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61 Cards in this Set

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Glandular stage

-Conception until week 16

Canalicular stage

-Weeks 16 to 24

Alveolar stage

-Week 24 to birth

RR: Infant (1 - 12mo)

30 - 60 / min

RR: Toddler (12 - 36mo)

24 - 40 /min

RR: Preschooler (4 - 5y)

22 - 34 /min

RR: School aged (6 - 12y)

18 - 30 /min

RR: Adolescent (13 - 18y)

12 - 16 /min

Respiratory Distress

-Body position, mental status, VS, breath sounds, effort, skin color


-Aspiration, foreign body, infection, asthma, bronchiolitis, RAD, trauma

Respiratory Failure

-Unrecognized / untreated respiratory distress


-Failing to improve /deteriorate with treatment


-Most common cause of cardiopulmonary arrest

Croup

-Couple of days with h/o URI


-Worsens with agitation, after nap


-Comes & goes


-Improves in bathroom (steam), humidity from night air


-Sitting upright, irritable & anxious, tachypnea, tachycardia, 101-102 deg., barky cough, stridor, hoarse voice, nasal flaring, retractions


-Remain in comfortable position


-Pulse ox


-Blow by humidified O2


-Racemic epinephrine


-Dexamethasone


-Lateral neck films

Racemic epinephrine

-Croup


-Decrease laryngeal edema & bronchospasm


-Observe in ED >3h

Dexamethasone

-Croup


-PO 0.15 - 0.6 mg/kg


-Decrease airway inflammation


-Reduces necessity of hospitalization

Epiglottitis (streptococcus pyogenes, s. pneumonia, s. aureus)

-Infection & inflammation in supraglottic area of upper airway & epiglottis


-3 - 7y


-Unrecognized / untreated: rapid edema, airway obstruction, respiratory failure


-No cough, sudden onset of fever + sore throat, tachy, shallow breathing, drooling, muffled voice, tripod position


-PPE, position, NPO, pulse ox, blow by O2, x-rays, DO NOT examine airway

Foreign bodies

-Nuts, popcorn, grapes, hot dogs, raw carrots, candy rolls, batteries, marbles, toys, pennies, dried beans


-Stridor, wheezes, coughing, cyanosis, unable to speak, drooling, hoarse voice


-Unconscious: open airway & BLS, cricothyrotomy


-Conscious: abdominal thrust / back & chest blows, ventilation assistance, O2 for respiratory distress, airway adjuncts

Otitis Media

-Short, wide, horizontal eustachian tube


-URI: blockage & congestion of tube


-Pain, pull on ears, upright, irritability, fever, URI symptoms, red bulging TM


-Decongestants, ear drops, antibiotics, antipyretics

Myringotomy tubes

-Inserted to ear to equalize pressure between middle & outer ear


-May fall out


-Keep ears clean & dry


-Ear plugs

Tonsillitis

-Sore throat, difficulty swallowing, fever, bad breath, swollen tonsils


-Hydration


-Antibiotics


-Bleeding postop: first 24h or 7-10d after (scabs come loose)

Respiratory Syncitial Virus (RSV)

