Pediatrics: Chapter 20: Respiratory Disorders

How long into a pertussis infection will the severe coughing begin?

1-2 weeks after onset of symptoms

Describe the catarrhal stage of pertussis

AKA runny nose stage 1-2 weeks Only during this stage that abx can halt progression*******

List signs of illness progression/respiratory distress (4)

Increased HR and RR Retractions Nasal flaring Restlessness

Describe the convalescent stage of pertussis

Chronic cough that is less paroxysmal and lasts for weeks to months

How is TB treated?

Long term abx

Why is hyperextension of the head/neck a compensatory mechanism?

Opens airway

How is asthma diagnosed?

Pulmonary function testing (PFT)

What are the generalized S/S in young children?

-Fever -Anorexia, N/V, abd pain -Cough, sore throat, nasal blockage and discharge -Respiratory sounds

What is Acute Respiratory Distress Syndrome (ARDS)?

-Type of respiratory failure -Acute, diffuse and inflammatory lung injury that allows fluid to leak into the lungs

RR for 17 y/o

12-20

RR for 10 y/o

16-20

RR for 7 y/o

16-22

RR for 3 y/o

20-30

Amandtadine, rimantadine, zanamivir, and oseltamivir are all examples of...

Antivirals (given for influenza)

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

Assisting with racemic epinephrine nebulizer therapy

Why are retractions a compensatory mechanism?

Assists with ventilation

Why is head bobbing a compensatory mechanism?

Assists with ventilation

Describe the paroxysmal stage of pertussis

Bouts of coughing with whoop Apnea, cyanosis, vomiting, and choking Lasts 1-10 weeks

Asthmatic bronchitis is more frequent in what type of weather?

Cold

During which 2 seasons are mycoplasmal infections most common?

Fall Winter

Nebulized racemic epinephrine should be administered for which croup disorder?

Laryngotracheobronchitis (LTB)

When is a tonsillectomy indicated?

Massive hypertrophy

What does conservative management for tonsillitis look like? (4 items)

Rest Warm fluids Warm salt-water gargles Abx therapy (bacterial only)

What causes allergic rhinitis?

Seasonal allergens (most often in autumn or spring)

What are the two other names for acute spasmodic laryngitis?

Spasmodic croup Midnight croup

Acute rheumatic fever and acute glomerulonephritis are complications of which disease process?

Strep throat

T/F: Children who had pertussis require long-term follow-up

TRUE

T/F: Respiratory infection are the cause of the majority of acute illnesses in children.

TRUE

T/F: Unlike adults, children are often asymptomatic even when a TB skin test is positive.

TRUE

T/F: bacterial epiglottitis is a medical emergency

TRUE Potential for complete obstruction and respiratory failure

T/F: Suctioning nares of an infant would the the first intervention to improve symptoms of nasopharyngitis.

TRUE This can alleviate irritability and respiratory distress since they're nose-breathers

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. A) Temperature 104°F (40°C) B) Flaring of the nostrils C) Circumoral cyanosis D) Intercostal retractions E) Respiratory rate of 44 breaths/min

Temperature 104°F (40°C) Flaring of the nostrils Circumoral cyanosis Intercostal retractions

A child presents to the ED with his mother complaining of a sore throat and difficulty swallowing. The pt has a history of otitis media with hearing difficulties. Which illness should the nurse be most concerned for?

Tonsillitis

When is RSV season?

Winter-spring

How does pertussis begin?

Common cold manifestations Ex. runny nose, congestion, sneezing, mild fever and MILD cough

A "barking" or "seal-like" cough is characteristic of which disease process?

Croup

A young child presents to the local ED being carried by dad. Dad states the child spiked a fever this morning and refused breakfast. Dad also reports he heard making a frog-like croaking sound and noticed his son drooling and agitated. The nurse notices retractions and inspiratory stridor during examination. Which disease is the nursing suspicious of? A) Croup B) Common cold C) Strep throat D) Bacterial epiglottitis E) Acute laryngotracheobronchitis

D) Bacterial epiglottitis

RR for 1 y/o

25-40

RR for newborns

30-55

Which of the following are post-op nursing interventions for a pt s/p tonsillectomy? Select all that apply. A) Assess for frequent swallowing B) Assess for drooling C) Avoid straws D) Avoid coughing/nose blowing E) Avoid cold foods

A) Assess for frequent swallowing C) Avoid straws D) Avoid coughing/nose blowing

A pale 12-year-old presents to the ED. Upon further inspection, the child has a fever of 104, a productive cough with white sputum, rhonchi, lethargic, retractions, and breathing at 44 bpm. Which illness is the nurse expecting? A) Bacterial pneumonia B) Influenza A C) Croup D) LTB

