Chapter 18: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder

The nurse is caring for a 10-year-old girl with cystic fibrosis who receives pancreatic enzymes. Which comment by a parent demonstrates understanding of the instructions regarding the medication? "I should give the enzymes before each meal or snack." "I should stop the enzymes if my child is taking antibiotics." "I should reduce the dose if she has large, malodorous stools." "Between meals is the best time to give the enzymes."

"I should give the enzymes before each meal or snack." The enzymes are necessary for appropriate digestion and absorption of food and nutrients. There is no interaction between enzymes and antibiotics. Large, malodorous stools are a sign of no pancreatic enzyme activity. Pancreatic enzymes must be given each time the child eats, usually in smaller doses for snacks than for meals.

A 4-week-old infant is diagnosed with acute bronchiolitis. The parent states, "I do not know how the baby got this!" How should the nurse respond? "Do you have allergies in the family?" "Do any family members have history of asthma?" "Do you have air conditioning in your house?" "Has your infant been around any crowds?"

"Has your infant been around any crowds?" Acute bronchiolitis is caused by a viral infection, most often, respiratory syncytial virus. Viruses are often spread between groups of people in close contact. Hereditary and environmental complications do not relate to this disorder.

The nurse is auscultating the lungs of a lethargic, irritable 6-year-old boy and hears wheezing. The nurse will most likely include which teaching point if the child is suspected of having asthma? "I'm going to have the respiratory therapist get some of the mucus from your lungs." "I'm going to have this hospital worker take a picture of your lungs." "We're going to go take a look at your lungs to see if there are any sores on them." "I'm going to hold your hand while the phlebotomist gets blood from your arm."

"I'm going to have this hospital worker take a picture of your lungs." The nurse should teach the child using terms a 6-year-old will understand. A chest x-ray is usually ordered for the assessment of asthma to check for hyperventilation. A sputum culture is indicated for pneumonia, cystic fibrosis, and tuberculosis; fluoroscopy is used to identify masses or abscesses as with pneumonia; and the sweat chloride test is indicated for cystic fibrosis.

What statement is the most accurate regarding the structure and function of the newborn's respiratory system? - The diameter of the child's trachea is the same as that of adults. - Most infants are nasal breathers rather than mouth breathers. - The respiratory tract in the child is fully developed by age 2. - Infants and young children have smaller tongues in proportion to their mouths.

- Most infants are nasal breathers rather than mouth breathers. Newborns are obligatory nose breathers until at least 4 weeks of age. The diameter of the infant and child's trachea is about the size of the child's little finger. The respiratory tract grows and changes until the child is about 12 years of age. During the first 5 years of life, infants and young children have larger tongues in proportion to their mouths.

What is the most common debilitating disease of childhood among those of European descent? Cystic fibrosis Asthma Pneumonia BPD

Cystic fibrosis Cystic fibrosis is the most common debilitating disease of childhood among those of European descent. Medical advances in recent years have greatly increased the length and quality of life for affected children, with median age for survival being the late 30s.

The nurse is teaching the caregivers of a child with cystic fibrosis. What is most important for the nurse to teach this family? Be sure the child exercises daily. Watch out for signs that family members are overly stressed. Avoid overprotecting the child. Encourage everyone in the family to use good handwashing techniques.

Encourage everyone in the family to use good handwashing techniques. The child with cystic fibrosis has low resistance, especially to respiratory infections. For this reason, take care to protect the child from any exposure to infectious organisms. Good handwashing techniques should be practiced by the whole family; teach the child and family the importance of this first line of defense. Practice and teach other good hygiene habits.

During a class for caregivers of children with asthma, a caregiver asks the nurse the following question when medications are being discussed. "They told me about a plastic device my child can hold in his a hand which will give him a premeasured and exact amount of his corticosteroid." The nurse recognizes that the caregiver is most likely referring to which device? Medication cup Metered-dose inhaler Nebulizer Needleless syringe

Metered-dose inhaler In the treatment of asthma, corticosteroids are most often delivered by metered-dose inhaler ([MDI], which is a hand-held plastic device that delivers a premeasured dose). The medication cup and needleless syringe may deliver PO medications, but most often corticosteroids are not given PO in the treatment of asthma, and those would not be premeasured and an exact dosage like a metered-dose inhaler would be. Corticosteroids are not administered by nebulizer.