-Virus causes respiratory infections


-Most common cause of bronchiolitis


-Various degrees of respiratory distress


-Most common hospitalization cause <1y


-Risk factor for asthma

RSV: Symptoms

-Rhinorrhea


-Pharyngitis


-Coughing, sneezing


-Intermittent fever


-Increased coughing > tachypnea (<70 + retractions) >cyanosis > apneic spells

RSV: Diagnosis

-Nasal swabs: RVP


-Enzyme linked immunosorbant assay (ELISA): detects RSV antigens


-Direct fluorescent antibody (DFA) staining

RSV: Treatment

-Cool humidified O2


-Hydration


-Suction


-Bronchodilators


-Racemic epinephrine


-Steroids

RSV: Prevention

-palivizumab (Synagis): antibody


-15 mg / kg / mo IM


-Infants <32 wk gestation


-<2y with BPD, received treatment in 6mo of RSV season


-Severe BPD treatment for 2 RSV seasons

RSV: Nursing Care

-Isolation, respiratory & contact precautions


-Respiratory therapy: O2, humidity


-Monitor: CRM, pulse ox


-Maintain airway: elevate HOB


-Suction


-Rest & hydration


-Relieve anxiety

RSV: When to contact PCP

-Increased RR


-Increased effort of breathing


-No improvement


-Not feeding or sleeping


-Deterioration

RSV: Parent Teaching

-Bulb syringe


-Adequate hydration


-Handwashing


-Rest

Asthma

-Chronic inflammatory disorder of airways


-Recurrent episodes of: wheezing, breathlessness, chest tightness, cough



Asthma: Risk Factors

-Maternal history


-LBW or smaller airways


-Patient / family history of allergy or asthma


-Second hand smoke


-Viral respiratory infections

Asthma: Patterns

-Early response: symptoms last about an hour & resolve


-Late response: 6-8h after early response, reoccurrence of symptoms

Asthma: Manifestations

-Respiratory problems worse at night


-Chest tightness


-SOB w/w/o exertion


-Allergen or emotional response


-Increased work of breathing


-Prolonged expiration


-Wheezes


-Dry cough


-NO wheezing: severe respiratory distress

Asthma: Nursing Care

-PPE


-Reverse hypoxia


-Hydration


-Monitor: pulse ox, cardiac


-O2


-Medications


-IV therapy

Asthma: Longterm control

-Inhaled corticosteroids


-Long-acting beta2-adrenergic agonists


-Combos: Symbicort, Advair


-Leukotriene blockers: Montelukast

Asthma: Rescue medications

-Short-acting beta2-adrenergic agonists: albuterol (Ventolin)


-Anticholinergic: ipratropium bromide (Atrovent)


-Mast cell inhibitors: cromolyn sodium


-Systemic corticosteroids: prednisone


-Epinephrine


-Magnesium sulfate: IV, unresponsive to others

Asthma: Nursing care

-Physical characteristics R/T chronic involvement


-Support


-Education: inhaled meds, triggers & allergens to avoid, written action plan

Pneumonia

-Lung tissue inflammation > fluid exudate & fibrin deposits in lungs

Pneumonia: Viral causes

-RSV


-Flu


-Adenovirus


-Rhinovirus


-Measles, rubella


-Varicella

Atypical pneumonia

-Mycoplasma, chlamydia


-Community-acquired pneumonias


->5y

Pneumonia: Bacterial

-Group B streptococci: newborn aspiration during delivery


-Staph. aureus, strep. pneumoniae: <3y


-Strep. pneumoniae, mycoplasma pneumoniae: >3y

Pneumonia: Manifestations

-Fever (chills), cough, tachypnea


-Crackles, retractions, nasal flaring


-Malaise, lethargy, decreased appetite


-Pallor or cyanosis


-Abdominal pain

Pneumonia: Nursing care

-PPE


-Assessment: breath sounds, RR & rhythm, color, VS, degree of restlessness


-Airway & breathing support


-Turn q2h, assist with coughing


-Pulse ox


-Meds: antipyretics, antibiotics, analgesics


-Hydration


-Labs

Bronchopulmonary Dysplasia (BPD)

-Acute lung injury that is complication of longterm ventilator assistance & high O2 concentrations


-Premies


-Unable to handle secretions secondary to ciliary inhibition


-Epithelial damage > thick, fibrotic alveolar walls

BPD: Consequences

-Developmental delay


-Growth retardation


-Continuing airway obstruction

BPD: Progression

-Immature lung (unable to produce surfactant) > respiratory failure


-Mechanical ventilation >barotrauma >inflammation >O2 toxicity >fibrosis >bronchiole edema >cellular damage

