respiratory dysfunction peds exam 3
what is an average number of colds per year for a baby
7-9
prevent infection with CF
-don't take things from other people because of germs -immunizations -cf pt aren't medically supposed to hang out with other CF patients but ONLINE
when is highest risk for hemorrhage after t & A
-first 24 hours -5-7 days after T&A scabs will fall off
symptoms of LTB
-gradual onset -low grade fever -typically occurs after URI and then get barking cough -inspiratory stridor -Carbon dioxide retention
if pt presents to LTB what is the treatment
- inhaled racemic epi & corticosteroids b/c pt is heading toward respiratory distress -encourage oral fluids -comfort measures
what children at the highest risk for pertussis?
-3-6 months old** -preterm infants -high risk infants with comorbidities
what best indicates an understanding of the management and treatment for asthma?
-Families must make every effort to eliminate any possible allergens from the home. Prevention is the most important aspect in the treatment of asthma. Learning how to use a peak flow meter, using a peak flow and symptom diary, and having the medications available are important aspects of treatment, but prevention is the best.
what is important to remember about decongestants and cold meds?
-NO DECONGESTANTS, NO COLD MEDS for anyone under 2
what can you teach parents about excersizing with cf
-aerobic exercise to facilitate airways opening up &stronger -can be hard to get parents to see what they can/cant do -good for them to use lungs and cough up mucus!
anatomically what looks different in a child's respiratory system vs. an adults
-airway diameter (smaller, narrower, shorter) -normally enlarged tonsils -floppy airways with little cartilage in airway walls -belly breathers but have weak abdominal muscles
croup nursing care
-calm reassurance, do nothing to make situation more anxious) -hydration (iv and oral) -assess for worsening respiratory effort
nursing care for RSV
-contact & droplet precautions -nutrition -strict i's and os -rest -respiratory assessment -be proactive about suctioning before they eat or sleep
education for parents who have child with nasopharyngitis
-how much tylenol & when -how to use bulb syringe and watch them do it -when to use bulb syringe -fever doesn't hurt child, just makes them uncomfortable --NO DECONGESTANTS, NO COLD MEDS for anyone under 2 -educate when to come back: s/s of respiratory distress or dehydration
patho of cystic fibrosis
-increased viscosity of mucus gland secretions obstructs small passages in organs -body creates excessive amounts of mucosal secretions all throughout body -thick mucus in their lungs, pancreas, intestines, reproductive tract and can causes obstructions in small passages
what is different about a child's airway in comparison to an adults?
-it is smaller, narrower, shorter -floppy (more prone to collapse)
treatment for cf
-iv antibiotics -mucolytics (thin) -cvl or pic or port to consistently have iv access -chest percussion therapy, -bronchodilators, postural drainage -aerobic exercise -pancreatic enzymes -double lung transplant -live as long as early 40's
why are newborns not as susceptible to pertussis as children 3-6 months?
-newborns are not as susceptible because in first 3 months babies are still protected by maternal antibodies. by 3 months, anibodies have worn off and they havent built up any of their own. no vaccines yet or antibodies.
nursing considerations for nutrition after T&A
-no acidic juices, carbonated beverages -No red liquids -Cautious use of ice cream - forms thick secretions. -Popsicles are better choice -Soft diet for first week at home
pancreatic insufficiency and GI issue requires what with CF
-pancreatic enzymes with meals and snacks -High protein, high calorie diet -Monitor stools for steatorrhea -tube feedings at night
nursing care for mono
-provide comfort care (lozenges, rest,liquids) -no contact sports -low impact activity -REST
what are signs of worsening respiratory effort to be aware of in pt with croup
-respiratory rate over 60 for infants -use of accessory muscles -decreased breath sounds -quiet child, restless child
nursing care for nasopharyngitis
-support parents b/c they will feel guilty. -elevate head of crib, place wedge under mattress or towels in order to make breathing easier -saline nose drops, bulb syringe suctioning -maintain fluids b/c they will get dehydrated -TYLENOL as an antipyretic!! no advil till over 6 mo -cool mist vaporizer teaching: how much tylenol, how to use bulb syringe and watch them do it, when bulb syringe, make schedule written out for times to give tylenol -educate when to come back: s/s of respiratory distress or dehydration
nursing care for ear infections
10 day course of antibiotics -analgesics/antipyretics -cautious use of decongestant nasal drops -myringotomy
what is the incubation period for nasopharyngitis
2-3 days
what is the first respiratory test done on an infant?
