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85 Cards in this Set

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What is a classic sign of a child in Resp distress who is greater than 6 mo
sitting in the tripod position
What is a sign of chronic hypoxia in the later pre-school, school age child
clubbing
What should you assess when doing a resp assessment
Rate/depth/ease and rhythm
lung sounds
skin-color
mucous membranes-color/hydration
CRT
POX
How often do you assess someone who is on cont. O2
Q hour
Other things that you assess
Breath for odor may indicate lung infection
Cough- type, productive
Infection-temp, lymph nodes
secretions- color and consistency
chest/throat pain
LOC
Lab values- CBC, ABG Lytes, CXR
What are some differences b/w child and afult
smaller passageways
lg. soft pallette
lyrnx 2-3 vertibre higher
tounge lg in proportion to soft tissue
less cartilidge in airway so < support
alveoli < mature and not securely attached
Resp infection risk factors
immunodeficiency
malnutrition
anemia
fatigue
allergies
asthma
cardiac disease
environment/daycare/smk
resp infection clinical manifestations
fever/instability in young
menigeal signs- h/a stiff neck
anorexia
vomiting
diarrhea
abd pain
nasal congestion
nasal drainage
cough
resp sounds
what are the goals of resp infections
ease resp effort-use warm mist from shower
promote rest/comfort-bedrest quiet play
temp. reduction-teach parent how to take temp
hydration/nutrition-pedilyte or gatorade teach parent s/s of dehydration
what should you never give if child has diarrhea
fruit juice or sweeten water
what does stridor indicate?
upper airway problem
CROUP
Define
general term used to describe barking cough. insp. stridor upper resp obstruction or edema of lyrnx
CROUP
two types of syndromes
acute epiglottis
acute laryngotracheobronchitis LTB
CROUP
ACUTE EPIGLOTTITIS
MUST KNOW facts
EMERGENCY/ supra glottic obstruction
do not examine throat w/ tongue depressor or use a culture swab
CROUP
ACUTE EPIGLOTTITIS
define
bacterial infection that causes laryngeal spasm. have intubation equipement ready at bedside
what does stridor indicate?
upper airway problem
CROUP
Define
general term used to describe barking cough. insp. stridor upper resp obstruction or edema of lyrnx
CROUP
two types of syndromes
acute epiglottis
acute laryngotracheobronchitis LTB
CROUP
ACUTE EPIGLOTTITIS
MUST KNOW facts
EMERGENCY/ supra glottic obstruction
do not examine throat w/ tongue depressor or use a culture swab
CROUP
ACUTE EPIGLOTTITIS
define
bacterial infection that causes laryngeal spasm. have intubation equipement ready at bedside
ACUTE EPIGLOTTITIS
S/S
hear stridor
high fever
tachycardia
tachypnea
look very ill or toxic
ACUTE EPIGLOTTITIS
prevelence 1-8yo
more sever
bacterial
progresses rapidly(have emergency airway equipment at bedside)
dysphasia/droolin
agitation
NO COUGH
ACUTE EPIGLOTTITIS
Treatment
IV ABX
Fluids
corticosteroids
ACUTE EPIGLOTTITIS
prevention
H influenza vaccine
ACUTE EPIGLOTTITIS
Nursing interventions
alieve anxiety
keep child and parent together
child in position of comfort
monitor reap status
POX
IV hydration
Acute laryngotracheobronchitis
LTB
define
inflammation of mucosal lining causing narrowing
LTB
treatment
corticosteroids
maintain airway
high humidity/cool mist/rest
fluids if RR <60
epi inhaler
have intubation/O2 available
LTB
assessment
resp and cardiac status
at risk for airway obstruction
hydration
LTB
differences
prevelence 3mo-8yo
virial
slower to progress
upper resp infection
horse raspy cough
look like a cold not toxic
stridor/high pitch
low grade fever
restless and irritable
TONSILLITIS
define
inflammation of lymphoid tissue in pharynx. Pallatine tonsils become edemetus and block airway. Adnoid- obstruct air from nose
TONSILLITIS
treatment
ABX for bacterial
viral tx symptomatically
tonsilectomy if reoccuring
TONSILLITIS
Nursing intervention
assess bleeding
IV pain meds/hydration
soft/cold/liquid diet
cool mist/cool vaporizer
warm Na h2o garlge
antipyretic
TONSILLITIS
IMPORTANT
place on abd.
