Pediatrics Exam 2 - Respiratory
Some clinical manifestations of the ________ are fever/chills, cough/hoarseness
influenza
LTB tends to occur in ________ children
young
In a conscious choking child, make attempts to relieve the obstruction only if the child is ________ (3)
- Unable to make any sounds - The cough becomes ineffective - The child has increasing respiratory difficulty with stridor.
Some clinical manifestations of CF include ________
- bulky frothy, foul stools - malabsorption & maldigestion - pancreatic insufficiency - delayed puberty and sterility - Failure to thrive
Acute Spasmodic Laryngitis can be managed at ________, and it is very important to keep the child ________, and under high ________
Home; hydrated; humidity
Some interventions to ease respiratory efforts are O2, ________, suction, and ________
Humidity; CPT
Some characteristics of CF include ________
- Abnormal chloride movement - ↑ Viscosity of mucous gland secretions - mechanical obstruction in glands and ducts.
Three clinical observations predictive of epiglottitis are ________
- Absence of spontaneous cough - Presence of drooling - Agitation
What are the three functions of the eustachian tube? (3)
1. Protection of the middle ear from nasopharygeal secretions 2. Drainage of secretions produced in the middle ear into the nasopharynx 3. Ventilation of the middle ear to equalize air pressure
Suctioning a children should be < ________ with 30 - 60 seconds rest periods, while hyper-oxygenating between
10 seconds
RSV's peak incidence is between ________
2 to 7 months
Acute Nasopharyngitis usually resolves on its own within ________
4 to 10 days
Suctioning an infant should be < ________ with 30 - 60 seconds rest periods, while hyper-oxygenating between
5 seconds
Infants and young children especially those between ________ and ________ of age react more severely to acute respiratory infections than older children
6 months; 3 years (due to the loss of maternal antibodies)
Seasonal allergies are also called ________
Allergic Rhinitis
Airway is obstructed if the ___________ is inflamed due to the smaller structure.
Epiglottis
Acute ________ is considered to be a medical emergency due to it's potential for respiratory ________
Epiglottitis; obstruction
Babies are ___________ breathers.
Nose
________ is an inflammation of the middle ear and is the most ________ illness of early childhood
Otitis Media; prevalent
___________ concentration determine the type of oxygen therapy you will use
Oxygen
________ is an acute viral infection at bronchiolar level
RSV
________ is the most frequent cause of hospitalization in children less than 1 year old
RSV
In management of asthma which medications are often used together to control asthma in short and longterm?
Salmeterol (long) and fluticasone (short) - Long acting bronchodilator w/ anti-inflammatory.
________ is characterized by unexplained death < 1 year old.
Sudden infant Death Syndrome (SIDS)
One treatment for croup is ________
Take them outside in the cold mist/ fog
When an infant's nose is congested, what complications does this cause?
They end up not wanting to eat resulting in nutritional complications.
When suspecting a child having Acute Epiglottitis, you should never examine the ________
Throat
A ________ is a surgical opening in the trachea between the second and fourth tracheal ring. It is done due to upper airway obstruction or for long term ________
Tracheostomy; ventilation
TRUE or FALSE: LTB is the inflammation of the mucosa lining trachea and larynx with narrowing
True
TRUE or FALSE: Many cases of bacterial OM are preceded by a viral respiratory tract infection
True
Most respiratory infections are caused by ___________
Viruses
Central Apnea is when both airflow and chest wall movements are ________
absent
Obstructive Apnea is when airflow is ________ but chest wall motion is ________
absent; present
Acute Nasopharyngitis is equivalent to the ________
common cold
Closely monitor the child's ________ in an oxygen tent
temperature
TRUE or FALSE: Acute OM occurs the first 24 months and occurs frequently in children older than 7 yrs old
False; occurs INFREQUENTLY in children older than 7 yrs old, but it incidence increase at age 5 or 6 when children enter school.
