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86 Cards in this Set
- Front
- Back
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What are the 4 classic signs of epiglottitis?
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1. Dysphonia (muffled, hoarse, or absent voice sounds)
2. Dysphagia (difficulty swallowing) 3. Drooling (child resists swallowing due to intense throat pain) 4. Distressed respiratory effort with inspiratory stridor. |
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What is contraindicated in children with epiglottitis and laryngotracheobronchitis?
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DO NOT VISUALLY INSPECT MOUTH AND THROAT OR DO ORAL TEMP.
CAN CAUSE LARYNGOSPASM AND RESPIRATORY DISTRESS. |
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How is epiglottitis dx?
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Culture after ET tube in place. X-ray reveals mass at base of tongue.
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How is epiglottitis most effectively prevented?
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HiB (flu) vaccine
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How are children usually positioned who have epiglottitis?
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Tripod position
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What are people most often referring to when they say "croup"?
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Laryngotracheobronchitis
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What are the symptoms of laryngotracheobronchitis?
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Early - runny nose, inspiratory stridor, seal-like barking cough
Late - expiratory stridor, O2 desat, retractions, cyanosis |
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What medications are used for croup?
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Corticosteroids
Beta adrenergics like albuterol Heliox (helium and o2) Epinephrine |
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What side effect can corticosteroids cause in children?
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HTN
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What are the interventions for croup at home?
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Cool air
Humidified air Avoid cough syrups (dries and thickens secretions) |
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What sort of precautions are taken for children with croup?
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Isolation until cause of URI is known.
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What are the symptoms of bronchitis?
What is the tx for bronchitis? |
Coarse hacking cough that is worse at night, rattling quality to breathing
Tx - Rest, humidity, hydration, cough syrup |
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How can respiratory syncytial virus be prevented?
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Giving palivizumab (Synagis), a monoclonal antibody to high-risk infants once a month, IM, for 5 months, usually Nov-March (better than immunoglobulin b/c you can still stay on the immunization schedule)
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What are the symptoms of RSV?
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Early - rhinorrhea, eye/ear drainage, pharyngitis, cough, sneeze, wheezing, intermittant fever
Progression - air hunger, retractions cyanosis |
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What is an important precaution for the child with RSV?
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ISOLATION
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How do you gather the nasal wash specimen to test for RSV?
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Instill 1-2 drops sterile saline w/o preservative in to each nare and then gently suction using an 8 Fr cathetar in to suction trap.
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What is a syncytia?
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RSV invades mucosal cells of small bronchi and bronchioles. Invaded cells die when virus burst from inside the cell, Membranes of infected cells fuse wih adjacent cells creating large masses of cell.
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Difference in lung sounds b/w RSV and pneumonia
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Pneumonia - crackles, decreased breath sounds if there is consolidation
RSV - inspiratory and expiratory wheezing (not like asthma b/c child has a fever, etc) |
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How does pneumonia look on the x-ray?
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Infiltrates and effusions
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What are the symptoms of a pneumonia?
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Chest pain with coughing (causes ineffective breathing pattern), fever, chills, crackles, dullness on percussion/fremitis
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What are the nursing interventions for a child with pneumonia?
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Teach to splint chest with pillow or teddy bear when coughing.
Monitor vitals/respiratory status/hydration. Acetaminophen/ibuprofen Soft foods in small amounts Lie on affected side. Isolation Suction mucus from infant's nose with bulb syringe. |
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What type of vaccine is indicated for children who are immunosupressed or have chronic diseases (sickle-cell, HIV, functional or anatomic asplenia, children on immunosuppressants)?
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23 valent pneumococcal vaccine
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What are symptoms of pneumonia in an infant?
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irritability, lethargy, poor feeding, abrupt fever, seizures, respiratory distress
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What are the symptoms of pneumonia in an older child?
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Headache, chills, abdominal pain, chest pain, meningeal symptoms
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What are the lab tests to dx asthma?
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Pulmonary function tests
Peak expiratory flow rate measurement (measures max flow of air that can be forcefully exhaled in 1 sec Bronchoprovocation test (expose mucous membranes directly to allergens) Skin tests Exercise challenges Radioallergosorbant test (blood test for sllergens) Chest radiograph (hyperexpansion of airways) |
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What are the biggest risk factors for mortality from asthma?
