Week 2 Chapter 40 Flashcards
Newborns nasal passages are very
Small and more prone to obstruction
Obligate nose breathers and produce very little mucus
More susceptible to infections
Sinuses are not developed
Infants
Increased risk for airway obstruction
Tongue is larger in relation to oropharynx
Children have enlarged tonsillar and adenoid tissue
Throat of the infant
Bifurcation of trachea of third thoracic vertebra
True
Important when suctioning or intubation children
How are the bronchioles of infants and children
Narrower
Increase risk for lower airway obstruction
Smaller numbers in alveoli in infants
Higher risk of hypoxemia
Symptoms of increased work of breathing
Tachypnea
Nasal Flaring
Chest Retractions
Grunting
Children have lower metabolic rate compared to adults
False
Resting RR faster
O2 demand is higher
Adults consume how many L O2?Children?
3-4 L /min
6-8 L/ min
Infants and children will develop hypoxemia more rapidly
RR vary with activity and excitement
Count 1 min
Children are abdominal breathers
Babies are nose breathers to be able to nipple feed
Risk Factors of Respiratory Disorders
Prematurity
Chronic illness
Developmental Disorders
Passive exposure to cigarette smoke
Immune Deficiency
Crowded living conditions or lower socioeconomic status
Daycare attendance
Inspection and Observation of Respiratory Disorders
Anxiety and restlessness
Pallor, cyanosis
Hydration Status
Clubbing
Breath Sounds
Rate and Depth of Respirations: Tachypnea
Respiratory Effort
Nose and Oral Cavity
Cough and other airways noises : stridor
Softening of the tissues of the larynx
Laryngomalacia
High Pitched Sound on inspiration or expiration
May Occur with obstruction in lower trachea or bronchioles
May occur in asthma or viral infections
Wheezing
Crackling sounds heard when alveoli become fluid filled
May Occur with pneumonia
Rales
High pitch squeak sound on inspiration
Heard without a stethoscope or over the trachea
Sign of Upper Airway Infection
May occur in epiglottitis or laryngomalacia
Stridor
Inward pulling of soft tissues with respirations
Retractions
Note use of accessory neck muscles
Mild
Moderate
Severe
Severity grading of reactions
Paradoxical Respirations
See saw chest falls on inspiration and rises on expiration
Oxygen saturation might be decreased significantly
Pulse Oximetry
Chest Radiograph may reveal
Hyperinflation and patchy areas of atelectasis or infiltration
What may blood gases show?
Co2 retention and hypoxemia
Positive Identification of RSV other viral illness via enzyme linked immunosorbent assay (ELISA) or immunofluorescent antibody IFA testing
Rapid strep testing via throat swab
Nasopharyngeal Washings
Common Medical Treatments for Respiratory Diseases
Oxygen
High Humidity
Suctioning
Chest Physiotherapy and Postural Drainage
Saline gargles or Lavage
Mucolytic Agents
Chest Tubes
Bronchoscopy
22-44% oxygen concentration max is 4L/min
Nasal Cannula
2-60L/Min
High Flow Nasal Cannula
Easily set up and well tolerated and creates positive pharyngeal pressure to reduce the work of breathing
In children flow rates greater than 6L/min considered high flow
35-60 % oxygen concentration
Simple Mask
6-10 L/min
50-60% O2 concentration and flow rate is 10-15 L/min
Partial Rebreathing
Nonrebreathing Mask
95 O2 concentration
Simple Facemask with valves and reservoir
10-15 L/min
Oxygen Hood
up to 80-90%
Infants only
Oxygen Tent
High humidity Environment up to 50% oxygen concentrationI
Name Acute Infectious Disorders
Common Cold
Influenza
Croup
Pharyngitis, tonsilitis, and laryngitis
RSV
Pneumonia and Bronchitis
Nasal Discharge is thin watery clear and length of illness varies
Allergic Rhinitis
Fever and bad breath is absent
Nasal discharge is thick, white, yellow, or green and can be thin
Common cold
10 days or less
Bad Breath is absent
Sinusitis nasal discharge is
Thick yellow or green
Longer 10-14 days
Sneezing is absent
Viral Upper Respiratory Infection
Common Cold
Caused by
Rhinovirus
Parainfluenza
RSV
Enteroviruses
Adenoviruses
Human Metapneumovirus
Potential Complications of Common Cold
Secondary Bacterial Infections of the ears, throat, sinuses, or lungs
Therapeutic Management includes normal saline and symptom relief
Influenza Viral Infection is spread through
Droplets with fine aerosols
Infected children shed the virus
True
1-2 days before symptoms begin
Up to two weeks
Complications of Influenza
Otitis Media
Reyes Syndrome
Pnemoniccal Pneumonia
Nurse Management Influenzas
Antiviral agents - dines and -virs
Supportive Treatment
Children over 6 months be immunized early
Inflammation of throat mucosa
Pharyngitis
Sore Throat
Viral sore throat shows
Nasal Congestion
Symptomatic relief - Analgesics, salt water gargles
Bacterial Sore Throat shows no
