1
Q
Difference between Children and Adult airway
A
children: funnel, smaller and less developed
adult: cylinder
2
Q
General Physiological Differences Children and Adults
A
- smaller and shorter airway
- larger tongue
- nose breathers
- belly/diaphragm breathers
- increased rate and effort
- retractions
- vagal nerve
- eustation tube
3
Q
Accessory Muscle Use in Children
A
-use of accessory muscles may present as head bobbing in young children
4
Q
Retractions
A
- infants and young children have immature chest muscles and cartilagious ribs making the chest wall very flexible
- negative pressure created by the downward movement of the diaphragm is increased in cases of respiratory distress, and the chest wall is pulled inward causing retractions
- intercostal retractions are seen in mild respiratory distress
5
Q
As respiratory distress severity increases…
A
substernal and subcostal retractions are seen
6
Q
in cases of severe distress…
A
supraclavicular and suprasternal retractions occur as the accessory muscles are used
7
Q
Normal bpm for infant
A
less than a yr
30-60
8
Q
Normal bpm for toddler
A
1-3 yrs
24-40
9
Q
Normal bpm for preschooler
A
4-5 yrs
22-34
10
Q
Normal bpm for school age
A
6-12 yrs
18-30
11
Q
Normal bpm for adolescent
A
13-18 yrs
12-16
12
Q
Oxygenation Assessment Guidelines
A
- position of comfort (tripod, sitting up, refuse to lay down)
- vital signs
- respiratory effort (apnea, decreased RR, retractions)
- lung auscultation (crackles, wheezing)
- color (late sign)
- cough (cough up and swallow is bad)
- behavior change
13
Q
Respiratory Distress
A
- any respiratory condition can progress to respiratory distress
- if not managed can lead to respiratory failure
- hypoxemia that persists when supplemental oxygen is given is a sign of respiratory failure
14
Q
General Care Standards
A
- Oxygen/O2 sats (greater or equal to 93 percent is ok)
- CPT/PD and suction (only with mucus, can cause irritation which means more secretions)
- IS (if 5 or over)
- saline nose drops (loosens secretions)
- antibiotics (only for bacterial infections)
- isolation
- rest (but let them play, means feeling better)
- reduce fever (no ibuprofen under 6 mths)
- hydration
- nutrition
- cough medications
-positioning (HOB elevated)
15
Q
Categorization of Respiratory Tract Infections
A
- Upper Respiratory Tract
- Croup Syndromes
- Lower Respiratory Tract
16
Q
tonsilitis
A
- mostly viral infection
- group A beta hemolytic strep (strep throat)
- change toothbrush
- AB 24-48 hrs
**tonsillectomy: bleeding precaution, look for frequent swallowing
- inspect back of throat
- no red drinks or foods
- avoid coughing
17
Q
Otitis Media
A
- immobile
- red or yellow bulding TM
- symptoms: otalgia, fever, otorrhea, crying, fussy, tendency to pull or rub ear, rolls head from side to side
- Eustachian tube is flat and can’t drain fluid
- tx with AB
18
Q
Therapeutic management of otitis media
A
- high dose amoxicillin
- myringotomy: Tympanoplasty/PE tubes
- pressure equalizing tubes used to put eat drops in ear
19
Q
Croup Syndromes
A
general term for a group of symptoms characterized by:
- “barking/brassy” or “seal-like” cough
- inspiratory stridor, at rest equals bad, with activity equals ok if better at rest
- respiratory distress
- swelling/obstruction in the region of the larynx
20
Q
Croup Syndromes includes…
A
- laryngotracheobronchitis: subglottic
- epiglottitis: supraglottic
21
Q
Laryngotracheobronchitis
A
-obstruction (SUBglottic) BELOW VOCAL CORDS
-slower onset, URI symptoms lead to cough and hoarseness
(viral)
- medical management (steeple sign)
- airway narrows at top
-nursing management: teaching
- supportive mainly
- hydration
- IVF
- O2
-Epinephrine…vasoconstriction will reduce edema and decrease inflammation
22
Q
Epiglottitis
A
- obstruction (SUPRAglottic)
- cherry red edematous epiglottis
- usually caused by Haemophilus influenzae (H.Flu) (bacteria)
- HIB vaccine
23
Q
Clinical Manifestations of Epiglottitis
A
- dyspnea
- dysphonia
- stridor aggravated when supine
- drooling
- high fever
- toxic appearance
- froglike croaking sound
- agitated/apprehensive
- tripod sitting
-safety alert: can develop quickly (6 hrs) have intubation ready
24
Q
At risk for epiglottitis
A
- 2 to 8 year olds
- teaching: vaccination (HIB vaccine)
- tx: AB 12-24 hr for improvement
- O2 if needed, limit activity, hydration
25
Respiratory Syncytial Virus/ Bronchiolitis
-inflammation and obstruction of bronchioles
26
