1.4 respiratory

Acute Viral Nasopharyngitis

(Common Cold) - Causes: rhinoviruses, RSV, adenovirus, influenza virus,and parainfluenza virus - Usually by 5 years old, most children will have developed immunity to many viruses - Daycare, infection rate is higher - Home before starting school have an increased infection rate - Symptoms: more severe in infants & children compared to adults

tonsillectomy and adenoidectomy

- Analgesics Cool water, crushed ice, diluted fruit juice, and ice pops cause vasoconstriction - Avoid red and/or brown color; Avoid citrus juices --> need to tell difference between blood Liquid to a soft diet - Food and fluids are restricted until the child is alert and able to swallow with no signs of hemorrhage - Milk, ice cream, and pudding are not offered until clear foods are retained since these can coat the throat Watch for post-op hemorrhage - Signs of bleeding: tachycardia, pallor, frequent swallowing (most obvious) - Position to facilitate drainage, avoid suction - Discourage coughing frequently, throat clearing, avoid use of gargles, limiting activity, and blowing the nose - Most resume normal activity 1 to 2 weeks after operation

respiratory auscultation

- Best heard if the child inspires deeply Breath sounds are classified as vesicular, bronchovesicular or bronchial - Vesicular: heard over entire surface of lungs, except for upper interscapular area and area beneath the manubrium, Inspiration is louder, longer and higher pitched than expiration, soft & swishing - Bronchovesicular: Heard over the manubrium and in the upper intracapsular, Inspiration is louder and higher pitched than in vesicular breathing - Bronchial: Heard only over the trachea near the suprasternal notch, The inspiratory phase is short, and the expiratory phase is long

tonsilitis

- Causative agents: may be viral or bacterial Waldeyer Tonsillar Ring (mass of lymphoid tissue encircling the nasopharynx and oropharynx) - Pharyngeal (Adenoids) - Tubal - Palatine - Lingual Tonsils - Filter and protect the respiratory alimentary tracts - Role in antibody formation - Children generally have larger tonsils than adolescents/adults Clinical Manifestations - Enlarged Tonsils (Kissing tonsils) - Difficulty swallowing/breathing - Offensive mouth odor - Muffled/nasal voice quality Management - Self limiting if viral - Bacterial: treat with antibiotics Tonsillectomy - Massive enlargement - Peritonsillar abscess - Airway obstruction - Chronic tonsillitis - Multiple antibiotic allergies and failures Adenoidectomy ◦ Indicated when obstructing nasal breathing or history of four or more episodes of recurrent rhinorrhea in the previous 12 months in a child younger than 12 years old

respiratory inspection assessment

- Color changes, clubbing --> hypoxia for a while, nasal flaring, head bobbing (trying to get more air), RR, retractions (can see muscles and ribs/neck struggling to breathe), audible sounds like stridor, grunting, coughing, pain Various patterns of respiration - Tachypnea, bradypnea, apnea, hyperpnea, hypoventilation, hyperventilation, Kussmaul, Cheyne-stokes, Seesaw, and agona, ronchi (hear the phlegm), wheezing (high pitched), crackles (fluid in lung)

Acute Spasmodic Laryngitis

- Distinct from laryngitis and LTB characterized by recurrent paroxysmal (SUDDEN!!!) attacks of laryngeal obstruction that occur chiefly at NIGHT!!!!! - Can be called: Spasmodic, midnight, or twilight croup - Age group: 1-3 years old Causative agents: - VIRAL with an allergic component Clinical Manifestations: - Croupy cough, slight hoarseness, restlessness, dyspnea, symptoms awakening child but disappearing during the day Therapeutic/Nursing Management: - Cool mist and/or warm mist - Reassurance - Self limiting

acute viral nasopharyngitis: younger child clinical manifestations

- Fever - Common in young children - 3 months to 3 years old, occurs suddenly - Irritability - Restlessness - Open mouth breathing - Decreased appetite & fluids - Decreased activity

