Lecture 9 Respiratory

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Lecture 9 Respiratory
2012-11-27 14:54:47

Lecture 9 Respiratory
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  1. What is included in the upper airway
    • nasal passages
    • pharynx
    • larynx
  2. What is included in the lower airway
    • larynx
    • bronchi/bronchioles
    • alveoli
  3. What are some pediatric differences in the respiratory system compared to adults respiratory system
    • smaller lower airways and undeveloped supporting cartilage predispose kids to an increased risk of obstruction by mucus, edema, and foreign bodies
    • infants airway is 50% smaller than adults
    • infants are obligatory nose breathers, have difficulty breathing through the mouth. If nasal congestion present, breathing is more difficult
    • breathing rate is faster than adults
    • brief periods of apnea , irregular rhthym normal in infants
  4. what are some acute respiratory problems?
    • bronchiolitis/RSV
    • pneumonia
  5. What are some chronic respiratory problems?
    • Asthma
    • Cystic Fibrosis
  6. What do you see with Bronchiolitis/RSV?
    Respiratory difficulty which includes nasal flaring, retractions/use of accessory muscles, SOB, tachys (HR and breathing), maybe cyanosis, wheezing, cough, rhinorrhea (runny nose)
  7. Who is at greatest risk for bronchiolitis/RSV
    • Infants
    • Chronic Illness
    • Immunocompromised
    • usually less than 2 years old
  8. What are you going to do for bronchiolitis/RSV
    • Lab testing
    • Not antibiotics unless there is underlying bacteria problem
    • suction as necessary
    • O2 as necessary
    • fluid volume maintenance as necessary
  9. What are the different kinds of pneumonia
    • aspiration
    • viral (most common, easiest to get)
    • bacterial
    • many others
  10. what are you going to see with pneumonia
    • fever
    • cough (may be productive)
    • respiratory distress (retractions, nasal flaring, maybe cyanosis)
    • behavioral changes
    • may have GI symptoms (like vomiting)
  11. What are you going to do with pneumonia
    • Respiratory support (provide O2, secretion management, chest physiotherapy like cupping, hitting)
    • Pharmacological support (depends on organism, maybe antibiotics, trial of albuterol)
    • emotional support
    • fluid support (often dehydrated)
  12. What is the most common chronic disease of childhood and the primary cause of school absences?
  13. What is happening with asthma?
    • airway inflammation/associated swelling
    • bronchospasm
    • airway obstruction
  14. What are triggers for asthma/RAD
    • allergens
    • irritants
    • exercise
    • changes in weather/temp
    • acute respiratory infections
    • animals
    • GERD
    • foods
    • smoke
    • and more
  15. What do you need to watch for in asthma/RAD
    • cough
    • respiratory distress
    • behavioral changes
    • tripod breathing pattern
    • difficulty speaking
    • wheezing
    • prolonged respiratory phase
    • skin color changes
  16. What is step 1 asthma
    • mild intermittent
    • symptoms few than 2 days/week
    • no nighttime symptoms
    • no interference with normal activity
    • use of short-acting beta agonist for symptom control fewer than 2 days/week
  17. what is step 2 asthma
    • mild persistent asthma
    • symptoms more than 2 times a week but less than 1 time a day
    • nighttime symptoms 1 to 2 times a month
    • minor interference with normal activity
    • use of short acting b agonist for symptom control more than 2 days a week but not daily
  18. what is step 3 asthma
    • moderate persistent asthma
    • daily symptoms
    • nighttime symptoms 3 to 4 times a month
    • some limitation to normal activity
    • use of short acting b agonist for symptom control daily
  19. what is step 4 asthma
    • severe persistent asthma
    • continual symptoms throughout the day
    • frequent nighttime symptoms
    • interference with daily activity
    • use of short acting b agonist several times a day
  20. What are you going to do for the patient with asthma/RAD
    • Respiratory support (O2)
    • Pharmacological support (bronchodilators and b-adrenergic agonists) Also rescue meds (albuterol) and long term control meds (Advair, spireva) and corticosteriods
    • education
    • Emotional support
  21. what is a sign of respiratory difficulty?
