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week 2 acute respiratory Flashcards

1
Q

children vs adult - smaller airway size (size of pinky)

A

children

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2
Q

children vs adult - belly breathers or chest breathers

A

children are belly breathers, adults are chest breathers

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3
Q

children vs adult - larynx and glottis are higher in the neck

A

children

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4
Q

children vs adult - distance between structures are shorter (infection spreads more easy)

A

children

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5
Q

children vs adult - have fewer number of alveoli

A

children

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6
Q

children vs adult - ribs are more horizontal (barrel chest)

A

children

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7
Q

children vs adult - eustachian tubes are more horizontal

A

children, mucus cant drain as well as adults

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8
Q

children vs adult - higher metabolic rate

A

children

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9
Q

children vs adult - ribs and sternum are more pliable

A

children

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10
Q

cardinal signs of respiratory distress

A

tachypnea
tachycardia
diaphoresis
change in LOC
change in color - cyanosis
restless
irritability
anxiousness
increased work of breathing (grunting, nasal flaring, retractions, head bobbing)
adventitious breath sounds (grunting, stridor, wheeze)
absent breath sounds
cough

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11
Q

explain the differences between
mild respiratory distress retractions,
moderate respiratory distress retractions, and
severe respiratory distress retractions

using:
subcostal (low rib)
suprasternal (top sternum)
supraclavicular (clavicles)
intercostal (between the rib cage spaces)
use of other accessory muscles in the neck

A

mild distress – intercostal rib space retractions

moderate distress – subcostal (low rib), suprasternal (top sternum) and supraclavicular (clavicles) retractions

severe distress – subcostal (low rib), suprasternal (top sternum) and supraclavicular (clavicles) retractions and use of accessory muscles in the neck

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12
Q

should we be concerned if an infants RR is 50?

A

yes 30-40 is normal range

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13
Q

should we be concerned if a childs RR is 12?

A

yes 20-24 is normal range

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14
Q

should we be concerned if an adolescents RR is 12?

A

yes 16-18 is normal range

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15
Q

general nursing interventions for respiratory distress

A
  1. ease respiratory effort, promote rest, promote comfort
  2. prevent spread of infection
  3. promote hydration and nutrition
  4. fever management
  5. family support and teaching
  6. provide support and plan for home care
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16
Q

how can we ease respiratory effort, promote rest, promote comfort for our respiratory distress patient?

A
  • positioning – sit up or prop up
  • warm or cool mist (no steam vaporizers)
  • mist tent
  • saline nose drops with bulb suctioning
  • bedrest of quiet activities
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17
Q

how can we prevent spread of infection for our respiratory distress patient?

A
  • handwashing
  • teaching
  • patient room assignments
  • immunizations
  • antibiotics
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18
Q

how can we promote hydration and nutrition for our respiratory distress patient?

A
  • high calorie fluids (Pedialyte)
  • avoid caffeine
  • allow child to self-regulate diet (if they don’t eat that’s ok, but they must be drinking)
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19
Q

whats more important in a child - eating regularly or adequate fluid intake?

A

(if they don’t eat that’s ok, but they must be drinking)

especially infants/toddlers

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20
Q

how can we manage a fever for our respiratory distress patient?

A

-low grade fever ok (less than 101.4 F)
-antipyretics to reduce fever
- fluids (water, clear broth)
- rest, comfort
- cold compress

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21
Q

what specific therapies can we provide to improve oxygenation (6)

A
  1. coughing
  2. deep breathing – bubbles, pin wheels
  3. aerosolized nebulizer medications
  4. percussion and postural drainage - Clapping or vibrating chest wall to loosen mucus; Positioning to drain mucus using gravity
  5. CPT (chest physiotherapy) - These techniques include percussion, postural drainage, vibration, deep breathing exercises, and coughing techniques.
  6. Supplemental oxygen
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22
Q

oxygen delivery methods:
1. nasal cannula
2. simple face mask
3. nonrebreather face mask
4. intubation
5. tracheostomy
6. bubble/CPAP
7. NHF (nasal high flow)