The nurse is administering medications to a child with cystic fibrosis. Which method would the nurse most likely use to give medications to treat the pancreatic involvement seen in this disease? Open capsule and sprinkle on food. Shake inhaler and hold close to mouth. Draw up in syringe and administer subcutaneously. Pour in medication cup and have the child drink.

Open capsule and sprinkle on food. Pancreatic enzymes should be administered at all meals and snacks to promote adequate digestion and absorption of nutrients. They are supplied in capsule form. For the infant and young child, they can be opened and sprinkled on foods such cereal, pudding, or applesauce. They also can be swallowed whole. They are not supplied in liquid form, so the child could not take them in a medication cup. They are not supplied for injection or inhalation, only oral use.

Which nursing diagnosis would best apply to a child with allergic rhinitis? Pain related to sinus edema and headache Ineffective tissue perfusion related to frequent nosebleeds Disturbed self-esteem related to inherited tendency for illness Risk for infection related to blocked eustachian tubes

Pain related to sinus edema and headache Many children with allergic rhinitis develop sinus headaches from edema of the upper airway. In younger children the maxillary and ethmoid sinuses are involved. In children aged 10 years and older the frontal sinuses are also involved. The pain comes from mucosal swelling, decreased ciliary movement and a thickened nasal discharge. Nosebleeds are not common with either allergic rhinitis or sinusitis nor are either of these inherited. The eustachian tubes would cause symptoms of otitis, not of the nasal passage.

A group of nurses is reviewing the diagnosis of cystic fibrosis. With regard to the effect of this disease on the body, which parts of the body (besides the lungs) are most affected by this disease? Brain and spinal cord Pancreas and liver Heart and blood vessels Kidney and bladder

Pancreas and liver The major organs affected are the lungs, pancreas, and liver. The brain, spinal cord, heart, blood vessels, kidney and bladder are not the most affected organs.

The nurse is caring for a child who has been admitted with a diagnosis of asthma. What laboratory/diagnostic tool would likely have been used for this child? Purified protein derivative test Sweat sodium chloride test Blood culture and sensitivity Pulmonary functions test

Pulmonary functions test Pulmonary function tests are valuable diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs. Purified protein derivative tests are used to detect TB. Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection.

The nurse is assessing the site of a client's Mantoux skin test. The client is HIV positive. The nurse notes the induration to be 10 mm. Which action will the nurse take next? Document the finding in the client's medical record Determine if the client has been exposed to tuberculosis. Place the client on droplet precaution. Schedule the client for a chest x-ray.

Schedule the client for a chest x-ray. Diagnosis of tuberculosis (TB) is confirmed with a positive Mantoux test. An induration of 5 mm is considered positive for clients with HIV. If a client's Mantoux test is positive, the client is next scheduled for a chest x-ray to look for lung changes related to TB, or for a sputum smear test. These tests are done to determine if a client has latent or active TB, which will then determine the course of action for the client. The nurse will document the results; however, documentation is not priority. There is no need to ask about exposure since the test results indicate exposure. The client with active TB will be placed on airborne precautions.

The nurse at a camp for children with asthma is teaching these children about the medications they are taking and how to properly take them. The nurse recognizes that many medications used on a daily basis for the treatment of asthma are given by which method? Directly into the vein Through a gastrostomy tube Using a nebulizer Sprinkled onto the food

Using a nebulizer Many of these drugs used in the treatment of asthma can be given either by a nebulizer (tube attached to a wall unit or cylinder that delivers moist air via a face mask) or a metered-dose inhaler ([MDI], which is a hand-held plastic device that delivers a premeasured dose). Emergency medications are given intravenously. Most children do not have a gastrostomy tube, and medications sprinkled on foods are given with cystic fibrosis.

The nurse is caring for a child with a history of cystic fibrosis (CF). Which finding will the nurse report to the primary health care provider? Clubbing of the fingers Barrel chest Delayed puberty Wheezing

Wheezing The nurse would report wheezing, as this indicates respiratory distress. Clubbing occurs with chronic respiratory illness. It is the result of increased capillary growth as the body attempts to supply more oxygen to distal body parts. Barrel chest refers to the shape the chest takes on in chronic respiratory illness. It takes the shape as chronically the lungs fill with air but are unable to fully expel the air. Delayed puberty is common in clients with cystic fibrosis and does not require reporting at this time.

