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pediatric resp. cond
uri, Lri, factors, evidence of infection, nursing dx,
| Question | Answer |
|---|---|
| Upper respiratory tract anatomy | Oronasopharynx. Pharynx. Larynx. Upper part of trachea. |
| Lower respiratory tract anatomy | Lower trachea. Mainstem bronchi. Segmental bronchi. Subsegmental bronchioles. Terminal bronchioles. Alveoli. |
| Anatomic differences | Smaller diameter of airways. Distance between structures is shorter. Short open eustachian tubes increase susceptibility |
| Ability to resist infections depends on | Immune system deficiencies. Malnutrition, anemia or fatigue. Allergies, asthma, cardiac anomalies, cystic fibrosis. Day care attendance |
| When do infections occur? | Most occur during the winter and springInfants less than 3 months have a lower infection rate |
| Common nursing diagnoses | Ineffective breathing pattern. Fear/anxiety. Ineffective airway clearance. Risk for infection. Activity intolerance. Pan. Altered family processes |
| How does a nurse promote rest for a pt suffering a resp infection | cluster care |
| Respiratory Infections Nursing Considerations | Ease respiratory efforts. Promote rest. Promote comfort. Careful handwashing. Decrease fever if necessary. Prevent dehydration. Nutrition. Support and encourage child and family |
| The lower respiratory tract includes? | The lower trachea, main stem bronchi, segmental bronchi, subsegmental bronchioles, terminal bronchioles and the alveoli. |
| Nasopharyngitis | The most common infection of the respiratory tract. Caused by a virus, usually a rhinovirus. Spread via sneezing, coughing and direct contact |
| What does persistent nasopharyngitis in older children indicate? | Persistent nasopharyngitis in an older child or adolescent may indicate inhaled cocaine or other drug abuse. |
| Nasopharyngitis Manifestations | <3yrs 104 temp, inflammation/edema ur membranes, Nasal discharge, irritability, sore throat, cough and general discomfort. May have vomiting and diarrhea. May develop into bronchitis, pneumonitis and ear infections. |
| Nasopharyngitis Treatment and Nursing Care | No cure. Antibiotics ineffective. Begin early with rest, keep airways clear, maintain adequate fluid intake, Tylenol or Motrin, and moist humidified air. |
| Nursing Care | Provide care in hospital. Teach parents care for at home. Teach children how to clear nose, cover mouth and nose when sneezing, wash hands and discard tissues. |
| Acute Pharyngitis Pathophysiology | Inflammation of the structures in the throat. Common in children from 5-15 years old. May progress to acute rheumatic fever (ARF), and/or acute glomerulonephritis. |
| what is acute pharyngitis caused by? what are sever effects? | 80-90% caused by virus, 10% from Group A beta-hemolytic streptococcus (strep throat). Hemophilus influenzae commonly causes condition in children less than 3 years old. Permanent damage can result from sequelae, especially ARF. |
| Acute Pharyngitis Manifestations | Fever, malaise, difficulty swallowing and anorexia. Viral: conjunctivitis, rhinitis, cough and hoarseness. |
| strep throat in children over 2 years of ageManifestations | High fever (104 F). Difficulty swallowing. May last longer than a week. |
| Acute Pharyngitis Treatment and Nursing Care, Antimicrobial | therapy orally for 10 days. Critical for nurse to emphasize the need to finish all of the medication. May also recommend salt water gargles if the child is old enough. |
| Acute Pharyngitis Treatment and Nursing Care Prompt treatment | to prevent complications: Rheumatic fever. Glomerulonephritis. Peritonsillar abscess. Otitis media. Mastoiditis. Meningitis. Osteomyelitis. Pneumonia. |
| Acute Pharyngitis Treatment and Nursing Care group A beta-hemolytic strep | A persistent infection may indicate that child is a carrier for group A beta-hemolytic strep, incomplete medications or medication resistant strain has evolved. |
| When is a child suffering from acute pharyngitis no longer contagious? | Once antibiotics are started and the fever has decreased the child is no longer contagious. |
| which therapy is painful for children? | Intramuscular benzathine penicillin G is an appropriate therapy, is very painful and not the first choice for children. |
| What is another name for nasopharyngitis? | The common cold. |
| Why aren't antibiotics given for nasopharyngitis? | Antibiotics are for bacteria and the common cold is caused by a virus. |
| Tonsillitis and/or Adenoiditis Manifestations | Difficulty swallowing and breathing. Enlarged adenoids. Mouth breathing. Other symptoms similar to those of nasopharyngitis. |
| Tonsillitis/Adenoiditis Nursing Care | Cool mist vaporizer. Salt water gargles and throat lozenges. Cool liquid diet. Acetaminophen for comfort. |
| Tonsillitis and/or Adenoiditis Treatment indications for antibiotics | Antibiotics not prescribed unless there's a positive throat culture. |
