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O2 Deviations

Oxygenation Deviations of the Child

QuestionAnswer
How does increased cartilage on children's ribs effect respiratory distress? More cartilage helps to compensate for respiratory distress with increased rate rather than depth; retractions.
Nursing Diagnoses for Respiratory Distress Ineffective Airway Clearance or Ineffective Breathing Pattern
Nursing Outcomes for Respiratory Distress Ease respiratory effort; promote hydration/nutrition; facilitate temperature reduction; promote rest/comfort; promote development.
What are the three (3) types of Croup Syndromes (The big "3")? Acute Laryngotracheobronchitis (LTB); Acute Epiglottitis; and Tracheitis
What is Acute Epiglottitis? It is a medical emergency. You should NEVER try to examine throat with tongue depressor and NEVER use a culture swab.
What causes wheezing? Constriction
How is Acute Epiglottitis diagnosed? Lateral neck x-ray.
What causes crackles? Fluid in the lungs.
What is Tracheitis? Progression of infection and patient should be admitted to PICU.
What does Bronchi sound like? Low pitch sound that will usually clear with coughing.
What is Stridor? Indicates upper airway edema. High Pitch.
What is normal childhood pH? 7.35 - 7.45
What would be important to assess for following a tonsillectomy? And for how long? Assess for bleeding during the first 24 hours, for the first 7-10 days after surgery and with any excessive swallowing.
How would you control pain after a tonsillectomy? Acetaminophen and use of an ice collar.
What should you tell your patient or patient's parents not to use after a tonsillectomy? Straws
What type of pain is common when clearing of the throat after a tonsillectomy? Ear pain.
What would you give to and/or have your patient avoid in terms of hydration after a tonsillectomy? Patient can start with cool liquids and move to soft solids but should avoid citrus juices.
What should patients who have just had a tonsillectomy avoid for at least one week? Vigorous activity.
What are some alternatives to deep breathing for children? Blowing bubbles.
Respiratory Childhood differences from adults. Maternal antibodies diminish between 3-6 months; they have a smaller airway diameter; shorter, more horizontal eustachian tube; right bronchus is straighter than left; ribs more cartilaginous and they are obligatory nose breathers up until about 1 month.
What are S/S's of Acute Otitis Media? Acute onset of ear pain (tugging) and redness of tympanic membrane. This can occur with or without effusion.
What is effusion? Escape of a fluid into a part
What is Otitis Media with Effusion? Otitis media with effusion (OME) is when there is thick or sticky fluid behind the eardrum in the middle ear, but there is no ear infection.
What can Otitis Media with Effusion lead to? Hearing loss.
What are signs of Otitis Media with Effusion? Rhinitis and cough.
Why may Dexamethasone (Decadron) administered for respiratory distress? To help decrease upper airway edema.
Is Croup viral or bacterial? Viral
Is Epiglottitis viral or bacterial? Bacterial
What is Otitis Media? Inflammation with or without infection of middle ear.
When is peak incidence for Otitis Media? Within the first two years of life.
What is the cause of Otitis Medis? Dysfunction of eustachian tube.
How is Otitis Media Diagnosed? Diagnosis is based on visualization and pneumatic otoscopy.
What are some Risk Factors for Otitis Medis? Recurrent URI, exposure to tobacco smoke, attendance at daycare, use of pacifier (after 10 months), absence of infant breastfeeding, bottle propping.
Why should tylenol with codeine be used with caution after a tonsillectomy? Because it can cause lethargy and respiratory distress and even death in children if not monitored properly.
How is Otitis Media treated? Antibiotic therapy for 10 days in children < 6years of age and for 5-7 days in children > 6 years of age.
Types of medications used to treat Otitis Media? Amoxicillin, augmentin, cefdinir, azithromycin and ceftriaxone.
What is the most common cause of Bronchiolitis? RSV is most common cause.
What are common symptoms of Bronchiolitis? Tachypnea, retractions, wheezing, nasal flaring, crackles, and apnea (may precede other RSV symptoms in young infants).
How should retractions be described/charted? Should be described according to their location.
How would you administer ear drops in a child under three (3) years? Pull pinna down and back.
How would you administer ear drops in a child over three (3) years? Pull the pinna up and back.
How is Chronic Effusion treated? With myringotomy and PE tubes.
What is Myringotomy? A surgical procedure in which a tiny incision is created in the eardrum to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear.
What are ways to prevent Bronchiolitis? Palivizumab (Synagis) in high risk infants; HAND HYGIENE, and limit exposure to tobacco smoke.
What is the nursing care/treatment you should provide in patients with Bronchiolitis? Racemic epinephrine/albuterol via nebulization, O2 therapy & monitoring, hypertonic saline, IV therapy & nutrition, SUCTION BEFORE FEEDING AND PRN, contact/droplet precautions and Ribavirin for select patients with potentially life-threatening infection.
What is the most common chronic disease of childhood? Asthma (Reactive Airway Disease - RAD).
Who is Asthma most prevalent in? Boys 0-17 years of age, non-hispanic black children and peurto ricans and children from poor families.
