Pediatrics week 3 study guide
Pediatrics week 3 study guide NURS 410
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This 6 page Study Guide was uploaded by Pallavi Battar on Sunday September 11, 2016. The Study Guide belongs to NURS 410 at San Francisco State University taught by Dr. Musselman in Fall 2016. Since its upload, it has received 28 views. For similar materials see Nursing Care of Children in NURSING at San Francisco State University.
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Date Created: 09/11/16
Pediatrics week 3 notes: Oxygenation Power Point: The child with Respiratory Dysfunction Slide Teacher’s/ Textbook Notes Questions (Answers #/Title below) 4/ Structure 1) Horizontal rib attachment until 7-8 yrs oldbarrel chest; IC 1) What should you & Function muscles function only to stabilize and have difficulty lifting ribsatch for if a young for chest expansion during respirations obligate belly child or infant develops breathers pneumonia? 2) Diaphragmhigher in thorax and more horizontal for infants 2) what condition and young kids impede diaphragmatic movements in kids? 3) Airway continuous growth (diameter & length); larynx is funnel shaped b/c of narrowing of cricoid cartilage (kids < 8yrs 3) what is the optimal old) increased resistance w/ sm. airways neck positon for maintaining airway? 4) wide angle of right mainstem bronchus aspiration risk 4) Complications the child may face in 5)obligate nose breathers up to 4-6 wks problems detailed in the #6 notes? 6) born w/ less alveoli, less surfactant (if premature), less compliance, poorly developed pathways of ventilation 5/ Adult vs. 1) disease frequency lack of lung cilia to push things out of Child airway; immune sys. Underdeveloped; everything goes in mouth 2) Premature infants (lungs not fully developed) have life-long respiratory issues 7/ 1) Less chemoreceptors can’t respond as fast to changes in Pathophysiol gas exchange response is to increase RR (happens fast) ogy increase work of breathing kid gets tired crashes fast 10/ Physical 1) LOC what’s typical for the kid; decreased activity and 5) What is important to assess for a child Assessment appetite admitted for altered 2) Signs of Distress respiratory status? a) retractions (IC, substernal, supraclavicular, subclavicular) 6) Focused Physical b) nasal flaringhaving really hard time Assessment? c) tripod position, head bobbing 7) Ominous signs of 3) Sounds heard on exp. and insp. can tell where problem is respiratory distress and impending respiratory 4) Cough productive/non-productive (sputum color, consistency, amount); sound, length, time or day, season. failure, that require immediate attention? 8) What are the 4 major Dx test for evaluating respiratory system and disorders? 9) When is Oxygen 11/Oxygen 2) Delivery routes mask. Nasal cannula, hood, ET-tube, Therapy Tracheal tube, blow-by, ventilatorbased on concentration therapy indicated? desired and kid’s ability to handle therapy Don’t fight the kid can increase RR (kids crash fast after RR is increased) 10) what happens if the O2 is not humidified during delivery through ET tube or tracheostomy tube? 12/ 1) biggest cause of cardiac arrest in kids!!! (Tx. kids, not the 11) Specific Vs. Non- Respiratory monitor, listen to parents) Specific Tx? List Non- Failure specific nursing 2) S/Sx restlessness, tachypnea/tachycardia (compensation interventions (slide 14). for decreased O2 status), diaphoresis, increase work of breathing, retractions, grunting, wheezing 12) Main classes of 3)Kids w/ chronic respiratory issues respond to O2, Meds, respiratory disorder meds? ACTs, nutritional support 16/ Croup 1) Not medical emergencykeep kid hydrated tx w/ antibiotics Syndromes and comfort measures @ homealso clears up w/ cold air/ moisture (reduces inflammation) 2) 6 months to 5 yrs of age (peak incidence @ age 2) 3) upper respiratory obstruction inflammation causing already small airway to become smaller laryngitis (spasmodic croup), epiglottitis, tracheitis, bronchitis, and laryngotracheobronchitits (LTB) all can be inflamed