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Family NRSG > wk 3: care of the child with a resp. disorder > Flashcards

wk 3: care of the child with a resp. disorder Flashcards

1
Q

Review of A&P

A
  • Lungs are the main component of the resp. system
  • Take in oxygen, release co2
  • The right lung has 3 lobes, the left lung has 2 lobes
  • Certain reps. diseases can alter the shape of the chest
    • Ex: CF, and asthma can produce a barrel shaped chest
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2
Q

Upper airway infection

A
  • Self limited irritation and swelling of the upper airways with associated cough and no signs of pneumonia
  • Nose, vocal cords, sinuses, middle ear
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3
Q

lower airway infection

A
  • Trachea, bronchi, lungs, alveoli
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4
Q

Common upper resp. tract infection

A
  • Rhinitis
  • Pharyngitis
  • Tonsilitis
  • Laryngitis
  • titis media (ear infection)
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5
Q

Lower resp. tract infection

A
  • Pneumonia
  • Bronchiolitis
  • Bronchitis
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6
Q

Most common serious complications of URI

A
  1. Ear infection –> deaf
  2. Strep throat (group A strep)
    - Untreated –> Rheumatic fever
    - Etiology: strep tricks immune system into attacking healthy tissue
    - Inflammation in heart, joints, brain, skin
    - Arthirtis
    - Heart inflammation and damage
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7
Q

9 differences betweeen child and adult:

A
  1. Chest or thorax shape
  2. Diaphragm and muscles of respiration
  3. Relative internal organ size
  4. Upper airway structural differences
  5. Airway diameter
  6. Bronchial walls
  7. Cilia
  8. Surfactant
  9. Alveoli
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8
Q

child vs adult: thorax shape

A
  • Chest wall is round, making lung expansion more difficult
  • Child’s trachea bifacturates higher (it “forks” earlier)
  • Means child is more prone to choking
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9
Q

child vs adult: Diaphragm and muscles of respiration

A
  • Diaphragm angle is more horizontal
  • Immature muscle
  • Fatigues easily
  • Only way to increase oxygen intake is by increasing RR (Cue for baby)
  • Normally expiration is passive
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10
Q

child vs adult: relative internal organ size

A
  • Internal organs reduce expansion, due to relative size in relation to lungs
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11
Q

child vs adult: Respiratory differences

A
  • Larger head
  • Obligate nose breathers
  • Smaller nares, and mouth
  • Larger tongue
  • Larger epiglotis, and larynx higher in neck
  • More flexible trachea
  • Cues of resp. difficulty: Mouth breathing, nasal flaring
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12
Q

child vs adult: Airway diameter

A
  • With edema, 50% reduction in lumen of airway
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13
Q

Airway resistance

A
  • Definition: the effort or force required to move air into the lungs
  • Greater in children than in adults because children’s airways are narrower
  • In infants, airway resistance is about 15 times that of an adult
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14
Q

Patho of edema or swelling in a child’s airway

A

When there is edema or swelling in the airway due to an irritant or infectious process, the airway is further narrowed, increasing the airway resistance even more

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15
Q

Cues to increased airway resistance

A
  • Increased respiratory rate
  • Retractions
  • Nasal flaring
  • Use of accessory muscles
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16
Q

child vs adult: Bronchial walls

A
  • Supported by cartilage
  • Less muscle tissue present
  • more prone to collapse
  • Beta-adrenergic receptors are immature
  • Less responsive to bronchodilation
  • Cues: chest tightness, chest tightness, dry cough. Less muscle tissue is present. More prone to collapse
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17
Q

child vs adult: Poorly developed cilia.

