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
What can lead to bacterial Otitis media
A. Flu
B. Varicella
C. Streptococcal C
D. Hepatitis B
A. Flu
Bacterial OM: often proceeded by viral respiratory infections
(RSV, flu).
What season is Otitis Media prevalent?
A. Summer
B. Fall
C. Spring
D. Winter
D. Winter
Prevalent in winter;
often follows viral
respiratory infection
Risk factors for OM Otitis Media
*Attending daycare is a significant risk factor for OM.
* Children who have siblings or parents with a history of chronic OM also have a higher incidence of OM.
*Second hand smoking
*A household with many persons
* no bottle propping
*NON IMMUNE TO FLU VACCINE
*
Nursing Management
Nursing Management: relieve pain; prevent recurrence: educate
family on breastfeeding, no bottle propping, avoid passive smoking,
immunize
Signs and Symptoms of Otitis Media
- Follows an upper respiratory tract infection
- Otalgia(earache)
- Fever—may or may not be present
- Purulent discharge(otorrhea)—may or may not be present
Therapeutic Management Otitis Media
Analgesics (ibuprofen and acetaminophen) are helpful in reducing severe ear pain and controlling fever. Ibuprofen has a longer duration of action (about 6 hours) and is especially beneficial for nighttime comfort but should not be used in children younger than 6 months of age unless directed by a medical provider. Lying on the affected side may reduce pain in some children, as it may facilitate drainage from a ruptured eardrum or myringotomy.
Prevention of recurrence requires adequate parent education on antibiotic therapy. Because the symptoms of pain and fever usually subside within 24 to 48 hours, nurses must emphasize that although the child may appear well, the infection is not completely eradicated until all prescribed medication is taken. It is important to stress the potential complications of OM, especially hearing loss, which can be prevented with adequate treatment and follow-up care.
What is croup syndrome?
Characterized by hoarseness, “barking” cough, inspiratory
stridor, and varying degrees of respiratory distress
* Croup syndromes affect larynx, trachea, and bronchi
1. Epiglottitis
2. Laryngitis
3. Laryngotracheobronchitis (LTB)
Is Epiglottis a medical emergency?
A. No
B. Yes
Obstructive inflammatory process: MEDICAL EMERGENCY
You notice that your pediatric pt is in a tripod position and drooling severely. What medical emerges diagnoses would you suspect them to have?
A. Croup Syndrpme’
B. Pharyngitis
C.Otitis media
D. Epiglottitis
D. Epiglottitis
- Clinical Manifestations: abrupt onset, progresses rapidly to
obstruction. Tripod position, drooling, inspiratory stridor, retractions,
agitation
Signs and Symptoms of Epiglottitis
- Clinical Manifestations: abrupt onset, progresses rapidly to
obstruction. Tripod position, drooling, inspiratory stridor, retractions,
agitation
Nursing management of Epiglottitis
Nursing Management: Stay calm. Allow child to sit in most
comfortable position.
No visualization of throat
Should you visualize the throat to see if the obstruction is getting worser ion a patient with Epiglottitis?
A. Yes
B. No
B. No
No visualization of throat
When does swelling tend to decrease after antibiotic medication is administered for Epiglotititis
A. 72 HRS
B. 30 MINUTES
C. 24 HOURS
D. 1 HOUR
Therapeutic Management: Swelling decreases after 24 hours of
antibiotic therapy
You are precepting a new graduate nurse is teaching a patient the cause of Laryngitis. Which statement would need immediate intervention?
A. This is a common after-effect with people who have been to lengthy concerts when they sing for long period of time
B. This is caused by H. influenza.
C. This can be caused by secondhand smoking.
D. This is caused by prolonged yelling.
\
CAUSES OF LARYNGITIS
URI(upper respiratory infection), cold, overuse
of voice (singing, yelling),
second hand smoke
DEFINITION OF laryngitis- Inflammation of vocal cords
What is the S/S of laryngitis
hoarseness, loss of voice,
throat pain
DEFINITION OF laryngitis-
laryngitis- Inflammation of vocal cords
Nursing Managment of Laryngitis
voice rest &
humidified air
What is Acute Laryngotracheobronchitis
Acute LTB is the most common type of croup syndrome that primarily affects children 6 months to 3 years old.
An upper airway infection that blocks breathing and has a distinctive barking cough.
