Pediatrics Exam 2 - Respiratory

Some clinical manifestations of the ________ are fever/chills, cough/hoarseness

influenza

LTB tends to occur in ________ children

young

In a conscious choking child, make attempts to relieve the obstruction only if the child is ________ (3)

- Unable to make any sounds - The cough becomes ineffective - The child has increasing respiratory difficulty with stridor.

Some clinical manifestations of CF include ________

- bulky frothy, foul stools - malabsorption & maldigestion - pancreatic insufficiency - delayed puberty and sterility - Failure to thrive

Acute Spasmodic Laryngitis can be managed at ________, and it is very important to keep the child ________, and under high ________

Home; hydrated; humidity

Some interventions to ease respiratory efforts are O2, ________, suction, and ________

Humidity; CPT

Some characteristics of CF include ________

- Abnormal chloride movement - ↑ Viscosity of mucous gland secretions - mechanical obstruction in glands and ducts.

Three clinical observations predictive of epiglottitis are ________

- Absence of spontaneous cough - Presence of drooling - Agitation

What are the three functions of the eustachian tube? (3)

1. Protection of the middle ear from nasopharygeal secretions 2. Drainage of secretions produced in the middle ear into the nasopharynx 3. Ventilation of the middle ear to equalize air pressure

Suctioning a children should be < ________ with 30 - 60 seconds rest periods, while hyper-oxygenating between

10 seconds

RSV's peak incidence is between ________

2 to 7 months

Acute Nasopharyngitis usually resolves on its own within ________

4 to 10 days

Suctioning an infant should be < ________ with 30 - 60 seconds rest periods, while hyper-oxygenating between

5 seconds

Infants and young children especially those between ________ and ________ of age react more severely to acute respiratory infections than older children

6 months; 3 years (due to the loss of maternal antibodies)

Seasonal allergies are also called ________

Allergic Rhinitis

Airway is obstructed if the ___________ is inflamed due to the smaller structure.

Epiglottis

Acute ________ is considered to be a medical emergency due to it's potential for respiratory ________

Epiglottitis; obstruction

Babies are ___________ breathers.

Nose

________ is an inflammation of the middle ear and is the most ________ illness of early childhood

Otitis Media; prevalent

___________ concentration determine the type of oxygen therapy you will use

Oxygen

________ is an acute viral infection at bronchiolar level

RSV

________ is the most frequent cause of hospitalization in children less than 1 year old

RSV

In management of asthma which medications are often used together to control asthma in short and longterm?

Salmeterol (long) and fluticasone (short) - Long acting bronchodilator w/ anti-inflammatory.

________ is characterized by unexplained death < 1 year old.

Sudden infant Death Syndrome (SIDS)

One treatment for croup is ________

Take them outside in the cold mist/ fog

When an infant's nose is congested, what complications does this cause?

They end up not wanting to eat resulting in nutritional complications.

When suspecting a child having Acute Epiglottitis, you should never examine the ________

Throat

A ________ is a surgical opening in the trachea between the second and fourth tracheal ring. It is done due to upper airway obstruction or for long term ________

Tracheostomy; ventilation

TRUE or FALSE: LTB is the inflammation of the mucosa lining trachea and larynx with narrowing

True

TRUE or FALSE: Many cases of bacterial OM are preceded by a viral respiratory tract infection

True

Most respiratory infections are caused by ___________

Viruses

Central Apnea is when both airflow and chest wall movements are ________

absent

Obstructive Apnea is when airflow is ________ but chest wall motion is ________

absent; present

Acute Nasopharyngitis is equivalent to the ________

common cold

Closely monitor the child's ________ in an oxygen tent

temperature

TRUE or FALSE: Acute OM occurs the first 24 months and occurs frequently in children older than 7 yrs old

False; occurs INFREQUENTLY in children older than 7 yrs old, but it incidence increase at age 5 or 6 when children enter school.

