Respiratory Deviations

Start Studying!

Terms

undefined, object

copy deck

What is a classic sign of a child in Resp distress who is greater than 6 mo: sitting in the tripod position
What is a sign of chronic hypoxia in the later pre-school, school age child: clubbing
What should you assess when doing a resp assessment: Rate/depth/ease and rhythm
lung sounds
skin-color
mucous membranes-color/hydration
CRT
POX
How often do you assess someone who is on cont. O2: Q hour
Other things that you assess: Breath for odor may indicate lung infection
Cough- type, productive
Infection-temp, lymph nodes
secretions- color and consistency
chest/throat pain
LOC
Lab values- CBC, ABG Lytes, CXR
What are some differences b/w child and afult: smaller passageways
lg. soft pallette
lyrnx 2-3 vertibre higher
tounge lg in proportion to soft tissue
less cartilidge in airway so < support
alveoli < mature and not securely attached
Resp infection risk factors: immunodeficiency
malnutrition
anemia
fatigue
allergies
asthma
cardiac disease
environment/daycare/smk
resp infection clinical manifestations: fever/instability in young
menigeal signs- h/a stiff neck
anorexia
vomiting
diarrhea
abd pain
nasal congestion
nasal drainage
cough
resp sounds
what are the goals of resp infections: ease resp effort-use warm mist from shower
promote rest/comfort-bedrest quiet play
temp. reduction-teach parent how to take temp
hydration/nutrition-pedilyte or gatorade teach parent s/s of dehydration
what should you never give if child has diarrhea: fruit juice or sweeten water
what does stridor indicate?: upper airway problem
CROUP Define: general term used to describe barking cough. insp. stridor upper resp obstruction or edema of lyrnx
CROUP two types of syndromes: acute epiglottis
acute laryngotracheobronchitis LTB
CROUP ACUTE EPIGLOTTITIS MUST KNOW facts: EMERGENCY/ supra glottic obstruction
do not examine throat w/ tongue depressor or use a culture swab
CROUP ACUTE EPIGLOTTITIS define: bacterial infection that causes laryngeal spasm. have intubation equipement ready at bedside
ACUTE EPIGLOTTITIS S/S: hear stridor
high fever
tachycardia
tachypnea
look very ill or toxic
ACUTE EPIGLOTTITIS: prevelence 1-8yo
more sever
bacterial
progresses rapidly(have emergency airway equipment at bedside)
dysphasia/droolin
agitation
NO COUGH
ACUTE EPIGLOTTITIS Treatment: IV ABX
Fluids
corticosteroids
ACUTE EPIGLOTTITIS prevention: H influenza vaccine
ACUTE EPIGLOTTITIS Nursing interventions: alieve anxiety
keep child and parent together
child in position of comfort
monitor reap status
POX
IV hydration
Acute laryngotracheobronchitis LTB define: inflammation of mucosal lining causing narrowing
LTB treatment: corticosteroids
maintain airway
high humidity/cool mist/rest
fluids if RR <60
epi inhaler
have intubation/O2 available
LTB assessment: resp and cardiac status
at risk for airway obstruction
hydration
LTB differences: prevelence 3mo-8yo
virial
slower to progress
upper resp infection
horse raspy cough
look like a cold not toxic
stridor/high pitch
low grade fever
restless and irritable
TONSILLITIS define: inflammation of lymphoid tissue in pharynx. Pallatine tonsils become edemetus and block airway. Adnoid- obstruct air from nose
TONSILLITIS treatment: ABX for bacterial
viral tx symptomatically
tonsilectomy if reoccuring
TONSILLITIS Nursing intervention: assess bleeding
IV pain meds/hydration
soft/cold/liquid diet
cool mist/cool vaporizer
warm Na h2o garlge
antipyretic
TONSILLITIS IMPORTANT: place on abd.
no coughing/nose blowing or throat clearing
observe for fresh bleeding freq
monitor swallowing
TONSILLITIS how to handle pain: ice
analgesic
no citrus juice or colored fluids
Otis media: most prevealent disease of early childhood
it is a dysfunction of eustachian tube
