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
22-44% oxygen concentration max is 4L/min
Nasal Cannula
26
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
27
35-60 % oxygen concentration
Simple Mask 6-10 L/min
28
50-60% O2 concentration and flow rate is 10-15 L/min
Partial Rebreathing
29
Nonrebreathing Mask
95 O2 concentration Simple Facemask with valves and reservoir 10-15 L/min
30
Oxygen Hood
up to 80-90% Infants only
31
Oxygen Tent
High humidity Environment up to 50% oxygen concentrationI
32
Name Acute Infectious Disorders
Common Cold Influenza Croup Pharyngitis, tonsilitis, and laryngitis RSV Pneumonia and Bronchitis
33
Nasal Discharge is thin watery clear and length of illness varies
Allergic Rhinitis Fever and bad breath is absent
34
Nasal discharge is thick, white, yellow, or green and can be thin
Common cold 10 days or less Bad Breath is absent
35
Sinusitis nasal discharge is
Thick yellow or green Longer 10-14 days Sneezing is absent
36
Viral Upper Respiratory Infection
Common Cold Caused by Rhinovirus Parainfluenza RSV Enteroviruses Adenoviruses Human Metapneumovirus
37
Potential Complications of Common Cold
Secondary Bacterial Infections of the ears, throat, sinuses, or lungs Therapeutic Management includes normal saline and symptom relief
38
Influenza Viral Infection is spread through
Droplets with fine aerosols
39
Infected children shed the virus
True 1-2 days before symptoms begin Up to two weeks
40
Complications of Influenza
Otitis Media Reyes Syndrome Pnemoniccal Pneumonia
41
Nurse Management Influenzas
Antiviral agents - dines and -virs Supportive Treatment Children over 6 months be immunized early
42
Inflammation of throat mucosa
Pharyngitis Sore Throat
43
Viral sore throat shows
Nasal Congestion Symptomatic relief - Analgesics, salt water gargles
44
Bacterial Sore Throat shows no
Congestion Group A StreptococciCo
45
Complications of Pharyngitis
Peritonsillar Abscess Retropharyngeal Abscess Acute Rheumatic Fever Acute Glomerulonephritis
46
Throat Culture and antibiotic therapy
Pharyngitis Use Penicillin generally
47
Inflammation of tonsils that may show muffled voice, pooling saliva
Tonsilitis May show Trismus- Inability to open mouth - Report to MD
48
Surgical Removal of Palatine tonsils Recurrent streptococcal tonsilitis Tonsillar hypertrophy Adenoidectomy ( removal of adenoids)
Tonsillectomy
49
Trismus
Immediate attention tonsillar abscess- collection of pus - prevents the mouth from opening in a blocked airway
50
Nursing Post Care tonsillectomy
Promoting airway clearance Maintaining Fluid Volume - Discourage coughing Encourage: fluid, avoid citrus, brown or red fluids
51
How to relieve pain from tonsillectomy
Ice collar and analgesics with or without narcotics - Frequent swallowing may indicate bleeding
52
Virus caused by Epstein Barr
Infectious Mononucleosis - Monospot, Epstein-Barr Virus Titers
53
S/S of Mononucleosis
Fever Malaise Sore Throat Lymphadenopathy Called Kissing disease common in adolescents
54
Complications of Mono
Splenic Rupture Gulen Bares Syndrome Aseptic MeningitisN
55
Nursing management
Symptomatic Tx- Analgesics, salt water gargles, bedrest
56
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
57
Parainfluenza is a viral infection of
Upper Airway
58
Audible Inspiratory Stridor
Croup Barking seal like cough
59
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
60
Caused by HIB and its rare with HIB Vaccine
Epiglottitis - Respiratory arrest and death may occur if airway becomes completely occluded
61
S/S of Epiglottis
Dysphasia Drooling anxiety Restlessness Tripod Respiratory Distress
62
Complications of Epiglottis
Pneumothorax and pulmonary edema
63
Therapeutic Management of Epiglottis
Airway Maintenance IV Antibiotics Assist with emergency Tracheostomy PICU admission
64
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
65
Nursing Management of Epiglottis Dos
Provide 100% oxygen in the least invasive manner Ensure tracheostomy and emergency equipment readily available
