Oxygenation, Asthma RSV, Bronchiolitis and the Pediatric Airway

Extrinsic Asthma triggers

**Allergic Asthma** -allergen enters the body, immune system over reacts and forms antibodies -common irritants: cockroach particles, cat and dog hair, house dust, molds, pollens

Intrinsic Asthma Triggers

**Non allergic** -caused by anything except an allergy -common irritants: smoke, exercise, gas, fumes, smog, viral respiratory infections, weather changes

LABA

*Long acting beta agonists* Advair/Salmetrol, Symbicort -prevent exacerbations especially at night -must be used with an anti-inflammatory therapy

SABA

*Short acting beta agonists* Albuterol, Racemic epi -rescue inhaler -to prevent exercise induced asthma

Nursing Interventions: Asthma

-Assess RR, WOB, breath sounds -Monitor vitals -CBC, ABG, Chest Xray -position for max ventilation -educate family about rescue vs maintenance med -absence of wheezing can indicate severe airway constriction -assess airway patency, RR, symmetry, WOB, use of accessory muscles

Education: Asthma

-avoid triggers -instruct on proper use of MDI (spacer) -s/s of exacerbation -when to use medications -humidity, fluids -stepwise treatment protocol (use smallest amount to control symptoms) -psychosocial support -asthma action plan -use PFM at same time each day (stand up straight, nothing in mouth, blow as hard/fast as possible, use best #) -immunizations -perform regular exercise

Pathology of Asthma

-chronic reversible obstructive airway disease -caused by a spasm of the bronchial tubes or swelling of bronchial mucosa -mast cells release histamine if it's allergy induced asthma and leukotrine

Manifestations of Asthma

-cough -dyspnea -course lung sounds (wheezing, crackles) -restless, irritable -increased WOB -use of accessory muscles (substernal retractions) -prolonged expiration -tripod positioning -sweating, mucous production -peak flow: <80% baseline -decreased O2 stats

how do you know if your asthma is under control?

-no use of rescue inhaler -PFR is good -no wheezing

Pediatric airway

-shorter, narrower -cartilage is weaker and more flexible -susceptible to swelling and edema -lung tissue not fully developed -obligatory nose breathers -small diameter occludes easily-secretions, swelling -large occiput places head in flexion -larger tongue -larger tonsils and adenoids -cricoid ring: narrowest part of child's airway

430. The clinic nurse reads the results of a tuberculin skin test (TST) on a 3 year old child. The results indicate an area of induration measuring 10mm. The nurse should interpret these results as which finding? 1. Positive 2. Negative 3. Inconclusive 4. Definitive and requiring a repeat test

1

433. The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions should the nurse include in the plan of care? SELECT ALL THAT APPLY. 1. Place the infant in a private room. 2. Ensure that the infant's head is in a flexed position. 3. Wear mask at all times when in contact with the infant. 4. Place the infant in a tent that delivers warm humidified air. 5. Position the infant on the side, with the head lower than the chest. 6. Ensure that nurses caring for the infant with RSV do not care for other high-risk children.

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424. A 10 year old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child should monitor for which sign, knowing that it indicates a worsening of the condition? 1. Warm, dry skin 2. Decreased wheezing 3. Pulse rate of 90 beats/minute 4. Respirations of 18 breaths/minute

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428. The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse should monitor for which indication that the child may be experiencing airway obstruction? 1. The child exhibits nasal flaring and bradycardia. 2. The child is leaning forward, with the chin thrust out. 3. The child has a low-grade fever and complains of a sore throat. 4. The child is leaning backward, supporting himself or herself with the hands and arms.

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432. The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the MOST APPROPRIATE nursing action? 1. Initiate strict enteric precautions. 2. Move the infant to a room with another child with RSV. 3. Leave the infant in the present room because RSV is not contagious. 4. Inform the staff that they must wear a mask, gloves, and a gown when caring for the child.

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431. The mother of a hospitalized 2 year old child with viral laryngotracheobronchitis (croup) asks the nurse why the health care provider did not prescribe antibiotics. Which response should the nurse make? 1. "The child may be allergic to antibiotics." 2. "The child is too young to receive antibiotics." 3. "Antibiotics are not indicated unless a bacterial infection is present." 4. "The child still has the maternal antibodies from birth and does not need antibiotics."

