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66 Cards in this Set
- Front
- Back
- 3rd side (hint)
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6 physiological differences b/w adults and children
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Abdominal breathers
Chest wall more compliant Higher risk of airway obstruction Higher oxygen consumption Higher RR* Right bronchi more vertical |
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infant is protected by mother's antibodies up to...
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3 mo old
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2 different types of retractions
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suprasternal
intercostal (ribs) |
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4 things pulmonary function tests can assess
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1. Tidal volume
2. Compliance 3. Pulmonary resistance 4. Forced expiratory volume Assess DEGREE of disease |
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function of pulse ox?
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Noninvasive, determines O2 saturation
Detects functional Hgb |
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details on blood gas procedure
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Info on lung function and tissue perfusion
Heparinized syringe, no air, on ice |
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advantages and disadvantages of oxygen masks in children
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Advantages:
Various sizes available Breathe nose/mouth Disadvantages: Skin irritation Fear of suffocation Difficult to control O2 concentration |
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advantages and disadvantages of nasal cannulas in children
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Advantages:
Constant O2 while eating/drinking Observe face better disadvantages: Disadvantages Uncomfortable Can’t give mist (to keep mucous membranes moist) |
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advantages and disadvantages of oxygen tents
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Advantages:
Good for lower O2 concentrations Can eat/drink disadvantages: Must fit bed well, no leakage Cool and wet Poor access to child (e.g., feeding) (starts to go awry during toddler age) need layers of chucks to prevent skin breakdown due to moisture. Can give mist |
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advantages and disadvantages of face tent.
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Advantages:
Better for high O2 concentrations Access to chest disadvantages: Need to remove for feeding/care |
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4 adverse effects of oxygen toxicity
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Damage capillaries
Decrease mucous flow Inactivate surfactant Alter ciliary function |
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3 types of meds often given through nebulizer
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Bronchodilators
Steroids Antibiotics |
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details of Chest PT
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Removal of excessive fluid or mucous
Position with gravity Every 4-6 hours, 20-30 minute intervals Deep breathing – be creative NEED AN ORDER because can be associated with onset of bronchospasm |
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indications for artificial ventilation
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Progressive hypoxia
Inadequate ventilation Excessive work of breathing Inadequate respiratory effort *have bag and mask at the bedside |
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description and indication for pedi tracheostomy
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Structural defects
Emergencies Long-term ventilator support Surgical opening of the trachea below the 2nd and 4th tracheal ring |
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considerations for pedi trach care
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Tracheostomy tube at bedside
Ambu bag, oxygen and suction Frequent suctioning Tracheostomy site care and tie changes |
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2 types of pharyngitis with examples of each
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Bacterial
(group A strep, mycoplasma pneumonia, N.gonorrheae, non group A strep, C diptheriae) Viral (Epstein Barr, cytomegalovirus,adenovirus,herpes, Influenza) |
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s/s of viral pharyngitis
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Viral – mild
Sore throat Fever General malaise Reddened pharynx |
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s/s of bacterial pharyngitis
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Bacterial - abrupt onset
Pharyngitis Difficulty swallowing Headache Fever Abdominal pain Inflamed tonsils & pharynx Tender lymph nodes |
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common causes of bacterial pharyngitis
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Mycoplasma
(>6 years old, 5-16 % of cases) Diptheria (undeveloped countries and unimmunized, gradual onset of symptoms) N.gonorrheae (sexually active patients, erythema,exudate) |
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details of group A strep bacterial pharyngitis
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15-30 % all cases ages 5-15 years
Peak incidence winter and early spring Abrupt onset, fever, headache, abdominal pain, nausea, vomiting, exudate, tender ant cervical nodes, palatal petechiae, inflammation Younger children can present with low grade fever after URI symptoms, decreased appetite Symptoms will resolve spontaneously May use azithromycin for pen allergic but must use 12 mg / kg (pharyngitis dosing) Treatment failure/ recurrence use keflex 50mg/kg x 10days |
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nursing care of pharyngitis
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Monitor resp status – good assessment for changes
Minimize symptoms Clear nasal passages Liquids/soft food Cool mist Compresses Gargles |
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why are we moving away from cough suppressants in pedi?
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overdose risk - duplicating pain medication that results in liver and kidney damage.
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surgical treatment of chronic strep infections?
