Chapter 40

Question 1

factors that increase the risk for respiratory illness

Answer 1

1. anatomy and genetics
2. age
3. prematurity
4. prolonged oxygen use at birth
5. environment

Question 2

1. are infants nose or mouth breathers?

2. other characteristics of newborn nose?

Answer 2

1. nose breather
2. -produce little mucus
   
   • small nasal passages
   • sinuses are not developed

Question 3

describe the tongue and tonsils of infant and children

Answer 3

1. tongue is large

2. tonsils and adenoids are enlarged

Question 4

difference in location of trachea in children compared to adults

Answer 4

trachea is located third thoracic vertebra in children and sixth in adults

Question 5

1. infants under three months use which type of antibodies?
2. toddler and preschool are at a high rate of which type of infection?
3. older than 5 years, what infection is at higher risk?
4. as age increases, what else increases in a child?

Answer 5

1. maternal antibodies
2. high rate of viral infections
3. pneumonia and beta strep infections
4. immunity increases due to maturity of immune system and increased exposure

Question 6

1. mycoplasmal infections are more common during?
2. asthmatic bronchitis are more frequent during?
3. RSV season is?

Answer 6

1. Fall and winter
2. cold season
3. Winter and spring

Question 7

when assessing the respiratory system, what do you assess for?

Answer 7

1. colour
2. breath sound, rate, depth (other noises like cough)
3. nose and oral cavity
4. anxiety and restlessness
5. clubbing
6. hydration

Question 8

Chronic disorders:

Answer 8

1. allergic rhinitis
2. asthma
3. Chronic lung disease
4. Cystic fibrosis
5. apnea

Question 9

Acute infectious disorders:

Answer 9

1. Cold, sinusitis
2. influenza
3. pharyngitis, tonsilitis, and laryngitis
4. croup
5. Respiratory syncytial Virus
6. Pneumonia and bronchitis
7. TB

Question 10

Laboratory and diagnostic tests for respiratory

Answer 10

1. Pulse oximetry
2. X ray
3. sputum culture
4. CBC
5. inflammatory markers
6. ASO titer
7. PFT (pulmonary function test)
8. blood gasses
9. sweat chloride test

Question 11

common medical treatments for respiratory disorders.

Answer 11

1. Oxygen therapy, humidification
2. suction
3. chest physiotherapy
4. saline gargles and lavage
5. chest tubes
6. bronchoscopy
7. Nebulizer, Inhalers

Question 12

nursing interventions for respiratory illnesses:

Answer 12

1. ease respiratory effort
2. fever management
3. promote rest and comfort
4. infection control
5. promote hydration and nutrition

Question 13

1. nasopharygitis aka

Answer 13

1. common cold

Question 14

1. Inflammation of the throat mucosa (pharynx) is referred to as?
2. Manifestations:
3. this is a risk for what?

Answer 14

1. Pharyngitis
2. -fever, sore throat and difficulty swallowing, headache, and abdominal pain.
   
   • inflammation with exudate
   • strawberry tongue and sandpapaer rash on skin on trunk or abdomen.
3. -Acute rheumatic fever
   
   • Acute glomerulonephritis

Question 15

1. Inflammation of the tonsils
2. often occurs with?
3. why would surgical removal of tonsils be warranted?

Answer 15

1. tonsillitis
2. pharyngitis
3. recurrent tonsillitis

Question 16

1. clinical manifestation of tonsillitis
2. therapeutic techniques for tonsillitis
3. in the event of a surgery, how to promote airway clearance?

Answer 16

1. hoarse voice sound, inflammation of pharynx and/or tonsils, difficulty breathing and swallowing, mouth breathing and snowing.
2. -promote comfort by saline gargles, analgesics, lozenges or hard candy, humidifier, cool liquids, ice chips or popsicles.
3. Until fully awake, place the child in a side-lying or prone position to facilitate safe drainage of secretions

Question 17

1. a self-limited illness caused by the Epstein–Barr virus.
2. signs and symptoms of this disease?
3. diagnosed through?

Answer 17

1. Mono, commonly called kissing disease
2. fever, malaise, sore throat, and lymphadenopathy, splenomegaly and hepatomegaly can occur
3. Definitive diagnosis may be made by Monospot or Epstein–Barr virus titers.

Question 18

1. therapeutic management of MONO

Answer 18

1. Symptomatic: analgesics and salt-water gargles are recommended, bed rest and res periods, corticosteroids may be given to decrease inflammation, avoid strenuous activity and contact sports. report signs of jaundice

Question 19

1. clinical manifestations of influenza
2. therapeutic management
3. prvention?