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425. The mother of an 8 year old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child complains of discomfort on the right side and that ibuprofen (Motrin IB) is not effective. Which instruction should the nurse provide to the mother? 1. Increase the dose of ibuprofen. 2. Increase the frequency of ibuprofen. 3. Encourage the child to lie on the left side. 4. Encourage the child to lie on the right side.

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426. A new parent expresses concern to the nurse regarding sudden infant death syndrome (SIDS). She asks the nurse how to position her new infant for sleep. In which position should the nurse tell the parent to place the infant? 1. Side or prone 2. Back or prone 3. Stomach with the face turned 4. Back rather than on the stomach

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427. The clinic nurse is providing instructions to a parent of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement should the nurse make to the parent? 1. "The immunization schedule will need to be altered." 2. "The child should not receive any hepatitis vaccines." 3. "The child will receive all the immunizations except for the polio series." 4. "The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination."

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429. A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The mother becomes concerned because the child is frightened, consistently crying and trying to climb out of the tent. Which is the MOST APPROPRIATE nursing action? 1.Tell the mother that the child must stay in the tent. 2. Place a toy in the tent to make the child feel more comfortable. 3. Call the health care provider and obtain a prescription for a mild sedative. 4. Let the mother hold the child and direct the cool mist over the child's face.

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trach suctions for an infant

5 seconds to precent hypoxia insert catheter length of trach tube with suction off and apply intermittent suction withdrawing the catheter with twisting motion deoxygenate between suction

TB positive

>5 for HIV or immunocompromised >10 if pt younger that 4 >15 if pt is >4 years old

Which child is at highest risk for requiring hospitalization to treat RSV a. a two-month-old born at 32 weeks b. A 16th month old with a tracheostomy c. A three-year-old with a congenital heart defect d. A four-year-old who is born at 30 weeks

A

Which statement indicates the parents need further teaching on how to prevent his other children from contracting RSV a. I should make sure that both my children receive synagis injections for the mermaid her of this year b. I should be sure to keep my infected child away from his brother until he has recovered c. I should insist that all people who come in contact with my children thoroughly wash their hands before playing with them d. I should insist that anyone with a respiratory illness avoid contact with my children until well

A

a nurse is explaning bronchioltis to the parents of an infant admitted with the condition. which is the best information for the nurse to provide a. it is a seasonal viral illness that causes inflammation and obstruction of the small airways b. causes decreased mucus secretion which causes air trapping and lobular collapse c. affects premature infants because they lack surfactant d. caused by a bacteria that causes epithelial necrosis and damage to the cilia

A

the nurse is planning care for an infant with bronchiolitis who requires monitoring for dehydration. what is the most important intervention for the nurse to provide a. daily weight b. blood levels every 4 hours c. urinalysis every 8 hours d. weighing each diaper

A

the nurse is teaching the parents of a 7mo with RSV. which statement by the parents would best indicate understanding of the infection..RSV bronchiolitis a. usually just cause a bad cold in people b. occur mostly in the fall c. usually only affect preterm infants d. are spread primarily through indirect contact

A

A child is admitted to the hospital with asthma. Which assessment findings support this diagnosis? a. Nonproductive cough, wheezing b. Fever, general malaise c. Productive cough, rales d. Stridor, substernal retractions

A Asthma presents with a nonproductive cough and wheezing. Pneumonia appears with an acute onset, fever, and general malaise. A productive cough and rales would be indicative of pneumonia. Stridor and substernal retractions are indicative of croup.

A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of which diagnosis? a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis

A Bronchitis is characterized by these symptoms and occurs in children older than 6 years. Bronchiolitis is rare in children older than 2 years. Asthma is a chronic inflammation of the airways that may be exacerbated by a virus. Acute spasmodic laryngitis occurs in children between 3 months and 3 years.

In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind? a. Diet should be high in carbohydrates and protein. b. Diet should be high in easily digested carbohydrates and fats. c. Most fruits and vegetables are not well tolerated. d. Fats and proteins must be greatly curtailed.

A Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Enzyme supplementation helps digest foods; other modifications are not necessary. A well-balanced diet containing fruits and vegetables is important. Fats and proteins are a necessary part of a well-balanced diet.