A
  • Ineffective mucociliary escalator
  • Inability to clear secretions
  • At birth: poorly developed cilia
  • Risk for airway obstruction
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18
Q

child vs adult: Insufficient surfactant in Premies

A
  • Reduces surface tension
  • Gestation week 23, and 30 - 34 wks.
  • Difficulty expanding alveoli
  • Increased work of breathing
  • Can develop atelectasis
  • High maternal blood sugar reduces production of surfactant
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19
Q

child vs adult: Fewer Alveoli Until age 2

A
  • Very few functioning alveoli at birth
  • Air sacs increase in size and numbers
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20
Q

Summary of child vs adult resp. system

A
  • Due to an immature system and large organs infants compensate by increasing their RR while in Resp. distress
  • Surfactant can be administered to premature babies
  • Important to understand these differences
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21
Q

Review Peds normal vital signs (chart is in my folder)

A
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22
Q

Deterioration in children

A
  • May be subtle and non-specific
  • May deteriorate slowly but crash quickly
  • Early intervention is vital
  • Increased RR is primary cue
  • Suspicion of respiratory failure should be raised when there are signs of exhaustion, reccurent episodes of apnea or if oxygen saturation cannot be maintained with oxygen supplementation
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23
Q

Primary cues to pediatric respiratory distress

A
  • Nasal flaring
  • Tachypnea
  • Retractions
  • Leaning forward, or tilting head back to breathe
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24
Q

Wheeze

A
  • musical and high-pitched inspiration/expiration
  • Upper airway obstruction
  • Widespread airflow limitation
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25
Q

Rhonchi

A
  • Musical and low-pitched inspiration/expiration
  • Airway narrowing by mucous thickening, edema, or bronchospasm
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26
Q

Fine crackles

A
  • Short explosive, nonmusical,, mild to late inspiration
  • Heard in interstitial lung disease, congestive heart failure, fibrosis, pneumonia
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27
Q

Coarse crackles

A
  • Short, explosive, nonmusical, early inspiration, throughout expiration
  • Indicates intermittent airway opening in COPD
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28
Q

Stridor

A
  • Musical, high pitched, audible to unaided ear
  • Upper airway obstruction, Extrathoracic in inspiration
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29
Q

Squawk

A
  • Short musical wheeze, accompanying crackles
  • Penumonia (acutely), Interstitial lung disease, Pneumonitis
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30
Q

Adventitious sounds

A
  • Sounds not normally heard on auscultation of the lungs
  • Due to thinness of chest wall, breath sounds seem louder and harsher in infants and young children
  • Sounds may seem to originate in the lungs, when actually they are referred from the upper airway in children (i.e. mucous in nose or throat)
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31
Q

When assessing pediatric breath sounds

A
  • Encourage children to breathe deeply (like blowing candles)
  • Listen with the bell of the stetheschope for low-pitched sounds
  • Listen with the diaphragm for higher pitched sounds
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32
Q

Capillary refill - peripheral or central

A
  • Press and count for 5 seconds
  • Release and count for another 5 seconds
  • Stop counting when original color returns
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33
Q

Don’t forget the carers

A
  • Empower parents with validation and support
  • Keep informed of interventions and pain management options, times, etc
  • Keep informed of timeframes and processes
  • Keep informed of your return and reassessments
  • Educate them on the child’s condition
    Offer play and distraction
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34
Q

Chest X-Ray

A
  • Dense tissue such as bone appears white and clearly defined
  • A bacterial infection such as pneumonia also appears
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35
Q

Chest x-ray is used to rule out:

A
  • Foreign body aspiration
  • Infectious process
  • Gain info on cardiac size, contour, status of pulmonary flow
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36
Q

Nursing considerations

A
  • Explain procedure
  • Protect child from radiation exposure with lead shields
  • Ensure child holds still during test
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37
Q

Resp. treatments and procedures

A
  • Aerosol therapy
  • Assisted ventilation
  • Chest physiotherapy (CPT)
  • ET intubation
  • 02 administration
  • Tracheotomy
38
Q

Resp. equipment

A
  • Pulse oximeters reflect amount of RBC hgb saturated by O2 to be delivered to tissue
  • Assure correct placement etc.
  • Vaporizers → to provide warm or cool mist to moisten air and thin secretions
39
Q

Nebulizers

A
  • Delivers meds by fine mist deep into lungs for resp. disorders such as asthma
  • Types: Hand held (MDIs) and ultrasonic nebulizer machines
  • Nursing implications: SEE PAGE 1151 IN TEXTBOOK FOR USE OF A METERED DOSE INHALER
40
Q

Mist tents

A
  • Specially designed plastic placed over crib and tube carrying nebulized water –> enters tent (used for croup and pneumonia)
  • Nursing implications: remember it may be scary to young children, change bedding and clothing frequently
41
Q

