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85 Cards in this Set
- Front
- Back
What is a classic sign of a child in Resp distress who is greater than 6 mo
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sitting in the tripod position
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What is a sign of chronic hypoxia in the later pre-school, school age child
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clubbing
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What should you assess when doing a resp assessment
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Rate/depth/ease and rhythm
lung sounds skin-color mucous membranes-color/hydration CRT POX |
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How often do you assess someone who is on cont. O2
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Q hour
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Other things that you assess
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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 |
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What are some differences b/w child and afult
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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 |
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Resp infection risk factors
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immunodeficiency
malnutrition anemia fatigue allergies asthma cardiac disease environment/daycare/smk |
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resp infection clinical manifestations
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fever/instability in young
menigeal signs- h/a stiff neck anorexia vomiting diarrhea abd pain nasal congestion nasal drainage cough resp sounds |
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what are the goals of resp infections
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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 |
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what should you never give if child has diarrhea
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fruit juice or sweeten water
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what does stridor indicate?
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upper airway problem
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CROUP
Define |
general term used to describe barking cough. insp. stridor upper resp obstruction or edema of lyrnx
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CROUP
two types of syndromes |
acute epiglottis
acute laryngotracheobronchitis LTB |
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CROUP
ACUTE EPIGLOTTITIS MUST KNOW facts |
EMERGENCY/ supra glottic obstruction
do not examine throat w/ tongue depressor or use a culture swab |
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CROUP
ACUTE EPIGLOTTITIS define |
bacterial infection that causes laryngeal spasm. have intubation equipement ready at bedside
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what does stridor indicate?
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upper airway problem
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CROUP
Define |
general term used to describe barking cough. insp. stridor upper resp obstruction or edema of lyrnx
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CROUP
two types of syndromes |
acute epiglottis
acute laryngotracheobronchitis LTB |
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CROUP
ACUTE EPIGLOTTITIS MUST KNOW facts |
EMERGENCY/ supra glottic obstruction
do not examine throat w/ tongue depressor or use a culture swab |
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CROUP
ACUTE EPIGLOTTITIS define |
bacterial infection that causes laryngeal spasm. have intubation equipement ready at bedside
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ACUTE EPIGLOTTITIS
S/S |
hear stridor
high fever tachycardia tachypnea look very ill or toxic |
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ACUTE EPIGLOTTITIS
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prevelence 1-8yo
more sever bacterial progresses rapidly(have emergency airway equipment at bedside) dysphasia/droolin agitation NO COUGH |
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ACUTE EPIGLOTTITIS
Treatment |
IV ABX
Fluids corticosteroids |
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ACUTE EPIGLOTTITIS
prevention |
H influenza vaccine
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ACUTE EPIGLOTTITIS
Nursing interventions |
alieve anxiety
keep child and parent together child in position of comfort monitor reap status POX IV hydration |
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Acute laryngotracheobronchitis
LTB define |
inflammation of mucosal lining causing narrowing
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LTB
treatment |
corticosteroids
maintain airway high humidity/cool mist/rest fluids if RR <60 epi inhaler have intubation/O2 available |
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LTB
assessment |
resp and cardiac status
at risk for airway obstruction hydration |
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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 |
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TONSILLITIS
define |
inflammation of lymphoid tissue in pharynx. Pallatine tonsils become edemetus and block airway. Adnoid- obstruct air from nose
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TONSILLITIS
treatment |
ABX for bacterial
viral tx symptomatically tonsilectomy if reoccuring |
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TONSILLITIS
Nursing intervention |
assess bleeding
IV pain meds/hydration soft/cold/liquid diet cool mist/cool vaporizer warm Na h2o garlge antipyretic |
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TONSILLITIS
IMPORTANT |
place on abd.
no coughing/nose blowing or throat clearing observe for fresh bleeding freq monitor swallowing |
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TONSILLITIS
how to handle pain |
ice
analgesic no citrus juice or colored fluids |
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Otis media
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most prevealent disease of early childhood
it is a dysfunction of eustachian tube |
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what are children more prone to OM
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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
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how do you hold the ear on an otoscopic exam
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<3yo down and back
>3 up and back |
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Otitis media
manisfestations |
ears hurt, earache if preverbal they are irritable and may tug at ear
poor eating fever purlent dc from ear anorexia |
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Otitis media
complications |
hearing loss can lead to speech deficit, chronic can cause perforation or scarring of the eardrum. Mastoiditis
meningitis |
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Otitis media
diagnosis |
otoscopic/ see bright red, buldging tympanic membrane.