A nurse is interpreting the results of a tuberculin skin test (TST) on an adolescent who is HIV positive. Which induration size indicates a positive result for this child 48-72 hours after the test? a. 5 mm b. 10 mm c. 15 mm d. 20 mm

A Clinical evidence of a positive TST in children receiving immunosuppressive therapy, including immunosuppressive doses of steroids or who have immunosuppressive conditions, including HIV infection is an induration of 5 mm. Children younger than 4 years of age with: (a) other medical risk conditions, including Hodgkin disease, lymphoma, diabetes mellitus, chronic renal failure, or malnutrition; (b) born or whose parents were born in high-prevalence (TB) regions of the world; (c) frequently exposed to adults who are HIV infected, homeless, users of illicit drugs, residents of nursing homes, incarcerated or institutionalized, or migrant farm workers; and (d) who travel to high-prevalence (TB) regions of the world are positive when the induration is 10 mm. Children 4 years of age or older without any risk factors are positive when the induration is 20 mm.

A nurse is conducting an in-service on asthma. Which statement is the most descriptive of bronchial asthma? a. There is heightened airway reactivity. b. There is decreased resistance in the airway. c. The single cause of asthma is an allergic hypersensitivity. d. It is inherited.

A In bronchial asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function. In bronchial asthma, there is increased resistance in the airway. There are multiple causes of asthma, including allergens, irritants, exercise, cold air, infections, medications, medical conditions, and endocrine factors. Atopy or development of an immunoglobulin E (IgE)-mediated response is inherited but is not the only cause of asthma.

The Heimlich maneuver is recommended for airway obstruction in children older than _____ year(s). a. 1 b. 4 c. 8 d. 12

A The Heimlich maneuver is recommended for airway obstruction in children older than 1 year. Younger than 1 year, back blows and chest thrusts are administered. The Heimlich maneuver can be used in children older than 1 year.

A school-age child has been admitted with an acute asthma episode. The child is receiving oxygen by nasal prongs at 2 liters. How often should the nurse plan to monitor the child's pulse oximetry status? a. Continuous b. Every 30 minutes c. Every hour d. Every 2 hours

A The child on supplemental oxygen requires intermittent or continuous oxygenation monitoring, depending on severity of respiratory compromise and initial oxygenation status. The child in status asthmaticus should be placed on continuous cardiorespiratory (including blood pressure) and pulse oximetry monitoring.

A nurse is teaching nursing students about clinical manifestations of cystic fibrosis (CF). Which is/are the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

A The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools are a later manifestation of CF. Recurrent respiratory tract infections are a later sign of CF.

what is Epiglottitis

A disease in which the epiglottis becomes inflamed and enlarged and may cause an upper airway obstruction.

The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which action should the nurse include in the child's postoperative care plan? (Select all that apply.) a. Notify the surgeon if the child swallows frequently. b. Apply a heat collar to the child for pain relief. c. Place the child on the abdomen until fully wake. d. Allow the child to have diluted juice after the procedure. e. Encourage the child to cough frequently.

A, C, D Frequent swallowing is a sign of bleeding in children after a tonsillectomy. The child should be placed on the abdomen or the side to facilitate drainage. The child can drink diluted juice, cool water, or popsicles after the procedure. An ice collar should be used after surgery. Frequent coughing and nose blowing should be avoided.

An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which interventions? (Select all that apply.) a. Cluster care to conserve energy b. Round-the-clock administration of antitussive agents c. Strict intake and output to avoid congestive heart failure d. Administration of antibiotics

A, D Antibiotics are indicated for a bacterial pneumonia. Often the child will have decreased pulmonary reserve, and the clustering of care is essential. Antitussive agents are used sparingly. It is desirable for the child to cough up some of the secretions. Fluids are essential to kept secretions as liquefied as possible.

An infant is being treated at home for bronchiolitis. what should the nurse teach the parent about home care. select all that apply a. offering small amounts of fluids frequently b. allowing the infant to sleep prone c. calling the clinic if the infant vomits d. writing down how much the infant drinks e. performing chest physiotherapy every 4 hours f. watching for difficulty breathing

A, F

a teaching care plan to prevent the transmission of RSV should include what info. select all that apply a. the virus can be spread by direct contact b. the virus can be spread by indirect contact c. palivizumab is recommended to prevent RSV for all toddlers in day care d. the virus is typically contagious for 3 weeks e. older children seldom spread RSV f. frequent handwashing helps reduce the spread of RSV

A,B, F

The nurse is caring for an infant with respiratory syncytial virus​ (RSV) in the hospital. The parents ask if their child will need to be on oxygen. Which response by the nurse is​ accurate? A. "If oxygen levels fall below​ 90%, we will start​ oxygen." B. "We will keep your​ child's oxygen levels at​ 100%." C. "Many children​ don't require oxygen unless their levels get below​ 75%." D. "As long as your​ child's oxygen levels are above​ 50%, we will not​ worry."