and are all common type of croup syndromes must differentiate croup from other conditions (supraglottis [acute epiglottitis] and tracheitis) b/c care/tx is significantly different 17/ Acute 1) Acute inflammation of supraglottic structures, epiglottis, 13) What are the S/Sx or Epiglottitis aryepiglottic folds (doesn’t involve subglottic and tracheal assessment findings of region may progress to complete airway obstruction and supraglottitis? (Supraglottiti Interventions? s) cardiopulmonary arrest 2) Occurs year-round but more common in winter and early 14) How can the community help? spring from infection of structuresGABHS, S. pneumoniae, HIB, beta-hemolytic streptococci, some viruses swelling or structures and bacteremia 3) The 4 D’s Drooling, Dysphonia, Dysphagia, Distress 4) DO NOT EXAMINE THROAT will irritate epiglottis and swell more; if completely block ET tube can’t be used must insert tracheostomy 5) cherry red epiglottis, swollen surrounding tissues, severely swollen laryngeal orifice, mucous secretion pooling. 6) Usually rapid recovery (2-3 days) after extubated, fever decreases, kid can handle expectorating secretions himself, and airway narrowing resolved. 15) What are the S/Sx or 18-19/ Acute 1) inflammation and edema of tracheal mucosal lining and LTB and laryngeal narrowing, subglottic narrowing (smallest part of assessment findings of Clinical upper airway in kids) bronchi, and laryngeal muscle spasm; supraglottitis? pro most common croup syndrome; kids <5 yrs old Interventions? manifestatio ns 2) usually viral infection and affects subglottic region parainfluenza 1 and 3 (most cases), influenza A and B, RSV (respiratory syncytial virus), adenovirus, rhinovirus, human metapneumovirus, enterovirus, measles and herpes simplex (rare) 3) Incubation period (2-6 days); preceded by mild upper respiratory infection (rhinorrhea, mild cough, low-grade fever); LTB should subside in 3-5 days w/ full recovery 4) Corticosteroids dexamethasone or budesonidedecreased airway edema, and other symptoms; Racemic Epinephrine decrease symptoms, effects are short lived, via topical alpha- adrenergic stimulation (causes mucosal vasoconstriction and decreased subglottic edema); Antipyretics if febrile (> 101 F or 38.3 C); Antibiotics and Antivirals (Depending on cause) 20-21/ RSV- 1) acute inflammation and obstruction of bronchioles, edema of 16) What are the S/Sx or Bronchiolitis airway wall, mucous and cellular debris accumulation, smooth assessment findings of muscle spasm, muscular wall thickening, ciliated cell supraglottitis? destruction Interventions? 2)impaired airway clearance and reduced airflow bronchiolar 17) List the classes of meds used to 0treat obstruction, atelectasis, hyperinflation (from impaired gas RSV. exchange) 3) risk groupspreme infant, immunodeficient infant, co- morbidities (BPD, CF, congenital heart disease); incidence (first 2 yrs of life; peak @ 2-6 months) 4) usually viral RSV has high affinity for respiratory tract mucosa; high contagious (direct and respiratory droplet transmission); prevalent during winter and spring; contact isolation pt. 5) Prevention Palivizumab (sygnasis) give one month for preme babies before RSV flu season 6) If RR < 60 NPO maintain hydration and caloric intake via IV fluids 22/ Foreign 1) 3-4 yrs old (developmental age/delays); separate play 1) Why would a Body time and eating radiograph appear Aspiration normal? 2) pathophysiology depends on size of object, location object 2) Interventions for F.B. was lodged, and acute or chronic nature of condition Aspiration? a) upper airway F.B. (larynx/trachea) mechanical/ partial obstruction; non-specific airway s/sx cough, wheeze, acute and fierce onset stridor, dyspnea, voice changes, cyanosis, retractions, hemoptysis b) bronchuspartial obstruction on inspiration and complete obstruction on expiration; localized wheezing to one side of chest on inspiration and diminished breath sounds on expiration c) esophageal distended esophagus compresses trachea; asymmetric chest movement; localized wheezing or diminished breath