Chapter 40: Alteration in Gas Exchange/Respiratory Disorder
_____________ are the most common causes of illness and hospitalization in children and account for the majority of acute illnesses in children
Respiratory disorders
respiratory distress syndrome
a severe respiratory disease that is characterized by rapid respiratory failure
The nurse is providing discharge teaching to the parents of a child who had a tonsillectomy. Which statements by the parents indicate learning has occurred? -"Hot drinks, like hot chocolate, will help with controlling the pain." -"If our child starts swallowing a lot, we may need to call the surgeon." -"Milkshakes should be drank with straws so that not too much is swallowed at a time." -"Fluids are very important. Our child loves popsicles so we will get a variety of flavors, except cherry and strawberry." -"We can use an ice collar on his throat as long as we don't leave it on too long at a time."
"If our child starts swallowing a lot, we may need to call the surgeon." "Fluids are very important. Our child loves popsicles so we will get a variety of flavors, except cherry and strawberry. We can use an ice collar on his throat as long as we don't leave it on too long at a time."
signs of pneumothorax
Chest pain might be present as well as signs of respiratory distress such as tachypnea, retractions, nasal flaring, or grunting
A 5-year-old child is brought to the clinic by his father because the child developed a high fever over the past 2 to 3 hours. The nurse suspects epiglottitis based on which signs and symptoms? Select all that apply. -Difficulty speaking -Drooling -Sitting with neck extended -Frightened appearance -Cough
-Difficulty speaking -Drooling -Sitting with neck extended -Frightened appearance
Respiratory Syncytial Virus
A highly contagious virus that causes an infection of the upper and lower respiratory system.
risk factors for pneumothorax
Chest trauma or surgery, intubation and mechanical ventilation, or a history of chronic lung disease such as cystic fibrosis
Inspection and Observation of the Respiratory System
Color: pallor, cyanosis, acrocyanosis Rate and depth of respirations: tachypnea Nose and oral cavity Cough and other airway noises: atelectasis, stridor Respiratory effort Anxiety and restlessness Clubbing Hydration status
signs of pharyngitis
Cough Fever Halitosis Facial pain Eyelid edema Irritability Poor appetite
signs of sinusitis
Cough Fever Halitosis Facial pain Eyelid edema Irritability Poor appetite
nursing management of epiglottis
Do not attempt to visualize the throat. Do not leave the child unattended. Do not place the child in a supine position. Provide 100% oxygen in the least invasive manner. If complete airway occlusion occurs, tracheostomy may be necessary. Ensure emergency equipment is available.
Croup Syndromes
Infections of the epiglottis and larynx
Tests for cystic fibrosis
Sweat chloride test: considered suspicious if the level of chloride in collected sweat is above 50 mEq/L and diagnostic if the level is above 60 mEq/L Pulse oximetry: oxygen saturation might be decreased, particularly during a pulmonary exacerbation Chest radiograph: might reveal hyperinflation, bronchial wall thickening, atelectasis, or infiltration Pulmonary function tests: might reveal a decrease in forced vital capacity and forced expiratory volume, with increase in residual volume
incentive spirometry
a common postoperative breathing therapy using a specially designed spirometer to encourage the patient to inhale and hold an inspiratory volume to exercise the lungs and prevent pulmonary complications
adventitious breath sounds
abnormal breath sound heard over the lungs Wheezing High-pitched sound on expiration May occur with obstruction in lower trachea or bronchioles Rales Crackling sounds heard when alveoli become fluid filled May occur with pneumonia
croup
acute viral infection of infants and children with obstruction of the larynx, accompanied by barking cough and stridor
The nurse is percussing the chest of a child with a suspected respiratory disorder. What sound might the nurse note that would indicate pneumonia? a. decreased fremitus b. dull sound c. tympany d. hyperresonance
b.dull sound Adull or flat sound would be percussed over partially consolidated lung tissue, as occurs with pneumonia. Decreasedfremitus is found on palpation and may be found with barrel chest, as may occur with cystic fibrosis. Tympany might be percussed with pneumothorax, and hyperresonance might be apparent with asthma.
halitosis
bad breath
atelectasis
collapsed lung
vMost common debilitating disease of childhood among those of European descent....
cystic fibrosis
pneumonia
inflammation of the lung parenchyma
sinusitis
inflammation of the sinuses
Airway lumen....