Answer: A

The nurse is concerned that a​ 9-month-old client being treated for bronchiolitis caused by respiratory syncytial virus​ (RSV) is developing respiratory distress. Which assessment finding supports this​ concern? (Select all that​ apply.) A. Onset of expiratory grunting B. Visible intercostal retractions with ventilations C. Respiratory rate increased from 30 to 48​ breaths/min D. Systolic blood pressure 10 mmHg less than previous measurement E. Femoral pulse weak and 120​ beats/min

Answer: A, B, C

During a home​ visit, the nurse assesses a​ 2-year-old child. Which factor should the nurse identify as putting the child at risk for contracting respiratory syncytial virus​ (RSV)? (Select all that​ apply.) A. Both parents are unemployed. B. Both parents smoke cigarettes. C. The toddler shares a drinking cup with older brother. D. There is an absence of soap at the kitchen sink. E. The toddler wears clean but rumpled pants and shirt.

Answer: A, B, C, D

Which factor should the nurse identify as a risk factor for the development of​ bronchiolitis? (Select all that​ apply.) A. Cigarette smoke exposure B. Chronic lung disease C. Attends daycare D. Premature birth E. Age 4 or older

Answer: A, B, C, D

The nurse is teaching the parents of a​ 9-month-old client with respiratory syncytial virus​ (RSV) about ways to help the child recover quickly from the disorder. Which information should the nurse​ include? (Select all that​ apply.) A. Provide​ frequent, small meals throughout the day. B. Use a bulb syringe to clear the nose before giving a bottle. C. Help the child to blow the nose to clear the airway. D. Wash hands thoroughly after caring for the child. E. Permit the child to rest and nap throughout the day.

Answer: A, B, E

A mother reports that her child is not eating since being diagnosed with respiratory syncytial virus​ (RSV) a week ago. Which manifestation should the nurse assess for next​? A. Insomnia B. Rapid breathing C. Nausea D. Hyperactive bowel sounds

Answer: B

The nurse is caring for an infant who is recovering from bronchiolitis. The parents ask if there will be any future risk for the child. Which condition should the nurse​ describe? A. Decreased lung capacity B. Asthma C. Chronic respiratory infections D. Chronic obstructive pulmonary disease​ (COPD)

Answer: B

The nurse is discussing with a parent the signs of dehydration to look for in a child with respiratory syncytial virus​ (RSV). Which manifestation should the nurse​ include? (Select all that​ apply.) A. Bluish tint to skin B. Poor skin elasticity C. Decreased urinary output D. Dry mucous membranes E. Labored cough

Answer: B, C, D

The nurse is examining a child with bronchiolitis. Which symptom should the nurse interpret as a sign of​ dehydration? (Select all that​ apply.) A. Intercostal muscle retractions B. Weak peripheral pulses C. Decreased urine output D. Dry, sticky mucous membranes E. Delayed capillary refill

Answer: B, C, D, E

A parent tells the nurse​ "When my older child had RSV years​ ago, the doctor prescribed a bronchodilator. Why has my child not been prescribed one this​ time?" When describing why bronchodilators are no longer routinely​ prescribed, which side effect of bronchodilators should the nurse​ describe? A. Muscle cramps B. Dehydration C. Tachycardia D. Increases blood pressure

Answer: C

The mother of a pediatric client diagnosed with bronchiolitis caused by respiratory syncytial virus​ (RSV) is upset to learn that the child will be admitted to a​ semi-private room. Which explanation by the nurse is appropriate regarding this room​ assignment? A. "RSV is not​ contagious, so the roommate will not contract the​ illness." B. "The children will have companionship when the parents are not able to​ visit." C. "RSV is contagious.​ However, placing two children with the same illness together is​ permissible." D. "The nurse can provide care to both children at the same​ time."