give flow rate - low, medium, high

give oxygen needs - mild, moderate, high

any other reason this method would be needed

A
  1. low flow rate, mild to moderate oxygen needs
  2. low to medium flow rate, moderate oxygen needs, can’t tolerate nasal cannula
  3. medium to high flow rate, moderate to severe oxygen needs, high oxygen concentration
  4. endotracheal tube inserted through nose/mouth down trachea to deliver oxygen directly, high flow rates, severe oxygen needs, can’t breath on their own
  5. create an opening in trachea through the neck where a tracheostomy tube is inserted, high flow rates, require long term oxygen therapy or can’t tolerate endotracheal tube
  6. low to moderate flow rate, premature infants with underdeveloped lungs
  7. high flow rate nasal cannula, moderate to severe oxygen needs, can’t tolerate face mask, less invasive alternative to intubation
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23
Q

General clinical manifestations of Respiratory infections in infants and children

A

Fever
Meningismus – sore neck, headache, light sensitivity
Anorexia – not hungry
Vomiting
Diarrhea
Abdominal pain
Nasal blockage and/or discharge
Respiratory sounds
Sore throat

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24
Q

does Nasopharyngitis AKA upper respiratory infection (URI) AKA the common cold require antibiotics?

A

Virus = Don’t need antibiotics

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25
Q

bacteria or virus requires antibiotics?

A

bacteria

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26
Q

2 year old girl has Nasopharyngitis AKA upper respiratory infection (URI) AKA the common cold, can you give OTC cold meds to her?

A

no, cant give OTC cold meds to children under 3

give her tylenol/advil to manage symptoms

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27
Q

5 year old boy has Nasopharyngitis AKA upper respiratory infection (URI) AKA the common cold and a fever of 102.1F

what should you do

A

assess respiratory and fluid status,
administer antipyretics (medications to reduce fever like acetaminophen)
Rest
comfort symptoms

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28
Q

5 year old boy has Nasopharyngitis AKA upper respiratory infection (URI) AKA the common cold and a fever of 101.1F

what should you do

A

Low grade fever can be beneficial (<101.4)
assess respiratory and fluid status,
Rest
comfort symptoms

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29
Q

what should mom give to an older child to manage Nasopharyngitis AKA upper respiratory infection (URI) AKA the common cold

decongestants, cough suppressants, cold meds
OR
antihistamines, antibiotics, expectorants

A

decongestants, cough suppressants, cold meds

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30
Q

Rhinovirus
Adenovirus
influenza virus
para-influenza virus
are causes of which acute respiratory condition

A

Nasopharyngitis AKA upper respiratory infection (URI) AKA the common cold

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31
Q

fever
irritability
restlessness
sneezing
vomiting/diarrhea

are clinical manifestations of Nasopharyngitis AKA upper respiratory infection (URI) AKA the common cold in a young or old child?

A

young

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32
Q

dryness and irritations of nose and throat
sneezing
chills
muscular aches
cough
edema and vasodilation of mucosa

are clinical manifestations of Nasopharyngitis AKA upper respiratory infection (URI) AKA the common cold in a young or old child?

A

older

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33
Q

how to treat a cold
C
O
L
D

A

comfort symptoms
offer fluids
look for complications - breathing, fever
decrease disease spread

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34
Q

sore throat tested negative for strep is called

A

tonsillitis

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35
Q

is tonsillitis bacterial or viral

A

can be either
a rapid test will determine
commonly viral

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36
Q

how do we treat viral tonsillitis

A

no antibiotics
treat symptoms

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37
Q

bacterial pharyngitis AKA

A

strep throat

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38
Q

sore throat tested positive for strep

A

bacterial pharyngitis

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39
Q

7 year old boy has these clinical manifestations, what should we expect is the acute respiratory condition?

Sudden onset
Sore throat – inflamed tonsils, exudate on tonsils
Headache
Fever
Vomit
Cervical Lymphadenopathy – swollen lymph nodes in neck
Abdominal pain
Beefy red throat
Bad breath

A

strep/pharyngitis

40
Q

risk of untreated strep/pharyngitis (5)

A
  1. Acute rheumatic fever – serious inflammatory disease
  2. Acute glomerulonephritis – inflammation of the kidneys
  3. Impetigo – bacterial skin infection
  4. Pyoderma – painful ulcers on legs
  5. Scarlett fever – bacterial illness
41
Q

how should mom treat Bobby’s strep/pharyngitis - select all that apply

10-day antibiotic

warm/cold compress on throat

tylenol/ibuprofen

gargle warm saline

A

ALL OF THE ABOVE

10-day antibiotic

Comfort/Treat symptoms – warm/cold compress on throat, tylenol/ibuprofen, gargle warm saline

42
Q

what should the nurse teach the parents regarding strep/pharyngitis?