no coughing/nose blowing or throat clearing
observe for fresh bleeding freq
monitor swallowing
TONSILLITIS
how to handle pain
ice
analgesic
no citrus juice or colored fluids
Otis media
most prevealent disease of early childhood
it is a dysfunction of eustachian tube
what are children more prone to OM
eustachian tube is shorter, straighter and wider causing to retain more fluid and increases negative pressure and if tube opens leaks fluid into middle ear
how do you hold the ear on an otoscopic exam
<3yo down and back
>3 up and back
Otitis media
manisfestations
ears hurt, earache if preverbal they are irritable and may tug at ear
poor eating
fever
purlent dc from ear
anorexia
Otitis media
complications
hearing loss can lead to speech deficit, chronic can cause perforation or scarring of the eardrum. Mastoiditis
meningitis
Otitis media
diagnosis
otoscopic/ see bright red, buldging tympanic membrane.
check ear for drainage, use sterile swab and h2o
otitis Media
Treatment
Goal is to keep middle ear free of fluid and air. current trend is no ABX use. myringotomy-sm cut in Tempanic membrane to relieve pressure
Tubes-keeps passage open, helps with drainage
tylenol or motrin
heat or ice
Otitis Media
Nursing Interventions
Teach that you may
have temp. hearing loss
Take full course of ABX
hold infant upright when feeding. environment can trigger. teach s/s
what may help lower the rate of Om
pneumocacal vaccine
Respiratory Syncytical Virus
RSV
most common cause of bronchitolitis
occurs in late fell-spring
RSV risk factors
prematurity
<6wk of age
infant with chronic lung disease (NICU baby)
socio-economic status
smk, daycare, older siblings
RSV patho
Virus affects the bronchiole causing inflammation, edema, and inccreased mucous, which progresses to alveoli causing atelectis and collapse.
RSV diagnosis
first test is nasophyrangel wash (aspirate nasal secretions)
IFA (flourescent antibody test) rapid immuno test done on nasal secretions.
RSV manifestations
apnea in young infant, CXR shows consolidation. , cough,Upper resp infection, OM, Rhinorrhea, conjunctivitis, wheeze, fever, severe tachypnea RR 70-80's, retractions, nasal flaring, grunting, diminished LS, hypoxia leads to resp acidosis
RSV TX
O2 suction nares, fluid IV if RR >60, rest, quiet dark room, ABGs, C&A monitor, steroids inhalers,nebs and abx prophilactically
what type of percautions are needed with RSV
contact with a mask
RSV Prevention
those at risk are given monthy IV tx of immuneglobulin (blood product) interferes with MMR vaccine
Palivizumab (synagis) wt based and expensive. often have monthly clinics
what does the AAP recommend with regards thoso synagis
synagis for those <2yo with chronic lung disease. done for 2 seasons. should be done at the beginning of the season.
ASTHMA
most common chronic disease of childhood primary cause of hospitailazations and school abscences.
Asthma Risk factors
male
socio-economic status
single mom
household smoke
daycare
ASTHMA
patho
disease of chronic inflammation. Bronchi hypersensitive. Increase in airway responsiviness.
what causes airway remodelling?
due to chronic condition of asthma. irreversible
Severity classifications of asthma
mild intermittent-sym <2/wk with brief exarcerbation
MILD persistent- sym >2/wk problems with activity
MOD persisten-symptoms affect activity. use inhaler QD
SEVERE persistent- continual symptoms restrictions on activity
ASTHMA triggers
environment: smk, allergies, viral infection, household chemicals, change in temp/weather. exercise induced asthma.
