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64 Cards in this Set
- Front
- Back
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obligate nose breathers til?
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6 months old
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Which bronchus is higher and wider?
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right
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Basal Metabolic rate of child
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2x higher than adult
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easily obstructed airway because
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less connective tissue
making it more likely to hear stridor |
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lungs easier to collapse (alveolar hypoventilation)
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when diaphragm expands
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Most common cause of bronchitis in children
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RSV
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Central cyanosis
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BAD sign, late sige of respiratory distress
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Wheezing
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Inspiratory is worse than expiratory, but can have both
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rhonchi
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trapped mucous, sounds horrible, but is benign, needs to cough
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normal apnea
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up to 20s
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Halitosis
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may be associated with pulmonary infections or upper respiratory infections and large adenoids/tonsils, some have specific smells
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W O R S T F E A R
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Used to evaluate acute respiratory exacerbations:
W- wheezing O- oxygen requirement R- respiratory rate S- Secretions T- Tussis (cough) F- Fever E- Energy level A- Appetite R- Retractions * compensate for a long time then all of a sudden are in distress |
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If the pulse ox is low
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look at pt! are they ok?
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Nursing Care in Acute Respiratory Distress
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- Frequent Assessments (changes can happen quickly!)
- Increase fluid intake (thins mucous) - Maintain nutrition (wound healing, fight infection, rapid respiration needs more metabolism) - Monitor O2 - Adminster nebulizer (nurses have responsibility that these treatments are being done! and know when to ask dr for one) - Postural drainage, breathing exercises (blow bubbles, and blowing birthday candles), chest physical therapy |
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S/S of Actue respiratory failure
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- Restlessness (especially with tachypnea)
- Tachycardia - Tachypnea - Diaphresis - Mood changes (CNS symptoms) - Increased WOB - Lethargy |
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Prolonged expirations
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bronchial obstruction
(bronchitis, asthma, pulmonary edema, foreign body) |
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Asthma/Reactive Airway Disease
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- Reversible
- increased reaction of airways to various stimuli |
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what are associated with asthma?
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Exzema and allergy rhinitis (allergies)
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leadig serious chronic illness among children and third leading cause of hospitalization among children under age 15 (lower age it is #1)
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asthma
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Common S/S/ of asthma
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cough- hacking, non productive becoming rattling or productive (frothy, clear, mucousy)
- SOB with prolonged expiration - Wheeze (insp and exp), crackles - sweating as acute attack continues - cyanosis (circumoral, nailbeds) - hyperresonance on percussion - Use of accessory muscles |
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Dx of asthma
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based on H&P, augment with lab and imaging studies
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Goal of asthma tx
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- prevent disability
- minimize physical and psychological morbidity - medications - allergen control - exercise (swimming is good choice) - CPT- breathing exercises to prevent overinflation and produce effective cough |
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Corticosteroids for asthma
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- most potent
- antiinflammatory - monitor growth, use spacers, rinse mouth after (growth is delayed, not halted) |
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Cromolyn sodium for asthma
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mild to moderate anti inflammatory med
- initial choice for long-term control tx, - preventive med for exercise induced bronchospasm - NOT FOR ACUTE |
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MEthylxanthinges
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- sustained release theophylline
- mild to moderate bronchodilator - used in addition to inhaled steroids to prevent nocturnal asthma symptoms |
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Leukotriene modifiers (singulair)
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- may be used as alternative to low doses of inhaled steroids in mild persistent asthma
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Beta 2 agonists
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therapy choice for ACUTE symptoms and prevention of exercise induced asthma
**If using >1 cannister a month then asthma is not controled (need additional treatment) * regular daily use is not recommended |
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Anticholinergics (Atrovent)
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can be used with beta2 agonists or alternativ bronchodilator for those who do not tolerate beta2 agonists
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Patient and parent teaching
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- avoid triggers
- recognize early S/S - accurate use of meds (swish, etc.) - accurate use of peak expiratory flow meter |
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proper use of EPF meter
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stand, big breath in and blow as hard and fast as possible and make dials go up to number (do 3 times, take best one)
* every child with asthma should have an asthma action plan at school and home. - optimum body position for breathing |
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Nursing care for asthma
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- adminster meds (inc. O2) per MD orders
- rest and nutrition - perform frequent and thorough respiratory assessments (be vigilant!) - vitals and pulse ox per unit policy |
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Croup
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general term for barky, brassy cough with hoarseness
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Croup syndrome
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described according to affected anatomic sites (eppiglottitis, laryngitis, tacheitis, laryngotracheobronchitis)
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Epiglottitis
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- MOST DANGEROUS!
-obstructive! inflammation of epiglottitis - needs emergency care! |
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S/S of epiglottitis
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- quick onset
- rapid progression from sore throat to respiratory distress - fever - air hunger (leaning forward, tongue protruding) - DROOLING (cardinal sign!) - difficulty swallowing/speaking - no spontaneous cough - agitation - restlessness - frightened expression - erythematous throat - retraction - cyanosis |
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Nursing care of epiglotitis
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- don't upset them, no crying, don't examine throat!