sounds 3) Chronic F.B. retention can cause marked inflammatory response and death chronic gas exchange obstruction to alveoli mimics obstructive emphysema on chest radiographs 4) Right mainstem bronchus common F.B. lodging site due to angle airway inflammation and narrowing secondary to edema occurs 5) Nut fats cause inflammatory response of the lung tissue lipoid pneumonia or lung abscess Answers (***From the book***) 1) Respiratory fatigue and respiratory failure due to anatomic variations. Complications cause increased work of breathing (retractions) a. Conditions that cause neuromuscular weakness or paralysis also cause respiratory compromise b/c IC muscles are underdeveloped 2) Abd distension (air or fluid) 3) Sniffing position 4) Decreased gas exchange (increase chance of hypoxia), inability to inflate and deflate airway (severe resp. distress and death), loss of alveolar patency (causes pulmonary edema, pneumomediastinum, PNX), less elastic recoil (atelectasis), and rapid small airway obstruction and respiratory distress 5) Current Hx, current meds., Past Med Hx (prenatal/ neonatal, previous health challenges, immunizations), Nutritional Assessment (weight loss), Family Medical Hx, Social Hx, Environmental Hx, and Growth and Development (ex. Age where they put everything in their mouths) all can help decipher why the kid has altered respiratory status and what the condition is and what caused it. 6) General appearance, integumentary system (skin, hair, nails,), head and neck (tenderness, lymph nodes), face, nose, oral cavity, thorax, lungs, cardiovascular system, abdomen, musculoskeletal system, and neurologic system (behavior and development, reflexes, motor and sensory) 7) Grunting (forces expiration to last longer usually in infants), increased work of breathing (severe retractions and grunting), diminished/ absent breath sounds, hypoventilation (apnea or gasping retractions), altered LOC (lethargy/ can’t be consoled), poor systemic perfusion (cap. refill > 2secs, mottling, or both), tachycardia, and bradycardia (late sign). 8) Measurement of lung volumes and flow rates (PFT and peak flow measurement), direct or indirect blood/ body fluid analysis (ABGs, Pulse Ox, capnography, fluid cultures, sweat, chloride test), imaging techniques (radiographs, fluoroscopy, bronchography , CT scan, scintigraphy, MRI), and direct visualization of respiratory tree (laryngoscopy, bronchoscopy). 9) indicated for hypoxemia (low PaO2), improve low cardiac output, decrease pulmonary vascular resistance, enhance CO2 elimination, or accelerate removal of nitrogen from air-containing spaces (PNX) 10)Increase risk of mucociliary dysfunction, injury to respiratory epithelium, thickening or secretions. 11)Specific tx for particular condition meds, labs, cultures & sensitivity testing, etc. Non-Specific general comfort/ tx measures O2, positioning, IV fluids (dehydration is also common cause of R.failure) a. Non-specific Nursing interventionsEase respiratory effort, promote rest, promote comfort, prevent infection, reduce fever, promote hydration and nutrition (IV or PO depending on respiratory status) 12)Medications (Bronchodilators, Corticosteroids, and mast cell nebulizers. Conjunction medsantibiotics, antivirals, mucolytics, expectorants, decongestants, antihistamines, diuretics a. Inhalation and Aerosol Therapy i. Bronchodilators, Corticosteroids, and mast cell nebulizers via inhalers or nebulizers. Bronchodilators, Corticosteroidsalso in IV and PO forms ii. Effective therapyreaches sm. airways & works directly on lungs iii. Best for kids younger than 5 and older kids who can’t use MDI (developmentally difficult) iv. Devices (rinse mouth after delivery to prevent systemic absorption and side effects) 1. MDI Advantage (portable, rapid preparation and admin. time). Disadvantage (difficult to coordinate developmentally difficult). Spacer used 2. Dry Powder inhaler (older kids only) suspension of microfine particles in MDI-sized device w/ mouthpiece relies on force of inhalation to propel particles to lower airways 