UNIT 7 RESPIRATORY DISORDERS CHAPTER 40 Flashcards
Why are pediatrics most likely to get sick?
Narrow nasal passages, glottis, & trachea + large
tongue
2. Fewer functional airway muscles
3.Large amounts of soft tissue & Increase mucus gland
ratio (50x more than adults)
4.Immature thyroid, cricoid, & tracheal cartilages
5.Intercostal and accessory muscles poorly developed
6.Large abdomen
7. Immune system is not mature
8. Patients do not wash hands
Is it important for parents to teach their children proper hand washing techniques and coughing and sneezing etiquette?
A. No
B. Yes
B. Yes
- put handsantizer in backpack
Children and families should use a tissue or their elbow to cover their mouth or nose when they cough or sneeze, dispose of the used tissues properly, and wash their hands. Used tissues should be immediately thrown into the wastebasket and not allowed to accu- mulate in a pile. \
Children with respiratory tract infections should not share drinking cups, eating utensils, washcloths, or towels. To decrease respiratory virus contamination, wash hands frequently and do not touch eyes or noses with the hands.
What are influences on infection
- Age
- Size
- Decreased Resistance(decrease exacerbation risk )
- Seasonal Variations like the yearly flu
S/S of Respiratory Distress
Respiratory Distress-
*grunting,
*nasal flaring,
*retractions,
*cyanosis(OXYGENATION ISSUE),
*tachypnea
*tachycardia
- Fever- may be absent in NB
- Anorexia – Very common(sick babies do not like to eat)
- Vomiting – small children vomit readily with illness
- Nasal Blockage / Discharge - secretions (keep nasal package clear)
*babies are mouth breathers
What is the golden sign of Chronic Hypoxia?
A. Tachycardia
B. Cyanosis
C. Clubbing
D. Weak cry
C. Clubbing
Nursing Management of Respiratory Distress
- Ease respiratory efforts: KEEP BABY CALM decreases oxygen demands.
- Promote rest
Moisturized air is a common therapeutic measure for symptomatic relief of respiratory discomfort. - Promote comfort
- Prevent spread of infection: BEST WAY HAND WASHING
Children and families should use a tissue or their elbow to cover their mouth or nose when they cough or sneeze, dispose of the used tissues properly, and wash their hands. Used tissues should be immediately thrown into the wastebasket and not allowed to accu- mulate in a pile.
- Reduce temperature
- Promote hydration/nutrition: Anorexic patient increase IV fluids
- Provide family support: Educate patients
What is Transient Tachypnea
a benign, self-limited condition that can present in infants of any gestational age, shortly after birth. It is caused due to delay in clearance of fetal lung fluid after birth which leads to ineffective gas exchange, respiratory distress, and tachypnea.
How do you treat viral conditions?
treat the symptoms as you see them
mild headache or pain-use of NSAIDS
dehydration-Increase fluid intake
fever- use antipyretic
stuffy nose- decongestant
How do you treat bacterial infections?
use of antibiotics
FLUID MAINTENANCE PEDIATRIC FORMULA
4:2:1 RULE
FOR EVERY 0-10KG: 4ml/kg/hr
FOR EVERY 10-20KG: 2ml/kg/hr
FOR EVERY 20KG+: 1ml/kg/hr
What is the Fluid maintenance for a patient that weighs 5kg?
20ml/hr
5kg : 5x 4=20ml/hr
What is the fluid maintenance for a patient that weights 60kg?
100ML/HR
60kg: 10x 4=40 ml
10x 2=20ml
40 x 1= 40 ml
TOATAL FLUID MAINTENCE IS 100ML/HR
FAMILY EDUCATION IS IMPORTANT
What is another name for the common cold
Nasopharyngitis
Your pediatric patient has been diagnosed with Nasopharyngitis. What prescriptions would you question for the Health Care Provider? Select all that apply
A. Aspirin
B. IV Assess
C. Antibiotics
D. Intermittent IV Fluid 0.9 NS
E. Varicella vaccine when newly prescribed and administered immunoglobulin therapy.
A. Aspirin
C. Antibiotics
E. Varicella vaccine when newly prescribed and administered immunoglobulin therapy.
The use of aspirin during a viral illness has most commonly been linked to Reye’s syndrome.
