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ADN005 Pediatrics > Week 2 Chapter 40 > Flashcards

Week 2 Chapter 40 Flashcards

1
Q

Newborns nasal passages are very

A

Small and more prone to obstruction

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2
Q

Obligate nose breathers and produce very little mucus
More susceptible to infections
Sinuses are not developed

A

Infants

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3
Q

Increased risk for airway obstruction
Tongue is larger in relation to oropharynx
Children have enlarged tonsillar and adenoid tissue

A

Throat of the infant

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4
Q

Bifurcation of trachea of third thoracic vertebra

A

True

Important when suctioning or intubation children

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5
Q

How are the bronchioles of infants and children

A

Narrower
Increase risk for lower airway obstruction

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6
Q

Smaller numbers in alveoli in infants

A

Higher risk of hypoxemia

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7
Q

Symptoms of increased work of breathing

A

Tachypnea
Nasal Flaring
Chest Retractions
Grunting

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8
Q

Children have lower metabolic rate compared to adults

A

False

Resting RR faster
O2 demand is higher

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9
Q

Adults consume how many L O2?Children?

A

3-4 L /min
6-8 L/ min

Infants and children will develop hypoxemia more rapidly

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10
Q

RR vary with activity and excitement

A

Count 1 min
Children are abdominal breathers
Babies are nose breathers to be able to nipple feed

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11
Q

Risk Factors of Respiratory Disorders

A

Prematurity
Chronic illness
Developmental Disorders
Passive exposure to cigarette smoke
Immune Deficiency
Crowded living conditions or lower socioeconomic status
Daycare attendance

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12
Q

Inspection and Observation of Respiratory Disorders

A

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

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13
Q

Softening of the tissues of the larynx

A

Laryngomalacia

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14
Q

High Pitched Sound on inspiration or expiration
May Occur with obstruction in lower trachea or bronchioles
May occur in asthma or viral infections

A

Wheezing

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15
Q

Crackling sounds heard when alveoli become fluid filled
May Occur with pneumonia

A

Rales

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16
Q

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

A

Stridor

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17
Q

Inward pulling of soft tissues with respirations

A

Retractions

Note use of accessory neck muscles

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18
Q

Mild
Moderate
Severe

A

Severity grading of reactions

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19
Q

Paradoxical Respirations

A

See saw chest falls on inspiration and rises on expiration

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20
Q

Oxygen saturation might be decreased significantly

A

Pulse Oximetry

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21
Q

Chest Radiograph may reveal

A

Hyperinflation and patchy areas of atelectasis or infiltration

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22
Q

What may blood gases show?

A

Co2 retention and hypoxemia

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23
Q

Positive Identification of RSV other viral illness via enzyme linked immunosorbent assay (ELISA) or immunofluorescent antibody IFA testing

Rapid strep testing via throat swab

A

Nasopharyngeal Washings

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24
Q

Common Medical Treatments for Respiratory Diseases

A

Oxygen
High Humidity
Suctioning
Chest Physiotherapy and Postural Drainage
Saline gargles or Lavage
Mucolytic Agents
Chest Tubes
Bronchoscopy

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25
Q

22-44% oxygen concentration max is 4L/min

A

Nasal Cannula

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26
Q

2-60L/Min

A

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

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27
Q

35-60 % oxygen concentration

A

Simple Mask

6-10 L/min

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28
Q

50-60% O2 concentration and flow rate is 10-15 L/min

A

Partial Rebreathing

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29
Q

Nonrebreathing Mask

A

95 O2 concentration

Simple Facemask with valves and reservoir

10-15 L/min

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30
Q

Oxygen Hood

A

up to 80-90%
Infants only

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31
Q

Oxygen Tent

A

High humidity Environment up to 50% oxygen concentrationI

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32
Q

Name Acute Infectious Disorders

A

Common Cold
Influenza
Croup
Pharyngitis, tonsilitis, and laryngitis
RSV
Pneumonia and Bronchitis

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33
Q

Nasal Discharge is thin watery clear and length of illness varies

A

Allergic Rhinitis

Fever and bad breath is absent

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34
Q

Nasal discharge is thick, white, yellow, or green and can be thin

A

Common cold

10 days or less

Bad Breath is absent

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35
Q

Sinusitis nasal discharge is

A

Thick yellow or green

Longer 10-14 days

Sneezing is absent

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36
Q

Viral Upper Respiratory Infection

A

Common Cold

Caused by
Rhinovirus
Parainfluenza
RSV
Enteroviruses
Adenoviruses
Human Metapneumovirus