Congestion
Group A StreptococciCo
Complications of Pharyngitis
Peritonsillar Abscess
Retropharyngeal Abscess
Acute Rheumatic Fever
Acute Glomerulonephritis
Throat Culture and antibiotic therapy
Pharyngitis
Use Penicillin generally
Inflammation of tonsils that may show muffled voice, pooling saliva
Tonsilitis
May show Trismus- Inability to open mouth - Report to MD
Surgical Removal of Palatine tonsils
Recurrent streptococcal tonsilitis
Tonsillar hypertrophy
Adenoidectomy ( removal of adenoids)
Tonsillectomy
Trismus
Immediate attention
tonsillar abscess- collection of pus - prevents the mouth from opening in a blocked airway
Nursing Post Care tonsillectomy
Promoting airway clearance
Maintaining Fluid Volume
- Discourage coughing
Encourage: fluid, avoid citrus, brown or red fluids
How to relieve pain from tonsillectomy
Ice collar and analgesics with or without narcotics
- Frequent swallowing may indicate bleeding
Virus caused by Epstein Barr
Infectious Mononucleosis
- Monospot, Epstein-Barr Virus Titers
S/S of Mononucleosis
Fever
Malaise
Sore Throat
Lymphadenopathy
Called Kissing disease common in adolescents
Complications of Mono
Splenic Rupture
Gulen Bares Syndrome
Aseptic MeningitisN
Nursing management
Symptomatic Tx- Analgesics, salt water gargles, bedrest
Most affected children are 3 months to 3 years of age
Inflammation and edema of the larynx, trachea, and bronchi
Croup
Referred to as Laryngotracheobronchitis
Parainfluenza is a viral infection of
Upper Airway
Audible Inspiratory Stridor
Croup Barking seal like cough
Nursing Management of Croup
Corticosteroids
Racemic Epinephrine aerosols
Exposure to humified air ( Open freezer or humidifier
- Children may be hospitalized if they have stridor at rest or severe retractions after several - hour period of observation
Caused by HIB and its rare with HIB Vaccine
Epiglottitis
- Respiratory arrest and death may occur if airway becomes completely occluded
S/S of Epiglottis
Dysphasia
Drooling
anxiety
Restlessness
Tripod
Respiratory Distress
Complications of Epiglottis
Pneumothorax and pulmonary edema
Therapeutic Management of Epiglottis
Airway Maintenance
IV Antibiotics
Assist with emergency Tracheostomy
PICU admission
Nursing Management of Epiglottis
DONTs
Attempt to visualize throat - reflex laryngospasm may occur, precipitating immediate airway occlusion
No oral temperature
Leave the child unattended
Place child in supine position
Nursing Management of Epiglottis
Dos
Provide 100% oxygen in the least invasive manner
Ensure tracheostomy and emergency equipment readily available
Acute Inflammatory response process of the bronchioles and bronchi and caused by RSV
Occurs Most often in infants and toddlers
Hypoventilation occurs because of increased work of breathing
Bronchiolitis
S/S of Bronchiolitis
Onset of illness with a clear runny nose (sometimes profuse)
Pharyngitis
Low grade fever
Development of cough 1-3 days into the illness, followed by wheeze shortly after
Poor Feeding
Therapeutic Management of Bronchiolitis
Supportive Tx
- Supplemental Oxygen, suctioning, hydration, inhaled bronchodilator therapy
(Racemic Epi or Albuterol)
- Administer Synagis ( Palivizumab) -monoclonal antibody vaccination to prevent severe RSV
Inflammation of the lung parenchyma
Pneumonia
Caused by virus, bacteria, mycoplasma or a fungus
Children with bacterial pneumonia present with a _____________ appearance
Toxic
- Streptococcus Pneumonia
- M. Pneumoniae
- Treated with appropriate antibiotics
S/S of Pneumonia
History of viral URI, fever, cough, increased RR, infants- lethargy, poor feeding, vomiting, diarrhea,
Older children- chills, headache, dyspnea, chest pain, abdominal pain, N/V
Complications of Pneumonia
Bacteremia, plural effusion, empyema, lung abscess-( requires chest tube and/or thoracentesis)
Therapeutic Management of Pneumonia
Antipyretics
Adequate hydration
Close Observation
Pneumonia Laboratory Diagnostic Tests
Pulse Oximetry- might be decreased significantly or within normal range
Chest X ray- Varies according to child age and causative agent
Sputum Culture- May be useful in determining causative bacteria in older children and adolescents
WBC- Might be elevated in the case of bacterial Pneumonia
Highly contagious disease caused by inhalation on droplets of mycobacterium tuberculosis or bovis
Tuberculosis
-Incubation is 2-10 weeks
S/S of Tuberculosis
Fever, malaise, weight loss, anorexia, pain and tightness in the chest, hemoptysis(rare)
6 Month Course of Oral Therapy
2 months Rifampin, isoniazid, pyrazinamide
Followed by twice weekly isoniazid and rifampin for 4 months
Children who test positive but do not have symptoms or radiographic/ laboratory evidence of the disease are considered ..