Upper resp. Infection

A
  • Acute viral infection of upper respiratory tract
  • Pathogens: most common = rhinovirus
  • Others include RSV, influenza
42
Q

Upper resp. Transmission

A
  • Nasal secretions and hands
  • Symptoms: runny nose, congestion, sore throat, cough, low grade fever, etc.
43
Q

Upper respiratory infections - treatment

A
  • Primarily supportive
  • Analgesics
  • maintain hydration
  • No antibiotics
  • RTC if symptoms persist beyond 7 days or worsens
  • Prevention: hand hygiene, limiting exposure
44
Q

Acute Otitis Media (AOM)

A
  • Most commonly diagnosed illness in childhood
    Inflammation of middle ear with rapid onset of symptoms / clinical signs
  • AOM occurs most commonly in children between 6 months and 3 years - uncommon after age 8
  • More common in winter
  • Lower incidence in breast-fed infants because breast milk provides immunity
45
Q

AOM continued - Infants more predisposed because they have:

A
  • Short, horizontally positioned eustachian tubes
  • Enlarged lymphoid tissue, which obstructs the eustachian tube opening
  • Any eustachian tube dysfunction = secretions retained in middle ear
  • Bottle feeding in supine position = increases risk, promotes pooling of milk in the pharyngeal cavity
46
Q

AOM TX

A
  • Analgesics & antipyretics to relieve pain/fever in first 24 hrs of infection
  • Wait and see: 48 -72 hrs, 6-23 m old, non-severe otitis media
  • Antibiotics: Younger than 6 months, fever greater than 102.2, Ages 2 and older with severe symptoms
  • Encourage prevention by breast-feeding/non propping of bottle, eliminate child’s exposure to tobacco smoke
47
Q

AOM TX cont.

A
  • After antibiotic therapy completed child re-evaluated that tx was effective
  • If not: Myringotomy (incision in tympanic membrane)
  • or Tympanoplasty ventilating tubes equalize pressure
48
Q

AOM severe cases TX:

A
  • Prophylactic antibiotics
  • Asses for hearing loss
  • Refer for audiology testing
49
Q

Influenza

A
  • highly contagious viral illness
  • seasonal: mid-october to february
  • Transmissible
  • Incubation of 2-7 days
  • Infectious 24 hours before onset of symptoms
50
Q

Influenza DX

A
  • Diagnostic: Nasopharyngeal culture obtained within the first 72 hours of illness
  • Diagnosis usually based on clinical signs
51
Q

Influenza TX

A
  • supportive
  • antiviral prophylaxis such as Oseltamivir (Tamiflu)
  • Immunization
52
Q

Croup

A

Acute upper airway obstruction caused by a viral infection of the larynx

53
Q

Croup symptoms and DX

A
  • Barky cough
  • Inspiratory stridor
  • Hoarseness
  • fever
  • URI symptoms
  • DX: pulse oximetry shows hypoxia in children with severe disease
54
Q

Croup treatment out-patient treatment

A

hydration, humidified air, fam edu regarding worsening S&S, most cases are self-limiting for 3 - 5 days.

55
Q

Croup tx: moderate - severe

A
  • Hospitalized for supportive care (O2 supplementation, IV fluids)
  • Medication: Dexamethasone and…
  • nebulized epinephrine (adrenaline) which reduces swelling in airway, working faster than dexa. alone
  • Budesonide (corticosteroid) decreases swelling and irritation in airways. Begins working within 6 hrs.
56
Q

Lower resp infections - Bronchitis

A
  • Acute: transient inflammation of the larger lower airways
  • Chronic: poorly defined in children - rarely an isolated entity in children
  • Most commonly occurs after viral infections
57
Q

Bronchitis symptoms

A
  • Mild URI symptoms
  • Dry hacking cough that becomes productive
  • Older kids may complain of chest pain, worse with cough
  • As disease progresses –> more generalized illness
  • Normal temp or mild elevation
58
Q

Bronchitis diagnostic tests

A
  • Dx based on H&P
  • CXR not routinely ordered
  • Elevated neutrophil or CRP is suggestive of bacterial etiology
59
Q

