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NRSG 329 > Week 2 - Respiratory conditions & Fluid/ electrolytes > Flashcards

Week 2 - Respiratory conditions & Fluid/ electrolytes Flashcards

1
Q

what is very common in children?

A

fever

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2
Q

what temperature of fever is considered febrile in children?

A

38.0 degrees celsius

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3
Q

what are the different routes to take temperatures for children?

A
  • oral
  • temporal
  • axillary
  • tympanic
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4
Q

what is classified as a low grade fever?

A

37.5-37.8 degrees celsius

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5
Q

most kids will experience a low grade fever during what?

A
  • growth spurts
  • teething
  • post vaccinations
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6
Q

why do we want to treat fevers in children?

A
  • comfort
  • prevent febrile seizures
  • decrease physical demands
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7
Q

how do you treat fevers for children?

A
  • antipyretics
  • warm bath
  • cool cloth
  • take off some layers
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8
Q

what are examples of antipyretics?

A
  • acetaminophen
  • ibuprofen
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9
Q

when children have fevers what’s going in inside their bodies?

A
  • increased RR
  • increased metabolic rate will look like Rosie cheeks
  • sweating to cool down
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10
Q

what can be a result of sweating in children?

A
  • dehydration
  • fluid and electrolyte imbalances
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11
Q

why should children under 4 years not have ASA?

A

can result in rye’s syndrome

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12
Q

What are paediatric differences in regards to the respiratory system?

A
  • abdominal breathers (infants)
  • diaphragm is attached higher
  • depend on accessory muscles
  • smaller airways
  • fewer alveoli
  • obligatory nose breather
  • soft tissue around lungs
  • less mucus production
  • underdeveloped smooth muscles
  • less developed intercostal muscles
  • faster resp rate
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13
Q

what are paediatric differences in regards to the respiratory system for newborns?

A

brief periods of apnea common

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14
Q

what are the key components of the respiratory assessment for paediatrics

A
  • effort
  • RR
  • colour
  • auscultation/ sounds
  • cough (productive or not)
  • nasal discharge
  • SpO2
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15
Q

What would indicate increased respiratory effort in a child or infant?

A
  • use of intercostal muscles
  • nasal flaring
  • retractions
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16
Q

most arrests in children are what?

A

respiratory

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17
Q

what are signs of distress in a child?

A
  • SOB
  • retractions
  • nasal flaring
  • grunting
  • head bobbing for infants
  • sea saw breathing
  • air hunger
  • O2 stat levels
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18
Q

what does SOB look like in a child?

A
  • use of accessory muscles
  • sitting in tripod position
  • sitting up
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19
Q

what does air hunger look like?

A
  • open mouth/ gasping for air
  • looks like they are eating air
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20
Q

what are late signs of distress in children?

A
  • head bobbing
  • tachycardia
  • hypertension
  • air hunger
  • desaturation
  • sweating
  • agitation
  • cyanosis
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21
Q

what are really late signs of distress in children?

A

respiratory failure

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22
Q

when we see hyperventilation, what can that result in?

A
  • decrease CO2 levels
  • decrease in SpO2
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23
Q

when a child has a decreased O2 reading and we apply oxygen why might we see a false positive?

A

after applying O2 stat may go back up to 100% but this isn’t actually the case child may still be compensating

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24
Q

if we see a patient hyperventilating what do you need to do?

A
  • call doctor
  • ask for blood gas volume (ABG) order
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25
Q

where do you look on a Childs body for retractions?

A
  • trach tug/ suprasternal
  • substernal
  • intercostal
  • subcostal
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26
Q

what does ARI stand for?

A

Acute Respiratory Infection

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27
Q

ARI is most common in children who are what?

A
  • HIV positive
  • under 2 years of age
  • malnourished
  • weaned from breastfeeding early
  • formula fed
  • parents with low social determinants of health
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28
Q

what is the most common type of ARI in children?

A

common cold

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29
Q

define asthma

A

syndrome caused by increased responsiveness of tracheobronchial tree to various stimuli that results in constriction of airway

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30
Q

asthma manifests by one of four components, what are they?

