week 2 : gas exchange pediatrics: resp disorders Flashcards
nursing care for any respiratory disorder:
easing respiratory efforts: what undergoes this
can usually be managed at home
running a steamy shower ( 10-15 mins )
true or false. hot steam or cool mist vaporizers are recommended for easing respiratory efforts
false, it is not.
true or false. encourage quiet play, rest is something to do.
yes this is true
what undergoes promoting cofort for a ped pt who happens to have a resp disorder ?
clear nasal secretions with saline drops, bulb suction
bulb suction
medicated drops not if < 6 years
if >6 years no more that 2-3 days
reducing temperature is also a must, what undergoes this category?
monitor temp
acetaminophen or ibuprofen as directed ( do not ever give aspirin )
cool liquids to prevent dehydration ( losing a lot due to diaphoresis )
what undergoes dehydration
asses s & s
observe frequency and color of voids
count diapers ( home, ) weigh diapers ( hospital )
continue breastfeeding if pssible
oral rehydration fluids- pedialyte
true or false. it is important to not force food , only give what they can eat. ( popsicles, pudding, soup )
true
what are signs of a dehydrated baby
rapid breathing
increased heart rate
restlessness and or irritability
lethargy/weakness
poor skin turgor ( pinching a fold of skin at the abdomen results in it returning slowly to normal )
define if these are a sign of a dehydrated baby
sunken fontanelle
sunken eyes
lack of tears when crying
wants to drink a lot of water ( but may vomit )
excessive thrist
decreased urine output
all
infants/babies- indicated by no wet diapers in 6-8 hrs eriof or diapers with a little dark - yellow urine
toddlers/older children very little-dark yellow urine
is typically what we see in a dehydrated baby.
true
what is a bronciolitis
a common vital illness most often caused by respiratory synctial virus
how are broncholiotis transmitted ?
by exposure to contaminated secretions. can live on fomitesseveral hrs and hands for 30 mins
where does broncholiotis start?
starts with upper airway and moves to lower airway
how are bronchiolitis characterized by
acute inflammation of airways, bronchospasm, and increased mucus production
when does bronchiolitis usually occurs?
typically occurs during late fall and winter months ( rsv season )
when does incubation occur for bronchiolitis infant pts?
5-8 days after contact
what is a fomite?
a surface that carries bacteria
what causes destruction?
the mucous is causing some destruction,preventing from normal breathing, this is contagious by contaminated excretion
what are some initial signs and symptoms of bronchiolitis
rhinorrhea
pharyngitis
coughing/sneezing
wheezing
possible ear or eye drainage
intermittent fever
what is rhinorrhea
runny nose
what is pharyngitis
inflammation of the pharynx ( throat )
true or false. the more coughing and more wheezing the more complex it gets
true
with progression of illness of bronchiliotis what happens?
increased coughing and wheezing
tatchypnea and restractions
cyanosis
what happens during severe illness of broncholiotis
tatchypnea greater tan 70/min
listlessnes ( lethargic & lazy ) not wanting to participate
apneic cells –> periods of not breathing
poor air exchange, decreased breath sounds
what are the ped resp rate that are considered normals
premature
0-3 months
3-6 months
6-12 months
1) 40-70
2)30-60
3)30-45
4)25-40
what are the ped resp rate that are considered normals
1-3 year
3-6 year
6-12 year
12+ year
1) 20-30
2)20-25
3)14-22
4)12-18
how do they distinguish that a baby has a rsv
they swab nasal secretion- thats how they distinguish that a baby has rsv
rsv - nursing care
what undergoes this
- If resp distress or poor hydration will be hospitalized
- Assign to separate rooms or grouped with other RSV patients
- Droplet, contact and routine precautions (gloves, mask, gown)
true or false. these are important when it comes to rsv- nursing care
* O2 to keep sats >90 (Humidified via N/C, mask, hood)
* Clear secretions
* Superficial suctioning in (hosp)
* Bulb suction (at home)
Oxygen
true
true or false. a lot of nasal secretion may benefit from this
- superficially into the nare to get rid of some of that secretion
before feeding is best
true
rsv- nursing care, what type of medications are we giving?
medication
◦ Nebulized Epinepherine ?
◦ Tylenol
◦ No abx - viral
◦ No OTC decongestants, cough/cold meds, etc. ◦ nosteroids
is it important for an rsv to be hydrated? if so what do we check or do ?
yes Hydration
◦ Hydration!!!
Check skin turgor, U/O
◦ Encourage Breastfeeding if tolerated
◦ Suction before feedings
◦ Small frequent as tolerated
◦ IV fluids or NG feeds
signs of dehydration what do we do?
always encourage feeding ( may go iv or ng tube )
prevention of rsv
monoclonal antibody : palivizumab
is monoclonal antibody palivizumab an actual vaccine?
not a rue vaccine
offers passive protection
antibody activates the immune system
monoclonal antibody is a annual injection
no monthly
which type of babies are monoclonal antibody given to
given to high risk babies ( underlying medical conditions that weaken immune system )
potential complications of rsv ( otitis media
what is it?
fluid/inflammation of middle ear
common to children < 2 years
majority of OM infectios preceded by rsv
true or false. chronic OM can cause hearing impairment. difficulties communicating
true
potential complications of rsv: otis media S & S
abrupt onset
- earache
-fever
-purulent discharge
if becomes chronic can cause hearing impairment
is this true : this is painful - babies are more cranky children are more common, inflammation of the middle ear with fluid there ( so much pressure it could rupture )
true
Om- treatment and nursing care what are our goals?
