Peds Respiratory

Management/nursing care for a smoke inhalation injury

100% humidified oxygen monitor for resp distress/impending failure monitor VS and resp status frequently Bronchodilators/humidified oxygen/corticosteroids CPT/postural drainage

What are early signs of respiratory distress in children?

nasal flaring grunting (sound like they're singing) restlessness retractions increased resp and pulse diaphoresis head bobbing cyanosis and pallor alterations in mental status see-saw?

What should you not do if you suspect a child has epiglottitis?

no attempts should be made to visualize the posterior pharynx, obtain a throat culture, or take an oral temperature. Otherwise, spasm of the epiglottis can occur, leading to complete airway occlusion

Education for mono (with splenomegaly)

no contact sports until spleen is calmed down fatigue is going to last for several weeks

By what age are kids fully vaccinated and immune to pertussis

one years old

Why is treatment important for a pt who has tonsillitis due to streptococcal bacteria?

pt is at risk for developing acute glomerulonephritis or rheumatic heart disease

Where would you place an RSV child on the floor at the hospital and with what kind of nurse would the patient go to?

put them in isolation with contact precautions Preferably with a nurse who have no responsibility for any other children to prevent transmission of the virus

What parts of the body are predominately affected by cystic fibrosis

respiratory system, GI, and pancreas

smart people word for runny nose

rhinorrhea

Clinical manifestations of RSV/bronchiolitis

rhinorrhea (runny nose) low grade fever conjunctivitis OM cough

Highest incidence for whooping cough

spring and summer

Signs of dehydration in kids

sunken fontanel (infants) nonelastic skin turgor, decreased and concentrated urinary output, dry mucous membranes decreased tear production

define a systemic injury r/t smoke inhalation

systemic injury comes from gases that are not toxic to airway but are to the rest of the body such as carbon monoxide (CO)

What are some ways to avoid aspiration pneumonia

talcum powders no chocking hazard foods no bottle propping or force feeding check NG placement

Education for OM

teach parents to get child to lie on affected side avoid exposure to second-hand smoke discourage bottle feeding when the child is in supine position

How is RSV spread

through contact. Virus can live on hands for several minutes and on hard surfaces for several hours

At what age do children usually get RSV

under one infant age

How you monitor for bleeding in a child who just had a tonsillectomy?

watch for frequent swallowing and clearing of throat If the vomit blood then of course they are bleeding

Pt c/o headache, fever, abdominal pain. Uvula is red and edematous and pt has strawberry tongue. What would you suspect the pt has?

acute infectious pharygitis

AKA the common cold

acute viral nasopharyngitis

therapeutic management for laryngotracheobronchitis

airway hydration *nebulized mist with supplemental O2* *nebulizer treatments: epinephrine (rapid acting bronchodilator), steroids

When does acute spasmodic laryngitis usually occur

at night. paroxysmal attacks of laryngeal obstruction

Which type of pneumonia has more of an acute onset

bacterial

purulent secretions that result in respiratory distress; similar to LTB and epiglottitis

bacterial tracheitis; infection of the mucosa of the upper trachea

Why is epiglottitis considered an emergency situation?

because it can progress rapidly to severe respiratory distress

What should you never do with a foreign body aspiration?

blind sweep! (never try and get it out by yourself )

Late signs of respiratory distress in children

bradycardia, extreme restlessnes, severe dyspnea

Treatment for foreign body aspiration

bronchoscopy/endoscopy

What vaccine can help prevent epiglottitis?

Hib vaccine B

What is acute respiratory distress syndrome?

characterized as respiratory distress and hypoxia after serious injury or surgery (sepsis, trauma, drug OD, near drowning) Occurs within 1 week of known incident high mortality rate

teaching for breathing at home for laryngotracheobronchitis

Instruct the parents to use a cool air vaporizer at home; other measures include having the child breathe in the cool night air or the air from an open freezer or taking the child to a cool basement or garage

What type of children usually get pertussis?

children who have not been immunized

How long is pertussis considered contagious

contagious for 5 days and then they can be taken out of quarantine after that

Why can't kids with the flu take aspirin

could cause Reye's syndrome (swelling of the liver and brain uh uh no thank you)

What are the general clinical manifestations of nasopharyngitis in younger children? Select all that apply. Fever Irritability Vomiting Sneezing Diarrhea Muscular aches

Rationale The general clinical manifestations of nasopharyngitis in younger children include fever, irritability, sneezing, vomiting, and diarrhea. Muscular aches are a clinical manifestation of nasopharyngitis for older children.

