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Nursing, LPN, Year 2 > x Resp: Pediatrics (Ms. Ci) > Flashcards

x Resp: Pediatrics (Ms. Ci) Flashcards

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1
Q

RESPIRATORY DISTRESS SYNDROME (RDS)

A
  • Cause: DEC in surfectant
  • Affects: Preterm, low birth weight infants
  • Rare in full term babies
  • big reason for mortality/morbidity in neonates
  • lungs formed in last weeks of pregnancy (26 - 34wks)
  • preemies don’t have fully formed lungs
  • 10/100 infants premies
  • more MALES
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2
Q

RDS: Risk Factors

A
  • preterm
  • Csec delivery
  • Diabetes (mom)
  • Asphyxia
  • maternal hemorrhage
  • abnormal genes for surfactant
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3
Q

Surfactant

A
  • Site: Lining of alveoli (made by epithelium of alveoli)
  • DEC surface tension of fluid
  • uniform expansion + maintenance of lung expansion
  • when infant lacks surfactant, they are unable to keep lungs inflated. they use lots of energy to keep lung inflated.
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4
Q

RDS: SS

A
  • dev 24 hrs after birth
  • hypoxic
  • hypercapnia (retain CO2, acidosis)
  • rapid shallow breath
  • expiratory grunting
  • nasal flaring
  • apnea
  • tachypnea
  • retractions (chest looks caved in because accessory muscles being used)
  • Mottling (red white spotty legs)
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5
Q

RDS: Complications

A
  • Pneumothorax
  • Bronchopulmonary dysplasia
  • blindess/retinopathy
  • necrotizing enterocolitis
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6
Q

RDS: Dx Tests

A
  • clinical presentation
  • CxR
  • ABG
  • Echo
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7
Q

RDS: Rx

A
  • surfactant replacement therapy (ETT, thru endotracheal tube)
  • breathing support (mech vent, cpap)
  • Nutrition support (breast milk, TPN, PPN)
  • Temp control (incubator)
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8
Q

RDS: NI

A
  • NICU
  • Frequent resp assess
  • suctioning (never routine)
  • skin care/oral hygiene
  • emotional support
  • if baby survive 96 hrs, prognosis UP
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9
Q

RDS: Prevention

A
  • prevent pre-term birth (if they think mom is going to deliver early , they give steroids to UP surfactant production in fetus
  • see MD prenatal
  • Avoid Smoking, ETOH, Drugs
  • control: ongoing med condition
  • Prevent: Infection
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10
Q

BRONCHOPULMONARY DYSPLASIA (BPD)

A

Lung disorder affecting:
-Born 10 or more wks b4 due date
-

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11
Q

BPD: Risk Factors

A
  • meconium aspiration
  • RDS
  • Pressure from mech vent or CPAP
  • Lung infections
  • UP O2 levels
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12
Q

BPD: SS

A
  • Pulmonary arterial HTN
  • Cor Pulmonale

and SS of RDS

  • dev 24 hrs after birth
  • hypoxic
  • hypercapnia (retain CO2, acidosis)
  • rapid shallow breath
  • expiratory grunting
  • nasal flaring
  • apnea
  • tachypnea
  • retractions (chest looks caved in because accessory muscles being used)
  • Mottling (red white spotty legs)
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13
Q

BPD: Dx

A
  • clinical presentation - no improvement 14-30 days old (2-4wks)
  • CxR, ABG, PFTs
  • Echo (is it the heart?)
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14
Q

BPD: Rx

A
  • Resp: Mech Vent/CPAP (lowest O2)
  • MED: Bronchodilators
  • Nutrition: Parental then gut (NGT, Gavage, Oral Feed)
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15
Q

TPN vs PPN

A
  • Total Parenteral Nutrition (thru Central Line)
  • Peripheral Parental Nutrition (can go in arm d/t LO Dextrose)
  • If Dextrose is UP 10%, needs to go through central line
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16
Q