Answer 19

1. fever, cough, irritability, pharyngitis, other respiratory symptoms
2. symptomatic treatment of fever, cough, and comfort measures.
3. vaccination

Question 20

1. infection of the external ear
2. aka
3. therapeutic techniques

Answer 20

1. Otitis externa
2. swimmer’s ear
3. relief of pain

Question 21

1. clinical manifestation of epiglottitis
2. therapeutic technique
3. prevention?

Answer 21

1. -Sore throat, pain, tripod positioning,
   retractions
   -Inspiratory stridor, mild hypoxia,
   distress
2. 100% oxygen, emergency equipment available, if airway becomes completely occluded tracheostomy can be done.
3. Hib vaccine

Question 22

1. things not to do in epiglottitis

Answer 22

1. -do not attempt to visualize the throat
   
   • do not leave child unattended
   • no supine

Question 23

nursing management of asthma

Answer 23

1. increase medications as child’s condition worsens and reducing when it improves.

Question 24

nursing management for tonsillectomy

Answer 24

1. promote airway clearance (sidelying and prone position)
2. maintain hydration (avoid citrus)
3. avoid coughing
4. realieving pain (ice collar, analgesics)

Question 25

1. most common of the croup syndrome? 2. this generally affects who? 3. what causes this?

Answer 25

1. acute laryngotracheobronchitis 2. younger than 5 3. RSV, Paraninfluenza, mycoplasma pneumoniae, influenza

Question 26

1. Manifestations of Laryngeotracheobronchitis | 2. therapeutic technique

Answer 26

1. air-hungry, exhibiting various degrees of cyanosis and respiratory distress, including tachypnea, retractions, accessory muscle use, grunting, and periods of apnea. Cough and audible wheeze. uninterested in feeding and surroundings. 2. focuses on supportive treatment. Supplemental oxygen, nasal and/or nasopharyngeal suctioning, oral or intravenous hydration, and inhaled bronchodilator therapy

Question 27

1. croup is characterized by? 2. aka 3. therapeutic managemnet.