Bronchitis TX

A
  • Supportive if viral
  • avoidance of resp. irriatnts
  • Increased fluid and rest
  • bronchodilators??
  • Inhaled steroids
  • Antibiotics useful if bacterial infection suspected
  • Pain meds for chest pain
  • Humidification of air promotes comfort
  • Cough medications???
  • No antihistamines
60
Q

Bronchiolitis

A
  • Acute viral infection
  • Seasonal: most common in midwinter to early spring
  • Almost all children have 1 episode before age of 3 years
  • Hospitalization more common in infants younger than 6 months
61
Q

Bronchiolitis S/S

A
  • coughing, rhinorrhea
  • tachypnea, labored breathing
  • hypoxia, irritability
  • poor feeding, vomitting, wheezing
  • crackles in lungs, fever
62
Q

Bronchiolitis diagnostics

A
  • based on hist and observation
  • CXR not recommended
  • pulse oximetry
  • WBC
  • viral culture
63
Q

Bronchiolitis tx + prog.

A
  • Supportive, hospitalization for some infants
  • prognosis is good as most resolve in 3-5 days
64
Q

Bronchiolitis new guidlines

A
  • Can be caused by many infections therefore testing is not necessary
  • imaging and lab tests are not needed
  • bronchodilators, steroids, and chest physio should not be used
  • nebulized hypertonic solution may be efffective
  • Oxygen may or may not be used
  • Pulse ox not recommended
  • No antibiotics unless another infection present
65
Q

Respiratory syncytial virus (RSV) symptoms

A
  • Runny nose
  • decrease in appetite
  • coughing
  • sneezing
  • fever
  • wheezing
66
Q

RSV

A
  • highly contagious agent
  • causes the majority of pneumonia cases among infants
  • Also causes bronchiotlits, croup, rhinitis
  • No complete immunity after infection, but partial immunity can limit severity of future upper resp. infections
67
Q

RSV - higher risk of severe infection for infants with:

A
  • CHD
  • underlying pulmonary diseases
  • Weak immune system
68
Q

RSV TX

A
  1. fluids, rest, 1 - 2 wks ,,, or ,,,
  2. Palivizumab (monoclonal antibody against RSV, given IM)
  3. Ribavirin
69
Q

Signs of RSV in babies

A
  • Fast or short breaths
  • Grunting noises
  • Chest caving in with each breath
  • Skin turns blue or purple due to lack of oxygen
  • On darker skin, look for changes to lips, tongue, gums, and around eyes
70
Q

RSV vs Bronchiolitis

A
  • Bronchiolitis and pneumonia have the potential to become life threatening conditions
  • Bronchiolitis is the most common serious infection that occurs during the infancy. In 80% of the cases, the causative agent of bronchiolitis is RSV
  • Thus, the key differences between RSV and bronchiolitis is that RSV is a pathogen whereas bronchiolitis is a disease that is mainly caused by RSV
71
Q

Pneumonia

A
  • an infection that inflames the air sacs in one or both lungs
  • The air sacs may fill with fluid or us causing cough with phlegm or pus, fever, chills, and difficult breathing
72
Q

Viral pneumonia - typical features include:

A
  • URI symptoms (fever, cough, hoarseness)
  • Wheezing or rales
  • Myalgia, malaise, headache (older children)
  • Most pneumonia in children is caused by bacterial infection following viral infections: RSV, influenza, etc.
73
Q

Viral pneumonia - S/S

A
  • URI precedes lower respiratory disease
  • Wheezing or stridor may be present
  • Cough, signs of resp. distress and physical findings may not be distinguishable from those in bacterial pneumonia
74
Q

Viral pneumonia - labs

A
  • WBC
  • CXR not as useful because it may be similar to bacterial presentation
75
Q

Viral pneumonia TX

A
  • Supportive care
  • Hospitalization reserved for level of illness and age of patient
  • Vaccinate kids !!!
76
Q

Bacterial pneumonia - DX criteria

A
  • Fever, cough, dyspnea
  • Abnormal chest examination (crackles, decreased sounds)
  • Abnormal CXR
77
Q