BPD: NI

A
  • Rest
  • small frequent oral feeds
  • LO risk of resp infections (don’t expose to sick), Flu shot
  • notify MD for SS resp infection
  • educate parent, CPR instruction
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17
Q

PNEUMONIA (PNA)

A

Infection and inflammation of the pulmonary parenchyma, bronchioles and alveoli
-associated w URIs

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18
Q

PNA: Types

A
  • Bacterial
  • Viral
  • Foreign body aspiration
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19
Q

PNA: SS

A
  • cough
  • wheeze
  • crackles
  • resp distress
  • CP
  • anorexia
  • irritability
  • lethargy
  • HA
  • F
  • Myalgia
  • Abd Pain
  • Nasal Discharge
  • Malaise
  • newborns/infants may be asymptomatic. may first vomit
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20
Q

PNA: Dx

A
  • CxR
  • CBC (UP WBC)
  • Sputum, Blood C/S
  • Thoracentesis (if develops pleural effusion)
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21
Q

PNA: Rx

A
  • O2
  • Abx
  • Chest PT
  • Suctioning
  • Fluids (to thin mucus)
  • MED: Bronchodilators
  • MED: antipyretics (tylenol)
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22
Q

PNA: NI

A
  • frequent resp asst
  • rest
  • infection control, hand washing
  • encourage pt participation in care
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23
Q

Respiratory Syncytial Virus (RSV)

A

causes PNA and Bronchitis

  • affects all ages
  • severe infection in infants, children, elderly
  • causes: lower resp tract infection
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24
Q

RSV

A

Almost ALL children are infected w the virus by 2nd bday, but only small % develop severe disease
-3-10days duration

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25
Q

RSV: Transmission

A
  • droplets
  • direct/indirect contact
  • (sneeze = 100,000 droplets, 90mph)
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26
Q

RSV: SS

A
  • cough
  • stuffy/runny nose
  • mild sore throat
  • earache
  • F
  • LO interest in surr
  • listless/sleepy
  • irritable/not sleeping
  • poor feeding
  • Apnea
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27
Q

RSV: Dx

A
  • Viral detection test (nasal washing)
  • CxR, ABGs, Pulse Ox
  • CBC
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28
Q

Nasopharngeal Swab, Aspirate, Wash

A

have to restrain baby. uncomfortable

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29
Q

RSV: MM

A
  • mist tent
  • O2 therapy
  • IV fluids
  • MEDS: Bronchodilator
  • MED: Ribavirin (Virazole) (admin in hospital, aerosol)
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30
Q

RSV: NI

A
  • resp and contact isolation
  • don’t use a nurse with other very sick patients, nurse assignments
  • prevent spread, frequent hand washing
  • freq respiratory assessment
  • emotional supp
31
Q

RSV: Prevention

A
  • handwashing
  • MED: Palivizumab (Synagis) (mostly preemies and UP risk from sever RSV Nov-Apr)
  • Influenza Vacc
  • avoid contact with sick people
32
Q

MED: Ribavarin

A

Antiviral
It can treat severe lung infections caused by respiratory syncytial virus (RSV) when inhaled. In its oral form it can be used with an interferon medicine to treat hepatitis C.

33
Q

MED: Palivizumab (Synagis)

A

a monoclonal antibody produced by recombinant DNA technology. It is used in the prevention of respiratory syncytial virus (RSV) infections. It is recommended for infants that are high-risk because of prematurity or other medical problems such as congenital heart disease.