After teaching the parents of an 8-year-old girl with asthma about common allergens their child should avoid, the nurse determines that the parents need additional teaching when they identify what as a common allergen for asthma? shellfish indoor molds pet dander dust mites

shellfish Eating shellfish is not a typical asthma trigger. Allergic reactions can occur with shellfish, but usually not an exacerbation of asthma. Indoor molds, pet dander, and dust mites are common asthma triggers.

The nurse is reinforcing teaching about medications with the parents of a 2-year-old who has cystic fibrosis. The nurse suggests that pancreatic enzymes may be given by which method? Directly into the vein Through a gastrostomy tube Using a nebulizer Sprinkled onto the food

Sprinkled onto the food

A child with asthma has been monitoring his peak expiratory flow rate (PEFR) and has been maintaining it within 90% of his personal best. Today, the child is experiencing symptoms and his PEFR is at 40% of his personal best. The child's mother calls the office and asks the nurse what she should do. What would the nurse instruct the mother to do first? "Have him use his short-acting bronchodilator right away." "You need to take him to the emergency department right away." "Continue to watch his PEFR readings and call back if they go below 40%." "Have him use his low-dose steroid inhaler now and again in 15 minutes."

"Have him use his short-acting bronchodilator right away." The child's symptoms and drop in PEFR suggest a medical alert or "red" situation, indicating the need for the short-acting bronchodilator and then a trip to the office or emergency department. The child should use his short-acting bronchodilator first and then go to the physician's or nurse practitioner's office or emergency room. Waiting for a greater drop in his PEFR readings would be inappropriate because the child is experiencing an acute condition that warrants immediate attention. The child is experiencing an acute situation and requires immediate attention. A low-dose steroid inhaler would not be appropriate because it would not help his bronchospasm.

The nurse is caring for a child who has been admitted with a possible diagnosis of cystic fibrosis. Which laboratory/diagnostic tools would most likely be used to help determine the diagnosis of this child? Purified protein derivative test Sweat sodium chloride test Blood culture and sensitivity Pulmonary functions test

Sweat sodium chloride test Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Purified protein derivative tests are used to detect TB. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection. Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.

The nurse is taking a health history for a 3-year-old girl suspected of having pneumonia who presents with a fever, chest pain, and cough. Which information places the child at risk for pneumonia? The child is a triplet. The child was a postmaturity date infant. The child has diabetes. The child attends day care.

The child attends day care.

The nurse sees a 3-year-old child in the ambulatory setting for localized wheezing on auscultation. Which statement by the parent would be most important to report to the health care provider? The child received the pneumococcal vaccine series within his or her first year. The child has two cousins who have many allergies. The parent has supervised the child in the same room for the past 24 hours. The child was eating peanuts yesterday.

The child was eating peanuts yesterday. Aspiration can cause airway mucosal inflammation. When aspiration from a small object occurs, the child may cough and gasp for a few seconds to a few minutes. Following that, the child may not be symptomatic for a day or longer. The aspiration of a foreign body may mimic an asthma attack, but an asthma attack would have generalized wheezing. Localized wheezing suggests only a small portion of a lung is involved, such as occurs following aspiration. Allergic situations cause early symptoms such as rash development and are generally not genetic or inherited in nature. The US Centers for Disease Control and Prevention recommends children receive pneumococcal vaccine series before 2 years of age, usually at 2, 4, and 6 months.

The nurse is providing education to a client newly diagnosed with asthma. Which statement by the parents indicates additional teaching is needed? "We will keep an albuterol inhaler with our child at all times." "It is okay for our child to do chores such as sweeping the floor." "We will both enroll in smoking cessation classes." "Our family dog will need to go live with a grandparent."

"It is okay for our child to do chores such as sweeping the floor." Sweeping the floor can trigger a child's asthma by making environmental allergens and irritants airborne, causing upper respiratory infections. The nurse will intervene if the parents make this statement. An inhaler should be with the child at all times in case of an asthma attack. Smoke and pet allergens can trigger an attack and exposure should be avoided. Other triggers are exercise, weather changes, air pollution, foods, and certain medications.

