CHAPTER 40 - NURSING CARE OF THE CHILD WITH AN ALTERATION IN GAS EXCHANGE/RESPIRATORY DISORDER

What is beclomethasone used for?

Beclomethasone is a corticosteroid prescribed for long-term asthma control. Mast cell stabilizers help to decrease bronchospasm and mucous membrane inflammation. A xanthine derivative such as theophylline is a time-released bronchodilator. Leukotriene inhibitors help with bronchodilation and decrease airway edema.

The nurse is caring for an infant whose oxygen saturation levels frequently drop below 90%. Which data is most important to relate to the health care provider?

Blood gasses Infants may respond to low blood oxygen levels with increased respirations followed by a period of apnea. Conditions such as bronchopulmonary dysplasia (chronic lung disease), pneumonia, and bronchiolitis can put infants at risk. The health care provider needs to be kept updated on blood oxygen levels. Vital signs, respiratory depth, and pattern, and breath sounds are basic nursing assessments that provide helpful data on the respiratory system, but these data are not as important as the laboratory results.

Which immunizations are suggested at 2 months of age to prevent bacterial pneumonia? Select all that apply.

HiB PCV The Hib (H. influenzae type B conjugate) and pneumococcal (PCV) vaccines are suggested at 2 months of age and were developed to decrease the incidence of respiratory infections, including bacterial pneumonia. The rubella vaccine protects against the German measles. The rotavirus vaccine protects against dehydration from a gastrointestinal virus. The varicella vaccine protects against the chickenpox virus.

What trait is unique in regards to the structure and function of the newborn's respiratory system?

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.

The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting forward with the neck extended to breathe. The signs the nurse noted indicate the child likely has:

The child with epiglottitis is very anxious and prefers to breathe by sitting forward with the neck extended. Immediate emergency attention is necessary. The child with asthma would have wheezing and distress trying to breathe. The child with cystic fibrosis would not have respiratory distress unless ill with respiratory infection. The drooling, leaning forward, and appearing distressed are not manifestations of TB.

Which piece of equipment is most helpful in determining airway obstruction in the client with asthma?

The peak flow meter provides the most reliable early sign of an asthma episode. Most episodes begin gradually, and a drop in peak flow can alert the client to begin medications before symptoms actually are noticeable. A nebulizer and inhaler treat symptoms. An incentive spirometer is used for lung expansion, especially after surgery.

An 8-year-old client is suffering from allergic rhinitis (hay fever). Which statement will the nurse include when providing education to the client's caregiver?

Pollen/mold The allergens that usually cause allergic rhinitis (hay fever) are pollens or molds rather than foods or drugs. Over-the-counter or prescription allergy medications may help provide relief for these clients when taken. Peanuts and soap are not associated with allergic rhinitis. Antibiotics are used to treat bacterial infections, not allergic responses in clients.

Which family member would be restricted from the room of an infant receiving ribavirin?

Ribavirin is classified as a category X drug, signaling a high risk for teratogenicity. The medication is administered by mist which may escape into the room. No pregnant female should be admitted in the room. The other family members may be present.

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 performing an abdominal assessment on a child. Which assessment techniques demonstrated by the nurse are appropriate when performing an abdominal assessment? Select all that apply.

-The nurse uses percussion and notes dullness along the costal margins and tympany over the remainder of the abdomen. -The nurse uses the technique of inspection to assess for the presence of an umbilical hernia. -The nurse auscultates for bowel sounds in all four quadrants of the abdomen. Correct techniques include percussion of the abdomen to determine dullness along the costal margins and tympany over the remainder of the abdomen, inspection to visualize an umbilical hernia, and auscultation of all 4 quadrants of the abdomen. Auscultation should occur prior to palpation in order to not alter bowel sounds, and absence of bowel sounds can only be determined when listening for at least 5 minutes in each quadrant.

Which measure would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis?

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.

A child presents to the health clinic with a temperature of 101.8°F (38.8°C), dysphagia, headache, and a sore, erythematous throat. Which collaborative intervention will the nurse complete first?

Obtain a throat culture A child presenting with fever, dysphagia, headache, and a sore, erythematous throat may have viral or bacterial pharyngitis. The nurse's first action should be to obtain a throat culture to determine if the child has a bacterial or viral infection. If the throat culture is negative, the child will not require antibiotics. If the culture is positive, the child will need antibiotics. Saltwater gargles will help relieve pain, but this is not a priority. Children with streptococcal pharyngitis may develop a sandpaper rash, but this information alone is not conclusive, and a throat culture should be obtained prior to administering antibiotics.

A 2-year-old toddler is seen for acute laryngotracheobronchitis. What observation would lead the nurse to suspect airway occlusion?

Acute laryngotracheobronchitis is also know as croup. It produces edema of the larynx, trachea, and bronchi. An increasing respiratory rate, retractions, and nasal flaring are signs of major respiratory distress and occlusion. The toddler is breathing faster because less air is received with each breath. Nasal discharge is generally not seen with croup. The cough of croup is due to the inflammation in the larynx and trachea and it is a barking cough (sounds like a seal). A 2-year-old toddler will become tired and fall asleep or be irritable and unable to fall asleep. This age group is unable to verbalize being tired and wanting to sleep.

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 do not understand why there might be bleeding in 1 week or so." What is the most appropriate explanation for the nurse to give this caregiver?

Bleeding can occur at this time because the clots dissolve and new tissue is not yet present. Hemorrhage is the most common complication of a tonsillectomy. Bleeding is most often a concern within the first 24 hours after surgery and up to the 10th postoperative day. Bleeding late postoperatively can occur when the clots dissolve and new tissue is not yet present. A tonsillectomy can be done at any age so stating that bleeding is a complication of age is incorrect. By 10 days postoperatively the child may still have a slight sore throat or have difficulty eating some solid foods so the child has not forgotten about the surgery. The pressure of coughing is most likely to cause bleeding early postoperatively. Salt will not cause bleeding and telling that to a parent is providing false information.

A 6-year-old child was diagnosed as having streptococcal pharyngitis. At the follow-up visit, the nurse will assess the child for which potential complication?

Development of rheumatic fever The Group A strain of streptococci causing streptococcal pharyngitis can cause a hypersensitivity reaction that results in either rheumatic fever or glomerulonephritis. Swollen lymph nodes obstructing the airway would occur during the illness, not afterward. They would have been addressed at an emergency visit, rather than at the routine follow-up visit. The organism will not affect the teeth. Nephrosis or nephrotic syndrome relates to increased edema and protein, not the infection of the kidney (glomerulonephritis).

What are the manifestations and risk factors of TB in children?

Tuberculosis is a highly contagious respiratory infection. A child who has been living in crowded locations, who is impoverished, or homeless is at an increased risk. Signs and symptoms of the disease include weight loss, night sweats, anorexia and pain. A child living in a household with parents and one sibling does not have an increased risk for infection. A sore throat is not associated with tuberculosis.