Acute Streptococcal Pharyngitis

- Group A beta-hemolytic strep pharyngitis (GABHS):Infection of the upper airway tonsils - Prevent spread - BACTERIAL - Scarlet fever: Pharyngitis and characteristics of erythematous-sandpaper-like rash Complications: - acute glomerulonephritis and rheumatic fever Symptoms - Sore throat - HA - Fever - Abdominal pain - Inflamed tonsils and pharynx - Anterior cervical lymphadenopathy- Symptoms subside in 3 to 5 days - MALODOROUS Diagnostic evaluation - Rapid streptococcal antigen testing: Vigorous swabbing of both tonsils and posterior pharynx - Throat culture: Rule out GABHS Management Antibiotics - Oral (PO): Penicillin or amoxicillin - Intramuscular (IM): Penicillin G benzathine or penicillin G procaine, NEVER administer these suspensions intravenously, Give into deep muscle mass (e.g., vastus lateralis or ventrogluteal muscle) - Warm salt water gargles - Cold and warm compresses to the neck - OTC - Compliance - CHANGE Toothbrush so you don't reinfect yourself - Considered infectious to others at the onset of symptoms and up to 24 hours after initiation of antibiotic therapy.

bronchitis

- Inflammation of large airways trachea and bronchi - Frequently associated with URI Causative agents: - Usually viral including Influenza A and B, parainfluenza, COVID, RSV, and rhinovirus; bacterial, fungi, allergic, and airborne irritants Clinical Manifestations: - Persistent dry, hacking, and nonproductive cough that is worse at night becoming productive in 2-3 days - Usually last more than 5 days, but can persist for 1 to 3 weeks Therapeutic/Nursing Management: - Mild and self-limiting disease - Cough suppressants may be needed - Can be chronic if cough is greater than 3 months: Adolescents: should be screened for tobacco or marijuana use

pneumonia

- Inflammation of the pulmonary (lung) parenchyma (tissue) - Infection of the lung Can be classified by etiologic agent: - Viral, bacterial, mycoplasmal, or aspiration of foreign substances - Neonates: Group B Strep, gram-negative enteric bacteria and cytomegalovirus - Infants: RSV, parainfluenza, influenza, adenovirus, S. pneumonia, H. influenzae group Astrep, M. catarrhalis - Preschool Children: S. pneumonia (most common), RSV, parainfluenza, influenza,adenovirus,, H. influenzae group A strep, M. catarrhalis - School Age Children: M. pneumoniae (most common), Chlamydia pneumoniae, group Astrep - Viral pneumonia occurs more frequently than bacterial pneumonia Diagonsitc - chest xray and sputum culture Clinical Manifestations: - Usually high fever, cough, unproductive to productive with whitish sputum, tachypnea,crackles/rhonchi, dullness with percussion, chest pain, retractions, nasal flaring,irritability, restlessness, lethargic, vomiting, diarrhea, and abdominal pain Therapeutic/Nursing Management: - Symptomatic treatment for viral - Antibiotic treatment for bacterial and atypical pathogens - Most older children can be children at home, infants and young children develop more severe symptoms - Follow-up recommended - Monitor vital signs, oxygenation, and nasal suctioning Complications: Pneumothorax - collapsed lung - Air accumulates in the pleural space making it more difficult to expand the affected lung - Signs of dyspnea, chest pain, often back pain, labored respirations, tachycardia, and decreased oxygen saturation - Definitive diagnosis by chest radiograph - need to put in chest tube

acute viral nasopharyngitis: older child clinical manifestations

- Low-grade fever - Nasal discharge causing mouth breathing - Chills - Muscular aches - Cough - Sneezing

Waldeyer Tonsillar Ring

- Pharyngeal (Adenoids) - Tubal - Palatine - Lingual

acute viral nasopharyngitis: management

- Self Limiting: symptoms typically last 10-14 days with peak of 2 to 3 days - Manage at home with no specific treatment Over the Counter (OTC) - Fever management - Cough suppressants/antihistamines: not routinely recommended - Fluids and Rest - Elevate head/bed - Nasal suctioning Prevention and reassurance - Frequent handwashing and avoiding touching one's eyes, nose and mouth - Frequent in children younger than 3 years old, may need reassurance that it's a normal part of childhood - Signs of dehydration, respiratory complications, the child does not improve within 2 to 3 days, notify HCP

