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