Week 5 - Respiratory Flashcards
Airway diameter of a newborn vs. adult
Newborn: 4 mm
Adult: 20 mm
Airway Diameter of a Newborn
KNOW THIS!!!!!
4 mm
Airway Diameter of an Adult
20 mm
When do alveoli grow & mature in children?
KNOW THIS!!!!!
- Grow by week 36 gestation
- Mature by 5-8 years
S/S of Mild Respiratory Distress
KNOW THIS!!!!!
Restlessness, tachypnea, tachycardia, diaphoresis
- Child is trying to compensate for 0-2 deficits & airway blockages
- Vital signs reflect compensation & beginning hypoxia
Signs & Symptoms Moderate Respiratory Distress with Early Decompensation
KNOW THIS!!!!!
- Nasal flaring
- Retractions
- Grunting, wheezing
- Anxiety, irritability, mood changes, confusion
- Hypertension
Signs & Symptoms of Severe Respiratory Distress: Respiratory Failure / Imminent Arrest
KNOW THIS!!!!!
- Dyspnea
- Bradycardia
- Cyanosis (LATE sign)
- Stupor, coma
Children with severe respiratory distress & a narrowed airway often sit in tripod position, leaning forward with arms on the legs. The head & neck are extended with the jaw thrust forward to help keep the airway open.
- this position may also be seen in a child with an acute asthma flare.
Croup
KNOW THIS!!!!!
Broad class of upper airway illnesses that result in inflammation & swelling of the epiglottis & larynx, swelling extends into the trachea & larynx
Cause: can be viral or bacterial
- Common among 3 months - 3 year olds
Dx: CXR with steeple sign
Signs & Symptoms of Croup (Laryngotracheitbronchitis / LTB)
KNOW THIS!!!!!
- Fever
- Barking / croupy cough
- Inspiratory stridor
- Retractions
- Hoarse cry
- Cyanosis
- Decreased level of consciousness (LOC)
Treatment / Clinical Therapy for Croup (Laryngotracheitbronchitis / LTB)
KNOW THIS!!!!!
- Oral dexamethasone
- Nebulized epinephrine
- Supplemental O2 (if hypoxic)
- Antipyretics PRN
- Hydration
- Continuous observation of respiratory status
- Administer medications
- Quiet environment to promote rest
Stridor
KNOW THIS!!!!!
High-pitched sound generated from partially obstructed air flow in the upper airway
Epiglottitis
KNOW THIS!!!!!
Inflammation & swelling of the epiglottis & larynx
Cause: bacterial infection often caused by haemophilis influenza
Dx: CXR = thumb sign
S/S of Epiglottitis
KNOW THIS!!!!!
- High fever
- Sore throat
- Drooling dysphagia
- Tachycardia
- Tachypnea
- Tripod position
Nursing Management of Epiglottitis
KNOW THIS!!!!!
- do NOT upset child
- do NOT put anything in their mouth
- Prep for intubation THEN IV access / labs
Tx of Epiglottitis
KNOW THIS!!!!!
- IV antibiotics
- IV dexamethasone
- Nebulized epinephrine
- Antipyretics
- O2
- Intubation
- Hib vaccine (influenza type B)
Bronchiolitis
KNOW THIS!!!!!
Inflammation & obstruction of the bronchioles
- lower respiratory infection (viral or bacterial)
- leading cause of hospitalizations in ages 1 year
- RSV = #1 cause
Dx: CXR = reactive airway disease
Respiratory Syncytial Virus (RSV)
KNOW THIS!!!!!
- Highly contagious viral respiratory infection
- major cause of bronchiolitis
- form syncytia or large masses of cells that clog & irritate the airway
S/S of Bronchiolitis / RSV
KNOW THIS!!!!!
- Nasal symptoms
- Cough
- Fever
- Wheezing
- Tachypnea
- Retractions / nasal flaring / grunting
- ↓ activity level
- ↓ oral intake
- Dehydration (dry lips, tachycardia, lethargy)
- Wheezing & crackles in airways
Nursing Management for Bronchiolitis
- Nasal swabs
- Suction
- IV fluids
- O2 (NC or high flow NC)
Tx of Bronchiolitis / RSV
KNOW THIS!!!!!
- Supportive care
- Antibiotics
- Nebulized albuterol
- Chest physiotherapy (CPT)
- Synagis: Immunoglobulin for high risk children less than 32 weeks old; administerd q30 days for 5 months (winter months)
High Flow Nasal Cannula (HFNC)
KNOW THIS!!!!!
Continuous positive airway pressure (CPAP)
- up to 60 L/min
Pneumonia
KNOW THIS!!!!!
Inflammation of the bronchioles & alveoli
- community or hospital acquired or from aspiration
- TYPES: viral, bacterial, mycoplasmal (atypical)
S/S of Pneumonia
KNOW THE BOLD!!!!!
- cough
- crackles / rhonchi
- congestion
- fever
- chest pain
- Retractions / nasal flaring / grunting / SOB / lethargy
- abdominal pain
- poor appetite
Tx for Pneumonia
Antibiotics for Bacterial
* ampicillin or amoxicillin for outpatient
* azithromycin for atypical
* ceftriaxone for high risk or unvaxxed
Pain / fever control
Asthma
KNOW THE BOLD!!!!!
Persistent inflammation of the airway causing hyper responsiveness leading to excess mucous, swelling, & muscle contraction
Triggers: environmental, exercise, viruses, or allergens, smoke, dander, feces, air pollutants
S/S of Asthma
KNOW THE BOLD!!!!!
- sudden onset of SOB
- cough
- inspiratory or expiratory wheezing
- tachypnea
- retractions
Tx for Asthma
Short-acting beta agonist (SABA)
* albuterol
Corticosteroids
* decadron, prednisone, solumedrol
Anticholinergics
* ipatropium
Adjuncts
* duoneb: albuterol/ipatropium, magnesium sulfate
Rule of Twos for Asthma
KNOW THIS!!!!!
- Do you use your quick-relief inhaler more than 2 times per week?
- Do you awaken at night due to ashtma more than 2 times per month?
- Do you refill a quick-relief inhaler prescription more than 2 times per year?
5-10-5 Rule (asthma)
KNOW THIS!!!!!
How to use a Spacer:
- Tilt head back & breath in for 5 seconds
- Hold breath for 10 seconds
- breathe out for 5 seconds
Cystic Fibrosis (CF)
KNOW THE BOLD!!!!!
Reduced water movement across cell membranes = blocked airways
- Inherited disorder, CFTR gene mutation; autosomal recessive trait
- Causes damage to the lungs, pancrease, gallbladder, & liver
- 30,000 in the US
- 10 million carriers
Dx: sweat test (gold standard)
Tx for Cystic Fibrosis (CF)
- Short-acting beta agonist (SABA) for airway inflammation
- inhaled (tobramycin) & IV antibiotics (Cefepime) for flare ups
- Hypertonic saline nebulizer tx
- Pulmozyme (liquifies secretions)
- pancreatic supplements
- Vit ADEK (fat soluble)
