Exam 1: Peds respiratory

How can you prevent epiglotittis?

Hib vaccine

**What is the black box warning for montelukast(singulair)?

can cause aggression in kids

Why are infants chests unable to support lungs like firmer adult ribs and sternum?

chest wall is very flexible

What is the therapeutic management of croup?

-cool mist vaporizer -nebulized racemic epinephrine -steroids -saline to nose if congestion -educate and reassure parent

What are nursing considerations for pertussis?

-droplet precautions -monitor O2 -supportive care (NG if unable to tolerate feedings)

How can nurses promote comfort with respiratory distress?

-ease anxiety through communication -positioning

How can the family support a. child with bronchiolitis?

-educate on droplet and standard precautions -removal of secretions -alterations in fluid intake -monitor status

How can the family support a child with acute infectious pharyngitis?

-education on when antibiotics are appropriate -change toothbrush. daycare/school return

What are possible complications of pneumonia?

-empyema -pneumothorax -pleural effusion -abscess -bacteremia

What are the clinical manifestations of influenza?

-fever -chills -body aches -runny nose -cough -diarrhea -fatigue

What are the clinical manifestations of TB?

-fever -malaise -anorexia -weight loss -cough -diminished breath sounds -pallor -weakness -night sweats

What are symptoms of mononucleosis?

-fever -malaise -sore throat -lymphadenopathy -transmitted by oropharyngeal secretions

How can you prevent acute nasopharyngitis?

-frequent handwashing -avoid sick contacts

How can you prevent pneumonia?

-handwashing -respiratory precautions -Prevnar-13: vaccine for pneumococcal bacteria

What are contributing factors to respiratory disorders?

- child's age: immature immune system and smaller airways - socioeconomic status: access to healthcare and good nutrition, poor living conditions - general health status: pre-existing conditions - season- fall and winter most prominent

What should you assess for when listening to lung sounds?

- equal and present -wheezing (high-pitched usually on expiration) - rales (crackling sound)

How should you auscultate lung sounds?

- leave child in caregivers arm if already there, keep them as calm/comfortable as possible - distract when needed

What parts of the mouth a proportionally larger in infants?

- tongue - tonsils - adenoids

What are the clinical manifestations of broncholitis>

-**rhinorrhea (mucos) -pharyngitis -coughing -wheezing -low-grade fever -retractions -apnea

What is pertussis?

-*highly contagious acute respiratory illness aka whooping cough

What is the GI management for CF?

-*pancreatic enzyme replacement to help break down fats: pancrelipase (pancrease, Creon) -*well balanced diet, high protein, high calories

What are the symptoms for pertussis?

-*paroxysmal cough (whooping cough) -copious secretions

What are potential complications of mononucleosis?

-*splenic rupture- no contact sports for 3 weeks -Guillain-Barre syndrome -aseptic meningitis- s/s but not bacterial -viral hepatitis -*increased risk of some type of cancers -rash with antibiotics

what is the diagnostic evaluation for broncholitis?

-ELISA assay -IFA staining -chest xray to show hyperinflation in the lungs, but is not routinely recommended

What is the diagnostic evaluation for asthma?

-PFTs -PEFR -skin testing or RAST for allergy triggers -chest x-ray (hyperinflation)

What are casuses of acute nasopharyngitis (common cold)?

-RSV -rhinovirus -adenovirus -enterovirus -influenza -parainfluenza virus

What are the diagnostic tests for TB?

-TB skin tests -chest x ray -cultures

What are. the clinical manifestations of epiglottitis?

-abrupt onset -starts with fever/sore throat -progression to drooling, anxiety, irritability, respiratory distress

What is the therapeutic management for TB?

-adequate nutrition -Isoniazid -rifampin and pyrazinamide daily -prevent exposure to other infections -airborne isolation with negative pressure room for active/infectious

How can you prevent acute otitis media?

-breastfeed infants if possible -*avoid second hand smoke -routine childhood immunizations

What age group does croup primarily effect?

-children 3 months to 3 yo

What patient population is most vulnerable to developing pertussis?

-children under 1

What should children with recurrent pneumonia be screened for?

-chronic lung diseases such as CF and asthma

What are the therapeutic manifestations of epiglottitis?

-comfort position -oxygen in least invasive manner -prepare for intubation -intensive observations -corticosteroids -antibiotics

What are complications of pertussis?

-hypoxia -apnea -pneumonia -seizures -encephalopathy -death

What is the ratio of alveloi in an infant to and adult?

150 million: 300 million - infants have approx half the amount of an adult

What is the chance a child is born with CF if both parents carry the gene?

