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NRSG 329- Peds > Week 2- Resp > Flashcards

Week 2- Resp Flashcards

1
Q

pediatric airway vs adult

A
  • smaller nasopharynx (can be obstructed during infection)
  • smaller nares easily occluded inhibiting ventilation
  • tongue, tonsils and adenoids are large relative to small size of the oral cavity
  • long floppy epiglottis is vulnerable to swelling and obstruction
  • larynx is superior/anterior in the neck, increasing risk of aspiration
  • thyroid, cricoid, and tracheal cartilages are narrow and flexible and may easily collapse when neck is flexed.
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2
Q

lung alveoli and chest wall development happen when

A
  • lung alveoli and chest wall development between 2-8 years old.
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3
Q

breathing characteristics

A
  • less developed supporting cartilage and intercostal muscles
  • obligate nose breathers (up to 1 year), problem when congested
  • higher RR, irregular pattern, apnea periods common
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4
Q

resp assessment
1st

A

observe: visual assessment of WOB, patterns and overall resp status, color, tired, lethargic

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5
Q

resp assessment 2nd

A

listen
rate, clear, adventitious sounds, UATS

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6
Q

resp assessment 3rd

A

feel

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7
Q

signs of respiratory distress

A

agitation
nasal flaring
grunting
sweating
sneezing
color changes
wheezing (adventitious sounds)
use of accessory muscle
low O2 sat below 92%
tachypnea
indrawing

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8
Q

primary cause of arrests

A

resp

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9
Q

Respiratory Distress

A

Outwardly evident, physically labored ventilation or respiratory efforts; clinically evident that the patient is compensating and beginning to not adequately ventilate and/or oxygenate.

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10
Q

Respiratory failure

A

Prolonged respiratory distress that results in the impairment of the lungs to maintain adequate gas exchange——resulting in Hypoxemia (can occur when the lungs are not functioning properly or when the heart is unable to pump enough blood to the lungs for oxygenation)

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11
Q

respiratory arrest

A

an emergent/acute situation where these is a cessation of resp function

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12
Q

Mild respiratory distress symptoms

A
  • dyspnea
  • tachypnea
  • no obvious increased WOB
  • able to speak in sentences
  • stridor without obvious airway obstruction
  • mild sob on exertion
  • frequent cough
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13
Q

moderate respiratory distress

A
  • increased WOB
  • restlessness, anxiety or combativeness
  • tachypnea
  • mild increased use of accessory muscles, retractions, flaring
  • speaking short phrases or slipped sentences
    -stridor, but airway protected
  • prolonged expiratory phase
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14
Q

severe respiratory distress

A
  • excessive WOB with cyanosis
  • lethargy, confusion, inability to recognize caregiver, decreased response to pain
  • single word or no speech
  • tachycardia or bradycardia
  • tachypnea or bradypnea
  • irregular resps
  • exaggerated retractions, nasal flaring, grunting
  • absent or decreased breath sounds
  • upper airway obstruction
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15
Q

mild mod sever resp distress quick way of knowing

A

ones access muscle use
two or three
three or more

gets worse as retractions move up the body

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16
Q

Nares
tongue
epiglottis
airways

A

small: easily become blocked by mucus or swelling
large: proportionally larger, making it easier for children to obstruct their airway.
Large: floppy epiglottis can block the airway, especially during inflammation.
Smaller: more susceptible to obstruction and inflammation, making breathing difficult.

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17
Q

Acute respirator infection is responsible for

A

20% (<5y.o) childhood deaths (90% from pneumonia)

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18
Q

ARI most common in children:

6

A

HIV positive

Under 2 years of age

Malnourished

Weaned early

Poorly educated parents (one of the most common reasons for asthma admissions)

Difficult access to healthcare

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19
Q

one of the most common reasons for asthma admissions

A

Poorly educated parents

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20
Q

why is pneumonia so bad in children

A

unpracticed immune system

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21
Q

what is asthma

A
  • long term condition that affects the airways in the lungs
  • inflammation and narrowing of the airways, mucous production and SM tightening= difficulty breathing
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22
Q

type of asthma triggers

5

A
  • exercise
  • cold air
  • allergens
  • infections
  • psychological
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23
Q

inflammatory process in asthma is caused by

A

body’s immune system reacting to an allergen or other triggers

release IgE, cortisol (kids with asthma have higher cortisol level)

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24
Q

Asthma Signs and Symptoms:

A

Wheezes
Coughing (common symptoms may occur in the absence of infection especially at night)
SOB
Anxiety
restlessness
pale skin
cyanotic lips or nail beds
decreased 02 sats