________ is the most common type of croup experienced by children less than 5 years of age

Laryngotracheobronchitis (LTB)

________ Apnea is when both central and obstructive components are present

Mixed

Some respiratory manifestations of CF include ↓ gas exchange, progressive lung dysfunction, frequent ________, and ________ secretions

infections; thick

Early signs of impeding airway obstructions include ↑ HR & RR, ________, ________, and ↑ restlessness

intercostal retractions; nasal flaring

Children with apiglottitis usually ________ worse than they ________.

look; sound

Concentration of oxygen in a ________ is difficult to control and to maintain above ________

oxygen tent (croup tent); 30% to 50%

Children with severe respiratory distress should be ________ to prevent ________ and increased work of breathing

NPO; aspiration

Clinical Manifestations of OM include acute onset of ________, diarrhea, ________, fever, tympanic membrane redness, and middle ear effusion

ear pain (ear pulling); vomiting

Complications of influenza include ________, severe viral pneumonia which can become ________

encephalitis; hemorrhagic

________ is seen primarily in older children

epiglottitis

Some clinical manifestations of Acute Nasopharyngitis in INFANTS are ________, irritability, restlessness, decreased ________, and nasal inflammation

fever; appetite

Some clinical manifestations of Acute Nasopharyngitis in CHILDREN are ________, nasal dryness/________ and muscle aches

fever; discharge

Ways to prevent the spread of infections are ________ and isolation

hand washing

In order to give ________ levels of O2, you need to switch from a NC to ________.

higher; mask

What diagnostic tests are done to find out if the child has CF?

A positive sweat chloride test, absence of pancreatic enzymes

During suctioning vacuum pressure should be between ________ for infants and children

60 to 100 mm Hg

For management of AOM in infants older than 6 months children include waiting up to ________ for ________ resolution

72 hours; spontaneous

Cold fluid or air applied to the face stimulates receptors that trigger the ___________ reflex, which causes ___________ and ___________ of blood from peripheral to central circulation

Driving; Bradycardia; shunting

What cause OM?

Dysfunction of the eustachian tube. Structurally in a child, the tube is much shorter, wider, straighter and more horizontal resulting in increased incidence of obstructions and aspiration/reflux

What are the two most common viruses that are most likely to precipitate OM?

RSV and Influenza

________ is the cause of cardiac arrest in children

Respiratory failure

GI Management of CF include ________ replacement, high protein/calorie diet, ________, vitamins, and relieve intestinal ________ which can lead to rectal prolapse

pancreatic enzyme; lipids, obstruction

Oxygen administration to infants is well tolerated using a ___________, which delivers a flow of ___________

plastic hood; 4 to 5 L/min

Management of influenza include antipyretics, fluids and ________

prevention

Ways to promote rests are age appropriate play and ________

quiet activities

________ is the cessation of respiration

respiratory arrest

___________ are when the baby breathes and their diaphragm/part of the abdomen goes into the thoracic cavity and is a sign of ___________

retractions; respiratory distress

Some interventions for management of asthma include avoiding ________, CPT, hyposensitization, meds, and ________

triggers; Peak expiratory flow (PEF)

Large amounts of bloody secretions in a child with a tracheostomy are ________ and should be considered a sign of ________

uncommon; hemorrhage

Some clinical manifestations of LTB are ________

- Low grade fever (gradual onset) - Inspiratory stridor - Suprasternal retractions - Barking or "seal-like" cough/hoarseness - Increasing respiratory distress and hypoxia

What are the organisms responsible for LTB (4 kinds)

- RSV - Parainfluenza virus - Mycoplasma pneumoniae - Influenza A & B

Some clinical manifestations of respiratory failure are ________

- Restlessness - Tachypnea/Tachycardia - Diaphoresis - Increased respiratory difficulty - Retractions/grunting, wheezing

What are some signs of respiratory distress?

- Retractions - Nasal flaring, grunting - Restlessness - Diaphoresis - Position - Head bobbing

What about the anatomy of the pediatric lungs are different from adults?

