1102 Test 2 Child With Respiratory Dysfunction

Front 1

Etiology & Characteristics

Back 1

Infectious Agents – RSV, Coxsackievirus A & B, adenovirus, parainfluenza, human metapneumonovirus, GABHS, staphlococci, Haemophilus influenza, Chlamydia trachomatis, Mycoplasma & pneuococci
Size – Anatomical variations
Resistance – healthy vs. unhealthy, malnutrition, anemia, fatigue, prematurity BPD, asthma, history of RSV, CF, cardiac anomalies that cause pulmonary congestion.
Seasonal Variations – resp. pathogens in winter & spring, mycoplasmal infections in autumn & early spring, RAD & RSV in winter & spring

Front 2

Respiratory rate-60 or great

Back 2

withholding feedings

Front 3

Respiratory distress

Back 3

easy to see in infants because of flexibility. Trapezius, hypertrophy, capillary refill.

Front 4

Stridor-

Back 4

high pitched inflammation in airway.

Front 5

Wheezing-

Back 5

asthma can cause, heard all over.

Front 6

Crackles

Back 6

fluid/snot infection (pus) in lungs. (fluid overload listen posteriorly)

Front 7

Rhonchi-

Back 7

mucus in lungs cough then listen again.

Front 8

Nursing Care Management

Back 8

Ease respiratory effort
Promote rest
Prevent spread of infection
Reduce body temperature
Promote hydration
Provide nutrition
Family support and home care

Spread of infection-handwashing, isolation
Febrile-dehydration
Feeding-ng tube if no risk of inspiration
Start discharge orders on admission

Front 9

Nasopharyngitis

Back 9

Usually viral “common cold”
Rhinovirus, RSV, adenovirus, influenza;
Symptoms more severe in infants and children. Fever is usual in infants, and low grade fever in older children. Along with irritability, restlessness, sneezing, cough
TX: No specific; antipyretics, rest, increasing fluids, decongestants > 6 mon, cough suppressants, bulb suctioning,

Runny nose congestion, sometimes fever, sneezing, rsv.

Front 10

Pharyngitis

Back 10

GABHS infection (strep throat) are at risk for rheumatic fever and acute glomerulonephritis (AGN)
Can be subclinical to toxic infection
Usually abrupt, characteristics include pharyngitis, headache, fever, and abdominal pain (tonsils may have exudate)
80-90% are viral
Treatment may include antibiotics, cold compress to throat, “magic mouthwash”

Front 11

Influenza

Back 11

Spread by direct contact (large droplet infection)
A, B, & C
Dry throat & mucosa, sore throat, cough, hoarseness, photophobia, myalgia, fatigue, fever & chills
Symptom management, anti-viral treatment (Tamiflu)
Prevention

Tamiflu must be started within 48 of onset of symptoms virus replicates every 3 days.

Front 12

Infectious Mononucleosis

Back 12

Usually in adolescents, Epstein-Barr (herpes-like) virus, incubation: 30-50 days
DX: heterophil antibody test – positive, increased immunoglobulin M, Monospot increased

TX: No specific Tx. Mild analgesic, rest, decrease activity, gargles, warm drinks for sore throat. No antibiotics unless a specific bacteria is identified.

Front 13

ACUTE EPIGLOTTIS

Back 13

S&S: abrupt onset and rapidly progresses to severe respiratory distress, sore throat, pain,
Insists on sitting up, leaning forward, mouth open and tongue protruding, drooling is noted, irritability, croaking sound on inspiration, retraction, and color change
DX: WBC > 20,000 – 30,000
TX: antibiotics, antipyretics, culture

Stridor-inflammation of upper airway.
Can be heard without stethescope….on inspiration

Front 14

Acute Laryngitis

Back 14

Usually viral

SX: hoarseness associated with a URI
TX: fluids and humidified air

Front 15

LARYNGOTRACHEO-BRONCHITIS

Back 15

Affecting 6 months to 5 year olds, boys > girls

S&S: preceded by URI, brassy barky cough, low grade fever, respiratory stridor, sore throat, hoarseness, anxiety, agitation, and use of accessory muscles (suprasternal retractions) can progress to respiratory failure

Affecting 6 months to 5 year olds, boys > girls
S&S: preceded by URI, brassy barky cough, low grade fever, respiratory stridor, sore throat, hoarseness, anxiety, agitation, and use of accessory muscles (suprasternal retractions) can progress to respiratory failure
TX: maintain airway, IV fluids, Nebulized Racemic Epinephrine, steroids (IM, IV or po Dexamethasone) reduce anxiety (decrease crying), promote rest, NPO if acute, oral fluids, cool mist humidification, education and support