Answer: C

The nurse is caring for an infant with bronchiolitis. Which situation should the nurse identify that nebulized epinephrine may be​ indicated? A. Treatment for nasal airway clearance B. Rescue treatment for coughing C. Rescue treatment for severe bronchiolitis D. Treatment for anorexia associated with bronchiolitis

Answer: C

The nurse is preparing a plan of care for an infant diagnosed with acute bronchiolitis due to respiratory syncytial virus​ (RSV). Which nursing diagnosis should the nurse select to guide this​ infant's care? A. Cardiac​ Output, Decreased B. Pain​ Response, Impaired C. Activity Intolerance D. Urinary​ Elimination, Impaired

Answer: C

The nurse is working with a mother and discussing the process of keeping the airway clear for a child diagnosed with respiratory syncytial virus​ (RSV). Which should the nurse teach the parent to do at​ home? A. Use a catheter to suction the airway B. Perform chest percussion C. Use a bulb syringe to suction the nose D. Auscultate lung sounds

Answer: C

The nurse is speaking with a parent who is sharing that her child has not been eating well at home since being sick with respiratory syncytial virus​ (RSV). Which should be the reason for consulting with a dietitian to work with this​ family? (Select all that​ apply.) A. Provide healthy snacks. B. Place a nasogastric tube. C. Assess fluid intake. D. Discuss the importance of​ frequent, small meals. E. Assess the caloric intake.

Answer: C, D, E

The nurse is discussing the importance of preventing the spread of infection with a mother whose​ 7-month-old is being discharged after hospitalization for respiratory syncytial virus​ (RSV). Which discharge teaching should the nurse provide to the mother of the​ client? A. Demonstrate nasal suctioning procedures. B. Stress the importance of isolation. C. Explain the importance of taking medications until they are gone. D. Stress the importance of not sharing cups.

Answer: D

The nurse is meeting with a parent and a​ 6-month-old client who has been coughing and demonstrating signs of air hunger. Which cause should the nurse suspect for this​ symptom? A. Increased pulse B. Dry mouth C. Edema D. Hypoxia

Answer: D

The nurse is working with a group of new nurses and discussing the importance of maintaining fluid balance in an infant with respiratory syncytial virus​ (RSV). Which statement demonstrates an understanding of maintaining fluid balance in​ infants? A. "We should encourage the parents to monitor​ sleeping." B. "We should encourage the parents to add proteins into the​ diet." C. "We should encourage the parents to force​ fluids." D. "We should encourage the parents to count​ diapers."

Answer: D

Which intervention should the nurse identify as a preventive measure for​ bronchiolitis? A. Antibiotic therapy B. Immunization C. Sputum culture D. Palivizumab

Answer: D

Which should be the reasoning behind prescribing antibiotics to a child with respiratory syncytial virus​ (RSV)? A. To thin secretions B. To treat a concurrent virus C. To break up congestion D. To treat a concurrent bacterial infection

Answer: D

a student asks the nurse if an precautions are needed when caring for a 2mo with RSV to prevent the spead of infection. what is the nurses best reponse a. gloves only b. gown, gloves and mask c. standard precautions only d. proper hand washing between clients

B

which child would be at increased risk for RSV a. 2mo child managed at home b. 2 mo child with bronchopulmonary dysplasia c. 3mo child requiring low flow oxygen d. a 2 year old child

B

Which consideration is the most important in managing tuberculosis (TB) in children? a. Skin testing annually b. Pharmacotherapy c. Adequate nutrition d. Adequate hydration

B Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and two or three times a week for the remaining 4 months. Pharmacotherapy is the most important intervention for TB

The nurse is assessing a child with acute epiglottitis. Examining the child's throat by using a tongue depressor might precipitate which symptom or condition? a. Inspiratory stridor b. Complete obstruction c. Sore throat d. Respiratory tract infection

B If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place. Stridor is aggravated when a child with epiglottitis is supine. Sore throat and pain on swallowing are early signs of epiglottitis. Epiglottitis is caused by H. influenzae in the respiratory tract.

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include: a. forcing fluids. b. monitoring pulse oximetry. c. instituting seizure precautions. d. encouraging a high-protein diet.

B Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. Maintenance of vascular volume and hydration is important and should be done parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is not helpful.