what are children more prone to OM: eustachian tube is shorter, straighter and wider causing to retain more fluid and increases negative pressure and if tube opens leaks fluid into middle ear
how do you hold the ear on an otoscopic exam: <3yo down and back
>3 up and back
Otitis media manisfestations: ears hurt, earache if preverbal they are irritable and may tug at ear
poor eating
fever
purlent dc from ear
anorexia
Otitis media complications: hearing loss can lead to speech deficit, chronic can cause perforation or scarring of the eardrum. Mastoiditis
meningitis
Otitis media diagnosis: otoscopic/ see bright red, buldging tympanic membrane.
check ear for drainage, use sterile swab and h2o
otitis Media Treatment: Goal is to keep middle ear free of fluid and air. current trend is no ABX use. myringotomy-sm cut in Tempanic membrane to relieve pressure
Tubes-keeps passage open, helps with drainage
tylenol or motrin
heat or ice
Otitis Media Nursing Interventions: Teach that you may
have temp. hearing loss
Take full course of ABX
hold infant upright when feeding. environment can trigger. teach s/s
what may help lower the rate of Om: pneumocacal vaccine
Respiratory Syncytical Virus RSV: most common cause of bronchitolitis
occurs in late fell-spring
RSV risk factors: prematurity
<6wk of age
infant with chronic lung disease (NICU baby)
socio-economic status
smk, daycare, older siblings
RSV patho: Virus affects the bronchiole causing inflammation, edema, and inccreased mucous, which progresses to alveoli causing atelectis and collapse.
RSV diagnosis: first test is nasophyrangel wash (aspirate nasal secretions)
IFA (flourescent antibody test) rapid immuno test done on nasal secretions.
RSV manifestations: apnea in young infant, CXR shows consolidation. , cough,Upper resp infection, OM, Rhinorrhea, conjunctivitis, wheeze, fever, severe tachypnea RR 70-80's, retractions, nasal flaring, grunting, diminished LS, hypoxia leads to resp acidosis
RSV TX: O2 suction nares, fluid IV if RR >60, rest, quiet dark room, ABGs, C&A monitor, steroids inhalers,nebs and abx prophilactically
what type of percautions are needed with RSV: contact with a mask
RSV Prevention: those at risk are given monthy IV tx of immuneglobulin (blood product) interferes with MMR vaccine
Palivizumab (synagis) wt based and expensive. often have monthly clinics
what does the AAP recommend with regards thoso synagis: synagis for those <2yo with chronic lung disease. done for 2 seasons. should be done at the beginning of the season.
ASTHMA: most common chronic disease of childhood primary cause of hospitailazations and school abscences.
Asthma Risk factors: male
socio-economic status
single mom
household smoke
daycare
ASTHMA patho: disease of chronic inflammation. Bronchi hypersensitive. Increase in airway responsiviness.
what causes airway remodelling?: due to chronic condition of asthma. irreversible
Severity classifications of asthma: mild intermittent-sym <2/wk with brief exarcerbation
MILD persistent- sym >2/wk problems with activity
MOD persisten-symptoms affect activity. use inhaler QD
SEVERE persistent- continual symptoms restrictions on activity
ASTHMA triggers: environment: smk, allergies, viral infection, household chemicals, change in temp/weather. exercise induced asthma.
STRESS, animal allergies, rodents, MOLD, GER, T-E fistula, adolescents who are preg have freq exacerbations
ASA-NSAID-BetaBlockers-menses
what is going on during an asthma attack: inflammation/edema of MM have thick mucous. Bronchi and cronchioles spasm which narrow the airway resistence to airflow. airtrapping occurs. hyperinflation of alveoli, co2 retention, hypoxia, resp acidosis
what is air trapping: you get air in but it is trapped and hard to exhale out.
what happens if asthma (hypoxia, resp acidosis) not treated: resp failure
