Nura 107 - Respiratory Problems

Front 1

Bronchitis

Back 1

-Inflammation of the trachea and bronchi,
-Usually caused by virus
-Symptoms include fever, dry hacking non productive cough that is worse at night and becomes productive in 2-3 days

Front 2

Bronchitis Interventions

Back 2

Treat symptoms as necessary
Monitor for signs of respiratory distress
Provide cool, humidified air
Encourage increased fluid intake
Administer antipyretics as prescribed
Cough supressants may be prescribed to promote rest

Front 3

Bronchiolitis

Back 3

Inflammation of bronchioles that causes production of thick mucus that occludes bronchioletubes and small bronchi.
Signs include rhinorrhea, eye or ear drainage, pharyngitis, coughing, sneezing, wheezing &intermittent fever
Later signs include tachypnea, increased coughing & wheezing, periods of cyanosis,listlessness, and apneic episodes

Front 4

RSV

Back 4

RSV is an acute viral infection and most common cause of bronchiolitis
Highly contagious but not airborne
Primarily in winter/spring
Rarer in children > 2, with peak incidence at 6 months

Front 5

Bronchiolitis / RSV Interventions

Back 5

Airway maintenance, administration of cool humidified air & oxygen
Ensure adequate fluid intake and medication administration
For children with RSV, isolate in own room or with another child with RSV
Use contact and standard precautions, do not care for other high-risk patients
Monitor airway status, maintain patent airway
For most effective airway maintenance, position at 30-40 degree angle with neck extended
Monitor pulse oximetry levels
Periodic suctioning if nasal secretions are copious

Front 6

Pneumonia

Back 6

Inflammation of the pulmonary parenchyma or alveoli or both caused by a virus, mycoplasmalagents, bacteria, or aspiration of foreign substances.

Front 7

Viral Pneumonia

Back 7

Acute or insidious onset. Mild fever, slight cough and malaise to high fever, severe cough and diaphoresis
Wheezes or fine crackles.
Treatment is symptomatic, administration of O2 and fluids, antipyretics and chest physiotherapy

Front 8

Primary Atypical Pneumonia

Back 8

Acute or insidious onset. Fever, chills, anorexia, headache, malaise, and myalgia (muscle pain). Rhinitis, sore throat, and dry hacking cough. Nonproductive cough initially progressing to production of seromucoid sputum that becomes mucopurulent or blood-steaked.Treatment is symptomatic, recovery generally within 7-10 days

Front 9

Bacterial Pneumonia

Back 9

Acute onset. Abrupt fever, lethargy, respiratory distress. Hacking, nonproductive cough. Diminished breath sounds or scattered crackles.

Front 10

Bacterial Pneumonia Interventions

Back 10

Antibiotic therapy as soon as diagnosed. O2 for respiratory distress. Cool mist tent as prescribed. Bulb syringe suction for infant. Chest physiotherapy Q4H. Bed rest. Encourage fluid intake. Lie on affected side. Administer antipyretics as needed. Monitor temp due to risk of febrile seizures. Isolation precautions. Cough suppressants as needed. Continuous chest drainage if purulent fluid is present. Thoracentesis for fluid in pleural cavity.

Front 11

Asthma

Back 11

Chronic imflammatory disease of the airways, classified based on severity. Mast cell release of histamine leads to a bronchconstrictive process, bronchospasm, and obstruction.

Front 12

Status asthmaticus

Back 12

Acute asthma attack, and the child displays respiratory distress despite vigorous treatment. Medical emergency and can result in respiratory failure if untreated.

Front 13

Asthma Assessment Signs

Back 13

Episodes of dyspnea, wheezing, breathlessness particularly at night and/or early morning.

Front 14

Sudden Infant Death Syndrome

Back 14

Unexpected death of an apparently healthy infant < 1 year. Usually occurs during sleep. Most frequent at ages 2 & 3 mos. More likely in boys, Native Americans, African Americans, Hispanics, and lower socioeconomic groups. Lower in breastfed and infants that sleep w/ pacifier.

Front 15

SIDS Assessment Signs

Back 15

Apneic, blue and lifeless. Frothy blood tinged fluid in nose and mouth. May appear to have been clutching bedding. Diaper may be wet and full of stool.

Front 16

SIDS Prevention & Interventions

Back 16

Place infant in supine position to sleep. Teach about risk factors including smoking and substance abuse during pregnancy, soft bedding, thermal stress, exposure to smoke after birth. Teach parents to monitor for positional plagiocephaly (flattened or bald spot on occiput). Alter head position to prevent.

Front 17

Epiglottitis

Back 17

Bacterial form of croup, imflammation of epiglottis due to H.influenzae type b or S.pneumoniae. Most frequent in 2-8 year olds. More often in winter. Abrupt, medical emergency due to progression to respiratory failure.