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37
Q

Potential Complications of Common Cold

A

Secondary Bacterial Infections of the ears, throat, sinuses, or lungs

Therapeutic Management includes normal saline and symptom relief

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38
Q

Influenza Viral Infection is spread through

A

Droplets with fine aerosols

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39
Q

Infected children shed the virus

A

True
1-2 days before symptoms begin
Up to two weeks

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40
Q

Complications of Influenza

A

Otitis Media
Reyes Syndrome
Pnemoniccal Pneumonia

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41
Q

Nurse Management Influenzas

A

Antiviral agents - dines and -virs
Supportive Treatment
Children over 6 months be immunized early

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42
Q

Inflammation of throat mucosa

A

Pharyngitis

Sore Throat

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43
Q

Viral sore throat shows

A

Nasal Congestion

Symptomatic relief - Analgesics, salt water gargles

44
Q

Bacterial Sore Throat shows no

A

Congestion

Group A StreptococciCo

45
Q

Complications of Pharyngitis

A

Peritonsillar Abscess
Retropharyngeal Abscess
Acute Rheumatic Fever
Acute Glomerulonephritis

46
Q

Throat Culture and antibiotic therapy

A

Pharyngitis

Use Penicillin generally

47
Q

Inflammation of tonsils that may show muffled voice, pooling saliva

A

Tonsilitis

May show Trismus- Inability to open mouth - Report to MD

48
Q

Surgical Removal of Palatine tonsils
Recurrent streptococcal tonsilitis
Tonsillar hypertrophy
Adenoidectomy ( removal of adenoids)

A

Tonsillectomy

49
Q

Trismus

A

Immediate attention
tonsillar abscess- collection of pus - prevents the mouth from opening in a blocked airway

50
Q

Nursing Post Care tonsillectomy

A

Promoting airway clearance
Maintaining Fluid Volume

  • Discourage coughing
    Encourage: fluid, avoid citrus, brown or red fluids
51
Q

How to relieve pain from tonsillectomy

A

Ice collar and analgesics with or without narcotics

  • Frequent swallowing may indicate bleeding
52
Q

Virus caused by Epstein Barr

A

Infectious Mononucleosis

  • Monospot, Epstein-Barr Virus Titers
53
Q

S/S of Mononucleosis

A

Fever
Malaise
Sore Throat
Lymphadenopathy

Called Kissing disease common in adolescents

54
Q

Complications of Mono

A

Splenic Rupture
Gulen Bares Syndrome
Aseptic MeningitisN

55
Q

Nursing management

A

Symptomatic Tx- Analgesics, salt water gargles, bedrest

56
Q

Most affected children are 3 months to 3 years of age

Inflammation and edema of the larynx, trachea, and bronchi

A

Croup

Referred to as Laryngotracheobronchitis

57
Q

Parainfluenza is a viral infection of

A

Upper Airway

58
Q

Audible Inspiratory Stridor

A

Croup Barking seal like cough

59
Q

Nursing Management of Croup

A

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
60
Q

Caused by HIB and its rare with HIB Vaccine

A

Epiglottitis

  • Respiratory arrest and death may occur if airway becomes completely occluded
61
Q

S/S of Epiglottis

A

Dysphasia
Drooling
anxiety
Restlessness
Tripod
Respiratory Distress

62
Q

Complications of Epiglottis

A

Pneumothorax and pulmonary edema

63
Q

Therapeutic Management of Epiglottis

A

Airway Maintenance
IV Antibiotics
Assist with emergency Tracheostomy
PICU admission

64
Q

Nursing Management of Epiglottis

DONTs

A

Attempt to visualize throat - reflex laryngospasm may occur, precipitating immediate airway occlusion

No oral temperature
Leave the child unattended
Place child in supine position

65
Q

Nursing Management of Epiglottis
Dos

A

Provide 100% oxygen in the least invasive manner
Ensure tracheostomy and emergency equipment readily available

66
Q

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

A

Bronchiolitis

67
Q

S/S of Bronchiolitis

A

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

68
Q

Therapeutic Management of Bronchiolitis

A

Supportive Tx
- Supplemental Oxygen, suctioning, hydration, inhaled bronchodilator therapy
(Racemic Epi or Albuterol)
- Administer Synagis ( Palivizumab) -monoclonal antibody vaccination to prevent severe RSV

69
Q

Inflammation of the lung parenchyma

A

Pneumonia

Caused by virus, bacteria, mycoplasma or a fungus

70
Q

Children with bacterial pneumonia present with a _____________ appearance

A

Toxic
- Streptococcus Pneumonia
- M. Pneumoniae
- Treated with appropriate antibiotics

71
Q

S/S of Pneumonia

A

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

72
Q

Complications of Pneumonia

A

Bacteremia, plural effusion, empyema, lung abscess-( requires chest tube and/or thoracentesis)

73
Q

Therapeutic Management of Pneumonia

A

Antipyretics
Adequate hydration
Close Observation

74
Q

Pneumonia Laboratory Diagnostic Tests

A

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

75
Q

Highly contagious disease caused by inhalation on droplets of mycobacterium tuberculosis or bovis

A

Tuberculosis

-Incubation is 2-10 weeks

76
Q

S/S of Tuberculosis

A

Fever, malaise, weight loss, anorexia, pain and tightness in the chest, hemoptysis(rare)

77
Q

6 Month Course of Oral Therapy

A

2 months Rifampin, isoniazid, pyrazinamide

Followed by twice weekly isoniazid and rifampin for 4 months

78
Q

Children who test positive but do not have symptoms or radiographic/ laboratory evidence of the disease are considered ..