What should the nurse say when mom asks when Bobby can return to school?

A

new toothbrush 24 hours after starting antibiotics,

stay hydrated,

don’t share food/drinks,

wash or replace orthodontics gear

Can return to school 24 hours after starting antibiotics

43
Q

which treatment is only indicated if strep is recurrent and frequent (or sleep apnea)

A

tonsillectomy

44
Q

3 year old girl has a cleft palate and strep is recurrent and frequent. would she be a good candidate for a tonsillectomy?

A

NO

Contraindications:
Cleft palate
Acute infections
Uncontrolled systemic disease or blood dyscrasias
Age <4 years

45
Q

5 year old 4 hours post op tonsillectomy, is drooling some blood tinged sputum. should we be concerned?

A

No - this is not a sign of excessive bleeding

bright red blood, excessive swallowing, constant clearing of throat

46
Q

7 year old 2 hours post op tonsillectomy, is drooling bright red blood, is swallowing excessively, and constantly clearing throat. should we be concerned?

A

yes - s/s of excessive bleeding

47
Q

nursing considerations for tonsillectomy:

bleeding
positioning
NO ___
diet
watch for ___
comfort measures
discharge teaching

A
  1. Watch for s/s of excessive bleeding (bright red blood, excessive swallowing, constant clearing of throat). Inspect secretions and vomitus for excessive bleeding – some blood tinged sputum and drooling is ok
  2. Positioning
  3. No straws, coughing, laughing, crying, suctioning
  4. Diet – soft diet, nothing red color, no milk
  5. Watch for swelling and airway compromise – stridor, respiratory distress signs
  6. Comfort ice collar, Pain management, Cool mist vaporizer
  7. Discharge teaching – bleeding risk again at days 8-10, watch for signs of excessive bleeding
48
Q

which ear condition is this

Inflammation/infection of outer ear (before eardrum)

Water trapped by earwax = growth medium for bacteria

Caused by bacteria or dermatitis

A

Otitis externa (OE) AKA external otitis AKA swimmers ear

49
Q

which ear condition would we suspect with these s/s

Pain – disproportionate, increases with movement

Drainage – serosanguineous, purulent

A

Otitis externa (OE) AKA external otitis AKA swimmers ear

50
Q

which ear condition would we suspect with these s/s

Otalgia - Ear pain
Irritable infants
Holds or pulls ear
Roll head from side to side
Fever up to 104
Ruptured tympanic membrane
Hearing loss (chronic)

A

Otitis Media (OM)

51
Q

how to treat Otitis externa (OE) AKA external otitis AKA swimmers ear

A

Antibiotic/steroid drops

Prevention – keep ear dry, drain water from ear

52
Q

which ear condition is this

Infection of middle ear (after eardrum)
Associated with collection of fluid or pus

Most prevalent disease of early childhood
Peak: 0-24 months and 5-6 years
Decline: after 24 months

A

Otitis Media (OM)

53
Q

risk factors for otitis media (OM)

A
  1. Anatomical structure
  2. Age
  3. Gender – males more likely
  4. Non-breast fed infants
  5. Infants are usually lying down
  6. Exposure to cigarette smoke, many people
  7. Bottles in bed
  8. Unimmunized
  9. Pacifier beyond infancy
  10. Family Hx of OM
  11. Allergic rhinitis
  12. Acquired immune deficiencies
  13. Craniofacial anomalies
  14. Winter
54
Q

Therapeutic management for acute otitis media

A

Teach parents prevention methods (see risk factors)

Analgesia for earache – Tylenol/ibuprofen, heat or cold compress, pain relief drops

Antibiotic therapy (amoxicillin)
if they are
1. younger than 6 months
2. have Bilateral AOM and ages 6-23 months
3. older than 6 months with ear drainage, high fever, ear pain lasting longer than 48 hours

