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155 Cards in this Set
- Front
- Back
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upper respiratory tract
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nose, pharynx, trachea (epiglottis and larynx)
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lower respiratory tract
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bronchi, bronchioles, alveolae
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differences in a child's respiratory tract vs. an adult's
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1-smaller diameter
2-shorter structures 3-progresses more rapidly |
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subcostal and substernal retractions in infants and children are usually correlated with a respiratory infection in the upper/lower tract
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lower respiratory tract
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suprasternal retractions in infants and children are usually associated with upper/lower respiratory infections
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upper
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What is the most prevalent diseases in childhood
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otitis media
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incidence of otitis media is greatest at what age and when does it spike again
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6mos-2yrs; when entering school
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Causes of Otitis Media
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1-bacterial infection
2-non-infectious 3-smoke 4-feeding techniques |
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What sorts of bacteria are responsible for otitis media?
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1-streptococcus pneumonia
2-haemophilus influenza 3-moraxella catarrhalis |
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Clinical manifestations of otitis media
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1-fever
2-irritability 3-rhonorrhea 4-decreased apetite 5-N/V maybe 6-lymphadenopathy |
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Tympanic membrane findings r/t acute otitis media
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1-membrane intact, red, bulging
2-no bony landmarks 3-no light reflex 4-check for mobility of tympanic membrane |
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If a child is having trouble hearing what might we consider is going on?
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acute otitis media
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A diagnosis of AOM requires...
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1-hx of acute onset of s&s's
2-the presence of MEE 3-s&s's of MEE |
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Define otalgia
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discomfort related to the ears
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At what age should a child be administered antibiotics r/t AOM regardless of diagnostic certainty
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< 6mos
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Under what conditions would we administer antibiotics to children ages 6mos-2yrs?
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1-certainty of diagnosis
2-uncertainty of diagnosis w/ sever signs |
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For children > 2yrs, what is the recommendation for prescribing antibiotics?
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after 48-72hrs after observation, if symptoms have not cleared or have gotten worse
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What antibiotic is the first line of defense in treating AOM
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amoxicillin
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When would it be appropriate to administer IM antibiotics
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concern of compliance
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What medications are commonly associated with treatment for AOM
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1-antibiotics
2-analgesics 3-antipyretics 4-Hib and Prevnar vaccine |
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Alternative treatment for AOM
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warm soaks
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Time period when determined ear infection is chronic
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persistent for weeks or months
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s&s's associated with chronic otitis media
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1-persisten effusion
2-mild to moderate hearing loss 3-ear popping 4-no severe pain |
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treatment for chronic otitis media
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myringotomy
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Under what conditions is a myringotomy ordered
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fluid persists for 3 months and associated hearing loss
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Two specific criteria for myringotomy
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(A) 3 or more episodes of OM in a 6-month period
(B) 4 episodes during a 1-year period |
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Characteristics of Croup
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1-hoarsness
2-cough 3-inspiratory stridor 4-respiratory distress |
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What causes these characteristic symptoms of croup
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swelling or obstruction in region of larynx
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What viral organisms are associated with croup
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1-parainfluenza
2-RSV 3-influenza A&B 4-mycoplasma pneumonia |
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acute epiglottis, laryngeotracheobronchitis (LTB), acute spasmodic laryngitis, and acute tracheitis are all types of what respiratory disorder
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croup
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How would you describe the cough associated with stridor?
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barking cough
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Incidence of croup is higher in boys/girls
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boys
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Season(s) associated with higher incidence of croup
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late autumn-early winter
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Age group associated with higher incidence of croup? Peak age?