Three clinical observations that are predictive of epiglottitis

*absence of spontaneous cough* *presence of drooling* *agitation* voice is thick and muffled "croaking" assuming upright sitting position with chin out and tongue protruding ("tripod position")

characterized by hoarseness, "barking" cough, inspiratory stridor, and varying degrees of respiratory distress; affects larynx, trachea, and bronchi

croup syndrome

clinical manifestations of OM

crying, fussiness, restlessness, irritability (especially on lying down) bulging/full/reddened tympanic membranes *tendency to rub, hold, or pull affected ear (infants) rolls head from side to side lethargy loss of appetite *have high fevers*

Precautions for flu?

droplet

What kind of precautions for pertussis

droplet

clinical manifestations of bronchitis

dry hacking nonproductive cough worsens at night fever

drug of choice for acute asthma attack

epinephrine HCL INH; albuterol, xopenex, terbutaline it's a rapid acting bronchodilator;

When is the highest risk for hemorrhage after a tonsillectomy?

first 24 hours and 5 to 10 days after surgery

Define cystic fibrosis

increased viscosity of mucous gland secretions elevation of sweat electrolytes (defective exocrine glands; overproductive) Increase in enzymatic constituents of saliva autonomic nervous system abnormalities *autosomal recessive trait* patho in lecture notes

clinical manifestations for laryngotracheobronchitis

inspiratory stridor "seal-like" coughing suprasternal retractions

most common of croup syndromes

laryngotracheobronchitis

Hallmark sign for RSV

lots of snot use bulb syringe for suctioning if it gets too bad

At what age can a child have the flu vaccine?

6 months or above

What is the maximum amount of time you are allowed to use decongestant drops?

72 hours

Discharge teaching for a parents whose child had a tonsillectomy

After tonsillectomy, the client is instructed to advance the diet from cool, clear liquids to full liquids. Hot fluids and carbonated beverages should be avoided because they may be irritating to the throat. Milk and milk products (pudding) are avoided because they may cause the client to cough, which could cause pain at the surgical site. Foods and snacks that are rough in texture, such as raw fruits or vegetables, should be avoided for 10 days to protect the operative site and prevent bleeding. The client should be instructed to rest in bed or on a couch for 24 hours after the surgical procedure and gradually resume full activity.

ABCs for SIDs

Alone, on my Back, in a Crib

what is status asthmaticus?

Life-threatening episode of airway obstruction that is unresponsive to common treatment continuation of respiratory distress despite vigorous therapeutic measures

How do you test for infectious mononucleosis?

Monospot test (blood test to confirm disease)

A child who is at high risk for developing a respiratory emergency is left under the care of an experienced nurse. What assessment findings should the nurse observe for in order to initiate resuscitative measures for respiratory failure? Select all that apply. Tachypnea or rapid breathing Enlarged cervical lymph nodes Tachycardia or rapid heart rate 39.5° C to 40.5° C temperature Hypo- or hypertensive changes Change in level of consciousness

Nursing assessments and judgments are vital in recognizing respiratory emergencies. Appropriate resuscitative measures should be taken. The primary health care provider can initiate suitable measures to decrease the chance of morbidity if informed in time by the nurse. The nurses should initiate resuscitation measures if the child shows a decrease or increase in blood pressure. It is a sign of shock. The nurse should also keep an eye for some cardinal signs of respiratory emergencies, like tachycardia and tachypnea. Resuscitate measures are not required for the child who shows 39.5° C to 40.5° C temperature and enlarged cervical lymph nodes. These are symptoms often observed in the child who is suffering from respiratory infections.

The nurse is educating new parents on how to prevent the occurrence of acute otitis media (AOM) in the child. What preventive measures does the nurse include in the teaching? Select all that apply. Breastfeed the infants for at least 6 months Preventing exposure to secondhand smoke Give the child analgesic drugs as prescribed Discontinue use of the pacifier after 6 months Clean the ear canals with sterile cotton swab

Parents are encouraged to reduce risk factors for AOM by breastfeeding infants for at least the first 6 months of their life. This prevents the occurrence of AOM and reduces any risks. The parents are also informed to discontinue the use of pacifier after six months and prevent the child from getting exposed to secondhand smoke for the same reason. Analgesics are used to treat mild pain in the ear when the child has AOM. It is a treatment measure not a preventative measure. Similarly, the parents have to clean the external ear of their child by using sterile cotton swabs to drain the fluid in the ear but they never go inside the ear canals. It is a treatment measure advised with topical antibiotic treatment.