66
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
67
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
68
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
69
Inflammation of the lung parenchyma
Pneumonia Caused by virus, bacteria, mycoplasma or a fungus
70
Children with bacterial pneumonia present with a _____________ appearance
Toxic - Streptococcus Pneumonia - M. Pneumoniae - Treated with appropriate antibiotics
71
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
72
Complications of Pneumonia
Bacteremia, plural effusion, empyema, lung abscess-( requires chest tube and/or thoracentesis)
73
Therapeutic Management of Pneumonia
Antipyretics Adequate hydration Close Observation
74
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
75
Highly contagious disease caused by inhalation on droplets of mycobacterium tuberculosis or bovis
Tuberculosis -Incubation is 2-10 weeks
76
S/S of Tuberculosis
Fever, malaise, weight loss, anorexia, pain and tightness in the chest, hemoptysis(rare)
77
6 Month Course of Oral Therapy
2 months Rifampin, isoniazid, pyrazinamide Followed by twice weekly isoniazid and rifampin for 4 months
78
Children who test positive but do not have symptoms or radiographic/ laboratory evidence of the disease are considered ..
Latent Infection
79
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)
80
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
81
Epistaxis
Recurrent or difficult to control should be elevated for underlying bleeding or platelet concerns.
82
Foreign Body Aspiration
Common in 6months - 3 years of age.
83
ARDs
Sepsis, viral pneumonia, smoke inhalation, near drowning Pneumothroax
84
Collection of air in pleural spaces
Pneumothorax
85
Risk Factors of Pneumothorax
Chest Trauma/ Surgery Intubation or mechanical ventilation Hx of chronic lung disease as cystic fibrosis
86
S/S of Pneumothorax
Chest Pain, Tachypnea, retractions, nasal flaring, grunting, pallor, cyanosis, absent of diminished breath sounds on affected side
87
Therapeutic Management of Pneumothorax
Needle Aspiration Placement of Chest Tube
88
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
89
Chronic inflammatory airway disorder - Airway hyperresponsiveness - Airway edema - Mucus production
Asthma
90
Results in airway obstruction that might be partially or completely reversed Allergens or triggers- Dust mites, pet dander, cockroach antigens, pollen, molds
Asthma
91
S/S of Asthma
Tachypnea Increased work of breathing Cough Wheeze
92
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.
93
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
94
MDI Teaching
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
Asthma Action Plan
Green= Good. 80-100% Yellow= Mellow, rescue every for hours for 1-2 days, call PCP Red= Really bad. Emergency Tx
96
Median age of 39 years Excess thick mucous lining airways Decreased pancreatic enzymes and hypersecretion of gastric acids
Cystic Fibrosis
97
Autosomal Recessive Disorder where mucous plugs the entire body
Cystic Fibrosis
98
S/S of Cystic Fibrosis
Chronic hypoxemia Bowel Obstruction Weight Loss and failure to thrive DM- High blood sugar
99
Complications of Cystic Fibrosis
Hemoptysis, pneumothorax, bacterial, intestinal obstruction, GERD, portal HTN, liver failure, gallstones, decreased fertility
100
Cystic Fibrosis Labs and Diagnostic tests
Sweat Chloride Test Pulse Oximetry Chest Radiograph PFTs
101
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
102
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
103
High Frequency Oscillators
RR up to 100 bpm with low tidal volumes
104
Nitric Oxide Inhalation
Inhaled nitric oxide gas, causes vasodilation to increase blood flow to alveoli
105
Perflucarbon Liquid
Acts life surfactant, provides improved gas exchange
106
Extracorpeal Membrane Oxygenation
Blood is removed from the body, warmed, oxygenated and returned to the patient via pump.