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6mons-3yrs; 2yrs
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LTB begins in upper/lower respiratory tract
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upper
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Age range associated with LTB
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3mos-8yrs
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Clinical manifestations of LTB
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1-gradual onset
2-URI 3-seal like cough 4-inspiratory stridor 5-suprasternal retractions 6-increased RR 7-distressed, frightened 8-may develop symptoms of hypoxia |
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Where is pt with mild LTB usually monitored
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at home
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What defines mild (from severe) LTB
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no stridor at rest
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What is a good form of therapeutic management recommended for a pt with croup
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high humidity with cool mist
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What diagnosis of LTB requires hospitalization
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severe LTB
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Should pt's with LTB be encourage to drink/administered fluids
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yes; IV if hospitalized
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Cool mist and occasional O2 is administered for pt's with what respiratory disorder
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severe LTB
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What medications are commonly prescribed to pt's with severe LTB
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1-corticosteroids
2-racemic epinephrine via nebulizer |
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What causes LTB
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viral infection
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Acute epiglottis is caused by a viral/bacterial infection
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bacterial
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Clinical manifestations of acute epiglottis (clue = acute)
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abrupt onset (clue) of:
severe sore throat, fever, muffled voice, pain w/ swallowing |
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T/F A cough is usually present with acute epiglottis
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F
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Describe the posture/positioning of pt's with acute epiglottis
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upright position, leaning forward, mouth open, drooling, tongue protruding
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Describe the sound associated with progression of acute epiglottis
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frog-like croak
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Describe the retractions associated with progression of acute epiglottis
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suprasternal, supraclavicular
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Describe the sort of throat assessment that should be performed on a child presenting with s&s's of acute epiglottis
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never assess throat; call ER; have crash cart available and ready
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In what instance should a child's throat never be inspected, why?
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presentign with s&s's of acute epiglottis; airway spasms
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Intubation and tracheotomy are often associated with what respiratory disorder
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acute epiglottis; often temporary tracheostomy to create immediate patency of airway
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What vaccine is recommended for prevention of acute epiglottis
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HIB
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What time of the year do we normally see Bronchialitis RSV
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winter and spring
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What respiratory disorder is associated most with ages 2-6mos, with a peak between 2-3mos
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Bronchialitis RSV
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Describe immunity associated w/ RSV
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it doesn't occur; incidence and severity decreases with age
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What respiratory virus have all children been infected with by age 3?
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RSV
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What respiratory disorder is RSV considered a risk factor for?
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asthma
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What strain os RSV is considered to be most serious
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A
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Pathophysiology of RSV invasion in the bronchial epithelial cells
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causes inflammation and edema; dead/necrotic shedding of epithelial cells; airway obstruction form shedding; air trapping, impaired gas exchange, hyperinflation, atelectasis
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Hyperinflation and atelectasis can result from RSV, how?
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air trapping above/below obstruction of dead epithelial cells
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What is a complication of O2 being directly pumped into the lungs, what disorder is this descriptive of?
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scarring; bronchial pulmonary displasia (BPD)
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What has decreased the incidence of BPD?
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development of c-pap
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Risk factors for RSV
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1-male
2-CHD, CLD 3-CF 4-BPD 5-immunodeficiceny 6-smoking 7-premature |
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How does RSV initially present
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URI
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s&s's of RSV
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1-low grade fever
2-cough may be present |
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How do you distinguish between asthma and RSV
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nasal pharyngeal secretions is RSV
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What symptoms are commonly associated with RSV that has progressed into a LRI
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increased coughing, wheezing, tachypnea, dyspnea, retractions, crackles, decreased breath sounds and prolonged expiratory phase
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A decreased/prolonged expiratory phase is associated with RSV
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prolonged
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Increased/decreased breath sounds are associated with RSV
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decreased
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What isolation precautions should be followed in accordance with RSV
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contact, maybe droplet since pt's cough
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How long are pt's with RSV contagious once s&s's have subsided
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1-3 weeks
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How long can RSV live on the skin, on paper, or on cribs?
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1hr, 6hrs
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What determines hospitalization for pt's with RSV
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1-tachypnic
2-marked retractions 3-listless 4-poor PO intake |
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What forms f therapeutic management are used when a pt with RSV is cared for at home?
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1-cool moist air
2-antipyretics 3-encourage fluids 4-elevate HOB 5-monitor s&s's of resp distress |
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Are antibiotics necessary with RSV
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not unless secondary to bacterial infection; RSV is a virus
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What is Ribovarian? What needs to be considered?
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an antiviral agent that can be administered to pt's with RSV; risk vs. benefits
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What is the best treatment for RSV?