A) Bacterial pneumonia

Which of the following are clinical manifestations of nasopharyngitis? Select all that apply. A) Fever B) Cough C) Nasal inflammation/secretions D) Irritability E) Poor sleep F) Poor PO intake G) Vomiting/diarrhea H) Permanent loss of taste/smell

A) Fever C) Nasal inflammation/secretions D) Irritability F) Poor PO intake G) Vomiting/diarrhea

Which of the following are post-op nursing interventions for a pt s/p tonsillectomy? Select all that apply. A) Give pain meds before PO intake B) Give pain meds after PO intake C) Avoid citrus or red liquid D) Position pt on side E) Position pt on abdomen

A) Give pain meds before PO intake C) Avoid citrus or red liquid D) Position pt on side E) Position pt on abdomen

The nurse suspects a child to have bacterial epiglottitis. She should... (SATA) A) Prepare for intubation B) Avoid throat culture or using a tongue blade C) Obtain an EKG D) Administer corticosteroids and NS E) Obtain a set of vitals

A) Prepare for intubation B) Avoid throat culture or using a tongue blade D) Administer corticosteroids and NS RN should already have gathered vitals at this point

An infant is hospitalized with RSV. The nurse should plan to (SATA) A) Reduce airway inflammation B) Administer a cough suppressant C) Hydrate the child D) Use aerosolized Ribavirin E) Administer abx

A) Reduce airway inflammation C) Hydrate the child D) Use aerosolized Ribavirin

How is TB diagnosed? SATA. A) Skin testing B) Chest X-ray C) QuantiFERON gold testing D) Lung biopsy E) Pulmonary functions testing

A) Skin testing B) Chest X-ray C) QuantiFERON gold testing

Which interventions can the nurse implement for a child with pertussis? SATA. A) Supplemental O2 B) Antipyretics C) Breathing treatments D) Antivirals E) Antibiotics

A) Supplemental O2 C) Breathing treatments E) Antibiotics

The nurse is caring for a child who has been brought to the clinic for the third time in a week for asthma symptoms. If the goal is to have the parents better manage the child's care, which information will the nurse emphasize? Select all that apply. A) adhering to the recommended immunization schedule B) engaging in sedentary age-appropriate activity daily C) importance of keeping child away from cigarette smokers D) instruction on peak flow meters and nebulizer treatments E) role of good handwashing to reduce transmission of disease

A) adhering to the recommended immunization schedule C) importance of keeping child away from cigarette smokers D) instruction on peak flow meters and nebulizer treatments E) role of good handwashing to reduce transmission of disease

An infant with a high respiratory rate is NPO and is receiving IV fluids. What assessment(s) will the nurse make to assure this infant is hydrated? Select all that apply. A) measure skin turgor B) palpate anterior fontanel (fontanelle) C) determine urine output D) review electrolyte laboratory results E) assess the lung sounds

A) measure skin turgor B) palpate anterior fontanel (fontanelle) C) determine urine output

What is cystic fibrosis (CF)?

Autosomal recessive d/o that causes abnormalities in body's salt, water and mucus-making cells. This causes thick, sticky mucus buildup in the lungs, sinuses, liver. pancreas. intestines and reproductive organs

A pediatric client presents to the ED with complaint of abrupt headache, fever, abd pain and sore throat. Upon further inspection, the nurse notices the tonsils and pharynx are inflamed and covered with exudate. The nurse should suspect which disease process? A) Tonsillitis B) Strep throat C) Croup D) LTB

B) Strep throat

What lab tests should be conducted on a child with suspected strep throat? A) COVID test B) Throat culture C) Blood culture D) Sputum culture

B) Throat culture + Rapid antigen testing

Which bacterium causes pertussis?

Bordetella pertussis

Another name for nasopharyngitis

Common cold

T/F: OTC pediatric cold remedies are recommended for treating the common cold.

FALSE Antihistamines are mostly ineffective, but antipyretics and cough suppressants/decongestants would be beneficial

T/F: Intubation equipment should not be left at bedside to prevent contamination and scaring the child.

FALSE Intubation equipment should be readily accessible in pts with respiratory issues

Performing a throat culture or rapid antigen test can rule out what infection?

GABHS

What causes streptococcal pharyngitis (strep throat)

Group A beta-hemolytic streptococci (GABHS)

Why is grunting a compensatory mechanism?

Helps keep alveoli open

How can bacterial epiglottitis be prevented?

Hib vaccine

What type of diet should a child with CF be on?

High protein High calorie High fat

Why is nasal flaring a compensatory mechanism?

Increases diameter of air passages

How is CF diagnosed?

Sweat chloride testing