Week 2 - Respiratory conditions & Fluid/ electrolytes Flashcards
what is very common in children?
fever
what temperature of fever is considered febrile in children?
38.0 degrees celsius
what are the different routes to take temperatures for children?
- oral
- temporal
- axillary
- tympanic
what is classified as a low grade fever?
37.5-37.8 degrees celsius
most kids will experience a low grade fever during what?
- growth spurts
- teething
- post vaccinations
why do we want to treat fevers in children?
- comfort
- prevent febrile seizures
- decrease physical demands
how do you treat fevers for children?
- antipyretics
- warm bath
- cool cloth
- take off some layers
what are examples of antipyretics?
- acetaminophen
- ibuprofen
when children have fevers what’s going in inside their bodies?
- increased RR
- increased metabolic rate will look like Rosie cheeks
- sweating to cool down
what can be a result of sweating in children?
- dehydration
- fluid and electrolyte imbalances
why should children under 4 years not have ASA?
can result in rye’s syndrome
What are paediatric differences in regards to the respiratory system?
- 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
what are paediatric differences in regards to the respiratory system for newborns?
brief periods of apnea common
what are the key components of the respiratory assessment for paediatrics
- effort
- RR
- colour
- auscultation/ sounds
- cough (productive or not)
- nasal discharge
- SpO2
What would indicate increased respiratory effort in a child or infant?
- use of intercostal muscles
- nasal flaring
- retractions
most arrests in children are what?
respiratory
what are signs of distress in a child?
- SOB
- retractions
- nasal flaring
- grunting
- head bobbing for infants
- sea saw breathing
- air hunger
- O2 stat levels
what does SOB look like in a child?
- use of accessory muscles
- sitting in tripod position
- sitting up
what does air hunger look like?
- open mouth/ gasping for air
- looks like they are eating air
what are late signs of distress in children?
- head bobbing
- tachycardia
- hypertension
- air hunger
- desaturation
- sweating
- agitation
- cyanosis
what are really late signs of distress in children?
respiratory failure
when we see hyperventilation, what can that result in?
- decrease CO2 levels
- decrease in SpO2
when a child has a decreased O2 reading and we apply oxygen why might we see a false positive?
after applying O2 stat may go back up to 100% but this isn’t actually the case child may still be compensating
if we see a patient hyperventilating what do you need to do?
- call doctor
- ask for blood gas volume (ABG) order
where do you look on a Childs body for retractions?
- trach tug/ suprasternal
- substernal
- intercostal
- subcostal
what does ARI stand for?
Acute Respiratory Infection
ARI is most common in children who are what?
- HIV positive
- under 2 years of age
- malnourished
- weaned from breastfeeding early
- formula fed
- parents with low social determinants of health
what is the most common type of ARI in children?
common cold
define asthma
syndrome caused by increased responsiveness of tracheobronchial tree to various stimuli that results in constriction of airway
asthma manifests by one of four components, what are they?
- bronchospasms
- edema/ mucous
- inflammation
- airway reactivity
airway reactivity can be caused by what?
- different scents
- allergens
- foods
risk factors for asthma can include what?
- family history
- high exposure to allergens
- exposures to smoke
- frequent ARI in infancy
- premature
- low birth weight
- C-section
why is it more common for C-section babies to have lung issues?
not squeezed/ squished on way of vagina > causes lungs to not be pushed up or emptied as much
what are signs and symptoms of asthma?
- coughing in absence of infection
- SOB
- audible wheeze
- restlessness/ anxiousness
- indrawing
- nasal flaring
- pale
- decreased O2 stat
- cyanotic lips, nail beds
- itching
- eczema
what do we see often see first prior to a respiratory problem developing?
rashes due to inflammatory/ immune response
what diagnostic orders should you expect for asthma in a child?
- history
- physical exam
- response to bronchodilators
- CT/ X-ray
- ABGs
- resp swabs
- pull Fx
what treatment orders should you expect for asthma in a child?
- rescue inhalers
- corticosteroids
- nebulizers
- maintain patent airway
- avoiding triggers
- fluids
- family teaching
- frequent assessments/ vitals
- elevate HOB
what score do we complete pre and post inhalers and why?
- PRAM score
- see how child is reacting to treatment
why do you give Ventolin before giving corticosteroids?