55
Q

Therapeutic management for Chronic OM

A

PE tubes = (pressure equalization) tympanostomy tubes

56
Q

teaching for PE tubes

A
  1. NO diving, jumping, prolonged submersion in water
  2. NO swimming in lakes, rivers
  3. AVOID pressure postoperatively
  4. AVOID straining, laughing, coughing
  5. Wear ear plugs in water
57
Q

8 year old with presents with:
swelling or obstruction in the region of the larynx
hoarseness
barky cough
inspiratory stridor
varying degrees of respiratory distress

we are expecting

A

general “croup” syndromes - viral

58
Q

2 types of croup

A

“croup” = viral croup

epiglottis = bacterial croup

59
Q

which type of croup is this

Inflammation of the mucosal lining of the larynx, trachea, and bronchi causing narrowing of the airway

Ages: <5 years old

Slow progression – may develop into influenza or bronchiolitis

A

croup = viral

60
Q

1 year old presents with:

  1. Epiglottis becomes swollen, occluding airway
  2. Trachea swells, restriction airway
  3. Mucosal inflammation and edema narrow airway = stridor
  4. Sudden onset of harsh, metallic, barky cough
  5. Inspiratory stridor or hoarseness
  6. Respiratory distress
  7. retractions
  8. Agitation
  9. Pallor or cyanosis
  10. Increased HR
  11. Extreme restlessness
  12. listlessness (lack of energy)
  13. Hypoxia

which acute respiratory distress condition do we expect

A

swelling
hoarseness
BARKY COUGH
stridor
respiratory distress

= viral “croup”

61
Q

therapeutic management for viral “croup”

A
  1. Priority = airway, breathing
  2. Stay clam
  3. High humidity with cool mist, croup tent
  4. Humidified oxygen
  5. Adequate fluid intake
  6. Comforting measures
  7. Racemic epinephrine – medication treats croup, watch for rebound (worsening of symptoms after meds wear off)
  8. corticosteroids
  9. AVOID cough syrup, cold medicines, bronchodilators and antibiotics (not helpful)
62
Q

signs of increasing severity of croup

RR - increase/decrease
agitation - increase/decrease
restlessness - increase/decrease
anxiety - increase/decrease
LOC - increase/decrease
cyanosis - absent/present

A

Increasing RR (infants >60 = NPO b/c of aspiration risk)

Increasing agitation, restlessness, anxiety

Decreasing LOC

Cyanosis

63
Q

infant RR are 65 what precaution must we take

A

RR (infants >60 = NPO b/c of aspiration risk)

64
Q

your neighbor tells you her 1 year old daughter has:

Stridor at rest
Cyanosis
Severe agitation or fatigue
Moderate to severe retractions
Inability to take oral fluids

what would you recommend?

A

seek emergency care

emergency care necessary

r/t to viral croup

65
Q

which type of croup is this

Serious life threatening obstructive inflammatory process

Ages: 2-5 years old

Caused by H influenza B (prevented by Hib vaccine) or streptococcus pneumoniae

A

“Epiglottitis” = bacterial croup

66
Q

which vaccine can help prevent “Epiglottitis” = bacterial croup

A

Caused by H influenza B (prevented by Hib vaccine)

67
Q

2 year old presents with

  1. Abrupt onset starts with sore throat and cold symptoms
  2. High fever
  3. Mouth open
  4. Tongue protruding
  5. Drooling
  6. Agitation
  7. Looks very sick
  8. Sitting up/tripod position
  9. Sore red inflamed throat
  10. Difficulty swallowing
  11. Muffled voice
  12. Inspiratory stridor
  13. NO spontaneous cough

what acute respiratory distress condition do we suspect?

A

“Epiglottitis” = bacterial croup

drooling
sitting up/wont lie back
no spontaneous cough
dysphagia
difficulty talking
distressed inspiratory efforts

68
Q

if you suspect “Epiglottitis” = bacterial croup

what should you do:

do respiratory and mouse/mouth/throat assessment

transport for xray of lungs

prepare crash cart, for sedation and intubation

A
  1. If you think it is epiglottis it is epiglottis
  2. React off s/s alone, don’t do an assessment
  3. Priority = maintain the airway
  4. NO tongue blades
  5. DO NOT look at the throat
  6. NO x-ray and transport
  7. Remain clam – let parents stay with child
  8. Prepare crash cart, sedation and intubation
69
Q