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prevention; RSV-IGIV (respigam)
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What is RSV-IVIG?
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an infusion given once a month to high risk pt's for RSV as prophylaxis
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What is Synagis?
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a vaccine administered IM q4 weeks to prevent RSV in high risk pt's as prophylaxis
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RSV-IVIG vs Synagis
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MMR &varicella doesn't have to be delayed with Synagis
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Bacterial/viral pneumonia is most common
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viral
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What viral URI's is viral pneumonia most commonly associated with?
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RSV, parainfluenza, influenza adenovirus
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What respiratory disorder starts as a gradual onset with fever and malaise, an unproductive cough, and presence of wheezes and crackles with breath sounds
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pneumonia
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what adventitious sounds are commonly heard on pt's with pneumonia
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wheezes and crackles
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What findings will be present on a chest x-ray of a pt with pneumonia
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patchy white infliltrates
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What pertinent lab data will be found on pt's with pneumonia
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< 20,000 WBC
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When a pt has respiratory distress or increased secretions, what alternative treatment can we use that doesn't need an order
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cupping, vibrations
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What respiratory disorder starts as a gradual onset with fever and malaise, an unproductive cough, and presence of wheezes and crackles with breath sounds
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pneumonia
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what adventitious sounds are commonly heard on pt's with pneumonia
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wheezes and crackles
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What findings will be present on a chest x-ray of a pt with pneumonia
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patchy white infliltrates
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What pertinent lab data will be found on pt's with pneumonia
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< 20,000 WBC
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When a pt has respiratory distress or increased secretions, what alternative treatment can we use that doesn't need an order
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cupping, vibrations
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What is RSV-IVIG?
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an infusion given once a month to high risk pt's for RSV as prophylaxis
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What is Synagis?
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a vaccine administered IM q4 weeks to prevent RSV in high risk pt's as prophylaxis
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RSV-IVIG vs Synagis
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MMR &varicella doesn't have to be delayed with Synagis
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Bacterial/viral pneumonia is most common
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viral
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What viral URI's is viral pneumonia most commonly associated with?
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RSV, parainfluenza, influenza adenovirus
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explain "vibrations," as it relates to therapeutic technique
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ask pt to make "sssss" sound upon expiration and rub the heel of your palm in intercostal spaces to break up secretions
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What sort of positioning is good for a pt with pneumonia
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HOB elevated; lay on affected side
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Common forms of therapeutic management with pneumonia
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1-antipyretics
2-encourage fluids 3-cool, moist air 4-administer O2 when necessary |
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What are the common forms of bacteria responsible for pneumonia
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1-strep
2-staph 3-omaxacin influenza 4-pneumococcal 5-mycoplasm |
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What differentiates bacterial pneumonia from viral pneumonia
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acute onset, w/ fever, and toxic appearance
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What respiratory disorder starts as a gradual onset with fever and malaise, an unproductive cough, and presence of wheezes and crackles with breath sounds
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pneumonia
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what adventitious sounds are commonly heard on pt's with pneumonia
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wheezes and crackles
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What findings will be present on a chest x-ray of a pt with pneumonia
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patchy white infliltrates
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What pertinent lab data will be found on pt's with pneumonia
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< 20,000 WBC
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When a pt has respiratory distress or increased secretions, what alternative treatment can we use that doesn't need an order
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cupping, vibrations
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describe "vibrations" as therapeutic technique for treating pneumonia
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ask pt to make "ssss" sound upon expiration; use the heel of your palm to create vibrations in intercostal spaces to break up secretions
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what positioning is best for pt's with penumonia
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elevate HOB; lay on affected side
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what forms of treatment are used to manage pneumonia, as seen with may respiratory disorders
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1-O2 when necessary
2-antipyretics 3-cool, moist air 4-encourage fluids |
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What differentiates bacterial pneumonia from viral pneumonia
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acute onset, with fever and toxic appearance
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What bacteria types are responsible for causing bacterial pneumonia
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1-strep
2-staph 3-pneumococcal 4-omoxacin influenza 5-mycoplasm |
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clinical manifestations of older children with pneumonia
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1-chest pain
2-stomach pains 3-headache 4-meningism |
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clinical manifestations of younger children with pneumonia
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1-lethargy
2-irritibility 3-poor feeding |
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describe the cough associated with pneumonia
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barking, non-productive
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breath sounds heard on pt's with pneumonia are loud/diminished
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may be diminished
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How does the cough experienced with pneumonia sound as the infection clears
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productive
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Diagnostic factors r/t pneumonia
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x-ray, + sputum culture, elevated WBC count
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Difference between patchy infiltrates and lung consolidation?