Ventolin opens bronchi and then corticosteroids go down to bases and help loosen mucous and relieve inflammation
What are discharge teachings you need to teach parents?
- triggers
- up to date on vaccinations including flu
- signs and symptoms
- medication action plan
- administration of medication c spacers
what would be included in a medication action plan for a child being discharged with asthma?
- reliever/ rescue meds
- controller
for the medication action plan for a child being discharged with asthma what is included in reliever/ rescue meds?
- short beta 2
- anticholinergic
- corticosteroid
for the medication action plan for a child being discharged with asthma what is included in the controller meds?
- long acting beta 2
- corticosteroid
what is another name for croup?
laryngotracheobronchitis (LTB)
acute group affects what?
upper airway
- larynx
- trachea
- bronchi
what is acute croup?
- inflammation/ edema of upper airway
- virus
what does acute croup start with?
- mild upper respiratory infection (cold)
- Barry cough
if acute croup gets worse what can it develop to?
- stridor
- respiratory distress
- hospitalization
what is the main/ key sign of croup?
croupy cough/ barky sounds
what are the early signs and symptoms of croup?
- Barky cough
- hoarseness
- restlessness
- fever (low or high grade)
- needing to sit upright
- respiratory distress
- frightened looks
what are the late signs of croup?
- stridor (often audible)
- hypoxia
- tachycardia
- diminished breath sounds
what are the orders/ treatments you should expect when treating a child with croup?
- frequent assessments c VS
- oxygen
- fluids
- antipyretics
- nebulizers
- steroids
- racemic epinephrine
- seldom given antibiotics
describe racemic epinephrine
- works on adrenergic receptor (alpha, beta 1&2)
- opens airways
- helps vasoconstrict areas with leakage
- helps reduce inflammation/ edema
what’s another name for epinephrine?
adrenaline
what types of treatments can parents do at home for children with croup?
- cool air
- antipyretics
- fluids
- humidifier
- no smoking inside
- elevate head
- co-sleeping
what is epiglottitis?
- inflammation and swelling of epiglottis and above vocal cords
- bacterial
- very rare
what can epiglottitis result in?
full airway obstruction
describe the onset of epiglottitis
abrupt, rapid and progressive
who is at risk of epiglottitis?
- children aged 3-6 years
- can also occur in older age groups
what are the signs and symptoms of epiglottitis?
- 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
what are the 4 cardinal signs of epiglottitis?
- drooling
- dysphagia (difficulty swallowing)
- dysphonia (difficulty speaking)
- distressed
what are the orders/ tests you should expect for a child with epiglottitis?
- DO NOT leave alone with medical attention
- DO NOT look in mouth with tongue depressors
- assessment
- X-ray to confirm diagnosis
what are the treatments you should expect for a child with epiglottitis?
- intubation on trach (usually only 24-48hrs)
- one to one nursing care
- oxygen
- IV fluids and antibiotics
- sometimes IV steroids
what is bronchiolitis?
swelling and inflammation of bronchiole
What is bronchiolitis caused by?
- viral infection
- typically RSV or influenza
what age can kids develop bronchiolitis? What percent are hospitalized?
6 months - 2 years
- 2%
what can bronchiolitis lead to later on?
asthma
what does RSV stand for?
respiratory syncytial virus
RSV is the leading cause of what in infants?
pneumonia and bronchiolitis
when is RSV mostly seen?
winter months
at what age do all children come in contact with RSV by?
3 years
is RSV highly contagious?
yes
what are used to diagnose bronchiolitis?
- CXR
- nasopharyngeal swab
- blood work
- ABGs
what are preventative measures for bronchiolitis?
- update vaccines
- annual flu shot
- RSV prevention monoclonal
what does monoclonal do? Who receives it?
- helps boost antibodies
- not given to all babies only those at high risk
what does NHF stand for?
nasal high flow
describe NHF
- used for respiratory distress
- minimizes room air inspiration
- washes out dead space
what are the 4 things NHF does?
- provides supportive care
- helps lower airway resistance
- has humidified air/ oxygen
- adds positive pressure
why is it key that a NHF added positive pressure ?
to open airways to allow gas exchange
When do you use NHF?