3. Breath-activated inhaler med delivered as pt breathes holds breath for 10 seconds after inhaling v. Assess breath sounds and respiratory effort pre and post med delivery for effectiveness 1. Assess HR and jitteriness for child on bronchodilators (beta- adrenergic agents) b. Airway Clearance Techniques (ACTs) i. Who benefits? cystic fibrosis, Bronchopulmonary dysplasia, bronchiectasis, dysfunctional cilia mobility, pt on mechanical ventilation, and kids w/ acute problems post general anesthesia 1. Suctioning also used for Dx purposes 2. CPT/ postural drainage/ percussion 4 parts postural drainage, percussion, deep breathing, coughing 3. Positive expiratory pressure (PEP), oscillatory PEP, high frequency chest compressions, specialized breathing techniques (autogenic drainage) 13) S/Sx sudden onset stridor (over few hrs), high fever (>102.2 F or 39 C), sore throat, hoarseness, dysphagia, drooling, irritability/ restless, tripod (hallmark). These are preceded by symptoms of upper respiratory infection. As obstruction increases cyanosis, supraclavicular and substernal retractions. Interventionsminimize crying, semi-fowlers or high-fowlers position, monitor (rate/ depth of respirations, retractions, nasal flaring, stridor, SaO2 levels w/ pulse ox, body temp), humidified O2 face mask, IV antibiotics, mild sedation (can allow spontaneous breathing making full mechanical unnecessary), adequate fluid and calorie intake (IV or PO depending or respiratory status) 14) HIB vaccine for pt and siblings; prophylactic Rifampin (oral) for everyone in household (esp. if younger than 4 yrs) regardless of immunization status 15) S/Sx hoarseness, Barking cough (from inflamed larynx tissues), appear ill and in acute respiratory distress, inspiratory stridor. If Severe retractions, cyanosis during cough, altered LOC (r/t hypoxia and CO2 retention), mild hypoxia (develops muscle fatigue and hypoventilation leading to severe hypoxemia and hypercapnia). Interventions support (hydration [IV or PO], quiet environment, fever reduction, airway support, oxygen); Meds (corticosteroids, nebulized epinephrine, Mist therapy; Monitor (tachycardia [seen w/ hypoxia], decrease LOC [ominous sign]) 16) S/Sx sneezing and nasal discharge followed by harsh, dry cough and low- grade fever; tachypnea, loss of appetite (can’t eat if they can’t breathe), increase work of breathing, hypoxia, retractions, auscultate (wheezing, rhonchi, crackles heard over all lung fields), dehydration (elevated RR causes insensible fluid loss), and restlessness/ irritability Interventions mechanical ventilation in acute phase (worsening respiratory distress, increase work of breathing, increase HR, poor peripheral perfusion, apnea, bradycardia, hypercarbia, altered LOC), Respiratory support; suction before feeding, inhalation therapy, and as needed; Helium Oxygen (relief for increased work of breathing), inhaled ribavirin, bronchodilator and corticosteroids (not effective for bronchiolitis but ease breathing, improve oxygenation, and increase respiratory drive). 17)Antihistamines (H1 receptor antagonist) Benadryl, Zyrtec, claritin Antitussive (cough suppressant)robitussin, phenergen w/ codiene Bronchodilators albuterol, atrovent, combivent Inhaled corticosteroidssingular, azmacort, flovent, beconase Antibiotics (not usual Rx b/c RSV is a viral disease)rocephin, zosyn, Bactrim, azithromax 18)Radiographs and CXRs are can’t always find the F.B. b/c the object may not be opaque. Also, chronic gas exchange obstruction to alveoli mimics obstructive emphysema on chest radiographs 19) Heimlich maneuver Bronchoscopy Diagnostic, assess airway condition, and safely removes object and associated inflammatory material a) Pre-opexplain procedure, IV hydration, empty stomach contents, Pre-op assessment and Respiratory status b) Post-op assess symmetry and quality of breath sounds, vitals, color, respiratory effort c) ComplicationsAtelectasis, bronchospasm, PNX Support/ Prevention (most effective !!!) O2, separate play time and eating
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