Answer 27

``` 1. hoarseness, “barking” cough, inspiratory stridor and varying degrees of respiratory distress 2. laryngotracheobronchitis 3. humidified air, dexamethasone ```

Question 28

1. laryngitis is characterized by 2. it is more common in 3. therapeutic technique

Answer 28

1. hoarse voice or loss of the voice, self limiting. Goes away on its own 2. older children and adolescents 3. oral fluids and resting voice.

Question 29

1. infection of mucosa of upper trachea 2. signs and symptoms? 3. can be a complication of? 4. what does thick purulent secretions suggest

Answer 29

1. Bacterial Tracheitis 2. features of croup, epiglottitis, and LTB 3. LTB 4. respiratory distress.

Question 30

1. lower airway includes: | 2. when does cartilaginous support develop?

Answer 30

1. bronchi and bronchioles | 2. adolescence

Question 31

1. Bronchitis clinical manifestations: 2. Pathophysiology 3. how is it diagnosed

Answer 31

1. - begin with URI. - fever, dry hacking cough that may wake the child at night and may become productive in older children. - coarse rales lung sounds - alveolar hyperinflation. 2. Bronchitis is an inflammation of the trachea and major bronchi. It is often associated with a URI. Caused by M. Pneumonia. 3.

Question 32

1. therapeutic technique for bronchitis.

Answer 32

1. supportive care: administer expectorant and adequate hydration. antibiotics can be given if bacterial. discourage cough suppressants.

Question 33

1. acute inflammatory process of the bronchioles and small bronchi 2. what causes this? 3. Manifestations:

Answer 33

1. Bronchiolitis. 2. RSV 3. -appear air hungry, cyanosis and respiratory distress (tachypnea, retractions and use of accessory muscles, grunting, and periods of apnea), cough and audible wheezes. - uninterested in eating or surroundings.

Question 34

Therapeutic technique for Brochiolitis and RSV:

Answer 34

- supportive care. (antipyretics, hydration, close observation - home care can be done, notify provider if condition worsen. - hospitalization is required for more severe conditions. - maintain patent airway (position, suction) - oxygen

Question 35

Preventing RSV

Answer 35

- hand washing - Palivizumab (Synagis) for those who are most susceptible (prematurity, Chronic lung disease, congenital heart disease, and neuromuscular disease).

Question 36

Most common cause of pneumonia in younger children and least common cause in older children 2. a child who presents with recurrent pneumonia should be evaluated for? 3. complicaitons 4. Manifestations

Answer 36

1. respiratory pneumonia. 2. Chronic lung disease like asthma or cystic fibrosis 3. pneumothorax 4. respiratory distress symptoms, wheezes and rales with deminished breath sounds

Question 37

1. manifestations of pneumonia 2. treatment of pneumonia 3. what is pneumonia

Answer 37

1. Fever, chills, flushing, malaise, cough and coryza, photophobia. 2. supportive care. symptomatic treaments 3. Pneumonia is an inflammation of the lung parenchyma. It can be caused by a virus, bacteria, Mycoplasma, or a fungus.

Question 38

1. Pertusis is aka | 2. caused by and highest incidence in?

Answer 38

1. whooping cough | 2. bordetella pertusis, spring in non immunized children.

Question 39

1. TB is caused by 2. clinical manifestations 3. treatment and prevention 4. diagnosed through 5. prevention of infection

Answer 39

1. Mycobacterium Tuberculosis 2. - can be asymptomatic - fever, malaise, - weight loss, anorexia - chest tightness and some times hemoptysis - cough may or may not be present. - asymmetric lung expansion, dullness and crackles 3. provide supportive care (managing nutrition, comfort, and fever) and adherence to treatment 4. mantoux test, interferon (IGRA) or X-ray. 5. Tuberculosis infection is prevented by avoiding contact with the tubercle bacillus

Question 40

Acute respiratory distress syndrome 1. Pathophysiology 2. treatment 3. nursing actions

Answer 40

1. a condition that occurs after an insult such as sepsis, viral pneumonia, smoke inhalation, or near drowning. Pulmonary edema occurs, ultimately gas diffusion is impaired. 2. aimed at improving oxygenation and ventilation (PEEP) 3. -supportive care with close monitoring of respiratory and cardiovascular. - manage pain, anxiety, nutrition, and prevention of infection.

Question 41

Allergic rhinitis 1. Pathophisiology 2. Manifestations 3. diagnosis and treatment 4. nursing teachings

Answer 41

1. an immune response to allergen 2. rhinorrhea, nasal congestion, sneezing, itchy nose, moth breathing and snoring. allergic salute) 3. -nasal smear - maintain patent airway with nasal washes - anti-inflammatory corticosteroids, antihistamine, 4. teach to avoid known allergens

Question 42

Asthma 1. Patho 2. therapeutic management 3. Manifestations

Answer 42

1. airway hyperresponsiveness with edema and mucus. 2. avoid triggers and medications (bronchodilators) 3. Cough, particularly at night: hacking cough that is initially nonproductive, becoming productive of frothy sputum Difficulty breathing: shortness of breath, chest tightness or pain, dyspnea with exercise Wheezing

Question 43

Describe the classification of asthma

Answer 43

1. Intermittent - 1 - 2 times a week with nighttime symptoms 1 - 2 times a month 2. Mild persistent -more than twice a week but less than once a day. nighttime symptoms 3 or 4 times a month 3. Moderate persistent - daily symptoms, nighttime symptoms greater than 1 times a week but not nightly. 4. severe persistent - throughout the day with nighttime symptoms almost daily.

Question 44

what are the goals of asthma management?

Answer 44

1.Avoid exacerbation 2.Avoid allergens 3.Relieve asthmatic episodes promptly 4.Relieve bronchospasm 5.Monitor function with peak flowmeter 6.Self-management of inhalers, devices, and activity regulation

Question 45

Emergency treatment for status asthmaticus

Answer 45

1. Epinephrine

Question 46

Talk about cystic fibrosis

Answer 46

1 Exocrine gland dysfunction that produces multisystem involvement 2. most common lethal genetic disease among white children.

Question 47

1. How is CF diagnosed? | 2. management goals

Answer 47

``` 1. • Quantitative sweat chloride test • Chest x-ray • PFT • Stool fat and/or enzyme analysis • Barium enema ``` 2.Prevent/minimize pulmonary complications • Adequate nutrition for growth • Assist in adapting to chronic illness

Question 48

how is CF managed? 1. respiratory 2. GI

Answer 48

``` 1. CPT Bronchodilators forced expiration aggressive treatment of pulmonary infection Antibiotics ``` ``` 2. • Replacement of pancreatic enzymes • High-protein, high-calorie diet as much as 150% RDA • Repair/Prevent Intestinal obstruction • Reduction of rectal prolapse • Salt supplementation ```