foreign body aspiration

- choking - Life-threatening event due to potential airway obstruction and inability to adequately oxygenate the body - Most common in children 1 to 3 years old Causative agents: - Seeds, nuts, carrots, popcorn, hot dogs, round candy, grapes, peanut butter, balloons, glass beads, marbles, pen, magnets, coins, medications, and disc batteries - Most inhaled FBs lodge in a mainstem or lobar bronchus, and the remaining lodge in the trachea Clinical Manifestations: - Laryngotracheal obstruction: Dyspnea, cough, stridor, hoarseness, and cyanosis - Bronchial obstruction: Paroxysmal coughing, wheezing, asymmetric breath sounds, decreased airway entry, and dyspnea - Larynx obstruction: Child is unable to speak or breather - Nasal obstruction: Unilateral purulent drainage that does not improve over time Therapeutic/Nursing Management: - Emergency management for choking: - Use of abdominal thrusts for children older than 1 year of age - Back blows and chest thrusts for children younger than 1 year of age - Recognize the signs of FB aspiration and implement immediate measures to relieve obstruction◦ (1) Cannot speak, (2) becomes cyanotic, and (3) collapses; these three signs indicate child is truly choking; child can die within 4 minutes - Prevention

resistance

- determined by velocity of air flow, physical property of gas breathed (viscous), airway diameter and airway length

compliance

- measure of chest wall distensibility (capacity to swell or stretch as a result of pressure from inside) - calculated by volume/pressure

seventh rib

7

normal arterial o2

80-100 --> more reliable than pulse o2

normal pulse o2

95 - 100

e

A 5-year-old client is 2 hours post-op tonsillectomy and asking for a snack. The best option to offer is A. Banana B. Red colored Popsicle C. Milk D. Pudding E. Diluted apple fruit juice

a, b, c, e, f (Postoperative hemorrhage is unusual but may occur between 5 and 10 days after surgery with the sloughing of the primary eschar as the tonsil bed heals (Mitchell et al., 2019). The nurse observes the throat directly for evidence of bleeding, using a good source of light and, if necessary, carefully inserting a tongue depressor. Other signs of hemorrhage are tachycardia, pallor, frequent clearing of the throat or swallowing by a younger child, and vomiting of bright red blood. Restlessness, an indication of hemorrhage, may be difficult to differentiate from general discomfort after surgery. Decreasing blood pressure is a much later sign of shock.)

A nurse is caring for a 5-year-old following a tonsillectomy and assesses the child for signs of active bleeding. Which findings would the nurse expect to observe if the child was bleeding? Select all that apply. One, some, or all responses may be correct. a) Frequent swallowing b) Hemoptysis c) Tachycardia d) Tachypnea e) Frequent clearing of the throat f) Epistaxis g) Facial flushing h) Cream-colored membrane in back of throat

b (The risk for aspiration is minimized when clients with a decreased level of consciousness are placed in a side-lying or upright position. Frequent turning prevents pooling of secretions in immobilized clients but will not decrease the risk for aspiration in clients at risk. Monitoring of parameters such as breath sounds and oxygen saturation will help detect pneumonia in immune compromised clients, but it will not decrease the risk for aspiration. Continuous subglottic suction is recommended for intubated clients but not for all clients receiving enteral feedings.)

A nurse is caring for a hospitalized child who is unconscious and at risk for aspiration pneumonia. To protect this child from aspiration pneumonia, the nurse will plan to do what? a) Turn and reposition the child at least every 2 hours b) Position clients with altered consciousness in lateral positions c) Monitor laboratory values frequently for signs of immunocompromise. d) Provide for continuous subglottic aspiration in the child receiving enteral feedings.

c

Acute streptococcal pharyngitis is A. a viral infection of the upper airway. B. a viral infection of the lower airway. C. a bacterial infection of the upper airway. D. a bacterial infection of the lower airway.

a (A small change in diameter has a huge effect on the resistance of an airway e.g. halving the radius of an airway would cause a 16-fold increase in resistance. Therefore, individually, the smaller airways have much higher resistance than larger airways such as the trachea.)

As the diameter of the airways increase, the airway resistance a) decreases b) increases c) stays the same d) equalizes.