Preceded by
Brassy barky cough
May see low grade fever-sore throat
Stridor goes hand in hand with brassy barky cough
Rescue breathing

Front 16

Acute Spasmodic Laryngitis

Back 16

Spasmodic Croup (midnight or twilight croup).
Characterized by paroxysmal attacks of laryngeal obstruction, barking, metallic cough, hoarseness, noisy inspirations, and restlessness, no fever
TX: Cool mist humidifier, if at home take the child to a cool environment (freezer/night air),if hospitalized: cool mist tent and racemic epinephrine as a secondary optio

Front 17

Bacterial Tracheitis

Back 17

Infection of the mucosa of the upper trachea
Features of both croup and epiglottitis
Usually occurs in children under 3 years old
May lead to resp. arrest if untreated
Usually Staph aureas responsible
Previous URI, croupy cough, stridor unaffected by position, absence of drooling, purulent tracheal secretions, toxicity, high fever
Tx: antibiotic therapy, symptom control

Stridor not affected by position. Epiglottitius drule but no drool with this.

Front 18

Bacterial Tracheitis

(bacteria responsible)

Back 18

Usually Staph aureas

Front 19

BRONCHITIS

Back 19

Inflammation of the bronchi
Caused by virus, bacteria, fungi, allergic disorders
S&S: coarse, dry hacking persistent non-productive cough, rhonchi, wheezing, chest and rib pain, low grade fever, increased mucosal secretions, cough becomes productive after 2-3 days
TX: cough suppressants if needed, rest, humidification, and hydration

Front 20

BRONCHIOLITIS

Back 20

Inflammation and obstruction of bronchioles
Respiratory Syncytial Virus (RSV) is a common cause, transmitted through direct or close contact with the secretions of an affected individual
Occurs in children 2-12 months and usually not after 2 years
S&S: history of rhinitis, serous nasal drainage, labored respirations, poor feeding, sneezing, tachpnea, cough, low grade fever, wheezing, crackles, rhonchi, retractions
DX: H&P, nasopharyngeal culture or washings. Positive rapid RSV smear,
TX: Contact Isolation, humidified oxygen, fluid therapy, airway support, analgesics, antipyretics and rest. Medications: may be given via aerosol
Ribavirin, RSV immune globulin or IM or IV RespiGam, Synergis; second generation prevention: motavizumab
Aerosal-albuterol
Synergis-IM
Ribavirin-


Head to toe q 4 hours

Front 21

Pneumonia

Back 21

Viral or Bacterial

S&S: Fever, abnormal breath sounds, HA, malaise, abdominal pain, X-ray reveals consolidation, elevated WBC

TX: oxygen, fluid therapy, antibiotics (if bacterial), chest tubes
Atypical pneumonia caused by bacteria not usually known to result in pneumonia

Front 22

Severe Acute Respiratory Syndrome

Back 22

Atypical pneumonia first reported in Asia in 2003
Fever > 100.4 (38 Celsius), headache, non-productive cough, SOB, dyspnea, malaise, myalgia
Supportive management – may require intubation
Require negative-pressure isolation

Front 23

Avian flu

Back 23

Mortality rate of 90-100%
Fever, resp. symptoms, rhinorrhea, sore throat & cough appearing 3-5 days after exposure
Leukopenia, elevated LFT’s & thrombocytopenia
Children may exhibit eye infection

Front 24

Thrombocytopenia

Back 24

is any disorder in which there is an abnormally low amount of platelets.

Front 25

Pertussis

Back 25

Whooping cough
Cause by: Bordetella pertussis
Highly contagious
Prevention: DTP vaccine

Front 26

Tuberculosis

Back 26

Mycobacterium tuberculosis
S&S: malaise, fever, night sweats, cough, hemoptysis rarely, weight loss, anorexia, lymphadenopathy
DX: PPD test, intradermal injection, read in 24, 48, and 72 hours; > or equal to 5-15mm induration and redness
TX: Droplet isolation, INH, 6 month course of anti-tuberculin meds (Rifampin, pyrazinamide (PZA). If drug resistant: plus, Streptomycin IM; Ethambutol or aminoglyc

Front 27

Tuberculosis

drug treatment:

Back 27

Rifampin, pyrazinamide (PZA). If drug resistant: plus, Streptomycin IM; Ethambutol or aminoglycoside

Front 28

REACTIVE AIRWAY DISORDERS (RAD)

Back 28

Croup is a general term applied to a complex group of symptoms characterized by inspiratory stridor, a harsh brassy or barky cough, hoarseness, varying degrees of respiratory distress
Acute Spasmodic Laryngitis, Acute Laryngotracheobronchitis, Acute tracheitis, Acute Epiglottis