| Tonsillitis and/or Adenoiditis Treatment indication for surgical removal | Removal of tonsils and adenoids not recommended for children under 3 unless there is persistent airway obstruction or difficulty in breathing. |
| Preoperative nursing care for surgical removal of tonsils includes: | Report loose teeth to the anesthesiologist. Apply identification bands. Initiate and document routine preoperative care. |
| Post-Surgical Care | Position, observe for bleeding, Ice collar. Small amounts clear liquids. Keep child quiet. Teach child to avoid coughing, clearing the throat and blowing the nose until healed. |
| Observe what signs for bleeding: | Increased pulse and respirations. Restlessness. Frequent swallowing. Vomiting of bright red blood. |
| Post-Surgical Care Discharge instructions: | Keep the child quiet for a few days and provide nourishing fluids and soft foods. Protect the child from exposure to infections.Observe for frequent swallowing. |
| What should the pt do for throat discomfort? | Avoid gargling and highly seasoned foods for the first week postoperatively.May give acetaminophen for throat discomfort. |
| What is the most common postoperative complication related to a tonsillectomy/adenoidectomy? | Hemorrhage |
| Croup Syndromes | Various conditions in which the primary symptom is a "barking" (croupy) cough and some degree of inspiratory stridor. |
| subglottic croup | Acute laryngotracheobronchitis is the most common |
| Epiglottitis | Epiglottitis is more common in older children. |
| Bacterial Tracheitis | May have inspiratory stridor unaffected by position. Fever. Thick, purulent tracheal secretions. |
| timing of Bacterial Tracheitis | Croupy cough mostly at night. Usually preceded by a URI.Children 1 month to 6 years of age. |
| Bacterial Tracheitis: Cause: | Staphylococcus aureus, group A beta-hemolytic streptococci and H. influenzae. |
| Bacterial Tracheitis Treatment | Humidified oxygen. Antipyretics. Antibiotics. May require intubation with frequent suctioning. Early detection is the key. |
| Acute Spasmodic Laryngitis timing | Occurs suddenly, usually at night, last a few hours.Children usually between 1 and 3 years old. |
| Spasmodic Croup Cause: | Virus, allergy or psychological. Gastroesophageal reflux often the cause. |
| Symptoms Acute Spasmodic Laryngitis | Barking, brassy cough. Respiratory distress. Child is anxious and parents may be frightened. Dyspnea is aggravated by excitement. Child appears well the next day |
| Acute Spasmodic Laryngitis (Spasmodic Croup) Treatment | Hospitalized. Cool mist. Racemic epinephrine. Corticosteroids. |
| otherwise in less severe cases: | Cool mist humidifier. Warm mist from steam. |
| Laryngotracheobronchitis Acute Croup | May progress into a respiratory emergency!Caused by a virus: Para-influenza. RSV. influenza A and B. Mycoplasma pneumoniae. |
| Laryngotracheobronchitis) Manifestations | Edema, destruction of respiratory cilia and exudate. Results in respiratory obstruction. Usually preceded by a mild upper respiratory infection. Characteristic barking or brassy cough, stridor and respiratory distress. |
| what may excacerbate the symptoms? what is the result of insult? | Infants prefer to be held upright. Crying and agitation make the symptoms worse.Hypoxia can develop along with tachycardia and decreased breath sounds. |
| (Laryngotracheobronchitis) Treatment and Nursing Care | Mist tent. Blow by. Intravenous fluids. Organize care to provide long rest periods. Monitor with cardiorespiratory monitor, frequent vital signs and pulse oximeter. Oxygen to reduce hypoxia. |
| Acute Croup (Laryngotracheobronchitis) Medications | Nebulized epinephrine. Oxygen therapy. Corticosteroids: no history of recent exposure to chickenpox. |
| Which form of croup can develop into a respiratory emergency | Acute croup (laryngotracheobronchitis). |
| Causative agent in 80% cases of bronchiolitis in infants and young children. | RSV |
| Most common cause of viral pneumonia | Respiratory Syncytial Virus |
| When are infections of RSV common? | Annual epidemics in the winter season. Most children infected before their 4th birthday and reinfection is common. |
| How is treatment different depending on age? | Infants and young toddlers between birth – 2 years may become seriously ill. Older children and adults continue to go to work or school. |
| RSV Diagnosis: | Diagnosis: Examination of nasopharyngeal washings for RSV antigen. Admission occurs after the diagnosis is confirmed. |
| RSV Treatment and Nursing Care | Treatment and Nursing Care: Infection control and isolation. Frequent handwashing. |
| Respiratory Syncytial Virus (RSV) Treatment and Nursing Care Con’t | Support. Symptomatic care. Priority nursing diagnosis: Ineffective breathing pattern. |