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patchy infiltrates are less condensed
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Treatment for bacterial pneumonia
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antibiotics specific to organism
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What determines need for hospitalization for children with pneumonia?
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1-infants
2-stapholococcal pneumonia 3-pleural effusion 4-need for suctioning 5-tachypnic, marked retractions, listless, poor PO intake (same as viral) |
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Signs of pleural effusion
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1-pain over scapula, affected side
2-SOB 3-decreased breath sounds |
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What pt's with bacterial pneumonia are most likely to end up in the ICU
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staph
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What is the most common chronic disease in children in the US
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asthma
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What underlying cause seen in asthma leads to mucous in the airway, swelling of the lining in the airway and spasms in the airway?
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narrowing of bronchioles
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Explain the allergy component associated with asthma
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not everyone with asthma has allergy component; associated with higher levels of IgE and requires additional treatment
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What are the different classifications of asthma
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1-intermittent asthma
2-mild persistent asthma 3-moderate persistent asthma 4-severe persistent asthma |
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What is the #1 trigger of asthma exacerbation
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infection
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Triggers of asthma exacerbation
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outdoor, indoor, irritants, exercise, colds/infections, animals, meds, emotions, foods, cold air, tobacco smoke
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Examples of indoor triggers of asthma
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dust, mold, cockroach
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How can we educate caregivers to help eliminate triggers of asthma at home?
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vacuum regularly, hard woo floors, stuffed animals in freezer, hypoallogenic/plastic covers on pillows
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Examples of medications that exacerbate asthma
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beta-blockers, aspirin
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What else has proven to be just as successful as medication to treat asthma?
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eliminating triggers
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Most common symptom of asthma
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persistent, non-rpoductive, paroxysmal cough that worsens at night
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Chest sounds commonly heard in pt's with asthma
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rhoncchi, wheezes
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Chest sounds r/t mild asthma
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wheezes upon expiration
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Chest sounds r/t severe asthma
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wheezes upon expiration and inspiration
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s&s's of respiratory distress associated with asthma
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1-increased RR
2-accessory muscles - neck, abdomen |
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Chronic asthma pt's may develop what chest shape?
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barrel chest
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If a pt is an asthmatic explain their response to spirometry treatment
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improvement with treatment then asthma
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How do we diagnose asthma
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r/o other diseases, pft's, pefr, spirometry
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What age is probably too young to start treatment for asthma using a peak flow meter or incentive spirometry
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< 4yrs
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What is an asthma action plan
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assess best performance with peak flow meter to determine treatment modifications that will prevent hospitalization; green, yellow, red
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Define complications seem with status asthmaticus
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persistent hypoventiliation; acidosis; vomiting; dehydration
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Nursing interventions for status asthmaticus
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1-observation
2-correct acidosis 3-IV fluid 4-Tylenol, not aspirin 5-corticosteroids, bronchiodilators, antibiotics |
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What medications can be used for quick relief for asthma
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1-corticosteroids
2-beta-adrenergic agents |
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Examples of quick relief beta-adrenergic agents
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1-albuterol
2-levabuterol |
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Examples of quick relief corticosteroids
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1-Prednisone (PO)
2-Solumedrol (IV) |
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What is the action of corticosteroids
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anti-inflammatory
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What is the action of beta-adrenergic agents
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bronchodilators
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What form of treatment is used for asthmatics with an allergy componenet
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Anti-IgE monoclonal antibodies
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What is Xolair, how is it administered?
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anti-IgE monoclonal antibodies; injection every 2-4 weeks
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