________ is the most common type of croup experienced by children less than 5 years of age
Laryngotracheobronchitis (LTB)
________ Apnea is when both central and obstructive components are present
Mixed
Some respiratory manifestations of CF include ↓ gas exchange, progressive lung dysfunction, frequent ________, and ________ secretions
infections; thick
Early signs of impeding airway obstructions include ↑ HR & RR, ________, ________, and ↑ restlessness
intercostal retractions; nasal flaring
Children with apiglottitis usually ________ worse than they ________.
look; sound
Concentration of oxygen in a ________ is difficult to control and to maintain above ________
oxygen tent (croup tent); 30% to 50%
Children with severe respiratory distress should be ________ to prevent ________ and increased work of breathing
NPO; aspiration
Clinical Manifestations of OM include acute onset of ________, diarrhea, ________, fever, tympanic membrane redness, and middle ear effusion
ear pain (ear pulling); vomiting
Complications of influenza include ________, severe viral pneumonia which can become ________
encephalitis; hemorrhagic
________ is seen primarily in older children
epiglottitis
Some clinical manifestations of Acute Nasopharyngitis in INFANTS are ________, irritability, restlessness, decreased ________, and nasal inflammation
fever; appetite
Some clinical manifestations of Acute Nasopharyngitis in CHILDREN are ________, nasal dryness/________ and muscle aches
fever; discharge
Ways to prevent the spread of infections are ________ and isolation
hand washing
In order to give ________ levels of O2, you need to switch from a NC to ________.
higher; mask
What diagnostic tests are done to find out if the child has CF?
A positive sweat chloride test, absence of pancreatic enzymes
During suctioning vacuum pressure should be between ________ for infants and children
60 to 100 mm Hg
For management of AOM in infants older than 6 months children include waiting up to ________ for ________ resolution
72 hours; spontaneous
Cold fluid or air applied to the face stimulates receptors that trigger the ___________ reflex, which causes ___________ and ___________ of blood from peripheral to central circulation
Driving; Bradycardia; shunting
What cause OM?
Dysfunction of the eustachian tube. Structurally in a child, the tube is much shorter, wider, straighter and more horizontal resulting in increased incidence of obstructions and aspiration/reflux
What are the two most common viruses that are most likely to precipitate OM?
RSV and Influenza
________ is the cause of cardiac arrest in children
Respiratory failure
GI Management of CF include ________ replacement, high protein/calorie diet, ________, vitamins, and relieve intestinal ________ which can lead to rectal prolapse
pancreatic enzyme; lipids, obstruction
Oxygen administration to infants is well tolerated using a ___________, which delivers a flow of ___________
plastic hood; 4 to 5 L/min
Management of influenza include antipyretics, fluids and ________
prevention
Ways to promote rests are age appropriate play and ________
quiet activities
________ is the cessation of respiration
respiratory arrest
___________ are when the baby breathes and their diaphragm/part of the abdomen goes into the thoracic cavity and is a sign of ___________
retractions; respiratory distress
Some interventions for management of asthma include avoiding ________, CPT, hyposensitization, meds, and ________
triggers; Peak expiratory flow (PEF)
Large amounts of bloody secretions in a child with a tracheostomy are ________ and should be considered a sign of ________
uncommon; hemorrhage
Some clinical manifestations of LTB are ________
- Low grade fever (gradual onset) - Inspiratory stridor - Suprasternal retractions - Barking or "seal-like" cough/hoarseness - Increasing respiratory distress and hypoxia
What are the organisms responsible for LTB (4 kinds)
- RSV - Parainfluenza virus - Mycoplasma pneumoniae - Influenza A & B
Some clinical manifestations of respiratory failure are ________
- Restlessness - Tachypnea/Tachycardia - Diaphoresis - Increased respiratory difficulty - Retractions/grunting, wheezing
What are some signs of respiratory distress?
- Retractions - Nasal flaring, grunting - Restlessness - Diaphoresis - Position - Head bobbing
What about the anatomy of the pediatric lungs are different from adults?