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tonsillectomy controversial)- pharyngeal
(sometimes remove adenoids as well) Watch for hemorrhage (7-10 days later), check color |
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4 common respiratory ENT referrals
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Recurrent strep infections (e.g., 4-6 times in a season)
Recurrent tonsillitis Interference of swallowing Suspected neoplasm |
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characteristics of peritonsillar abscesses
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Most common in older children and adolescents
Diagnosis from visual inspection Abscess is typically fluctuant (feels soft and mobile), unilateral and uvula deviates to opposite side Fever, sore throat, muffled voice, drooling, bad breath |
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3 typical causes of viral pharyngitis
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Adenovirus
(fever, erythema) Influenza (high fever, cough, exudative pharyngitis, myalgias, headache, Herpangina / herpes (ulcerative lesions, vesicles, fever, drooling) |
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describe epiglottitis
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Rapid, severe swelling and inflammation of supraglottic structures
(can lead to airway obstruction) Pathogens : Haemophilus influenzae, group A strep, pneumococci Highest incidence 6-10 years H. flu vaccine now common for this reason. Sudden onset fever, sore throat, muffled voice, drooling, poor color, labored breathing in previously well child Restless, irritable, anxious Hyperextension of neck, tripod, “sniffing dog” position Respiratory distress, retractions, stridor, flaring Beefy, erythematous epiglottis If suspected do not attempt to visualize |
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tests and treatment for peritonsillar abscess
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CBC (increased WBC)
Rapid strep / throat culture Immediate referral to ENT/ ER Surgical I & D Antibiotics (penicillin) Hospitalization or daily follow up |
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3 diagnostic tests for epiglottitis
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CBC (increased WBC >18,000) (do not wait for labs)
Blood, secretion cultures (positive for H influenzae -50% cases) Radiograph : lateral neck shows thickened swollen epiglottis (thumb sign) |
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treatment of epiglottitis
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True medical emergency
Oxygen, keep child calm, paramedic transport to ER Establish airway (nasopharyngeal or endotracheal or tracheotomy) IV antibiotics then PO (3rd generation cephalosporins initially) Corticosteroids Prevention = HIB vaccine |
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describe retropharyngeal abscess
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Infection of retopharyngeal lymph nodes
Posterior pharynx is inflammed Comes after an episode of illness Staph aureus, Group A strep Rare (usually ages 3-6) |
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s/s retropharyngeal abscess
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Fever, throat pain (severe)
Drooling, ill appearing Tachypnea, stridor Neck hyper extends, torticollis |
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diagnostic tests for retropharyngeal abscess
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Lateral neck radiography- retropharyngeal space > 6 mm at C2
Prominent swelling of post pharyngeal wall Elevated WBC CT –confirms abscess |
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treatment of retropharyngeal abscess
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ENT referral
Hospitalization/ PICU admit Surgical I & D (incision and drainage) IV antibiotics |
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common issues with ear
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Otitis externa
(swimmers ear) Otitis media (acute, chronic, serous otitis) Draining ear Cerumen impaction |
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describe otitis externa
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Acute infection / inflammation of canal (swimmers ear)
Pseudomonas, staph aureus,streptococcus,proteus mirabilis, fungi Presents as itching, pinna pain, fullness in ear downs syn. esp vulnerable to otitis externa. |
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treatment of otisis externa
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Oral antibiotics may be indicated
Antibiotic drops (cortisporin otic suspension, Floxin otic) Topicals (hydrocortisone, antifungals |
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3 subtype acronyms associated with otitis media
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Acute Otitis Media (AOM)
Otitis Media With Effusion (OME) Chronic Otitis Media (COM) |
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3 criteria for otitis media
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3 criteria- acute onset of symptoms, evidence of ear effusion, redness of TM
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predisposing factors for OM
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Physiological issues (short horizontal Eustachian tube)
Hereditary factors Bottle feeding Birth defects Tobacco smoke exposure Day care settings |
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behavioral indicators of OM
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Fever, irritability, complaint of pain, nausea, vomiting, pulling on ears, sleep disturbances
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treatment/nursing care of OM
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Antibiotics-entire course
Antipyretics-proper dosages Tubes for chronic OM Prevention-upright during feedings Teaching |
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criteria for OM referral to ENT
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Persistent resistant AOM (over 1-2 months)
Frequent recurrent otitis media (3-6 episodes in 6 months) Persistent chronic OME (>3 months) Evidence of hearing/ speech delay |
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describe tympanostomy tubes
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Surgical incision of ear drum (myringotomy) with placement of tube to relieve pressure, drain fluid, pus from middle ear
> 1 million tubes inserted annually |
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indications for tympanostomy tubes
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OME for at least 3 months and unresponsive to aggressive medical therapy
3 or > episodes of ROM within the preceding 6 months when antimicrobial prophylaxis has failed. Eustachian tube dysfunction with increased hearing loss, otalgia, vertigo, tinnitus, or severe atelectasis Following tympanoplasty when poor eustachian tube function. Suppurative (puss formation) complications (facial paralysis) |
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describe croup
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Hoarse voice, Barky cough, stridor, respiratory distress
Most common form is acute laryngotracheobronchitis infection and inflammation of larynx (steeple sign) usu. treated with a single dose of oral steroids or occasionally epinephrine |
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what is coryza?