25%

When does the reflex to open mouth when nose is obstructed?

3-4 months

What is the durations of influenza?

4-5 days.

What is the median age for CF patient survival?

46

What is the size of an infant trachea?

4mm wide

How can you prevent bronchiolitis?

Palivizumab (Synagis)- only if meet criteria. Given once monthly during RSV season

What is a long term complication of asthma?

airway remodeling

What medication is prescribed for children with strep induced pneumonia?

amoxicillin

What is asthma?

chronic inflammation of airways characteristic of airway hyperresponsiveness, airway edema, mucus production

what part of the ear does acute otitis media effect?

middle ear

What should you do when a childs nasal cavity is obstructed?

saline and suction

Why are infants more susceptible for acute otitis media?

shorter and more horizontal eustachian tubes

How can an infants hydration status be affected by poor breathing?

to much effort to suck bottle while trying to breathe

Is the prevalence of asthma increasing or decreasing?

increasing -possibly d/t urbanization, increased air pollution and more accurate diagnosis

What is the cause of epiglottitis?

H. influenza B

**What is the stepwise approach?

increasing medications as condition worsens then reducing as symptoms improve -every asthma kid has an asthma action plan -if in hospital patient and family will tend an asthma class

**What should you have bedside for an epiglottitis patient?

intubation supplies

Is cyanosis a late or early sign?

late

What condition is a medical emergency?

epiglottitis

How often should you administer saline for a nasal obstruction?

every diaper change

What are symptoms of acute otitis media?

fever and pain

What are clinical manifestations for acute nasopharyngitis?

-more severe in infants and children than adults -nasal mucus (abundant) causing mouth breathing -irritability/restlessness -fever is common in young and older children -*duration is 7-10 days

What are causes of acute infectious pharyngitis?

-multiple viruses -group a B-hemolytic streptococci (GABHS)

What is the diagnostic eval for CF?

-newborn screening (heel stick) -*sweat chloride test -chest x ray -PFTs -stool fat or enzyme analysis

What patient population is at the most severe risk for influenza?

high risk children with chronic conditions

What is the theraputic management for acute infectious pharyngitis?

-oral penicillin, azithromycin or cephalosporin if allergic to PCN -pain management -encourage fluid intake -saline gargles -lozenges -cool liquids

How is hydration promoted with repiratory distress?

-oral rehydration solutions -clear nose first with saline and suction -IV fluid hydration if unable to tolerate PO

What are the clinical manifestations acute infectious pharyngitis?

-pharyngitis -headache -abd pain -faver

What are observations that should indicate a screening for CF?

-pneumonia more than 4 times -short stature

What is the theraputic management for pneumonia?

-promote oxygenation -position of comfort -fluids -family support -antibiotics if bacterial -pulse ox

What is the pulmonary management for CF?

-provide CPT -percussion, vibration, and postural changes -positive expiratory pressure mask -breathing exercises -physical exercises -medications -prompt tx of respiratory infections

What is the diagnostic evalulation for acute infectious pharyngitis?

-rapid strep test -throat culture

What are the clinical manifestations of asthma?

-recurrent cough -SOB -wheezing -exercise intolerance -hypoxia

How can the family help support a child with influenza?

-relieving symptoms -limiting spread of flu -education on how to treat fevers -when to call physician

What are nursing measures for COVID-19?

-respiratory assessment -*monitor for sign of multisystem inflammatory syndrome (MIS-C): -*rash,erythema, and edema in hands/feet -conjunctivitis without exudate -AMS, lethargy -*hypotension

What is the therapeutic management for acute nasopharyngitis?

-rest -cool mist humidifier -fluids -decongestants -elevate HOB -saline to nose -bulb syringe suction -hand washing -family support and education

What are complications of strep throat?

-rheumatic fever -*acute glomerulonephritis -*peritonsillar or retropharyngeal abscess (behind of on tonsil, **deviated uvula indicates presence of abscess)

What are the clinical manifestations of CF?

-salty taste of skin, alterations in electrolyte balance and dehydration -meconium ileus -*bulky, greasy stools -pancreatic enzyme activity is lost, malabsorption of nutrients, failure to thrive -mucus plugs in small airways -chronic of recurrent respiratory infections -decreased fertility

What are complications from influenza?

-secondary bacterial infections (OM, sinitus, pneumonia) -myositis (pain and tenderness in legs/refusal to walk)

Why are children under 1 most vulnerable to pertussis?

-smaller airways -havent has all vaccines

How do we prevent spread of infection with respiratory disorders?

-strict hand washing -proper sneeze/cough technique

What are clinical manifestations of croup?