34
Q

ACUTE PHARYNGITIS (Sore Throat)

A

Sore throat

  • inflammation of pharynx
  • cause: viral/bacterial (strep throat)
  • ages 4-12
35
Q

Acute Pharyngitis: SS

A

VIRAL Pharyngitis

  • LO fever
  • Pharangeal Erythema
  • Sore throat
  • HA
  • Cough
  • Rhinitis

BACTERIAL Pharyngitis

  • UP fever
  • sore throat
  • white throat exudate
  • vomit/abd pain
36
Q

Acute Pharyngitis: Dx

A

Throat culture

37
Q

Acute Pharyngitis: Rx

A

VIRAL/BACTERIAL Pharyngitis

  • Rx SS
  • Lozenges
  • Saline Gargle
  • Tylenol
  • Abx (Bacterial only)
38
Q

Acute Pharyngitis: NI

A
  • Diet: Cool liquids/soft bland food
  • Warm compress to neck
  • teach, finish Abx
  • replace toothbrush after 24hrs
39
Q

TONSILITIS

A

Infection and inflammation of the tonsils

  • Cause: Bacteria (strep) or Viral
  • d/t Pharyngitis
40
Q

Tonsilitis: SS

A

Viral/Bacterial

  • sore throat
  • HA/F
  • swolen/tender lymph nodes
  • Hoarseness
  • Cough

Bacterial

  • Vomiting
  • muscle aches
  • dysphagia
41
Q

Tonsilitis: Rx

A
  • Tonsilectomy (chronic infection, 5+ yrs)
  • Abx (bac)
  • comfort
  • Tx SS
42
Q

Tonsilitis: NI

A
  • Diet: cool liquids/soft bland diet
  • warm compress to neck
  • finish Abx
  • replace toothbrush after 24hrs
43
Q

Tonisilitis: Pre-Op

A

Pre-op

  • loose teeth (aspirate)
  • bleeding gums (aspirate)

Post OP

  • semi prone
  • monitor for bleeding
  • pain mgmt
  • fluids then soft foods
44
Q

Hemorrhage: SS

A
  • LO BP
  • tachycardia
  • restlesness (d/t hypoxia)
45
Q

Tonsilectomy: Avoid colored fluids

A 
-Brown, Purple, Red b/c appears as blood in stool
give them yellow etc.
-avoid straws, pressure from sucking could damage sutures
-avoid HI seasoned/irritating foods
-avoid gargles, vigorous tooth brushing
-LO cough, throat clearing
-use ice collar
-MED: mild analgesics
-no ASA/NSAIDS
-monitor for bleeding
46
Q

CROUP (Laryngotracheobronchitis (LTB) + Acute Epiglottititis)

A
  • group of conditions cause inflame of upper resp tract
  • Types: Laryngotracheobronchitis (LTB) + Acute Epiglottititis
  • Viral
  • Tx SS
  • cough strikes around 2am
  • seal like bark
47
Q

Croup LTB

A
  • 3mos - 3yrs

- Cause: swelling and narrowing of the airways

48
Q

Croup LTB: SS

A

4Ds

  • Drooling
  • Dyspnea
  • Dysphagia
  • Dysphonia (loss voice)
  • Barking cough
  • Inspiratory stridor
  • tachypnea
  • retractions (cave chest, accessory muscles)
  • norm - mild temp
49
Q

Croup LTB: Dx

A
  • Med Hx (recent URI)
  • Physical Exam
  • CBC (UP WBC, infection)
50
Q

Croup LTB: Rx

A
  • maintain airway
  • mist tent w LO O2 (30%)
  • MED: Epinephrine aerosol (bronchodilator)
  • NPO
  • IV, hydration
HOME
-push fluids
-steamy shower
-nebulizer
0outside in cold air
-MED: antypyretic, Tylenol
51
Q

Croup LTB: NI

A
  • NEVER examine mouth or throat (can cause epiglottal spasms which can obstruct airway.
  • monitor responses
  • semi-fowler, promotes breathing
  • assess Resp CV status
  • trach set @ bedside (emergencies)
  • 3-7 day recovery
52
Q

CROUP EPIGLOTTIS

A
  • inflammed epiglotis. cherry red, edematous –> complete airway obstruction (medical emergency)
  • affects older kids
  • cause: H. Influenzae Type B
53
Q

Croup Epiglottis: SS

A
  • laryngeal obstruction
  • HI fever
  • stridor
  • drooling
  • posture: hyperextend neck, sit up and lean forward w mouth open, tongue protruding, nostrils flaring
  • edematous, bright red epiglottis
54
Q