Acute Laryngotracheobronchitis cause
Cause: Viral agents- parainfluenza, RSV, rhinovirus, adenovirus
Clinical Manifestations Acute Laryngotracheobronchitis
Clinical Manifestations: gradual onset of low grade fever, nighttime
awakening with barky cough, inspiratory stridor, retractions
Therapeutic and Nursing Management
Therapeutic Management: management of airway, breathing
treatments, steroids
* Nursing Management: humidified cool air, continuous monitoring,
encourage parent presence
Where does Bronchiolitis take place
A. Upper respiratory
B. Lower respiratory
C. Larynx
D. Nasal passageway
Bronchiolitis
B. Lower respiratory
Bronchitis (sometimes referred to as tracheobronchitis) is inflamma- tion of the large airways (trachea and bronchi), which is frequently associated with URIs. Viral agents are the primary cause of the disease, including influenza A and B, parainfluenza, coronavirus
S/S of Bronchiolitis
begins with URI, rhinorrhea, low
grade temp, cough, intercostal retractions, wheezing,
crackles, tachypnea, diminished breath sound
Nursing management
Therapeutic Management: Supportive: humidified O2,
nasal suction, fluids
- Nursing Management: Contact precautions, continuous
CR/sat monitoring. Prevention: handwashing, breastfeeding,
avoidance of passive smoking, vaccine for high-risk
preemies
Due to the copious nasal secretions associated with RSV infection, infants often have difficulty with breathing and feeding. Breastfeeding mothers are encouraged to continue feeding the infant or, if feedings are contraindicated due to severity of the illness, mothers should pump their milk and store it appropriately for later use. Parents are taught how to instill normal saline drops into the nares and suction the mucus with bulb syringe before feedings and before bedtime so that the child may more easily eat, rest, and sleep.
Pertussis, what sound is related to this disorder
A. Stridor
B. Whooping cough
C. Crackles
D. Wheezing
B. Whooping cough
What is the cause of Pertussis
Cause: by Bordetella pertussi
Treatment and nursing management oof pertussis
Therapeutic Management: antibiotics
Nursing Management: Highly contagious; remain isolated
for 5 days after antibiotics started
When can a pediatric pt go back to school after starting their antibiotic medications that has been diagnosed with Pertussis
- Nursing Management: Highly contagious; remain isolated
for 5 days after antibiotics started
Foreign Body Aspiration
small items (toys, food) aspirated into trachea
With foreign body aspiration, should you do a blind sweep
A. Yes
B. No
B. No
S/S foreign body aspiration
diagnosis based on S/S-
choking,
gagging,
wheezing,
drooling,
coughing. Confirmed with xraY
When an object is lodged in the larynx, the child is unable to speak or breathe.
Nursing Intervention for Foreign Body aspiration
Therapeutic Management: abdominal thrusts and back
slaps; removal by bronchoscopy
* Nursing Management: teach prevention: “fun” foods often
the culpri
Back blows or abdominal thrusts performed by both health professionals and prop- erly instructed lay persons can save lives.
NO BLIND SWEEPING CHIN TILT
Teaching for foreign body aspiration(PREVENTION)
Nurses are able to teach prevention in a variety of settings.
They can educate parents singly or in groups about the hazards of aspiration in relation to the developmental level of their children and encourage them to teach their children safety.
Caution parents about behaviors that their children might imitate (e.g., holding FBs such as pins, nails, and toothpicks between their lips or in the mouth).
Educate parents on age-appropriate toys and how older siblings’ toys could be hazardous for younger siblings.
Asthma
Chronic inflammatory disorder of the airways resulting in
airway obstruction
cause of asthma
Cause: atopy, exposure to allergens, previous RSV
exposure
S/S of Asthma
Clinical Manifestations: Wheezing, breathlessness, chest
tightness, cough (especially at night
Therapeutic management of Asthma
Therapeutic Management: allergen control, drug therapy
* Corticosteroids, bronchodilators, mast cell stabilizers, etc
Asthma teaching . education for parents
Nursing Management: teach prevention of
exacerbations
* Avoid allergens
* Relieve bronchospasms
* Exercise
* Asthma teaching plan- identify respiratory deterioration
Which of the following drugs is a rescue drug?