  22. T or F: infants are obligatory mouth breathers
  23. What is not associated with Cystic fibrosis
    endocrine gland dysfunction
  24. What is cystic fibrosis
    • inherited autosomal recessive trait
    • mutated gene (long arm of chromosome 7)
  25. What is involved with cystic fibrosis
    • exocrine gland dysfunction
    • increased viscosity of secretions (secretions are so thick they block everything)
    • increased electrolyte levels in sweat (Na, Cl, sometimes dx with sweat test)
    • abnormalities in autonomic nervous system function (body produces super thick secretions from exocrine glands)
  26. What are the primary systems involved with Cystic fibrosis?
    • respiratory
    • GI
    • endocrine/exocrine
  27. why are kids with CF in hospital
    • most often for respiratory dysfunction (rehydrate, wear vest to get secretions loose)
    • CF related diabetes (secretions block pancreatic ducts)
  28. What do you watch for with CF?
    • wide variety in breath sounds
    • dyspnea
    • respiratory distress
    • cough
    • secretions (different colors, very thick)
    • sometimes barrel chest (b/c have to accommodate to breath)
    • appetite (voracious early and then loss late)
    • OFTT (organic failure to thrive)
    • vitamin deficiency (A,D,E,K, body can't absorb nutrient)
  29. What else should you watch for in kids with CF
    • anemia
    • weight loss
    • large, bulky, frothy, foul-smelling stools
    • constipation
    • liver, gall bladder, pancreas issues
    • increase of symptoms as progression through disease occurs
  30. What are you going to do for kids with CF?
    • respiratory support (O2, chest physiotherapy, different machines)
    • pharmacological interventions (bronchodilators, antibiotics, supplemental gastric enzymes that help with digestion, vitamin supplements)
    • Emotional support
    • dietary support (encourage dietary intake, high fat high cal diet, lots of snacks, problem with diabetes and diet)
  31. What is the position where the child insists on sitting upright and lean forward with the chin thrust out, mouth open and tongue protruding
    tripod position
  32. what is characterized by hoarseness and a "barking" cough
  33. what is a serious inflammatory process that occurs most often in kids 2-8 years old
    acute epiglottitis
  34. Most respiratory infections in kids are caused by
  35. The nurse should suspect epilgottitis if the child has
    absence of cough in presence of drooling and agitation
  36. General signs of pneumonia include
    cough, tachypnea and retractions
  37. The principle treatment for the insufficiency that occurs in cystic fibrosis is the administration of
    pancreatic enzymes
  38. A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because this environment facilitates:
    Soothing inflamed mucous membrane.
  39. what is an early sign of hemorrhage in a child who has had a tonsillectomy
    continuous swallowing
  40. A 4-year-old girl is brought to the emergency room. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should:
    Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.
  41. The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C. The nurse suspects croup and should recommend:
    Trying a cool-mist vaporizer at night and watching for signs of difficulty breathing.
  42. A child with asthma is having pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to:
    Assess the severity of asthma.
  43. Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is:
    Mechanical obstruction caused by increased viscosity of mucous gland secretions
  44. The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of:
  45. Because the absorption of fat-soluble vitamins is decreased in children with cystic fibrosis, supplementation of which vitamins is necessary?
    A, D, E, K
  46. What are the S/S of nasopharyngitis
    • young kid = fever, irritability, restlessness, sneezing, vomiting, diarrhea
    • older kid dryness and irritation of nose and throat, sneezing, chilling sensation, muscular aches, cough sometimes
  47. what is the treatment of nasopharyngitis
    managed at home, no specific treatment, antipyretics for mild fever, rest, decongestants for kids older than 5, fluids, wash hands
  48. what is epiglottitis caused by
    H. influenzae
  49. how do you treat epiglottitis
    with O2, anti-inflammatory meds like corticosteriods, antibiotics
  50. What are the S/S of pharyngitis
    sore throat, difficulty swallowing, fever, malaise, cough, elevated WBC
  51. How do you treat pharyngitis
    antibiotics, antifungal, or comfort measures, bed rest, fluid, analgesics, antipyretics