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pediatric pulmonary
wong's pulmonary peds
| Question | Answer |
|---|---|
| Name the differences in the pulmonary system of children, as opposed to an adults. | abdominal breathing, nose breathing for first three weeks, smaller airwary size, less muscles in airways, larynx higher in vertebrae, cartilage trachea and bronchi not well developed, cough not well developed until 6 y/o, and immature immune systems |
| What are the clinical manifestations of pediatric respiratory distress? | nasal flaring, sternal retractions, tripoding, use of accessory muscles, tachypnea, cyanotic |
| What are the cardinal signs of respiratory FAILURE? | restlessness-->listlessness, tachypnea, tachycardia, diaphoresis, decreased stridor or wheezing, retractions without improvement |
| Describe pathophysiology of Bronchopulmonary Dysplasia (BPD). | respiratory failure > tx (O2 or positive pressure ventilation) > damage samll airways > interstitial fibrosis & edema > abnormal ventilation distribution > atelectasis & emphysema > BPD |
| What is the goal of medical management of BPD? And what types of medical management are used? | The goal is to maintain adequate ABG with administration of O2 and to avoid progression of the disease. Medical treatments used are corticosteroid therapy, oral diuretics, bronchodilators, prevention, supplemental nutrition, and prophylactic Palivizumab |
| Name the nursing interventions for BPD. | Early detection. Providing rest periods. Suctioning. Weaning from respiratory support. Feeding evaluation and techniques. |
| Further describe nursing interventions r/t feeding for BPD. | Increase caloric intake by 120-150 kcal/kg/day. Increase FiO2. Promote nonnutritional sucking. Decrease environmental stimuli. Swaddle. Frequent feedings, but limit length of feeding. Elevate HOB. Supplemental NG or GT feeding. |
| Describe sx of bacterial tonsilitis. | Come to health center. Swollen uvula, whitish spots, red swollen tonsils, throat redness, gray furry tongue. |
| Describe sx of nonbacterial/viral tonsilitis. | Monitor at home, gargle with salt water. Red swollen tonsils, throat redness. |
| Name four Croup Syndromes. | Acute epiglottitis. Acute Laryngotracheobronchitis (LTB). Acute Spasmodic Laryngitis. Acute Tracheitis. |
| Describe the three cardinal signs of acute epiglottitis, and other important sx. | 1. No spontaneous cough. 2. Drooling 3. Agigationcherry-red edematous epiglottis |
| What vaccine is key to preventing acute epiglottitis? | H. influenzae type B |
| Describe the medical management used to treat epiglottitis. | Endotracheal intubation or tracheostomy (extubated after 24 hrs of antibiotics and corticosteroids). Antibiotics (cefurozime). corticosteroids. Prophylactic Rifampin for > 4 y/o contacts. Chest x-ray "thumb sign". |
| What nursing interventions do you use for epiglottities? | Do not exam the throat or do a throat culture. Prepare for intubation. No x-ray or IV before intubation. Elevate the HOB. Keep children and parents calm, avoid crying. |
| T/F: Acute Laryngotrachobronchitis (LTB) is an inflammation mucosa lining larynx and trachea causing narrowing area | True |
| LTB occurs with what types of virus? | Parainfluenza virus type 1, also RSV and adenovirus |
| At what ages are children at the most risk for aquiring LTB? | 3 mos- 8 years |
| Sally returns to ER following an URI. She has a harsh, barky cough, hoarse voice and mild inspiratory stridor. Her mom reports that her fever has not been too high. What do you think Sally has? | LTB |
| How would you treat Sally's LTB if it were a mild form? | Corticosterioids (2mg/kg x 1 to 4 doses PO daily) or Dexamethasone (0.6mg/kg IM x 1) cool air vaporizer increase fluids no antihistamines or cough medicines |
| If Sally presented with a severe case of LTB, how would you treat it? | Dx-narrowing subglottic "steeple sign". Tx - nebulized racemic epinephrine corticosteroids |
| Paroxysmal attacks of laryngeal obstruction that occur chiefly at night refer to... | Acute Spasmodic Laryngitis |
| June's mother called the doctor reporting that June suddenly developed a "barky cough", became restless and sounded noisy when she breathed in. She stated that June went to bed feeling well, and has no fever. She also said June felt better in the AM. | June is exhibiting signs of ASL. |
| _____ _______ is an infection of the mucosa of the upper airway. | Bacterial Tracheitis |
| Bill was seen with the doctor and exhibiting sx of a URI, with a croupy cough, stridor, prurulent secretions and a high fever. You suspect, that he has what? | Acute Tracheitis |
| As the nurse, you know that the doctor will probably manage Bill's sx of acute tracheitis by... | humidified oxygen, frequently endotracheal intubation, antipyretics, antibiotics |