What disease is the most frequent cause of hospitalizations under one year of age?

RSV and bronchiolitis

The nurse is caring for a 10-year-old child with a severe cold and a runny nose. The patient's parent tells the nurse, "Steam really helps. I plan to use steam vaporizers for the cold." What is an appropriate response by the nurse? "Steam baths can be helpful." "An antibiotic would be better for your child." "Steam vaporizers are the safest for children." "Steam can harm children. Please avoid using it."

Rationale A time-honored method of producing steam is the shower. Running a shower of hot water into the empty bathtub or open shower stall with the bathroom door closed is a quick source of steam. Keeping a child in this environment for approximately 10 to 15 minutes humidifies inspired air and can help relieve symptoms. The use of steam vaporizers in the home is discouraged because of the hazards related to their use and limited evidence to support their efficacy. Steam benefits children if used appropriately. Antibiotics are not known to work for treating every type of cold.

The nurse is teaching a group of students about respiratory infections in children. What statement by a student indicates a need for additional teaching? "Repeated exposure to organisms confers increasing immunity." "Infection rate increases from 3 to 6 months of age." "Two-month-old full-term infants have a lower risk of infection." "Respiratory infections become more frequent by 5 years of age."

Rationale By 5 years of age, viral respiratory tract infections become less frequent as the immune system gets stronger. Repeated exposure to organisms confers increasing immunity as the infant's body remembers the germs. The infection rate increases from 3 to 6 months of age because this is the time between the disappearance of maternal antibodies and the infant's own antibody production. Healthy full-term infants younger than 3 months are presumed to have a lower infection rate than older infants because of the protective function of maternal antibodies.

It is important that a child with group A ß-hemolytic streptococci (GAS) infection be treated with antibiotics to prevent what? Otitis media Diabetes insipidus Nephrotic syndrome Acute rheumatic fever

Rationale Children with group A ß-hemolytic streptococci (GAS) infection are at risk for acute rheumatic fever and acute glomerulonephritis. Otitis media and diabetes insipidus are not sequelae to GAS. Children are at risk for glomerulonephritis, not nephritic syndrome.

The nurse is teaching a group of students about pertussis. The nurse says, "Pertussis and several other respiratory infections are common in young children." What represents the possible etiology for that statement? Select all that apply. Children have small airways. Germs have an affinity for children. Many children do not get vaccinated. Children are exposed to more germs. Children have weaker immune systems.

Rationale Deficiencies of the immune system place children at risk for infection. Anatomic differences influence the response to respiratory tract infections. The diameter of the airways is smaller in young children, and the distance between structures within the respiratory tract is also shorter, so organisms may move rapidly down the respiratory tract, causing more extensive involvement. Children are often exposed to greater variety of germs than are adults. Lack of vaccination usually leads to polio and other such diseases. Germs do not have any greater affinity for children than for adults.

The primary health care provider prescribes a nasal spray for an older child. What precautionary instructions should the nurse provide the parents and the child on the use of the nasal sprays? Select all that apply. "Do not compress the plastic container during inspiration." "Do not share your nasal spray with anyone else in the family." "Do not breathe in the medicated nasal spray with one nostril." "Do not use nasal sprays for more than three consecutive days." "Do not use clean tuberculin syringes to administer nasal spray.

Rationale Most older and cooperative children are easily able to use nasal sprays. However, there are some precautionary measures that need to be taken. The nasal spray should only be used by one child and for one illness because they are easily contaminated with bacteria and viruses. In addition, nose drops or sprays should not be administered for more than 3 days to avoid rebound congestion. The correct way of using the nasal spray is compressing the plastic container at the moment of inspiration. The child will be unable to breathe in the medicine if it is not compressed. During administration of the nasal spray, one nostril is closed up while the child breathes in with the other. This is the correct procedure to administer the nasal spray. To prevent cross-contamination, the nasal spray solution can be drawn into a clean tuberculin syringe and injected into the child's nostrils using the blunt syringe.