A
  • bronchospasms
  • edema/ mucous
  • inflammation
  • airway reactivity
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31
Q

airway reactivity can be caused by what?

A
  • different scents
  • allergens
  • foods
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32
Q

risk factors for asthma can include what?

A
  • family history
  • high exposure to allergens
  • exposures to smoke
  • frequent ARI in infancy
  • premature
  • low birth weight
  • C-section
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33
Q

why is it more common for C-section babies to have lung issues?

A

not squeezed/ squished on way of vagina > causes lungs to not be pushed up or emptied as much

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34
Q

what are signs and symptoms of asthma?

A
  • coughing in absence of infection
  • SOB
  • audible wheeze
  • restlessness/ anxiousness
  • indrawing
  • nasal flaring
  • pale
  • decreased O2 stat
  • cyanotic lips, nail beds
  • itching
  • eczema
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35
Q

what do we see often see first prior to a respiratory problem developing?

A

rashes due to inflammatory/ immune response

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36
Q

what diagnostic orders should you expect for asthma in a child?

A
  • history
  • physical exam
  • response to bronchodilators
  • CT/ X-ray
  • ABGs
  • resp swabs
  • pull Fx
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37
Q

what treatment orders should you expect for asthma in a child?

A
  • rescue inhalers
  • corticosteroids
  • nebulizers
  • maintain patent airway
  • avoiding triggers
  • fluids
  • family teaching
  • frequent assessments/ vitals
  • elevate HOB
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38
Q

what score do we complete pre and post inhalers and why?

A
  • PRAM score
  • see how child is reacting to treatment
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39
Q

why do you give Ventolin before giving corticosteroids?

A

Ventolin opens bronchi and then corticosteroids go down to bases and help loosen mucous and relieve inflammation

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40
Q

What are discharge teachings you need to teach parents?

A
  • triggers
  • up to date on vaccinations including flu
  • signs and symptoms
  • medication action plan
  • administration of medication c spacers
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41
Q

what would be included in a medication action plan for a child being discharged with asthma?

A
  • reliever/ rescue meds
  • controller
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42
Q

for the medication action plan for a child being discharged with asthma what is included in reliever/ rescue meds?

A
  • short beta 2
  • anticholinergic
  • corticosteroid
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43
Q

for the medication action plan for a child being discharged with asthma what is included in the controller meds?

A
  • long acting beta 2
  • corticosteroid
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44
Q

what is another name for croup?

A

laryngotracheobronchitis (LTB)

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45
Q

acute group affects what?

A

upper airway
- larynx
- trachea
- bronchi

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46
Q

what is acute croup?

A
  • inflammation/ edema of upper airway
  • virus
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47
Q

what does acute croup start with?

A
  • mild upper respiratory infection (cold)
  • Barry cough
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48
Q

if acute croup gets worse what can it develop to?

A
  • stridor
  • respiratory distress
  • hospitalization
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49
Q

what is the main/ key sign of croup?

A

croupy cough/ barky sounds

50
Q

what are the early signs and symptoms of croup?

A
  • Barky cough
  • hoarseness
  • restlessness
  • fever (low or high grade)
  • needing to sit upright
  • respiratory distress
  • frightened looks
51
Q

what are the late signs of croup?

A
  • stridor (often audible)
  • hypoxia
  • tachycardia
  • diminished breath sounds
52
Q

what are the orders/ treatments you should expect when treating a child with croup?

A
  • frequent assessments c VS
  • oxygen
  • fluids
  • antipyretics
  • nebulizers
  • steroids
  • racemic epinephrine
  • seldom given antibiotics
53
Q

describe racemic epinephrine

A
  • works on adrenergic receptor (alpha, beta 1&2)
  • opens airways
  • helps vasoconstrict areas with leakage
  • helps reduce inflammation/ edema
54
Q

what’s another name for epinephrine?

A

adrenaline

55
Q

what types of treatments can parents do at home for children with croup?

A
  • cool air
  • antipyretics
  • fluids
  • humidifier
  • no smoking inside
  • elevate head
  • co-sleeping
56
Q

what is epiglottitis?