A. Enoxaparin
B. Heparin
C. Prednision
D. Albuterol
Short Term
* Short acting beta-agonists-Albuterol (#1)
* rescue inhaler for symptomatic treatment
Asthma Pharmacologic
Short Term
* Short acting beta-agonists-Albuterol (#1)
* rescue inhaler for symptomatic treatment
- Long Term/Preventative
- Corticosteroids (inhaled form is the anti-inflammatory drug of choice for persistent asthma.)
- Mast cell stabilizers (anti-inflammatory drugs)
- Long acting beta-agonists (bronchodilators often used along with an anti-inflammatory drug)
- Theophylline (a bronchodilator used along with an anti-inflammatory drug to prevent
nighttime symptoms) - Leukotriene modifiers (an alternative to steroids and mast cell stabilizers)
- Xolair (an injectable asthma medication used when inhaled steroids for asthma failed to
control asthma symptoms in people with moderate to severe asthma who also have allergies)
- A nurse is reviewing the diagnostic findings for a preschool age child who is suspected of having cystic fibrosis. Which of the following findings should the nurse identify as an indication of cystic fibrosis?
A. Sweat chloride content 85 mEg/L
B. Increased blood levels of fat-soluble vitamins
C. 72 hr stool analysis sample indicating hard, packed stools
D. Chest x-ray negative for atelectasis
A. Sweat chloride content 85 mEg/L
- A nurse is admitting a child who has cystic fibrosis. Which of the following medications should the nurse expect to include in the plan of care? (Select all that apply.)
A. Tobramycin
B. Loperamide
C. Fat-soluble vitamins
D. Albuterol
A. Tobramycin
C. Fat-soluble vitamins
D. Albuterol
- A nurse is performing an admission assessment for a child who has cystic fibrosis. Which of the following findings should the nurse expect? (Select all that apply.)
A.Wheezing
B. Clubbing of fingers and toes
C. Barrel-shaped chest
D. Thin, watery mucus
E. Rapid growth spurts
C. Barrel-shaped chest
B. Clubbing of fingers and toes
A.Wheezing
- A nurse is providing discharge teaching for a child who has cystic fibrosis. Which of the following instructions should the nurse include?
A. Provide a low-calorie, low-protein diet.
B. Administer pancreatic enzymes with meals and snacks.
C.Implement a fluid restriction during times of infection.
D.Restrict physical activity.
B. Administer pancreatic enzymes with meals and snacks.
before a meal for snack (30 minutes)
Oral care metered dose inhalers
It’s important to rinse your mouth out after using a steroid inhaler, such as your preventer inhaler. This is so that any medicine that is stuck in your mouth or throat is cleaned away. This will prevent side effects such as oral thrush.
Young children and those who are unable to manipulate the MDI or hold their breath for 10 seconds should use a spacer. A spacer is a 4- to 8-inch tube that fits on the end of the MDI mouthpiece. These devices allow the parent or child to deliver the medication from the MDI into the spacer, from which the child then inhales the medication while taking slow, steady breaths at his or her own pace. Spacers also help prevent yeast infections in the mouth when corticosteroids are inhaled via an MDI.
Cystic fibrosis
Exocrine gland dysfunction that produces multisystem
involvement
* Inherits defective gene from both parents with an overall
incidence of 1:4
* Increased viscosity of mucous gland secretion
* Thick mucous accumulates in glands and ducts
* Respiratory tract and pancreas are predominantly affect
Respiratory Manifestations of Cystic fibrosis
Stagnation of mucus and bacterial colonization result in destruction of
lung tissue
* Tenacious secretions are difficult to expectorate—obstruct
bronchi/bronchioles
* Compression of pulmonary blood vessels and progressive lung
dysfunction lead to pulmonary hypertension, cor pulmonale,
respiratory failure, and death
GI ma infestations of Cystic fibrosis
- Pancreatic enzyme deficiency
- Failure to thrive
- Increased weight loss despite increased appetite
- Steatorrhea
- Eventual diabetes from pancreatic fibrosis
- Eventual cirrhosis from focal biliary obstruction
Is Steatorrhea a common finding in cystic fibrosis?
yes
Is weight gain a common finding in Cystic fibrosis ?