Bronchiolitis

CILIA SWELL, SLOUGH OFF AND OCLUDE AIRWAY - MOST OF THE TIME HOSPITALIZED - Most common infectious disease of lower airways - Maximum obstructive impact at the bronchiolar level - Causative agents: Predominantly Respiratory Syncytial Virus (RSV), adenovirus, parainfluenza, and Mycoplasma pneumoniae - Causes loss of cilia (ciliated cells swell, protruded into the lumen, and lose their cilia) in the respiratory tract, occludes airway - Age group: Usually 2-12 months; rare after 2 years old Clinical Manifestations: - Labored respirations - poor feeding - cough - tachypnea - retractions - crackles - flaring nares - increased nasal mucus - wheezing - diminished breath sounds - and low-gradefever Therapeutic/Nursing Management: - Most children can be managed at home with fluid intake, airway maintenance, and medications - Hospitalization is recommended for those with poor feeding, lethargy, dehydration, moderate to severe respiratory distress, apnea, or hypoxemia. - Continuous pulse oximetry Respiratory Support - Supplemental oxygen is not necessary if O2 are 90% or higher - Nasal suctioning - Heated high-flow nasal cannula (HHFNC) may be useful before intubation - Endotracheal intubation if worsening severe distress - Fluids by mouth may be contraindicated, IV fluids may be preferred - Monitor oxygenation, vital signs, urine output - Contact and droplet precautions - Breastfeeding mothers are encouraged to continue feeding infant or by pumping their milk and storing it - Ribavirin: Not routinely recommended for RSV infection - Palivizumab: May be used for the prevention of RSV infection, expensive vaccination if both parents have to go to work

a, b, c, e, g (Early signs of impending airway obstruction include increased pulse and respiratory rate; substernal, suprasternal, and intercostal retractions; flaring nares; and increased restlessness.)

Early signs of impending airway obstruction due to acute laryngootracheobronchitis in a child include what? Select all that apply. One, some, or all responses may be correct. a) Tachypnea b) Tachycardia c) Substernal and intercostal retractions d) Stridor e) Nasal flaring f) Hoarseness g) Increased restlessness

increased pulse (tachycardia) and respiratory rate (tachypnea); substernal, suprasternal, and intercostal retractions; flaring nares; and increased restlessness.

Early signs of impending airway obstruction in LTB include

c (FB aspiration may result in life-threatening airway obstruction, especially in infants because of the small diameters of their airways. Current recommendations for the emergency treatment of the choking child include the use of abdominal thrusts for children older than 1 year of age and back blows and chest thrusts for children younger than 1 year old. An FB is rarely coughed up spontaneously)

Emergency management for choking in a child younger than 1 year of age include a) chest compressions b) abdominal thrusts c) back blows and chest thrusts d) having the child forcefully cough it out and perform a finger sweep to remove the foreign body.

croup syndromes

General term applied to a symptom complex characterized by - Hoarseness, barking/brassy cough, varying degrees of inspiratory stridor, and varying degrees of respiratory distress - Occurs primarily in children 6 months to 3 years of age, rare after 6 years Can affect the larynx, trachea, and bronchi - Laryngeal involvement often dominates, with severe effects on the voice and breathing - Larynx greater importance in infants and children due to the smaller airway diameter Croup Syndromes described according to the primary anatomical area affected - Epiglottitis (more common in older children, medical emergency) - Laryngitis (can't talk) - Laryngotracheobronchitis (more common in very young children, barking seal cough) Monitoring for worsening symptoms - Respiratory status, adequate hydration, and nourishment

why do we take blood from veins compared to arteries?

High pressure in the arteries compared to veins

compliance curve

Increasing Lung Compliance: - When lung compliance increases, it means that the lungs can more easily expand and accommodate changes in volume. - This is often associated with conditions that reduce the elastic recoil of the lungs or make the lung tissue more compliant. - Example: In some cases of chronic obstructive pulmonary disease (COPD), there is destruction of elastic tissue in the lungs, leading to increased compliance. Emphysema, a type of COPD, is characterized by increased lung compliance. COPD caused by smoking Decreasing Lung Compliance: - When lung compliance decreases, it means that the lungs are less able to stretch and expand, and there is increased stiffness. - This is often associated with conditions that cause fibrosis or scarring of the lung tissue, making it less compliant. - Example: Pulmonary fibrosis is a condition characterized by the formation of scar tissue in the lungs, leading to decreased lung compliance. The stiffening of the lung tissue makes it more resistant to expansion.