check ear for drainage, use sterile swab and h2o |
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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 |
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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 |
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what may help lower the rate of Om
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pneumocacal vaccine
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Respiratory Syncytical Virus
RSV |
most common cause of bronchitolitis
occurs in late fell-spring |
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RSV risk factors
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prematurity
<6wk of age infant with chronic lung disease (NICU baby) socio-economic status smk, daycare, older siblings |
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RSV patho
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Virus affects the bronchiole causing inflammation, edema, and inccreased mucous, which progresses to alveoli causing atelectis and collapse.
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RSV diagnosis
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first test is nasophyrangel wash (aspirate nasal secretions)
IFA (flourescent antibody test) rapid immuno test done on nasal secretions. |
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RSV manifestations
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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
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RSV TX
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O2 suction nares, fluid IV if RR >60, rest, quiet dark room, ABGs, C&A monitor, steroids inhalers,nebs and abx prophilactically
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what type of percautions are needed with RSV
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contact with a mask
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RSV Prevention
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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 |
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what does the AAP recommend with regards thoso synagis
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synagis for those <2yo with chronic lung disease. done for 2 seasons. should be done at the beginning of the season.
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ASTHMA
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most common chronic disease of childhood primary cause of hospitailazations and school abscences.
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Asthma Risk factors
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male
socio-economic status single mom household smoke daycare |
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ASTHMA
patho |
disease of chronic inflammation. Bronchi hypersensitive. Increase in airway responsiviness.
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what causes airway remodelling?
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due to chronic condition of asthma. irreversible
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Severity classifications of asthma
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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 |
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ASTHMA triggers
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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 |
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what is going on during an asthma attack
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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
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what is air trapping
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you get air in but it is trapped and hard to exhale out.
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what happens if asthma (hypoxia, resp acidosis) not treated
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resp failure
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what is the classic sign of asthma
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chronic cough with no cold symptoms
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ASTHMA diagnosis
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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 |
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Peak expiratory flow meters
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measures max forcefully expired air flow in 1 second. do it three times 30sec apart and take best (over 3 wk period
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what is the purpose of finding your best on the peak flow meter
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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
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What does the green zone mean for peak flow
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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
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what does the yellow zone mean
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50-79% signals caution. your overall asthma may not be under control and your healthcare provider may nn to change asthma management plan
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what does the red zone mean?
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below 50% of best. signals a MEDICAL ALERT. call health care professional IMMEDIATELY
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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 |
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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 |
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Asthma treatment
pharmacologic |
treated with both long-term control or preventer meds and quick-relief meds or rescue meds
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what do Long term control
what do Quick release do |
LT- control inflammation
QR- treats symptoms |
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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) |
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ex of coritcosteroids
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pulmicort
flovent azmacort |
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ex of LT meds
Fluticasone and salmeterol |
Advair diskus- controls symptoms and improves lung function cortico and bronchodilator combo
SE infection |
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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 |
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ex of QR meds
B-adrenerigic agonist |
albuterol/terbutaline
bronchodilator and relaxes sm muscle used for rescue and prevention of exercise induced exacerbation. |
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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 |
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excerise with the asthma patient
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self-limiting. choose sports with short bursts of activity. swimming good b/c encourages pursed lip breathing.
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what is status asthmaticus
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sustained asthmatic reaction that doesn't respond to treatment
A MEDICAL EMERGENCY |
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STATUS ASTHMATICUS CONT...
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severe resp distress. agietated and can't sit still or lay down. causes resp failure or death.
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STATUS ASTHMATICUS
s/s |
agitation followed by sudden quiet, respiratory arrest
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STATUS ASTHMATICUS
treatment |
ventilation, drugs are epinephrine, B2-agonists, steroids, o2
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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 |
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education asthma
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children can lead full active lives and grow into adulthood
have a pulmonary plan and do peak flows test for allergies and remove them |