal (5) Claviclular
- Nasal flaring
- Head bobbing (inhale=head up, exhale=head down (from exhaustion).
- Color changes: circumoral cyanosis
- Noisy breathing/Grunting/Cough
- Secretions = note color and consistancy
- Long-term clues (clubbing/barrel chest)
- Assess before and after each treatment, so you can compare the two.
- Do NOT depend on O2 sats… not always indicative. Ex: Anemic pt may have great O2 sat score but low over all O2 circulating.
Why no aspirin if they have a virus?
Reye’s Syndrome;
Reye’s syndrome is a rare but serious condition that causes swelling in the liver and brain. Signs and symptoms such as confusion, seizures and loss of consciousness require emergency treatment.
The need for increasing amounts of medicine/drug to get the same effect:
Tolerance
Withdrawal is expected and has the need to taper the med to avoid withdrawal:
Physical dependency
The dysfunctional loss of control and has a preoccupation with getting the drug:
Addiction.
They’ll do anything to get the drug.
This infection of the middle ear presents with a bright red tympanic membrane:
AOM Acute Otitis Media
Bulging, no light reflex, no visible landmarks, child is symptomatic with pain, irritability, ear pulling, maybe fever, not wanting to lie down (increased pressure), anorexia, vomiting.
Complications: TM rupture (abrupt decrease in pain) Scarred TM - affects hearing Mastoiditis (infection in mastoid bone) Hearing loss Tinnitus or Vertigo
What is the treatment for acute otits media?
WASP (wait and see protocol) for antiobiotics
Analgesics
Antipyretics
Warmth
- Recheck: stress follow-up
- Teach preventative immunizations (Prevnar and Hib)
What are the causes for ear infections?
- Streptococcus pseumonia is #1
- Haemophilus influenzae
- Moraxella catarrhalis
Due to short, horizontal, straight and flexible, Eustachian tubes. The flexible cartilage opens at inappropriate times. The short, horizontal, straight tubes are easier to invade, the child lies down more, bottle propping, adenoid obstruction, and if they are around smokers =will exacerbate the risk.
What is OME and how is it different than AOM?
OME is Otitis Media with Effusion, or serous otitis media.
- Inflammation of the middle ear in which FLUID collects (“glue ear”).
Manifestations: TM is dull Visible yellowish fluid Obscured landmarks Child can be non-symptomatic. Possible intermittent pain.
- Can be acute or chronic (>3 months)
- Decreased mobility of TM reduces hearing.
- Feeling of fullness in the affected ear.
Treatment of OME:
Antibiotics long term (for season)
Mechanical drainage with needle or tubes (keep ears dry!!)
EBP: studies show that if delay tube insertion, children are no further behind at 3 and at 6 (behavior, speech, intelligence).
TEACH:
Notify Dr. if SandS of earache occur.
Avoid smoking around child
Feed upright and NO propped bottles in bed.
What does “flat tympanogram” mean?
It’s an expected finding for middle ear effusion.
What respiratory infection is on the rise and requires airborne isolation precautions?
TB
PED’s? to test the risk of the patient. Ex: if patient has HIV, decrease enduration they may have. They don’t have to have the same size of enduration as you (a healthy person) would have.
What causes pharyngitis/tonsillitis?
Signs and Symptoms?
10% are caused by strep
80-90% caused by viruses.
- General malaise
- Fever
- Sore throat
- Difficulty swallowing
- Cervical node enlargement
- Referred pain to ear
- HA
- Abdominal pain
- Obstructed airway from enlarged tonsils.
Complications:
Acute rheumatic fever
Acute glomerular nephritis
– These are from the group A beta hemolytic strep from strep pharyngitis.
How do we treat Pharyngitis/Tonsillitis/Adenoiditis?
If bacterial = antibiotics
If viral = symptomatic care
Frequent recurrent strep infection = TandA surgery.
Other complications from this: > Scarlet fever aka Scarlatina rash-strep pharyngitis > Otitis media with adenoiditis > Peritonsillar abscess > Continued hypertrophy > Difficulty eating/breathing