Front 29

ASTHMA

Back 29

Characterized by smooth muscle spasms in the bronchi and bronchioles, accompanied by edema and abnormal secretions and resulting in narrowing of the airway
Manifestations: wheezing with prolonged expiration, use of accessory muscles, retractions, nasal flaring, nonproductive cough, decreased tactile fremitus, hyperresonant sounds, diaphores(sweating)

Respiratory Acidosis
Wheezing on expiration
Bronchodilators mucolitics
Status asthaticus-if you hear wheezing all over lung fields. Come back and don’t hear anything they are worse. Breath sounds means getting better.

restless, dyspnea, non-productive cough, thick tenacious mucus production, physical exhaustion, dehydration
TX: acute: bronchodilator (Albuterol or Atrovent Jet Nebs), sit upright, corticosteroids, moist oxygen, IVFs
Newest drug Nebulized Levalbuterol (Xopenex)
Cromolyn Sodium (Intal)- inhaled NSAIDS
Maintenance: eliminate causative agent, teaching, FORBID SMOKING
Peak Flow Meters: page 793 Family-Centered Care

restless, dyspnea, non-productive cough, thick tenacious mucus production, physical exhaustion, dehydration

TX: acute: bronchodilator (Albuterol or Atrovent Jet Nebs), sit upright, corticosteroids, moist oxygen, IVFs
Newest drug Nebulized Levalbuterol (Xopenex)
Cromolyn Sodium (Intal)- inhaled NSAIDS
Maintenance: eliminate causative agent, teaching, FORBID SMOKING
Peak Flow Meters: page 793 Family-Centered Care

Front 30

Status Asthmaticus

Back 30

if you hear wheezing all over lung fields. Come back and don’t hear anything they are worse. Breath sounds means getting better.

continuous nebulized albuterol, continuous pulse ox
Intubation may be necessary

Front 31

Asthma

Treatment Acute:

Back 31

bronchodilator (Albuterol or Atrovent Jet Nebs), corticosteroids, moist oxygen, Newest drug Nebulized Levalbuterol (xopenex)

Front 32

Inhaled NSAIDS

Back 32

Cromolyn Sodium (Intal)

Peak Flow Meters: page 793 Family-Centered Care

Front 33

Bronchopulmonary Dysplasia

Back 33

Chronic obstructive disease
Causes: oxygen exposure, positive pressure ventilation, neonatal respiratory infections
S&S: tachycardia, tachypnea, increased work of breathing, use of accessory muscles, pallor, FTT, poor feeding
DX: Infants with respiratory symptoms > 28 days and oxygen dependent; or mechanical ventilation during the first week of life
TX: oxygen, diuretics and fluid restriction, inhaled bronchodilators, increased nutrition

Lungs and guts mature at 32-33 weeks.

Front 34

Cystic Fibrosis

Back 34

Inherited autosomal recessive disorder
Causes mechanical obstruction by increased viscosity of mucous gland secretions.
S&S: cough and frequent respiratory infections. Salty taste of the skin. Steatorrhea (fatty stools), delayed bone growth and development

DX: meconium ileus; two positive sweat tests. Values greater than 60 mEq/L. Chest x-ray - patchy atelectasis and obstructive emphysema. Stool fat analysis
TX: Maintain adequate respiratory function, prevent infection, and encourage exercise and good nutrition

PT & CPT 1-3 times daily before eating and before bedtime. Aerosolized meds (Mucomyst) before chest PT. Pancreatic enzymes (Pancrease) with all meals and snacks. Add extra salt to food and offer salty snacks. Teaching parents and child of disease. Encourage genetic counseling. Refer to support groups
Mucomyst used for acetemetaphin overdose and for a mucolytic. Given IV or by mouth



Pancreas secretes-Amylase protease lypase
Steatera-fatty stool
Inerferes with sweat glands-loose salt thru skin. Sweat test-sweat band around elbow area.
Pancreas are enzymes-how much patient weighs and growth determines how much they take.

Front 35

Obstructive Sleep Apnea

Back 35

DX: Sleep Study – polysomnography

TX: T&A, Continuous positive airway pressure (CPAP) or bilateral positive airway pressure (BPAP)

Front 36

Apnea of Infancy

Back 36

Cessation of breathing for a period of 20 seconds or longer, or for a shorter period but accompanied by pallor, bradycardia or cyanosis
CPR

Front 37

Sudden Infant Death Syndrome (SIDS)

Back 37

Sudden and unexplained death of an infant less than 1 year old and usually occurs in sleep

Cause theories: genetic, maternal smoking, co-sleeping and soft bedding

Prevention: back to sleep
Autopsy
Grieving parents