APGAR at birth
prevention of pertussis and education
DTaP; TdAP -ONLY lasts 10 years so adults are at risk for spreading if don't get booster
what gene is cf on
It is transmitted as an autosomal recessive trait with the gene localized on the long arm of chromosome 7.
what is croup condition is caused by a virus?
LTB causes: RSV, influenza A and B, Mycoplasma pneumoniae)
is there a cure for cf?
NO -double lung transplant is not a cure, but starts them back over with new lungs. feels much better instantly! because evry cell in their body is knowing to make mucus
if you suspect acute epiglottis what should nurse assess
NO ORAL OR THROAT ASSESSMENT -do nothing to make child scared -nothing in mouth
A 6-month-old infant who was born premature is being seen for a follow-up examination. The child is to receive an intramuscular injection monthly through the winter and spring season. Which drug would the nurse expect to be ordered?
Palivizumab
bronchiolitis is caused by
RSV (virus causes inflammation and obstruction of bronchioles and debris clogs bronchioles and produces lots of secretions)
symptoms of pertussis
extreme, explosive cough that interrupts breathing, eating, and sleeping -lasts for months -children can cough till vomit, break ribs, lose weight b/c can't feed which = dehydration -low o2
what antipyretic is NOT used for children under 6 months
advil! only use tylenol till over 6 months
nursing considerations for asthma
family teaching about identify & avoiding triggers pulmonary function tests controller & quick relief meds exercise support and reassurance
The child has been diagnosed with asthma and the child's physician is using a stepwise approach. Rank the order in which the nurse should administer these medications as the child's condition worsens.
albuterol as needed Low-dose inhaled corticosteroid Medium-dose inhaled corticosteroid Medium-dose inhaled corticosteroid and salmeterol
who does RSV occur in
almost exclusively in infants (less than 6 months)
treatment for tonsillitis
analgesis antipyretic penicillin= bacterial viral= comfort -tonsillectomy -adenoidectomy
(see full question) When the nurse is reinforcing teaching with the caregiver of a 3-year-old child being discharged following a tonsillectomy, the caregiver states to the nurse, "I understand why there might be bleeding in the first 24 hours, but I don't understand why there might be bleeding in a week or so." The most appropriate explanation for the nurse to give this caregiver is:
You selected: "By next week your child will be eating regular foods again and some rough food hitting the tissue would be likely to cause bleeding." Incorrect Correct response: "Bleeding can occur at this time because the clots dissolve and new tissue isn't yet present." Explanation: Hemorrhage is the most common complication of a tonsillectomy. Bleeding is most often a concern within the first 24 hours after surgery and the fifth to seventh postoperative day. Bleeding can occur when the clots dissolve between the fifth and seventh postoperative days if new tissue is not yet present.
what does expiratory grunt sound like in children
a quieter uh uh uh -parents will report it sounds like they are snoring
what is included in the nursing assessment for respiratory?
