Level 1 W2013

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Author:
jtisby
ID:
197639
Filename:
Level 1 W2013
Updated:
2013-02-03 17:39:23
Tags:
Test Respiratory
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Description:
respiratory 4 WWCC
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  1. Objective 1: features of the child upper respiratory
    • Abdominal and diaphragm for primary breathing
    • Accessory muscles 
    • Nose breathers
    • Smaller airway
    • Airway cartilage soft 
    • Less alveoli
    • ↑ RR
  2. Objextive 2: Effects of aging on Upper respiratory
    • Stiffing of the chest wall
    • Elastic Recoil
    • ↓ chest wall Compliance
    • ↓ functioning alveoli
    • ↓ Exp muscle strength
    • Costal cartilage calcification
    • Residual Volume 
    • ↑ Ant/Pst Thoracic cage diameter
  3. Obj.# 2: Pediatric considerations of Upper Respiratory disorders
    • Anorexia 
    • Irritability
    • GI symptoms w/infection (Abd pain, vomiting, diarrhea => URIs, UTIs, pneumonia & Otis Media )
    • Risk: dehydration & Fluid imbalences
    • URI complications (Otis Media, Lower Resp. Infection, Septicemia, Meningitis)
    • <3 yrs react more severely 
    • Viruses esp sever in infants
  4. Obj#3: Acute Pharyngitis (Strep Throat)
    -Patho
    -Clinical Manifestations
    • Patho: inflammation of the structures of the throat.
    • -common between 5-15 yrs
    • -80% caused by beta-hemolytic streptococcus
    • -Influenza common cause in chlidren <3 yrs

    CM: Fever, Malaise, Dysphagia, Anorexia, Red throat w/ tonsilar exudate, Swollen lymph nodes
  5. Obj# 3: Acute Pharyngitis (Strep Throat)
    -Treatment 
    -Interventions
    • Throat culture (routine:24-48hrs, rapid:10-15min)
    • Antibiotics
    • Antipyretics (ibuprofen, Tylenol)
    • Teach Pt.'s antibiotics must be finished to prevent complications
  6. Obj#3: Epiglottitis
    Patho
    Clinical Manifestations
    • Patho: infection & inflammation of epiglottitis
    • CM: dysphagia, drooling, resp distress: Insp. stridor, tachypnea, nasal flaring, tripod positioning, anxiety/agitation), fever, sore throat,
  7. Obj#3: Epiglottitis
    Treatment 
    Interventions
    • Emergency!
    • Anticipate intubation w/oxygen
    • Do not inspect throat
    • Do not leave child unattended
    • Do not upset the child
    • Avoid sedation until airway secured
    • Cool-mist O2 therapy per order
    • Monitor VS closely
    • Blood culture
    • Antibiotics
    • IV fluids
  8. Obj#3: Laryngotracheobronchitis (Croup)
    Patho
    Clinical Manifestations
    • Patho: inflammation of the larynx, trachea, bronchi
    • CM:
    • usually preceeded by URI
    • Mostly children <5 yrs
    • Progresses slowly in stages (stages 1-4)
    • Symptoms worse @ night, better in day
  9. Obj#3: Laryngotracheobronchitis (Croup)
    Treatment/Interventions
    • Maintain patent airway (accessory muscle use?, cyanosis?)
    • Elevate HOB
    • Rest and fluid
    • Humidified air
    • Bronchodialators 
    • Nebulizers
    • Corticosteroids
  10. Obj#3: Laryngotracheobronchitis (Croup)
    Stage progression
    • Stage 1:
    • Low-grade fever 
    • Brassy, Barking cough
    • Insp. Stridor 
    • hoarseness
    • Fear; restlessness

    • Stage 2:
    • labored breathing
    • crackles
    • wheezing
    • retractions

    • Stage 3:
    • Hypoxia & Hypercapnia: anxiety, diaphoresis, Tachypnea, Tachycardia 


    • Stage 4:
    • Cyanosis
    • Resp. arrest
  11. Obj #3: Tonsillitis & Adenoiditis
    Patho
    Clinical Manifestations
    • Patho: persistent/recurrent swollen, red, inflammed tonsils/adnoids
    • CM:
    • viral>bacterial
    • most common cause is Step throat
    • droplet precautions
  12. Obj #3: Tonsillitis
    Clinical manifestations (S/S)
    • persistent/recurrent sore throat
    • fever
    • headache
    • tonsils red, edematous, w/white exudate
    • dysphagia
    • swollen, tender Lymph nodes
    • reffered ear pain
  13. Obj #3: Adenoiditis
    Clinical manifestations (S/S)
    • mouth breathing
    • noisy breathing
    • nasal speech
    • Rhinorrhea
  14. Obj #3: Tonsillitis & Adenoiditis
    Pre-Op: Treatment/Interventions
    • Tonsillectomy & Adenoidectomy
    • PostOp:
    • bleeding?
    • clotting studies
    • inform child throat will be sore and will need to drink lots of fluids 
    • loose teeth? (aspiration risk)
    • CBC, Platelet count
  15. Obj #3: Tonsillitis & Adenoiditis
    Post-Op: Treatment/Interventions
    • Position prone or side lying
    • suction for airway obstr
    • assess S/S hemorrhage
    • Discourage coughing, throat clearing
    • clear liquids (no citris or carbonation)
    • No straws, forks, or sharp objects in mouth
    • Admin pain med
    • Teach if fever, ear ache, or bleeding notify physician

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