Front 18

Epiglottitis Assessment Signs

Back 18

High fever, sore red and imflammed throat, pain on swallowing, abscence of spontaneous cough, drooling, agitation, muffled voice. Retractions, inspiratory stridor, tachycardia and tachypnea, Tripod positioning: While supporting body w/ hands, child leans forward & thrusts chin forward & opens mouth.

Front 19

Epiglottitis Interventions

Back 19

Maintain patent airway. Assess respiratory status. Assess temperature via axillary route. Monitor pulse O2. Maintain NPO. Do not leave child unattended. Avoid placing supine. Do not restrain the child. Administer analgesics, antibiotics, antipyretics, fluids, corticosteroids as needed. Do not attempt to visualize pharnyx, take throat culture or oral temp.

Front 20

Laryngotracheobronchitis

Back 20

Inflammation of larynx, teachea and bronchi. Most common type of croup, most common in children < 5.

Front 21

Laryngotracheobronchitis Assessment Signs (Stage 1,2,3,4)

Back 21

Stage 1 - Low grade fever, hoarseness, inspiratory stridor, croup cough.
Stage 2 - Retractions, use of access. muscles, crackles, labored respirations.
Stage 3 - Pallor, diaphoresis, tachypnea, anoxia and hypercapnia.
Stage 4 - Intermittent cyanosis progressing to permanent cyanosis. Apneic episodes.

Front 22

Laryngotracheobronchitis Interventions

Back 22

Maintain patent airway. Assess respiratory status. Monitor for adequate resp exchange. Elevate head of bed, provide rest. Cool air or mist tent. Cool air vaporizer at home. Isolation precautions for a hospitalized child w/ upper resp inf. until laryngotreacheobronchitis is ruled out or diagnosed.

Front 23

Influenza

Back 23

Acute, contagious viral infection. Most common in Ages <5 and >65. Spread by direct or indirect contact by small particle droplets generated by coughing. Preexisting heart or respiratory problems most at risk.

Front 24

Influenza Assessment Signs

Back 24

Severe headache, muscle aches, fever, chills, fatigue, weakness, sore throat, cough, watery nasal discharge.

Front 25

Influenza Interventions

Back 25

Symptomatic- saline gargles, antihistamines.
Antibiotics only with secondary bacterial infection.
Prevention/immunization.
Bedrest and increase fluid intake.

Front 26

Severe Acute Respiratory Syndrome (SARS)

Back 26

Most likely a Coronavirus. Similar to common cold and usually cause mild illnesses. Droplet transmission
Cough/sneeze/talking. Potential for contact and airborne. Communicability of infected person is unknown at this time. Incubation period is thought to be 2-10 days

Front 27

SARS Assessment Signs

Back 27

Chills, HA, general feeling of discomfort, body aches
Mild respiratory symptoms-runny nose, sore throat and watery eyes. After 2-7 days: Dry, nonproductive cough that progresses to shortness of breath that becomes severe.

Front 28

SARS Interventions

Back 28

No known effective treatment
Prevent transmission
Isolation (respiratory & contact)
handwashing
Supportive care
O2
Intubation and mechanical ventilation prn
Treat secondary infection if present

Front 29

Apnea

Back 29

Cessation of breathing for 20 seconds or longer or for shorter periods accompanied by bradycardia or cyanosis. Can occur while awake or asleep, usually requires emergency resuscitation.

Front 30

Apnea Assessment Signs

Back 30

Color change, limp muscle tone, choking, or gagging.

Front 31

Apnea Interventions

Back 31

Provide tactile stimulation. Prepare for emergency resuscitation. Administer methyxanthines/caffeine. Set alarms on apnea monitor. Supportive care.

Front 32

Pneumothorax

Back 32

Accumulation of atmospheric air in the pleural space which results in a rist in intrathoracic pressure and reduced vital capacity.

Front 33

Pneumothorax Assessment Signs

Back 33

Absent breath sounds on affected side, cyanosis, decreased chest expansion unilaterally, dyspnea, hypotension, sharp chest pain, subcutaneous emphysema, sucking sound with open chest wound, tracheal deviation to unaffected side.

Front 34

Pulmonary Embolism

Back 34

Occurs when a thrombus forms, detaches, and travels to the right side of the heart.

Front 35

Pulmonary Embolism Assessment Signs

Back 35

Blood tinged sputum (pink, frothy), chest pain, cough, crackles and wheezes, cyanosis, distended neck veins, dyspnea, feeling of impending doom, hypotension, petechiae over the chest and axilla.

Front 36

Pulmonary Embolism Interventions

Back 36

Notify rapid response team. Reassure client and elevate head of bed. Prepare to administer O2. Obtain vitals and check lung sounds. Prepare to obtain ABG. Perpare for heparin therapy. Document the event, interventions taken, and pt response.