apgar feeding or activity respirations cough sputum s/s infection
how long are children on soft diet after t&A
one week
symptoms of acute epiglottis
abrupt onset, rapid progression -high fever -cherry red epiglottis -tripod position -toxic appearing(frightened, anxious) -4 D's (dysphonia, dysphagia, drooling, decreased respiratory effort )
what recreation activities should nurse encourage for kids with asthma
active, sports swimming***
what croup condition is caused by a bacteria
acute epiglottises hemophilus influenza
removal of the pharyngeal tonsils
adenoidectomy
quick relief inhaler
asthma attack "episode" — albuterol
what trait is CF detected as
autosomal recessive trait
goal of cf therapy
open airways, facilitate mucus getting out
inflammation of the middle ear
otitis media
a respiratory rate of what is a sign of worsening respiratory effort in infants
over 60
cause of tonsillitis
bacterial or viral
complications of pertussis
bacterial pneumonia
why do we not perform an oral or throat assessment in a child if we suspect acute epiglottis
because its upsetting and we don't want to make them more distressed
when do you use bulb suction and saline drops
before feeding
A 7-year-old child has been scheduled for a tonsillectomy. What would be most important to assess prior to surgery?
bleeding and clotting times r/t hemorrhage
asthma meds long term
budesonide (steroid)
what can nurse use in child with a cold to decrease nasal secretions
bulb syringe and saline drops
crackling sounds heard on auscultation when the alveoli become fluid filled
rales
what is done 4 times per day
chest percussion and postural drainage listen to lungs before and after
what does a nurse need to remember when assessing sputum in a child if she wants to visualize it?
children don't know how to productively cough mucus up because they swallow it. -if you want to see what it looks like you must coach them to spit it out! -if can't spit, use yonker
what does tonsillar tissue in a healthy child look like on assessment
children have enlarged tonsils normally
why is tonsillitis common in children
children more prone to infecton because of big tonsils that can catch more infection.
if cf patient has impaired gas exchange from not effectively moving air, what can occur
chronic acidosis
characteristics of cystic fibrosis
chronic moist productive cough frequent respiratory infections -tons of mucus that they can't cough up
what is the determinant for how much cf effects their life?
compliance with treatment
what is the isolation precaution for nasopharyngitis
contact isolation
how is pertussis spread
contact with respiratory droplets
first line of defense for LTB
cool mist vaporizer
swelling or obstruction of epiglottis and laryynx and possible trachea and bronchi.
croup
what disease is collection of 3 pediatric respiratory conditions
croup
what could a nurse educate a patient about not doing after T&A
discourage coughing, nose blowing, straws, throat clearing because risk of hemorrhage if cautery is knocked off by the pressure
what is a way to increase blood supply, reduce edema, & reduce pain after T&A
drinking!!
what are the 4 D's
dysphonia, dysphagia, drooling, decreased respiratory effort
how can nurse make breathing easier for a child with nasopharyngitis
elevate head of crib (wedge or towels)
what should a nurse educate parents about a child with bacterial tonsillitis
encourage compliance with 10 day course penicillin even after child is well.
The caregivers of a child report that their child had a cold and complained of a sore throat. When interviewed further they report that the child has a high fever, is very anxious, and is breathing by sitting up and leaning forward with the mouth open and the tongue out. The nurse recognizes these symptoms as those seen with which disorder?
epiglottitis
how do you do a peak flow meter
exhale into peak flow meter and see score. do 3x until they get solid consistent and write it down. (red, yellow, or green day for breathing)
if pt with LTB goes in steamy shower & does cool mist vaporizer and still has stridor at rest
go to ER.
why could a kid with CF have developmental or body image issues
have CVL or pic line so they look different and missing lots of schools
if pt with LTB not getting better after cool mist vaporizer & there is stridor at rest..
have steamy shower in hopes that steam will reduce inflammation and stridor
primary concern after T&A
hemorrhage
initial assessment of a child with epiglottitis should include
history vital signs auscultation of chest observe swallowing ability
what is one of the best indicators of respiratory function in infants
how they are feeding (as normall, frequently as they do when they're well? do they finish? have to stop feeding to breathe? babies cant eat and breathe when theyre congested.)