3 year old presents with

drooling
sitting up/wont lie back
no spontaneous cough
dysphagia
difficulty talking
distressed inspiratory efforts

what should you do

A
  1. If you think it is epiglottis it is epiglottis
  2. React off s/s alone, don’t do an assessment
  3. Priority = maintain the airway
  4. NO tongue blades
  5. DO NOT look at the throat
  6. NO x-ray and transport
  7. Remain clam – let parents stay with child
  8. Prepare crash cart, sedation and intubation
70
Q

later treatment for epiglottis:

disease precautions?

diagnostic tests?

antipyretics or antibiotics?

when should we see improvement?

when can we expect discharge?

A
  1. Droplet precautions
  2. Throat and blood specimen are obtained for culture are child is intubated
  3. Antipyretics for fever
  4. Antibiotics per IV until child is extubated
  5. Usually dramatic improvement after 48 hours of antibiotic therapy and can be extubated
  6. Antibiotic treatment 7-10 days
  7. Discharge can occur in about 3-7 days with a regimen of oral antibiotics continued at home
71
Q

what acute respiratory distress condition do we suspect?

Acute viral infection resulting in inflammation of the smaller bronchioles, too much thick mucus, causes obstruction, impairs gas exchange

Age: <2 years old, peaks at 2-5 months

A

Bronchiolitis/RSV

72
Q

4 month old presents with:

  1. Apnea (may be 1st sign)
  2. Rhinorrhea – runny nose
  3. Pharyngitis – sore throat
  4. Coughing/sneezing
  5. Wheezing, crackles, decreased lung sounds
  6. Eye/ear infection
  7. Intermittent low-grade fever
  8. Difficulty feeding
  9. Irritability
  10. Tachypnea
  11. Air hunger
  12. Retractions
  13. Cyanosis
  14. THICK MUCUS

what acute respiratory distress condition do we suspect?

A

Bronchiolitis/RSV

73
Q

what is the treatment for a 2 month old with severe risk of Bronchiolitis/RSV?

What is treatment for a 2 month old with low risk of Bronchiolitis/RSV?

A

Priority = airway maintenance

Symptomatic treatment
and Supportive care:
protect airway,
Suction,
Oxygen therapy,
humidity,
antipyretics,
rest,
fluids

Medications – ribavirin (for kids with severe risk), bronchodilators (usually not used), corticosteroids (controversial)

74
Q

1 year old girl with congenital defects and severe immune deficiencies.

Her mom asks if she would be a good candidate for synagis, the brochoiolittis/RSV vaccine?

If so, what education would you provide the parents?

A

Synagis – vaccine for at risk kids under 2 years old

“at risk” =
Sever immune deficiencies
Congenital defects
Chronic lung disease
<29 weeks gestation

Expensive

IM injection monthly (nov – April)

75
Q

what acute respiratory distress condition involves Inflammation of the alveoli

A

Pneumonias

76
Q

Causes:
Viral
Mycoplasma
Bacterial (most common)
Aspiration

what acute respiratory distress condition do we suspect?

A

Pneumonias

77
Q

6 year old presents with

Fever - mild to high
Chest pain
Dullness to percussion
Nonproductive cough
Rhonchi or fine rales
Decreased breath sounds
Respiratory distress

what acute respiratory distress condition do we suspect?

A

Pneumonias

78
Q

which treatment/nursing care is appropriate for pneumonia: SATA

humidified oxygen

antibiotics

bronchodilators

lie flat

chest tube

postural drainage/CPT

A
  1. Humidified oxygen
  2. Antibiotics
  3. Bronchodilators
  4. Chest tube for purulent drainage
  5. Postural drainage or CPT
  6. Supportive and symptomatic care
  7. Rest
  8. Hydration
  9. Elevate HOB and position comfortably
  10. Watch for increased signs of respiratory distress
  11. Watch pulse ox
79
Q

which acute respiratory distress condition do we suspect?

Caused by
Bordetella pertussis (can be prevented with vaccine)

Unimmunized children ages:
<4 years old
>10 years old

Clinical manifestations
<6 months = apnea
>6 months = cough

A

Pertussis (whooping cough)

80
Q

you see in the EHR that a 9 year old doesnt have his TDap. What acute respiratory distress condition is he at risk for with out the pertussis vaccine?