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Past hx of sudden exacerbation
Prior intubation for asthma/admission to ICU 3+ ER visits in 1 yr for asthma ER care for asthma in past month Use of >1 canister/month of rescue inhaler Chronic use of corticosteroids Low economic status Illicit drug use Serious psychiatric disease or psychosocial problems |
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What contributes to the development of asthma?
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TOBACCO SMOKE
RSV infection, dust mites, rockroaches, mold |
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What causes the asthma attack from exercise?
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Rapidly breathing air that is cooler and drier than is in the respiratory tract, causes inflammation
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What happens during an acute asthma attack?
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Smooth muscles constrict, basement membrane thickens, increased mucous production, inflammaotry reaction
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What is an indicator of inadequate asthma control?
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Use of more than one canister of rescue inhaler/month
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How do you give bronchodilators and corticosteroid inhalers to children?
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Bronchodilator, wait 1 min b/w puffs.
Wait 15 min. Give corticosteroid. Rinse mouth. |
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What time of day do you give oral corticosteroids?
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In the a.m. with food to mimic natural corticosteroid release
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What are the leukotriene modifiers and how do you give them?
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FOR ASTHMA
Monteleukast - give in pm with or w/o food Zafirlukast - give 1 hr before or 2 hrs after meal Report flu-like symptoms, severe headaches, lethargy, acute asthma attacks, fever |
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How is a child's personal best peak expiratory flow rate determined?
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Average of flow rates measured 2-3x/day for 2-3 weeks
Treat child with meds during this time so best flow rate is determined |
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What do you do if your child's peak expiratory flow rate falls to <50% of personal best?
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Call doc or go to ER if PEFR does not return to <50% after action plan is initiated
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If a child or infant has frequent episodes of coughing or respiratory infections, what should they be evaluated for?
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ASTHMA
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What is important to know about the hydration of a child with asthma?
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IV hydration may be necessary. Thins secretions.
GIVE ROOM TEMP FLUIDS B/C ICED BEVERAGES MAY CAUSE BRONCHOSPASM! |
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How old should a child be before attempting using a metered dose inhaler?
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6yo
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What sort of inhaler spacer should be used for an infant?
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A mask attachment b/c they are nasal breathers
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Do you ever use a spacer with a dry powder inhaler?
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No
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What is the first indication of an asthma attack?
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Irritability, restlessness, headache, feeling tired, chest tightness....
Localized itching in the front of neck or upper back. |
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What position do children with asthma attacks assume?
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Tripod or hunched over
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What does the nurse do in the event of an acute asthma attack?
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1. Assess airway.
2. Administer humidified o2 by NC or mask. 3. Administer quick-relief meds 4. Initiate IV 5. Prepare for chest x-ray 6. Prepare for blood sample for abg's |
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What does "silent chest" mean with asthma?
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Fatigued respiratory muscles and impending arrest
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What is cystic fibrosis?
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Autosomal recessive.
Abnormally thick mucous secretion what obstructs small passageways of organs like lungs, intestines, pancreas, and liver |
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What dx test for cystic fibrosis?
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Sweat test
Usually choride is <40. Cystic fibrosis it is >60. |
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What are the typical symptoms of cystic fibrosis?
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COPD in child, intestinal obstruction, malabsorption syndrome, portal HTN
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What is the earliest manifestation of cystic fibrosis in a newborn?
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Meconium ileus
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What are the GI symptoms of cystic fibrosis?
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Pancreas obstructed so....
Steatorrhea Malabsorption of protein and vit DEAK Rectal prolapse Diabetes from pancreatic fibrosis |
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What are the integumentary symptoms of cystic fibrosis?
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Electrolyte imbalances especially during hyperthermic conditionss
Parents report infant tastes salty when kissed |
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What are symptoms of O2 narcosis?
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N/V, malaise, fatigue, numbness/tingling of extremities, substernal distress
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What are the interventions for hemoptysis in a child with cystic fibrosis?
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For hemoptysis >250ml, bedrest, antibiotics, blood replacement therapy, vit K
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What sort of interventions do you do for cystic fibrosis?
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Chest physiotherapy bid
Diet high in protein, moderate in fat, pancreatic enzyme replacement Acid suppression Hyperosmoler enemas, fluid lavage of intestines for obstruction Chest tubes for pneumothorax Antibiotics and vaccines for pulmonary infections EXERCISE to improve tolerance |
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What do you assess when a pt is on tobramycin?