The mother of a child with asthma tells the nurse that she occasionally gives her child the steroid medicine she takes for her rheumatoid arthritis when the child has a "flare-up" of asthma. "It's easier than going to the hospital or doctor every time a flare-up happens," the mother says. What is the best response by the nurse? - "I understand that appointments can be annoying but steroid use can cause your child to have high blood sugar, peptic ulcers, slowed growth rate, and various other problems." - "An adult should never give a child their medication. The doses may be very different." - "As long as you only occasionally give your child the medication it shouldn't be a problem." - "I'm sure it must be difficult to cope with the flare-ups, but there are many side effects from steroid use and the physician needs to monitor your child's asthma symptoms."

- "I'm sure it must be difficult to cope with the flare-ups, but there are many side effects from steroid use and the physician needs to monitor your child's asthma symptoms." Showing empathy for the parent is important when explaining the possibility of the steroid's side effects and the importance of the physician monitoring the child's asthma. Just listing all of the side effects of the steroid is not therapeutic communication and doesn't address the need for the child to be seen by the physician. Scolding the parent by telling her that she should never give her child her medication does not encourage good rapport. Giving the child the mother's medication even "occasionally" is not advisable.

A 9-year-old female child was brought to the emergency department after experiencing wheezing and shortness of breath while playing soccer. The parents administered two puffs of albuterol metered dose inhaler (MDI) with little effect, and 911 was notified. Paramedics applied oxygen 2 liters by nasal cannula for oxygen saturation of 90% on room air, and administered an albuterol nebulizer treatment. Audible wheezing was heard, and a 20-gauge intravenous (IV) catheter was inserted. Vital signs upon arrival at the emergency room: temperature, 98.8°F (37.1°C); heart rate, 125 beats/min; blood pressure, 88/50 mm Hg; respiratory rate, 32 breaths/min; oxygen saturation, 92% on simple face mask. Child appears anxious. Complete the following sentence(s) by choosing from the lists of options. The emergency room nurse should first _______ then ________.

assess airway; administer intravenous (IV) methylprednisolone The nurse should assess the child's airway first. Assessment should always be prioritized using the ABCs (airway, breathing, and circulation).Intravenous (IV) methylprednisolone should be administered promptly to decrease inflammation in the lungs, which will improve air flow.

What is a complication of cystic fibrosis? pneumothorax urinary tract infection kidney disease Crohn disease

pneumothorax Cystic fibrosis (CF) is a genetic disorder causing thickened tenacious secretions of the sweat glands, gastrointestinal tract, pancreas, respiratory tract and exocrine tissues. The treatment is aimed at minimizing pulmonary complications, maximizing lung function, preventing infection, and facilitating growth. A pneumothorax is a complication of CF. A rupture of the subpleural blebs through the visceral pleura takes place. There is also a high reoccurrence rate and incidence increases with age. Crohn disease is a gastrointestinal disorder that is not associated with cystic fibrosis. Urinary tract infection and kidney disease are also not associated with CF. Most of the problems and complications associated with CF relate to the respiratory system, the gastrointestinal system, and infectious disorders.

Which measure would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis? Urging the child to continue to take oral fluids Administering an oral analgesic Teaching the child to take long, slow breaths Assisting with racemic epinephrine nebulizer therapy

Assisting with racemic epinephrine nebulizer therapy Croup is a viral infection that causes inflammation and edema of the larynx, trachea, and bronchi. One form of treatment is the use of nebulized racemic epinephrine. Racemic epinephrine is an alpha adrenergic agent. It works on the mucosal vasoconstriction to reduce the edema. This increases the lumen of airways, allowing for better intake of air. A child in respiratory distress is unable to take slow, deep breaths. The child should not be offered fluids because this is an aspiration risk and analgesics will not reduce swelling.

The pediatric unit has multiple clients experiencing upper respiratory system complications. Which pediatric client is at the highest risk for respiratory distress? 3-year-old child with croup 11-month-old infant with nasopharyngitis 2-year-old child with epiglottitis 16-year-old adolescent with asthma

2-year-old child with epiglottitis Epiglottitis is a medical emergency due to the swelling of the epiglottis covering the larynx. This client needs frequent assessment for respiratory distress, especially since young children have smaller, more compliant airways. The 3-year-old child has more developed respiratory passages than a 2-year-old child, and although croup may cause respiratory distress, the likelihood of airway obstruction is lower when compared to epiglottitis. The 11-month-old infant has a common cold, typically from a virus. The 16-year-old adolescent with asthma has fully developed respiratory airways, which are less likely to be obstructed.