What viruses cause Nasopharyngitis
RSV,
rhinovirus,
adenovirus,
influenza
parainfluenza viruses
Is there a cure for Nasophyrngitis
NO TREAT SYMPTOMS
treat the symptoms as you see them
mild headache or pain-use of NSAIDS
dehydration-Increase fluid intake
fever- use antipyretic
stuffy nose- decongestant
Fluids and rest are recommended.
S/S OF NASOPHYRNGITIS
varies with age. May include fever, nasal
mucus, sneezing, Congestion
Nasopharyngitis
Younger Children
* Fever
* Irritability, restlessness
* Decreasedappetiteandfluidintake
* Sneezing
*Nasal mucus(abundant )causing mouth breathing
* Vomiting or diarrhea may be present
* Decreased activity
Older Children
* Dryness and irritation of nose and throat initially *
Nasal discharge causing mouth breathing
* Chilling sensations
* Muscular aches
* Cough or sneezing(occasionally)
Your 12-year-old pediatric pt has been prescribed a vasoconstrictive nose drop due to Nasopharyngitis. What is the priority teaching to prevent rebound congestion?
To avoid rebound nasal congestion, vasoconstrictive nose drops or sprays should not be administered for more than 3 days.
Nursing Management of Nasopharyngistis
Fluids,
rest, elevation of HOB, suction.
Prevention is key
(handwashing & cough etiquette!)
Children and families should use a tissue or their elbow to cover their mouth or nose when they cough or sneeze, dispose of the used tissues properly, and wash their hands. Used tissues should be immediately thrown into the wastebasket and not allowed to accu- mulate in a pile. \
Children with respiratory tract infections should not share drinking cups, eating utensils, washcloths, or towels. To decrease respiratory virus contamination, wash hands frequently and do not touch eyes or noses with the hands.
What Pharyngitis caused by
80-90% of cases are viral; others Group A Beta-Hemolytic
Streptococci (Strep throat)
What is the common symptom for Pharyngitis
sore throat
headache, fever, possible rash,
abdominal pain (esp in small children)
Scarlet fever may also occur as a result of a strain of group A strep- tococcus. The clinical manifestations of scarlet fever include pharyngi- tis and a characteristic erythematous sandpaper-like rash; otherwise, scarlet fever shares the same clinical manifestations as those men- tioned for GABHS, and treatment and sequelae are the same. Severe scarlet fever is rarely seen in the United States.
Pharyngitis
Younger Children
* Fever
* General malaise
* Anorexia
* Moderate sore throat
* Headache
Older Children
* Fever(may reach104°F[40°C])
* Headache
* Anorexia
* Dysphagia
* Abdominal pain
* Vomiting
Assessment
- Mild to bright red, edematous pharynx
- Hyperemia of tonsils and pharynx;
- Cervical glands enlarged and tender
- Often abundant follicular exudate that’ spreads and coalesces to form pseudo-
membrane on tonsils
What would suspect the Health Care Provider to prescribe before medications in a patient with suspected Pharyngitis
throat culture, rapid strep test (antigen detection
test)
TO DETERMINE IF THE CASE IS BACTERIAL OR VIRAL
After the throat culture, the patient results came back and showed that the patient has a bacterial case of pharyngitis
What medication would you suspect the health care provider to prescribe
A. Penicillin
B. Aspirin
C. Fluconazole
D.Acyclovir
A. Penicillin
Therapeutic management: PCN
If streptococcal sore throat infection is present, oral penicillin or other antibiotics such as amoxicillin are prescribed for 10 days to control the acute local manifestations and maintain an adequate level to eliminate any organisms that might remain to initiate rheumatic fever symptoms. Penicillin does not prevent the development of acute glomerulonephri- tis in susceptible children.