- Size of airway are small and swell/clog really quickly. - Upper respiratory infections can lead to lower respiratory infection due to the close proximity of each other. - Frequent infections - Resistance is lower

________ are paroxysmal attacks of laryngeal obstructions the occurs at night and most often affects children ages ________

Acute Spasmodic Laryngitis (Spasmodic Croup); ages 1 to 3 years old

All cases of AOM in infants younger than 6 months should be treated with ________, Why?

Antibiotics; Because of their immature immune system and potential for infection of other bacteria.

Management of Acute Nasopharyngitis includes rest, ________, elevate HOB, Saline drops/suctioning, adequate and ________.

Antipyretics; fluid intake

________ is the cessation of breathing for more than 20 seconds or for a shorter period when associated with hypoxemia or ________

Apnea; Bradycardia

________ is a chronic inflammatory disorder of the airways

Asthma

One assessment of asthma includes looking at speech patterns, why?

Because how much they can say is how much they can breath.

Some clinical manifestations of asthma include ________ wheeze, decreased ________, SOB, and tripod positioning

Expiratory; breath sounds

Cardiac arrest is less often a ___________ origin, but rather of prolonged ___________ secondary to ___________ oxygenation, ventilation and circulation (shock).

Cardiac; hypoxemia; inadequate

___________ is a result of ___________ poor tissue perfusion

Clubbing; chronic

True or False: Sucking relieves pain in Otitis Media

False - sucking/chewing aggravates pain resulting in a decrease in apetite

TRUE or FALSE: LTB and epiglottitis occur together

False: They do not occur together.

________ is a general term applied to a group of symptoms characterized by hoarseness, a "barking" cough, inspiratory stridor, and obstruction of the larynx

Croup

________ is characterized by exocrine gland dysfunction that produces multisystem involvement

Cystic Fibrosis

In infants, not being able to pass their first meconium stool predisposes them of having ________, obstruction leads to the formation of meconium ________

Cystic fibrosis: ileus

TRUE or FALSE: A chest X-ray can diagnose asthma

False: a CXR does not Dx Asthma but is done to r/o other diseases

When performing emergency care for a child you can perform the ___________, which is recommended for children older than 1 years old.

Heimlich

By age 5, incidence of viral respiratory tract infections are less frequent, but the incidence of ________ and ________ infections increase

M. pneumoniae; Group A Beta Hemolytic Strep. (GABHS)

The ME is ROME for acid base mnemonic stands for ________

Metabolic Equal pH ↑ HCO3 ↑ = ALKALOSIS pH ↓ HCO3 ↓ = ACIDOSIS

________ is a common therapeutic measure for symptomatic relief of respiratory discomfort and is beneficial when there is ________ and laryngeal. Why?

Warm or cool Mist; hoarseness; because moisture soothes inflamed membranes

The RO in ROME for acid base mnemonic stands for ________

Respiratory Opposite pH ↑ PCO2 ↓ = ALKALOSIS pH ↓ PCO2 ↑ = ACIDOSIS

________ is the inability of the respiratory apparatus to maintain adequate gas exchange

Respiratory failure

When performing emergency care for an infant, you can perform a series of ___________

back blows

influenza is most infectious for 24 hours ________ and ________ the onset of symptoms

before; after

Children are often ___________ breathers, due to their weak ___________ muscles

belly; abdominal

Respiratory management for CF include CPT, ________, O2, anti-inflammatory agents, aggressive treatment of ________ and transplantation

bronchodilators, infections

Possible treatments of RSV include ________ isolation, high humidity NC, ________, fluids, and meds (INH Epi, corticosteroids, ribavirin)

cohort; suction

Influenza is transmitted through ________ and has an incubation period of ________

direct contact; 1 to 4 days

When administering oxygen, always ________ it to children

humidify

An indication for oxygen administration is ___________

hypoxemia

Ways to help promote comfort are ________, throat gargles, and nasal ________

nose drops; aspirators

To help prevent acute OM, avoid ________, breastfeed, and get the child immunized for ________

smoke; influenza

Children with LTB ________ worse than they ________

sound; look

Usual airway obstructions are due to ___________

structural