A child with cystic fibrosis (CF) is receiving recombinant human deoxyribonuclease (DNase). Which is an adverse effect of this medication? a. Mucus thickens b. Voice alters c. Tachycardia d. Jitteriness

B One of the only adverse effects of DNase is voice alterations and laryngitis. DNase decreases viscosity of mucus, is given in an aerosolized form, and is safe for children younger than 12 years. β2 agonists can cause tachycardia and jitteriness.

A nurse is admitting an infant with asthma. The nurse understands that asthma in infants is usually triggered by: a. medications. b. a viral infection. c. exposure to cold air. d. allergy to dust or dust mites.

B Viral illnesses cause inflammation that causes increased airway reactivity in asthma. Medications such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics may aggravate asthma, but not frequently in infants. Exposure to cold air may exacerbate already existing asthma. Allergy is associated with asthma, but 20% to 40% of children with asthma have no evidence of allergic disease.

the nurse is preparing a child/family for a nasopharyngeal was to obtain a specimen. which statement, by the nurse would be most accurate in explaining the procuedure. select all that apply a. the child will need to be held still for this procedure b. nasal secretions are aspriated after 3ml of saline is instilled in each nostril c. nasal secretions are suctioned out of each nostril d. the procedure will take only a few minutes e. the child will not be able to eat until the gag reflex is assessed

B (only way to detect RSV)

A nurse is caring for a school-age child with left unilateral pneumonia and pleural effusion. A chest tube has been inserted to promote continuous closed chest drainage. Which interventions should the nurse implement when caring for this child? (Select all that apply.) a. Positioning child on the right side b. Assessing the chest tube and drainage device for correct settings c. Administering prescribed doses of analgesia d. Clamping the chest tube when child ambulates e. Monitoring for need of supplemental oxygen

B, C, E Nursing care of the child with a chest tube requires close attention to respiratory status; the chest tube and drainage device used are monitored for proper function (i.e., drainage is not impeded, vacuum setting is correct, tubing is free of kinks, dressing covering chest tube insertion site is intact, water seal is maintained, and chest tube remains in place). Movement in bed and ambulation with a chest tube are encouraged according to the child's respiratory status, but children require frequent doses of analgesia. Supplemental oxygen may be required in the acute phase of the illness and may be administered by nasal cannula, face mask, flow-by, or face tent. The child should be positioned on the left side, not the right. Lying on the affected side if the pneumonia is unilateral ("good lung up") splints the chest on that side and reduces the pleural rubbing that often causes discomfort. The chest tube should never be clamped; this can cause a pneumothorax. The chest tube should be maintained to the underwater seal at all times.

A parent asked the nurse how it will be determined if the child has RSV which is the nurses best response a. We will do a simple blood test to determine whether your child has RSV b. There is no specific test for RSV the diagnosis is made based on the child's symptoms c. We will swap your child knows and send that specimen for testing d. We will have to send a viral culture to an outside lab for testing

C

And 11-month-old was born at 28 weeks gestation and require two weeks of ventilation the baby is currently well and is being seen in the clinic the position recommends that the baby receive preventative therapy for RSVP for the next five months since winter is approaching which medication will be ordered a. RSV immunoglobulin b. ribavirin c. palivizumab (synagis) d. pneumococcal vaccine

C

the nurse is planning care for an infant with bronchiolitis. what is the nurses priority intervention for this child a. position the infant with the head elevated b. monitor intake and output c. assess respiratory status frequently d. incorporate parents into the childs care

C

the nurse is teaching home care to the parents of a child with bronchiolitis. what is the most important information for the nurse to provide a. place the child in a prone position for comfort b. use warm mist to replace insensible fluid loss c. recognize the signs of increasing respiratory distress d. engage the child in many activities to prevent developmental delay

C

It is generally recommended that a child with acute streptococcal pharyngitis can return to school: a. when sore throat is better. b. if no complications develop. c. after taking antibiotics for 24 hours. d. after taking antibiotics for 3 days.

C After children have taken antibiotics for 24 hours, they are no longer contagious to other children. Sore throat may persist longer than 24 hours after beginning antibiotic therapy, but the child is no longer considered contagious. Complications may take days to weeks to develop.

A child is diagnosed with influenza, probably type A disease. Management includes which recommendation? a. Clear liquid diet for hydration b. Aspirin to control fever c. Amantadine hydrochloride (Symmetrel) to reduce symptoms d. Antibiotics to prevent bacterial infection

C Amantadine hydrochloride may reduce symptoms related to influenza A if administered within 24 to 48 hours of onset. It is ineffective against type B or C. A clear liquid diet is not necessary for influenza, but maintaining hydration is important. Aspirin is not recommended in children because of increased risk of Reye syndrome. Acetaminophen or ibuprofen is a better choice. Preventive antibiotics are not indicated for influenza unless there is evidence of a secondary bacterial infection.