BPD: Treatment

-Assess & treat hypoxia


-Bronchodilators, dexamethasone, diuretics, O2


-High calorie meals: increased O2 consumption >increased caloric needs


-Supplemental O2 & humidity


-Chest PT


-Rest & normal development

BPD: Nursing Care

-Rest during feedings


-Increased caloric feedings


-Adequate O2


-Administer diuretics, bronchodilators, inhaled steroids


-Monitor for & prevent infection

Pertussis

-Respiratory droplets


-Incubation period: 7 - 10d


-Tdap vaccine substitutes for Td booster

Pertussis: Catarrhal Stage

-Gradual onset


-Runny nose, mild cough, fever <101 deg.


-Cough increasing severity over 1-2wk

Pertussis: Paroxysmal Stage

-Lasts 1-6wk


-Cough bursts 15 episodes / day: ad noc (thick mucus in tracheobronchial tree)


-Cyanosis


-Loud whooping noises when inhaling


-Inhalation lengthened


-Fatigue

Pertussis: Convalescent Stage

-Gradual recover


-Over 2-3wk


-Treat patients & close contacts with erythromycin


-Droplet precuations

Cystic Fibrosis

-Inherited disease of mucus and sweat glands


-Affects: lungs, pancreas, liver, intestines, sinuses, & sex organs


-CF transmembrance conductance regulator (CFTR): transmission


-Mucus thick & sticky

CF: Manifestations

-Meconium ileus: lack of pancreatic enzymes; abdominal distention, vomiting, failure to defecate, rapid dehydration


-GI: large, bulky, loose, frothy, foul stools (malabsorption); voracious appetite s weight gain; loss of appetite (later); weight loss; failure to grow; anemia

CF: Pulmonary Manifestations

-Initial signs: wheezy, dry, non-productive cough


-Eventually: increased dyspnea, paroxysmal cough


-Progressively: barrel-shaped chest, cyanosis, clubbing, repeated episodes of bronchitis & bronchopneumonia

CF: Diagnosis

-Meconium ileus


-FTT


-Recurrent respiratory infections


-Pilocarpine iontophoresis (sweat test)

CF: Treatment

-Exercise


-Chest PT


-Flutter mucus clearance device


-Antibiotics


-Immunizations


-Tune ups


-Complication treatment


-Lung transplant

CF: GI & Nutritional therapy

-Zantac / acid suppression med


-Isotonic fluid lavage: distal intestinal obstruction


-Hyperosmolar enemas: infants c meconium ileus


-120 - 150% caloric RDA


-200% protein RDA, moderate fate


-Pancreatic enzyme supplements

CF: Medications

-Bronchodilators


-Aerosol DNAs


-Corticosteroids & NSAIDS


-Pancreatic enzymes


-Multivitamins & fat-soluble vitamins (A, D, E), iron


-Ursodeoxycholate: delay liver progression & portal HTN


-Lactulose: prevents distal intestinal obstruction


-Treat DM


-Annual flu vaccine

CF: Nursing care

-Respiratory & GI assessment


-Newborn: feeding & stooling patterns


-Treat infections aggressively: increased lung damage


-Nutritional support


-CPT: pulmonary hygiene 2-4x/d


-Assist with mechanical vest


-O2


-Exercise + rest

Sudden Infant Death Syndrome (SIDS)

-Sudden unexplained death of healthy baby


-Leading COD for >1wk to <1y


-Postmortum exam diagnosis


-Intrathoracic petechiae, pulmonary edema

SIDS: Risk Factors

-Prematurity, seizure disorders, family history of SIDS, apnea


-Lower socioeconomic class


-Males


-Non-caucasians

SIDS: Prevention

-Apnea assessment in newborns


-Apnea monitoring with home teaching


-BLS for caregivers


-"Back to Sleep"

SIDS: Treatment

-Offer momentos: bereavement boxes


-Contact ME


-Family support


-Allow family to remain during CPR efforts


-Give info for support groups