NCLEX/HESI Pediatric Respiratory Problems

The parent of a hospitalized 2-year-old child with viral laryngotracheobronchitis (croup) asks the nurse why the pediatrician did not prescribe antibiotics. Which response would the nurse make?

"Antibiotics are not indicated unless a bacterial infection is present."

The clinic nurse is providing instructions to the parent of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement would the nurse make to the parent?

"The child will receive the recommended basic series of immunizations along with a yearly in- influenza vaccination."

CF GI s/s

*Meconium ilius. Intestinal obstruction. Frothy/foul stool. A,D,E,K deficiency. FTT. Hypoalbuminemia. Edema. Rectal prolapse. Panreatic fibrosis and DM risk. *High calorie/protein -A,D,E,K vitamins. -pancreatic enzymes.

Croup Interventions

-monitor resp status -keep child calm -cool mist -hydration -beta-adrenergics -corticosteroids -antibiotics. *No cough meds.

Epiglottis (Croup syndrome)

Abrupt, 2-8 y/o. High fever. Sore inflamed throat. Dysphonia. Dysphagia. Dyspnea. *Drooling. Agitation Retractions. *Inspiratory stridor. Tachycardia. Tachypnea. *Tripoding.

Asthma exacerbation

Allergens-pollen, dust, mites, mold. Irritants-smoke, sprays, cold air, exercise. Environmental changes-new home or school. Colds/infections. Animals. Medications. Strong emotions. Foods-nut/milk. Endocrine factors-menses, pregnancy, thyroid disease.

cystic fibrosis

Autosomal recessive exocrine gland dysfunction. The exocrine glands is abnormally thick, tenacious, and copious, causing obstruction.

Bronchiolitis and RSV

Bronchiolitis is an inflammation of the bronchioles that causes production of thick mucus that occludes bronchiole tubes and small bronchi. RSV causes an acute viral infection. Usually <6 months. *humidified air

Foreign body aspiration signs

Choking. Gaggong. Coughing. Retrations. Cyanosis. Dyspnea. Asymmetrical breath sounds. Unconsciousness. Cannot speak.

Laryngotracheobronchitis (Croup)

Common, <5 y/o. Inflammation of the larynx, trachea, and bronchi. Caused by RSV, flu or pneumonia. After URI. *Bark cough. *Stridor. *Diaphoresis. *Cyanosis.

RSV interventions

Droplet precaution. HOB 30-40 degrees. Extended neck. Encourage fluids. Suctioning. Antivirals.

The parent of an 8-year-old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The parent tells the nurse that the child complains of discomfort on the right side and that ibuprofen is ineffective. Which instruction would the nurse provide to the parent?

Encourage the child to lie on the right side.

CF integumentary s/s

High sodium and chloride. Salty taste. Dehydration. Electrolyte imbalance. Delayed puberty and infertility.

Emergency asthma treatment

Humitified oxygen face mask. Rescue meds (short acting B2 agonists, anticholinergics and systemic corticosteroids). IV line. Corticosteroids. Chest radiograph. ABG blood sample.

bacterial pneumonia

Infant: Irritability, lethargy, poor feeding; abrupt fever (may be accompanied by seizures); respiratory distress (air hunger, tachypnea, and circumoral cyanosis) c. Older child: Headache, chills, abdominal pain, chest pain, meningeal symptoms (meningism) d. Hacking, nonproductive cough e. Diminished breath sounds or scattered crackles f. With consolidation, decreased breath sounds are more pronounced. g. As the infection resolves, the cough becomes productive and the child expectorates purulent sputum; coarse crackles and wheezing are noted. Blood cultures and antibiotic therapy, administer O2. humidified O2, cool mist tent, bulb suction, *lie on affected side. *Isolation percaution.

Pneumonia

Inflammation of the pulmonary parenchyma or alveoli or both, caused by a virus, myoplasmal agents, bacteria or foreign body aspiration. 5-12 years old.

TB s/s

Inhaled/droplet. Asynptomatic. Malaise. Fever. Weight loss. anorexia. Lymphadenopathy. Crackles. Dull to percussion.

A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The parent becomes concerned because the child is frightened, consistently crying, and trying to climb out of the tent. Which is the most appropriate nursing action?

