The child w/ respiratory dysfxn Flashcards

Question

Otitis media: infant feeding methods

Answer 1

* Breastfed infants have less OM than bottle-fed infants * Immunoglobulin A * Position in breastfeeding may decrease reflex in Eustachian tubes

Answer 2

* If over age 6 month --> “watchful waiting” up to 72 hours for spontaneous resolution * Antibiotics if less than 2 years with persistent acute symptoms of fever & severe ear pain * Antibiotics if less than 6 months * Topical relief heat or cold or benzocaine drops (Rx)

Answer 3

Prevention: pneumococcal vaccine, breastfeeding, preventing exposure to tobacco smoke

Answer 4

* “Swimmer’s ear” * Infections of the external ear canal * Etiology: Staphylococcus or Corynebacterium * Acute Otitis Externa (AOE)

Answer 5

● First-line antibiotics: Amoxicillin PO 80 to 90 mg/kg/day, divided twice daily ×10 days ● Second-line antibiotics: Amoxicillin-clavulanate (Augmentin), azithromycin, Cephalosporins IM (If highly resistant organism or noncompliant with oral doses, IM is painful --> Reconstitute with 1% lidocaine, w/o EPI, to decrease pain of injection) ● Analgesic–antipyretic drugs: Acetaminophen, Ibuprofen (only if > 6 m) ● No steroids, antihistamines, decongestants, antibiotic ear drops

Answer 6

● Serious obstructive, inflammatory process ● Clinical manifestations: Abrupt onset, Sore throat, pain, tripod positioning, retractions, Inspiratory stridor, mild hypoxia, distress, Fever ● Therapeutic mgmt: Potential for complete respiratory obstruction ● Nursing mgmt: position for comfort, no tongue blade, keep suction at bedside, keep emergency respiratory equipment at bedside, decrease anxiety ● Prevention: Hib vaccine

Answer 7

● Characterized by hoarseness, “barking” cough, inspiratory stridor & varying degrees of respiratory distress ● Affect larynx, trachea & bronchi ● Described by anatomic area primarily affected: Epiglottitis (or supraglottitis), laryngitis, laryngotracheobronchitis (LTB) & tracheitis

Answer 8

● More common in older children & adolescents ● Usually caused by virus ● Chief complaint --> hoarseness ● Generally self-limiting & without long-term sequelae ● Acute laryngotracheobronchitis (LTB): Most common type of croup experienced by children admitted for hospitalization, Primarily affects children 6 to 36 months old

Answer 9

● Also called spasmodic croup, midnight croup ● Paroxysmal attacks of laryngeal obstruction ● Occurs chiefly at night ● Inflammation: mild or absent ● Most often affects children ages 1 through 3

Answer 10

● Infection of the mucosa of the upper trachea ● Distinct entity, features of croup & epiglottitis in older children (5 to 7 years) ● s/s: Thick, purulent secretions, Respiratory distress & stridor, May develop life-threatening obstruction or respiratory failure ● Mgmt: Humidified O2, Antipyretics, abx, intubation

Answer 11

● Considered the “reactive” portion of the lower respiratory tract ● Includes bronchi and bronchioles ● Cartilaginous support not fully developed until adolescence ● Constriction of airways

Answer 12

● AKA tracheobronchitis ● Inflammation of the large airways, frequently associated with URIs: Persistent dry, hacking, non-productive cough ● Usually viral ● Mild and self-limiting

Answer 13

● Most often caused by respiratory syncytial virus (RSV) ● Primarily affects the bronchi and bronchioles: Occurs at bronchiolar level, Intraluminal obstruction from swelling leads to hyperinflation, obstructive emphysema, and areas of atelectasis ● Initially, URI symptoms which progress to increased WOB and hypoxia ● Infants are typically hospitalized ● Prevention of RSV: prophylaxis (palivizumab [Synagis])

Answer 14

-Copious secretions, tachypnea, apnea, cyanosis -Monitor O2 and respiratory status -Dx: PCR nasal swab -Tx: deep suctioning before eating, fluids, antipyretics -Droplet precautions

Answer 15

-Airborne precautions -Tx: veklury (remdesivir),

Answer 16

-Post-covid syndrome --> hyperinflammatory syndrome -Fluids, O2, BP meds, abx, blood clot meds

