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OB/PEDS: Midterm > The Child with Respiratory Dysfunction > Flashcards

The Child with Respiratory Dysfunction Flashcards

1
Q

Anatomical Differences of the Respiratory Tract

A
  • Poorly developed accessory muscles
  • Thoracic cage relatively soft & thin chest wall
  • 1:1 Anterior Posterior to Transverse ratio
  • Chest circumference less than head circumference
  • Obligatory nasal breathers
  • Tongue larger proportionately
  • Respiratory rate of:
    — 60 at birth: less rhythmic
    — 26 at 2 years
    — 18 at 10 years
  • Immature immune system
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2
Q

Components of Assessing Respiratory Function
Respirations

A
  • Rate
  • Depth
  • Ease
  • Labored Breathing
  • Rhythm
  • Restlessness
  • Accessory muscles
  • Retractions
  • Nasal flaring
  • Other Observations:
    — Evidence of infection
    — Cough
    — Adventitious sounds
    — Cyanosis
    — Chest pain
    — Sputum
    — Halitosis (bad breath)
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3
Q

Nasopharyngitis:
Treatment

A
  • URI- Upper respiratory Infection or common cold
    Treat with:
  • Humidifier
  • decongestant
  • antipyretics
  • fluids
  • saline nose drops
  • *Do not give infants <2 yrs cough and cold products unless instructed by physician
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4
Q

Tonsillitis/Pharyngitis
S/S:

A
  • Throat infection
  • redness
  • exudate
  • Mouth breathing
  • Enlarged cervical lymph nodes
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5
Q

Tonsilectomy Nursing Considerations

A
  • Maintain patent airway
  • Minimizing activities or interventions that precipitate bleeding
  • Cool-mist vaporizer
  • Soft to liquid diet
  • Non-vigorous Warm saltwater gargles
  • Analgesic/antipyretic drugs
  • Avoid red drinks or red foods
  • Avoid irritating, sharp or highly seasoned foods
  • Discouraging the child from coughing or clearing the throat or putting objects in the mouth
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6
Q

Otitis Media (OM)
S/S

A

OM is primarily a result of a Dysfunctioning Eustachian Tube
- Ear pain
- Pulling at ears
- Redness of tympanic membrane
- purulent drainage after tympanic membrane ruptures
- postarticular and cervical lymph node enlargement
- Fever: 104° common
- Diarrhea & vomitting
- Irritability
- sucking aggravate pain
- Decreased drinking and eating and sucking (appetite)

  • note:
    — Otitis media with [pleural] effusion (OME) is diagnosed with the presence of fluid behind the tympanic membrane, without acute onset or signs of inflammation or infection.
    — Acute Otitis Media (AOM) on the other hand, while it may include Eustachian tube dysfunction and middle ear fluid, it must include signs of acute inflammation or infection.
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7
Q

Otitis media treatment

A
  • Antibiotics- Amoxicillin
  • Decongestant
  • Antipyretic and Analgesic
  • Myringotomy (tubes)
  • Tympanostomy tubes
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8
Q

Otitis media teaching

A
  • Decrease exposure to secondhand smoke
  • Pacifier or bottle or breast while laying down can increase incidence
  • Get immunizations- Hib and Pneumococcal
  • Take complete course of antibiotics
  • Recognize s/s of tympanic membrane rupture
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9
Q

Croup Syndromes

A
  • Upper airway illnesses caused by swelling of epiglottis and larynx.
    — Acute Spasmotic Laryngitis
    — Laryngotracheobronchitis (LTB)- (pic below)
    — Bacterial Tracheitis
    — Epiglottitis
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10
Q

Acute Epiglottitis
What?
Cause?
Onset is:

A
  • Or acute supraglottitis, is a serious obstructive inflammatory process
  • Occurs in children between 2 and 5 years of age
  • Causative agent usually Haemophilus influenzae- Bacterial
  • Onset of epiglottitis is usually abrupt
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11
Q

Acute Epiglottitis:
S/S

A
  • Tripod position supported by arms, chin thrust out, mouth open
  • Drooling
  • inspiratory stridor
  • strident cough
  • Irritability or lethargy
  • increased pulse
  • epiglottis edema
  • cherry red
  • High Fever
  • pain
  • obstructed airway=hypoxia=acidosis=death
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12
Q

Epiglottis Treatment:

A
  • decrease anxiety
  • Don’t examine throat
  • Position for comfort
  • trach tray available
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13
Q

Croup (Acute Laryngotracheobronchitis LTB):
S/S

A
  • age 3 months to 3 years
  • Upper respiratory infections frequently preceed LTB
  • Restlessness
  • retractions
  • slow onset
  • Barking cough
  • Crowing sounds
  • Inspiratory stridor
  • Occurs at night
  • Increase in fall and winter
  • May progress to hypoxic state
  • May have slight temperature: 102°
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14
Q

Therapeutic Management & Nursing Care of LTB (croup)

A
  • Teach parents signs of respiratory distress
  • High humidity with cool mist provides relief for most children
  • With severe respiratory distress child NPO
  • Corticosteroids
  • Watch for symptoms of respiratory distress
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15
Q

Respiratory Syncytial Virus (RSV)/Bronchiolitis
peaks when

A

in Fall/Winter

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16
Q

Respiratory Syncytial Virus (RSV)/Bronchiolitis
S/S

A
  • Tachypnea
  • Retractions/nasal flaring
  • Rhinorrhea
  • Pharyngitis
  • Cough & sneezing
  • Wheezing
  • Severe Mucous
  • Possible ear or eye infection
  • Intermittent fever
17
Q

Respiratory Syncytial Virus (RSV)/Bronchiolitis:
Treatment

A
  • Hydration
  • Humidified O2
  • Nasopharyngeal suctioning
  • Corticosteroids
  • Respiratory therapy
  • Synagis for at risk infants
18
Q