Who is at highest risk for Respiratory Syncytial Virus/ Bronchiolitis
- under 2 years
- chronic lung disease
- congenital heart disease
- preterm, less than 35 wks
27
Clinical Manifestations of Respiratory Syncytial Virus/ Bronchiolitis
- rhinorrhea
- increased cough and wheezing
- tachypnea
- unstable O2 sats
- full of snot, rhonchi and wheezing
*Begins as URI
28
Diagnosis of Respiratory Syncytial Virus/ Bronchiolitis
- Rhinorrhea
- increasing respiratory distress
- chest x-ray
* ****positive RSV swab of nasopharyngeal seretions
-can cause pneumonia
29
Treatment of Respiratory Syncytial Virus/ Bronchiolitis
-ribavirin aerosol (controversial)
- RSV immunoglobulin (Synagis) *prevention not treatment
* can't use AB
* only for high risk (PT, lung dz, less than 2)
-given every 28-30days
30
Pulmonary Dysfunctions not caused by infectious agents
- foreign body aspiration
- asthma
- cystic fibrosis
31
Foreign Body Aspiration
- symptoms: choking, cyanotic, can't talk, cough
- heimlich and back blows (less than 1 yr)
- bronchoscopy
- teaching
- lay on side
- monitor for breathing
- wait for swallow and gag reflex to come back
32
Asthma
- reactive airway disease: for kids less than 3 happens only when sick
- pathophysiology: chronic inflammatory disorder of airways
- classification for children 5 years and older
33
Primary Prevention: Whos ar risk?
- infants
- usually starts between 3-8 years
- atopy (allergies)
- ALLERGY TRIAD: asthma, eczema, rhinitis
- complex disorder
- genetic predisposition
34
Cystic Fibrosis
- autosomal recessive trait
- exocrine gland dysfunction that produces multisystem involvement
- mutated gene on chromosome 7
- greatest effect in lung
35
Pathophysiology of CF
- CFTR: cystic fibrosis transmembrane regulator
| - abnormal chloride movement leads to increased viscosity of mucous gland secretion
36
Diagnosis of CF
- history
- quantitative sweat chloride test
- chest xray
- stool fat and/or enzyme analysis
- salty sweat
37
Goals of CF
- prevent/minimize pulmonary complications
- adequate nutrition for growth
- assist in adapting to chronic illness
38
Signs of distress
- increased RR
- retractions
- head bobbing
39
Clinical Manifestations of Mild distress and initial signs of failure (compensating)
- increased HR
| - increased RR
40
Clinical Manifestations of moderate distress/early decompensation
- retractions
- nasal flaring
- anxiety
- irritability
- head bobbing
- grunting
41
Clinical Manifestations of severe distress/imminent failure or arrest
- cyanosis
- bradycardia
- apnea
42
Nursing care of RSV/Bronchiolitis
1. nutrition, hydration, small and frequent feeds
2. handwashing to prevent spread
3. duration of illness lasts 3-4 days peak 3-4 days
43
Goal of asthma treatment
- open airway
- symptoms helped with meds
- decrease of attacks
- chronic remodeling and changes in airways
44
Short term asthma meds
- bronchodilator (albuterol)
- ipotropium bromide
- corticosteroids
- IV Mag (bronchodilator)
45
Long term asthma meds
- advair (combo med)
- long acting bronchodilators
- allergy med (singulair)
- NSAID
- cromolyn sodium
46
Secondary Prevention of Asthma
- MDI: younger kids
- aerochamber/spacer: take 6 breaths in and out
- nebulizer: easiest to use for child
47
Peak flow meters
shows how well they are
- establish personal best
- blow into
- shows if they are getting worse
48
Oxygenation assessment for CF: Bronchi
- chronic pneumonia
- generalized obstructive emphysema
- clubbing
- infections
**isolation
49
Collaborative care for CF
- prevent colonization of pathogens and move secretions
- aerosol: bronchodilators
- daily CPT/PD
- flutter valve (PEP therapy, vibrating vests
- AB
- resp tx is given before food because they get nauseated from tx
50
Elimination assessment for CF
- meconium illeus
| - bowel obstruction
51
Nutrition assessment for CF
- pancreatic ducts: malabsorption and fibrosis, eventual CFRD
- bile ducts: decreased bile, decreased ADEK, portal HTN
52
CF Tx
- ursodiol/actigall
- supplemental tube feedings
- ADEK vitamins
- increase calories and protein
- insulin?
* *Pancreatic enzymes
53
-ursodiol/actigal
improves bile flow and prevents gallstones
54
pancreatic enzymes
- take with meals/snacks
- can open capsule and sprinkle on food
- enzyme can burn, irrtate teeth and mouth
- take as directed
55
Alternative to IS
- blowing bubble
- pin wheel
- blowing out birthday candles
Peds Exam 1
flashcards
Decks in class (6)
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