| RSV Report indicates what? | Tachypnea and tachycardia which may indicate hypoxemia. Wheezing, rales or rhonchi, or sudden "quiet chest" which puts child at risk for respiratory arrest. Signs and symptoms of respiratory distress. |
| RSV) Nursing Care Con’t | I/O's, Monitor oxygen saturation levels and adjust oxygen to keep level at 90-95%. Suction to maintain patent airway. |
| RSV I/O monitoring includes? | Give Pedialyte or Ricelyte as ordered for infants at risk of dehydration. Weigh daily. |
| Ribavirin (Virazole | Severely ill infants or infants with heart or lung problems. Fine-droplet aerosol mist for 18-24 hours a day for a minimum of 3 days. In infant on ventilator: check tubing which may be warped by medication. |
| contraindications | Keep all women who are of childbearing age, pregnant or breastfeeding away from medication related to teratogenic effects |
| S/E | May cause conjunctivitis if wearing contact lenses around medication. |
| ribarin considerations | Use caution when opening mist tent and changing linens to avoid releasing droplets of Ribavirin into the air. Complications include reactive airway disease later in life. |
| Virazole benefits | improves o2 sats, reduces viral shedding |
| How long can the RSV survive on countertops, tissues and soap bars? | More than 6 hours. |
| Pneumonia | Inflammation of the lungs in which the alveoli become filled with exudate. |
| Primary pneumonia | Primary: pneumonia is the initial disease. |
| Secondary: pneumonia | Secondary: pneumonia occurs as a complication of another illness. |
| classification of pneumonia | May be classified by causative organism (i.e. viral or bacterial) or by the part of the respiratory system involved (i.e. lobar or bronchial). |
| three main causes of pneumonia | RSV, Para-influenza/adenovirus, community acquired |
| what causes acquired pneumonia? | Streptococcus pneumoniae most common bacterial pathogen for community - acquired pneumonia. |
| What cause of pneumonia decreased because of imunnizations? | H. influenzae decreasing r/t immunizations. |
| what causes pneumonia commonly in older children? | Para-influenzia, and adenovirus in older children. |
| what is the most common cause of pneumonia in infants? | RSV is the most common cause of viral pneumonia in infants. |
| what are three less common causes of pneumonia? | Aspiration, lipioid pneumonia, hypostatic pneumonia |
| Hypostatic pneumonia | Hypostatic pneumonia may occur in patients who have poor circulation in the lungs. |
| Lipoid pneumonia | Lipoid pneumonia: an oil substance inhaled into the airways. |
| Aspiration pneumonia | Aspiration pneumonia due to inhaled substances. |
| Pneumonia Manifestations | Respiratory rate increases and breaths become shallow. Sternal retractions and nasal flaring. May be listless and have a poor appetite. May have chest pain. An elevated white blood cell count. |
| timing of pneumonia | May develop suddenly or gradually; may be preceded by an upper respiratory infection. May have a cough that is dry at first and then productive and a high fever (103-104 F). |
| Pneumonia Treatment | Antibiotics are ordered if a bacterial infection is suspected. Antipyretics. Oxygen is indicated for cyanosis and restlessness. |
| what confirms dx before treatmen? | Radiographic study confirms the diagnosis and is used to determine the exact location and presence of any complications. |
| Pneumonia Nursing Care | Check vital signs at regular intervals. Cluster care. Encourage fluid intake.control fever |
| how is fever controlled? | Antipyretics as ordered. Cool mist tent. Remove blankets and warm clothing. |
| Provide appropriate parent education | Emphasize the need to complete all medication as prescribed. Tobacco use should be avoided. Stress the need for Hib immunizations. The use and disposal of tissues, covering the mouth during a cough and modeling proper hand washing techniques. |
| How is pneumonia classified? | Causative organism, part of the respiratory system involved and other classifications (aspiration, lipoid, and hypostatic). |
| chronic inflammatory disorder of the airways. | Asthma |
| 4 Categories: | Mild intermittent asthma. Mild persistent asthma. Moderate persistent asthma. Severe persistent asthma. |
| Step I: mild intermittent asthma. | Symptoms occur less than two times a week. Peak expiratory flow (PEF) or forced expiratory volume (FEV) in 1 sec is greater than 80% of predicted value. |
| Step II: mild persistent asthma. | Symptoms occur greater than once a week, but less than once a day. PEF or FEV is greater than 80%. |
| Step III: moderate persistent asthma. | Symptoms occur daily. PEF or FEV is between 60% and 80%. |
| Step IV: severe persistent asthma. | Symptoms are continual. PEF or FEV is less than 60%. |
| Asthma Triggers | pollen, dust mites, pet dander, mold, smoke, smog, exercise, foods, stress |
| pathophysiology of asthma | Inflammation and edema. Accumulation of tenacious secretions. Spasms of smooth muscles and decreased caliber of bronchioles. |