Which drug is considered the most useful in treating childhood cardiac arrest? a. Bretylium tosylate (Bretylium) b. Lidocaine hydrochloride (Lidocaine) c. Epinephrine hydrochloride (Adrenaline) d. Naloxone (Narcan)

C Epinephrine works on alpha and beta receptors in the heart and is the most useful drug in childhood cardiac arrest. Bretylium is no longer used in pediatric cardiac arrest management. Lidocaine is used for ventricular arrhythmias only. Naloxone is useful only to reverse effects of opioids.

A nurse is teaching an adolescent how to use the peak expiratory flowmeter. The adolescent has understood the teaching if which statement is made? a. "I will record the average of the readings." b. "I should be sitting comfortably when I perform the readings." c. "I will record the readings at the same time every day." d. "I will repeat the routine two times."

C Instructions for use of a peak flowmeter include standing up straight before performing the reading, recording the highest of the three readings (not the average), measuring the peak expiratory flow rate (PEFR) close to the same time each day, and repeating the entire routine three times, waiting 30 seconds between each routine.

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which disease or assessment findings may develop? a. Cough b. Osteoporosis c. Slowed growth d. Cushing syndrome

C The growth of children on long-term inhaled steroids should be assessed frequently to assess for systemic effects of these drugs. Cough is prevented by inhaled steroids. No evidence exists that inhaled steroids cause osteoporosis. Cushing syndrome is caused by long-term systemic steroids.

a charge nurse is assinging pateints on a pediatric unit. the nurse should most avoid assigning the same nurse to care for a 2yo with RSV and a. an 18mo with RSV b. a 9yo 8 hours postappendectomy c. a 1yo with a heart defect d. a 6yo with sickle cell crisis

C (2yo are most at risk for RSV, pairing with other RSV children is idea, older children are less likely to get it)

How will a child with respiratory distress and stridor and who is diagnosed with RSV be treated a. IV antibiotics b. IV steroids c. Nebulized racemic epinephrine d. Alternating doses of Tylenol and Motrin

C (mucosal vasoconstriction)

the nurse in the ER is caring for a toddler with dx of bronchiolitis. which sign/symptom should this nurse anticipate during his assessment. select all that apply a. heart rate of 157 b. temp of 101.8 c. subcostal retractions d. poor feeding e. diarrhea

C, D

a nurse is teachign parents of an infant with bronchiolitis how to bulb suction. which statement should be included a. feed the infant 20 minutes prior to stuctioning b. place the infant in a head down position c. suciton as often as the infant seems to need it d. repeat the suctioning process several times until most of the mucus is removed

D

in preparation for discharge, the nurse teaches the mother of an infant diagnosed with bronchiolitis about the condition and its treatment. which statement by the mother indicates successful teaching a.i need to be sure to take my childs temperature every day b. i hope i do not get a cold from my child c. next time my child gets a cold i need to listen to his chest d. i need to wash my hands more often

D

Which frequency is recommended for childhood skin testing for tuberculosis (TB) using the Mantoux test? a. Every year for all children older than 2 years b. Every year for all children older than 10 years c. Every 2 years for all children starting at age 1 year d. Periodically for children who reside in high-prevalence regions

D Children who reside in high-prevalence regions for TB should be tested every 2 to 3 years. Annual testing is not necessary. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present

Pancreatic enzymes are administered to the child with cystic fibrosis (CF). Nursing considerations should include to: a. not administer pancreatic enzymes if child is receiving antibiotics. b. decrease dose of pancreatic enzymes if child is having frequent, bulky stools. c. administer pancreatic enzymes between meals if at all possible. d. pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

D Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole. Pancreatic enzymes are not a contraindication for antibiotics. The dosage of enzymes should be increased if child is having frequent, bulky stools. Enzymes should be given just before meals and snacks.

Which drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a. Ephedrine b. Theophylline c. Aminophylline d. Short-acting β2 agonists

D Short-acting β2 agonists are the first treatment in an acute asthma exacerbation. Ephedrine is not helpful in acute asthma exacerbations. Theophylline is unnecessary for treating asthma exacerbations. Aminophylline is not helpful for acute asthma exacerbation.