what is one of the best indicators of respiratory function in older children
how they are playing (if they cant breathe well they wont be able to keep up. children wont hold themselves back unless they have to)
if a child appears restless, irritable, whiny, and cannot be consoled by parent what is she probably experiencing
hypoxia
mucus in intestines causes what in cf
impaired nutrient absorption
risk of cf
impairs gas exchange, resistant organisms, acidosis
who is nasopharyngitis concerning for
infants usually appear sicker and can be hospitalized
bacterial tracheitis
infection of mucosa of upper trachea
home care teaching with CF
infection risks nutrition CPT and breathing exercises immunizations school progress developmental issues (body image, peers) anticipatory grieving genetic counseling
inflammation of tonsils becomes a concern when
it causes difficulty swallowing and breathing
treatment for acute epiglottis
iv antibiotics & corticosteroids possibly incubation; prepare tray
If the child with cystic fibrosis has an infection, what treatment will be done
iv medications. but not on a daily basis
what is the purpose of cool mist vaporizers for nasopharyngitis
keeps secretions moist and reduces the risk of burning
what form should analgesics come in after T&A
liquid analgesics
Peak expiratory flow rate
measure lung velocity -is decreased during asthma attack
newborn symptoms of cf
meconium ileus rectal prolapse, fibrotic pancreas
goal of nursing for asthma
minimize effects of asthma on day to day life and keep them out of hospital
why is excess mucus so dangerous for cf
mucus is supposed to be protective because holds pathogen and there mucus is viscous and sticky and does too good of a job of holding onto pathogens which makes them develop antibiotic resistant lung infections
symptoms of croup
mucusal inflammation and edema brassy, barking cough (seal) inspiratory stridor hoarseness
what is one of the first signs of respiratory worsening
nasal flaring
the common cold is
nasopharyngitis
why is it important to monitor intake with nasopharyngitis
need to maintain fluids because they will get dehydrated
what would a newborns respiratory mucus look like
newborns have very little respiratory mucus
should children be encouraged to eat a lot of ice-cream after t&A
no! it forms thick secretions. cautious use of ice-cream and eat popsicles instead
if a child is scheduled to have his tonsils removed but tonsils appear infected will the surgery occur?
no. they won't remove actively infected tonsils because of the risk of systemic infection
medication for mono
none! mono is self-limiting and they will recover in 4-6 weeks without medication
what medication is prescribed for tonsillitis that is viral
none. comfort measures only
if child with CF is coughing, what does this indication
normal! doesn't mean sick or infectious. its good for them to cough and get mucus out
if adult is exposed to RSV, what occurs
nothing. only produces severe effects in infants
what are infants at high risk for RSV eligible for
palivizumab (synagis) injection (RSV antibody vaccine)
daily pulmonary function test
peak flow meter (spirometer)
what medication is prescribed for tonsillitis that is bacterial
penicillin for 10 days
disorder involving infection and inflammation of the alveoli.
pneumonia
postural drainage
positioning to get mucus out -various head down positions drain all lung segments
who is at high risk for RSV
pre term infant, high risk, comorbid conditions
if a child is on antibiotics and wearing diapers, parents should be encouraged to also put them on
probiotics (diapers = diaper rash)
why are tonsils enlarged on child normally?
protective factor
help measure airway function, lung volumes, and gas exchange.
pulmonary function tests
what is one of the priorities in kids with asthma
put control back in kids so they can manage it themselves and be as normal as possible
what are signs of respiratory distress?
restlessness tachypnea tachycardia sweating mood changes altered depth and patterns of respiration's flaring retractions expiratory grunts wheezing toxic appearance
why does otitis media occur
results from block eustachian tubes
when would a child need to come back to the hospital who has nasopharyngitis
s/s of respiratory distress or dehydration
what does retractions look like in child
see belly pull out around ribs= sucking really hard to get air in
what causes nasopharyngitis
several viruses
symptoms of RSV
severe respiratory distress refused to feed, dehydrated may spit up thick mucus b/c not able to clear
why are children more prone to ear infections
shorter, flatter eustachian tubes allow mucus to back up easily and sit there and allows pathogens to sit in ear.