- have intubation/crash cart there with you just in case - DO NOT USE TONGUE DEPRESSOR FOR ASSESSMENT OR TAKE THROAT CULTURE, MONITOR CLOSELY ** If confirmed case, then they need to go to PICU |
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Treatment for epiglotitis
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- imaging studies STAT
- may need ET intubation or tracheostomy, O2, IV antibox, ,corticoids, IV fluids |
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Prevention of epiglotitis
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vaccination o gH. influenza
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Tonsilitis S/S
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- redness
- hypertrophy of tonsils - fever - changes in tongue (strawberry tongue) |
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Post tonsilectomy care
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- on side for drainage
- assess frequently for bleeding - monitor vitals - monitor for breathing difficulty - provide comfort: ice collars, analgesics, clear liquids ** Don't give aspirins or NSAIDS * Acetametaphen is best, don't want to increase bleeding * May give steroid also for decrease in swelling- kids do better with this - provide discharge instructions |
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Tonsilectomy bleeding signs
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- frequent swallowing
- red emesis - pallor - and other bleeding signs |
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tonsilectomy discharge instruction
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- cough syrups with no red dyes so know if bleeding
- no straws or sippy cups, avoid coughing or clearing throat monitor I&O to make sure not getting dehydrated - pain meds on schedule for first 24-48 hrs |
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Respiratory Syncytial "Si sheal" Virus (RSV)
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- causes over half of bronchitis hospitalizations
- Season is Oct- April - Affects children less than 2 more serious than adults * most serious if less than 3 mo ** highly contagious |
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S/S of RSV
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- rhinorrhea
- fever - cough (paroxysmal or spasmodic) - dyspnea - tachypnea - tachycardia - retractions - wheezing - rhonchi - congestion |
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Dx of RSV
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nasal washing for rapid RSV panel (no nasal swab)
- xray finding are not diagnositc but sometimes show air trapping and hyperinflation or appear normal |
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Tx of RSV
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- supportive
- adequate fluids (IV or PO) - oxygen - humidity (w/o this will dry secretions) - anipyretics - rest - Ribaviran (antiviral): expensive and only given to compromised immune systems - suctioning- don't be too excessive- trauma will cause more mucous |
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Prevention of RSV
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- prophylaxis via RSV immune globulin (respigam) for depressed immune systems (HIB, chemo, or exposure to RCV)
- monoclonal antibody (Synagis for less than 34 weeks old) |
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Transmission of RSV
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- hand to eye or nose is most common mode
- contact with contaminated objects may survive up to 45 minutes on clothing or linens - 6 hours on hard surfaces (toys, etc.) - Contact precautions even though its respiratory |
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Incubation for RSV
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3-5 days
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high risk population
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- hx of prematurity
- infants less than 6 wks old - congenital heart disease - chronic lung conditions - immunodeficiency - significant morbidity in RSV with congenital heart disease pts |
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S/S of foreign body obstruction
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- choking
- gagging - stridor - asymmetric wheeze - retraction - cough - inability to speak or breath --> may unconsciousness and asphyxiation |
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Cystic fibrosis
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- autosomal recessive- Chromosome 7
- CFTR (CF transmembrane regulator protein): sodium and water movement across membranes #1 genetic disease among European descent |
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Result of CFTR
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disturbance of the exocrine glands production of dehydrated, excessively thick, tenacious mucous (too much and really sticky and thick)
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Dx of CF
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sweat test- gold standard- > or equal to 60 mmol/L on 2 separate occasions
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Clinical manifestations of CF
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infancy: meconium ileus, failure to thrive
Beyond infancy: frequent cough and colds thick mucous salty taste of sweat bulky stools with steatorrhea and it floats inability to gain weight despite eating a lot |
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CF tx
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Medications
- antibiotics, mucolytics, pulmozyme, bronchodilators, antiinflammatories Nutrition - high calories, need pancreatic enzyme supplementation, vitamins andminerals (ADEK, Na) - need 120% of normal calories Pulmonary toilet: CPT with postural drainage, percussion or vibration devices, pursed lip breathing "Tune ups" or "Clean outs" Surgery if needed (lobectomy, transplant) |
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Growth and development in CF
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- failure to thrive
- delayed puberty - decreased bone density - vulnerable child syndrome |
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ENT problems with CF
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nasal polyps- may alert a provider to test for CF if other symptoms are there as well
-sinusitis |
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Endocrine problems with CF
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- CF related DM: becasue it affects pancreas--> beta cells of pancreas actually get clogged with mucous and can become resistant or stop making (or combo of both)
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GI problems with CF
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- Distal intestinal Obstruction Syndrome
-GERD - Pancreatitis - Rectal prolapse - Hepatobiliary disease |
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Pulmonary problems with CF
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- Hemoptysis (bloody sputum)
- Bronchiectasis - Infections (B. cepacia is worst, resistant, and very contagious) |
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Reproductive problems with CF
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- delayed sexual development
- infertility for males - decreased fertility for females |
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Cardiac problems with CF
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Cor pulmonale (usually an adult only disease except in this instance)
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Cf family concerns
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- financial (lifelong tx)
- insurance coverage (what if run out?) - stress on marriage/siblings - missing school - genetic counseling - pediatric to adult transition- have to prep for this and other diseases too - lung transplantation- hope to be sick enough to be high on the list but not sick enough to not recover from surgery |