Croup Epiglottis: Dx

A

-Clinical Presentation

55
Q

Croup Epiglottis: Rx

A

Emergency

Trach or Intubation

56
Q

Croup Epiglottis: NI

A
  • artificial airway
  • suctioning (never routine, only PRN)
  • monitor respiratoin
  • MED: aerosol EPI
  • sitting up, at least semi fowlers
57
Q

BRONCHITIS

A

inflammation of large airway, trachea, bronchi

  • Viral
  • Mainly in Winter
  • Children UNDER 4yrs
58
Q

Bronchitis: SS

A

1-2 days

  • cough (non prod)
  • Coryza (runny nose)
  • Mild/no fever

2-3 days

  • cough (productive)
  • cough worse @ nighttime
59
Q

Seizure over 5 min

A

medical emergency

60
Q

Bronchitis: Dx

A
  • CxR
  • Pulse Ox
  • Sputum C&S
  • Physical Exam
61
Q

Bronchitis: Rx

A
  • Humidifier
  • fluids
  • Tylernol
  • cough sup if sleep affected
62
Q

PULMONARY TB

A

contacted by exposure to infected adult

  • Dx in children difficult because hard to get sputum specimen from kids. need 3 samp, 3 consec days
  • gastric aspirate (several samples)
63
Q

Pulmonary TB:

A

Cause: Mycobacterium tuerculosis

64
Q

Pulmonary TB: Dx

A
  • tuberculin skin test (Mantoux test)
  • PPD (read 48-72hrs)
  • CxR (if TB test comes back pos)
65
Q

Pulmonary TB: SS

A
  • most kids asymptomatic
  • cough
  • F
  • night sweat
  • swollen glands
  • LO appetite/activity
  • weight loss
  • dyspnea
66
Q

Pulmonary TB: MM/RX

A
  • diff in aging kids vs adults
  • kids should be higher mg per kg body weight d/t higher metabolism
  • kids have less microorganisms and less likely to develop secondary resistance
67
Q

CYSTIC FIBROSIS

A
  • inherited chronic incurable disease
  • disorder of exocrine glands (mucous secreting)
  • produce usually things, sticky mucous that obstructs lungs and pancreas and prevent flow of enzymes
68
Q

Cystic Fibrosis

A
  • M and F
  • 1/1800 births
  • caucasians
  • Death b/t pulmonary failure even though its a multi system disorder. Lung Transplant
69
Q

Cystic Fibrosis: Organs Affected

A
  • Sinuses: infection
  • Lungs: mucous UP, infection, thick
  • Sweat: salty
  • Liver: blocked biliary ducts
  • Pancreas: panc ducts
  • GI: cant’s absorb nutrients
  • Repro: complications
70
Q

Cystic Fibrosis: SS

A
  • salty tasting skin
  • persistent cough, @times w sputum
  • frequent lung infec
  • wheezes or SOB
  • poor growth, weight low but w good appetite
  • steatorrhea or difficulty in BM
71
Q

Cystic Fibrosis: Dx

A
  • Family Hx
  • absence of pancreatic enemies
  • sweat test
  • CxR, PFTs
72
Q

Cystic Fibrosis: Sweat Test

A

-measures ant of chloride in sweat
-CF = 2-5xs normal amount
-skin stimulated to produce sweat and absurd in a collector
-see pic.
.one node has med,
.one has elec current which sim MEDS to go into skin
-MED stimulates sweat
-Collector then test

73
Q

Cystic Fibrosis: Rx

A
  • Pulmonary Therapy
  • breathing exercised/exercise
  • Abx (aerosol/IV), Expectorants, Mucolytics
  • Nutrition
  • Pancreatic enzyme replacement
  • take B4 first bite of food
74
Q

MED: DNase (Pulmozyme)

A

to thin and liquefy mucous

  • aerosol/nebulizer
  • SE: throat irritation

Nursing, LPN, Year 2 (27 decks)

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