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inflammation of the mucous membranes of nasal passages leading to congestion and loss of smell.
responsible for symptoms of the common cold. |
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nursing treatment of croup
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cool mist
uau. does not require hospitalization, but if it does: Bag, mask, & oxygen at the bedside Encourage drinking fluids avoid agitation |
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describe bronchiolitis
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acute lower respiratory tract infection usually children 2years or younger
Commonly wheeze Almost all viral with RSV most noted Peak: Oct to April 80% RSV! spread by nasal secretions |
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list risk factors for bronchiolitis
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Low SES
Smoking Non breast fed babies |
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describe hospital treatment of bronchiolitis
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Mist therapy/Oxygen
IVF/Possible NPO Medications Respiratory assessment – O2 sats, ABG Contact precautions |
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patho of RSV bronchiolitis
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Epithelial cells in the
respiratory tract die, others fuse into large multinucleated masses of protoplasm, a huge cell (syncytia) that cause swelling and obstruction Leads to acidosis secondary to air trapping and hyperventilation |
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s/s pneumonia
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Cough
Fever Abdominal pain Chest pain Tachypnea, expiratory grunting Decreased level of activity |
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typical viral causes of pneumonia
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RSV, parainfluenza, adenovirus
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typical bacterial causes of pneumonia
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strep, mycoplasma, h. flu
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describe CF
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Multisystem disorder with exocrine glands
Most common lethal genetic illness among Caucasian children, adolescents and young adults 1 in 29 is a symptom free carrier Is present in African-Americans and Asians autosomal recessive Increased viscosity of mucous gland secretions Obstruction in mucus producing glands and ducts Increases sodium & chloride in saliva and sweat Decreases ability of airway epithelial cells and pancreas to transport chloride side 3: other manifestations of CF |
Failure to thrive (FTT) with increased weight loss
GI: Pancreatic ducts blocked by thick secretions, risk for obstructions Liver – biliary obstruction Salivary glands – similar to findings in pancreas, interferes with saliva GERD, PUD, viscous reproductive secretions, risk for salt loss |
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briefly describe pertussis
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Primarily in children < 4 years age, most common < 6 mos
Incubation 6-20 days, usually 7-10 Direct contact or droplet transmission caused by Bordetella pertussis (Gram - bacterium) 5 immunizations before age 5, now boosters @ 11 side 3: s/s |
Catarrhal stage:
URI symptoms - cough, sneezing, low-grade fever Paroxysmal stage: Cough short, rapid Sudden inspiration w/ high-pitched crowing sound Young infants - apnea Flushing, cyanosis, vomiting, profuse nasal drainage |
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nursing care of pertussis
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Isolation
Close respiratory assessment Emergency equipment nearby (severe RDS) Treat fever Encourage food & fluids if able Reportable disease PREVENTION |
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what is a paroxymal attack?
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Paroxysmal attacks are short, frequent and stereotyped symptoms that can be observed in various clinical conditions.
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what's the earliest sign of CF in a newborn?
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meconium ileus
(congested meconium in the ileum) side 3: tests for CF? |
genetic screening
sweat chloride test stool fat/enzyme analysis |
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respiratory management of CF
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Prevention & treatment of infection
Daily CPT!!! Twice daily, usually morning & evening Do with deep breathing & coughing Devices to assist Medications Bronchodilators Antibiotics O2 only during acute episodes, maybe at night Exercise |
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GI management of CF
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Pancreatic enzyme replacement
Well balanced, high protein, high calorie diet Constipation GoLYTELY Laxatives Stool softeners Rectal Prolapse Manual reduction Decrease bulky stools with enzymes Salt supplementation – most kids ok with diet, like salty foods |
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describe bronchopulmonary dysplasia (BPD)
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Iatrogenic chronic lung disease
Develops in premie infants following prolonged respiratory therapy O2 injury Barotrauma (high pressure from ventilator) side 3: patho of BPD |
Positive inspiratory pressure, High O2 concentrations injure alveolar sacs and small airways
Cystic areas & atelectasis Smooth muscle hypertrophy, bronchospasm, interstitial edema Further aggravates airway obstruction |
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S/S BPD
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Respiratory Distress
Cyanosis Tachypnea Wheezing Retractions Dyspnea Pulmonary edema Neurological abnormalities Clubbing if severe side 3: Dx |
History with S/S
PFT CXR ("bubbly" appearance) ECG |
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treatment of BPD
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Need to prevent it!
Decrease pressure/O2 Medications Fluid restriction-pulmonary congestion OR may hydrate to replace losses Increased calories Conserving oxygen consumption Promoting growth & development Parent CPR RSV prophylaxis |
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