how can nurse facilitate drainage to visualize after tonsillectomy and adenoidectomy
side lying!
if a parent reports a child recently has sounded like they're snoring and is making an uh uh uh sound and has nasal flaring what does the nurse realize this is a sign of
sign of worsening!!
nursing care for tonsillectomy & adenoidectomy preop
soft or liquid diet warm salt gargles cool mist vaporizer throat lozenges analgesics/antipyretics prep for surgery
The nurse is reinforcing teaching with the parents of a 2-year-old who has cystic fibrosis regarding medications. The nurse suggests that pancreatic enzymes may be given by which method?
sprinkled onto the food
what causes bacterial tracheitis
staphylococcus aureus, group A beta hemolytic step
During an assessment, a child exhibits an audible high-pitched inspiratory noise. The nurse documents this as:
stridor
signs of hemorrhage after T&A
subtle excessive swallowing or drinking -anxiety, restlessness -first 24 hours or 1 week later are highest risk
Myringotomy
surgical incision of the eardrum to allow drainage
what are compensations in respiratory distress for not exchanging air well
tachypnea, tachycardia
who is hardest to get to comply to cf treatment
teenagers
what is the biggest concern with ear infections and why we need to be aggressive in treatment
that the cilia will be damaged and result in permanent hearing loss & speaking issues -AGGRESSIVE about ear infections
pulmonary function tests are useful in determining
the degree of disease, they are not useful during an attack.
why are children at risk for respiratory distress?
they are abdominal breathers but the muscles are weaker
what makes children more prone to respiratory dysfunction?
they have a smaller, narrower, shorter airway so pathogens travel much more quickly to lungs
why are children's airway more prone to collapse?
they have floppy airways (not toned) with little cartilage in airway walls
what usually occurs before pt is diagnosed with bacterial tracheitis
they were misdiagnosed as LTB but it was unresponsive to usual treatment (b/c not a virus)
what is the purpose of saline nose drops
thins out secretions
why would decongestant nasal drops be used with ear infections
to open up eustachian tubes *this is uncommon
what does a child's normally enlarged tonsils put them at risk for
tonsilitis (it becomes very large, very quickly)
removal of palatine tonsils
tonsillectomy
The child with what may have a fever, sore throat, difficulty swallowing, hypertrophied tonsils, and erythema of the soft palate. Exudate may be visible on the tonsils.
tonsillitis
infection/inflammation of the palatine tonsis (visible tonsils)
tonsillitis
a sound heard with percussion over an air-filled area.
tympany
if a nurse needs to assess a child's sputum but the child is not able to productively cough and spit it out, what will she have to do
use a yonker to suction it out
to support nutrition needs in child with pertussis, nurse may
use ng tube to feed since can't feed because coughing
nursing interventions for cystic fibrosis
vigorous pulmonary hygiene --chest percussion therapy 4x per day : shaking vest, then breathing treatment and suction. -high calorie, high protein diet -increase tube feed during the night to increase calories -positioning -goal: open airways, facilitate mucus getting out -good for them to use lungs and cough up mucus! -iv antibiotics: cvl or pic or port to consistently have iv access; keep their life as normal as possible. -double lung transplant is not a cure, but starts them back over with new lungs. feels much better instantly! because evry cell in their body is knowing to make mucus -cf always considered pediatric regardless of age
high-pitched sound heard on auscultation, usually on expiration.
wheeze It is due to obstruction in the lower trachea or bronchioles.
when is RSV season
winter and early spring
A 4-year-old child is brought to the emergency department experiencing severe respiratory distress. The physician has diagnosed epiglottitis. What information should the nurse include in the child's plan of care/treatment? Select all that apply
• Antibiotic therapy • Admission to ICU • Intravenous fluids