- SpO2 <90% despite max low flow
- prolonged respiratory distress c impending respiratory failure
- severe tachypnea
- tachycardia
- apnea
- bradycardia
- decreasing LOC
what do you start NHF at?
2L/kg/ min
what are the benefits to using NHF?
- improve breathing pattern/ rapid unloading of resp muscles
- reduction in work of breathing
- improvement to resp distress
- improved mucosal function/ secretion
early use of NHF outside of the PICU can lead to what?
reduced intubation and PICU admissions
what are your nursing priorities when providing care for a respiratory patient in the paediatric setting?
- assess respiratory status
- positioning
- O2 monitoring
- VS monitoring
- fluid balance
- temperature control
- organize/ prioritize care
- treat cause/ symptoms
kids have greater what compared to adults?
greater intracellular and interstitial fluid
do kids have a higher % of water mass in their bodies compared to adults?
yes
what happens to kids water mass as they get older?
younger the kid is the more water % they are going to have as they get older this will lesson
what systems are affected the most by kids having a higher water loss?
- metabolic/ heat
- respiratory
- cardiac
- GI
- hormones
why is the GI system affected in kids and them having a higher water %?
- immature kidneys
- shorter colon
why does having a shorter colon affect water % in children?
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
why are hormones affected in kids and them having a higher water %?
- immature
- sensible losses
- insensible losses
what are examples of sensible losses?
- vomiting
- urine
- blood loss
what are examples of insensible losses?
- sweating
- tears
- respiratory rate
what are conditions that increase fluid requirements?
- GI conditions (vomiting, diarrhea)
- fever
- blood loss (hypovolemia)
- respiratory conditions
- infections/ sepsis
what are conditions that decrease fluid requirements?
- fluid overload (IV)
- cardiac conditions
- renal conditions
- lymphatic conditions (Adison’s)
- metabolic conditions
which electrolytes do we want to look at when a child has fluid and electrolyte imbalances?
- sodium
- potassium
- calcium
- magnesium
what does sodium affect?
key for osmosis/ fluid regulation
what does potassium affect?
- action potential
- any type of system with electrical conduction
what does calcium affect?
- bones
- action potential
what does magnesium affect?
- muscle contraction
- cofactor for potassium and calcium
- helps with reabsorption of potassium and calcium
what are the 3 types of dehydration?
- isotonic
- hypertonic
- hypotonic
describe isotonic dehydration
- equal loss of fluid and salt
- also called hypovolemia
describe hypertonic dehydration
more water is lost and sodium kept
describe hypotonic dehydration
more sodium is lost than water
what is hypotonic dehydration commonly seen in?
- cystic fibrosis
- Adison’s disease
- diuretic use
- renal disease
what are some paediatric conditions that would cause respiratory acidosis? give an example
- anything with HYPOventilatoin
ex. asthma
what are some paediatric conditions that would cause respiratory alkalosis? give an example
anything with HYPERventilation
ex. fever, pain, some respiratory conditions
what are some paediatric conditions that would cause metabolic acidosis? give an example
issues with kidneys
ex. sepsis, DKA
what are some paediatric conditions that would cause metabolic alkalosis?
- GI suctioning
- vomiting
- diarrhea
- dehydration
how are CO2 and pH affected in respiratory acidosis?
CO2 increased
pH decreased
how are CO2 and pH affected in respiratory alkalosis?
CO2 decreased
pH increased
how are HCO2 and pH affected in metabolic acidosis?
HCO3 decreased
pH decreased
how are CO2 and pH affected in metabolic alkalosis?
HCO3 increased
pH increased
what is important to cause for dehydration in kids?
underlying cause
to treat mild-moderate dehydration what would you use?
oral rehydration therapy
what are included in the first options when treating mild-moderate dehydration in kids?
- broth
- electrolyte drinks
- anything with healthy electrolytes and nutrients
what are included in the second options when treating mild-moderate dehydration in kids?
any fluids they will take in
to treat severe dehydration what would you use?
IV therapy
what are the treatments for bronchiolitis?
- O2 therapy
- supportive care
- assess fluids
- airvo/ CPAP if necessary
- ensure up to date on vaccinations
why do we not use inhalers to treat bronchiolitis?
may trial Ventolin to see how they respond for the most part they don’t have any effect
