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Peds Comp Final

Respiratory Comprehensive Final on Pediatrics

O2 Therapy Hazards ROP, Fire hazards, O2 Toxicity, Cerebral vasoconstriction
Sxn Hazards Bradycardia, Hypoxemia, Mucosal damage, Increased ICPs, Atelectasis, Accidental Extubation, Infection, Vagal stimulation
CPT Hazards Increased ICP, Hypoxemia and SOB, Increased HR and RR (baby develops distress or decreased SpO2 while doing CPT (or sxn) stop tx, notify RN and MD
CPT Indications Mobilized secretions, Treat Atelectasis, Increased secretions, Diseases indicating clearance: CF, BPD, pneumonia
Silverman Score Grades severity of underlying lung disease
Head Injury Tx Begin at accident site, Maintain airway: Intubate if Glasgow <7, Hyperventilate to keep PaCO2 25-30 mmHg(cerebral vasoconstriction & decreases blood flow to head), Hyperoxygenate, Treat high ICPs,: Phenobarbital & Lasix, Keep head of bed 30-45 degrees
Glasgow Determines LOC
Lanugo Fine hair on fetus skin
CF Late Complications Cor pulmonale, Pulmonary hypertension, Bronchiectasis, Hemoptysis
BPD Factors O2 toxicity, Barotrauma, Presence of PDA, Fluid overload
Croup Tx Cool mist or cool air, Racemic epinephrine, Steroids, Hydration, Intubations only if VERY SEVERE and airway is compromised
Oxyhood 7-10 LPM
Racimic Epinephrine Used for upper airway edema, Vasoconstrictor
BPD Tx Support bronchial hygiene
BPD Signs/Symptoms Refactory hypoxemia, Cyanosis >50% FiO2, Expiratory grunting, Tachypnea, Marked (severe) retractions, Nasal flaring, Severe distress, Crackles and wheezes
RDS CXR Ground glass appearance and hypoinflation; Reticulogranular densities and air bronchograms; Total white out in later stages of RDS
TTN CXR Perihilar streaking w/ hyperinflation; Ground glass or reticulogranular w/ air bronchograms (like RDS CXR, but lungs HYPERINFLATED not HYPOINFLATED)
Anti-convulsants Phenobarbital: Alters CNS by either depression or excitation, Dilantin: Inhibits spread of seizure in motor cortex of brain, Felbatol: peds mostly, Depakote- petit mal seizures, Tegretol- peds mostly
Sedatives Chloral hydrate, Diazepam (valium), Lorazepam (ativan), Midazolam (versed), Morphine sulfate, Fentanyl citrate
Chloral hydrate Used to calm agitation and aid in sleep
Diazepam (valium) Sedative that also relieves anxiety, Also used for opiate withdrawal
Lorazepam (ativan) Used for anxiety & sleep
Midazolam (versed) Short-acting, rapid onset sedative, Hypnotic agent used for anesthesia (“twilight drug” pt not fully out, but doesn’t remember), Often used before procedure
Morphine sulfate Muscle relaxant, Used for pain & sedation
Fentanyl citrate 100 times more potent than morphine, Used for pain & sedation before procedure, Used to control chronic pain (fentanyl pops!)
Paralytics Panuronium bromide (Pavulon), Vecuronium bromide (Norcuron), Rocuronium bromide (Zemuron)
Succinylcholine (Anectine) Only depolarizing muscle relaxant, Used often due to short onset (<1 min) & short duration (<5 min)
Capillary Sticks Useful for pH and CO2 (not O2), Primarily used once UAC removed, Best way to see acid-base on infants few weeks old
RDS Signs & Symptoms May present healthy and deteriorate within 1st few hours, Refactory hypoxemia (not response to O2): Cyanosis >50% FiO2, Expiratory grunting, Tachypnea, Marked (severe) retractions, Nasal flaring, Severe distress, Major contributor Prematurity
NIF Normal spontaneously breathing pt= > -60 cmH2O, Normal ventilator Pt= >-20 cmH2O, NIF < -20 cmH2O indicates muscle weakness (vented or non-vented)
T-wave Ventricular Repolarization
ABG Needle Position Hold like pencil (bevel side up), @ 35-45 degree angle, Advance until flash of blood then stop
P-wave Atrial Depolarization
Sinus Rhythm Rates SA= 60-100, AV= 40-60, Perkinje Fibers= 20-40
DLCO Diffusion capacity of the lung for Carbon Monoxide, Differentiates between asthma and emphysema, Decreased DLCO=Emphysema
Wrights respirometer Sensitive to flows over 300 LPM, Sensitive to moisture, NEVER used for PEFR or FVC (too much flow)
Torsades De Pointes (TDP) "Twisted Helix" Tx: Magnesium
Goals of Home Care Support and maintain life, Promote quality of life, Improve patients well being, Improve self sufficiency, Ensure cost effective patient care
Home Care Conditions to be Met Stable- no longer needs acute/sub-acute care, Can care for themselves safely, Can accurately administer prescribed therapy, If patient cannot, family/ caregivers must be able to perform therapy, Home environment must be adequate
Home Mechanical Ventilation Conditions No dyspnea on vent, Acceptable ABGs, FiO2 <40%, Psychologically stable, No life threatening cardiovascular issues, PEEP <10 cmH2O, Less sxn needed, No re-admission to hospital for over a month
Discharge Planning Incorporates 3 basic principles: Appropriateness of discharge, Optimal site of patient care, Financial resources
O2 Conserving Devices Reservoir cannula (or pendant cannula), Transtracheal delivery system (catheter), Pulsed dose system
Pre-Pulmonary Rehabilitation Before: Objective baseline, repeated halfway through: Objective measure of progress, to be done @ end: Objective measure of success- Includes:Complete pt hx, lab work, Diagnostic studies, Cardiopulmonary stress testing, Lvl of dyspnea, 6 min walk test
Good Candidates for Pulmonary Rehab Moderate to severe COPD, Exercise limits due to severe dyspnea, Post lung resection, Motivated, willing participants
Poor Candidates for Pulmonary Rehab Malignant neoplasms in lungs (cancer), Progressive neuromuscular abnormalities, Severe arthritis
3 Domains of Learning Cognitive: Understanding why, Affective: Understanding benefit, Psychomotor: Understanding how
Created by: geko546
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