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