- Size of airway are small and swell/clog really quickly. - Upper respiratory infections can lead to lower respiratory infection due to the close proximity of each other. - Frequent infections - Resistance is lower
________ are paroxysmal attacks of laryngeal obstructions the occurs at night and most often affects children ages ________
Acute Spasmodic Laryngitis (Spasmodic Croup); ages 1 to 3 years old
All cases of AOM in infants younger than 6 months should be treated with ________, Why?
Antibiotics; Because of their immature immune system and potential for infection of other bacteria.
Management of Acute Nasopharyngitis includes rest, ________, elevate HOB, Saline drops/suctioning, adequate and ________.
Antipyretics; fluid intake
________ is the cessation of breathing for more than 20 seconds or for a shorter period when associated with hypoxemia or ________
Apnea; Bradycardia
________ is a chronic inflammatory disorder of the airways
Asthma
One assessment of asthma includes looking at speech patterns, why?
Because how much they can say is how much they can breath.
Some clinical manifestations of asthma include ________ wheeze, decreased ________, SOB, and tripod positioning
Expiratory; breath sounds
Cardiac arrest is less often a ___________ origin, but rather of prolonged ___________ secondary to ___________ oxygenation, ventilation and circulation (shock).
Cardiac; hypoxemia; inadequate
___________ is a result of ___________ poor tissue perfusion
Clubbing; chronic
True or False: Sucking relieves pain in Otitis Media
False - sucking/chewing aggravates pain resulting in a decrease in apetite
TRUE or FALSE: LTB and epiglottitis occur together
False: They do not occur together.
________ is a general term applied to a group of symptoms characterized by hoarseness, a "barking" cough, inspiratory stridor, and obstruction of the larynx
Croup
________ is characterized by exocrine gland dysfunction that produces multisystem involvement
Cystic Fibrosis
In infants, not being able to pass their first meconium stool predisposes them of having ________, obstruction leads to the formation of meconium ________
Cystic fibrosis: ileus
TRUE or FALSE: A chest X-ray can diagnose asthma
False: a CXR does not Dx Asthma but is done to r/o other diseases
When performing emergency care for a child you can perform the ___________, which is recommended for children older than 1 years old.
Heimlich
By age 5, incidence of viral respiratory tract infections are less frequent, but the incidence of ________ and ________ infections increase
M. pneumoniae; Group A Beta Hemolytic Strep. (GABHS)
The ME is ROME for acid base mnemonic stands for ________
Metabolic Equal pH ↑ HCO3 ↑ = ALKALOSIS pH ↓ HCO3 ↓ = ACIDOSIS
________ is a common therapeutic measure for symptomatic relief of respiratory discomfort and is beneficial when there is ________ and laryngeal. Why?
Warm or cool Mist; hoarseness; because moisture soothes inflamed membranes
The RO in ROME for acid base mnemonic stands for ________
Respiratory Opposite pH ↑ PCO2 ↓ = ALKALOSIS pH ↓ PCO2 ↑ = ACIDOSIS
________ is the inability of the respiratory apparatus to maintain adequate gas exchange
Respiratory failure
When performing emergency care for an infant, you can perform a series of ___________
back blows
influenza is most infectious for 24 hours ________ and ________ the onset of symptoms
before; after
Children are often ___________ breathers, due to their weak ___________ muscles
belly; abdominal
Respiratory management for CF include CPT, ________, O2, anti-inflammatory agents, aggressive treatment of ________ and transplantation
bronchodilators, infections
Possible treatments of RSV include ________ isolation, high humidity NC, ________, fluids, and meds (INH Epi, corticosteroids, ribavirin)
cohort; suction
Influenza is transmitted through ________ and has an incubation period of ________
direct contact; 1 to 4 days
When administering oxygen, always ________ it to children
humidify
An indication for oxygen administration is ___________
hypoxemia
Ways to help promote comfort are ________, throat gargles, and nasal ________
nose drops; aspirators
To help prevent acute OM, avoid ________, breastfeed, and get the child immunized for ________
smoke; influenza
Children with LTB ________ worse than they ________
sound; look
Usual airway obstructions are due to ___________
structural