The mother of your pediatric is concerned that her 3 year old toddler will miss activities in daycare due to his pharyngitis diagnosis. What teaching will ease her concerns are penicillin is administered
Nursing care management:
* No school/daycare for 24 hrs
* Acetaminophen/ibuprofen for pain
* Finish full course of antibiotics!
Tonsillitis
Causes: often occurs with pharyngitis; causative agent may be viral or
bacterial
- Clinical manifestations: edema/enlargement of tonsils;
difficulty
swallowing;
mouth breathing - Therapeutic management: antibiotics if bacterial; possible
tonsillectomy if criteria met - Nursing management: pain management
Tonsillectomy & Adenoidectomy
- Tonsils are removed for usually either frequent strep throat infections and/or
airway obstructions (sleep apnea) - Post op care:
- Cool, clear liquids (no red liquids)
- No milk or milk products
*no citrus - Frequent swallowing=bleeding
- Vomiting bright red blood=call surgeon/doctor stat!
- Avoid coughing, crying, screaming, blowing nose etc post-operatively
- Pain meds around the clock
What is the cause of Tonsillitis
Causes: often occurs with pharyngitis; causative agent may be viral or
bacterial
What is your main concern with tonsillitis?
A. Serous drainage
B. Airway Obstruction
C. Barking cough
D. peeling of skin
B. Airway Obstruction
KISSING TONSILS
As the palatine tonsils enlarge from edema, they may meet in the midline (touching or kissing tonsils), obstructing the passage of air or food.
S/S of Tonsilitis
- Clinical manifestations:
*edema/enlargement of tonsils;
*difficulty swallowing;
*mouth breathing
*the voice may have a nasal and muffled quality, and a persistent cough is also com- mon
Contraindications of Tonsillectomy
Contraindications to either tonsillectomy or adenoidectomy are (1) cleft palate, because the tonsils help minimize escape of air during speech;
(2) acute infections at the time of surgery, because locally in-flamed tissues increase the risk of bleeding; and (
3) uncontrolled systemic diseases or blood dyscrasias.
Therapeutic management Post Operatively of Tonsillitis
Nursing care of the child with tonsillitis involves providing comfort and minimizing activities or interventions that precipitate bleeding.
A soft to liquid diet is generally preferred. Warm saltwater gargles, warm fluids, throat lozenges, and regularly prescribed nonopioids (such as acetaminophen and ibuprofen) are used to promote comfort.
What position is most appropriate for a patient post operative of Tonsillectomy
A. Supine
B. Prone
C.High fowlers
D. Trensdelenburg
C.High fowlers
After the surgery, until they are fully awake, children are positioned to facilitate drainage of secretions.
Suctioning is usually avoided, but when performed, it is done carefully to avoid trauma to the orophar- ynx.
When alert, the child may prefer sitting up. The child is discouraged from coughing frequently, clearing the throat, blowing the nose, and any activities that may aggravate the operative site.
What should the patient be discouraged from doing post-operative Tonsillectomy
The child is discouraged from coughing frequently, clearing the throat, blowing the nose, and any activities that may aggravate the operative site.
Soft foods being when post-op if patients can tolerate it after a Tonsillectomy
Children often begin soft foods, particularly gelatin, cooked fruits, sherbet, soup, and mashed potatoes, on the first or second postopera- tive day or as the child tolerates feeding. The pain from surgery often inhibits oral intake, reinforcing the need for adequate pain control.
What equipment should be readily available post operatively Tonsillectomy
Suction equipment and oxygen should be available after tonsillectomy.
Signs of Airway Obstruction
Airway obstruction may also occur as a result of edema or accumulated secretions and is indicated by signs of
respiratory distress,
such as stridor,
drooling,
restlessness,
agitation,
increasing respiratory rate, and progressive cyanosis.
What is Otitis Media
An inflammation of the middle ear without reference to etiology or pathogenesis
What is Otitis media with effusion(OME)
Fluid in the middle ear space without symptoms of acute infection