No
What is the best diagnostic test to rule in Cystic fibrosis
sweat CHLORIDE test
infant 3 months or less 40 mEQ/L - POSITIVE
3 months or greater 60 mEQ/L - POSITIVE
S/S OF CYSTIC FIBROSIS
*Wheezing respiration,
* dry nonproductive cough
* Generalized obstructive emphysema
* Patchy atelectasis
* Cyanosis
* Clubbing of fingers and toes
* Repeated bronchitis and pneumonia
* Wasting of tissues
* Delayed puberty in females
* Dehydration
* Sterility in males
* Parents report children taste “salty”
* Hyponatremic/hypochloremic alkalosis
* Hypoalbuminemia
* Meconium ileus
* Distal intestinal obstruction syndrome
* Excretion of undigested food in stool;
increased bulk, frothy, and foul
* Prolapse of the rectum
DAISPLINARY CARE MANAGMEMNT FOR CYSTIC FIBROSIS
- CPT- Chest physiotherapy
- Bronchodilator medication
- Forced expiration
- Prevention/aggressive treatment of pulmonary infections
- Aerosolized antibiotics
- Steroid/NSAID
- Transplantation
Family and patient teaching for Cystic Fibrosis
Family support
* Coping with lifelong illness; affects on family
- Maximize health potential- 30 years old maximum. survival age
- Nutrition- high calories , high protein, low fat , cannot break down fat
- Prevention of infection- avoid large crowds, wash hands
- New research
- New pharmacologic agents
- Transplantation- survival rate 55% at 3-yrs post bilateral lung transplant
- A 10-year-old child with asthma is treated for acute ex- acerbation in the emergency department. The nurse car- ing for the child would monitor for which sign, know- ing that it indicates a worsening of the condition?
- Warm, dry skin
- Decreased wheezing
- Pulse rate of 90 beats per minute
- Respirations of 18 breaths per minute
- Decreased wheezing
Asthma is a chronic inflammatory disease of the airways. Decreased wheezing in a child with asthma may be interpreted incorrectly as a positive sign when it may actually signal an inability to move air. A “silent chest” is an ominous sign during an asthma episode. With treatment, increased wheezing actually may signal that the child’s condition is improving. Warm, dry skin indicates an improvement in the child’s condition, because the child is normally diaphoretic during exacerbation. The normal pulse rate in a 10-year-old is 70 to 110 beats per minute. The normal respiratory rate in a 10-year-old is 16 to 20 breaths per minute.
- A new parent expresses concern to the nurse regard- ing sudden infant death syndrome (SIDS). The par- ent asks the nurse how to position the new infant for sleep. In which position would the nurse tell the parent to place the infant?
- Side or prone
- Back or prone
- Stomach with the face turned
- Back rather than on the stomach
- Back rather than on the stomach
The clinic nurse is providing instructions to the parent of a child with cystic brosis regarding the immunization schedule for the child. Which state- ment would the nurse make to the parent?
1. “The immunization schedule will need to be al- tered.”
2. “The child should not receive any hepatitis vaccines.”
3. “The child will receive all of the immunizations
except for the polio series.
4. “The child will receive the recommended basic series of immunizations along with a yearly inFLuenza vaccination.”
- “The child will receive the recommended basic series of immunizations along with a yearly inFLuenza vaccination.”
- The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse would monitor for which indication that the child may be experiencing airway obstruction?
- The child exhibits nasal flaring and bradycardia.
- The child is leaning forward, with the chin thrust out.
- The child has a low-grade fever and complains of a sore throat.
- The child is leaning backward, supporting self with the hands and arms
- The child is leaning forward, with the chin thrust out.
Epiglottitis is a bacterial form of croup. A pri- mary concern is that it can progress to acute respiratory dis- tress. Clinical manifestations suggestive of airway obstruction include tripod positioning (leaning forward while supported by arms, chin thrust out, mouth open), nasal flaring, the use of accessory muscles for breathing, and the presence of stridor. Option 4 is an incorrect position. Options 1 and 3 are incor- rect because epiglottitis causes tachycardia and a high fever.
A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The parent becomes con- cerned because the child is frightened, consistently crying, and trying to climb out of the tent. Which is the most appropriate nursing action?
1. Tell the parent that the child must stay in the tent.
2. Place a toy in the tent to make the child feel more comfortable.
3. Call the pediatrician and obtain a prescription for a mild sedative.
4. Let the parent hold the child and direct the cool mist over the child’s face.
- Let the parent hold the child and direct the cool mist over the child’s face.
