Peds Midterm3

Front 1

Where is lead stored in the body?

Back 1

the brain, kidney, bone marrow, liver and teeth.

Front 2

Formula for Fahrenheit to Centigrade

Back 2

(F-32) / 1.8

Front 3

Formula for Centigrade to Fahrenheit

Back 3

(C x 1.8) + 32

Front 4

What degree to insert needle when giving infant an IM injection?

Back 4

90 degrees

Front 5

Can we mix crushed pills with honey?

Back 5

No, due to botulism spores.

Front 6

If giving crushed meds, is it a good idea to mix with a cup of pudding?

Back 6

No, we want to use small amount of food to mix with to ensure child gets full dose

Front 7

What types of choices are appropriate to give toddlers when giving meds?

Back 7

Cup or spoon?
What flavor juice would you like to drink afterward?
Right or left leg?
Etc.
Do not over negotiate

Front 8

Until 4 weeks of age, infants are obligatory _____ breathers, because of this _______ patency is critical

Back 8

nose

nasal

Front 9

95% of codes in children are due to _____________ failure.

Back 9

respiratory

Front 10

What sounds should we hear over all lung fields of a child under 2?

Back 10

bronchial vesicular sounds over entire lung fields

Front 11

Are lungs fully developed at birth?

Back 11

No, just the size

Front 12

How long do peds lungs continue to develop?

Back 12

until they are 12

Front 13

How does the peds upper airway differ from an adult?

Back 13

Short and narrow (Child’s pinky estimates their airway diameter)

Front 14

the ______ increase by 7 times in number from birth to adulthood and the surface area of the ______ increases by 20 times

Back 14

alveoli

alveoli

Front 15

There is an increase in ____ and _______ of alveoli to adult levels by time child is 12 years.

Back 15

size and number

Front 16

Because children have less alveoli, and the alveoli they do have are smaller, this means they have limits to ____ ______.

Back 16

Gas exchange

Front 17

Why is an increase in edema or mucus in the respiratory tract a serious threat for infants?

Back 17

Because the lumen of their respiratory tract is already very narrow, and they do not have stiff cartilage in the trachea, and thus is will collapse easier.

Front 18

How does the young child's trachea differ from an adult?

Back 18

It is proportionately shorter, is higher (closer to esophagus and epiglottis), and the angle of the right bronchus at bifurcation is more acute than in the adult. It bifurcates at about T3 where an adult bifurcates at about T6.

Front 19

What potential hazard does the location of the trachea pose for small children?

Back 19

Increased chance for aspiration.

Front 20

For peds: Is cartilage in the respiratory tract stiff?

Back 20

No (this means it can collapse easier)

Front 21

lumen of an infants airway is about __mm, so an increase in edema or mucous of __mm is a serious threat.

Back 21

4mm

1mm

Front 22

Why do a lot of kids "outgrow" asthma?

Back 22

Because then they are little their airway diameter is so small that the littlest bit of swelling causes major problems. As they grow so does their airway diameter, and thus more room for swelling.

Front 23

What is the diameter of an older child's airway? An adults airway?

Back 23

Older child: 10mm
Adult: 20mm

Front 24

Why do smaller children have more airway resistance to get air into and out of lungs?

Back 24

They are a smaller airway

Front 25

Why is an infants respiratory rate much higher than an adults?

Back 25

At birth 25 million alveoli, in adulthood 300 milllion. Small children have to breathe much faster to have the same amount of gas exchange as an adult. Also, air must move more quickly in the infant’s narrowed airway to get the same amt of air to the lungs as an adult.

Front 26

Children have smaller oral cavity and large tongue which leads to greaster risk of _________

Back 26

obstruction

Front 27

What is the epiglottis like in the small child, and what problem can it cause?

Back 27

Long, floppy epiglottis vulnerable to swelling with resulting obstruction

Front 28

What are the differences between the young child's lower airway and the adult's lower airway?

Back 28

Intercostal muscles immature – diaphragm primary muscle used to breathe
Ribs are primarily cartilage and are very flexible – therefore retractions seen, especially during respiratory distress

Front 29

What are the 5 sites that retractions are seen in children?

Back 29

supraclavicular
suprasternal
intercostal
substernal
subcostal

Front 30

What is the major difference in acute and chronic respiratory conditions in children?

Back 30

Acute: generally reversible

Chronic: generally irreversible

Front 31

What are acute respiratory conditions in children?`

Back 31

Foreign Body aspiration
Croup Syndrome
Epiglottitis
viral and bacterial respiratory infections

Front 32

What are chronic respiratory conditions in children?`

Back 32

Obstructive sleep apnea
Asthma
Cystic fibrosis
Bronchopulmonary dysplasias (BPD)

Front 33

What injury puts pt at an increased risk for pneumothorax?

