Unit II Flashcards
- Fluid is squeezed from the lungs of the fetus during the birthing process
- Respiratory center in medulla is stimulated to initiate breathing
- Decrease of oxygen and increase of carbon dioxide in blood also stimulates respiratory center
process of birth
physiological differences btwn pediatric and adult lung
- Bronchi and bronchioles much smaller – airway of an infant is about the size of a cat’s airway
- Fewer alveoli
- Eustachian tubes shorter & more horizontal
- Tonsils and lymphoid tissue enlarged
how do neonates breathe?
through nose
difference between children and adults with oxygenation
- Narrower airways increase airway resistance
- Infant airways have less cartilage
- Infants have less respiratory mucus
- Increased respiratory & metabolic rates increase need for oxygen
Cardinal signs of respiratory distress in children
- Restlessness
- Increased respiratory rate
- Increased pulse rate
- Retractions
WET FROG
- Wheezing
- Effort
- Tachypnea
- Flaring (nasal)
- Retractions
- Oxygenation
- Grunting
Medications for Respiratory:
- Bronchodilators
- Corticosteroids
- Non-steroidal anti-inflammatories
- Diuretics
- Mucolytics
- Antibiotics
malformation of structures in nose
choanal atresia
failure of esophagus to develop, leading to a blind pouch
esophageal atresia
abnormal communication between trachea & esophagus
tracheoesophageal fistula
- multisystem disorder of exocrine glands, leading to increased production of thick mucus – mucus is about 3x as thick as a health person’s mucus
- Autosomal recessive trait
- Affects bronchioles, small intestines, pancreatic & bile ducts
- Chronic use of accessory muscles leads to development of barrel chest
Cystic Fibrosis
diagnosis of cysctic fibrosis
sweat test
Evaluate Cystic Fibrosis
- Family ability to follow home care regimen
- Child gains weight consistently
- Child participates in self care
- Child demonstrates ability to clear secretions, keep sats >94%
Nursing care for Cystic Fibrosis
- Monitor for respiratory distress
- Encourage coughing and deep breathing
- Administer meds
- Provide high calorie, high protein diet
- Give pancreatic enzymes
- Administer fat-soluble vitamins
- Avoid pulmonary treatments immediately after meals
chronic obstructive pulmonary disease occurring in infants after prolonged oxygen therapy and mechanical ventilation
Bronchopulmonary Dysplasia
- chronic inflammatory disorder of airways, characterized by hyper-reactivity to stimuli which results in spasms of bronchial muscles –>resultingin increased respiratory effort and increased airway resistance
- Bronchial smooth muscle constricts, edema in the lower airways and production of thick mucus increases.
- Expiration is impaired
Asthma
Diagnosis of Asthma:
- Reversible airway constriction (Pulmonary function tests) 20% improvement after bronchodilator administration
- Chest x-ray
- Presence of wheezing and dry cough
Viral infection causing inflammation, edema and narrowing of the larynx, trachea and bronchi; usually preceded by a recent upper respiratory infection.
Acute laryngotracheobronchitis (LTB) or Croup
What is Acute laryngotracheobronchitis (LTB) or Croup is caused by
parainfluenzae virus, influenza A & B, RSV and mycoplasma pneumonia (or many other respiratory viruses)
Acute laryngotracheobronchitis (LTB) or Croup is characterized by:
stridor, barking cough, use of accessory muscles, and low-grade fever (occasionally)
In acute laryngotracheobronchitis how do you decrease airway swelling quickly
administer racemic epinepherine
what can you administer to decrease inflammation and edema (longer acting) in respiratory problems
corticosteroids
what is the cardinal sign of pertussis?
paroxysmal cough, which causes bradypnea and bradycardia
what causes pertussis
bordatella pertussis
how is pertussis transmitted?
droplet, child/adult to a neonate
who is the most vulnerable population for pertussis
birth-2months
what does DtaP prevent, when is it given?
Pertussis, 2mo
inflammation of the bronchioles, Caused by a respiratory virus, most common from October – May every year, RSV is most common virus, symptomatic care
bronchiolitis
viral vs. bacterial, antibiotics may be necessary for improvement, most often occurs secondary to a respiratory illness
pneumonia
inflammation of the epiglottis, characterized by tripod positioning and child drooling
epiglottitis
inflammation of tonsils, most commonly caused by Strep or respiratory viruses
tonsillitis
What do you do to prevent food particles from entering trach tube whie feeding?
cloth bib over trach
how to bathe a child with a trach tube
baths, make sure to keep water from entering tube, showers not recommended
what is a cause of tracheal spasms
strong wind and cold, cover loosely to prevent
what can you use to clean around trach tube daily?
half strength saline and hydrogen peroxide and cotton-tipped applicators
how often do you change trach ties?
weekly
pulmonic valve
R. Ventricle to Pulmonary Artery
aortic valve
left ventricle to aorta
tricuspid valve
right atrium to right ventricle
mitral valve
left atrium to left ventricle
umbilical vein carries oxygenated blood from placenta to fetus, bypassing the liver. After the umbilical cord is clamped, ductus venosus closes and blood flows through the liver.
ductus venosus
systemic blood enters right atrium; oxygenated blood flows from right to left atria through the foramen ovale, bypassing the lungs.
foramen ovale
fistula between aorta and pulmonary artery allowing for mixing of blood
ductus arteriosus
oxygen is bound to hemoglobin on?