A
  • inflammation and swelling of epiglottis and above vocal cords
  • bacterial
  • very rare
57
Q

what can epiglottitis result in?

A

full airway obstruction

58
Q

describe the onset of epiglottitis

A

abrupt, rapid and progressive

59
Q

who is at risk of epiglottitis?

A
  • children aged 3-6 years
  • can also occur in older age groups
60
Q

what are the signs and symptoms of epiglottitis?

A
  • child insists on sitting up/ leaning forward
  • drool
  • sore throat
  • agitation/ anxious frightened expression
  • red inflamed throat
  • high fever
  • rapid pulse/ resps
  • stridor
  • croaking frog like sounds in inspiration
  • substernal retractions
61
Q

what are the 4 cardinal signs of epiglottitis?

A
  • drooling
  • dysphagia (difficulty swallowing)
  • dysphonia (difficulty speaking)
  • distressed
62
Q

what are the orders/ tests you should expect for a child with epiglottitis?

A
  • DO NOT leave alone with medical attention
  • DO NOT look in mouth with tongue depressors
  • assessment
  • X-ray to confirm diagnosis
63
Q

what are the treatments you should expect for a child with epiglottitis?

A
  • intubation on trach (usually only 24-48hrs)
  • one to one nursing care
  • oxygen
  • IV fluids and antibiotics
  • sometimes IV steroids
64
Q

what is bronchiolitis?

A

swelling and inflammation of bronchiole

65
Q

What is bronchiolitis caused by?

A
  • viral infection
  • typically RSV or influenza
66
Q

what age can kids develop bronchiolitis? What percent are hospitalized?

A

6 months - 2 years
- 2%

67
Q

what can bronchiolitis lead to later on?

A

asthma

68
Q

what does RSV stand for?

A

respiratory syncytial virus

69
Q

RSV is the leading cause of what in infants?

A

pneumonia and bronchiolitis

70
Q

when is RSV mostly seen?

A

winter months

71
Q

at what age do all children come in contact with RSV by?

A

3 years

72
Q

is RSV highly contagious?

A

yes

73
Q

what are used to diagnose bronchiolitis?

A
  • CXR
  • nasopharyngeal swab
  • blood work
  • ABGs
74
Q

what are preventative measures for bronchiolitis?

A
  • update vaccines
  • annual flu shot
  • RSV prevention monoclonal
75
Q

what does monoclonal do? Who receives it?

A
  • helps boost antibodies
  • not given to all babies only those at high risk
76
Q

what does NHF stand for?

A

nasal high flow

77
Q

describe NHF

A
  • used for respiratory distress
  • minimizes room air inspiration
  • washes out dead space
78
Q

what are the 4 things NHF does?

A
  • provides supportive care
  • helps lower airway resistance
  • has humidified air/ oxygen
  • adds positive pressure
79
Q

why is it key that a NHF added positive pressure ?

A

to open airways to allow gas exchange

80
Q

When do you use NHF?

A
  • SpO2 <90% despite max low flow
  • prolonged respiratory distress c impending respiratory failure
  • severe tachypnea
  • tachycardia
  • apnea
  • bradycardia
  • decreasing LOC
81
Q

what do you start NHF at?

A

2L/kg/ min

82
Q

what are the benefits to using NHF?

A
  • improve breathing pattern/ rapid unloading of resp muscles
  • reduction in work of breathing
  • improvement to resp distress
  • improved mucosal function/ secretion
83
Q

early use of NHF outside of the PICU can lead to what?

A

reduced intubation and PICU admissions

84
Q

what are your nursing priorities when providing care for a respiratory patient in the paediatric setting?

A
  • assess respiratory status
  • positioning
  • O2 monitoring
  • VS monitoring
  • fluid balance
  • temperature control
  • organize/ prioritize care
  • treat cause/ symptoms
85
Q

kids have greater what compared to adults?

A

greater intracellular and interstitial fluid

86
Q

do kids have a higher % of water mass in their bodies compared to adults?

A

yes

87
Q

what happens to kids water mass as they get older?

A

younger the kid is the more water % they are going to have as they get older this will lesson

88
Q

what systems are affected the most by kids having a higher water loss?