Answer 17

● Causative organism varies greatly by age category: Young children at risk for aspiration PNA ● The most useful classification is etiologic agent: Viral, Bacterial, Mycoplasmal, foreign substances ● Hospitalization for O2 therapy, IV hydration, and IVAB may be necessary if s/s of respiratory distress: tachypnea, retractions, nasal flaring, low SaO2 ● s/s: Fever, malaise, rapid respiration, cough, Chest or abdomen pain, nausea ● Dx: X-ray --> Pulmonary infiltrates, Lobar consolidation, Pleural effusion ● Lab tests: Cultures --> sputum, blood cultures, lung aspiration, & biopsy; WBC ● Prevention: PCV vaccine

Answer 18

● Most common chronic respiratory illness of childhood -Chronic inflammatory disorder of the airways: Can lead to airway remodeling ● Recurring episodic symptoms: Wheezing, Breathlessness,Chest tightness, Cough (especially at night), Limited air flow or obstruction that reverses spontaneously or w/ tx, Bronchial hyperresponsiveness

Answer 19

● Occurs in the immediate neonatal period ● Infected mother transmits to fetus via ascending infection or during delivery ● Multiple organisms ● Infant is afebrile with cough, tachypnea, rales ● X-ray ● Abx

Answer 20

● Risk for child with feeding difficulties ● Types: lipoid, inhalation, hydrocarbon ● Mgmt: Prevention of aspiration, Feeding techniques, positioning ● Avoid these aspiration risks: Oily nose drops, petroleum distillates, Solvents, Talcum powder

Answer 21

● Severity of lung injury depends on ingested substance ● Hydrocarbons: Petroleum distillates often contain heavy metals or other toxic chemicals, Often found in home or garage, Severe effect even with small amount ingested, Spread over surface of tissues & interfere with gas exchange

Answer 22

● Coughing, vomiting, aspiration ● CNS: agitation, restlessness, confusion, drowsiness, and coma ● Elevated body temperature (37.8° to 40° C) ● Dyspnea, cyanosis, tachycardia, tachypnea, nasal flaring, retractions ● Hemoptysis, pulmonary edema, severe cyanosis & death within 24 hrs of aspiration

Answer 23

-Types: cardiogenic (hydrostatic hemodynamic), noncardiogenic (factors that increase pulmonary capillary permeability) -Tx: PEEP, pulse ox, ventilation, intubation

Answer 24

● Continuum of symptoms of ALI, with ARDS the most severe form ● Characterized as respiratory distress and hypoxia within 72 hours after serious injury or surgery in person w/ previously normal lungs -ICU, high mortality ● Animation: Bag Ventilation, dx criteria are based on the Berlin definition of ARDS ● Mgmt: oxygenation, pulmonary perfusion, tx of infection, adequate cardiac output, intubation

Answer 25

● History of exposure to flames whether burns are present ● Soot around nose or in sputum, singed nasal hairs, or mucosal burns of the nose, lips, mouth, or throat ● Hoarse voice & cough -Swollen neck, burned hair -FLASH (facial skin, lips, airway, sputum, hair ● Increased inspiratory & expiratory stridor ● Tachypnea, tachycardia, abnormal breath sounds

Answer 26

● Early carbon monoxide poisoning, airway obstruction & pulmonary edema ● ARDS 24 to 48 hours after injury ● Late complications: bronchopneumonia & pulmonary emboli ● Airway compromise from eschar after a severe burn

Answer 27

● Heat injury: Thermal injury to upper respiratory tract, Reflex glottis closure ● Local chemical Injury: Insoluble gases in the lower respiratory tract ● Systemic injury: CO causing tissue hypoxia ● Mgmt: 100% O2, bronchodilators

Answer 28

● Children exposed to passive or environmental smoke ● Legislation to prevent smoking in public places ● Use of e-cigs

Answer 29

-Occur repeatedly -Seasonal -No fever -Itching in eyes and nose -Trigger constant sneezing -Accompanied by eye and ear problems