relieving pain, facilitating drainage of fluid, preventing complications or recurrence, provide support to child and family
what are the treatment for most om: are abx required
no abx are not required, for severe OM the abx required is amocillin
how do we manage pain and fever for om
analgesics/antipyretics ( ibu or acetaminophen )
how do we facilitate drainage for om?
cotton balls, sterile cotton swabs
om- tx and nursing care surgical intervention to drain fluid decrease pain
myringotomy- surgical of eardrum - decrease pain
pressure equalizer tubes. tympanoplasty tubes - allows continous drainage
how do we prevent om?
prevention - rpoutine immunization with pneumococcal vaccine ( the bug can cause om so it is suggested to get this vaccine )
why do we not want to prescribe to antibiotics ?
doesnt want children to be immune to abx
potential complications of rsv: laryngobronchitis
what is it “?
inflammation of larynx and tranchea and bronchi
viral ( most ) can be bacterial ( tissue is inflated )
what are the signs and symptoms of laryngobronchitis ( croup )
hoarse voice, milf fever, restless, irritable
cough ( barking seal )
stridor “ darth vader: inhaaltion sound ( harsh and raspy = inspiratory wheeze )
are these true about laryngobronchitis ( croup )
progressive breathing difficulty as the air passages narrow- risk for obstruction
- increased rr, nasal flaring, restrations
cyanosis
true
what would you do if you start hearing stridor ?
take the patient to the hospital
If mild croup ( no stridor on inhalation ) , what does this mean ?
this can be managed at home
- teach parents to closely monitor breathing ( esp at night ) and seek medical attention if labored respirations or stridor, night air seems to behelpful
if more severe will be hospitalized, vigilant assesment/observation by nurse for worsening symptoms
such as
02, pulse oximetry, oral fluids, iv
oral steroids ( dexamethasone ) im or iv if cant be tolerate po
nebulized epinephrine
true or false. giving abx is rare when a baby has a corup?
yes this si true
true or false. parent should remain with child as much as possible, hold on lap during tx.
true
what could possible happen when an infant has a croup?
possible intubation, be ready for emergencies
as this can lead to destruction so intubation is a must
where does the intubation goes ?
go in through the mouth and then through the larynx , tranchea, and then ventilate and regulate
what is this describing : requiring of symptom and constriction of bronchioles
asthma
what is asthma, ( explain )
chronic pulmonary disorder
causes inflammation
bronchiole constriction
mucus hyper secretion
OBSTRUCTION
what age is common for asthma to be hospitalized
hospitalized common < 5 years
true or false. asthma is life threatening if not controlled.
true
what are the classic s&s for asthma
recurrent episodes of wheezing, breathlessness, chest tightness, and cough, especially at night or in the early morning
recall that recurrent episodes of wheezing, breathlessness, chest tightness, and cough, especially at night or in the early morning are a part of the classic s & s of asthma
what else?
restlessness, agitation common, may experience itching ( on front og the neck and chest ) prior to attack
what would be a warning sign of asthma ?
if they become hypoxic- restless and agitated ( itchiness prior to having an attack )
asthma therapeutic management ( long term )
what are out goals ?
maintian normla activity, normal pulmonary function, prevent symtoms and reccurent exacerbations
true or false. we do not want kids to participate in family school activities and sports as this can cause exhaustion
false, we still want them to be involved.
how will our goals with asthma therapeutic management ( long term ) be accomplished ?
*Regular HCP visits (1-6 mths), Prevent exacerbations (avoid triggers), use meds as prescribed and adjust when needed
* Pulmonary Function tests done to assess for changes *Encourage activity and exercise and teach how to manage
these are encouraged for out goals to be accomplished when it comes to asthma therapeutic management :
*Optimum medication therapy that is individualized for the child
*Long Term Asthma Good teaching to child and parents with child being part of the plan
true
medication therapy ( for long term )
medications will prevent , what are the the 2 main categories?
1) controllers or preventers
- decrease inflammation and prevent episodes
2) relievers
- treat symptoms quickly
what would help for accuracy when it comes to inhalers?
spacers
if coming to er with severe symptoms of asthma will step up therapy until under control. true or false?
true
what are some examples of controllers or preventers inhalers?
corticosteroids or long term treatments
what are example of releivers?
bronchodialator ( resuce drug ) very quick acting
what are some examples of triggers that precipitate/aggravate asthma exacerbations
smoke
colds
animals
pollens
molf
dust
strong smells
weather changes
string emotions
allegy proofing the home and community to avoid asthma exacerbations
air quiality
cleaning …..
acute asthma - nursing care
exercise induced bronchospasm
is what ?
is acute and reversible
cough, sob, chest pain, tightness, wheezing that develops during activity or after
what can u tak before exercise for prevnetion of asthma
sabas ( salbutamel )
what is staus asthmaticus?
med emerg, comes to er and then most often go to peds icu
what are the sympotoms of resp distress ( status asthmaticus )
may developgradullay or suddenly
severe sob, 02 sats is <94 , profuse diaphoresis, sitting upright, refusing to lie down
what are the most severe of status asthmaticus symptoms
changes in loc, wheezes that become absent ( silent chest )
what is a sign of distress in status asthamaticus?
silent chest ( concern if cannot hear the wheezes anymore= tired and just not breathing )
true or false. we must keep sats > 94% . ventilator if resp stress worsens on a pt who has status asthmaticus
true
true or false. will increase inhaled drugs ( step up ) if continue on someone who has staus asthmaticus
true
what can we add for someone who has status asthmaticus
will add oral/iv steroids and muscle relexants to decrease increase pulmonary function
what will we monitor for someone who has status asthmaticus
will monitor and correct deydation, hypoxia, acidosis ( ventilation is necessary )