| when is resp difficulty more pronounced in pts with Asthma? | Respiratory difficulty is more pronounced during expiration. |
| what are the effects of inspiration strengthening? | Inspiration is at higher lung volumes and hyperinflates the alveoli. |
| what is the snowball effect of asthma? | As severity increases, there is decreased ventilation with carbon dioxide retention, hypoxemia, respiratory acidosis and eventually respiratory failure. |
| What is a sign of ventilatory failure and imminent asphyxia associated with Asthma? | Absence of breath sounds with a sudden rise in respiratory rate |
| what are goals of asthma treatment? | Prevent disability. Minimize physical and psychologic morbidity. Assist the child in living a normal life. |
| Most important to pt/family teaching? | Symptoms and management. Allergens. Drug therapy: Long term. Quick-relief. |
| How and what are used with nebulizer or metered-dose indicator | Always use a spacer. Corticosteroids. Beta-agonists. |
| what is chest pt? | Helps strengthen respiratory muscles. Do not do when in acute episodes. (pulmonary therapy) |
| Status Asthmaticus treatment aimed at | Improving ventilation. Correcting dehydration and acidosis. Treating any infections. Beta2 agonists are used along with corticosteroids and subcutaneous epinephrine if needed. |
| Common nursing diagnoses | Risk for suffocation. Ineffective airway clearance. Activity intolerance. Interrupted family processes. Risk for fluid volume deficit. Risk for injury |
| Education includes: How to avoid allergens. How to relieve asthma episodes. Avoid: | Exposing child to excessive cold, wind or other weather extremes. Smoke. Sprays or other irritants. Foods that cause exacerbation. |
| Early signs of an impending attack: | Rhinorrhea. Cough. Low-grade fever. Irritability. Itching especially in the front of the neck and chest. Apathy. Anxiety. Sleep disturbance. Abdominal discomfort. Loss of appetite. |
| What are the signs of air hunger? | Nostril flaring, cyanosis, use of accessory muscles and orthopnea. |
| What is a good exercise for children to strength muscles of breathing? | Swimming. |
| Cystic Fibrosis | inherited as an autosomal recessive trait; the affected child inherits the defective gene from both parents, with an overall incidence of 1:4. |
| CF is characterized by: | Increased viscosity of mucous gland secretions. Elevation of electrolytes lost via sweat. |
| CF is also characterized by: | Increase in several organic and enzymatic constituents of saliva. Abnormalities in autonomic nervous system function. |
| Earliest manifestation | Earliest manifestation is meconium ileus in the newborn. |
| CF Manifestations | Pancreatic fibrosis. Steatorrhea and azotorrhea. Thick mucous causes atelectasis. Mucous serves as a medium for bacteria |
| Reduced exchange causes | Variable degrees of hypoxia. Hypercapnia. Acidosis. |
| CF Diagnosis | Sweat Analysis |
| Goals | Prevent or minimize pulmonary complications. Ensure adequate nutrition for growth. Encourage appropriate physical activity. Promote a reasonable quality of life. |
| CF Therapeutic Management | Antibiotics. Removing secretions. Perform Chest PT at least twice a day right after bronchodilators are given. Encourage aerobic exercise. |
| Observe for signs of a pneumothorax | Tachypnea. Tachycardia. Dyspnea. Pallor. Cyanosis. |
| Manage GI problems | Replacing pancreatic enzymes. Need a well-balance, high-protein, high-calorie diet. May need OG feeding if still not getting enough calories. |
| CF Nursing Considerations | Pulmonary assessments paying attention to lung sounds, cough. GI assessment. |
| CF Nursing Considerations If admitted | Meticulous handwashing. Private room. Give treatments as ordered. Use oxygen cautiously. Frequent skin care. |
| Home care for CF | Parents need education about home equipment and know how to use it. Educate parent and child on healthy diet.Home antibiotics. Keep regular follow-up appointments.Teach parents how to do chest PT and breathing exercises. |
| Teach parents about the preferred diet | Fat, increased protein and carbs. Do not restrict salt especially if warm weather. Adequate fluid intake. |
| CF Nursing Considerations Family support: | Meet the emotional needs of the child. Help the family seek out respite care. Take part in age appropriate activities. Help prepare family for end-of -life decisions. |
| What are the two basic problems related to the GI system as seen in Cystic Fibrosis? | Steatorrhea and prolapsed rectum from bulky stools. |
| What exercises can the parents be taught to do at home to help move secretions up and out? | Postural drainage and chest physical therapy. |
| What exercises can the parents be taught to do at home to help move secretions up and out? | Postural drainage and chest physical therapy. |
Created by:
redhawk101
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