Answer 30

● Chronic inflammatory disorder of airways ● Bronchial hyperresponsiveness ● Episodic ● Limited airflow or obstruction that reverses spontaneously or w/ treatment ● Atopy (genetic) ● s/s: Dyspnea, Wheeze, Cough ● Dx: PFTs most accurate, peak expiratory flow meter ● Nursing mgmt: education plan, severity classification, acute asthma care, avoid allergens, relieve bronchospasm, inhalers ● Risks: mother < 20 y, smoking on maternal side, African American ethnicity, allergic genes on chromosome 5, lack of access to medical care, prior life-threatening attacks

Answer 31

● Types: Recurrent wheezing usually precipitated by a viral respiratory tract infection (e.g. RSV), Chronic asthma associated with allergy persisting into later childhood and often adulthood, Associated w/ girls who develop obesity and early-onset puberty by 11 y, Cough-variant asthma ● Categories: Intermittent, mild persistent, moderate persistent, and severe persistent

Answer 32

● Stage I—mild, intermittent asthma ● Stage II—mild, persistent asthma ● Stage III—moderate, persistent asthma ● Stage IV—severe, persistent asthma

Answer 33

● Long-term control meds: Inhaled corticosteroids, cromolyn sodium and nedocromil, long-acting β2-agonists, methylxanthines, leukotriene modifiers (Advair or Pulmicort), theophylline, leukotriene modifiers, Mg sulfate, oral steroids ● Quick-relief (“rescue”) medications: Short-acting β2-agonists, anticholinergics, systemic corticosteroids AKA bronchodilators, EPI-pen

Answer 34

● Inhaled for most medications: MDI with spacer, Nebulizer (Albuterol tx) ● Generally less effective in treating asthma: Oral, IV

Answer 35

-Breathing exercises and physical therapy -Chest physiotherapy (CPT) -Hyposensitization

Answer 36

● Calm nursing presence ● Monitor with pulse oximetry ● Assess breath sounds ● Allow older children to sit up if they are more comfortable in that position ● Safety precautions ● Allow parents to remain with children: Try to decrease parental stress

Answer 37

● Remains sitting upright, refuses to lie down ● Sudden agitation ● Agitated child who suddenly becomes quiet ● Diaphoresis ● Pale

Answer 38

● Life threatening episode of airway obstruction that is often unresponsive to common treatments: Can result in respiratory failure and death ● Medical Emergency!: Lack of air movement in lungs, Be prepared for intubation, Monitor SaO2 and ABGs carefully ● Humidified O2, continuous bronchodilator nebulizer tx, corticosteroid, Mg sulfate, sit the child up ● Emergency tx: EPI 0.01 mL/kg subq (max is 0.3 mL), IV Mg sulfate, IV ketamine, IV corticosteroids, heliox (breathing gas mix of He and O2)

Answer 39

● Autosomal recessive genetic disease ● Abnormal gene is located on the long arm of chromosome 7 ● 95% known cases occur in Caucasians ● Most common lethal genetic illness among Caucasian children ● Approximately 3% of US Caucasian population are symptom-free carriers

Answer 40

● Characterized by several unrelated clinical features: Respiratory system, GI system (small intestine, pancreas, bile ducts, Growth patterns), Reproductive system and skin ● Increased viscosity of mucous gland secretion: Results in mechanical obstruction, Thick, inspissated mucoprotein accumulates, dilates, precipitates, coagulates to form concretions in glands and ducts, Respiratory tract and pancreas are predominantly affected

Answer 41

● Early infancy screening ● DNA testing (autosomal recessive) ● Sweat chloride test (garbage bag sweatsuit, test level of Cl in sweat, 3x normal child) ● Chest radiography ● Pulmonary function tests (PFTs) ● Stool fat (fatty, stinky stools) and/or enzyme analysis ● History and physical exam

Answer 42

● Meconium ileus at birth ● Prolapse of the rectum ● Distal intestinal obstruction syndrome ● Pancreatic enzyme deficiency (d/t pancreatic fibrosis) steatorrhea ● Excretion of undigested food in stool: Stool is bulky, frothy, and foul smelling ● Failure to thrive/growth failure/wasting of tissues, hx of repeated respiratory infections ● Sweat gland dysfunction ● Increased weight loss despite increased appetite ● Gradual respiratory deterioration ● Wheezing respiration; dry, nonproductive cough ● Generalized obstructive emphysema ● Patchy atelectasis ● Cyanosis ● Clubbing of fingers and toes ● Repeated bouts of bronchitis and pneumonia ● Stasis of mucus increases the risk for life-threatening respiratory infections ● Delayed puberty in females ● Sterility in males ● Parents report that children taste “salty” ● Dehydration ● Hyponatremic or hypochloremic alkalosis