Foreign Body Aspiration (FBA):
S/S:

A
  • Coughing
  • choking
  • gagging
  • dysphonia
  • wheezing
  • dyspnea
  • nasal flaring
  • retractions
  • *?inability to say P words
  • anxiety
  • decreased LOC
19
Q

Pediatric Asthma Overview

A
  • Third leading cause of hospitalization in children younger than 15 years
  • Leading cause of chronic illness in children
  • Leading cause of school absences
20
Q

Asthma s/s

A
  • Wheezing (usually on expiration)
  • Decreased Breath Sounds
  • Coughing, especially at night
  • Shortness of Breath
  • Chest Tightness
  • Retractions and Nasal Flaring
  • Use of Accessory Muscles
  • Anxiety or Agitation
  • Tachypnea
21
Q

Asthma triggers:

A

Smoke
- Colds
- Cockroaches
- Food, allergies
- Dust
- Mold and mildew
- Pollen
- Exercise
- Strong emotions
- Furry pets
- Changes in the weather
- Cold weather
- Strong smells

22
Q

Asthma treatment

A
  • Oxygen if O2 saturation is less than 95%
  • Respiratory Treatments- to decrease Bronchospasm and Inflammation
  • IV (Solu-Medrol) or PO (Prednisone) corticosteroid to decrease inflammation
23
Q

Asthma
Nursing Interventions

A
  • Assess lung sounds q4h
  • Monitor vital signs and O2 saturation q4h
  • Keep pt in High Fowler’s position
  • Encourage coughing and deep breathing q2h
  • Monitor hydration status
24
Q

Asthma
Patient and Family Teaching

A
  • Identify and avoid triggers
  • Recognize signs and symptoms of asthma exacerbation
  • Medication
  • Nebulizer and aerochamber use
  • Peak Expiratory Flow Meter Use
  • Avoid sick contacts
  • Encourage child to receive an annual flu vaccine
25
Q

Cystic Fibrosis (CF)

A
  • Autosomal recessive genetic condition found most often in Caucasian European decent.
  • Approximately 8 million people carry the gene. If both parents have the gene, they have a 25% chance the child will have CF.
  • It is caused by a genetic variation in the CFTR (Cystic Fibrosis Transmembrane Regulator channel in which chloride ions cannot pass through the skin, and membranes of organs. (lungs, pancreas, reproductive organs, GI Tract) This is what causes an extreme build up of mucus.
26
Q

Cystic Fibrosis (CF)
S/S

A
  • fatigue
  • Salty taste on skin
  • Chronic cough
  • Recurrent URIs
  • Thick, sticky mucus
  • Chronic hypoxia: clubbing, barrel chest
  • Decreased and absorbtion a Vitamins and enzymes
  • Abdominal distention
  • Decreased digestive enzymes
  • Rectal prolapse
  • Fatty, stinky stools (steatorrhea)
  • Meconium ileus in newborn
27
Q

Cystic Fibrosis (CF)
Treatment

A
  • diet: increased Ca/ protein
  • Pulmonary therapy
  • Chest physiotherapy
    — Postural drainage
  • Breathing exercises
  • Aerosol therapy
  • meds:
    — antibiotics
    — supplemental vitamins
    — aerosol Bronchodilators
    — mucolytics
    — pancreatic enzymes
    — salty snacks? Pretzels
28
Q

Cystic Fibrosis (CF)
Impact on systems

A

Bronchi
- Bronchial obstruction=chronic bronchial pneumonia; generalized obstructive emphysema
Small intestine
- inspissated meconium= intestinal obstruction of newborn
Pancreatic ducts
- secondary degeneration of pancreas= pancreatic achylia= malabsorption syndrome
Bile ducts
- focal biliary fibrosis with concretions= biliary cirrhosis= portal hypertension

29
Q

Cystic fibrosis effect on lungs
What
Treatment

A

Pneumonia: Poor oxygenation and gas exchange
Treatments:
- Antibiotics
- O2
- Pulmonary aerosol treatments:
— bronchodilators
— mucolytics
— steroids
- CFTR modulators: Medications that work on specific genetic mutations in the protein that regulates the fluctuation of sodium (only for children 2yrs and older)
- Chest physiotherapy (either a vibration vest or with hand) - This is to “jiggle” and break apart the mucus so it is easier to cough and expel.

30
Q

Cystic fibrosis effect on Pancreas
Treatment

A
  • Inability to absorb vitamins, especially fat soluble vitamins (A,D,E,K)
  • Inability to digest food
    Treatments: Pancreatic enzymes with each meal
31
Q

Cystic fibrosis effect on GI System
Treatment

A
  • Decreased absorption of nutrients
  • Rectal prolapse from constipation
  • Steatorrhea- fatty stools due to decreased ability to absorb fats
  • **Meconium Ilius in newborn. This is often the first sign that a child may have CF!!
  • Treatments: stool softeners, Vitamin supplementation- Especially Vit A,D,E.K, encourage salty snacks since they are often hyponatremic.
32
Q

Cystic fibrosis effect on skin
Test?

A
  • **Skin “tastes” salty (when parents kiss their child) due to decreased ability for sodium to flow through the channel and builds up underneath skin.
  • ** Sweat Chloride Test- diagnostic
  • A sample is obtained from the skin using a special filter paper/cloth. There shouldn’t be much if any chloride in sweat, but a CF patient usually has 2-5 times the amount. If they have 60 meq/L or more, that is diagnostic for CF.
33
Q

Cystic Fibrosis effect on reproductive tract

A
  • Males- Vas deferens is blocked with mucous which leads to sterility.
  • Females- May delay puberty in females

OB/PEDS: Midterm (21 decks)

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