STRESS, animal allergies, rodents, MOLD, GER, T-E fistula, adolescents who are preg have freq exacerbations
ASA-NSAID-BetaBlockers-menses
what is going on during an asthma attack
inflammation/edema of MM have thick mucous. Bronchi and cronchioles spasm which narrow the airway resistence to airflow. airtrapping occurs. hyperinflation of alveoli, co2 retention, hypoxia, resp acidosis
what is air trapping
you get air in but it is trapped and hard to exhale out.
what happens if asthma (hypoxia, resp acidosis) not treated
resp failure
what is the classic sign of asthma
chronic cough with no cold symptoms
ASTHMA diagnosis
hx/physical
X-ray to r/o other cause
PFT-pulm function test ie peak flow or spirometry
skin testing
provocative testing-sample of MM-air allegens
Radioallergosorbent testRAST
Peak expiratory flow meters
measures max forcefully expired air flow in 1 second. do it three times 30sec apart and take best (over 3 wk period
what is the purpose of finding your best on the peak flow meter
b/c if you use it every day and compare results to your best you should be able to pick up early a change in resp status
What does the green zone mean for peak flow
80-100% of personal best, signals good control. take your usual daily long term-control medicines, if you take any. keep taking daily long term meds even in yellow or red zone
what does the yellow zone mean
50-79% signals caution. your overall asthma may not be under control and your healthcare provider may nn to change asthma management plan
what does the red zone mean?
below 50% of best. signals a MEDICAL ALERT. call health care professional IMMEDIATELY
ASTHMA
clincial maniestations
barrel chest
elevated shoulders
LS-coarse, crackels, wheeze
hacking proxismal non-productive cough
audible wheeze
color change lip/ears=dark red
restless or apprehensive may mean hypoxic
tri-pod position
ASTHMA
non pharmacologic treatment
allergen control (pets, carpet, dust etc)
foam or rubber mattress
wash inean weekly
Chest PT
breathing exercises-controlled purse lipped, IS, cough and deep breathe, amb, fluids
Asthma treatment
pharmacologic
treated with both long-term control or preventer meds and quick-relief meds or rescue meds
what do Long term control
what do Quick release do
LT- control inflammation
QR- treats symptoms
ex of LT meds
Corticosteroids
anti-inflammatory
oral/IV- short term use 3-10day
Inhalation-prevent and supress symptoms
SE-supress long bone growth
cough and thrush (rinse P use)
ex of coritcosteroids
pulmicort
flovent
azmacort
ex of LT meds
Fluticasone and salmeterol
Advair diskus- controls symptoms and improves lung function cortico and bronchodilator combo
SE infection
ex of LT meds
Cromolyn sodium
NSAID for asthma.-anti allergic inflam drug interferes with relaease of mast cells so no release of histamine
prophalactic
SE- cough on inhalation
ex of QR meds
B-adrenerigic agonist
albuterol/terbutaline
bronchodilator and relaxes sm muscle
used for rescue and prevention of exercise induced exacerbation.
ex of LT meds
Leukotriene modifiers
singular (montelukast sodium) stops leukotriene (unsat fatty acid that causes that are released when inflammation going on and increases secretion)mediates inflam and bronchospasm PO in combonation with B-agonistsused for prevention mild-persistent asthma
SE: dizzy, fatigue, h/a, abd pain
excerise with the asthma patient
self-limiting. choose sports with short bursts of activity. swimming good b/c encourages pursed lip breathing.
what is status asthmaticus
sustained asthmatic reaction that doesn't respond to treatment
A MEDICAL EMERGENCY
STATUS ASTHMATICUS CONT...
severe resp distress. agietated and can't sit still or lay down. causes resp failure or death.
STATUS ASTHMATICUS
s/s
agitation followed by sudden quiet, respiratory arrest
STATUS ASTHMATICUS
treatment
ventilation, drugs are epinephrine, B2-agonists, steroids, o2
Asthma
RN interventions for the hospitalized child
resp status
adm O2 based on parimeters
nebs
steroids as ordered
COLD LIQUIDS MAY TRIGGER BRONCHOSPASMS
SODA INCREASES RISK OF ASPIRATION
does well with sm, freq feeds
education asthma
children can lead full active lives and grow into adulthood
have a pulmonary plan and do peak flows
test for allergies and remove them