-stridor -retractions -nasal flaring -barky or seal like cough -hoarseness -tachypnea -slight increased temp -mild URI symptoms -symptoms often at night -lasts 3-5 days

What is the therapeutic management for influenza?

-symptomatic -antipyretic med -antiviral influenza med -honey for cough in children < 2 yo

What is the tx for mononucleosis?

-symptomatic care -NSAIDs -lozenges -saltwater gargles -NO antibiotics unless ear infection is developed

What is the cause of pneumonia?

-viral -bacterial -fungal -aspiration

What is the cause of broncholitis?

-viral -most common RSV

What are clinical manifestations of pneumonia?

-viral is generally better tolerated while bacterial may be more toxic appearing -high fever -cough -tachypnea -crackles -malaise -lethargy -anorexia -abd pain -CXR: diffuse or patchy irritation

What are ways to ease respiratory efforts?

-warm or cool mist -oxygen -saline nasal spray

What is the incubation period for pertussis?

6-21 days

What causes mononucleosis?

Epstein-Barr virus

what issue are we worried about with a muffled voice?

pharyngeal

What disorders are the most common cause of illness and hospitalization in children?

repiratory

How would a child who is attempting to manage secretions present?

tripod sitting and drooling

What is the admission criteria for broncholitis?

unable to maintain adequate hydration and feeding

How can pertussis be prevented?

vaccination

What is the cause of TB?

very contagious -incubation of 2 to 10 weeks

What are common tests used for children with repiratpry distress?

-allergy skin test -ABGs -fluorescent antibody testing (flu) -gastric washing for AFB (TB) -peak expiratory flow (asthma) -pulmonary function test (asthma, CF) **-RAST (radioallergosorbent test): blood test for food allergy, find asthma triggers -Sweat chloride test (CF test *gold standard)

What is the therapeutic management for asthma?

-avoid asthma triggers -reduction of inflammatory episodes -keep child active

How can you prevent TB?

-avoid contact with tubercle bacillus -increased incidence in crowded living conditions, HIV+

**What are potential complications of acute nasopharyngitis?

-bacterial infection of the ears, throat, sinuses, or lungs -pneumonia -sinus infection

What is the therapeutic management for bronchiolitis?

-humidified oxygen -fluids -*airway maintenance -saline to nose -*suction -positioning -medications -handwashing -contact iso -pulse ox -monitor RR and rhythm

What are observation for deterioration of repiratory status?

-increased WOB -fatigue -change in mental status -new onset not eating or drinking

What are characteristics of Group A strep throat?

-inflamed tonsils with exudate -**sandpaper rash (scarlatina), cervical lymphadenopathy with tenderness, pain (usually found on torso but can be on the rest of the body)

How do you prevent influenza?

-influenza vaccines

what is the cause of influenza?

-influenza virus -spread by inhalation of droplets or contact with fine particle aerosols

What are the goals of management for CF?

-minimize pulmonary complications -maximize lung function -ensure adequate nutrition for growth -prevent infection -coping and adjustment by child and family

What does stridor sound like?

High-pitched, inspiratory

What is tx for acute otitis. media?

antibiotic if bacterial, viral wi;ll resolve without treatment

What medication is prescribed for mycoplasma caused pneumonia?

arythromycin

What age do babies use obligate nose breathing?

at LEAST 4 weeks

What are the 3 A's?

atopic dermatitis, asthma, allergies

*What is the treatment for pertussis?

azithromycin

how often should you use saline AND suction for a nasal obstruction?

before every meal

What is common complaint by children with pneumonia?

belly pain

what is the diagnostic tool for pertussis?

bordetella pertussis PCR

With what disease do you see stridor?

croup

why has there been an increase in cases of pertussis?

decreased vaccination rates

Due to the smaller area for gas exchange what is the child at risk for?

increased r/o hypoxia

What is the patho of Cf?

increased viscosity of secretions from sweat glands, GI tract, pancreas, respiratory tract and other exocrine tissues

What is the causative agent for pneumonia in school aged children and adolescents?

mycoplasm

*what is the hallmark sign for TB?

night sweats and unexplained weight loss

*What type of obligate breathing do newborns partake in?

nose breathing

*Is the trachea bigger or smaller in a pediatric pt in comparison to an adult?

smaller

*What position should you place a nose-breathing baby in?

sniffing position

What seasons is bronchitis most common in?

spring and winter

What is the causative agent for pneumonia in infancy/toddler?

strep

When do you use racemic epi?

stridor -watch for 2 hours for rebound

What is typically the first sign of respiratory illness?

tachypnea

What is the progression of repiratory distress?

tachypnea --> retraction/nasal flaring--> cyanosis