| As the nurse what are some things you need to consider when treating bacterial tracheitis? | continuous respiratory assessment frequent suctioning frequent assessment of temp |
| T/F Those who develop bronchiolitis will most likely develop asthma | True. >50% develop asthma |
| Sherri is 6 mos old and comes to the hospital with sx of sneezing, clear nasal drainage, difficulty feeding, wheezing, rales, and retractions. She has had a URI for several days. Her RR is 42. What do you think Sherri has, and what should you do? | Bronchiolitis. If RR is less than 60, they should be hospitalized or if they are less than 6 wks old. |
| How will the doctor medically manage Sherri's Bronchiolitis? | Contact isolation. Mist therapy, if on oxygen. Palivizumab (Synagis) for prophylactic tx in high risk infants. Ribavirin, but this is controversial. |
| The nursing interventions you provide for Sherri's bronchiolitis includes isolation precautions, HOB elevated, frequent VS and respiratory status, and what else? | symptomatic care small frequent feedings, no PO if resp >60/min IV |
| How is bronchiolitis transmitted? | Direct contact with secretions |
| _______ (_____ _____) is an acute respiratory infection caused by Bordetella pertussis, occurs in children <4 y/o without immunization in July-October. | Pertussis (whooping cough) |
| How is pertussis (whooping cough spread)? | direct contact or droplet spread |
| Pertussis is a lengthy disease with 3 stages. What are those stages? | 1. catarrhal stage 1-2 wks 2. paroxysmal stage 4-6 wks 3. convalescent stage (several weeks) |
| Describe the first stage of pertussis. | Catarrhal stage - begins with URI, sneezing, coughing, low grade fever, progresses to 1-2 wks with dry hacking cough |
| Describe the second stage of pertussis. | Paroxysmal stage - cough at night, machine gun burst cough, followed by sudden inspiratory high pitched whoop, during paroxysmals, cheeks are flushed or cyantoic, eyes bulge, tongue protrudes, thick mucous plug dislodges, 4-6 wks |
| Describe the third stage of pertussis. | cough may be louder at times, gradually decreases in frequency for several weeks. |
| What medical management is provided for pertussis? | analgesic for pain antipyretics for fever erythromycin bedrest some hospitalized, if dehydrated or resp complications |
| Paul comes to the doctor with reports of an itchy nose, sneezing, watery discharge, and stuffy nose. What does he most likely have? | allergic rhinitis |
| T/F: airway obstruction and inflammation in response a variety of factors including: spasm of airway smooth muscle; edema of airway mucosa; increased mucus secretion; cellular infiltration of airway walls; injury and desquamination of airway epithelium i | True this is asthma |
| t/f Changes in temp, strong emotions, cockroaches and dust mites all can trigger asthma | true |
| Pulmonary function tests are used to evaluate what 3 aspects of lung function? | 1. lung vol 2. airway function 3. gas exchange |
| t/f With the spirometer you take a full breath in and blow out as hard and completely as possible. 2 highest readings are recorded | true |
| _ _ _ _ is a test used to see a change in a pulmonary condtion, not to diagnose. | peak expiratory flow rate (PEFR) |
| ___ ____ is an asthma classification where sx are brief, < or = 2/wk and nighttime sx < or = 2/mo | mild intermittent |
| ___ ____ is an asthma classification where sx are >2/wk, <1/day and nighttime sx >2/mos | mild persistent |
| _____ ______ is an asthma classification where daily sx occur with episodes of >2/wk and nighttime sx >1/wk, daily use of bronchiodilators and PEF is >60% & <80% at best. | moderate persistant |
| Robbie comes in from playing outside and tells his mom his "tummy hurts", he is wheezing, coughing and seems restless. Robbie is probably experiencing what? | asthma |
| ___ ___ is an abnormal chloride movement in cells causing increase in viscosicity mucous gland secretions. | cystic fibrosis |
| In cystic fibrosis, exocrine gland dysfunction can occur in the bronchi, small intestine, pancreatic ducts or bile ducts. T/F | true |
| Sam is seen by the doctor with respiratory sx of wheezing, non productive cough, irregular aeration, secondary infection, dyspnea, cyanosis, clubbing and barrel chest. What is Sam presenting sx of? | cystic fibrosis (bronchi) |
| Sam has a large frothy loose stool with a foul odor, this is a GI clinical manifestation of what? | cystic fibrosis |
| What test do they use to diagnose CF? | sweat chloride test (gold standard): need 2 positive restuls of 60 meq/l of chloride for dx |
| What is the primary treatment goal of CF? | effective airway clearance |
Created by:
newsom.kate
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