Post op care for tonsillectomy

monitor for bleeding encourage fluids: offer them frequent sips because it will be hard for them to swallow a lot at once Administer pain meds bc if they're in pain they won't drink no straws/ no red foods (mimics signs of bleeding)

A 3-year-old child is diagnosed with acute laryngotracheobronchitis (LTB). The graduate nurse asks for help from the senior nurse as the child is extremely restless. What should the senior nurse advise the graduate nurse about managing the care of this child? Select all that apply. "Continuously observe and assess the child's respiratory status." "Plan for immediate intubation or tracheostomy during an examination." "Pulse oximetry should be assessed often to monitor oxygenation status." "Oral steroids should be prescribed and given to treat and manage croup." "Therapy should be adapted based on the child's response and tolerance."

Rationale The most important nursing Intervention for a child with LTB is continuous and vigilant assessment. The nurse can take appropriate measures if the airway narrows due to inflammation of the mucosal lining. Thus the nurse can prevent the condition from worsening. Assessment of the respiratory status using pulse oximetry is necessary. This device is useful and commonly used for monitoring oxygenation status. In addition, therapy should be provided based on the nurses' observations and assessments as well as the child's response to it and tolerance of procedures. These therapies relieve stress, restlessness, and irritability of the child. Though the trend is to provide early intubation to the child based on the nursing observations, it is done by the primary health care provider. Mostly oral steroids are provided for relief and prescribed by the primary health care provider and not by the nurse.

What should be included in a plan of care as nursing interventions for a child admitted with acute otitis media? Select all that apply. Prescribe acetaminophen (Tylenol) for the pain Prevent complications or recurrence of infection Relieve the pain and facilitate drainage of the ear Educate the family and provide emotional support Perform a surgical incision of the affected eardrum

Rationale The primary nursing goals for a child admitted for acute otitis media are relieving pain, facilitating drainage, and preventing complications or recurrence of the infection. It is also important to educate the family about this condition and provide them with emotional support. This is done so that the family can continue the after-care support at home. The nurse does not prescribe medicines for this complication. It is done, as required, by the primary health care provider. Surgical incision of the eardrum, known as myringotomy, is also done by the primary health care provider.

A 5-year-old child is brought to the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? Select all that apply. Vital signs Throat culture Medical history Assessment of breath sounds Emergency airway equipment readily available

Rationale Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis in addition to knowing immunization status. Assessment of breath sounds is important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.

A child is scheduled for a tonsillectomy. The nurse plans care, knowing that which condition would be a priority because it presents the highest risk of aspiration during surgery? Presence of loose teeth Bleeding during surgery Difficulty in swallowing Exudate in the throat area

Rationale: A tonsillectomy is the surgical removal of the tonsils. In the preoperative period, the child should be observed for the presence of loose teeth to decrease the risk of aspiration during surgery. Bleeding during surgery will be controlled via packing and suction as needed. Difficulty in swallowing and exudate in the throat area are incorrect because these are characteristics that may indicate the need for the surgery.

After a tonsillectomy, a child is brought to the pediatric unit. The nurse should appropriately place the child in which position?

The child should be placed in a prone or side-lying position after tonsillectomy to facilitate drainage. The positions in the remaining options will not achieve this goal.

The parents of a child with pertussis ask the nurse about the nursing care and management of their child at home. What should the nurse include in the teaching plan for the parents? Select all that apply. Administer antipyretics Monitor chest tube insertion Encourage adequate hydration Provide adequate psychological support Administer a dose of palivizumab (Synagis)

The child with pertussis would need proper nursing care at home. Therefore the parents need to be taught about the supportive care necessary for their child. The parents must encourage their child to have enough fluids to prevent dehydration. The parents should administer antipyretics as prescribed by the primary health care provider for the fever. When the coughing spasms occur in small children with pertussis, they get easily frightened and would require adequate psychological support. Psychological support can reduce the anxiety and promote assurance. It also creates a favorable environment around the child. The nurse will not need to administer palivizumab. It is administered in the child born before 32 weeks' gestation period to prevent hospitalization associated with respiratory syncytial virus (RSV). Chest tube insertions are done in the hospital, and the nurse is responsible for monitoring this device.

Cystic fibrosis presentation

wheezing respiration dry, non productive cough generalized obstructive emphysema Patchy atelectasis cyanosis clubbing of fingers and toes repeated bronchitis and pneumonia meconium ileus (meconium is thicker and stickier than normal kids. Causes obstruction in bowel) distal intestinal obstruction syndrome excretion of undigested food in stool; increased bulk, frothiness, and foul odor wasting of tissues prolapse of rectum delayed growth delayed puberty in girls sterility in boys skin tastes "salty" dehydration *in conclusion, they've got lots of probs*