A

Pertussis (whooping cough)

81
Q

Therapeutic management and nursing considerations for Pertussis (whooping cough)

A

Erythromycin

Humidified oxygen

Maintain hydration

Watch for and prevent pneumonia

<6 months = ventilator support

82
Q

resistance to TB in infants - decreased/increased

resistance to TB in puberty - decreased/increased

resistance to TB in adolescence - decreased/increased

A

all decreased

83
Q

common symptoms of which acute respiratory distress condition:

Asymptomatic
Malaise
Fever
Night sweats
Slight cough
Weight loss
Anorexia
Lymphadenopathy

A

TB

84
Q

true or false

TB disease children are rarely hospitalized

A

true

85
Q

true or false

TB disease children must adhere to medication

A

true

86
Q

true or false

TB disease children cant attend school until their skin test is negative

A

false

can attend school once on therapy and clinical s/s reduced

once person has been exposed and develops antibodies, they will always test positive even if disease is not active

87
Q

which TB diagnostic test is best to confirm presence of the active disease:

skin

xray

A

TB disease = positive skin test, chest x-ray positive, s/s of disease

once person has been exposed and develops antibodies, they will always test positive even if disease is not active

88
Q

true or false

nutrition is just as important as medication in TB disease children

A

true

89
Q

30 week old presents with:

Apnea >20 seconds
Color change – cyanosis or pallor
Marked change in muscle tone
Choking or gagging

which acute respiratory distress condition do we suspect?

A

Apnea of Infancy AKA apparent life threatening event (ALTE)

Ages: >37 weeks gestation

90
Q

mom asks what caused her 20 week old child to have an Apnea of Infancy AKA apparent life threatening event (ALTE). what do you tell her?

A

Causes
Idiopathic
Symptoms of other disorders

91
Q

Therapeutic management of Apnea of Infancy AKA apparent life threatening event (ALTE).

A

Continuous cardiorespiratory monitoring until episode free for 6 months

Methylxanthine – caffeine, used for premature babies

92
Q

Nursing considerations for Apnea of Infancy AKA apparent life threatening event (ALTE).

A

Family support

SIDS risk increases

Education of caregivers
-CPR
-Attend infant not cardiorespiratory monitor (monitor could be malfunctioning)
-No extension cords
-Interference with tv, radio, cell phones, police scanner
-Emergency # on phone

93
Q

Sudden death of a child under 1 years old that occurs during sleep and remains unexplained after a complete post mortem examination, including an investigation of the death scene and a review of the case history

A

Sudden infant death syndrome (SIDS)

94
Q

what disorder is this baby at high risk for

-non-white
-male
-lower socioeconomic class
-currently winter months
-born premature
-low apgar score
-not breast fed
-mother is 16 years old
-mother was unaware she was pregnant until 3rd trimester
-mother cosleeps with baby in bed

A

Sudden infant death syndrome (SIDS)

  1. Race – non white
  2. Gender – male
  3. Premature or low birth weight infants
  4. Multiple births – twins, triplets, etc.
  5. Low apgar score – test assesses physical condition of newborns
  6. CNS disturbances and respiratory disorders
  7. Later birth order – 4th, 5th, etc.
  8. Overheating
  9. Unsafe sleeping arrangements
  10. Bottle fed
  11. Young mother
  12. Prenatal and postnatal smoking
  13. Substance abusers
  14. Poor prenatal care
95
Q

what teaching should the nurse give a mom to prevent SIDS

A

Teach – “back to sleep”

Teach - Safe sleeping arrangements
No pillow or toys in crib
70-72 F
No extra clothes – just onesie and sleeper outfit
Don’t co sleep

96
Q

which acute respiratory distress conditions that we learned about are viral

A

tonsillitis

croup

Bronchiolitis/RSV

some pneumonias

Nasopharyngitis AKA upper respiratory infection (URI) AKA the common cold

97
Q

which acute respiratory distress conditions that we learned about are bacterial

A

epiglottitis

pneumonias

strep

TB

pertussis (whooping cough)?

Otitis externa (OE) AKA external otitis AKA swimmers ear

Otitis Media (OM)?

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