Back 33

Blunt Chest Trauma (usually MVA)

Front 34

Why do we need to assess respiratory distress in peds very quickly?

Back 34

In children can code very fast. Energy drains very fast. Need to pay close attention to any child in respiratory distress.

Front 35

What is respiratory failure?

Back 35

Body can no longer maintain effective gas exchange

Front 36

Where does the process of respiratory failure begin?

Back 36

at the alveolar level

Front 37

Respiratory failure results in ______ and ________

Back 37

hypoxemia and hypercapnia

Front 38

What is the permanent damage that hypoxemia causes?

Back 38

No O2 to brain cells! Cannot reverse the brain damage that occurs.

Front 39

What are the S/S of MILD respiratory distress?

Back 39

Restlessness
Tachypnea
Tachycardia
Diaphoresis

Front 40

Nursing interventions for MILD respiratory distress:

Back 40

sit up
breathing treatment- #1 choice albuterol, also Zoponex

Front 41

albuterol (what is it and how long does it take to have an effect)

Back 41

Fast acting bronchodilator, acting within 5-10 minutes

Front 42

When do we reassess pt after giving albuterol?

Back 42

10 min after treatment given

Front 43

Why is Zoponex a good choice to give peds?

Back 43

because it does not cause HR to increase

Front 44

S/S of MODERATE Respiratory Distress: Early Decompensation

Back 44

Nasal flaring
Retractions
Grunting, wheezing
Anxiety, irritability, mood changes, confusion
Hypertension

Front 45

Nursing interventions for MODERATE respiratory distress:

Back 45

Start O2
labs/tests done
hydration- give fluids
any resp treatments that are necessary

Front 46

S/S of SEVERE Respiratory Distress: Respiratory Failure/Imminent Arrest

Back 46

Dyspnea
Bradycardia
Cyanosis (note that cyanosis is a late sign)
Stupor, coma

Front 47

What nursing intervention for EVERE Respiratory Distress?

Back 47

Calling a code

Front 48

What happens to HR when pt hypoxic?

Back 48

HR goes down

Front 49

What are general nursing implementations for respiratory distress?

Back 49

Ease Respiratory Efforts
Warm or Cool mist- in tent
Promote Rest
Promote Comfort
Prevent Spread of Infection
Reduce Temperature
Promote Hydration & Nutrition

Front 50

What should always be nearby an infant (in case of respiratory difficulty)

Back 50

Rubber Bulb Syringe

Front 51

What does stridor indicate on a ped, and what med is necessary?

Back 51

Obstructed airway- need steroids

Stridor at rest is VERY BAD

Front 52

What is RSV?

Back 52

Respiratory Syncytial Virus- respiratory viral infection that occurs in annual epidemics.

Causes respiratory tract infection causing inflammation and mucous in the bronchioles

Front 53

What type of isolation for RSV pts?

Back 53

Contact isolation (because babies cannot cough hard enough to create droplets)

Front 54

Who susceptible to RSV?

Back 54

-Infants under 2 years with chronic lung disease who have required medical therapy within 6 months of RSV onset
-Infants with significant congenital heart disease
-Preterm infants under 35 weeks gestation

Front 55

Clinical Manifestations of RSV

Back 55

Rhinitis, Cough
retractions, nasal flaring
lethargy
Low grade fever
Wheezing, grunting
Tachypnea (can be > 70)
Poor feeding/Vomiting/diarrhea (dehydration can follow)
Distended abd from overexpanded lungs

Front 56

Are immunizations available for RSV?

Back 56

Yes- they are given based on risk factors

Vaccine called synagis

Front 57

RSV presents a lot like _______ but is more susceptible to ____ ______

Back 57

Bronchiolitis

Respiratory Failure

Front 58

What medications are given to treat RSV?

Back 58

Antivirals
Bronchodilators
corticosteroids
Sometimes Racemic Epinephrine

Front 59

Parent teaching for RSV

Back 59

Isolate from other kids
Hydration/nutrition
positioning, limit activity
use of humidifier
Monitor urine output
How to assess vitals
How/when to suction

Front 60

With Foreign Body aspiration for infants and toddlers, that ____ lung is the most common sire of obstruction. Why is this?

Back 60

Right lung, this is due to the angle of the right branch of the trachea

Front 61

S/S of Foreign Body aspiration

Back 61

Spasmodic coughing or gagging
Dyspnea
No fever or other signs of illness
May become asymptomatic after coughing for 15 to 30 minutes, then later have signs of respiratory distress

Front 62

What is croup?

Back 62

Broad term for upper airway illnesses

Front 63

Is the cause of croup usually bacterial or viral?

Back 63

viral

Front 64

What is the usual age range for croup?