An 8-year-old girl presents with drooling and a complaint of painful swallowing. She has a high fever and is lethargic. On examination the nurse sees that her palatine tonsils are bright red and swollen. The girl's mother says that she has never had these symptoms before. A throat culture indicates a streptococcus infection. What is the course of treatment that the nurse would expect in this situation? Antipyretic, analgesic, and antibiotic Antipyretic and analgesic Tonsillectomy Adenoidectomy

Antipyretic, analgesic, and antibiotic These symptoms are consistent with bacterial tonsillitis. Therapy for bacterial tonsillitis includes an antipyretic for fever, an analgesic for pain, and a full 7- to 10-day course of an antibiotic such as penicillin or amoxicillin. If the cause is viral, no therapy other than comfort or fever reduction strategies is necessary. Tonsillectomy is removal of the palatine tonsils. Adenoidectomy is removal of the pharyngeal tonsils. In the past, tonsillectomy was recommended for children after an episode of tonsillitis. This is no longer recommended as tonsillar tissue is an important component of the immune system.

During an assessment, a child exhibits an audible high-pitched inspiratory noise, a tripod stance and intercostal retractions. Using SBAR communication, the nurse notifies the health care provider and states which breath sounds that are congruent with the clinical presentation of the child? Respiratory stridor Wheezing in the bases Rales in the middle lobe Rhonchi throughout the lung

Respiratory stridor Stridor is a high-pitched, readily audible inspiration noise that indicates an upper airway obstruction. The child presents in severe respiratory compromise and struggles to breathe. A wheeze is a high-pitched sound heard on auscultation, usually on expiration. It is due to obstruction in the lower trachea or bronchioles. Rales are crackling sounds heard on auscultation when the alveoli become fluid filled. Rhonchi is a snoring sound heard throughout the lung field when inflammation occurs.

A school-aged child develops a nosebleed (epistaxis). Which action should the nurse take? Elevate the head of the bed slightly and apply pressure to the forehead. Sit the child upright and apply pressure to the sides of the nose. Turn the child's head to the side and press on the nasal ridge. Keep the child flat and apply pressure to the bridge of the nose.

Sit the child upright and apply pressure to the sides of the nose. Epistaxis occurs more frequently in children than adolescents. The bleeding occurs from the anterior portion of the septum. To stop the bleeding, have the child sit up and lean forward. Apply continuous pressure to the anterior portion of the nose by pinching it closed. Ice may be used on the bridge of the nose. Having the child lie flat increases the risk of aspiration from the blood in the back of the throat. Putting pressure on the forehead will not stop nasal bleeding. Lying on the side and putting pressure on the bridge of the nose will not effectively put pressure on the bleeding vessels to cause them to coagulate and stop bleeding.

A child who has had a tracheostomy is admitted to the hospital for abdominal surgery. When assessing the child's tracheostomy, what would the nurse identify as normal findings? Select all that apply. clear, clean tracheostomy tube tube free of secretions stoma pale pink small amount of clear drainage from stoma two fingers slide under tracheostomy ties

clear, clean tracheostomy tube tube free of secretions stoma pale pink A tracheostomy tube should be clean and free from secretions and the stoma should appear pink and without bleeding or drainage. The tracheostomy ties should fit securely, allowing one finger (not two) to slide beneath the ties.

The nurse is caring for a 5-year-old girl who shows signs and symptoms of epiglottitis. The nurse recognizes a common complication of the disorder is for the child to: report ear pain. experience nuchal rigidity. have unilateral breath sounds upon auscultation. be at risk for respiratory distress.

be at risk for respiratory distress. If the airway becomes completely occluded due to epiglottitis, respiratory distress may lead to respiratory arrest and death. Aseptic meningitis is a complication of infectious mononucleosis, resulting in nuchal rigidity; acute otitis media resulting in ear pain is a complication of influenza; and children with pneumonia are at risk for pneumothorax.

The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be: impaired digestive activity. high sodium chloride concentration in the sweat. chronic lack of oxygen. decreased respiratory capacity.

chronic lack of oxygen. In the child with cystic fibrosis the development of a barrel chest and clubbing of fingers indicate chronic lack of oxygen. Impaired digestive activity may occur due to a lack of pancreatic enzymes. The high sodium concentration makes the child taste salty, but is not related to the barrel chest and clubbing of the fingers. Respiratory issues are a concern, but the barrel chest and clubbing of the fingers are not because of the child's respiratory capacity.