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which intervention should be included in the child's care? (Select all that apply.) a. Place in a mist tent. b. Administer antibiotics. c. Administer cough syrup. d. Encourage to drink 8 ounces of formula every 4 hours. e. Cluster care to encourage adequate rest. f. Place on noninvasive oxygen monitoring.

D, E, F Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. Clustering of care promotes periods of rest. The use of noninvasive oxygen monitoring is recommended. Mist tents are no longer used. Antibiotics do not treat illnesses with viral causes. Cough syrup suppresses clearing of respiratory secretions and is not indicated for young children.

Diagnosis of asthma

DX procedures: -pulmonary fx tests -PEFR -Skin prick -Chest xray -CBC (^WBC) DX based on symptoms: -intermittent: 2 or less/week -mild persistent: > 2x/week -moderate persistent: every day -severe persistent: continuous

tonsillectomy what do you do if pt vomits bright red blood

FIRST turn patient on their side to prevent aspiration and then notify HCP

How to position a pt with RSV

HOB 30-45 degrees, neck slightly extended to maintain open airway (decreases pressure on diaphragm)

What causes epiglottitis?

Haemophilus influenzae type B (can be prevented by vaccinations during the 2-4 month visit) rarely seen in vaccinated children

Anticholinergics

Ipratopium, Atrovent -block PNS -relieve acute bronchospasms -administer prior to exercise

Leukotrine Receptor Agonist

Montelukast/Singulair -decrease airway resistance

Tonsillectomy what to monitor before surgery

PTT

Corticosteroid

Prednisone, Solumedrol, Flovent,fluticasone -decrease airway inflammation -inhaled daily as preventative measure -rinse mouth out afterwards to avoid thrush -take oral w/ food -drink plenty of fluids -watch for redness, sores in mouth, white patches (thrush)

the nurse is caring for a 7mo with bronchiolitis. which symptoms would the nurse expect to find during his assessment. select all that apply a. wheezing b. rr of 46 c. HR of 128 d. RR of 68 e. hr of 82 f. poor feeding

a,c,d,f

what kind of trait is cystic fibrosis

autosomal recessive trait

what to avoid with chest physiotherapy

avoid meals or snacks 1 hour before or 2 hours following to prevent GI upset

what does croup sound like

barking cough, stridor

Smallest airway diameter

child: cricoid ring, below cords adult: vocal cords

Asthma

chronic childhood inflammatory disorder of the airways that equals intermittent and reversible airflow obstruction of the bronchioles

What precautions is used for RSV

contact precautions (wash hands, gown, gloves) NOT airborne do NOT need a mask

RSV how do you breastfeed

continue breastfeeding with additional fluids

What specific s/s is seen with epiglottitis

drooling

Risk factors for asthma

family hx of asthma or allergies gender (more boys until adolescence then more girls) exposure to smoke low birth weight obesity

s/s of airway position with croup

leaning forward while supported by arms, chin thrust out, mouth open

tonsillectomy highest risk for aspiration during surgery

loose teeth

how is testing done for RSV

nasal or nasopharyngeal secretions

What can asthma cause at night

night coughing until they vomit

cystic fibrosis diet

pancreatic enzymes within 30 minutes of meals and snacks high protein high carb diet increase salt and water intake during hot weather, exercise, and fever CPT and exercise in daily routine

what systems does cystic fibrosis affect

respiratory, GI, reproduction

What are the asthma rescue medications

short acting beta 2 agonist (bronchodilator) anticholinergic (relief of acute bronchospasm) systemic corticosteroids

tonsillectomy post op position

side-lying or prone No suctioning

what area of the chest would the nurse monitor for suprasternal retractions in an infant diagnosed with bronchiolitis

suprasternal retractions

what test is used for cystic fibrosis

sweat chloride test positive if >60

what is the best position for epiglottitis

tripod position

Croup what position

tripod-position= airway obstruction

Cystic fibrosis breathing exercises and postural drainages

twice daily postural drainage 1st and then breathing exercises will assist with expectoration

Upper vs lower airway obstruction

upper: stridor (gasping to get air) lower: wheezing (high pitched, breathing through a straw)

what to teach parents with RSV

use saline nose drops and suction the nares