what is the classic sign of asthma: chronic cough with no cold symptoms
ASTHMA diagnosis: hx/physical
X-ray to r/o other cause
PFT-pulm function test ie peak flow or spirometry
skin testing
provocative testing-sample of MM-air allegens
Radioallergosorbent testRAST
Peak expiratory flow meters: measures max forcefully expired air flow in 1 second. do it three times 30sec apart and take best (over 3 wk period
what is the purpose of finding your best on the peak flow meter: b/c if you use it every day and compare results to your best you should be able to pick up early a change in resp status
What does the green zone mean for peak flow: 80-100% of personal best, signals good control. take your usual daily long term-control medicines, if you take any. keep taking daily long term meds even in yellow or red zone
what does the yellow zone mean: 50-79% signals caution. your overall asthma may not be under control and your healthcare provider may nn to change asthma management plan
what does the red zone mean?: below 50% of best. signals a MEDICAL ALERT. call health care professional IMMEDIATELY
ASTHMA clincial maniestations: barrel chest
elevated shoulders
LS-coarse, crackels, wheeze
hacking proxismal non-productive cough
audible wheeze
color change lip/ears=dark red
restless or apprehensive may mean hypoxic
tri-pod position
ASTHMA non pharmacologic treatment: allergen control (pets, carpet, dust etc)
foam or rubber mattress
wash inean weekly
Chest PT
breathing exercises-controlled purse lipped, IS, cough and deep breathe, amb, fluids
Asthma treatment pharmacologic: treated with both long-term control or preventer meds and quick-relief meds or rescue meds
what do Long term control what do Quick release do: LT- control inflammation
QR- treats symptoms
ex of LT meds Corticosteroids: anti-inflammatory
oral/IV- short term use 3-10day
Inhalation-prevent and supress symptoms
SE-supress long bone growth
cough and thrush (rinse P use)
ex of coritcosteroids: pulmicort
flovent
azmacort
ex of LT meds Fluticasone and salmeterol: Advair diskus- controls symptoms and improves lung function cortico and bronchodilator combo
SE infection
ex of LT meds Cromolyn sodium: NSAID for asthma.-anti allergic inflam drug interferes with relaease of mast cells so no release of histamine
prophalactic
SE- cough on inhalation
ex of QR meds B-adrenerigic agonist: albuterol/terbutaline
bronchodilator and relaxes sm muscle
used for rescue and prevention of exercise induced exacerbation.
ex of LT meds Leukotriene modifiers: singular (montelukast sodium) stops leukotriene (unsat fatty acid that causes that are released when inflammation going on and increases secretion)mediates inflam and bronchospasm PO in combonation with B-agonistsused for prevention mild-persistent asthma
SE: dizzy, fatigue, h/a, abd pain
excerise with the asthma patient: self-limiting. choose sports with short bursts of activity. swimming good b/c encourages pursed lip breathing.
what is status asthmaticus: sustained asthmatic reaction that doesn't respond to treatment
A MEDICAL EMERGENCY
STATUS ASTHMATICUS CONT...: severe resp distress. agietated and can't sit still or lay down. causes resp failure or death.
STATUS ASTHMATICUS s/s: agitation followed by sudden quiet, respiratory arrest
STATUS ASTHMATICUS treatment: ventilation, drugs are epinephrine, B2-agonists, steroids, o2
Asthma RN interventions for the hospitalized child: resp status
adm O2 based on parimeters
nebs
steroids as ordered
COLD LIQUIDS MAY TRIGGER BRONCHOSPASMS
SODA INCREASES RISK OF ASPIRATION
does well with sm, freq feeds
education asthma: children can lead full active lives and grow into adulthood
have a pulmonary plan and do peak flows
test for allergies and remove them

Start Studying!

Deck Info

Number of cards 80