Bacterial pneumonia: common causative agent & S/S

A
  • Staph. pneumoniae
  • S/S: varies w/ age of child
  • high fever
  • tachypnea
  • cough
  • crackles in lungs
  • decreased sounds
  • Abdominal pain
78
Q

Bacterial pneumonia TX

A
  • outpatient: children under 5 w/ CXR generally recieved Rx for Amoxicillin –> follow up within 12 hrs to 5 days
  • Hospital admission for all infants and toddlers with:
  • moderate to severe resp. distress, apnea, hypoxemia, poor feeding, clinical deterioration in spite of TX
79
Q

Foreign bodies in the lower resp. Tract: Clinical findings

A
  • Sudden onset of coughing, wheezing, or resp. distress
  • Asymmetrical physical findings of decreased breath sounds or localized wheezing
  • Asymmetrical radiographic findings, especially with forced expiratory view
80
Q

Suspect foreign bodies in lower resp. Tract if:

A
  • Chronic cough
  • Persistent wheezing
  • Recurrent pneumonia
  • Long standing foreign body may lead to:
  • Bronchiectasis
  • Lung abscess
81
Q

Location of various tonsillar masses !! Textbook p. 1117 !!

A
  • Tonsils are lymph nodes at the back of the mouth and top of the throat
82
Q

Tonsillectomy/adenoidectomy: nursing care

A
  • Pre-op assessment - note any bleeding tendencies, any evidence of infections
  • Post-op care - refer to p. 1118 for the recommended position immediately after T&S until the patient is fully awake (to facilitate drainage of secretions)
  • Assessing for possible hemorrhage is a main concern; so asses for this possible S&S: very frequent swallowing, especially when the patient is asleep
83
Q

T & A Care - Discharge education

A
  • Avoid high acid juices, irritating/dry toast, raw veggies, or foods difficult to swallow/chew, high seasoned or spicy foods
  • Instruct parents on S/S of infection: increased temp and pain
  • Avoid placing hand objects in mouth, use of irritating gargles or very vigorous toothbrushing
  • Remind parents that hemorrhage may occur 5-10 days post-op when tissue sloughs off
  • So review S/S of hemorrhage & stress with immediate HCP contact
84
Q

Asthma

A
  • Most common chronic disease of childhood
  • Affects >6.7 million children in teh U.S.
  • 1 in 11 children has asthma
  • Prevalence, morbidity, and morality rates for asthma are higher among minority and inner city populations
  • Up to 80% of children with asthma develop symptoms before their 5th birthday
85
Q

Asthma definition

A

Disease characterized by inflammation of air passages to the lungs and affecting the sensitivity of the nerve endings in the airways so they become easily irritated and narrowed, reducing airflow

86
Q

Asthma patho

A
  • Chronic condition
  • Results from bronchospasms, increased mucous secretion, and mucosal edema
  • Caused by inflammation of the lungs, mucous formation, swelling and airway muscle contraction
87
Q

Asthma is characterized by:

A
  • Recurrent cough
  • Wheezing
  • SOB
  • Reduced expiratory flow
  • Exercise intolerance
  • Resp. distress
88
Q

four types of asthma

A
  • intermittent: symptoms occur less than two times per week
  • Mild persistent: symptoms occur more than two times per week but less than once per day
  • Moderate persistent: symptoms occur throughout the day
  • Severe persistent: Symptoms occur throughout the day
89
Q

Best TX of Asthma

A
  • Meds
  • Management of environmental triggers
  • Education and support of the child and parents
  • Choice of meds to promote optimal resp. function is typically based on the asthma’s level of control and severity
90
Q

Asthma nursing interventions

A
  • Focused on maintaining airway patency and fluid status + rest + decreasing stress
  • Evaluate child’s resp. status, remember airway, breathing, and circualtion (ABCs)
  • Child not moving air + cant talk? –> emergency action
  • Continue to assess breathing, O2, pulse ox, cap refill
91
Q

Pertussis (whooping cough)

A
  • Caused by Bordetella pertussis
  • In USA, occurs most often in children who have not been immunized
  • Highly contagious
  • See p. 1133: TX, whos at risk

Family NRSG (8 decks)

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