is smaller in infants and children than in adults and when edema, mucus, or bronchospasm is present, the capacity for air passage is greatly diminished
"shift to the left" in CBC
neutrophil
Newborns are obligatory _________- _________until at least 4 weeks of age and cannot automatically open their mouths to breathe if the nose is obstructed
nose breathers do not know how to breathe out of their mouths yet
epistaxis
nosebleed
acute respiratory distress syndrome (ARDS)
respiratory insufficiency marked by progressive hypoxia Sepsis Viral pneumonia Smoke inhalation Drowning Note that respiratory distress and hypoxemia occur acutely within 72 hours of the insult in infants and children with previously healthy lungs
Congenital laryngomalacia due to...
the funnel shape and location of the larynx, increasesthe chance of aspiration of foreign material into the lower airways
true or false: children have a significantly higher metabolic rate than adults and how this affects normal oxygen transport
true
The nurse is carefully assessing the infant diagnosed with bacterial pneumonia whose respiratory status is declining. Which nursing findings are reported immediately to the charge nurse and health care provider? Select all that apply. -Temperature 104°F (40°C) -Flaring of the nostrils -Circumoralcyanosis -Intercostal retractions -Respiratory rate of 44 breaths/min
-Temperature 104°F (40°C) -Flaring of the nostrils -Circumoralcyanosis -Intercostal retractions
The nurse is caring for a child with thickened pulmonary secretions. Which action(s) would the nurse use to assist the child breath with less effort? Select all that apply. -Perform chest physiotherapy -Encourage oral fluids -Avoid humidification of oxygen if oxygen is in use -Assess pulse oximetry every 12 hours -Observe for cyanosis and labored breathing every 12 hours
-Perform chest physiotherapy -Encourage oral fluids
The child has been admitted to the hospital with a possible diagnosis of pneumonia. Which findings are consistent with this diagnosis? Select all that apply. -The child's temperature is 98.4° F (36.9°C). -The child's chest x-ray indicates the presence of perihilarinfiltrates. -The child's white blood cell count is elevated. -The child's respiratory rate is rapid. -The child is producing yellow purulent sputum.
-The child's chest x-ray indicates the presence of perihilarinfiltrates. -The child's white blood cell count is elevated. -The child's respiratory rate is rapid. -The child is producing yellow purulent sputum.
prolonged expiration is a sign of...
vbronchial or bronchiolar obstruction
Tests for bronchiolitis
Pulse oximetry: oxygen saturation might be decreased significantly Chest radiograph: might reveal hyperinflation and patchy areas of atelectasis or infiltration Blood gases: might show carbon dioxide retention and hypoxemia Nasal-pharyngeal washings: positive identification of RSV can be made via enzyme-linked immunosorbent assay (ELISA) or immunofluorescent antibody (IFA) testing
Tests for pneumonia
Pulse oximetry: oxygen saturation might be decreased significantly or within normal range Chest x-ray: varies according to child age and causative agent Sputum culture: may be useful in determining causative bacteria in older children and adolescents White blood cell count: might be elevated in the case of bacterial pneumonia
most critical infectious disorder for infants and peds?
RSV because you have to kick it yourself
true or false: The nurse caring for a child with asthma documents lung function as forced expiratory volume (FEV) 60% to 80% of predicted. This child is classified as having intermittent asthma.
False. Achild with lung function documented as forced expiratory volume (FEV) 60% to 80% predicted is classified as having moderate persistent asthma. Intermittentand mild persistent asthma is FEV 80% or more and severe persistent asthma is FEV less than 60% of predicted.
Risk of TB
HIV infection Incarceration or institutionalization Positive recent history of latent TB infection Immigration or travel to endemic countries Exposure at home to HIV-infected or homeless persons, illicit drug users, persons recently incarcerated, migrant farm workers, or nursing home residents
nursing care post tonsillectomy
Promoting airway clearance Place child in side-lying or prone position Maintaining fluid volume Discourage coughing Encourage fluids; avoid citrus, brown, or red fluids Relieving pain Ice collar and analgesics with or without narcotics
The nurse is caring for a child with cystic fibrosis. Which treatment would be used to promote mucus clearance through percussion or vibration? a. suctioning b. chest tube c. bronchoscopy d. chest physiotherapy
chest physiotherapy Chestphysiotherapy promotes mucus clearance through percussion or vibration. Suctioningremoves secretions via bulb syringe or suction catheter, chest tubes remove air or fluid througha drain inserted into the pleural cavity, and bronchoscopy is the introduction of a bronchoscope into the bronchial tree for diagnostic purposes.
Congenital laryngomalacia
congenital abnormality of the laryngeal cartilage. a delay of maturation of the supporting structures of the larynx. (floppy epiglottis) most common cause of congenital stridor and is the most common congenital lesion of the larynx.
virus most common cause of pneumonia in...
younger children and the least common cause in older children