Back 64

3 months to 3 years

Front 65

Clinical manifestations of croup:

Back 65

Abrupt onset, usually at night- Resolves by morning
Afebrile
Barking seal cough, noisy inspiration
Hoarse voice
Mild respiratory distress- tachypnea, slight retractions

Front 66

What sound to we need to worry about in croup kids?

Back 66

Stridor on expiration

Front 67

What illnesses fall under the Croup category?

Back 67

- Acute Laryngotracheobronchitis (LTB) and
- Epiglottitis

(as well as others but we won't be tested on them)

Front 68

What is the most common type of croup?

Back 68

LTB

Front 69

What is LTB?

Back 69

Inflammation of the mucosa lining the larynx and trachea causing a narrowing of the airway

Front 70

Who is affected by LTB?

Back 70

Primarily affects children from 3 mo to 3 years.

Front 71

What organisms are responsible for LTB?

Back 71

parainfluenza virus type I, virus types 3 and 2
RSV, Influenza A and B, Mycoplasma pneumoniae

Front 72

S/S LTB?

Back 72

Tachypnea
Inspiratory stridor (occurs at night)
Seal-like barking cough/crowing sounds
Restlessness, retractions

Front 73

What usually preceeds LTB?

Back 73

Upper Respiratory Infection

Front 74

What is the main objective for LTB?

Back 74

Maintaining an airway and providing for adequate respiratory exchange

Front 75

Will LTB go away on it's own?

Back 75

No, it will progress if left untreated

Front 76

LTB: Ineffective Airway Clearance d/t

Back 76

increase mucusal swelling and obstruction

Front 77

What is Epiglottitis?

Back 77

Inflammation of the epiglottis that Will obstruct the epiglottis

Front 78

Is epiglottitis serious?

Back 78

Yes- Potentially life-threatening

Front 79

Do we examine the mouth if we suspect epiglottitis?

Back 79

NO! NEVER LOOK IN THE MOUTH OF SOMEONE THAT YOU THINK HAS EPIGLOTTIS

Front 80

Who can look in the mouth if epiglottitis suspected, and what needs to be on hand?

Back 80

Only doctor does- have Trach kit ready!!!!!!

Front 81

What causes epiglottitis?

Back 81

Usually caused by H. influenzae type B (Hib)

Front 82

Is there a vaccine for Hib?

Back 82

Yes, and the Hib vaccination is now required for children at 2, 4, and 6 months of age

Front 83

Peak age for epiglottitis?

Back 83

2-8 years

Front 84

S/S epiglottitis:

Back 84

Fever
Drooling (because they cannot swallow)
Difficulty swallowing
Tripod position
Difficulty breathing

Front 85

Why are corticosteriods given for children in resp distress and which one is given most frequently to peds?

Back 85

To reduce inflamamtion of bronchioloes
Prednisolone given to kids a lot

Front 86

Where is mild croup treated?

Back 86

Mild croup is treated at home with humidification and observation for respiratory distress.

Front 87

How to achieve cool-air vaporizer for croup kids at home?

Back 87

cool mist- cool night air- go outside at night

Front 88

How does cold temp remedy work to help croup?

Back 88

assist by constricting edematous blood vessels.

Front 89

Why do we put children in severe respiratory distress on NPO?

Back 89

to prevent aspiration and decrease the work of breathing.

Front 90

Why must we keep a constant close eye on children in severe respiratory distress?

Back 90

Symptoms frequently reappear – typically called “relapse” as opposed to “rebound” – within 2 hours.

Front 91

Early Signs of impending airway obstruction

Back 91

Increased pulse and respiratory rate;
Substernal, suprasternal, and intercostal retractions; Flaring nares; and
Increased restlessness.

Front 92

What does the child with croup look like?

Back 92

Child in tripod position chin thrust out mouth open and tongue protruding. Irritable and extremely restless and has an anxious, apprehensive, and frightened expression. Frog like croaking sound; Not hoarse

Front 93

Is onset of epiglottitis slow or abrupt?

Back 93

abrupt

Front 94

If epiglottitis not recognized or treated what happens?

Back 94

Progressive obstruction leads to hypoxia, hypercapnia, and acidosis followed by decreased muscular tone, reduced level of consciousness and, when obstruction becomes more or less complete, a rather sudden death.

Front 95

What meds for epiglottitis?

Back 95

Abx- 7-10 day course
Corticosteriods- for reducing edema

(prevention- Hib vaccine)

Front 96

What test is performed to diagnose RSV?

Back 96

nasal swab

Front 97

Which type of croup is a medical emergency?

Back 97

Epiglottitis

Front 98

How rapid is the onset of epiglottitis?

Back 98

minutes to hours

Front 99

Acute epiglottitis AIRRAID

Back 99

Airway closed
Increased pulse
Restlessness
Retractions
Anxiety (increased)
Inspiratory stridor
Drooling

Front 100

How to diagnose epiglottitis without looking in mouth?

Back 100

lateral neck X-ray