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25
treat asthma | 5
#1 bronchodilator (open airway) corticosteroids (inhaled) also oral and IV route sit up in bed comfort regular monitoring (rate, effort, O2 sats, overall appearance) oxygen fluid therapy: loosen secretions
26
what is croup | affects
childhood resp infection affects larynx, trachea, bronchi causing swelling and inflammation
27
cause of croup
most often virus (parainfluenza or RSV)
28
how do symptoms progress with croup
slowly, often after a cold like upper resp illness
29
patho of croup
viral infection leads to mucosal inflammation and edema in the airway. can lead to airway obstruction and hypoxia narrowing of airways= breathing difficulties and the characteristic croup cough
30
complications of croup
can lead to hypoxia (tissues are properly oxygenated) in severe cases intubation may be necessary to secure the airway
31
symptoms of croup | 5
- low grade fever - barking cough - hoarseness - stridor - restless
32
treatment/meds of croup
cool humidified air rest fluids elevate HOB no smiking in house N- nebs A- acetamoniphen/NSAIDs R- racemic epi if severe S- steroids
33
Epiglottitis is caused by
bacterial infection (haemophilus influenza type b (Hib) kids are vaccinated for this
34
what is epiglottitis
the flap of tissue at the top of the trachea, becomes inflamed and swollen, obstructing the airway
35
epiglottitis onset
abrupt, rapid and progressive medical emergency- can quickly lead to respiratory failure
36
age range epiglottitis
primarily children between 2 and 5 but can happen at any age
37
epiglottitis always requires
intubation
38
Signs and Symptoms of Epiglottitis | 7
- sore throat - agitation - red inflamed throat - high fever - rapid pulse and resps - stridor - croaking froglike sound on inspiration
39
cardinal signs of epiglottitis
Drooling Dysphagia Distress Dysphonia
40
Epiglottitis Treatment
Immediate medical attention - do not leave child unattended Intubation or tracheostomy - may be necessary to secure the airway (usually temporary lasting 24-48 hours) One to one nursing care - close monitoring is crucial Supportive care - O2, IV fluids, Abx to combat underlying infection
41
DO NOT DO what with epiglottitis
look in mouth with tongue depressor X ray to confirm dx is needed
42
common causes of bronchiolitis | affects
RSV (most common) affects epithelial cells of the resp tract, leading to inflammation and varying degrees of obstruction
43
manifestations of bronchiolitis | 4
- hyperinflation - patchy atelectasis - edema - increased mucus production - progressive overinflation may occur as disease progresses
44
bronchiolitis typically occurs during - peak
the first 2 years of life, peak occurrence at about 3-6 months of age
45
__ of bronchiolitis is caused by
50% RSV
46
recovery of RSV typically takes
8-15 days
47
other 50% of viruses that cause bronchiolitis
adenovirus, parainfluenza, mycoplasma
48
spread of RSV
highly contagious and spreads easily through respiratory secretions, such as droplets from coughing and sneezing.
49
rsv lives on hands for
30 minutes
50
prevalence of RSV
nearly all children are infected by age 3
51
rsv may lead to the development of
asthma and COPD
52
Individuals with weakened immune systems are at increased risk for
severe RSV complications, leading to significant morbidity and mortality.
53
Less acute RSV Symptoms | 4
Runny nose Congestion Mild Coughing Mild low grade fever
54
Severe/Acute RSV Symptoms
SOB Difficulty breathing Increase HR Retractions Flared nostril Rapid shallow breathing
55
Management Strategies RSV | 5
Maintain a calm and quiet environment. Avoid unnecessary interruptions to decrease crying. Administer humidified oxygen as needed Administer antipyretics and ventolin inhalations. Provide oral or intravenous fluids
56
comfort measures for RSV
cool mist and cool air educate and supprt family
57
Confirmation of RSV
nasopharyngeal swab collected sample is examined under a microscope to identify the presence of RSV. A molecular test, such as polymerase chain reaction (PCR), can detect RSV RNA in the sample
58
Synagis®
a monoclonal antibody that provides passive immunity against RSV. given as a monthly injection during the RSV season. recommended for infants at high risk for severe RSV disease.
59
high risk infants for rsv | 5
- prematurely - low birth weight, - chronic lung disease - congenital heart disease. Multiples, such as twins or triplets, also have a higher risk due to their immature immune systems.
60
what temp is considered fever
reaches 37.5°C (99.5°F) or higher when measured axillarily.
61
is fever common and what is it caused by
yes usually virus
62
how to measure temp
The most common routes for measuring temperature are axillary (underarm) for children under 6 years old and oral (by mouth) for children over 6 years old.
63
febrile seizures | - most common in - triggered by
tonic clonic most common in children between 6 months and 3 years old, peaking around 18-22 months. family hx triggered by a rapid rise in temperature often associated with a viral or bacterial infection
64
In what ways can we treat fever and why do we want to treat it?
Tylenol, advil (antipyretic) Tepid bath Cool cloth Remove clothing Lots of fluids Blood moves from periphery to organs and then limbs feel cold Why we treat Comfort Decrease demands on body will have higher HR and RR Reduce impact that fever has
65
IF STUFFED UP CAN’T SUCK OFTEN THE NURSE WILL INSTILL
1.2 ML then suction
66
Spasmodic Croup:
Really is Spasmodic Laryngitis ◦Possible allergy component Sudden onset, often at night
67
leading cause of pneumonia and bronchiolitis in infants
RSV
68
meds for rescue/acute episode of asthma | 3
- beta 2 agonist (ventolin) - bronchodilator (atrovent) - systemic corticosteroids (take 8 our for full effect)
69
routine long term med management for asthma
- LABA (selmeterol) - Inhaled corticosteroids (budesonide, fluticasone)
70
what age are children belly breathers
until 5-6 years
71
When is irregular breathing considered apnea?
- >20 secs - color change - bradycardia (<100)
72

NRSG 329- Peds (6 decks)

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