a (Movement of the chest wall should be symmetric bilaterally and coordinated with breathing. During inspiration, the chest rises and expands, the diaphragm descends, and the costal angle increases. During expiration, the chest falls and decreases in size, the diaphragm rises, and the costal angle narrows. Through exhaling, the carbon dioxide is carried back out of the lungs where it can exit through the mouth or nose)

Inspiration involves a) chest rising and expanding where the diaphragm descends b) chest falls where the diaphragm rises c) carbon dioxide is carried back out of the lungs where it can exit through the mouth or nose d) An asymmetric movement of the chest wall that is paradoxical movement of the diaphragm

acute epiglottis

NO COUGH A: airway inflammation --> obstruction I: inc pulse & respirations R: restlessness R: retractions A: anxiety inc I: inspiratory stridor (increased when supine) D: drooling Bacterial - Medical emergency that required immediate medical attention - Age Group: 2-5 years old - Causative agents: usually H. influenza but lower due to Hib conjugate vaccine, now more often caused by viral agents; Can be caused by noninfectious such as inhaling smoke and ingesting foreign bodies Clinical Manifestations: (3 clinical observations that are predictive 1,2,3) - NO COUGH(1), drooling (2), agitation (3), dysphagia, high fever, toxic appearance, irritable, tripod position (takes gravity off --> easier to breathe because stridor aggravated when supine) - Rapidly progressive Therapeutic/ Nursing Management: Lateral neck radiograph of the soft tissues is indicated for diagnosis - DON'T EXAMINE THROAT it could totally block their airway Examination of the throat with a tongue depressor is contraindicated( Only performed by the HCP when immediate endotracheal intubation and emergency tracheostomy can be performed) - Prepare for possible endotracheal intubation, nasotracheal intubation, and tracheostomy - Monitor respiratory status, antibiotic therapy if bacterial, corticosteroids - By 3rd day, epiglottis is near normal - let their parents hold them --> soothing

a (Oxygenation is the process of supplying oxygen to the body's cells. Ventilation is the process of exchanging oxygen and carbon dioxide, which is essentially breathing. Oxygen comes in to the body via the airway, it's offloaded onto the red blood cells while carbon dioxide diffuses across the membrane into the alveoli and is then exhaled. You breathe in oxygen and exhale CO2. Diffusion involves substances moving across concentration gradients from areas of higher concentration to areas of lower concentration. This is the process involved with gas exchange. Perfusion flow of blood to alveolar capillaries)

Perfusion is a) flow of blood to the alveolar capillaries. b) exchange of gas in the lung c) process of supplying oxygenation to the body's cells d) involves substances moving across concentration gradients from areas of higher concentration to areas of lower concentration

d (Since more and more children are getting immunizations against H. influenzae B, the incidence of epiglottitis has declined. Other organisms can cause epiglottitis, but because of infant immunizations, this disease occurs less in young children and when it does occur in older children, it is not so serious because of larger airways and a better immune system)

The number of cases of acute epiglottitis have decreased in recent years due to the routine immunization of infants with which vaccine? a) Diphtheria Toxoid attenuated pertussis b) Pneumococcal c)Quadrivalent Influenza Vaccine d) Hemophilus influenzae type b

a, b, f

The nurse is caring for an adolescent in the hospital with pneumonia. Which information should the nurse include in the nursing management plan for this patient? Select all that apply. One, some, or all responses may be correct. a) Provide the patient with oxygen as needed b) Plan activities so there are periods of rest during the day c) Place the patient on a fluid restriction of 1200 ml/day d) Restrict the patient's smoking to 2-3 cigarettes/day e) Monitor the patient's pulse oximetry readings once a shift f) Encourage the patient to cough into a tissue and dispose of it in the wastebasket.

a (When the upper airway is edematous as it is with LTB, there is always the chance that the airway will be blocked. The child must be monitored for absence of air flow, inability to swallow, increasing distress. The most important nursing function in the care of children with LTB is continuous, vigilant observation and accurate assessment of respiratory status. Cardiac, respiratory, and pulse oximetry monitoring supplement visual observation. Changes in therapy are frequently based on the nurses' observations and assessments of a child's status, response to therapy, and tolerance of procedures. The trend away from early intubation of children with LTB emphasizes the importance of nursing observations and the ability to recognize impending respiratory failure so that intubation can be implemented without delay. Therefore intubation equipment and bag valve mask (BVM) equipment should be readily accessible.)