Let the parent hold the child and direct the cool mist over the child's face.

Asthma

Mast cell release of histamine leads to a bronchospasm. Dyspnea. Wheezing. Breathlessmess. Chest tightness. Nonproductive the frothy Cough. Mucosal edema. *Hypoxemia. Asphyxia.

bronchitis interventions

Monitor respiratory distress. Cool humidified air. Increased fluid intake. Antipyretics.

The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the most appropriate nursing action?

Move the infant to a private room.

TB diagnosis

Mycobacterium in sputum culture. Chest x-ray. Positive skin test.

The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions would the nurse include in the plan of care? Select all that apply.

Place the infant in a private room. Wear a mask, gown, and gloves when in contact with the infant. Ensure that nurses caring for the infant with RSV do not care for other high-risk children.

The clinic nurse reads the results of a tuberculin skin test (TST) on a 3-year-old child. The results indicate an area of induration measuring 10 mm. The nurse would interpret these results as which finding?

Positive

CF diagnosis

Positive sweat chloride test. DNA analysis. Chest x-ray shows atelectasis and obstructive ephysema. Abnormal PFT. Stool with trypsin.

SIDS RF

Prone position. Use of soft bedding, sleeping in a noninfant bed such as a sofa. Overheating (thermal stress). Co-sleeping. Birthing parent who smoked cigarettes or abused substances during pregnancy. Exposure to tobacco smoke after birth.

Lab test to diagnose asthma

Pulmonary function test-spirometer. Peak expiratory flow rate-exhaled. Bronchoprovication. Skin testing for allergens. Exercise challenge. Radioallergosorbent -blood test. Chest radiograph- to see hyperextension.

TB treatment

RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)

RSV s/s

Rhinorrhea. Eye/ear drainage. Pharyngitis. Coughing. Sneezing. Wheezing. Fever. Tachypnea. Listless. Decreased breath sounds.

The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse would monitor for which indication that the child may be experiencing airway obstruction?

The child is leaning forward, with the chin thrust out

CF respiratory s/s

Wheeze/cough. Dyspnea. Cyanosis, Clubbing. Barrel chest. Bronchitis. Pneumonia. *chest physiotherapy *Bronchodilators. *IV antibiotis. *Exercise and O2.

Signs of dehydration

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

Primary Atypical Pneumonia

a. Acute or insidious onset b. Fever (lasting several days to 2 weeks), chills, anorexia, headache, malaise, and myalgia (muscle pain) c. Rhinitis; sore throat; and dry, hacking cough d. Nonproductive cough initially, progressing to production of seromucoid sputum that becomes mucopurulent or blood-streaked 2. Interventions a. Treatment is symptomatic. b. Recovery generally occurs in 7 to 10 days.

viral pneumonia

a. Acute or insidious onset b. Symptoms range from mild fever, slight cough, and malaise to high fever, severe cough, and diaphoresis. c. Nonproductive or productive cough of small amounts of whitish sputum d. Wheezes or fine crackles. Treatment is symptomatic. b. Administer oxygen with cool humidified air as prescribed. c. Increase fluid intake. d. Administer antipyretics for fever as prescribed. e. Administer chest physiotherapy and postural drainage as prescribed.

A new parent expresses concern to the nurse regarding sudden infant death syndrome (SIDS). The parent asks the nurse how to position the new infant for sleep. In which position would the nurse tell the parent to place the infant?

back rather than the stomach.

A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child would monitor for which sign, knowing that it indicates a worsening of the condition?

decreased wheezing (sign of no air flow)

Bronchitis s/s

inflammation of the bronchi and trachea; URI. Fever. Dry hack. Nonproductive cough.

How to prevent rebound bronchoconstriction?

long-acting beta-adrenergic agonists (LABAs), would be given with an inhaled corticosteroid

What should not be attempted with epiglottis?

no attempts would be made to visualize the posterior pharynx, obtain a throat culture, take an oral temperature, or any other interventions that may cause agitation or crying until the airway is adequately secured

SIDS

unexpected death of an apparently healthy infant younger than 1 year for whom an investigation of the death and a thorough autopsy fail to show an adequate cause of death.