A

Latent Infection

79
Q

Children contract Tb usually by?

A

Household member

TB can spread by the bloodstream and lymphatic system to other parts of the body ( GI Tract or CNS)

80
Q

Risk Factors for TB

A

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

81
Q

Epistaxis

A

Recurrent or difficult to control should be elevated for underlying bleeding or platelet concerns.

82
Q

Foreign Body Aspiration

A

Common in 6months - 3 years of age.

83
Q

ARDs

A

Sepsis, viral pneumonia, smoke inhalation, near drowning
Pneumothroax

84
Q

Collection of air in pleural spaces

A

Pneumothorax

85
Q

Risk Factors of Pneumothorax

A

Chest Trauma/ Surgery
Intubation or mechanical ventilation
Hx of chronic lung disease as cystic fibrosis

86
Q

S/S of Pneumothorax

A

Chest Pain, Tachypnea, retractions, nasal flaring, grunting, pallor, cyanosis, absent of diminished breath sounds on affected side

87
Q

Therapeutic Management of Pneumothorax

A

Needle Aspiration
Placement of Chest Tube

88
Q

Chronic Respiratory Disorders

A

Allergic Rhinitis- Associated with atopic dermatitis and asthma
Asthma
Chronic Lung Disease ( Bronchopulmonary dysplasia)
Cystic Fibrosis
Apnea- Absence of breathing for 20 seconds- Bradycardia

89
Q

Chronic inflammatory airway disorder
- Airway hyperresponsiveness
- Airway edema
- Mucus production

A

Asthma

90
Q

Results in airway obstruction that might be partially or completely reversed

Allergens or triggers- Dust mites, pet dander, cockroach antigens, pollen, molds

A

Asthma

91
Q

S/S of Asthma

A

Tachypnea
Increased work of breathing
Cough
Wheeze

92
Q

Correct Order

A

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.

93
Q

Asthma Management

A

Tiered system of therapy: Based on asthma severity classification

Rescue medicine- Short acting bronchodilators
Maintenance medicines -
Leukotriene modifiers
Inhaled corticosteroids
Long - Acting-Bronchodilators

94
Q

MDI Teaching

A
  1. Shake the MDI and attach it to the spacer
  2. Exhale fully
  3. Firmly place lip around the mouthpiece
  4. Deliver one push of the medication
  5. Take a deep breath slowly and hold for 10 seconds
  6. Wash mouth with water
95
Q

Asthma Action Plan

A

Green= Good. 80-100%
Yellow= Mellow, rescue every for hours for 1-2 days, call PCP
Red= Really bad. Emergency Tx

96
Q

Median age of 39 years
Excess thick mucous lining airways
Decreased pancreatic enzymes
and hypersecretion of gastric acids

A

Cystic Fibrosis

97
Q

Autosomal Recessive Disorder where mucous plugs the entire body

A

Cystic Fibrosis

98
Q

S/S of Cystic Fibrosis

A

Chronic hypoxemia
Bowel Obstruction
Weight Loss and failure to thrive
DM- High blood sugar

99
Q

Complications of Cystic Fibrosis

A

Hemoptysis, pneumothorax, bacterial, intestinal obstruction, GERD, portal HTN, liver failure, gallstones, decreased fertility

100
Q

Cystic Fibrosis Labs and Diagnostic tests

A

Sweat Chloride Test
Pulse Oximetry
Chest Radiograph
PFTs

101
Q

Cystic Fibrosis Tx

A

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

102
Q

Interventions to minimize Psychosocial Impact of Chronic Respiratory Conditions

A

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

103
Q

High Frequency Oscillators

A

RR up to 100 bpm with low tidal volumes

104
Q

Nitric Oxide Inhalation

A

Inhaled nitric oxide gas, causes vasodilation to increase blood flow to alveoli

105
Q

Perflucarbon Liquid

A

Acts life surfactant, provides improved gas exchange

106
Q

Extracorpeal Membrane Oxygenation

A

Blood is removed from the body, warmed, oxygenated and returned to the patient via pump.

ADN005 Pediatrics (21 decks)

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