What disease is the primary reason for school absences/hospitalizations? Asthma.
List the clinical symptoms of Asthma. Cough, wheeze, shortness of breath, chest pain, quick reliever medication use (SABA), diurnal variation (worsens at night), limited exercise tolerance.
What are some triggers of asthma? Upper respiratory infections, irritants in the air, exercise, weather changes, medications, hereditary factors.
What are the four (4) components of Asthma management? Assessment and monitoring; education for a partnership in asthma care; control of environmenal factors and co-morbid conditions that affect asthma; and pharmacological therapy.
What is intermittent asthma? Symptoms 1-2 times/week with nighttime symptoms 1-2 times/month.
What is mild persistent asthma? Symptoms more than twice/week with nighttime symptoms 3-4 times/month.
What is moderate persistent asthma? Daily symptoms with nighttime symptoms > once weekly.
What is severe persisitent asthma? Symptoms throughout the day with nighttime symptoms 7 times/weekly.
What does SABA stand for? Short-acting beta 2-agonists.
What type of pharmacalogical intervention is used in acute asthma episodes? Usually a short-acting beta 2-agonist (SABA).
How should Albuterol be used? May be taken/given every 20 minutes x3 for quick relief. Effect lasts 4-6 hours and can be used 4-6 times per day.
What are types of inhaled cotricosteroids (ICS)? Fluticasone (Flovent), Budesonide (Pulmicort), Beclomethasone (QVAR, Beconase), Mometasone (Asmanex).
What is considered the "Gold standard for asthma management"? Inhaled Corticosteroids
What are some adverse effects of cotricosteroids? Oral candidiasis (thrush), hoarse voice (dysphonia) and high doses effect linear growth.
What types of physical affects can Inhaled Corticosteroids have? Easy bruisability and should avoid exposure to eyes.
What do Long-acting Beta Agonists (LABAs) do? Relax bronchial smooth muscle.
What are long-acting beta agonists NOT recommended for? Monotherapy.
What are two types of long-acting beta agonists? Salmeterol (Serevent) and Formoterol (Foradil).
How many times a day can long-acting beta agonists be used? Twice
Long-acting beta agonists are most effective when combined with what? Inhaled steroids.
What are the two types of Asthma combination therapy? Fluticasone and Salmeterol (Advair Diskus) and Budesonide and Formoterol (Symbicort).
What do Leukotriene modifiers do? They block chemicals that start airway inflammation.
What is Omalizumab (Xolair) used for? Used for severe asthma, children > 12 years, and risk of anaphylaxis.
What are types of Leukotriene modifiers? Singular (Montelukast) - Daily tablet; Accolate (Zafirlukast)- BID; Zyflo (Zukeuton)- BID extended release tablet.
What is Theophilline? Provides continuous airway relaxation; sustained release for control of nocturnal symptoms.
What is Cromolyn Sodium (MDI)? Anti-inflammatory: May be used for inavoidable allergen exposure.
What is the Stepwise Approach? It is used to assist, not replace, clinical decision making.
What activities are usually tolerated well with people who have exercise-induced bronchospasms? Swimming, baseball, gymnastics.
What other considerations can help prevent bronchospasms? Warm-up before exercise, pre-treatment before exercise, wearing scarf or mask over nose/mouth in cold weather and avoiding activities such as soccer, and basketball.
What helps to reduce both asthma and allergic rhinitis symptoms? Intranasal Corticosteroids.
What are spacer devices for? Used for people who have difficulty with technique and can reduce potential side effects.
What is Cystic Fibrosis? It is thick mucous blocks pancreatic ducts which lead to pancreatic enzyme deficiencies.
What kind of things can Cystic Fibrosis lead to? Can lead to malabsorption - poor growth and failure to thrive, vitamin (A,D,E,K) deficiencies, steatorrhea (bulky, frothy, pale floating stools).
What are the symptoms of GI malabsorption related to Cystic Fibrosis? Failure to thrive and general malnutrition, vitamin deficiencies, steatorrhea, protuberant abdomen and poor weight gain.
What are GI symptoms related to Cystic Fibrosis? Constipation, rectal prolapse from the large difficult-to-pass stools, meconium ileus in newborn, or late/difficult passage of meconium is one of the earliest symptoms.
What are respiratory symptoms related to Cystic Fibrosis? Frequent URIs with increased risk of Pseudomona Aeruginosa or Burkholderia Cepacia, chronic moist cough, nasal polyps, clubbing of fingers/toes and barrel chest.
What are the treatments for Cystic Fibrosis? Respiratory therapy and the prevention of infection.
What does the respiratory therapy treatment consist of in regards to Cystic Fibrosis? Chest Pt (1 hour ac or 2 hours pc); aerosol therapy with bronchodilators, Dnase Oscillating vests; hypertonic saline via nebulization in older children.
How do you go about preventing infection in patients with Cystic Fibrosis? Antibiotic therapy (oral, inhaled, IV routes); Monitor renal function with high dose antibiotics.
What are the reproductive issues that can be cause by CF? Increased infertility but women can conceive and genetic implications (children will be carriers).
Created by: nglidden