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HEARING!!!!
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What meds are used for cystic fibrosis?
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Inhaled tobramycin
Corticosteroids alternated with high dose NSAIDS Aerosol DNAase Pancrease Vitamins A, D, E, K Ursodeoxycholate to slow progression of hepatic lesions Lactulose |
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What sort of isolation are children with cystic fibrosis on?
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Single room so there is less chance of getting a respiratory infection
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When do you do chest physiotherapy in regards to meals?
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Not before or immediately after
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What kind of diet is important for a pt with cystic fibrosis?
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High protein diet
Vitamins bid Fat and salt 1.5-2x RDA calorie |
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When do you take Pancrease?
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30 min before meals
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What is SIDS?
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Sudden death of an infant that occurs before 1 year old unexplained after autopsy, scene investigation, and review of the hx
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What factors put an infant at risk for SIDS?
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Prematurity (<28wks)
Low birth weight Multiple birth Race (Native American) Male Infant 2-4mo Wintertime Exposure to passive smoke Hx of cyanosis, respiratory distress, irritability, poor feeding Cosleeping Pillows/quilt use Sleeping prone |
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What are the maternal/familial risk factors for SIDS?
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Maternal age <20
Prenatal smoking, binge alcohol, illicit drug use Anemia Multiple pregnancies w/short intervals b/w births Hx of sibling with SIDS Low socioeconomic status No/late prenatal care, low weight gain |
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What is SIDS thought to be related to but NOT!?
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Apnea and DTP vaccine
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What are the clinical findings with a SIDS baby?
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Frothy, blood-tinged sputum, no struggle...found dead...parents report no cry
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How should baby's be placed for sleeping?
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SUPINE
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What are the nursing interventions for a family of a SIDS baby?
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Explain it is not their fault.
Baby will be cool, eyes closed, dependant edema. Support groups. Comb hair, clean baby's mouth, apply vasoline to lips, wrap in clean blanket. Support for siblings Give lock of hair, footprints or handprints for memory book. Explain that we have to do autopsy. |
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Where is a foreign body likely to be aspirated to?
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The right main stem bronchus because of the more acute angle than an adult
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What are the most common things kids aspirate?
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Hot dogs, candy, peanuts, popcorn, grapes
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What are the normal respiratory ranges by age?
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Newborn - 30-60
1yo - 20-40 2yo - 20-30 3-10yo - 16-22 17yo - 12-20 |
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What are the symptoms of nasopharyngeal obstruction?
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Snoring
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What is the symptoms of partially obstructed upper airway?
Lower airway? |
Inspiratory stridoe
Expiratory stridor/wheeze |
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What is the symptoms of airway obstruction of epiglotis?
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Muffled voice
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What is the symptom of tracheal foreign body or croup?
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Barking cough
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Describe 1st, 2nd, and 3rd degree obstruction with foreign body aspiration.
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1st degree - obstruction allows passage of air in both directions
2nd degree - air able to move past the obstruction in one direction only. 3rd degree - air unable to move in either direction |
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How do you assess expiratory effort?
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Have the child say P words
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What places children at increased risk with TB?
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They are at greater risk for developing TB in the meninges, kideys, bone marrow, liver, and spleen.
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What are the symptoms of TB in a child?
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fever, cough, weight loss, anorexia, lymphadenopathy
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What are positive results of the Mantoux skin test?
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>15mm - positive
>10mm - positive for children under 4 or child with chronic illness or high risk child >5 positive for children with immonosuppressive conditions |
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How is the dx of TB confirmed in children under 12?
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positive test on 3 consecutive days of gastric washings.
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How long are TB meds taken?
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6 months
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What does isoniazid, rifampin, and pyrazinamide kill?
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Your liver
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What vitamin is given with isoniazid?
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B6 (pyridoxine)
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What is ethambutol for and what side effect does it have?
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TB, color discrimination
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What side effect does any med ending in mycin...like streptomycin...have?
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Ototoxicity
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What can cause a false negative TB test?
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Measles vaccine
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Which children should have directly observed TB therapy?
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Children with active TB everyday for 2 wks
Children with latent TB - bi-weekly |