The nurse is caring for an infant with acute laryngotracheobronchitis (LTB). The most important nursing function in the care of children is a) vigilant observation and accurate assessment of respiratory status b) providing patients with frequent reassurance c) treatment with antibiotics d) ensuring adequate fluid intake

d (Postoperative hemorrhage is unusual but may occur between 5 and 10 days after surgery with the sloughing of the primary eschar as the tonsil bed heals (Mitchell et al., 2019). The nurse observes the throat directly for evidence of bleeding, using a good source of light and, if necessary, carefully inserting a tongue depressor. Other signs of hemorrhage are tachycardia, pallor, frequent clearing of the throat or swallowing by a younger child, and vomiting of bright red blood. Restlessness, an indication of hemorrhage, may be difficult to differentiate from general discomfort after surgery. Decreasing blood pressure is a much later sign of shock.)

The nurse is preparing the parents of a child for home care. The 7 year-old child just had a tonsillectomy 6 hours post op. Which instruction should the nurse give to these parents? a) May resume normal activity in 1 to 2 days b) Recommend saltwater gargles starting 24 hours after day of surgery c) May use ice pops to soothe the throat that include natural citrus juices d) Watch carefully for frequent swallowing.

a, b, f (Three clinical observations that are predictive of epiglottitis are absence of spontaneous cough, presence of drooling, and agitation.)

What clinical observations are predictive of acute epiglottitis? Select all that apply. One, some, or all responses may be correct. a) absence of spontaneous cough b) presence of drooling c) paroxysmal croupy cough d) symptoms awaken but disappear during the day e) supine position with chin thrust out, mouth open and tongue protruding f) agitation

d (Bronchiolitis is an acute viral infection with maximum effect at the bronchiolar level. The infection typically begins with upper respiratory symptoms and occurs primarily in winter and early spring. Most cases of bronchiolitis are caused by RSV, adenoviruses, parainfluenza viruses, and human metapneumovirus, but RSV is the most common cause, resulting in more than 57,000 hospitalizations and 2.1 million outpatient visits each year)

What disease is usually caused by the pathogen: respiratory syncytial virus (RSV)? a) Acute epiglotitis b) Infectious Mononucleosis c) Bacterial Pneumonia d) Bronchiolitis

c (The child who is suspected of having epiglottitis should be examined in a setting where emergency airway equipment is readily available. Examination of the throat with a tongue depressor is contraindicated until experienced personnel and equipment are available to proceed with immediate intubation or tracheostomy if the examination precipitates further or complete obstruction.)

What is contraindicated when examining a patient who may have acute epiglottitis? a) Moving the head from side to side b) Having the patient to refrain from talking c) Examination of throat with a tongue depressor d) Palpating the lymph nodes

a (Caring for a child or an adult with pneumonia requires supportive care. That means that promoting rest and encouraging fluids are very important. Rest decreases the O2 demand of tissues, while fluids help keep secretions moist and easy to cough up. So fluids are given, but rest is encouraged - not activity. Aspirin is contraindicated at this age for this condition. PCV 13 is given at 2 months, 4 months, 6 months and 12 months. The child should have already received all the vaccinations. If catchup is needed, only 1 dose of PCV 13 would be needed to catchup.)

What is the most appropriate acute nursing intervention when caring for a 4 year old child with pneumonia? a) Encourage fluids b) Encourage ambulation as much as possible c) Control fever with aspirin d) Preparing for the pneumococcal vaccination (PCV13)

c (Acute LTB is the most common type of croup syndrome that primarily affects very young children from 6 months to 3 years old)

What is the most common type of croup in very young children? a) Acute epiglottitis b) Bronchiolitis c) Laryngotracheobronchitis d) Acute spasmotic laryngitis

b (Acute epiglottitis, or acute supraglottitis, is a medical emergency that requires immediate medical attention. It is a serious obstructive inflammatory process that occurs predominantly in children 2 to 5 years old but can occur from infancy to adulthood.)