A
  • metabolic/ heat
  • respiratory
  • cardiac
  • GI
  • hormones
89
Q

why is the GI system affected in kids and them having a higher water %?

A
  • immature kidneys
  • shorter colon
90
Q

why does having a shorter colon affect water % in children?

A

colon absorbs more water if shorter can’t absorb as much compared to adults this is why baby poops are more runny and as they age get more formed

91
Q

why are hormones affected in kids and them having a higher water %?

A
  • immature
  • sensible losses
  • insensible losses
92
Q

what are examples of sensible losses?

A
  • vomiting
  • urine
  • blood loss
93
Q

what are examples of insensible losses?

A
  • sweating
  • tears
  • respiratory rate
94
Q

what are conditions that increase fluid requirements?

A
  • GI conditions (vomiting, diarrhea)
  • fever
  • blood loss (hypovolemia)
  • respiratory conditions
  • infections/ sepsis
95
Q

what are conditions that decrease fluid requirements?

A
  • fluid overload (IV)
  • cardiac conditions
  • renal conditions
  • lymphatic conditions (Adison’s)
  • metabolic conditions
96
Q

which electrolytes do we want to look at when a child has fluid and electrolyte imbalances?

A
  • sodium
  • potassium
  • calcium
  • magnesium
97
Q

what does sodium affect?

A

key for osmosis/ fluid regulation

98
Q

what does potassium affect?

A
  • action potential
  • any type of system with electrical conduction
99
Q

what does calcium affect?

A
  • bones
  • action potential
100
Q

what does magnesium affect?

A
  • muscle contraction
  • cofactor for potassium and calcium
  • helps with reabsorption of potassium and calcium
101
Q

what are the 3 types of dehydration?

A
  • isotonic
  • hypertonic
  • hypotonic
102
Q

describe isotonic dehydration

A
  • equal loss of fluid and salt
  • also called hypovolemia
103
Q

describe hypertonic dehydration

A

more water is lost and sodium kept

104
Q

describe hypotonic dehydration

A

more sodium is lost than water

105
Q

what is hypotonic dehydration commonly seen in?

A
  • cystic fibrosis
  • Adison’s disease
  • diuretic use
  • renal disease
106
Q

what are some paediatric conditions that would cause respiratory acidosis? give an example

A
  • anything with HYPOventilatoin
    ex. asthma
107
Q

what are some paediatric conditions that would cause respiratory alkalosis? give an example

A

anything with HYPERventilation
ex. fever, pain, some respiratory conditions

108
Q

what are some paediatric conditions that would cause metabolic acidosis? give an example

A

issues with kidneys
ex. sepsis, DKA

109
Q

what are some paediatric conditions that would cause metabolic alkalosis?

A
  • GI suctioning
  • vomiting
  • diarrhea
  • dehydration
110
Q

how are CO2 and pH affected in respiratory acidosis?

A

CO2 increased
pH decreased

111
Q

how are CO2 and pH affected in respiratory alkalosis?

A

CO2 decreased
pH increased

112
Q

how are HCO2 and pH affected in metabolic acidosis?

A

HCO3 decreased
pH decreased

113
Q

how are CO2 and pH affected in metabolic alkalosis?

A

HCO3 increased
pH increased

114
Q

what is important to cause for dehydration in kids?

A

underlying cause

115
Q

to treat mild-moderate dehydration what would you use?

A

oral rehydration therapy

116
Q

what are included in the first options when treating mild-moderate dehydration in kids?

A
  • broth
  • electrolyte drinks
  • anything with healthy electrolytes and nutrients
117
Q

what are included in the second options when treating mild-moderate dehydration in kids?

A

any fluids they will take in

118
Q

to treat severe dehydration what would you use?

A

IV therapy

119
Q

what are the treatments for bronchiolitis?

A
  • O2 therapy
  • supportive care
  • assess fluids
  • airvo/ CPAP if necessary
  • ensure up to date on vaccinations
120
Q

why do we not use inhalers to treat bronchiolitis?

A

may trial Ventolin to see how they respond for the most part they don’t have any effect

NRSG 329 (5 decks)

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