Latent Infection
Children contract Tb usually by?
Household member
TB can spread by the bloodstream and lymphatic system to other parts of the body ( GI Tract or CNS)
Risk Factors for TB
HIV Infection
Incarceration or institutionalized
Positive recent history of latent TB
Immigration or travel to endemic countries
Exposure at home to HIV infected or homeless persons, illicit drug users, persons recently incarcerated. migrant farm workers or nursing home residents
Epistaxis
Recurrent or difficult to control should be elevated for underlying bleeding or platelet concerns.
Foreign Body Aspiration
Common in 6months - 3 years of age.
ARDs
Sepsis, viral pneumonia, smoke inhalation, near drowning
Pneumothroax
Collection of air in pleural spaces
Pneumothorax
Risk Factors of Pneumothorax
Chest Trauma/ Surgery
Intubation or mechanical ventilation
Hx of chronic lung disease as cystic fibrosis
S/S of Pneumothorax
Chest Pain, Tachypnea, retractions, nasal flaring, grunting, pallor, cyanosis, absent of diminished breath sounds on affected side
Therapeutic Management of Pneumothorax
Needle Aspiration
Placement of Chest Tube
Chronic Respiratory Disorders
Allergic Rhinitis- Associated with atopic dermatitis and asthma
Asthma
Chronic Lung Disease ( Bronchopulmonary dysplasia)
Cystic Fibrosis
Apnea- Absence of breathing for 20 seconds- Bradycardia
Chronic inflammatory airway disorder
- Airway hyperresponsiveness
- Airway edema
- Mucus production
Asthma
Results in airway obstruction that might be partially or completely reversed
Allergens or triggers- Dust mites, pet dander, cockroach antigens, pollen, molds
Asthma
S/S of Asthma
Tachypnea
Increased work of breathing
Cough
Wheeze
Correct Order
Peak Flow Meter
1. Stand or sit in upright position
2. Put the flow meter scale to ) or lowest value
3. Inhale deeply
4. Put the mouthpiece in mouth and create a seal with lips
5. Exhale as quickly and forcibly as possible and record reading
6. Repeat 2 more times, with a break of 5-10 seconds
7. Record 1 score= The highest of the 3 attempts.
Asthma Management
Tiered system of therapy: Based on asthma severity classification
Rescue medicine- Short acting bronchodilators
Maintenance medicines -
Leukotriene modifiers
Inhaled corticosteroids
Long - Acting-Bronchodilators
MDI Teaching
- Shake the MDI and attach it to the spacer
- Exhale fully
- Firmly place lip around the mouthpiece
- Deliver one push of the medication
- Take a deep breath slowly and hold for 10 seconds
- Wash mouth with water
Asthma Action Plan
Green= Good. 80-100%
Yellow= Mellow, rescue every for hours for 1-2 days, call PCP
Red= Really bad. Emergency Tx
Median age of 39 years
Excess thick mucous lining airways
Decreased pancreatic enzymes
and hypersecretion of gastric acids
Cystic Fibrosis
Autosomal Recessive Disorder where mucous plugs the entire body
Cystic Fibrosis
S/S of Cystic Fibrosis
Chronic hypoxemia
Bowel Obstruction
Weight Loss and failure to thrive
DM- High blood sugar
Complications of Cystic Fibrosis
Hemoptysis, pneumothorax, bacterial, intestinal obstruction, GERD, portal HTN, liver failure, gallstones, decreased fertility
Cystic Fibrosis Labs and Diagnostic tests
Sweat Chloride Test
Pulse Oximetry
Chest Radiograph
PFTs
Cystic Fibrosis Tx
Chest Physiotherapy
Inhaled Dornase alfa
Inhaled antibiotics for exacerbation
Pancreatic Enzyme supplementation
ADEK vitamin supplementation
Well- Balanced high diet in calories, protein, fat, and carbs
Interventions to minimize Psychosocial Impact of Chronic Respiratory Conditions
Promoting child’s self esteem through education and support
Allowing school- age child to take control management of the disease
Promoting family coping through education and encouragement
Providing culturally sensitive education and interventions
High Frequency Oscillators
RR up to 100 bpm with low tidal volumes
Nitric Oxide Inhalation
Inhaled nitric oxide gas, causes vasodilation to increase blood flow to alveoli
Perflucarbon Liquid
Acts life surfactant, provides improved gas exchange
Extracorpeal Membrane Oxygenation
Blood is removed from the body, warmed, oxygenated and returned to the patient via pump.