What type of croup is a medical emergency that requires immediate medical attention? a) Acute Spasmodic Laryngitis b) Acute Epiglottitis c) Bronchiolitis d) Acute Laryngotracheobronchitis (LTB)

d (Many organisms can cause pneumonia, and vary according to the child's age: Neonates: Group B streptococci, gram-negative enteric bacteria, cytomegalovirus, Ureaplasma urealyticum, Listeria monocytogenes, C. trachomatis Infants: RSV, parainfluenza virus, influenza virus, adenovirus, metapneumovirus, S. pneumoniae, H. influenzae, M. pneumoniae, Mycobacterium tuberculosis, group A streptococci, M. catarrhalis Preschool children: RSV, parainfluenza virus, influenza virus, adenovirus, metapneumovirus, S. pneumoniae, H. influenzae, M. pneumoniae, M. tuberculosis, group A streptococci, M. catarrhalis School-age children: M. pneumoniae, Chlamydia pneumoniae, M. tuberculosis, group A streptococci, S. aureus, M. catarrhalis, and respiratory viruses)

What type of pathogen can be seen in school aged children who have been diagnosed with primary atypical pneumonia? a) Group B streptococci b) Parainfluenza virus c) Cytomegalovirus d) Mycoplasma pneumoniae

Acute Laryngotracheobronchitis (LTB)

YOUNGER, SLOWER PROGRESSION, NON TOXIC APPEARANCE, NOT MEDICAL EMERGENCY - Usually occurs in young children (Infants) - Most common type of croup on children 6 months-3 years - Causative agents: VIRAL! Parainfluenza, adenovirus, RSV, and M pneumoniae Clinical manifestations - Low-grade fever, Brassy/seal like cough, stridor, hoarseness, non toxic! and mild to mod respiratory distress - Slowly progressive Therapeutic/Nursing Management: - Humidified mist and/or cool mist if needed for mild cases - Nebulized racemic epinephrine if moderate to severe - Supplemental oxygen - Oral steroids - Early signs of impending airway obstruction include increase pulse and respiratory rate, retractions, flaring nares and increased restlessness - Frequent reassurance

inspiration vs expiration

breathing in: diaphragm contracts and moves down, chest expands/moves up, costal angle inc breathing out: diaphragm relaxes and moves up, chest gets smaller/moves down, costal angle narrows RR 12-20

child airway anatomy differences

child - tongue is larger in proportion to mouth - pharynx smaller - epiglottis larger and floppier - larynx more anterior and superior - narrowest at cricoid - trachea narrow and less rigid

adults

do adults or children have higher risk for bleeding out

ventilation

flow of air into and out of alveoli 1:1 ratio ventilation/ perfusion

perfusion

flow of blood to alveolar capillaries 1 ml air: 1 ml blood - we have 4 L blood

As the diameter of the airways decreases, the airway resistance?Increases or Decreases

increases (The diameter of the airways is dynamically regulated by physiological factors, primarily the smooth muscle surrounding them. Bronchoconstriction, induced by factors like the parasympathetic nervous system and histamine, decreases airway diameter, increasing airway resistance)

type of breathing in infants

infants - diaphragmatic breathing - Airway cartilage in young infants is soft and compressible-> highly reactive to stimuli such as vagal stimulation - 9 times more alveoli are present at age 12 than at birth Newborn small airway diameter-4mm - Older child 10mm - Adult 17-24mm - Children more susceptible to inhaled irritants, more phlegm can get trapped - Children have higher metabolism --> breathes faster

diffusion

involves substances moving from concentration gradient from higher to greater

oxygenation

process of supplying oxygen to the body's cells 95-100 Pulse O2 80 - 100 Arterial O2 --> more reliable

Anterior cervical lymphadenopathy

swollen lymph nodes in the neck - 30% to 50% usually occurs early - lymph nodes can also be on axillary and inguinal/groin area

signs of dehydration

thirst, darker urine, dry mouth, dizziness, decreased skin turgor, constipation, elevated HR, decreased urine must be 30/ml/hr, decreased BP

lung function

ventilation, perfusion, compliance, resistance, diffusion, oxygenation

addison's disease

what happens if you don't taper off steroids

not taking in fluids

when would a child be admitted to the hospital for the cold?