Answer 43

● Viscous secretions are difficult to expectorate and obstruct bronchi and bronchioles: Cause atelectasis and hyperinflation, Stagnant mucus leads to destruction of lung tissue, Stagnant mucus provides a favorable environment for bacteria growth ● Mgmt: Improving ventilation, removing mucopurulent secretions, and administering antimicrobial agents

Answer 44

● Gradual progression follows chronic infection ● Bronchial epithelium is destroyed ● Infection spreads to peribronchial tissues, weakening bronchial walls ● Peribronchial fibrosis ● Decreased O2/CO2 exchange ● Chronic hypoxemia causes contraction and hypertrophy of muscle fibers in pulmonary arteries and arterioles ● Pulmonary hypertension ● Cor pulmonale (RHF, enlarged RV d/t high BP in lungs) ● Pneumothorax ● Hemoptysis

Answer 45

● Thick secretions block ducts → cystic dilation → degeneration → diffuse fibrosis ● Prevents pancreatic enzymes from reaching duodenum -Meconium ileus --> meconium is abnormally thick and sticky ● Impaired digestion/absorption of fat → steatorrhea ● Impaired digestion/absorption of protein → azotorrhea ● Endocrine function of pancreas initially stays unchanged ● Eventually pancreatic fibrosis occurs; may result in diabetes mellitus ● Focal biliary obstruction results in multilobular biliary cirrhosis ● Impaired salivation

Answer 46

● Airway clearance therapies (ACTs): Chest PT, PEP, Active-cycle-of-breathing, forced expiration, mechanical vest ● Bronchodilator medication prior to ACT ● Dornase alfa (Pulmozyme): Decreases mucus viscosity ● Aggressive treatment of pulmonary infections: Home IV abx therapy, Aerosolized abx ● Pneumothorax ● Hemoptysis ● Transplantation: heart, lung, pancreas, and liver for adolescents who have advanced disease

Answer 47

● Administration of pancreatic enzymes & ADEK ● High-protein, high-calorie diet, as much as 150% rDA increase fluids ● Reduction of rectal prolapse ● Salt supplementation ● Oral glucose-lowering agents or insulin injections as needed ● Treat gastroesophageal reflux: Place the patient in the upright position after meals, H2 Blockers

Answer 48

● CFRD (cystic fibrosis-related diabetes): Characteristics of both Type 1 & Type 2 DM, Increased risk for glucose mgmt problems ● Screening: oral glucose tolerance test at 10 years of age ● Monitor blood glucose levels: 3x/day, Insulin ● Diet ● Exercise ● A1C measurements ● Regular eye examinations: Retinopathy

Answer 49

● Estimated life expectancy for a child born with CF is 40 yrs ● CF continues to be a progressive, incurable disease ● Organ transplantation has increased the survival rate: Heart–lung and bilateral lung transplantation, Liver and pancreas transplantation ● Maximize health potential: Nutrition, Prevention and early aggressive treatment of infection, Pulmonary hygiene

Answer 50

● New research hope: Transplantation, Gene therapy, Bilateral lung transplants, Improved meds ● Child requires treatments multiple times each day: child may rebel, Depression & anxiety common ● Frequent hospitalizations: Nosocomial infections (pt may be on contact precautions)

Answer 51

● Respiratory insufficiency: Increased work of breathing (WOB), Hypoxemia and acidosis ● Respiratory arrest: Complete cessation of respiration ● Apnea: Cessation of breathing for > 20 sec ● Restlessness, tachypnea, tachycardia, diaphoresis ● Retractions, grunting, changes in resp pattern, CNS symptoms ● Supplemental O2, positioning, suctioning, CPAP/BiPAP, consider early intubation ● Resuscitative measures if respiratory arrest