Week 6 - Pediatric conditions Flashcards
(61 cards)
When dealing with pediatric conditions, how should care be delivered?
Family-centered
For bloodwork, what sites are used based on age?
Heel pokes for under 18 months
Finger pokes for most routine tests
Chronic inflammatory disorder of the airways resulting from a complex interaction of airway obstruction, bronchial hyper-responsiveness and inflammation
asthma
Asthma causes _______ airway obstruction.
reversible
In asthma, what will you hear when listening to breathing?
Expiration wheezes
Exacerbations of this illness is the leading case of pediatric hospital admission
asthma
most children who present to the ER with an asthma exacerbation are
5
Why is it that most asthma exacerbations are for children less than 5?
Not diagnosed yet more active don't follow med schedule unaware of triggers smaller airways
What time of the year do asthma exacerbations peak?
September when they go back to school (peaks 17.7 days after Labour day) - exposed to germs and may have low adherence to asthma meds at this time
What are some common viruses that could cause asthma exacerbations?
Rhinovirus, coronavirus, influenza, parainfluenza, RSV
What is the biggest trigger for asthma?
Second hand smoke or dust
What are some triggers for asthma?
environmental allergens (pollen, dust), dry and cold air, exercise, second hand smoke
If asthma exacerbation is suspected, what should we do?
Ask the parents if they had it before
vitals - ox sats
sit them up
don PPE (may be pneumonia)
What two instruments are used in dx of asthma?
Spirometry/pulmonary function test
Peak flow monitoring
Measures the total volume of air that is inhaled and exhaled.
Forced vital capacity (inhaled) and forced expiratory volume (exhaled)
Spirometry
Spirometry is difficult to accomplish in children under the age of ?
6
Describe peak flow monitoring
Patient takes a full breath, blows out quickly and as hard as they can
This is repeated 3x and the highest value is recorded
Peak flow is compared to normal values or patient’s personal best to see whether they need to go to the ER
Why would peak flow be used? Why wouldn’t it?
Readily available BUT
less sensitive measure of airway obstruction and may be unreliable for children under 10
When a child presents with suspected asthma, what questions should you ask?
Have they had this before/been to ED before/PCCU before?
Do they have puffers?
Any allergies?
What has the family tried?
What assessments are completed for children with asthma?
Vitals + head to toe + resp assess
Look for lower oxygen sats, tachypnea and more breaths per minute
Look for skin colour, LOC, use of accessory muscles, anxiety, diaphoresis
listen for breth sounds
What nursing interventions might be completed for asthma?
Oxygen spirometry/peak flow [ABGs] - rarely used BW (lactate, acidosis, PCO2) [CXR - rarely used]
Is a CXR common for asthma?
What about blood gases?
No, unless the clinician suspects complications (e.g. pneumothorax)
Blood gases rarely checked unless they do not respond to aggressive therapy –> normal capillary carbon level despite persistent respiratory distress is a sign of respiratory failure
What is the order of puffers for asthma management?
Salbutamol/blue puffer - bronchodilator (ventolin - SABA)
Beclomethastone - corticosteroid
Long acting beta agonist - Advair/serevent
LTRA (leukotriene receptor antagonist - singulair - chewable tablet with min sides
IV/PO steroids - e.g. dex
How does one breathe when using salbutamol/blue puffer?
How about the disk/advair?
Salbutamol - do not breathe in hard and fast
Avair disk - hard and fast inhalation (particulate)
6 blue puffer; 6 little green puffer