RBCs
Cardiac output is dependent on heart rate until child is how old?
5years old
- Heart conditions that do not cause deoxygenation or low oxygenation levels; skin and mucus membrane color is normally pink.
- Blood shunts from L R
- Pressure in left side of heart greater than right side
- Many of the septal defects close spontaneously on their own.
Acyanotic defects
- dyspnea, fatigue, poor growth, increased pulmonary blood flow.
- L to R shunting leads to hypertrophy in right side of heart; this in turn can lead to congestive heart failure
- Loud harsh murmur
Ventricular Septal Defect, most common defect
- foramen ovale fails to close - sometimes more of the atrial wall is missing
- L to R shunting
- Loud harsh murmur
Atrial Septal Defect
- Normal in fetal circulation
- Fails to close after birth
- Results in increased pulmonary blood flow (L to R shunt)
- Machine-like murmur
- Wide pulse pressure
- Bounding pulses
Patent Ductus Arteriosus
- Narrowing of aortic valve
- Infantile symptoms: faint pulses, hypotension, tachycardia, intolerance to feeding
- Symptoms in children: intolerance to activity, dizziness, chest pain, possible ejection murmur
Aortic Stenosis
- Narrowing of the pulmonary valve/artery
- Results in obstructed outflow from the right ventricle
- Variable cyanosis
- Systolic ejection murmur
Pulmonary Stenosis
- A narrowing of the descending aorta; restricts blood flow leaving the heart
- Obstructive Lesion
Coarctation of the Aorta
Symptoms:
- Blood pressure higher in upper extremities than lower extremities
- Upper pulses full, lower pulses weak
Coarctation of the Aorta
Management of symptoms of congestive heart failure:
- Furosemide
- Digoxin
- Ultimately, if the child is symptomatic and the defects fail to close on their own, surgery will be warranted.
- Child will require prophylactic antibiotics for any surgery or dental work
- Heart conditions that cause blood to contain less oxygen than required
- Skin and mucus membranes are usually bluish gray in color.
- R L shunting of blood means that unoxygenated blood mixes in with oxygenated blood and pumped throughout the body.
Cyanotic Heart Defects
Classic signs of cyanotic heart defects:
polycythemia, clubbed fingers, cyanosis of mucus membranes
- Aorta is connected to R ventricle instead of L
- Pulmonary artery is connected to L ventricle instead of R or a PDA must be present to oxygenate blood
- Variable cyanosis depending on size of defect
- Murmur
Transposition of Great Arteries
defect allows pooling of blood from left and right ventricles
ventricular septal defect
prevents blood in right ventricle from getting to lungs
pulmonic stenosis
causes pressure in right ventricle to be greater than that in left ventricle
Right Ventricular Hypertrophy
allows unoxygenated blood to be transferred all over the body
Displacement of aorta over ventricular septal defect
Classic symptoms of Tetrology of Fallot
- “Tet” spell caused by exertion; mucus membranes and extremities turn blue,
- Children will draw their legs up to their chest to improve blood flow.
- Complete closure of tricuspid valve resulting in mixed blood flow
- An ASD needs to be present to allow blood to enter L atrium
Tricuspid Atresia
Symptoms:
- Infant: cyanosis, dyspnea, tachycardia
- Children: hypoxemia, clubbing
Tricuspid Atresia
- Failure of septum formation
- Results in single vessel coming off of ventricles
Truncus Arteriosis
Symptoms:
- Murmur
- Heart failure
- Variable cyanosis
- Delayed growth
- Fatigue
- Poor feeding to FTT
Truncus Arteriosis
- L side of heart is underdeveloped
- An ASD or PFO allows for oxygenation of blood
Hypoplastic Left Heart Syndrome
Symptoms:
- Cyanosis (mild)
- Heart failure
- Lethargy
- Cool extremities
- Demise once PDA closes
- Needs surgery quickly
Hypoplastic Left Heart Syndrome
- Inflammatory disease resulting from a GABHS infection in throat
- Occurs 2-6 weeks following an untreated or partially treated GABHS infection
Rheumatic Fever
Symptoms: macular rash on trunk (erythema marginatum), polyarthritis, cardiac involvement, CNS involvement
Rheumatic Fever
Treatment for Rheumatic Fever
long term antibiotic therapy
- Acute systemic vasculitis – especially cardiac (think aneurysms!)
- Acute phase: onset of high fever that is unresponsive to antipyretics along with other symptoms (rash, strawberry tongue, hand/feet swelling, joint pain)
- Subacute phase: fever resolves, irritability, peeling skin around nails, palms and soles
- Convalescent: no clinical manifestations
- Resolves in 6-8 weeks from onset
Kawasaki Disease
Kawasaki’s Disease
